A comparative evaluation of fluoride release and rechargeability in conventional GIC (type II), pediatric GIC (type IX), and Cention-N: an in vitro study

PURPOSE

A comparative evaluation of fluoride release and re-chargeability in conventional glass ionomer cement (GIC) (type II), Pediatric GIC (type IX), and Cention-N-an in vitro study at an interval of first, fourteenth, and twenty first days.

METHODS

Three groups of test materials, each with twenty samples, were prepared. Measurements of the cumulative fluoride release [parts per million (ppm)] and re-release measured on the first, fourteenth, and twenty first days. Analysis of variance (ANOVA) was used to compare the means for different readings, and Tukey's post hoc analysis was used to compare each group with each other.

RESULTS

Initial and subsequent fluoride release of Cention-N at days one, fourteen, and twenty-one were all noticeably higher than those of conventional and pediatric GIC.

CONCLUSION

Compared to the Conventional and Pediatric GIC restorative materials, Cention-N was more effective in the initial and fluoride re-release.

Estimating meaningful change thresholds for Skin Pain-Numeric Rating Scale, Sleep-Numeric Rating Scale and Dermatology Life Quality Index in patients with prurigo nodularis

BACKGROUND

Prurigo nodularis (PN) is characterized by intensely itchy nodules/lesions and skin pain, which can have a substantial impact on health-related quality of life (HRQoL). Treatment benefits on such symptoms and impacts are best assessed in trials using patient-reported outcome (PROs) instruments such as Skin Pain Numerical Rating Scale (NRS), Sleep-NRS and Dermatology Life Quality Index (DLQI). However, no guidance exists for interpreting meaningful changes in scores using these PROs in patients with PN.

OBJECTIVES

The main objective was to derive within-patient (responder definition) and between-group improvement thresholds for interpreting Skin Pain-NRS, Sleep-NRS and DLQI total scores in patients with PN. The measurement properties of the three PROs were also evaluated.

METHODS

Intention-to-treat (ITT), blinded and pooled data were used from the Phase 3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN. Anchor- and distribution-based methods were applied to derive responder definition and between-group thresholds for Skin Pain-NRS, Sleep-NRS and DLQI. Data were additionally used to examine the instrument measurement properties, including reliability, validity and responsiveness.

RESULTS

A total of 311 patients (mean age 49.5 years, 65.3% female) were included in the pooled ITT population. The within-patient improvement threshold for Skin Pain-NRS was estimated as 4.0 points, 2.0 points for Sleep-NRS and 9.0 points for DLQI total score. A 1.5-point improvement in Skin Pain-NRS scores, 1.0-point in Sleep-NRS and 4.0-point in DLQI indicated a between-group meaningful change. Adequate to good psychometric properties were demonstrated for all three instruments.

CONCLUSIONS

The results of this study can aid interpretation of Skin Pain-NRS, Sleep-NRS and DLQI scores in patients with PN in both clinical trials and clinical practice to better understand and treat PN-related skin pain and the impact of PN on sleep quality and HRQoL.

Cost-Effectiveness of Unrelated Umbilical Cord Blood vs. HLA Haploidentical Related Bone Marrow Transplant: Evidence from BMT CTN 1101

BACKGROUND

BMT CTN 1101 was a Phase III randomized controlled trial comparing reduced intensity conditioning followed by double unrelated umbilical cord blood (UCB) versus HLA-haploidentical related donor bone marrow (haplo-BM) transplantation for patients with high-risk hematologic malignancies.

OBJECTIVE

The objective of this study is to report the results of a parallel cost-effectiveness analysis.

STUDY DESIGN

Three hundred sixty-eight patients were randomized to unrelated UCB (n=186) or haplo-BM (n=182) transplant. We estimated healthcare utilization and costs using propensity score-matched BMT patients from the OptumLabs^Ⓡ Data Warehouse for trial participants <65 years and Medicare claims for participants ≥65 years. Weibull models were used to estimate 20-year survival. EQ-5D surveys by trial participants were used estimate Quality-Adjusted Life Years (QALYs).

