Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial

Objective: Assess ustekinumab efficacy (week 24/week 52) and safety (week 16/week 24/week 60) in patients with active psoriatic arthritis (PsA) despite treatment with conventional and/or biological anti-tumour necrosis factor (TNF) agents. Methods: In this phase 3, multicentre, placebo-controlled trial, 312 adults with active PsA were randomised (stratified by site, weight (≤100 kg/>100 kg), methotrexate use) to ustekinumab 45 mg or 90 mg at week 0, week 4, q12 weeks or placebo at week 0, week 4, week 16 and crossover to ustekinumab 45 mg at week 24, week 28 and week 40. At week 16, patients with <5% improvement in tender/swollen joint counts entered blinded early escape (placebo→45 mg, 45 mg→90 mg, 90 mg→90 mg). The primary endpoint was ≥20% improvement in American College of Rheumatology (ACR20) criteria at week 24. Secondary endpoints included week 24 Health Assessment Questionnaire-Disability Index (HAQ-DI) improvement, ACR50, ACR70 and ≥75% improvement in Psoriasis Area and Severity Index (PASI75). Efficacy was assessed in all patients, anti-TNF-naïve (n=132) patients and anti-TNF-experienced (n=180) patients. Results: More ustekinumab-treated (43.8% combined) than placebo-treated (20.2%) patients achieved ACR20 at week 24 (p<0.001). Significant treatment differences were observed for week 24 HAQ-DI improvement (p<0.001), ACR50 (p≤0.05) and PASI75 (p<0.001); all benefits were sustained through week 52. Among patients previously treated with ≥1 TNF inhibitor, sustained ustekinumab efficacy was also observed (week 24 combined vs placebo: ACR20 35.6% vs 14.5%, PASI75 47.1% vs 2.0%, median HAQ-DI change −0.13 vs 0.0; week 52 ustekinumab-treated: ACR20 38.9%, PASI75 43.4%, median HAQ-DI change −0.13). No unexpected adverse events were observed through week 60. Conclusions: The interleukin-12/23 inhibitor ustekinumab (45/90 mg q12 weeks) yielded significant and sustained improvements in PsA signs/symptoms in a diverse population of patients with active PsA, including anti-TNF-experienced PsA patients

A characteristics framework for Semantic Information Systems Standards

Semantic Information Systems (IS) Standards play a critical role in the development of the networked economy. While their importance is undoubted by all stakeholders—such as businesses, policy makers, researchers, developers—the current state of research leaves a number of questions unaddressed. Terminological confusion exists around the notions of “business semantics”, “business-to-business interoperability”, and “interoperability standards” amongst others. And, moreover, a comprehensive understanding about the characteristics of Semantic IS Standards is missing. The paper addresses this gap in literature by developing a characteristics framework for Semantic IS Standards. Two case studies are used to check the applicability of the framework in a “real-life” context. The framework lays the foundation for future research in an important field of the IS discipline and supports practitioners in their efforts to analyze, compare, and evaluate Semantic IS Standard

Antihypertensive efficacy and safety of amlodipine maleate in the treatment of patients with mild to moderate essential hypertension : comparison with amlodipine besylate

