A multicentre, randomized, double-masked, parallel group, vehicle-controlled phase IIb study to evaluate the safety and efficacy of 1% and 3% topical minocycline gel in patients with papulopustular rosacea

Background

Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti‐inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions.

Objectives

To assess the safety and efficacy of once‐daily topical minocycline gel 1% and 3% in patients with papulopustular rosacea.

Methods

This was a prospective, 12‐week, double‐blinded study conducted at 26 sites in the United States; 270 patients with papulopustular rosacea and 12–40 inflammatory lesions were randomized to minocycline 1%, minocycline 3% or vehicle. The primary endpoint was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on an Investigator's Global Assessment (IGA).

Results

Baseline mean lesion counts were 24·6, 25·1 and 24·3 in the minocycline 1%, minocycline 3% and vehicle groups, respectively; at week 12, the counts had decreased by 12·6, 13·1 and 7·9, respectively. Minocycline significantly decreased lesions, compared with the vehicle [P = 0·01, 95% confidence interval (CI) 7·9 to 0·9, for minocycline 1%; P = 0·007, 95% CI 8·3 to 1·3, for minocycline 3%]. The proportion of patients achieving IGA success was 39% in the minocycline 1% arm [P = 0·34, odds ratio (OR) 1·396 and OR 95% CI 0·71 to 2·75 vs. vehicle], 46% in the minocycline 3% arm (P = 0·04, OR 2·03 and OR 95% CI 1·04 to 3·95 vs. vehicle) and 31% in the vehicle arm.

Conclusions

Minocycline topical gel appears to be safe and tolerable at concentrations of 1% and 3%, and both concentrations significantly decreased inflammatory lesion counts, with a significantly larger proportion of patients achieving IGA success at week 12 in the minocycline 3% arm. These findings support further evaluation of minocycline gel for treating inflammatory lesions associated with papulopustular rosacea.

Linked Comment: Hampton. Br J Dermatol 2020; 183:412–413.

What is already known about this topic?

Papulopustular rosacea is characterized by inflammatory facial lesions and chronic erythema of the face.

Oral minocycline has been reported to have efficacy in the treatment of inflammatory lesions of papulopustular rosacea.

What does this study add?

The study shows that a topical gel preparation of minocycline significantly decreased the number of inflammatory lesions and significantly improved the Investigator's Global Assessment score in patients with papulopustular rosacea.

This may offer a topical therapeutic alternative to oral doxycycline or oral minocycline for the treatment of inflammatory lesions in papulopustular rosacea, with potentially fewer systemic side‐effects, owing to lower systemic drug exposure.

Linked Comment: Hampton. Br J Dermatol 2020; 183:412–413.

Plain language summary available online

Determining the number of states in dynamic functional connectivity using cluster validity indexes

BACKGROUND

Clustering analysis is employed in brain dynamic functional connectivity (dFC) to cluster the data into a set of dynamic states. These states correspond to different patterns of functional connectivity that iterate through time. Although several cluster validity index (CVI) methods to determine the best clustering partition exists, the appropriateness of methods to apply in the case of dynamic connectivity analysis has not been determined.

NEW METHOD

Currently employed indexes do not provide a crisp answer on what is the best number of clusters. In addition, there is a lack of CVI testing in the context of dFC data. This work tests a comprehensive set of twenty four cluster validity indexes applied to addiction data and suggest the best ones for clustering dynamic functional connectivity.

RESULTS

Out of the twenty four considered CVIs, Davies-Bouldin and Ray-Turi were the most suitable methods to find the number of clusters in both simulation and real data. The solution for these two CVIs is to find a local minimum critical point, which can be automated using computational algorithms.

COMPARISON WITH EXISTING METHODS

Elbow-Criterion, Silhouette and GAP-Statistic methods have been widely used in dFC studies. These methods are included among the tested CVIs where the performances of all twenty four CVIs are compared.

CONCLUSIONS

Davies-Bouldin and Ray-Turi CVIs showed better performance among a group of twenty four CVIs in determining the number of clusters to use in dFC analysis.

