Effects of the use of raw or cooked chickpeas and the sausage cooking time on the quality of a lamb-meat, olive-oil emulsion-type sausage

Reformulation of cooked sausages using high-protein plant-based food such as chickpea as meat extenders and vegetable oils to replace animal fat can be a suitable approach to promote the consumption of smaller portions of meat. The pre-processing of chickpea and the sausage cooking intensity can potentially affect the quality of reformulated sausages. In this study, an emulsion-type sausage made with lamb meat, chickpea and olive oil was prepared in triplicate following three different formulations containing the same targeted levels of protein (8.9%), lipids (21.5%), and starch (2.9%): control sausage (CON; control, without chickpea), and raw (RCP) and cooked chickpea (CCP) sausages (both with 7% chickpea). Sausages were cooked at 85 °C for two heating times (40 min or 80 min) and were analysed for weight loss, emulsion stability, colour, texture, lipid oxidation and volatile composition. Compared to CON sausages, the use of raw chickpea reduced the elasticity and significantly increased lipid oxidation during the sausage-making process resulting in major changes in the volatile composition. The use of previously cooked chickpea, however, resulted in the sausages having greater cooking loss, hardness and chewiness than CON sausages, while there was no difference in lipid oxidation, and differences in volatile compounds were scarce. The reformulation with cooked chickpea could provide a sausage with more similarity to the CON sausage. The extended heating time of 80 min at 85 °C did not significantly affect the quality traits in either CON or reformulated sausages except for a higher cooking loss.

Dietary administration of l-carnitine during the fattening period of early feed restricted lambs modifies lipid metabolism and meat quality

Early feed restriction of lambs promotes a permanent mitochondrial dysfunction that impairs β-oxidation of fatty acids along the whole life. Therefore, dietary l-carnitine might help to improve the mitochondrial function of these lambs, thus modifying lipid metabolism and meat quality traits. In order to test this hypothesis an experiment was carried out with 22 Merino lambs that were subjected to an early feed restriction during the suckling period. Once weaned, the lambs were allocated to a control group (CTRL, n = 11) being fed ad libitum a complete pelleted diet during the fattening phase, whereas the second group (CARN, n = 11) received the same diet formulated with 3 g/kg of l-carnitine. Carcass characteristics were not affected (P > 0.05) by treatment. However, lambs fed l-carnitine showed higher amounts of intramuscular fat (26.5 vs. 33.6 g/kg fresh matter; P = 0.047) with a lower ratio between polyunsaturated and saturated fatty acids (0.425 vs 0.333; P = 0.023) and a higher atherogenic (0.507 vs 0.597; P < 0.001) and thrombogenic index (1.23 vs 1.42; P < 0.001). An increase in lightness (P < 0.05) and a tendency to improved oxidative stability in cooked meat (P = 0.066) were also observed in the CARN group. Consequently, dietary l-carnitine supplied during the fattening period of early feed restricted lambs modifies meat quality traits thus increasing lightness, oxidative stability and intramuscular fat content, but worsening the fatty acid profile.

Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study

BACKGROUND

Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study.

PATIENTS AND METHODS

This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate.

RESULTS

Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable.

CONCLUSIONS

Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.

Grain grinding size of cereals in complete pelleted diets for growing lambs: Effects on animal performance, carcass and meat quality traits

The main goal of the present study was to clarify the effects of different grinding particle size of grains (2-mm vs. 6-mm) included in complete pelleted diets (CPD) for fattening lambs on animal performance, carcass and meat quality. Twenty male merino lambs (14.8 kg; n = 10 per group) were fed the corresponding diet ad libitum and slaughtered when they reached 27 kg. No differences were observed in the feed conversion ratio or carcass characteristics. However, lambs fed coarser diets (6 mm) were more efficient with less residual feed intake (-14.0 vs. 15.4 g DM/animal/d; P < .05) than lambs fed the 2 mm CPD. Lambs fed the 6-mm CPD showed higher levels of intramuscular fat and saturated fatty acids. Consequently, increasing the particle size of the grains included in CPD allows for improving feed efficiency and intramuscular fat in fattening lambs.