RESULTS

At 5-year follow-up, survival was 42% for haplo-BM versus 36% for UCB (P=.06). Over a 20-year time horizon, haplo-BM is expected to be more effective (+0.63 QALY) and more costly +$118,953) for persons under 65. For those over 65, haplo-BM is expected to be more effective and less costly. In one-way uncertainty analyses, for persons <65, the cost per QALY result was most sensitive to life years and health state utilities. For persons ≥65, life years were more influential than costs and health state utilities.

CONCLUSION

Compared to UCB, haplo-BM was moderately cost-effective for patients aged <65 years, and less costly and more effective for persons ≥65 years. Haplo-BM is a fair value choice for commercially insured patients with high-risk leukemia and lymphoma who require HCT. For Medicare enrollees, haplo-BM is a preferred choice when considering costs and outcomes.

Tether-free optogenetic control of insulin secretion using an upconversion nanoparticle-doped hydrogel platform

Glucagon-like peptide-1 (GLP-1), as a molecular therapeutic, induces glucose-dependent stimulation of insulin secretion, which has drawn significant attention in treating type II diabetes. However, it always suffers from hurdles such as short half-lives or instability. Thus, producing such therapeutics endogenously, as and when needed, is beneficial. Optogenetics-based production of GLP-1 offers an attractive alternative, wherein, the cell lines such as HEK293T can be genetically modified to bring the expression of the gene of interest under visible light control. However, the need for blue light for activation necessitates the implantation of invasive optical fibers owing to high tissue scattering and low depth of penetration through biological tissue at this wavelength. Here, we overcome this problem by proposing an upconversion nanoparticle (UCNP)-based system. HEK293T cells, rewired to produce GLP-1 under blue light illumination, were co-encapsulated with UCNPs in a hydrogel. The UCNPs act as near-infrared (NIR) to blue light nano-transducers, allowing deep penetration toward implementing a tether-free optogenetic gene expression platform. This platform is particularly powerful for thick gel implants (>3 mm) that cannot be illuminated throughout using a blue light source. Moreover, the GLP-1 produced in this platform was sufficient to increase insulin secretion in rat insulinoma cells, providing a powerful and controllable therapeutic tool for diabetes.

Googling "Anatomy dissection": Pre-pandemic, pandemic, and current scenario

OBJECTIVES

The present study was proposed to assess if the online search behavior for Anatomy dissection was affected by actual dissection being performed in the labs. The interest in dissection was ascertained and compared between pre-pandemic, pandemic, and current times.

METHODS

Online web search behavior for key terms related to "Anatomy dissection" was noticed worldwide using Google Trends Tool. Relative search volume (RSV) was downloaded for these keywords worldwide using all categories, and web search settings during a period from January 1, 2018, to July 31, 2022.

RESULTS

There was almost a similar google trend for the first three months in years 2018 and 2020, with a slightly lower RSV in March and a noticeable RSV decrease from April onwards in 2020. During the pre-pandemic period, the peak for RSV in the month of May was noticed. These peaks were missing in 2020 and 2021. In May 2022, RSV again increased. The top five countries with the highest search hit for "Anatomy Dissection" web were the Philippines, the United States, Canada, Australia, and India.

CONCLUSIONS

There was lower search trend for "Anatomy dissection" during the pandemic period as compared to pre-pandemic period. The search trends may be associated with the closure of dissection labs and it may be concluded that Anatomy learners search for this term more often, if they are actually performing the dissections. The future integrated multi-country data and analysis from different set-ups about their ways of dissection and labs before and after the pandemic may further clarify.

The effectiveness of prenatal and postnatal home visits by paramedical professionals and women's group meetings in improving maternal and child health outcomes in low and middle-income countries: a systematic review and meta-analysis

OBJECTIVE

To assess the effectiveness of prenatal and postnatal home visits (HVs) and women group meetings (WGMs) by paramedical professionals to improve maternal and child health outcomes in low- and middle-income countries (LMICs).

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We conducted a systematic review of trials published till December 2020, as per registered protocol in The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42018091968). Outcomes were neonatal mortality rate (NMR), maternal mortality ratio (MMR), the incidence of low birth weight, and still birth rate (SBR). The Cochrane Pregnancy and Childbirth Group's Trials Register, Cochrane Central Register of Controlled Trials, PubMed, and Excerpta Medica Database (EMBASE) were searched. Pooled results were estimated using random-effects meta-analysis in RevMan version 5.2.