Comparison of activity levels derived from two accelerometers in dogs with osteoarthritis: Implications for clinical trials

Accelerometer measurements are frequently reported as total weekly activity counts (AC). Methods of utilizing activity parameters to allow differentiation of activity intensities (i.e., manually derived cut-points) have been described. While this information may provide valuable data for researchers, only few investigators have utilized these methods. This may, in part, be due to the challenge associated with data processing. Some devices, however, generate activity intensity data automatically. This study was conducted to evaluate a novel accelerometer that allows for remote download of data via Wi-Fi (Heyrex), to compare automatically generated parameters quantifying activity levels to previously established cut-points (Actical) and to describe the variability of accelerometer data in dogs with osteoarthritis. Twelve client-owned dogs with osteoarthritis were fitted with a collar with two accelerometers (Heyrex and Actical). Accelerometer data were recorded for 28 days. Pearson bivariate correlations and coefficient of variation (CV%) were calculated for accelerometer data. There was a strong correlation between the AC reported by Heyrex and Actical devices. Several automatically generated parameters showed strong correlations to previously validated cut-points and displayed lower CV% than weekly AC. The activity intensity derived from the Heyrex was associated with the lowest CV% of all parameters from both accelerometers. Automatically generated activity intensity parameters should be considered as potential outcome measures in clinical trials for dogs with osteoarthritis. This novel technology may allow for convenient acquisition of activity intensity data in companion animals. However, technical difficulties (e.g., lack of Wi-Fi connectivity) may pose challenges when using this novel device.

Prevalence and predictors of lower urinary tract symptoms in Pakistani men: A cross-sectional study

Objective:

The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life.

Methods:

A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms.

Results:

The overall prevalence of lower urinary tract symptoms in our sample was 33.7%. The frequency of individuals having mild, moderate and severe lower urinary tract symptoms was 66.3, 30.3 and 3.4%, respectively. Storage symptoms were more common than voiding symptoms (35.6% vs 28.2%, respectively). Increasing age (one-decade interval age stratum), higher education levels, working status (currently not working), smoking, hypertension, diabetes and renal impairment were positive predictors of lower urinary tract symptoms. Moreover, the condition of lower urinary tract symptoms was associated with a significant reduction in an individual’s quality of life.

Conclusion:

Around one-third of adult Pakistani men suffer from clinically relevant urinary symptoms, with lower urinary tract symptoms sufferers having poor quality of life as compared to non-sufferers. We recommend that the aging population should be made aware of conventional measures to mitigate mild urinary symptoms affecting their routine activities. Level of evidence: 2c

Parallel group ICA+ICA: Joint estimation of linked functional network variability and structural covariation with application to schizophrenia

There is growing evidence that rather than using a single brain imaging modality to study its association with physiological or symptomatic features, the field is paying more attention to fusion of multimodal information. However, most current multimodal fusion approaches that incorporate functional magnetic resonance imaging (fMRI) are restricted to second-level 3D features, rather than the original 4D fMRI data. This trade-off is that the valuable temporal information is not utilized during the fusion step. Here we are motivated to propose a novel approach called "parallel group ICA+ICA" that incorporates temporal fMRI information from group independent component analysis (GICA) into a parallel independent component analysis (ICA) framework, aiming to enable direct fusion of first-level fMRI features with other modalities (e.g., structural MRI), which thus can detect linked functional network variability and structural covariations. Simulation results show that the proposed method yields accurate intermodality linkage detection regardless of whether it is strong or weak. When applied to real data, we identified one pair of significantly associated fMRI-sMRI components that show group difference between schizophrenia and controls in both modalities, and this linkage can be replicated in an independent cohort. Finally, multiple cognitive domain scores can be predicted by the features identified in the linked component pair by our proposed method. We also show these multimodal brain features can predict multiple cognitive scores in an independent cohort. Overall, results demonstrate the ability of parallel GICA+ICA to estimate joint information from 4D and 3D data without discarding much of the available information up front, and the potential for using this approach to identify imaging biomarkers to study brain disorders.