Valorization of agro-industrial wastes to produce hydrolytic enzymes by fungal solid-state fermentation

Nowadays, significant amounts of agro-industrial wastes are discarded by industries; however, they represent interesting raw materials for the production of high-added value products. In this regard, orange peels (ORA) and exhausted sugar beet cossettes (ESBC) have turned out to be promising raw materials for hydrolytic enzymes production by solid state fermentation (SSF) and also a source of sugars which could be fermented to different high-added value products. The maximum activities of xylanase and exo-polygalacturonase (exo-PG) measured in the enzymatic extracts obtained after the SSF of ORA were 31,000 U·kg^-1 and 17,600 U·kg^-1, respectively; while for ESBC the maximum values reached were 35,000 U·kg^-1 and 28,000 U·kg^-1, respectively. The enzymatic extracts obtained in the SSF experiments were also employed for the hydrolysis of ORA and ESBC. Furthermore, it was found that extracts obtained from SSF of ORA, supplemented with commercial cellulase, were more efficient for the hydrolysis of ORA and ESBC than a commercial enzyme cocktail typically used for this purpose. In this case, maximum reducing sugars concentrations of 57 and 47 g·L^-1 were measured after the enzymatic hydrolysis of ESBC and ORA, respectively.

Vemurafenib in patients with BRAFV600 mutation-positive metastatic melanoma: final overall survival results of the randomized BRIM-3 study

Background

The BRIM-3 trial showed improved progression-free survival (PFS) and overall survival (OS) for vemurafenib compared with dacarbazine in treatment-naive patients with BRAFV600 mutation-positive metastatic melanoma. We present final OS data from BRIM-3.

Patients and methods

Patients were randomly assigned in a 1 : 1 ratio to receive vemurafenib (960 mg twice daily) or dacarbazine (1000 mg/m2 every 3 weeks). OS and PFS were co-primary end points. OS was assessed in the intention-to-treat population, with and without censoring of data for dacarbazine patients who crossed over to vemurafenib.

Results

Between 4 January 2010 and 16 December 2010, a total of 675 patients were randomized to vemurafenib (n = 337) or dacarbazine (n = 338, of whom 84 crossed over to vemurafenib). At the time of database lock (14 August 2015), median OS, censored at crossover, was significantly longer for vemurafenib than for dacarbazine {13.6 months [95% confidence interval (CI) 12.0-15.4] versus 9.7 months [95% CI 7.9-12.8; hazard ratio (HR) 0.81 [95% CI 0.67-0.98]; P = 0.03}, as was median OS without censoring at crossover [13.6 months (95% CI 12.0-15.4) versus 10.3 months (95% CI 9.1-12.8); HR 0.81 (95% CI 0.68-0.96); P = 0.01]. Kaplan-Meier estimates of OS rates for vemurafenib versus dacarbazine were 56% versus 46%, 30% versus 24%, 21% versus 19% and 17% versus 16% at 1, 2, 3 and 4 years, respectively. Overall, 173 of the 338 patients (51%) in the dacarbazine arm and 175 of the 337 (52%) of those in the vemurafenib arm received subsequent anticancer therapies, most commonly ipilimumab. Safety data were consistent with the primary analysis.

Conclusions

Vemurafenib continues to be associated with improved median OS in the BRIM-3 trial after extended follow-up. OS curves converged after ≈3 years, likely as a result of crossover from dacarbazine to vemurafenib and receipt of subsequent anticancer therapies.

ClinicalTrials.gov

NCT01006980.

Assessment of the antioxidant effect of astaxanthin in fresh, frozen and cooked lamb patties

