Randomized, double-blind, active-controlled, multicentre, phase III clinical trial with two stages to assess the safety and efficacy of letibotulinum toxin a vs. onabotulinum toxin a for subjects with moderate to severe crow's feet

BACKGROUND

Letibotulinum toxin A (LeBA) was approved by the Ministry of Food and Drug Safety (known as the Korea Food & Drug Administration) for cosmetic indications in 2012. However, the efficacy and safety of this newly introduced LeBA have not been investigated in crow's feet lines (CFL) treatment and standardization before its universal use.

OBJECTIVE

The aim of this multicentre, double-blind, randomized, parallel, active-controlled Phase III clinical trial with two stages (ClinicalTrials.gov identifier: NCT03408236) was to investigate the non-inferiority of LeBA vs. the existing onabotulinum toxin A (OnBA) for the treatment of CFL.

METHODS

A total of 240 subjects were randomized to either the test (LeBA) or control (OnBA) group. At the baseline and at weeks 4 while maximum smiling (primary efficacy assessment), 8, 12 and 16, investigator's on-site evaluation, independent evaluator, evaluation by the subjects, subjects' satisfaction assessment and safety assessment were performed.

RESULTS

At week 4, the response rate of primary efficacy assessment was 69.75% and 68.33% in the test (LeBA) and control (OnBA) groups, respectively, without a significant difference. Other minor secondary evaluation results showed significant differences suggesting that LeBA offered better improvement than OnBA, but the overall results did not show significant differences between the two groups.

CONCLUSION

This study showed that LeBA was as effective and safe as OnBA for the treatment of CFL at the same doses.

Breast Tumor Malignancy Classification using Smartphone Compression-induced Sensing System and Deformation Index Ratio

Smartphone-based compression-induced sensing system uses the light diffusion pattern to characterize the early-stage breast tumor noninvasively. The system is built on a smartphone and cloud platform to capture, transfer, and interface with the user. The compressed tissue's deforming pattern creates distinctive tactile images due to the size and hardness of the tumor. From the compression-induced images, we estimate the size of the tumor using projection analysis and the tumor's malignancy using the tissue deformation index ratio. Deformation index ratio is based on the changes of a healthy region over the tumorous region. By using the projection analysis, the human patient tumor size estimation resulted in 52.3% of the average error. For a small number (seven) of the feasibility test, the tumor's malignancy was classified based on the deformation index ratio with 67.0% of sensitivity and 100% specificity.

Topically applied treatments for external genital warts in nonimmunocompromised patients: a systematic review and network meta-analysis

Selecting a topical treatment from among the numerous topical agents for external genital warts remains challenging without clear evidence. Our aim was to evaluate comparatively the efficacy and safety of topical agents for external genital warts using a network meta-analysis. We included all randomized controlled trials that evaluated any topically applied treatment for external genital warts. Using the R package netmeta, network meta-analyses were performed with a frequentist approach. We identified 41 relevant studies comprising 6371 patients. Among conventional agents, podophyllotoxin 0·5% solution (odds ratio 1·94, 95% confidence interval 1·02-3·71) was significantly more efficacious than imiquimod 5% cream for lesion clearance; however, it was associated with a higher overall adverse event rate. Sinecatechins 15% ointment (odds ratio 0·21, 95% confidence interval 0·12-0·34) was significantly less efficacious than imiquimod 5% cream. Idoxuridine, polyhexamethylene biguanide, cidofovir and SB206 showed comparable therapeutic efficacies with conventional therapies. None of the treatments were significantly different from each other with respect to recurrence, patients with severe adverse events, or patients who withdrew because of treatment-related adverse events. Conventional modalities were efficacious and well tolerated, although each of them had their advantages and disadvantages. Additional efficacy and safety studies are warranted for unconventional agents.

Efficacy and safety of PAC-14028 cream - a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild-to-moderate atopic dermatitis: a phase IIb randomized trial

Background

Transient receptor potential vanilloid subfamily, member 1 (TRPV1) may play an important role in pruritus and inflammation induction in atopic dermatitis (AD). The treatment effect of TRPV1 antagonist via topical application in patients with AD remains unknown.