Updated results from the phase 3 HELIOS study of ibrutinib, bendamustine, and rituximab in relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma

We report follow-up results from the randomized, placebo-controlled, phase 3 HELIOS trial of ibrutinib+bendamustine and rituximab (BR) for previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without deletion 17p. Overall, 578 patients were randomized 1:1 to either ibrutinib (420 mg daily) or placebo, in combination with 6 cycles of BR, followed by ibrutinib or placebo alone. Median follow-up was 34.8 months (range: 0.1-45.8). Investigator-assessed median progression-free survival (PFS) was not reached for ibrutinib+BR, versus 14.3 months for placebo+BR (hazard ratio [HR] [95% CI], 0.206 [0.159-0.265]; P < 0.0001); 36-month PFS rates were 68.0% versus 13.9%, respectively. The results are consistent with the primary analysis findings (HR = 0.203, as assessed by independent review committee, with 17-month median follow-up). Median overall survival was not reached in either arm; HR (95% CI) for ibrutinib+BR versus placebo: 0.652 (0.454-0.935; P = 0.019). Minimal residual disease (MRD)-negative response rates were 26.3% for ibrutinib+BR and 6.2% for placebo+BR (P < 0.0001). Incidence of treatment-emergent adverse events (including grades 3-4) were generally consistent with the initial HELIOS report. These long-term data support improved survival outcomes and deepening responses with ibrutinib+BR compared with BR in relapsed CLL/SLL.

An Evaluation of Three Different Cranial Cruciate Ligament Surgical Stabilization Procedures As They Relate to Postoperative Meniscal Injuries

Cranial cruciate ligament (CrCL) rupture is the most commonly diagnosed stifle condition in the dog. Meniscal injury, in conjunction with CrCL rupture is also common in both man and dogs. There is a growing concern regarding meniscal injuries, whether unrecognized at the time of CrCL surgical stabilization or subsequent to stabilization, and the relationship to poor postoperative functional outcome. However, current literature is not specific as to an actual number of dogs subsequently requiring a second arthrotomy/meniscectomy.

Three different CrCL stabilization operations in dogs were compared, retrospectively, for the occurrence of post-operative meniscal damage requiring a second arthrotomy and meniscectomy. Additional information concerning: signalment, weight, history of injury, CrCL ruptured, surgeon, type of CrCL rupture and amount of arthritis present was recorded in 665 cases. It was found that 13.8% of the stifles at risk (i. e. those stifles that did not have the meniscus removed at the time of initial surgical stabilization) returned for a second arthrotomy/meniscectomy. A significant difference in outcome was not found between the results when initially performed by different surgeons. The number of dogs which returned for a second arthrotomy/ meniscectomy whose weight were ≤ 15 kg was significant, when compared to the total number of dogs considered at risk for this weight range. There was a significantly lower rate of return, in those dogs at risk, which had received fibular head transposition stabilization.

A retrospective study of 665 canine cranial cruciate ligament rupture cases documents the incidence (13.8%) of those dogs requiring a second arthrotomy, and subsequent meniscectomy, after one of three initial surgical stabilization procedures. Of the three procedures, the fibular head transposition technique had a significantly lower return rate requiring subsequent meniscectomy.

Prevalence and risk factors associated with intestinal parasitic infections among schoolchildren in Punjab, Pakistan

Intestinal parasitic infections (IPIs) are a major cause of morbidity worldwide and have been described as an important public health concern. The present study aimed to determine the prevalence and identification of risk factors associated with IPIs among 3-15 years old school age children residing in Mandi Bahauddin, Pakistan from 2011- 2013. A cross sectional school-based study was conducted using a structured pre-tested questionnaire. Anthropometric tools and stool tests were used to obtain epidemiological and disease data. The direct wet mount preperation in saline/iodine/haematoxylin stain and Kato-Katz methods were used for stool examination. Data were analysed using appropriate descriptive, univariate and multivariable logistic regression methods. Of the 1,434 children studied (mean age of 8.6±3.6 years) the overall prevalence rate for intestinal parasitic infections was found to be 33.3%. Children infected with single parasite accounted for 27.6% and 5.7% were detected with poly-parasitism. The study showed that helminths (21.4%) were more prevalent than protozoans (17.9%). Ascaris lumbricoides (17.5%), Giardia lamblia (9.8%), Entamoeba histolytica (8.2%), Hymenolepis nana (2.0%), Trichuris trichiura (1.3%) and Taenia saginata (0.7%) were identified in children living in irrigated areas. The multiple logistic regression model indicated that age of the child, gender, family size, source of drinking water, type of milk used, house condition, feeding habit, personal hygiene and socioeconomic status were significantly (p<0.05) associated with the IPIs. Intestinal parasites were prevalent in varying magnitude among the schoolchildren located in irrigated areas. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children, and the need for development of effective poverty control programmes because deworming alone is not adequate to control parasitic infections.

