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Gadbois EA, Meehan A, Uth R, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Identifying strategies that promote staff and resident influenza and COVID-19 vaccination in nursing homes: Perspectives from nursing home staff. Geriatr Nurs 2023; 54:205-210. [PMID: 37844537 DOI: 10.1016/j.gerinurse.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023]
Abstract
Resident and staff influenza and COVID-19 vaccination are critical components of infection prevention in nursing homes. Our study sought to characterize strategies that nursing home staff use to promote vaccination. Twenty-six telephone/videoconference interviews were conducted with administrators, directors of nursing, infection preventionists, and Minimum Data Set coordinators at 14 nursing homes across the US. Transcripts were analyzed using content analysis and a detailed audit trail was maintained. Staff described resident and staff influenza and COVID-19 vaccine hesitancy and confidence as well as varying approaches to promote vaccination. These included incentives, education efforts, and having a "vaccine champion" responsible for vaccine promotion. While many strategies had been in place prior to COVID-19 in support of improving influenza vaccination, participants reported implementing additional approaches to promote COVID-19 vaccination. Findings may inform future efforts to promote vaccination, which will be critical to mitigate the burden of influenza and COVID-19 in nursing homes.
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Affiliation(s)
- Emily A Gadbois
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States.
| | - Amy Meehan
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rebecca Uth
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rosa R Baier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Stefan Gravenstein
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States
| | - Andrew R Zullo
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States; Department of Pharmacy, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, United States
| | - Heidi Kabler
- Medical Affairs, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Barbara H Bardenheier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Westat, Inc., 1600 Research Blvd., Rockville, MD 20850, United States
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Meehan A, Uth R, Gadbois EA, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Impact of COVID-19 on influenza and infection control practices in nursing homes. J Am Geriatr Soc 2022; 71:661-665. [PMID: 36146903 PMCID: PMC9538598 DOI: 10.1111/jgs.18061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Meehan
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rebecca Uth
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rosa R. Baier
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Stefan Gravenstein
- Brown University School of Public HealthProvidenceRhode IslandUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
| | - Andrew R. Zullo
- Brown University School of Public HealthProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA,Rhode Island HospitalProvidenceRhode IslandUSA
| | | | | | - Barbara H. Bardenheier
- Brown University School of Public HealthProvidenceRhode IslandUSA,Westat, Inc.RockvilleMarylandUSA
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Alkhouri N, Herring R, Kabler H, Kayali Z, Hassanein T, Kohli A, Huss RS, Zhu Y, Billin AN, Damgaard LH, Buchholtz K, Kjær MS, Balendran C, Myers RP, Loomba R, Noureddin M. Safety and efficacy of combination therapy with semaglutide, cilofexor and firsocostat in patients with non-alcoholic steatohepatitis: A randomised, open-label phase II trial. J Hepatol 2022; 77:607-618. [PMID: 35439567 DOI: 10.1016/j.jhep.2022.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is associated with increased risk of liver-related and cardiovascular morbidity and mortality. Given the complex pathophysiology of NASH, combining therapies with complementary mechanisms may be beneficial. This trial evaluated the safety and efficacy of semaglutide, a glucagon-like peptide-1 receptor agonist, alone and in combination with the farnesoid X receptor agonist cilofexor and/or the acetyl-coenzyme A carboxylase inhibitor firsocostat in patients with NASH. METHODS This was a phase II, open-label, proof-of-concept trial in which patients with NASH (F2-F3 on biopsy, or MRI-proton density fat fraction [MRI-PDFF] ≥10% and liver stiffness by transient elastography ≥7 kPa) were randomised to 24 weeks' treatment with semaglutide 2.4 mg once weekly as monotherapy or combined with once-daily cilofexor (30 or 100 mg) and/or once-daily firsocostat 20 mg. The primary endpoint was safety. All efficacy endpoints were exploratory. RESULTS A total of 108 patients were randomised to semaglutide (n = 21), semaglutide plus cilofexor 30 mg (n = 22), semaglutide plus cilofexor 100 mg (n = 22), semaglutide plus firsocostat (n = 22) or semaglutide, cilofexor 30 mg and firsocostat (n = 21). Treatments were well tolerated - the incidence of adverse events was similar across groups (73-90%) and most events were gastrointestinal in nature. Despite similar weight loss (7-10%), compared with semaglutide monotherapy, combinations resulted in greater improvements in liver steatosis measured by MRI-PDFF (least-squares mean of absolute changes: -9.8 to -11.0% vs. -8.0%), liver biochemistry, and non-invasive tests of fibrosis. CONCLUSIONS In patients with mild-to-moderate fibrosis due to NASH, semaglutide with firsocostat and/or cilofexor was generally well tolerated. In exploratory efficacy analyses, treatment resulted in additional improvements in liver steatosis and biochemistry vs. semaglutide alone. Given this was a small-scale open-label trial, double-blind placebo-controlled trials with adequate patient numbers are warranted to assess the efficacy and safety of these combinations in NASH. CLINICAL TRIAL REGISTRATION NUMBER NCT03987074. LAY SUMMARY Non-alcoholic fatty liver disease and its more severe form, non-alcoholic steatohepatitis (NASH), are serious liver conditions that worsen over time if untreated. The reasons people develop NASH are complex and combining therapies that target different aspects of the disease may be more helpful than using single treatments. This trial showed that the use of 3 different types of drugs, namely semaglutide, cilofexor and firsocostat, in combination was safe and may offer additional benefits over treatment with semaglutide alone.
