A review of topical corticosteroid sprays for the treatment of inflammatory dermatoses

Background: Topical corticosteroids are available in many vehicles. However, patients' preference for vehicles are variable and could be tailored to maximize patient adherence. Spray vehicles may offer, convenience, and strong efficacy. Methods: A literature review was conducted using keywords: clobetasol, desoximetasone, betamethasone, triamcinolone, corticosteroid, topical, spray, vehicles, treatment, and clinical trial. Results: For moderate-to-severe plaque psoriasis, 87% of subjects achieved an Overall Disease Severity (ODS) Score ≤2 at week two and 78% achieved an ODS ≤1 after four weeks with clobetasol propionate (CP) 0.05% spray compared to 17% and 3% in the control group, respectively (P<0.001). For desoximetasone 0.25% spray, 31%-53% with moderate-to-severe psoriasis achieve Physician's Global Assessment (PGA) score ≤1 at day 28 versus 5%-18% in the vehicle spray group (P<0.01). For betamethasone dipropionate 0.05% spray, 19% with mild-to-moderate plaque psoriasis achieved an Investigator's Global Assessment (IGA) score ≤1 or a 2-grade reduction in IGA versus 2.3% in vehicle group (P≤0.001). For mild-to-severe steroid responsive inflammatory dermatoses, 64% using triamcinolone acetonide 0.2% spray achieved clear or almost clear skin at day 14 (no P value reported). Adverse events including burning, irritation, and dryness were similar across all corticosteroids

Scalp psoriasis associated with central centrifugal cicatricial alopecia

AbstractScalp psoriasis is a very common dermatological condition with a variety of presentations, but only rarely presents as severe alopecia. We present a case of a 50-year-old female with many years of recalcitrant hair loss that was thought to be secondary to central centrifugal cicatricial alopecia which was later diagnosed as psoriasis. This case highlights an interesting presentation and rare complication of a common disease

Myeloid conditioning with c-kit-targeted CAR-T cells enables donor stem cell engraftment

We report a novel approach to bone marrow (BM) conditioning using c-kit-targeted chimeric antigen receptor T (c-kit CAR-T) cells in mice. Previous reports using anti-c-kit or anti-CD45 antibody linked to a toxin such as saporin have been promising. We developed a distinctly different approach using c-kit CAR-T cells. Initial studies demonstrated in vitro killing of hematopoietic stem cells by c-kit CAR-T cells but poor expansion in vivo and poor migration of CAR-T cells into BM. Pre-treatment of recipient mice with low-dose cyclophosphamide (125 mg/kg) together with CXCR4 transduction in the CAR-T cells enhanced trafficking to and expansion in BM (\u3c1%-13.1%). This resulted in significant depletion of the BM c-ki

Representative Farm Analysis of the H.R. 2646 Farm Bill Proposal

Agricultural and Food Policy,

Adalimumab improves health-related quality of life in patients with moderate to severe plaque psoriasis compared with the United States general population norms: Results from a randomized, controlled Phase III study

<p>Abstract</p> <p>Objective</p> <p>To evaluate the impact of adalimumab on health-related quality of life (HRQOL) for patients with moderate to severe plaque psoriasis.</p> <p>Background</p> <p>Psoriasis is a chronic, inflammatory, immune-mediated disease that has a significant impact on patients' HRQOL. Adalimumab is a fully human monoclonal antibody that blocks tumor necrosis factor, a pro-inflammatory cytokine, and is effective and well-tolerated for patients with moderate to severe psoriasis.</p> <p>Methods</p> <p>Data were obtained for a secondary analysis of patients in a randomized, controlled Phase III trial evaluating the effect of adalimumab in patients with psoriasis (N = 1,205). Patients with moderate to severe psoriasis were randomized in a 2:1 ratio to adalimumab 80 mg (two 40 mg injections administered subcutaneously at baseline followed by one 40 mg injection every other week from Week 1 to Week 15) or placebo. Short Form-36 (SF-36) Health Survey scores of psoriasis patients were used to assess HRQOL and were compared with United States (US) population norms at baseline and Week 16.</p> <p>Results</p> <p>Baseline Physical Component Summary (PCS) scores for the placebo and adalimumab groups were similar to the general US population. Baseline mean Mental Component Summary (MCS) scores were significantly lower for the adalimumab and placebo groups compared with the general population (47.4, 47.7, and 50.8 points, respectively; p < 0.0001). PCS scores at Week 16 for patients receiving adalimumab had improved and were significantly greater than scores for the general US population (52.7 vs 48.9; p < 0.001). Compared with the general US population, MCS scores at Week 16 were similar for patients receiving adalimumab (51.2 vs 50.8; p = 1.000) and lower for patients receiving placebo (50.8 vs 48.7; p < 0.0001).</p> <p>Conclusion</p> <p>Psoriasis has a broad impact on patient functioning and well-being. Improvement in skin lesions and joint symptoms associated with adalimumab treatment was accompanied by improvements in HRQOL to levels that were similar to or greater than those of the general US population.</p> <p>Trial registration</p> <p>Clinicaltrials.gov NCT00237887</p