First characterization of immunogenic conjugates of Vi negative Salmonella Typhi O-specific polysaccharides with rEPA protein for vaccine development

Efficacious typhoid vaccines for young children will significantly reduce the disease burden in developing world. The Vi polysaccharide based conjugate vaccines (Vi-rEPA) against Salmonella Typhi Vi positive strains has shown high efficacy but may be ineffective against Vi negative S. Typhi. In this study, for the first time, we report the synthesis and evaluation of polysaccharide-protein conjugates of Vi negative S. Typhi as potential vaccine candidates. Four different conjugates were synthesized using recombinant exoprotein A of Pseudomonas aeruginosa (rEPA) and human serum albumin (HSA) as the carrier proteins, using either direct reductive amination or an intermediate linker molecule, adipic acid dihydrazide (ADH). Upon injection into mice, a significantly higher antibody titer was observed in mice administrated with conjugate-1 (OSP-HSA) (P=0.0001) and conjugate 2 (OSP-rEPA) (P≤0.0001) as compared to OSP alone. In contrast, the antibody titer elicited by conjugate 3 (OSPADH-HSA) and conjugate 4 (OSPADH-rEPA) were insignificant (P=0.1684 and P=0.3794, respectively). We conclude that reductive amination is the superior method to prepare the S. Typhi OSP glycoconjugate. Moreover, rEPA was a better carrier protein than HSA. Thus OSP-rEPA conjugate seems to be efficacious typhoid vaccines candidate, it may be evaluated further and recommended for the clinical trials.

Level of dietary energy and 2,4-thiazolidinedione alter molecular and systemic biomarkers of inflammation and liver function in Holstein cows

Background

The objective of the study was to evaluate the effect of overfeeding a moderate energy diet and a 2,4-thiazolidinedione (TZD) injection on blood and hepatic tissue biomarkers of lipid metabolism, oxidative stress, and inflammation as it relates to insulin sensitivity.

Results

Fourteen dry non-pregnant cows were fed a control (CON) diet to meet 100% of NRC requirements for 3 wk, after which half of the cows were assigned to a moderate-energy diet (OVE) and half of the cows continued on CON for 6 wk. All cows received an intravenous injection of 4 mg TZD/kg of body weight (BW) daily from 2 wk after initiation of dietary treatments and for 2 additional week. Compared with CON cows and before TZD treatment, the OVE cows had lower concentration of total protein, urea and albumin over time. The concentration of cholesterol and tocopherol was greater after 2 wk of TZD regardless of diet. Before and after TZD, the OVE cows had greater concentrations of AST/GOT, while concentrations of paraoxonase, total protein, globulin, myeloperoxidase, and haptoglobin were lower compared with CON cows. Regardless of diet, TZD administration increased the concentration of ceruloplasmin, ROMt, cholesterol, tocopherol, total protein, globulin, myeloperoxidase and beta-carotene. In contrast, the concentration of haptoglobin decreased at the end of TZD injection regardless of diet. Prior to TZD injection, the mRNA expression of PC, ANGPTL4, FGF21, INSR, ACOX1, and PPARD in liver of OVE cows was lower compared with CON cows. In contrast, the expression of HMGCS2 was greater in OVE compared with CON cows. After 1 wk of TZD administration the expression of IRS1 decreased regardless of diet; whereas, expression of INSR increased after 2 wk of TZD injection. Cows fed OVE had lower overall expression of TNF, INSR, PC, ACOX1, FGF21, and PPARD but greater HMGCS2 expression. These differences were most evident before and after 1 wk of TZD injection, and by 2 wk of TZD differences in expression for most genes disappeared.

Conclusions

Based on molecular and blood data, administration of TZD enhanced some aspects of insulin sensitivity while causing contradictory results in terms of inflammation and oxidative stress. The bovine liver is TZD-responsive and level of dietary energy can modify the effects of TZD. Because insulin sensitizers have been proposed as useful tools to manage dairy cows during the transition period, further studies are required to investigate the potential hepatotoxicity effect of TZD (or similar compounds) in dairy cattle.

Electronic supplementary material

The online version of this article (doi:10.1186/s40104-017-0196-y) contains supplementary material, which is available to authorized users.