Objectives

To assess the clinical efficacy and safety of PAC‐14028, a TRPV1 antagonist, via topical application in patients with AD.

Methods

In this 8‐week, phase IIb, randomized, double‐blind, multicentre, vehicle‐controlled study, patients with mild‐to‐moderate AD were randomized to receive PAC‐14028 cream 0·1%, 0·3%, 1·0% or vehicle cream twice daily. The primary efficacy end point was the Investigator's Global Assessment (IGA) success rate defined as the percentage of patients with an IGA score of 0 or 1 at week 8. The secondary efficacy end points included the severity Scoring of Atopic Dermatitis (SCORAD) index and Eczema Area and Severity Index (EASI) 75/90.

Results

A total of 194 patients were enrolled. IGA success rates at week 8 were 14·58% for vehicle cream, 42·55% for PAC‐14028 cream 0·1% (P = 0·0025 vs. vehicle), 38·30% for PAC‐14028 cream 0·3% (P = 0·0087 vs. vehicle) and 57·45% for PAC‐14028 cream 1·0% (P < 0·001 vs. vehicle). In particular, statistically significant differences were found between the vehicle and treatment groups in the IGA success rates with two‐grade improvement. The SCORAD index, EASI 75/90, sleep disturbance score and pruritus visual analogue scale showed a trend towards improvement. No significant safety issues were reported.

Conclusions

PAC‐14028 cream may be an effective and safe treatment modality for the treatment of patients with mild‐to‐moderate AD.

What is already known about this topic?

Atopic dermatitis (AD) is one of the most common inflammatory skin diseases characterized by pruritic erythematous skin lesions and barrier dysfunction.

Transient receptor potential vanilloid subfamily, member 1 (TRPV1) antagonists suppress the release of pruritic and proinflammatory mediators.

The preclinical results demonstrate the feasibility of TRPV1 as a potential therapeutic target for the treatment of AD.

What does this study add?

TRPV1 regulates inflammation and pruritus in patients with AD.

PAC‐14028 cream, a novel TRPV1 antagonist, was superior to vehicle in improving clinical symptoms and signs with a favourable safety profile in adults with mild‐to‐moderate AD.

TRPV1 antagonism may play a role as a promising nonsteroidal topical treatment target for AD with a new mechanism of action.

Linked Editorial:https://doi.org/10.1111/bjd.17777.

https://doi.org/10.1111/bjd.17802 available online

https://www.bjdonline.com/article/

Tumor size and elasticity estimation using Smartphone-based Compression-Induced scope

A simple-to-use, noninvasive, and risk-free system, which will provide accurate identification of potentially life threatening malignant tumors using tactile pressure, is developed. The Smartphone-based Compression-Induced (SCI) Scope will allow physicians to quickly capture the mechanical properties of a benign or malignant tumor with the convenience of a smartphone platform. The size and elasticity property is described using estimating methods from the pressure-induced images of SCI Scope. The device is based on the Apple iPhone 6. The image will be captured through a waveguide. The image information in combination with the force sensor value will be transmitted wirelessly to a computer for processing. The size and elasticity estimation experiments with SCI Scope showed that the size estimation error of 2.31% and estimated relative elastic modulus error of 23.9%.

Secondary cutaneous lymphoma: comparative clinical features and survival outcome analysis of 106 cases according to lymphoma cell lineage

BACKGROUND

The relative frequency, clinical features and survival outcomes of secondary cutaneous lymphoma remain poorly understood.

OBJECTIVES

To determine the clinical characteristics and survival outcomes of secondary cutaneous lymphoma.

MATERIALS AND METHODS

The present retrospective cohort study included all 106 patients who presented with secondary cutaneous lymphoma. Patient medical records were reviewed to determine the clinical features, survival outcomes and prognostic factors. Survival outcomes were analysed by using the Kaplan-Meier method and comparisons between lymphoma cell lineages [T or natural killer (T-/NK)-cell vs. B-cell lymphoma] were performed using the log-rank test.