Astaxanthin is a natural red carotene exerting a strong antioxidant action. The effect of this carotene on the oxidative stability of raw and cooked lamb patties was evaluated. Seven experimental treatments were included in this study depending on the antioxidants added, which are: no antioxidant added (control), 450 mg/kg of sodium metabisulphite, 500 mg/kg of sodium ascorbate, and 20 mg/kg, 40 mg/kg, 60 mg/kg and 80 mg/kg of astaxanthin. The raw patties were either refrigerated for up to 11 days or frozen for 3 months under aerobic conditions. Changes in thiobarbituric reactive substances (TBARS), instrumental colour, pH and Eh were determined in the refrigerated patties and TBARS in the frozen patties. Volatile compounds were determined in cooked patties and cholesterol oxides in both cooked and after cooking microwave reheated patties. The changes in TBARS of cooked patties during a four-day refrigerated storage were also studied. Compared to the control patties, the use of astaxanthin reduced the TBARS generation in a manner depending on the dose for both raw and cooked patties during storage (P < 0.05). Astaxanthin added at levels of 60 and/or 80 mg/kg showed a greater antioxidant effect than ascorbate and metabisulphite. The presence of astaxanthin, like that of ascorbate, decreased the oxysterols levels of cooked patties with regard to controls. The amount of volatiles released from the cooked patties was also reduced by astaxanthin. This effect was not observed for ascorbate or metabisulphite. Astaxanthin in lamb patties at levels of 60-80 mg/kg could improve raw and cooked lamb patty oxidative stability during refrigerated aerobic storage, protect their lipids against thermal degradation more than ascorbate and metabisulphite, and reduce oxysterols formation during cooking in a similar way to ascorbate.

Bayesian modeling of two- and three-species bacterial competition in milk

Listeria monocytogenes is a well-known food-borne pathogen and is among the bacteria best adapted to grow at low temperatures. Psychrotrophic spoilage microorganisms present in milk and milk products are primarily in the genus Pseudomonas, and their numbers increase during cold storage leading to deterioration and/or spoilage. The nature of the competition in two- or three-species bacterial systems with L. monocytogenes, L. innocua, and P. fluorescens in skimmed milk at 7 or 14°C was studied. The Baranyi growth model was used to estimate the growth rate and the maximum population density of the three microorganisms for each strain in single cultures or in two- or three-strains co-cultures. The highest Listeria populations were achieved by pure cultures, decreasing in co-culture with P. fluorescens at both temperatures. A modified deterministic logistic model was applied which includes inhibition functions for single cultures, and two- or three-species cultures. A subsequent Bayesian approach was applied for modelling the bacterial interactions. There was not a direct correlation between the growth rate of P. fluorescens and its inhibitory effect on Listeria species. The use of some species from the natural food microflora to inhibit pathogen growth may be an important tool to enhance the safety of refrigerated foods such as milk and dairy products.

Evaluation of the use of multiflora bee pollen on the volatile compounds and sensorial profile of Palomino fino and Riesling white young wines

This study investigates the impact of bee pollen on volatile compounds, odour activity values and sensory profiles in Palomino fino and Riesling young white wines. Commercial bee pollen was added to grape must using six different doses (0 (control), 0.1, 0.25, 1, 5, 10 and 20g/L) and fermented under controlled conditions. Volatile compounds were determined with GC and GC-MS chromatography and sensorial analysis using a qualified panel of tasters. Bee pollen produces an increase in volatile compounds depending on the grape variety and the dose applied. It also increases the synthesis of higher alcohols, methanol, esters, acetaldehyde and terpenes, reducing alcohols and fatty acids. Wines with low doses (0.1 and 0.25g/L) showed the higher OAV values (fruity and floral) and scores in overall judgment for the sensory evaluation. High pollen doses decrease fruity character and could result in deviations affecting the sensorial quality.

Valorization of exhausted sugar beet cossettes by successive hydrolysis and two fermentations for the production of bio-products

Exhausted sugar beet cossettes (ESBC) show an enormous potential as a source of sugars for the production of bio-products. Enzyme hydrolysis with the combined effect of mainly cellulases, xylanases and pectinases, turned out to be very efficient, obtaining almost double the concentration of sugars measured with the sole action of Celluclast® and β-glucosidase, and increasing 5 times the hydrolysis rate. As the sole pretreatment, ESBC soaked in the hydrolysis buffer were autoclaved, avoiding the application of severe conventional biomass pretreatments. Moreover, a promising alternative for the complete utilization of glucose, xylose, arabinose, mannose and maltose contained in ESBC is proposed in this paper. It consists of sequential fermentation of sugars released in the hydrolysis step to produce bioethanol and lactic acid as main bio-products. Compared to separate fermentations, with this strategy glucose and hemicellulose derived sugars were completely consumed and the 44% of pectin derived sugars.