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Affiliation(s)
| | | | | | - Zeid Kayali
- Inland Empire Liver Foundation, Rialto, CA, USA
| | | | | | | | - Yanni Zhu
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | | | | | | | | | - Rohit Loomba
- University of California at San Diego, La Jolla, CA, USA
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Yu KC, Gupta V, Kabler H, Watts JA, Amiche A. A multicenter analysis of inpatient antibiotic use during the 2015-2019 influenza seasons in the United States: Untapped opportunities for antimicrobial stewardship. Antimicrob Steward Healthc Epidemiol 2022; 2:e140. [PMID: 36483354 PMCID: PMC9726518 DOI: 10.1017/ash.2022.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 06/17/2023]
Abstract
Outpatient antibiotic use increases during winter months, but information on temporal changes in inpatient antibiotic use in US hospitals is limited. The use of certain inpatient antibiotics, including extended-spectrum cephalosporins, macrolides, and tetracyclines, was strongly associated with influenza activity during the 2015-2019 viral respiratory seasons.
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Affiliation(s)
- Kalvin C. Yu
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States
| | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States
| | | | - Janet A. Watts
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States
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Meehan A, Meehan A, Gadbois E, Uth R, Baier R, Gravenstein S, Zullo A, Kabler H, Loiacono M, Bardenheier B. Strategies to Promote Staff and Resident Flu and COVID-19 Vaccination in Skilled Nursing Facilities. J Am Med Dir Assoc 2022. [PMCID: PMC9159938 DOI: 10.1016/j.jamda.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gupta V, Yu KC, Kabler H, Watts JA, Amiche A. Antibiotic Resistance Patterns and Association with the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Associations Between Influenza Season and Resistance in Gram-negative Pathogens. Open Forum Infect Dis 2022; 9:ofac039. [PMID: 35237702 PMCID: PMC8883593 DOI: 10.1093/ofid/ofac039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Viral infections are often treated with empiric antibiotics due to suspected bacterial coinfections, leading to antibiotic overuse. We aimed to describe antibiotic resistance (ABR) trends and their association with the influenza season in ambulatory and inpatient settings in the United States. Methods We used the BD Insights Research Database to evaluate antibiotic susceptibility profiles in 30-day nonduplicate bacterial isolates collected from patients >17 years old at 257 US healthcare institutions from 2011 to 2019. We investigated ABR in Gram-positive (Staphylococcus aureus and Streptococcus pneumoniae) and Gram-negative (Enterobacterales [ENT], Pseudomonas aeruginosa [PSA], and Acinetobacter baumannii spp [ACB]) bacteria expressed as the proportion of isolates not susceptible ([NS], intermediate or resistant) and resistance per 100 admissions (inpatients only). Antibiotics included carbapenems (Carb), fluoroquinolones (FQ), macrolides, penicillin, extended-spectrum cephalosporins (ESC), and methicillin. Generalized estimating equations models were used to evaluate monthly trends in ABR outcomes and associations with community influenza rates. Results We identified 8 250 860 nonduplicate pathogens, including 154 841 Gram-negative Carb-NS, 1 502 796 Gram-negative FQ-NS, 498 012 methicillin-resistant S aureus (MRSA), and 44 131 NS S pneumoniae. All S pneumoniae rates per 100 admissions (macrolide-, penicillin-, and ESC-NS) were associated with influenza rates. Respiratory, but not nonrespiratory, MRSA was also associated with influenza. For Gram-negative pathogens, influenza rates were associated with the percentage of FQ-NS ENT, FQ-NS PSA, and Carb-NS ACB. Conclusions Our study showed expected increases in rates of ABR Gram-positive and identified small but surprising increases in ABR Gram-negative pathogens associated with influenza activity. These insights may help inform antimicrobial stewardship initiatives.