RESULTS

Secondary cutaneous lymphomas consisted of mature T-/NK-cell lymphomas (56%), mature B-cell lymphomas (35%), immature haematopoietic malignancies (8%) and Hodgkin lymphoma (1%). The T-/NK-cell lineage lymphoma cases were more likely to have multiple and disseminated skin lesions than the B-cell lineage lymphoma cases. The lymphoma cell lineage did not significantly influence survival outcomes. Patients who showed cutaneous involvement within 6 months of the initial diagnosis of primary disease had a poorer overall survival (OS) outcome than patients who developed cutaneous dissemination 6 or more months after the initial diagnosis (P < 0.001). Patients with disseminated skin lesions had a poorer OS than patients with localized skin lesions (P = 0.028). The two lymphoma cell lineages differed in terms of prognostic factors that influenced survival.

CONCLUSIONS

Skin lesion characteristics such as time point of appearance and extent affect the survival outcomes of secondary cutaneous lymphoma. Cell lineage did not influence survival outcomes but the two lineages are associated with different prognostic factors.

Synchronous infection with Mycobacterium chelonae and Paecilomyces in a heart transplant patient

A 41-year-old male who was 3 years status post heart transplant presented with a 3-month history of painful erythematous nodules and ulcers on his lower legs and right hand. First, Mycobacterium chelonae infection was revealed through several biopsies with molecular sequence analysis, and combination treatment, including clarithromycin, was started. During the treatment, lesions of the legs showed an improvement, but a fluctuant erythematous nodule on the thumb did not respond. Repetitive biopsy from the thumb ultimately identified Paecilomyces species and the patient was treated with itraconazole and terbinafine sequentially. Our case is the first report, to our knowledge, of synchronous infection with non-tuberculous mycobacteria (NTM) and Paecilomyces in a solid organ transplant recipient. Our findings highlight the importance of recognizing cutaneous NTM infections or deep mycoses, as well as the importance of choosing an appropriate treatment.

A multicenter trial of the efficacy and safety of 0.03% tacrolimus ointment for atopic dermatitis in Korea

BACKGROUND

Atopic dermatitis is a chronically relapsing, common inflammatory skin disease, which significantly affects quality of life negatively in many respects. Topical steroids are the mainstay of atopic dermatitis treatment but they carry the risk of local side effects. A topical formulation of tacrolimus, a macrolide calcineurin inhibitor, has recently been developed.

OBJECTIVE

To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of moderate to severe atopic dermatitis in Korea.

METHODS

An open, non-comparative, multi-center study with 4 weeks' follow-up was performed. A total of 180 patients (aged 2-57 years old) were enrolled. Tacrolimus ointment (0.03%) was applied to all involved areas twice daily. Efficacy was evaluated by an investigator's global assessment, the eczema area and severity index score, and by the patient's assessment of pruritus and clinical response at baseline, and after weeks 1, 2 and 4. Dermatology life quality index (DLQI), children's DLQI (CDLQI) and toddler's DLQI were assessed at baseline and at week 4. The safety assessment included monitoring all adverse events and clinical laboratory values.

RESULTS

All efficacy parameters were improved. The mean EASI (eczema area and severity index) score was 19.7 at baseline and reduced to 8.0 at the end of the study. Moderate improvement was observed by the investigator's global assessment after 4 weeks' treatment. A marked decrease of pruritus was observed, and mild or moderate improvement was observed by patients' global assessments after the treatment period. Significant benefits in terms of quality of life in adults and children with atopic dermatitis were obtained. The most common adverse events associated with tacrolimus treatment were transient skin burning sensation (45.3%) and pruritus (41.6%) at the site of application.

CONCLUSION

0.03% tacrolimus ointment should be considered effective and safe in both Korean children and adults with moderate to severe atopic dermatitis.