RESULTS

Twenty-five trials met the inclusion criteria. HVs were the key intervention in 12, WGMs in 11, and both interventions in 2 trials. The pooled estimates have shown that NMR was significantly reduced by HVs (OR 0.77, confidence interval [CI]: 0.67-0.90, P = 0.0007, I² = 77%) and WGMs (OR 0.76, CI: 0.65-0.90, P = 0.001, I² = 71%). SBR was significantly reduced by HVs (OR 0.77, CI: 0.70-0.85; P < 0.001, I² = 0%). Subgroup analysis of studies in which more than 10% of pregnant women participated in the WGMs showed significant reduction in NMR (OR 0.67, CI 0.58-0.77, P = 0.00001, I² = 31%) and MMR (OR 0.55, CI 0.36-0.84, P = 0.005, I² = 27%). Two studies reported improvement in birth weight by HVs.

CONCLUSIONS

HVs and WGMs (with >10% pregnant women) by paramedical professionals are effective strategies in reducing the NMR and MMR in LMICs. HVs were also effective in reducing SBR.

Prevalence and determinants of sexual abuse among adolescent girls during the COVID-19 lockdown and school closures in Ghana: A mixed method study

BACKGROUND

In the wake of the COVID-19 pandemic, concerns have been raised that the pandemic may derail global efforts against child sexual abuse (CSA).

OBJECTIVES

This study examines the prevalence and associated factors of sexual abuse among adolescent girls in the context of the COVID-19 pandemic in Ghana.

PARTICIPANTS AND SETTING

The sample comprised 853 adolescent girls aged 13-19 (16.03 ± 2.04 years) in Ghana.

METHODS

The study employed a concurrent mixed-method design.

RESULTS

Overall, the prevalence of CSA during the COVID-19 lockdown and school closures was 32.5 %. Protective factors for CSA were feeling safe in neighbourhood (AOR = 0.526, 95 % CI = [0.325, 0.850]) and parents often listen to opinions (AOR = 0.446, 95 % CI = [0.241, 0.826]). Risk factors for CSA were physical activity (AOR = 1.649, OR = 1.783, 95 % CI_AOR = [1.093, 2.487, 95 % CI_OR = [1.241, 2.561]), parents sometimes listen to opinions (AOR = 1.199, OR = 1.924, 95 % CI_AOR = [0.504, 2.853], 95 % CI_OR = [1.034, 3.582]), living with another relative (AOR = 2.352, OR = 2.484, 95 % CI_AOR = [0.270, 20.523], 95 % CI_OR = [0.317, 19.475]), Akan ethnicity (AOR = 1.576, OR = 1.437, 95 % CI_AOR = [0.307, 8.091], 95 % CI_OR = [0.316, 6.534]), having no disability (AOR = 1.099, OR = 1.138, 95 % CI_AOR = [0.679, 1.581], 95 % CI_OR = [0.786, 1.649]) and having a close relationship with parents (AOR = 1.334, OR = 1.752, 95 % CI_AOR = [0.746, 2.385], 95 % CI_OR = [1.096, 2.802]).

CONCLUSION

Knowledge of the risk and protective factors identified in this study can guide and inform the development of CSA prevention programmes during disruptive occurrences like school closures and lockdown.

Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography

Funding Acknowledgements

Type of funding sources: None.

Introduction

Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear.

Purpose

We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters.

Methods

Of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all.

Results

All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%; moderate: -15.3 ± 3.4%; severe: -10.7 ± 5.1%; P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%; moderate: -16.8 ± 4.8%; severe: -9.7 ± 4.6%; P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%; moderate: -18.1 ± 5.5%; severe: -9.3 ± 4.4%; P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission.

Conclusions

Subclinical LV and RV dysfunction was seen in majority of  COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.