Wstęp Amlodipina należy do jednych z najdłużej działających antagonistów wapnia, charakteryzuje się łagodnym początkiem działania hipotensyjnego i długotrwałym efektem hipotensyjnym, przekraczającym 24 godziny. Celem przeprowadzonego badania III fazy było porównanie skuteczności hipotensyjnej i tolerancji dwóch form amlodipiny - maleinianu amlodipiny i benzenosulfonianu amlodipiny - u chorych z łagodnym i umiarkowanym nadciśnieniem tętniczym pierwotnym. Materiał i metody Badanie o charakterze prospektywnym, randomizowanym, przeprowadzonym metodą podwójnie ślepej próby w grupach równoległych, wykonano w 7 ośrodkach w Polsce. Do programu włączano chorych z nadciśnieniem tętniczym pierwotnym, z ciśnieniem rozkurczowym mieszczącym się w zakresie 95-114 mm Hg i ciśnieniem skurczowym poniżej 180 mm Hg. Po okresie wstępnym, w trakcie którego chorzy otrzymywali placebo, 250 losowo chorych przydzielono do dwóch grup - grupy otrzymującej lek oceniany, maleinian amlodipiny (Tenox, Krka) w dawce 5 mg, lub do grupy otrzymującej lek referencyjny, benzenosulfonian amlodipiny (Norvasc, Pfizer) w dawce 5 mg. Po 6 tygodniach leczenia u chorych, u których nie uzyskano obniżenia wartości ciśnienia rozkurczowego poniżej 90 mm Hg, zwiększano dawkę leku do 10 mg maleinianu lub benzenosulfonianu amlodipiny. Głównym kryterium oceny badania było porównanie względnego średniego obniżenia rozkurczowego ciśnienia tętniczego w badanych grupach, wyrażonego jako różnica pomiędzy ciśnieniem rozkurczowym na początku i na końcu 12-tygodniowego okresu leczenia. Dodatkowymi kryteriami oceny badania było porównanie względnego średniego obniżenia skurczowego ciśnienia tętniczego i częstości akcji serca w badanych grupach, wyrażonych jako różnica pomiędzy wartościami tych parametrów zmierzonymi na początku i na końcu 12-tygodniowego okresu leczenia. Dokonano także oceny skuteczności hipotensyjnej ocenianej uzyskaniem docelowych wartości rozkurczowego ciśnienia tętniczego. Wyniki Końcowej analizie skuteczności hipotensyjnej leku, ocenianego i referencyjnego benzenosulfonianu amlodipiny, poddano 219 chorych (średnia wieku 45,5 roku - 154 mężczyzn i 65 kobiet), odpowiednio 110 i 109 chorych w badanych grupach. Po 6 tygodniach leczenia u 47 chorych leczonych maleinianem amlodipiny (43% tej grupy) i u 51 chorych leczonych benzenosulfonianem amlodipiny (47% tej grupy) należało zwiększyć dawkę leku do 10 mg. Oceniając główne kryterium badania, wykazano, że chorzy leczeni maleinianem i benzenosulfonianem amlodipiny charakteryzowali się podobnym obniżeniem rozkurczowego ciśnienia tętniczego po 12 tygodniach leczenia, wynoszącym odpowiednio - 17,5 ± 6,1 mm Hg i –18,4 ± 5,4 mm Hg (p =NS). W odniesieniu do pozostałych kryteriów oceny - obniżenie skurczowego ciśnienia tętniczego (-21,1 ± 12,3 vs. -21,1 ± 12,7 mm Hg; p = NS), obniżenie częstości akcji serca, osiągnięcie docelowego rozkurczowego ciśnienia tętniczego (93,6% vs. 92,7%) - nie zaobserwowano różnic pomiędzy pacjentami leczonymi badanymi solami amlodipiny. W trakcie badania zaobserwowano łącznie 129 działań niepożądanych, które wystąpiły u 35 chorych w grupie maleinianu amlodipiny i u 47 chorych w grupie benzenosulfonianu amlodipiny (28,9% vs. 37,9%; p = NS). Wnioski Uzyskane wyniki wskazują, że maleinian amlodipiny i benzenosulfonian amlodipiny stosowane w monoterapii u chorych z łagodnym i umiarkowanym nadciśnieniem tętniczym pierwotnym charakteryzują się porównywalną wysoką skutecznością hipotensyjną. Porównywane sole amlodipiny charakteryzują się porównywalną częstością działań niepożądanych w trakcie 12-tygodniowego okresu leczenia.Background As a long acting, slow onset and metabolically neutral compound, calcium channel blocker amlodipine is a well established drug for the treatment of essential hypertension. The aim of the study was to evaluate the efficacy and safety of amlodipine in the form of maleate salt compared with amlodipine in the form of besylate salt in patients with mild to moderate essential hypertension. Material and methods The study was carried out as a randomized, double blind and parallel trial. It was performed in seven study centers in Poland. Patients, aged 18 to 75 years, with diastolic blood pressure between 95 and 114 mm Hg were included in the study. All enrolled patients were given placebo once daily in a single blind fashion for two weeks. Then patients were randomly assigned to take whether amlodipine maleate or amlodipine besylate 5 mg once daily in a double blind fashion. After 6 weeks of treatment in patients whose diastolic blood pressure remained 90 mm Hg or higher, the dose of each drug was increased to 10 mg once daily. The primary efficacy variable was the mean change in diastolic blood pressure from the end of treatment measured after 12 weeks, to baseline values after placebo run-in period at week 2. Results 219 patients (mean age 45.5 lat - 154 male, 65 female) were included in the final per-protocol analysis of the efficacy of the studied drugs. After 6 weeks of treatment the drug dose was increased in 47 (43%) and 51 (47%) patients in the amlodipine maleate and amlodipine besylate groups respectively (p = NS). After 12 weeks of treatment the mean change in diastolic blood pressure in the amlodipine maleate group was –17.5 mm Hg compared to the –18.4 mm Hg in the amlodipine besylate group (p = NS). There was no difference in the percentage of patients reaching the goal of diastolic blood pressure lowering to 90 mm Hg between the studied groups (93.6% vs. 92.7%). 35 patients in the amlodipine maleate group and 47 patients in the amlodipine besylate group reported adverse reactions (28.9% vs. 37.9%, p = NS). Conclusions Amlodipine maleate and amlodipine besylate were equally effective in the treatment of patients with mild to moderate essential hypertension. During 12 weeks of treatment incidence of adverse reactions was comparable in the studied groups