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Affiliation(s)
- Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Kalvin C Yu
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | | | - Janet A Watts
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
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Amiche A, Kabler H, Weeks J, Yu K, Gupta V. 176. Antibiotic Resistance Patterns, Seasonality, and Correlation with the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Association Between Influenza Season and Gram Negative Pathogens. Open Forum Infect Dis 2021. [PMCID: PMC8644034 DOI: 10.1093/ofid/ofab466.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Influenza infection may affect bacterial transmission dynamics and seasonality of antimicrobial resistance (AMR). There is a paucity of data on the association of influenza season and AMR rates. We aimed to describe trends of AMR and their correlation with the influenza season in ambulatory and inpatient settings in the United States (US).
Methods
We used the BD Insights Research Database (Franklin Lakes, NJ USA) to identify 30 day non-duplicate isolates collected from patients >17 years old with susceptibility profile of Gram-negative (GN) (Enterobacterales (ENT), P. aeruginosa (PSA), A. baumannii spp. (ACB), and S. maltophilia (Sm)) and Gram-positive (GP) pathogens (S. aureus (SA), and S. pneumoniae (Sp)) in up to 257 US healthcare institutions from 2011-19. We defined the outcomes as rates per 100 admissions and % of non-susceptibility (NS), stratified by community and inpatient settings, resistance type (resistance to carbapenem (Carb-NS), quinolone (FQ-NS), macrolide (Macr NS), penicillin (PCN NS), and extended spectrum cephalosporin (ESC NS)) and isolate origin (respiratory and non-respiratory). Influenza data were presented as the % of positive laboratory tests. We used descriptive statistics and generalized estimating equations models to evaluate the monthly trends of AMR outcomes and correlation with the influenza season.
Results
We identified 16 576 274 confirmed non-duplicate pathogens, of which 154 841 were GN Carb-NS, 1 502 796 GN FQ-NS, 498 012 methicillin resistant SA (MRSA), and 44 131 Macr-NS, PCN-NS, and ESC-NS Sp. Among the Carb-NS pathogens, Influenza rate was correlated with % ACB-NS [β= 0.205, p< .001]. In the FQ-NS group, influenza was associated with overall % ENT-NS [β= 0.041 p< .001] and % PSA-NS [β= 0.039, p = .015]. For the GP pathogens, all Sp. rates were correlated with increased influenza positivity % (See Table). Only MRSA rates of respiratory source were associated with influenza [β= .066, p=.028].
Summary of Multivariate regressions of AMR and % Flu by Source and Setting (controlling for hospital level factors): 2011-2019
Data in each cell is presented as the coefficient and p-value is in parentheses. ^adjusted for region, teaching, urban, bed size, and season. + p<.10 *p <.05 **p <.01 ***p <.001
Conclusion
Our study revealed surprising association between influenza epidemics and GN resistance and corroborated the evidence of correlation between respiratory GP and influenza infections. These insights may help inform targeted antimicrobial stewardship initiatives during influenza season.
Disclosures
Amine Amiche, PhD, Sanofi (Employee, Shareholder) Heidi Kabler, MD, Sanofi Pasteur (Employee) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)
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Affiliation(s)
- Amine Amiche
- Sanofi Pasteur, Dubai, Dubai, United Arab Emirates
| | - Heidi Kabler
- Sanofi Pasteur, Dubai, Dubai, United Arab Emirates
| | - Janet Weeks
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
| | - Kalvin Yu
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
| | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
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Loomba R, Noureddin M, Kowdley KV, Kohli A, Sheikh A, Neff G, Bhandari BR, Gunn N, Caldwell SH, Goodman Z, Wapinski I, Resnick M, Beck AH, Ding D, Jia C, Chuang JC, Huss RS, Chung C, Subramanian GM, Myers RP, Patel K, Borg BB, Ghalib R, Kabler H, Poulos J, Younes Z, Elkhashab M, Hassanein T, Iyer R, Ruane P, Shiffman ML, Strasser S, Wong VWS, Alkhouri N. Combination Therapies Including Cilofexor and Firsocostat for Bridging Fibrosis and Cirrhosis Attributable to NASH. Hepatology 2021; 73:625-643. [PMID: 33169409 DOI: 10.1002/hep.31622] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Advanced fibrosis attributable to NASH is a leading cause of end-stage liver disease. APPROACH AND RESULTS In this phase 2b trial, 392 patients with bridging fibrosis or compensated cirrhosis (F3-F4) were randomized to receive placebo, selonsertib 18 mg, cilofexor 30 mg, or firsocostat 20 mg, alone or in two-drug combinations, once-daily for 48 weeks. The primary endpoint was a ≥1-stage improvement in fibrosis without worsening of NASH between baseline and 48 weeks based on central pathologist review. Exploratory endpoints included changes in NAFLD Activity Score (NAS), liver histology assessed using a machine learning (ML) approach, liver biochemistry, and noninvasive markers. The majority had