Evaluation of Risk of Major Adverse Cardiovascular Events With Biologic Therapy in Patients With Psoriasis

BACKGROUND

Psoriasis is associated with increased risk of major adverse cardiovascular events (MACE).

OBJECTIVES

Compare MACE risk with biologics vs topical/phototherapy use.

METHODS

Psoriasis Longitudinal Assessment Registry (PSOLAR) is an international psoriasis registry of patients eligible to receive biologic/systemic treatments prospectively. MACE is defined as myocardial infarction, stroke, or cardiovascular death. Biologic cohorts, including tumor necrosis factor-alpha (TNF-α) inhibitors (ie, adalimumab, etanercept, and infliximab) and ustekinumab, combined and by class, were compared with a topical/phototherapy cohort. Incidence rates of MACE per 100-patient-years (100PY) with 95% confidence intervals (95% CI) are reported. Multivariate analyses were performed to evaluate the effect of treatment on the risk of MACE adjusting for confounders.

RESULTS

Analyses included 7550 patients: 6767 in the combined biologics cohort (3949 and 2818 in the TNF-α inhibitors and ustekinumab cohorts, respectively) and 783 in the topical/phototherapy cohort. Mean duration of exposure was approximately 2.8 years (combined biologics) and 4.1 years (topical/phototherapy). A total of 52 MACE were reported; MACE incidence rates were 0.22/100PY (95% CI: 0.16, 0.30) for the combined biologics cohort (TNF-α inhibitors [0.20/100PY (0.12, 0.31)] and ustekinumab [0.24/100PY (0.15, 0.37]) and 0.34/100PY (0.17, 0.61) for the topical/phototherapy cohort. For the combined biologics (hazard ratio=0.92; 95% CI [0.426, 1.988]), TNF-α inhibitor (0.85 [0.373, 1.928]), and ustekinumab (1.03[0.440, 2.402]) cohorts, treatment was not associated with increased risk of MACE versus the topical/phototherapy cohort.

CONCLUSION

Based on data accumulated to date in PSOLAR, treatment with biologics did not have an impact on the risk of MACE in patients with moderate-to-severe psoriasis. <p><em>J Drugs Dermatol. 2017;16 (10):1002-1013.</em></p>.

Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry

BACKGROUND

The effect of systemic therapy on malignancy risk among patients with psoriasis is not fully understood.

OBJECTIVE

Evaluate the impact of systemic treatment on malignancy risk among patients with psoriasis in the Psoriasis Longitudinal Assessment and Registry (PSOLAR).

METHODS

Nested case-control analyses were performed among patients with no history of malignancy. Cases were defined as first malignancy (other than nonmelanoma skin cancer) in the Psoriasis Longitudinal Assessment and Registry, and controls were matched by age, sex, geographic region, and time on registry. Study therapies included methotrexate, ustekinumab, and tumor necrosis factor-α (TNF-α) inhibitors. Exposure was defined as 1 or more doses of study therapy within 12 months of malignancy onset and further stratified by duration of therapy. Multivariate conditional logistic regression, adjusted for potential confounders, was used to estimate odds ratios of malignancies associated with therapy.

RESULTS

Among 12,090 patients, 252 malignancy cases were identified and 1008 controls were matched. Treatment with methotrexate or ustekinumab for more than 0 months to less than 3 months, 3 months to less than 12 months, or 12 months or longer was not associated with increased malignancy risk versus no exposure. Longer-term (≥12 months) (odds ratio, 1.54; 95% confidence interval, 1.10-2.15; P = .01), but not shorter-term treatment, with a TNF-α inhibitor was associated with increased malignancy risk.

LIMITATIONS

Cases and controls could belong to 1 or more therapy categories.

CONCLUSIONS

Long-term (≥12 months) treatment with a TNF-α inhibitor, but not methotrexate and ustekinumab, may increase risk for malignancy in patients with psoriasis.

Dijet imbalance measurements in Au+Au and pp collisions at sqrt[s_{NN}]=200 GeV at STAR

We report the first dijet transverse momentum asymmetry measurements from Au+Au and pp collisions at RHIC. The two highest-energy back-to-back jets reconstructed from fragments with transverse momenta above 2  GeV/c display a significantly higher momentum imbalance in heavy-ion collisions than in the pp reference. When reexamined with correlated soft particles included, we observe that these dijets then exhibit a unique new feature-momentum balance is restored to that observed in pp for a jet resolution parameter of R=0.4, while rebalancing is not attained with a smaller value of R=0.2.