Assessing adherence to dermatology treatments: a review of self-report and electronic measures

Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self-report measures may be less reliable.To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease.A PubMed literature search was conducted using the terms ‘scale,’‘measure,’‘self-report,’‘electronic,’ and ‘medication adherence.’ Relevant articles were reviewed and selected if they addressed self-report or electronic measures of adherence in chronic disease.Eleven self-report instruments for the measurement of adherence were identified. Four were validated using electronic monitors. All produced an estimate of adherence that correlated with actual behavior, although this correlation was not strong for any of the measures. None of the scales was tested in patients who had dermatologic disease and/or used topical medications. Several electronic monitoring systems were identified, including pill counts, pharmacy refill logs, and the Medication Event Monitoring System (MEMS ® ). Validity was higher among electronic monitoring systems compared with self-report measures.While several self-report measures of adherence have been validated in chronic disease populations, their relevance in dermatology patients has not been studied. A dermatology-specific instrument for the measurement of adherence would contribute to improved outcomes; until such a tool exists, researchers and clinicians should consider nonadherence as a possible factor in skin disease that is not responsive to treatment. Electronic monitoring provides the most reliable means of measuring adherence, and may provide additional clues to identify barriers to adherence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79087/1/j.1600-0846.2010.00431.x.pd

Admittance measurement for tuning bi-ventricular pacemakers

An apparatus for treating a heart of a patient includes a first lead and at least a second lead for pacing the heart adapted to be in electrical communication with the heart. The apparatus includes a microcontroller in communication with the first and second leads which triggers the first lead at either different times or the same time from when the microcontroller triggers the second lead. Alternatively, the apparatus includes a microcontroller in communication with the first and second leads that determines heart volume, including stroke volume, end-systolic volume, and calculated values including ejection fraction, from admittance from signals from the first and second leads and uses the admittance as feedback to control heart volume ejected, as measured by stroke volume, calculated values such as ejection fraction, and control end-systolic volume, with respect to the first and second leads. A method for treating the heart of a patient.Board of Regents, University of Texas Syste

Economic Outlook for Representative Cotton Farms Given the August 2003 FAPRI/AFPC Baseline

The farm level economic impacts of the Farm Security and Rural Investment Act of 2002 on representative cotton farms are projected in this report. The analysis was conducted over the 2001-2007 planning horizon using FLIPSIM, AFPC’s whole farm simulation model. Data to simulate farming operations in the nation’s major cotton production regions came from two sources: - Producer panel cooperation to develop economic information to describe and simulate representative cotton farms. - Projected prices, policy variables, and input inflation rates from the Food and Agricultural Policy Research Institute (FAPRI) August 2003 Baseline. The primary objective of the analysis is to determine the farms’ economic viability by region through the life of the 2002 Farm Bill, given sector level conditions projected in the August 2003 FAPRI Baseline. The FLIPSIM policy simulation model incorporates the historical risk faced by cotton farmers for prices and production. This report presents the results of the August 2003 Baseline in a risk context using selected simulated probabilities and ranges for annual net cash farm income values. The probability of a farm experiencing annual cash flow deficits and the probability of a farm losing real net worth are included as indicators of the cash flow and equity risks facing farms through the year 2007. This report is organized into five sections. The first section summarizes the process used to develop the representative farms and the key assumptions utilized for the farm level analysis. The second section summarizes the FAPRI August 2003 Baseline and the policy and price assumptions used for the representative farm analyses. The third section presents the results of the simulation analyses for cotton farms. Two appendices constitute the final section of the report. Appendix A provides tables to summarize the physical and financial characteristics for each of the representative farms. Appendix B provides the names of producers, land grant faculty, and industry leaders who cooperated in the panel interview process to develop the representative cotton farms.Agribusiness, Agricultural and Food Policy, Crop Production/Industries,

Representative Farms Economic Outlook for the January 2003 FAPRI/AFPC Baseline

The farm level economic impacts of the Farm Security and Rural Investment Act of 2002 on representative crop and livestock operations are projected in this report. The analysis was conducted over the 2001-2007 planning horizon using FLIPSIM, AFPC’s whole farm simulation model. Data to simulate farming operations in the nation’s major production regions came from two sources: - Producer panel cooperation to develop economic information to describe and simulate representative crop, livestock, and dairy farms. - Projected prices, policy variables, and input inflation rates from the Food and Agricultural Policy Research Institute (FAPRI) January 2003 Baseline. The FLIPSIM policy simulation model incorporates the historical risk faced by farmers for prices and production. This report presents the results of the January 2003 Baseline in a risk context using selected simulated probabilities and ranges for annual net cash farm income values. The probability of a farm experiencing annual cash flow deficits and the probability of a farm losing real net worth are included as indicators of the cash flow and equity risks facing farms through the year 2007.Agribusiness, Agricultural and Food Policy, Crop Production/Industries,