Do semantic standards lack quality? : a survey among 34 semantic standards

The adoption of standards to improve interoperability in the automotive, aerospace, shipbuilding and other sectors could save billions. While interoperability standards have been created for a number of industries, problems persist, suggesting a lack of quality of the standards themselves. The issue of semantic standard quality is not often addressed. In this research we take a closer look at the quality of semantics standards, development processes, and survey the current state of the quality of semantic standards by means of a questionnaire that was sent to standards developers. This survey looked at 34 semantic standards, and it shows that the quality of semantic standards for inter-organizational interoperability can be improved. Improved standards may advance interoperability in networked business. Improvement of semantic standards requires transparency of their quality. Although many semantic standard development organisations already have quality assurance in place, this research shows that they could benefit from a quality measuring instrument

Meta-analysis of gene–environment-wide association scans accounting for education level identifies additional loci for refractive error

This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/Myopia is the most common human eye disorder and it results from complex genetic and environmental causes. The rapidly increasing prevalence of myopia poses a major public health challenge. Here, the CREAM consortium performs a joint meta-analysis to test single-nucleotide polymorphism (SNP) main effects and SNP × education interaction effects on refractive error in 40,036 adults from 25 studies of European ancestry and 10,315 adults from 9 studies of Asian ancestry. In European ancestry individuals, we identify six novel loci (FAM150B-ACP1, LINC00340, FBN1, DIS3L-MAP2K1, ARID2-SNAT1 and SLC14A2) associated with refractive error. In Asian populations, three genome-wide significant loci AREG, GABRR1 and PDE10A also exhibit strong interactions with education (P<8.5 × 10(-5)), whereas the interactions are less evident in Europeans. The discovery of these loci represents an important advance in understanding how gene and environment interactions contribute to the heterogeneity of myopia

Chemical Library Screening and Structure-Function Relationship Studies Identify Bisacodyl as a Potent and Selective Cytotoxic Agent Towards Quiescent Human Glioblastoma Tumor Stem-Like Cells

Cancer stem-like cells reside in hypoxic and slightly acidic tumor niches. Such microenvironments favor more aggressive undifferentiated phenotypes and a slow growing "quiescent state" which preserves them from chemotherapeutic agents that essentially target proliferating cells. Our objective was to identify compounds active on glioblastoma stem-like cells, including under conditions that mimick those found in vivo within this most severe and incurable form of brain malignancy. We screened the Prestwick Library to identify cytotoxic compounds towards glioblastoma stem-like cells, either in a proliferating state or in more slow-growing "quiescent" phenotype resulting from non-renewal of the culture medium in vitro. Compound effects were assessed by ATP-level determination using a cell-based assay. Twenty active molecules belonging to different pharmacological classes have thus been identified. Among those, the stimulant laxative drug bisacodyl was the sole to inhibit in a potent and specific manner the survival of quiescent glioblastoma stem-like cells. Subsequent structure-function relationship studies led to identification of 4,4'-dihydroxydiphenyl-2-pyridyl-methane (DDPM), the deacetylated form of bisacodyl, as the pharmacophore. To our knowledge, bisacodyl is currently the only known compound targeting glioblastoma cancer stem-like cells in their quiescent, more resistant state. Due to its known non-toxicity in humans, bisacodyl appears as a new potential anti-tumor agent that may, in association with classical chemotherapeutic compounds, participate in tumor eradication