Towards translational optogenetics

Optogenetics is widely used to interrogate the neural circuits underlying disease and has most recently been harnessed for therapeutic applications. The optogenetic toolkit consists of light-responsive proteins that modulate specific cellular functions, vectors for the delivery of the transgenes that encode the light-responsive proteins to targeted cellular populations, and devices for the delivery of light of suitable wavelengths at effective fluence rates. A refined toolkit with a focus towards translational uses would include efficient and safer viral and non-viral gene-delivery vectors, increasingly red-shifted photoresponsive proteins, nanomaterials that efficiently transduce near-infrared light deep into tissue, and wireless implantable light-delivery devices that allow for spatiotemporally precise interventions at clinically relevant tissue depths. In this Review, we examine the current optogenetics toolkit and the most notable preclinical and translational uses of optogenetics, and discuss future methodological and translational developments and bottlenecks.

The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND

Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD).

OBJECTIVES

To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD.

METHODS

In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16.

RESULTS

Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group.

CONCLUSIONS

In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.

Pro-poor policies and improvements in maternal health outcomes in India

BACKGROUND

Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997-2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India.

METHODS

This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015-16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India.

RESULTS

On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors.

CONCLUSIONS

The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India's impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

Does closed treatment of paediatric mandibular condyle fractures result in restitutional remodelling?

The treatment of paediatric mandibular condylar fracture (PMCF) is typically non-operative. The purpose of this study was to determine if non-operative management of PMCF results in a new condylar process of normal morphology to regenerate after closed treatment (restitutional remodelling). The specific aim of the study was to observe restitutional remodelling (RM) in PMCF and review the literature. The investigators designed and implemented a retrospective study on paediatric patients (age<12) with unilateral or bilateral condyle fractures treated with non-operative treatment between January 2005 and July 2015. Patients with complete records and at least 1-year follow-up were included in the study. Primary outcome variable was RM and secondary outcome variables were occlusion, maximal incisal opening (MIO), displacement, infection, facial asymmetry, and signs of temporomandibular joint ankylosis (TMJA). The study evaluated 41 patients {n=57 PMCF, (m:f-35:6)} of unilateral (n=25) and bilateral (n=16) PMCF. Fractured condyles remodelled to normal morphology in all the cases at follow-up. The Wilcoxon test revealed a statistically significant difference in MIO from the preoperative value to postoperative (p=0.001). Occlusion (except 1) was satisfactory in all cases, at follow-up with no gross facial asymmetry. There was no sign of infection at the surgical site (anterior mandible). None of the patients showed signs of TMJA at follow-up. The result of the present study demonstrates that RM of condylar fracture occurs with non-operative management. Non-operative management should be the point of care in PMCF, owing to the rapid RM, bone regeneration, and satisfactory outcome. Review of the literature also supports closed treatment.

Verification and Validation of Digital Pathology (Whole Slide Imaging) for Primary Histopathological Diagnosis: All Wales Experience

Aims:

The study is aimed to verify Aperio AT2 scanner for reporting on the digital pathology platform (DP) and to validate the cohort of pathologists in the interpretation of DP for routine diagnostic histopathological services in Wales, United Kingdom.

Materials, Methods and Results:

This was a large multicenter study involving seven hospitals across Wales and unique with 22 (largest number) pathologists participating. 7491 slides from 3001 cases were scanned on Leica Aperio AT2 scanner and reported on digital workstations with Leica software of e-slide manager. A senior pathology fellow compared DP reports with authorized reports on glass slide (GS). A panel of expert pathologists reviewed the discrepant cases under multiheader microscope to establish ground truth. 2745 out of 3001 (91%) cases showed complete concordance between DP and GS reports. Two hundred and fifty-six cases showed discrepancies in diagnosis, of which 170 (5.6%) were deemed of no clinical significance by the review panel. There were 86 (2.9%) clinically significant discrepancies in the diagnosis between DP and GS. The concordance was raised to 97.1% after discounting clinically insignificant discrepancies. Ground truth lay with DP in 28 out of 86 clinically significant discrepancies and with GS in 58 cases. Sensitivity of DP was 98.07% (confidence interval [CI] 97.57–98.56%); for GS was 99.07% (CI 98.72–99.41%).

Conclusions:

We concluded that Leica Aperio AT2 scanner produces adequate quality of images for routine histopathologic diagnosis. Pathologists were able to diagnose in DP with good concordance as with GS.