Combined UASB reactor and DAF/BF/anoxic/aerobic process for the removal of high-concentration organic matter and nutrients from slurry-type swine waste

This research aimed to effectively remove high-concentration organic matter and nutrients from slurry-type swine waste using a combined upflow anaerobic sludge blanket reactor with the dissolved air flotation/aerobic submerged biofilm/anoxic/aerobic process. The upflow anaerobic sludge blanket reactor was operated at an organics volumetric loading rate of 3.2-6.1 kg COD/m3/day, and the removal rates of COD were 53.9-65.5%. The removal rate of COD of the overall process was more than 99%. In the aerobic submerged biofilm, over 95% of ammonium nitrogen was removed at a volumetric loading rate of 0.08-0.16 kg NH4+-N/m3/day. The specific denitrification rate was 0.257 g NO3-N/g MLVSS/day and the removal rate of total nitrogen was 86.7%. Phosphorus was removed by flocculation in the dissolved air flotation process, and 0.16 g of PO4-P was removed by 1 g of ferric ion.

Effect of resin type and manufacturing method on wear of polyethylene tibial components

The purpose of this study was to examine the effect of ultrahigh molecular weight polyethylene resin type and manufacturing method on wear of Miller-Galante I and II tibial knee components. Thirteen Miller-Galante I and 10 Miller-Galante II components were retrieved at revision surgery. The Miller-Galante I tibial components were made by direct compression molding of Hi-fax 1900 resin and the Miller-Galante II tibial components were made by machining from ram extruded rod of GUR 415 resin. Both generations were gamma radiation sterilized in air. The Miller-Galante I retrievals had significantly more wear damage in the form of scratching and embedded metallic debris, whereas the Miller-Galante II retrievals had significantly more wear damage in the form of delamination. For the implants with an implantation time of 5 years or more, the Miller-Galante II polyethylene had a significantly greater maximum density value than did the Miller-Galante I polyethylene. Examination of thin sections of the Miller-Galante II components revealed that delamination occurred through a subsurface region of severely oxidatively degraded polyethylene; no such subsurface degraded region was observed for the Miller-Galante I components. The results of this study suggest that delamination of polyethylene tibial components that have been gamma radiation sterilized (in air) is influenced by resin type or manufacturing method or both.

Micromotion of cementless hemispherical acetabular components. Does press-fit need adjunctive screw fixation?

Adult human cadaver pelves were tested to determine micromotion at the prosthesis-bone interface in cementless hemispherical acetabular components during simulated single-limb stance. The micromotion of non-press-fit components with screw fixation in response to cyclic loads to a maximum of 1500N was compressive (interface closing) at the superior iliac rim and distractive (interface opening) at the inferior ischial rim; that of press-fit components was compressive all around the acetabular rim regardless of screw fixation. Adding screws to the component decreased the micromotion at the site of the screw, but sometimes increased it at the opposite side. Two dome screws with the press-fit component decreased the micromotion at the superior iliac rim but at the inferior ischial rim there was either no change or increased movement. A press-fit cup shows less micromotion than a non-press-fit cup with screw fixation. The addition of screws to a press-fit cup does not necessarily increase the initial stability.

Micromotion of cementless hemispherical acetabular components. Does press-fit need adjunctive screw fixation?

Adult human cadaver pelves were tested to determine micromotion at the prosthesis-bone interface in cementless hemispherical acetabular components during simulated single-limb stance. The micromotion of non-press-fit components with screw fixation in response to cyclic loads to a maximum of 1500N was compressive (interface closing) at the superior iliac rim and distractive (interface opening) at the inferior ischial rim; that of press-fit components was compressive all around the acetabular rim regardless of screw fixation. Adding screws to the component decreased the micromotion at the site of the screw, but sometimes increased it at the opposite side. Two dome screws with the press-fit component decreased the micromotion at the superior iliac rim but at the inferior ischial rim there was either no change or increased movement. A press-fit cup shows less micromotion than a non-press-fit cup with screw fixation. The addition of screws to a press-fit cup does not necessarily increase the initial stability.