Measurement of D^{0} Azimuthal Anisotropy at Midrapidity in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report the first measurement of the elliptic anisotropy (v_{2}) of the charm meson D^{0} at midrapidity (|y|<1) in Au+Au collisions at sqrt[s_{NN}]=200  GeV. The measurement was conducted by the STAR experiment at RHIC utilizing a new high-resolution silicon tracker. The measured D^{0} v_{2} in 0%-80% centrality Au+Au collisions can be described by a viscous hydrodynamic calculation for a transverse momentum (p_{T}) of less than 4  GeV/c. The D^{0} v_{2} as a function of transverse kinetic energy (m_{T}-m_{0}, where m_{T}=sqrt[p_{T}^{2}+m_{0}^{2}]) is consistent with that of light mesons in 10%-40% centrality Au+Au collisions. These results suggest that charm quarks have achieved local thermal equilibrium with the medium created in such collisions. Several theoretical models, with the temperature-dependent, dimensionless charm spatial diffusion coefficient (2πTD_{s}) in the range of ∼2-12, are able to simultaneously reproduce our D^{0} v_{2} result and our previously published results for the D^{0} nuclear modification factor.

Six Minute Walk Distance and Reference Equations in Normal Healthy Subjects of Nepal

Background The self-paced six minute walk test is a simple assessment for sub-maximal functional capacity. It correlates well with sophisticated tests and gives good prediction for morbidity, mortality, quality of life and pulmonary functions.Objective To evaluate six minute walk distance in healthy adults to identify reference values and formulate reference equations.Method We conducted six minute walk test on 250 random volunteers at and above 18 years of age as per standard protocol. Age, gender, height and weight were measured. Pre-test and post-test vital parameters were recorded including pulse oximetry. The six minute walking distance was identified in all subjects. Multiple regression analysis was done to formulate regression equations to predict six minute walking distance. This also correlated age, gender, height, weight, body mass index with six minute walking distance.Result The mean six minute walking distance was 489±86 meters with males walking 509±82 meters and females 445±78 meters. Age, gender, weight and body mass index had significant contribution for prediction of six minute walking distance. Gender was the single most important predictor. Height had the least significance. Depending on coefficients of these variables we formulated three regression equations and tested them for accurate prediction. The two best equations were identified as: Predicted SMWD = 395–1.5xAge+2.47xWT–35.89xGender and Predicted SMWD = 440–1.82xAge–53.07xGender+5.12xBMI.Conclusion Gender, age and height are the most important predictors of six minute walking distance. Reference values and equations for both genders, different age groups with varying weights were derived for local population.

Pregnancy-associated morphea: a case report and literature review

Morphea, also known as localized scleroderma, is arare fibrosing disorder of the skin, the pathogenesisof which is incompletely understood. It is thought,however, to involve interplay of genetic dispositionand triggering environmental factors, such asinfections and autoimmunity. Pregnancy as a potentialtrigger has only been reported in four cases. Herein,we present a patient who developed morphea of thebreasts during pregnancy, which rapidly resolvedwith a normal delivery. Our patient was distinct fromsome of the reported patients because her conditionwas tightly correlated with her pregnancy, as judgingby rapid resolution after delivery. In addition, therewas no apparent infection, history of autoimmunity,or development of autoimmunity during or afterpregnancy. Although the pathogenesis of pregnancyassociatedmorphea is largely unknown, we exploredpotential mechanisms of this condition, which mayinvolve mechanical injury, "microchimerism," andshifts in intrapartum hormones, such as TGF-β.

Charge-Dependent Directed Flow in Cu+Au Collisions at sqrt[s_{NN}]=200 GeV

We present the first measurement of charge-dependent directed flow in Cu+Au collisions at sqrt[s_{NN}]=200  GeV. The results are presented as a function of the particle transverse momentum and pseudorapidity for different centralities. A finite difference between the directed flow of positive and negative charged particles is observed that qualitatively agrees with the expectations from the effects of the initial strong electric field between two colliding ions with different nuclear charges. The measured difference in directed flow is much smaller than that obtained from the parton-hadron-string-dynamics model, which suggests that most of the electric charges, i.e., quarks and antiquarks, have not yet been created during the lifetime of the strong electric field, which is of the order of, or less than, 1  fm/c.