Low variability of growth parameters among six O157:H7 and non-O157:H7 Escherichia coli strains

Five Escherichia coli O157:H7 strains and one nonpathogenic E. coli strain were used. All strains were cultured in brain heart infusion broth and were inoculated in 16-well disposable module cassettes of a Bactometer impedance system. Two initial concentrations were obtained in the wells: 1.37 × 10(3) and 1.36 × 10(5) CFU/ml. The impedance measurements were monitored for 72 h at 5, 10, or 15°C, 48 h at 20°C, and 24 h at 25, 30, 35, 40, 45, 50 or 55°C. The lag time and the generation time of each culture were calculated from the detection time data. The coefficients of variation between the strains' growth parameters were low (0.009 to 0.105 for generation time and 0.074 to 0.475 for lag time). An F test showed no significant differences between strains at 5 or 1% confidence levels.

Characterization of certain bacterial strains for potential use as starter or probiotic cultures in dairy products

The present work was aimed at characterizing 12 strains of lactic acid bacteria (LAB) to obtain improved potential starter or probiotic cultures that could be used for making dairy products from ewe's milk and cow's milk. Eight strains with antimicrobial properties, isolated from ewe's milk and from cheese made from ewe's and/or cow's milk, were studied. They were identified as Enterococcus faecalis (five strains), Lactococcus lactis subsp. cremoris, Leuconostoc mesenteroides, and Lactobacillus paracasei subsp. paracasei (one strain of each species). Additionally, four strains were obtained from the American Type Culture Collection: Lactobacillus casei 393 (isolated from cheese), L. lactis subsp. lactis 11454 (origin nonspecified and a producer of nisin), and two strains isolated from human feces (L. paracasei subsp. paracasei 27092 and Lactobacillus rhamnosus 53103, antibacterial agent producer). All E. faecalis strains showed at least one virulence factor (either hemolysin or gelatinase), which emphasizes the importance of these studies in this species. Both L. lactis strains and most Lactobacillus spp. were good acidifiers in ewe's milk and cow's milk at 30°C. High β-galactosidase activity, as well as aminopeptidase activities that favor the development of desirable flavors in cheese, were detected in all Lactobacillus spp. strains. Furthermore, L. rhamnosus ATCC 53103 showed α-fucosidase activity (thought to help colonization of the intestine) and lack of α-glucosidase activity (a trait considered positive for diabetic and obese humans). This last enzymatic activity was also lacking in L. lactis ATCC 11454. L. mesenteroides was the only strain D(2)-lactic acid producer. The selection of any particular strain for probiotic or dairy cultures should be performed according to the technological and/or functional abilities needed.

Composition, yield, and functionality of reduced-fat Oaxaca cheese: effects of using skim milk or a dry milk protein concentrate

The effect of adding either skim milk or a commercial dry milk protein concentrate (MPC) to whole milk on the composition, yield, and functional properties of Mexican Oaxaca cheese were investigated. Five batches of Oaxaca cheeses were produced. One batch (the control) was produced from whole milk containing 3.5% fat and 9% nonfat solids (SNF). Two batches were produced from milk standardized with skim milk to 2.7 and 1.8% fat, maintaining the SNF content at 9%. In the other 2 batches, an MPC (40% protein content) was used to standardize the milk to a SNF content of 10 and 11%, maintaining the milk fat content at 3.5%. The use of either skim milk or MPC caused a significant decrease in the fat percentage in cheese. The use of skim milk or MPC showed a nonsignificant tendency to lower total solids and fat recoveries in cheese. Actual, dry matter, and moisture-adjusted cheese yields significantly decreased with skim milk addition, but increased with MPC addition. However, normalized yields adjusted to milk fat and protein reference levels did not show significant differences between treatments. Considering skim milk-added and control cheeses, actual yield increased with cheese milk fat content at a rate of 1.34 kg/kg of fat (R=0.88). In addition, cheese milk fat and SNF:fat ratio proved to be strong individual predictors of cheese moisture-adjusted yield (r(2) ≈ 0.90). Taking into account the results obtained from control and MPC-added cheeses, a 2.0-kg cheese yield increase rate per kg of milk MPC protein was observed (R=0.89), with TS and SNF being the strongest predictors for moisture adjusted yield (r(2) ≈ 0.77). Reduced-fat Oaxaca cheese functionality differed from that of controls. In unmelted reduced-fat cheeses, hardness and springiness increased. In melted reduced-fat cheeses, meltability and free oil increased, but stretchability decreased. These changes were related to differences in cheese composition, mainly fat in dry matter and calcium in SNF.