Tenure, gender and household structure

Starting with a review of recent literature on gender and housing, this paper goes on to develop a new theory of household structure, in which concepts of gender and generation play a key role. The utility of this theory is then demonstrated in the analysis of data from a survey of households in the City of Salford

Genome-wide associations for birth weight and correlations with adult disease

Birth weight (BW) is influenced by both foetal and maternal factors and in observational studies is reproducibly associated with future risk of adult metabolic diseases including type 2 diabetes (T2D) and cardiovascular disease1. These lifecourse associations have often been attributed to the impact of an adverse early life environment. We performed a multi-ancestry genome-wide association study (GWAS) meta-analysis of BW in 153,781 individuals, identifying 60 loci where foetal genotype was associated with BW (P <5x10-8). Overall, ˜15% of variance in BW could be captured by assays of foetal genetic variation. Using genetic association alone, we found strong inverse genetic correlations between BW and systolic blood pressure (rg-0.22, P =5.5x10-13), T2D (rg-0.27, P =1.1x10-6) and coronary artery disease (rg-0.30, P =6.5x10-9) and, in large cohort data sets, demonstrated that genetic factors were the major contributor to the negative covariance between BW and future cardiometabolic risk. Pathway analyses indicated that the protein products of genes within BW-associated regions were enriched for diverse processes including insulin signalling, glucose homeostasis, glycogen biosynthesis and chromatin remodelling. There was also enrichment of associations with BW in known imprinted regions (P =1.9x10-4). We have demonstrated that lifecourse associations between early growth phenotypes and adult cardiometabolic disease are in part the result of shared genetic effects and have highlighted some of the pathways through which these causal genetic effects are mediated

Genome-wide associations for birth weight and correlations with adult disease

Birth weight (BW) has been shown to be influenced by both fetal and maternal factors and in observational studies is reproducibly associated with future risk of adult metabolic diseases including type 2 diabetes (T2D) and cardiovascular disease. These life-course associations have often been attributed to the impact of an adverse early life environment. Here, we performed a multi-ancestry genome-wide association study (GWAS) meta-analysis of BW in 153,781 individuals, identifying 60 loci where fetal genotype was associated with BW ($\textit{P}$  < 5 × 10$^{-8}$). Overall, approximately 15% of variance in BW was captured by assays of fetal genetic variation. Using genetic association alone, we found strong inverse genetic correlations between BW and systolic blood pressure ($\textit{R}$ $_{g}$ = -0.22, $\textit{P}$  = 5.5 × 10$^{-13}$), T2D ($\textit{R}$ $_{g}$ = -0.27, $\textit{P}$  = 1.1 × 10$^{-6}$) and coronary artery disease ($\textit{R}$ $_{g}$ = -0.30, $\textit{P}$  = 6.5 × 10$^{-9}$). In addition, using large -cohort datasets, we demonstrated that genetic factors were the major contributor to the negative covariance between BW and future cardiometabolic risk. Pathway analyses indicated that the protein products of genes within BW-associated regions were enriched for diverse processes including insulin signalling, glucose homeostasis, glycogen biosynthesis and chromatin remodelling. There was also enrichment of associations with BW in known imprinted regions ($\textit{P}$ = 1.9 × 10$^{-4}$). We demonstrate that life-course associations between early growth phenotypes and adult cardiometabolic disease are in part the result of shared genetic effects and identify some of the pathways through which these causal genetic effects are mediated.For a full list of the funders pelase visit the publisher's website and look at the supplemetary material provided. Some of the funders are: British Heart Foundation, Cancer Research UK, Medical Research Council, National Institutes of Health, Royal Society and Wellcome Trust