Optimization of postharvest ultrasonic treatment of kiwifruit using RSM

This study reports the optimization of ultrasonic treatment combined with sodium hypochlorite (NaOCl) solution on kiwifruit (Actinidia deliciosa) to evaluate its effect on microbial population, respiration rate and its textural quality. Response surface methodology (RSM) based on four factors three level central composite design was applied to investigate the effects of process variables on ultrasonic treatment. Four independent variables include ultrasonic intensity (184-368W/cm(2)), temperature (25-40°C), treatment time (8-15min) and concentration of the solvent (30-60ppm) were considered for this study. According to RSM analysis, the optimal treatment parameters obtained were ultrasonic intensity (368W/cm(2)), temperature (25°C), treatment time (8min) and concentration of the solvent (30ppm). Microbial population, respiration rate and some quality parameters were compared with NaOCl treated kiwifruits. An ultrasound combined with NaOCl was found to be the most effective treatment in inhibiting the microbial growth (bacteria, yeast and mold) and preserving the quality of kiwifruits, and these results suggest that the ultrasound treatment may provide an alternative for extending the shelf life of whole kiwifruit, maintains the quality of fresh cut kiwifruits and further increases the shelf life of chitosan coated fresh cut kiwifruit.

Measurement of the Transverse Single-Spin Asymmetry in p^{↑}+p→W^{±}/Z^{0} at RHIC

We present the measurement of the transverse single-spin asymmetry of weak boson production in transversely polarized proton-proton collisions at sqrt[s]=500  GeV by the STAR experiment at RHIC. The measured observable is sensitive to the Sivers function, one of the transverse-momentum-dependent parton distribution functions, which is predicted to have the opposite sign in proton-proton collisions from that observed in deep inelastic lepton-proton scattering. These data provide the first experimental investigation of the nonuniversality of the Sivers function, fundamental to our understanding of QCD.

Beam Energy Dependence of the Third Harmonic of Azimuthal Correlations in Au+Au Collisions at RHIC

We present results from a harmonic decomposition of two-particle azimuthal correlations measured with the STAR detector in Au+Au collisions for energies ranging from sqrt[s_{NN}]=7.7 to 200 GeV. The third harmonic v_{3}^{2}{2}=⟨cos3(ϕ_{1}-ϕ_{2})⟩, where ϕ_{1}-ϕ_{2} is the angular difference in azimuth, is studied as a function of the pseudorapidity difference between particle pairs Δη=η_{1}-η_{2}. Nonzero v_{3}^{2}{2} is directly related to the previously observed large-Δη narrow-Δϕ ridge correlations and has been shown in models to be sensitive to the existence of a low viscosity quark gluon plasma phase. For sufficiently central collisions, v_{3}^{2}{2} persist down to an energy of 7.7 GeV, suggesting that quark gluon plasma may be created even in these low energy collisions. In peripheral collisions at these low energies, however, v_{3}^{2}{2} is consistent with zero. When scaled by the pseudorapidity density of charged-particle multiplicity per participating nucleon pair, v_{3}^{2}{2} for central collisions shows a minimum near sqrt[s_{NN}]=20  GeV.

Centrality and Transverse Momentum Dependence of Elliptic Flow of Multistrange Hadrons and ϕ Meson in Au+Au Collisions at √[sNN]=200 GeV

We present high precision measurements of elliptic flow near midrapidity (|y|<1.0) for multistrange hadrons and ϕ meson as a function of centrality and transverse momentum in Au+Au collisions at center of mass energy √[sNN]=200  GeV. We observe that the transverse momentum dependence of ϕ and Ω v2 is similar to that of π and p, respectively, which may indicate that the heavier strange quark flows as strongly as the lighter up and down quarks. This observation constitutes a clear piece of evidence for the development of partonic collectivity in heavy-ion collisions at the top RHIC energy. Number of constituent quark scaling is found to hold within statistical uncertainty for both 0%-30% and 30%-80% collision centrality. There is an indication of the breakdown of previously observed mass ordering between ϕ and proton v2 at low transverse momentum in the 0%-30% centrality range, possibly indicating late hadronic interactions affecting the proton v2.

Observation of Transverse Spin-Dependent Azimuthal Correlations of Charged Pion Pairs in p^{↑}+p at sqrt[s]=200 GeV

We report the observation of transverse polarization-dependent azimuthal correlations in charged pion pair production with the STAR experiment in p^{↑}+p collisions at RHIC. These correlations directly probe quark transversity distributions. We measure signals in excess of 5 standard deviations at high transverse momenta, at high pseudorapidities η>0.5, and for pair masses around the mass of the ρ meson. This is the first direct transversity measurement in p+p collisions.