Development of a kinetic model for the alcoholic fermentation of must

We Propose a kinetic expression which accounts for the temperature dependence of ethanol yield losses in batch alcoholic fermentation. Moreover, the characteristic parameters of the microbial growth equation have been calculated for Saccharomyces cerevisiae under typical wine industry conditions. A substrate consumption equation is established which minimizes possible model deviations in the latter process stages. Experimental data were obtained in the laboratory and the proposed equations were then applied at an industrial level (2.5 x 10(4) L) where they described the data well.

Efalizumab: results of a 3-year continuous dosing study for the long-term control of psoriasis

Background

Efalizumab, a T-cell-targeted, recombinant, humanized, monoclonal IgG1 antibody, inhibits key T-cell-mediated steps in the pathogenesis of psoriasis. Efalizumab is approved for the treatment of moderate-to-severe chronic plaque psoriasis in adults in more than 50 countries.

Objectives

To evaluate the efficacy and safety of long-term, continuous efalizumab therapy in patients with psoriasis.

Methods

This open-label, multicentre phase III study enrolled 339 patients with moderate-to-severe chronic plaque psoriasis. During the initial 3-month phase, patients received subcutaneous efalizumab 2 mg kg⁻¹ weekly with randomization to receive concomitant fluocinolone acetonide or placebo ointment during month 3. The second phase was a long-term observational period; patients achieving a ≥ 50% improvement in the Psoriasis Area and Severity Index (PASI) score were eligible to receive efalizumab 1 mg kg⁻¹ weekly for up to 33 months. The final 3-month treatment period was an optional transition period for patients who completed the 33-month segment before efalizumab became commercially available.

Results

After 3 months, 41·3% of patients achieved a ≥ 75% improvement in PASI (PASI-75) and 13·0% achieved a ≥ 90% improvement (PASI-90). Continued improvement was observed: 45·4% and 24·5% achieved PASI-75 and PASI-90, respectively, at the end of the observational phase. The safety profile was stable, with no new or no increase in common events over 36 months of treatment.

Conclusions

This was the longest continuous study using a biologic therapy for psoriasis. Clinical benefit of efalizumab improved over the first 18 months and was maintained during 36 months of continuous therapy. Long-term efalizumab therapy is appropriate for many patients with plaque psoriasis.

Conflicts of interest

C.L. with 3M Pharmaceuticals, Abbott, Allergan, Altana, Amgen, Astellas-Biogen, Bristol Myers, Centocor, CombinatoRx, Fujisawa Healthcare, Galderma, Genentech, Merck Serono International SA, Schering Plough, RTL, Vitae and Warner Chilcott; A.M. with 3M Pharmaceuticals, Abbott, Allergan, Allermed, Amgen, Astralis, Berlex, Biogen Idec, Celgene, Centocor, Cephalon, Collagenex Pharmaceuticals, CombinatoRx, Connetics, Corixa, Dermik Laboratories, Doak Dermatologics, Dow, Ferndale Laboratories, Fujisawa Healthcare, Galderma, Genentech, Genzyme, GlaxoSmithKline, Ligand Pharmaceuticals, Medicis, MedImmune, Novartis Pharmaceuticals, Otsuka Pharmaceutical, Protein Design Labs, QLT USA, Regeneration Pharma AG, Roche, Merck Serono International SA, Sinclair, Synta Pharma, Thermosurgery, Vertex, Warner Chilcott, Wyeth, XOMA and Zars; T.H. with Genentech; A.B.G. with Abbott, Actelion, Almirall, Amgen, Beiersdorf, Biogen Idec, Bristol Myers Squibb, Can-Fite, Celera, Celgene, Centocor, DermiPsor, Eisai, Genentech, Immune Control, Incyte, Kemia, Medacorp, Medarex, Novo Nordisk, Pharmacare, Roche, RxClinical, Sankyo, Schering Plough, TEVA, UCB, Warner Chilcott and Wyeth. All income derived from these sources goes to her employer. I.C. and B.X. are employees and stockholders of Genentech.