cirrhosis (56%) and NAS ≥5 (83%). The primary endpoint was achieved in 11% of placebo-treated patients versus cilofexor/firsocostat (21%; P = 0.17), cilofexor/selonsertib (19%; P = 0.26), firsocostat/selonsertib (15%; P = 0.62), firsocostat (12%; P = 0.94), and cilofexor (12%; P = 0.96). Changes in hepatic collagen by morphometry were not significant, but cilofexor/firsocostat led to a significant decrease in ML NASH CRN fibrosis score (P = 0.040) and a shift in biopsy area from F3-F4 to ≤F2 fibrosis patterns. Compared to placebo, significantly higher proportions of cilofexor/firsocostat patients had a ≥2-point NAS reduction; reductions in steatosis, lobular inflammation, and ballooning; and significant improvements in alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, bile acids, cytokeratin-18, insulin, estimated glomerular filtration rate, ELF score, and liver stiffness by transient elastography (all P ≤ 0.05). Pruritus occurred in 20%-29% of cilofexor versus 15% of placebo-treated patients. CONCLUSIONS In patients with bridging fibrosis and cirrhosis, 48 weeks of cilofexor/firsocostat was well tolerated, led to improvements in NASH activity, and may have an antifibrotic effect. This combination offers potential for fibrosis regression with longer-term therapy in patients with advanced fibrosis attributable to NASH.
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Affiliation(s)
- Rohit Loomba
- NAFLD Research CenterUniversity of California at San DiegoLa JollaCA
| | | | | | | | | | - Guy Neff
- Covenant Research, LLCSarasotaFL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Reem Ghalib
- Texas Clinical Research InstituteArlingtonTX
| | | | - John Poulos
- Cumberland Research AssociatesFayettevilleNC
| | | | | | | | | | - Peter Ruane
- Ruane Medical and Liver Health InstituteLos AngelesCA
| | | | - Simone Strasser
- Royal Prince Alfred Hospital and The University of SydneyCamperdownNew South WalesAustralia
| | - Vincent Wai-Sun Wong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongHong Kong
| | - Naim Alkhouri
- Texas Liver InstituteUT Health San AntonioSan AntonioTX
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Alexander R, Peyrani P, Ramirez JA, Self WH, Grijalva C, Counselman F, Volturo GA, Kabler H, Ostrosky-Zeichner L, Wunderink R, Sherwin RL, Pena S, File T, Wiemken TL, Gray S, Pride M, Ford KD, Jiang Q, Isturiz R. Rationale and Methods of the Study Protocol: Streptococcus pneumoniae Serotypes in Adults 18 Years and Older with Radiographically-Confirmed Community-Acquired Pneumonia (CAP). JRI 2017. [DOI: 10.18297/jri/vol1/iss4/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Corey GR, Kabler H, Mehra P, Gupta S, Overcash JS, Porwal A, Giordano P, Lucasti C, Perez A, Good S, Jiang H, Moeck G, O'Riordan W. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med 2014; 370:2180-90. [PMID: 24897083 DOI: 10.1056/nejmoa1310422] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Oritavancin is a lipoglycopeptide with bactericidal activity against gram-positive bacteria. Its concentration-dependent activity and prolonged half-life allow for single-dose treatment. METHODS We conducted a randomized, double-blind trial in which adults with acute bacterial skin and skin-structure infections received either a single intravenous dose of 1200 mg of oritavancin or a regimen of intravenous vancomycin twice daily for 7 to 10 days. Three efficacy end points were tested for noninferiority. The primary composite end point was defined as cessation of spreading or reduction in lesion size, absence of fever, and no need for administration of a rescue antibiotic 48 to 72 hours after administration of oritavancin. Secondary end points were clinical cure 7 to 14 days after the end of treatment, as determined by a study investigator, and a reduction in lesion size of 20% or more 48 to 72 hours after administration of oritavancin. RESULTS The modified intention-to-treat population comprised 475 patients who received oritavancin and 479 patients who received vancomycin. All three efficacy end points met the prespecified noninferiority margin of 10 percentage points for oritavancin versus vancomycin: primary end point, 82.3% versus 78.9% (95% confidence interval [CI] for the difference, -1.6 to 8.4 percentage points); investigator-assessed clinical cure, 79.6% versus 80.0% (95% CI for the difference, -5.5 to 4.7 percentage points); and proportion of patients with a reduction in lesion area of 20% or more, 86.9% versus 82.9% (95% CI for the difference, -0.5 to 8.6 percentage points). Efficacy outcomes measured according to type of pathogen, including methicillin-resistant Staphylococcus aureus, were similar in the two treatment groups. The overall frequency of adverse events was also similar, although nausea was more common among those treated with oritavancin. CONCLUSIONS A single dose of oritavancin was noninferior to twice-daily vancomycin administered for 7 to 10 days for the treatment of acute bacterial skin and skin-structure infections caused by gram-positive pathogens. (Funded by the Medicines Company; SOLO I ClinicalTrials.gov number, NCT01252719.).