Strengths and Limitations of this Study:

Strengths of this study – This was a prospective blind study. Different pathologists reported digital and glass arms at different times giving an ambience of real-time reporting. There was standardized use of software and hardware across Wales. A strong managerial support from efficiency through the technology group was a key factor for the implementation of the study.

Limitations:

This study did not include Cytopathology and in situ hybridization slides. Difficulty in achieving surgical pathology practise standardization across the whole country contributed to intra-observer variations.

A phase 2, open-label study of single-dose dupilumab in children aged 6 months to <6 years with severe uncontrolled atopic dermatitis: pharmacokinetics, safety and efficacy

BACKGROUND

Dupilumab has demonstrated efficacy and acceptable safety in adults and children (aged 6-17 years) with moderate-to-severe atopic dermatitis (AD), but effective systemic therapy with a favorable risk-benefit profile in younger children remains a significant unmet need.

OBJECTIVES

To determine the pharmacokinetics, safety and efficacy of single-dose dupilumab in children with severe AD aged ≥6 months to <6 years.

METHODS

This open-label, multicenter, phase 2, sequential, two-age cohort, two-dose level study (LIBERTY AD PRE-SCHOOL; NCT03346434) included an initial cohort of older children aged ≥2 to <6 years, followed by a younger cohort aged ≥6 months to <2 years. Pharmacokinetic sampling, safety monitoring and efficacy assessments were performed during the 4-week period after a single subcutaneous injection of dupilumab, in two sequential dosing groups (3 mg/kg, then 6 mg/kg). The use of standardized, low-to-medium potency topical corticosteroids was allowed.

RESULTS

Forty patients were enrolled (20/age cohort, 10/dose level within a cohort) between December 20, 2017 and July 22, 2019. Within each age cohort, pharmacokinetic exposures after a single injection of dupilumab increased in a greater than dose-proportional manner. At week 3, treatment with 3 and 6 mg/kg dupilumab reduced scores of mean Eczema Area and Severity Index by -44.6% and -49.7% (older cohort) and -42.7% and -38.8% (younger cohort), and mean Peak Pruritus NRS scores by -22.9% and -44.7% (older cohort) and -11.1% and -18.2% (younger cohort), respectively. At week 4, improvements in most efficacy outcomes diminished in both age groups, particularly with the lower dose. The safety profile was comparable to that seen in adults, adolescents and children.

CONCLUSIONS

Single-dose dupilumab was generally well tolerated and substantially reduced clinical signs/symptoms of AD. Slightly better responses were seen in older than younger children. The pharmacokinetics of dupilumab were non-linear, consistent with previous studies in adults and adolescents.

Dupilumab provides favourable long-term safety and efficacy in children aged ≥ 6 to < 12 years with uncontrolled severe atopic dermatitis: results from an open-label phase IIa study and subsequent phase III open-label extension study

Background

Children aged ≥ 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16‐week, randomized, placebo‐controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)‐4/IL‐13 signalling, significantly improved signs and symptoms with acceptable safety; longer‐term safety and efficacy data are lacking.

Objectives

To report the pharmacokinetic profile and long‐term safety and efficacy of dupilumab in children (aged ≥ 6 to < 12 years) with severe AD.

Methods

Children (aged ≥ 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study and subsequent open‐label extension (OLE) study. Patients received single‐dose dupilumab 2 or 4 mg kg⁻¹ followed by 8‐week pharmacokinetic sampling, then 2 or 4 mg kg⁻¹ weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration–time profile and treatment‐emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP‐NRS) score.

Results

Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target‐mediated pharmacokinetics characterized dupilumab concentrations (week 24–48 mean serum concentrations: 2 mg kg⁻¹, 61–77 mg L⁻¹; 4 mg kg⁻¹, 143–181 mg L⁻¹). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg⁻¹, 47%; 4 mg kg⁻¹, 56%) and AD exacerbation (29% and 13%, respectively). Single‐dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP‐NRS improved by −37%/−33% and −17%/−20% at week 2 (phase IIa) and −92%/−84% and −70%/−58% at week 52 (OLE), respectively.