Phenotypical characteristics of Shiga-like toxin Escherichia coli isolated from sheep dairy products

AIMS

To analyse phenotypical characteristics of Shiga toxin-producing Escherichia coli (STEC) strains from ovine origin.

METHODS AND RESULTS

A total of 13 STEC strains (eight O157 and five non-O157) isolated from sheep dairy products were used in this study. Biochemical traits, motility, haemolytic activity, resistance to tellurite-cefixime, maximum growth temperature and antibiotic resistance were determined. The STEC strains were grouped into nine biochemical and physiological biotypes (five for the O157 and four for the non-O157 strains). All STEC strains showed resistance to bacitracin, cloxacilin, penicillin and tylosin.

CONCLUSIONS

Different biotypes and antibiotic resistance patterns of STEC isolated from sheep dairy products were observed.

SIGNIFICANCE AND IMPACT OF THE STUDY

This work will be a contribution to the better characterization of STEC isolated from sheep dairy products, which have, to date, been scarcely studied, and to the better understanding of the risks associated with its consumption.

Economic evaluation of therapeutic interventions to prevent Type 2 diabetes in Canada

AIMS

To compare the health and economic outcomes of using acarbose, an intensive lifestyle modification programme, metformin or no intervention to prevent progression to diabetes in Canadian individuals with impaired glucose tolerance (IGT).

METHODS

A model was developed to simulate the course of individuals with IGT under each treatment strategy. Patients remain in the IGT state or transition from IGT to diabetes, to normal glucose tolerance (NGT) or to death. Effectiveness and resource use data were derived from published intervention trials. A comprehensive health-care payer perspective incorporating all major direct costs, reported in 2000 Canadian dollars, was adopted.

RESULTS

Over a decade, 70 of the 1000 untreated patients are expected to die and 542 develop diabetes. Intensive lifestyle modification is estimated to prevent 117 cases of diabetes, while metformin would prevent 52 and acarbose 74 cases. The proportion of those who return to NGT also increases with any treatment. While lifestyle modification is more effective, it can increase overall costs depending on how it is implemented, whereas acarbose and metformin reduce costs by nearly $1000 per patient. Lifestyle modification was cost effective, varying from CAD $10 000/LYG vs. acarbose. Acarbose costs somewhat more than metformin, but is more effective: CAD $1798/LYG.

CONCLUSION

The results of this model suggest that the treatment of IGT in Canada is a cost-effective way to prevent diabetes and may generate savings. While pharmacological treatments tended to be less costly, intensive lifestyle modification, if maintained, led to the greatest health benefits at reasonable incremental costs.

T-Cell Modulation for the Treatment of Chronic Plaque Psoriasis with Efalizumab (Raptiva™): Mechanisms of Action

Psoriasis is a chronic, incurable, auto-immune disorder with cutaneous manifestations. New evidence on the central role of the immune system in the pathogenesis of psoriasis increasingly provides insight into pathogenic steps that can be modulated to provide disease control. Numerous biological therapies are in various stages of clinical development, with expectation of providing enhanced safety and efficacy over currently available psoriasis therapies. Efalizumab, a recombinant humanized monoclonal IgG1 antibody, is a novel targeted T-cell modulator that inhibits multiple steps in the immune cascade that result in the production and maintenance of psoriatic plaques, including initial T-cell activation and T-cell trafficking into sites of inflammation, including psoriatic skin, with subsequent reactivation in these sites. This article reviews the pharmacodynamic, pharmacokinetic and clinical effects observed during phase I, II and III efalizumab trials in patients with moderate to severe chronic plaque psoriasis.

Does electronic implementation of questionnaires used in asthma alter responses compared to paper implementation?

BACKGROUND

Electronic implementation of questionnaires has many advantages, but there may be concerns that it alters versions that were validated on paper.

OBJECTIVE

To determine whether electronic implementation alters responses to the SF-36 and asthma quality of life questionnaire (AQLQ), compared to paper implementation.

METHODS

Patients with asthma presenting to a pneumologist were asked for consent to participate. Each patient completed both forms of each questionnaire. The order of presentation was alternated sequentially, with the first patient completing the electronic version first. Each patient waited at least 2 hours between completions to minimize recollection of answers. For both the SF-36 and AQLQ, intraclass correlations coefficients were calculated to compare patients' scores, for each scale and overall, on the electronic and paper versions.