Azimuthal Anisotropy in U+U and Au+Au Collisions at RHIC

Collisions between prolate uranium nuclei are used to study how particle production and azimuthal anisotropies depend on initial geometry in heavy-ion collisions. We report the two- and four-particle cumulants, v_{2}{2} and v_{2}{4}, for charged hadrons from U+U collisions at sqrt[s_{NN}]=193  GeV and Au+Au collisions at sqrt[s_{NN}]=200  GeV. Nearly fully overlapping collisions are selected based on the energy deposited by spectators in zero degree calorimeters (ZDCs). Within this sample, the observed dependence of v_{2}{2} on multiplicity demonstrates that ZDC information combined with multiplicity can preferentially select different overlap configurations in U+U collisions. We also show that v_{2} vs multiplicity can be better described by models, such as gluon saturation or quark participant models, that eliminate the dependence of the multiplicity on the number of binary nucleon-nucleon collisions.

Precision Measurement of the Longitudinal Double-Spin Asymmetry for Inclusive Jet Production in Polarized Proton Collisions at sqrt[s]=200 GeV

We report a new measurement of the midrapidity inclusive jet longitudinal double-spin asymmetry, A_{LL}, in polarized pp collisions at center-of-mass energy sqrt[s]=200  GeV. The STAR data place stringent constraints on polarized parton distribution functions extracted at next-to-leading order from global analyses of inclusive deep-inelastic scattering (DIS), semi-inclusive DIS, and RHIC pp data. The measured asymmetries provide evidence at the 3σ level for positive gluon polarization in the Bjorken-x region x>0.05.

Synthesis and Biological Studies of a Novel CB1 Antagonist

This paper describes the synthesis, early process development, salt selection strategies and pre clinical evaluation of novel, potent and selective CB1 antagonist, 8-Chloro-1-(2,4-dichloro-phenyl)-4,5-dihydro-1H-6-oxa-1,2-diaza-benzo[e]azulene-3-carboxylic acid piperidin-1-ylamide 1. The CB1 antagonism of compound 1 is also confirmed by reversal of CB1 agonist-induced hypothermia in Swiss albino mice. The process for the preparation of the compound 1 as a crystalline solid is also described. The crystalline form of the compound is found to be low bioavailable, therefore attempts have been made to improve its bioavailability through polymorphic transformation and salt formation. None of the salts prepared were found to be suitable for further development. The amorphous form of the compound 1 is found to be better suited. In vivo efficacy study of the amorphous form of compound 1 in 5% sucrose solution intake model in female Zucker fa/fa rats at single oral dose of 10 mg/kg demonstrates better reduction in the sucrose solution consumption than the corresponding crystalline form. The plasma concentration Cmax at AUC exposure of the amorphous form of the compound 1 is significantly improved and better than the Cmax of the corresponding crystalline form of the compound 1. On the basis of the efficacy, pharmacokinetic and toxicological evaluations, the compound 1 in the amorphous form is selected as a pre-clinical lead candidate.

Use of traditional Indian plants in the inhibition of caries-causing bacteria--Streptococcus mutans

The aim of the study was to comparatively evaluate the antibacterial activity of six Indian plant extracts and 0.2% chlorhexidine against clinical strains of Streptococcus mutans, which were isolated from the plaque samples of 45 pediatric patients. Six plant extracts were prepared in three different forms, namely aqueous extracts, organic solvent-based extracts and crude (raw) extracts. The antimicrobial sensitivity testing was done by agar well diffusion method. Antimicrobial activity of the extracts was determined by measuring the mean zones of inhibition (mm) produced against the bacterial isolates. Results showed that crude garlic extract exhibited greater antibacterial activity than chlorhexidine. Aqueous extract of amla and organic solvent-based extract of ginger showed the maximum antibacterial activity against S. mutans, whereas aqueous extract of tulsi and organic solvent based extract of amla showed the minimum antibacterial activity. This study suggests that plant extracts like garlic in crude form, amla as aqueous infusion and ginger as alcoholic tincture have potential for the control of S. mutans. These extracts can be used as an alternative remedy for dental caries prevention or in the form of mouthwash, which is safe and economical.

ΛΛ Correlation function in Au+Au collisions at √[S(NN)]=200 GeV

We present ΛΛ correlation measurements in heavy-ion collisions for Au+Au collisions at sqrt[s_{NN}]=200  GeV using the STAR experiment at the Relativistic Heavy-Ion Collider. The Lednický-Lyuboshitz analytical model has been used to fit the data to obtain a source size, a scattering length and an effective range. Implications of the measurement of the ΛΛ correlation function and interaction parameters for dihyperon searches are discussed.