Conclusions

These safety and efficacy results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD.

What is already known about this topic?

Severe atopic dermatitis (AD) has a marked negative impact on patient quality of life and can cause financial burden owing to a lack of effective treatments.

Dupilumab significantly improved signs and symptoms of AD with an acceptable safety profile in a 16‐week randomized, double‐blind, placebo‐controlled phase III study in children aged ≥ 6 to < 12 years with severe AD.

What does this study add?

This study extends information on the safety, efficacy and pharmacokinetic profile of dupilumab treatment for up to 52 weeks in children aged ≥ 6 to < 12 years with severe AD.

The results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD.

Linked Comment: Sibbald. Br J Dermatol 2021; 184:792–793.

A Flexi-PEGDA Upconversion Implant for Wireless Brain Photodynamic Therapy

Near-infrared (NIR) activatable upconversion nanoparticles (UCNPs) enable wireless-based phototherapies by converting deep-tissue-penetrating NIR to visible light. UCNPs are therefore ideal as wireless transducers for photodynamic therapy (PDT) of deep-sited tumors. However, the retention of unsequestered UCNPs in tissue with minimal options for removal limits their clinical translation. To address this shortcoming, biocompatible UCNPs implants are developed to deliver upconversion photonic properties in a flexible, optical guide design. To enhance its translatability, the UCNPs implant is constructed with an FDA-approved poly(ethylene glycol) diacrylate (PEGDA) core clad with fluorinated ethylene propylene (FEP). The emission spectrum of the UCNPs implant can be tuned to overlap with the absorption spectra of the clinically relevant photosensitizer, 5-aminolevulinic acid (5-ALA). The UCNPs implant can wirelessly transmit upconverted visible light till 8 cm in length and in a bendable manner even when implanted underneath the skin or scalp. With this system, it is demonstrated that NIR-based chronic PDT is achievable in an untethered and noninvasive manner in a mouse xenograft glioblastoma multiforme (GBM) model. It is postulated that such encapsulated UCNPs implants represent a translational shift for wireless deep-tissue phototherapy by enabling sequestration of UCNPs without compromising wireless deep-tissue light delivery.

Cadaverless anatomy: Darkness in the times of pandemic Covid-19

The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.

Upconversion superballs for programmable photoactivation of therapeutics

Upconversion nanoparticles (UCNPs) are the preferred choice for deep-tissue photoactivation, owing to their unique capability of converting deep tissue-penetrating near-infrared light to UV/visible light for photoactivation. Programmed photoactivation of multiple molecules is critical for controlling many biological processes. However, syntheses of such UCNPs require epitaxial growth of multiple shells on the core nanocrystals and are highly complex/time-consuming. To overcome this bottleneck, we have modularly assembled two distinct UCNPs which can individually be excited by 980/808 nm light, but not both. These orthogonal photoactivable UCNPs superballs are used for programmed photoactivation of multiple therapeutic processes for enhanced efficacy. These include sequential activation of endosomal escape through photochemical-internalization for enhanced cellular uptake, followed by photocontrolled gene knockdown of superoxide dismutase-1 to increase sensitivity to reactive oxygen species and finally, photodynamic therapy under these favorable conditions. Such programmed activation translated to significantly higher therapeutic efficacy in vitro and in vivo in comparison to conventional, non-programmed activation.

Dupilumab in adolescents with uncontrolled moderate-to-severe atopic dermatitis: results from a phase IIa open-label trial and subsequent phase III open-label extension

Background

Dupilumab (monoclonal antibody inhibiting IL‐4/IL‐13 signalling) is approved for use in adolescents aged ≥ 12 years with inadequately controlled moderate‐to‐severe atopic dermatitis (AD). Dupilumab significantly improved AD signs/symptoms in a 16‐week, randomised, placebo‐controlled phase III trial in adolescents (NCT03054428).

Objectives

To characterize the pharmacokinetics of dupilumab, and long‐term safety and efficacy in adolescents.