RESULTS

Sixty-eight patients (mean age: 48 years, 50 females) of 311 contacted were enrolled. Overall intraclass correlation coefficients for the SF-36 and AQLQ were excellent (0.965 and 0.991 respectively). For paper versions, eight questions (AQLQ) and 24 (SF-36) were left blank and nine questions (SF-36) were answered incorrectly by patients selecting more than one answer. Electronic data for one patient could not be retrieved.

CONCLUSION

Collecting SF-36 and AQLQ data electronically can decrease the number of spoiled responses without altering the results. Successful implementation depends on proper instruction of the respondent in the handling of the electronic instrument.

Diabetes in Canada: direct medical costs of major macrovascular complications

OBJECTIVES

To estimate direct medical costs of managing major macrovascular complications in diabetic patients.

METHODS

Costs were estimated for acute myocardial infarction (AMI) and ischemic stroke by applying unit costs to typical resource use profiles. Data were obtained from many Canadian sources, including the Ontario Case Cost Project, provincial physician and laboratory fee schedules, provincial formularies, government reports, and peer-reviewed literature. For each complication, the event costs per patient are those associated with resource use specific to the acute episode and any subsequent care occurring in the first year. State costs are the annual costs per patient of continued management. All costs are expressed in 1996 Canadian dollars.

RESULTS

Acute hospital care accounts for approximately half of the first year management costs ($15,125) of AMI. Given the greater need for postacute care, acute hospital care has less impact (28%) on event costs for stroke ($31,076). The state costs for AMI and stroke are $1544 and $8141 per patient, respectively.

CONCLUSIONS

Macrovascular complications of diabetes potentially represent a substantial burden to Canada's health care system. As new therapies emerge that may reduce the incidence of some diabetic complications, decision makers will need information to make critical decisions regarding how to spend limited health care dollars. Published literature lacks Canadian-specific cost estimates that may be readily translated into patient-level cost inputs for an economic model. This paper provides two key pieces of the many needed to understand the scope of the economic burden of diabetes and its complications for Canada.

Dermatomyositis

Dermatomyositis is a disease that has a characteristic skin eruption that may occur with or without a proximal myopathy. The disease with cutaneous features only is classified as amyopathic dermatomyositis. The origin is unknown, but autoimmune factors are believed to play an important role. Autoantibodies are found in most patients and some have myositis-specific antibodies. Systemic changes may occur and there appears to be a relationship to internal malignancy, particularly in older patients. Juvenile disease has an associated vasculopathy. Treatment includes systemic corticosteroids and other immunosuppressive agents. The cutaneous changes may be difficult to treat.

Vamos a Traducir los MRV (let's translate the VRM): linguistic and cultural inferences drawn from translating a verbal coding system from English into Spanish

Translating a verbal coding system from one language to another can yield unexpected insights into the process of communication in different cultures. This paper describes the problems and understandings we encountered as we translated a verbal response modes (VRM) taxonomy from English into Spanish. Standard translations of text (e.g., psychotherapeutic dialogue) systematically change the form of certain expressions, so supposedly equivalent expressions had different VRM codings in the two languages. Prominent examples of English forms whose translation had different codes in Spanish included tags, question forms, and "let's" expressions. Insofar as participants use such forms to convey nuances of their relationship, standard translations of counseling or psychotherapy sessions or other conversations may systematically misrepresent the relationship between the participants. The differences revealed in translating the VRM system point to subtle but important differences in the degrees of verbal directiveness and inclusion in English versus Spanish, which converge with other observations of differences in individualism and collectivism between Anglo and Hispanic cultures.