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Affiliation(s)
- G Ralph Corey
- From Duke University Medical Center, Durham, NC (G.R.C.); Sunrise Hospital and Medical Center, Las Vegas (H.K.); Sharp Chula Vista Medical Center, Chula Vista (P.M., W.O.), and Sharp Grossmont Hospital, San Diego (J.S.O.) - both in California; MV Hospital and Research Center, Lucknow (S. Gupta), and Inamdar Multispecialty Hospital, Pune (A. Porwal) - both in India; Orlando Health, Orlando, FL (P.G.); and South Jersey Infectious Disease, Somers Point (C.L.), and the Medicines Company, Parsippany (A. Perez, S. Good, H.J., G.M.) - both in New Jersey
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Abstract
The enzyme steryl sulfatase may help support the growth of hormone-dependent tumors, including prostate cancers, by facilitating the conversion of circulating precursor steroids to active hormones. We sought to determine the presence of steryl sulfatase activity in the androgen-dependent human prostate cancer cell line LNCaP, and to determine if this activity was inhibited by known steryl sulfatase inhibitors. Intact LNCaP cultures had steryl sulfatase activity, as determined by conversion of [3H]estrone sulfate (E(1)S) to unconjugated steroids. The level of steryl sulfatase activity was relatively low (4.6 pmol/18 h/million cells) compared to MDA-MB-231 breast cancer cells (284.0 pmol/18 h/million cells). The observed activity in both cell lines was blocked by addition of 1 microM estrone sulfamate (EMATE), an active-site-directed, steroidal inhibitor of steryl sulfatase. Steryl sulfatase activity was also inhibited by Danazol, and by (p-O-sulfamoyl)-tetradecanoyl tyramine (C2-14), a non-steroidal inhibitor. Microsomes prepared from LNCaP cultures also showed steryl sulfatase activity, as determined by hydrolysis of [3H]E(1)S and [3H]dehydroepiandrosterone sulfate (DHEAS) to unconjugated forms. LNCaP and MDA-MB-231 microsomes both hydrolyzed E(1)S about two times faster than DHEAS. Hydrolysis of E(1)S in LNCaP and MDA-MB-231 microsomes was blocked by steryl sulfatase inhibitors with the following relative potencies: EMATE>C2-14>Danazol. These data demonstrate that LNCaP prostate cancer cells contain a steryl sulfatase with properties similar to that found in human breast cancer cells, and that the activity of this enzyme can be blocked by known steryl sulfatase inhibitors. Steryl sulfatase inhibitors may be useful as an adjuvant to androgen deprivation therapy for prostate cancer.
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Affiliation(s)
- Kyle W Selcer
- Department of Biological Sciences, Bayer School of Natural and Environmental Sciences, Duquesne University, Pittsburgh, PA 15282, USA
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Abstract
The present study concerned the perceptual processing of complex auditory stimuli in 10 children (M age = 8.1) as compared to 10 young adults (M age = 19.3) and 10 older adult subjects (M age = 54.2). The auditory stimulus used was 10 sec. of rock music (Led Zeppelin, 1969). All three groups provided numerical responses to nine intensities of the rock music stimulus (10, 20, 30, 40, 50, 60, 70, 80, 90 dB above threshold). Analysis showed that the children reported a wider range of numerical responses than both adult groups. The mean numerical responses for the children ranged from .54 to 54.24. For the young adults the range was .76 to 11.37, and for the older subjects it was 1.6 to 23.31. Results suggest that the children were not bound by the same set of rules as the adults with regard to magnitude estimation scaling of the loudness of the rock music stimulus. Their internal scaling mechanisms appeared to be more flexible and broader based than those of the adults who participated in this study.
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Affiliation(s)
- D Fucci
- School of Hearing & Speech Sciences, Ohio University, Athens 45701, USA
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