Methods

This was a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study with a phase III open‐label extension (OLE) in adolescents with moderate‐to‐severe AD. In the phase IIa study, patients received one dupilumab dose (2 mg kg⁻¹ or 4 mg kg⁻¹) and 8 weeks of pharmacokinetic sampling. Thereafter, patients received the same dose weekly for 4 weeks, with 8‐week safety follow‐up. Patients then enrolled in the OLE, continuing 2 mg kg⁻¹ or 4 mg kg⁻¹ dupilumab weekly. Primary end points were dupilumab concentration–time profile and incidence of treatment‐emergent adverse events (TEAEs). Secondary outcomes included Eczema Area and Severity Index (EASI).

Results

Forty adolescents received dupilumab in the phase IIa study; 36 enrolled in the OLE. Dupilumab showed nonlinear, target‐mediated pharmacokinetics. Mean ± SD trough dupilumab concentrations in serum at week 48 (OLE) were 74 ± 19 mg L⁻¹ and 161 ± 60 mg L⁻¹ for 2 mg kg⁻¹ and 4 mg kg⁻¹, respectively. Dupilumab was well tolerated over 52 weeks; the most common TEAEs were nasopharyngitis (week 52: 41% [2 mg kg⁻¹], 47% [4 mg kg⁻¹]) and AD exacerbation (29%, 42%). After one dupilumab dose in the phase IIa study, EASI improved from baseline to week 2 [mean ± SD reduction −34% ± 20% (2 mg kg⁻¹) and −51% ± 29% (4 mg kg⁻¹)]. With continuing treatment, EASI scores improved further [week 52: −85% ± 12% (2 mg kg⁻¹) and −84% ± 20% (4 mg kg⁻¹)].

Conclusions

In adolescents with moderate‐to‐severe AD, dupilumab's pharmacokinetic profile was similar to that in adults. These 52‐week safety and efficacy data support long‐term use of dupilumab in this patient population.

What's already known about this topic?

Adolescents with moderate‐to‐severe atopic dermatitis (AD) have high unmet medical need, with significant disease burden and limited treatment options.

Dupilumab (monoclonal antibody against interleukin‐4 receptor α) is approved for the treatment of adolescents with moderate‐to‐severe AD who are inadequately responsive to standard of care (U.S.A.) or candidates for systemic therapy (European Union).

A 16‐week, randomized, placebo‐controlled phase III trial in adolescents demonstrated significant improvements in AD signs/symptoms with an acceptable safety profile.

What does this study add?

These studies demonstrate the long‐term safety and efficacy of dupilumab in adolescents with moderate‐to‐severe AD for up to 52 weeks of treatment, thus extending and reinforcing the findings from the 16‐week dupilumab phase III trial.

The data from these studies also support the use of dupilumab in combination with current standard of care (topical corticosteroids), which was not evaluated in the 16‐week phase III monotherapy trial.

Linked Comment: https://doi.org/10.1111/bjd.18627.

https://doi.org/10.1111/bjd.18661 available online

Manipulating energy migration within single lanthanide activator for switchable upconversion emissions towards bidirectional photoactivation

Reliance on low tissue penetrating UV or visible light limits clinical applicability of phototherapy, necessitating use of deep tissue penetrating near-infrared (NIR) to visible light transducers like upconversion nanoparticles (UCNPs). While typical UCNPs produce multiple simultaneous emissions for unidirectional control of biological processes, programmable control requires orthogonal non-overlapping light emissions. These can be obtained through doping nanocrystals with multiple activator ions. However, this requires tedious synthesis and produces complicated multi-shell nanoparticles with a lack of control over emission profiles due to activator crosstalk. Herein, we explore cross-relaxation (CR), a non-radiative recombination pathway typically perceived as deleterious, to manipulate energy migration within the same lanthanide activator ion (Er³⁺) towards orthogonal red and green emissions, simply by adjusting excitation wavelength from 980 to 808 nm. These UCNPs allow programmable activation of two synergistic light-gated ion channels VChR1 and Jaws in the same cell to manipulate membrane polarization, demonstrated here for cardiac pacing.

Orthogonal light based control of biology is of interest, yet the synthesis of materials capable of this is complex. Here, the authors report on the synthesis of simpler upconversion nanoparticles which used cross-relaxation to change emission spectra from red to green light with a change in NIR wavelength.