Human cutaneous allergic late-phase response is inhibited by soluble IL-1 receptor

The late-phase allergic reaction (LPR) occurs 4 to 8 h after allergen exposure and probably causes the symptoms of chronic allergic disease. To determine the effects of soluble IL-1 receptor on the cutaneous LPR, we performed a prospective, randomized, double-blind, placebo-controlled study on 15 allergic subjects. Intradermal injections of allergen were placed on subjects' forearms, followed by immediate subcutaneous injections at the same site of either 1, 10, 25, 50, or 100 micrograms of rhu IL-1R to three subjects in each dosage group. Placebo was given to matched allergen-injected sites on the contralateral arm. Erythema, induration, and itching were recorded for each site. Sites were biopsied at 8 h for immunohistologic evaluations. Rhu IL-1R significantly reduced the clinical reaction at all concentrations. At 1 and 10 micrograms, measurements of LPR were significantly less (p < 0.05) than at placebo sites at several time points from 2 to 8 h. At higher concentrations, LPR was suppressed at rhu IL-1R and placebo sites, suggesting a systemic effect of rhu IL-1R. Histologic evaluation and indirect immunofluorescence for eosinophil granule major basic protein, neutrophil elastase, and mast cell tryptase showed no statistical differences between rhu IL-1R and placebo sites or among doses. IL-1 plays an important role in the generation of allergic LPR. While microgram quantities of rhu IL-1R inhibited the clinical signs and symptoms of LPR, its effects on the allergic inflammatory infiltrate are yet to be defined. In this short term trial, rhu IL-1R was neither immunogenic nor toxic.

Human cutaneous allergic late-phase response is inhibited by soluble IL-1 receptor

The late-phase allergic reaction (LPR) occurs 4 to 8 h after allergen exposure and probably causes the symptoms of chronic allergic disease. To determine the effects of soluble IL-1 receptor on the cutaneous LPR, we performed a prospective, randomized, double-blind, placebo-controlled study on 15 allergic subjects. Intradermal injections of allergen were placed on subjects' forearms, followed by immediate subcutaneous injections at the same site of either 1, 10, 25, 50, or 100 micrograms of rhu IL-1R to three subjects in each dosage group. Placebo was given to matched allergen-injected sites on the contralateral arm. Erythema, induration, and itching were recorded for each site. Sites were biopsied at 8 h for immunohistologic evaluations. Rhu IL-1R significantly reduced the clinical reaction at all concentrations. At 1 and 10 micrograms, measurements of LPR were significantly less (p &lt; 0.05) than at placebo sites at several time points from 2 to 8 h. At higher concentrations, LPR was suppressed at rhu IL-1R and placebo sites, suggesting a systemic effect of rhu IL-1R. Histologic evaluation and indirect immunofluorescence for eosinophil granule major basic protein, neutrophil elastase, and mast cell tryptase showed no statistical differences between rhu IL-1R and placebo sites or among doses. IL-1 plays an important role in the generation of allergic LPR. While microgram quantities of rhu IL-1R inhibited the clinical signs and symptoms of LPR, its effects on the allergic inflammatory infiltrate are yet to be defined. In this short term trial, rhu IL-1R was neither immunogenic nor toxic.

Dermatomyositis as a systemic disease

Dermatomyositis is a classic example of a disease that has both cutaneous and systemic manifestations. The skin and muscle disease are described as well as the possible systemic manifestations including overlap syndromes, joint symptoms, pulmonary disease, and other internal organ involvement. The association with pregnancy is also discussed.

The aging face. Why changes occur, how to correct them

Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injection are safe and effective nonsurgical procedures that can improve the appearance of the aging face. Plastic surgical procedures to remove excess skin at the upper eyelids, raise the eyebrows, tighten the lower lids, and elevate the nasal tip can provide functional as well as cosmetic improvement.

Multicenter clinical evaluation of ketoconazole in the treatment of cutaneous fungal infections

An open, multicenter study was conducted to evaluate the efficacy and adverse effects of ketoconazole in patients with cutaneous fungal infections seen in typical dermatology practices. One hundred twelve American investigators entered 954 patients into this trial. Responses based on clinical and mycologic assessments were available on 672 patients. Mycologic evaluations were conducted using pre- and post-therapy wet mounts in potassium hydroxide. Eighty percent of these patients were mycologically clear and clinically rated as either excellent (cured) or marked improvement. Adverse effects were mild to moderate in severity and only rarely caused therapy to be interrupted. Gastrointestinal effects were the most frequently reported complaints.

Scar sarcoidosis

A patient with erythema nodosum, bilateral hilar adenopathy, and induration of a scar is presented. Scar sarcoidosis is one of the specific but more unusual manifestations of sarcoidosis.