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This paper deals with the stability and decomposition of a recently predicted noble-gas compound, HXeNH2. Despite natural progress and interest in noble-gas hydrides, little is known of their decomposition reaction. In this study, the dissociation reaction is explored by ab initio calculations and by Ab Initio Molecular Dynamics (AIMD) simulations. The results could be important for the future experimental search of the compound. It is found that the main decomposition channel is HXeNH2 → H+Xe+NH2. A key step in the reaction is found to be a rearrangement of the partial charges of the atoms involved. The results could be of significance also for reactions of other compounds with Xe-N chemical bond and other noble-gas hydrides.

Few studies explore the burden of mild-to-moderate atopic dermatitis (AD). We aimed to investigate disease burden in mild-to-moderate AD using real-world data from adults with AD and their physicians in the United States. Data were drawn from the Adelphi Real World AD Disease Specific Programme™, a cross-sectional survey of physicians and their patients with AD in real-world clinical practice in the US from November 2014 to February 2015. Physicians provided data for the next five eligible adults who consulted the physician. Patients had a physician-reported history of moderate-to-severe AD. Overall, 284 and 554 adults with physician-perceived mild or moderate AD at the most recent consultation, respectively, were included in the analysis. Patients with moderate AD experienced more flares ( p  <.001) and had dry skin, pruritus, and cracking/raw skin day-to-day that were more severe ( p  <.0001) and when experiencing a flare ( p  <.05) than patients with mild AD. Adults with either mild or moderate AD used a similar number of treatments. Patients with moderate AD reported greater impact on health status, health-related quality of life, and productivity than those with mild AD. Adults with mild-to-moderate AD experienced substantial daily impact from symptoms despite multiple therapies. Unmet needs remain and more can be done to improve disease control in adults with mild-to-moderate AD.

In The Lancet, Olivier Varenne and colleagues 6 investigate use of a new thin-strut DES versus BMS in elderly patients (>=75 years) with a tailored curtailed antiplatelet approach in the SENIOR trial. DAPT was discontinued at 1 month in stable patients and at 6 months in patients with acute coronary syndrome regardless of having received either DES or BSM.

IntroductionNo published studies exist comparing the effectiveness of tofacitinib with other advanced therapies for the treatment of rheumatoid arthritis (RA) in real-world clinical practice. Here, we report differences in effectiveness of tofacitinib compared with standard of care, tumor necrosis factor inhibitors (TNFi), with or without concomitant methotrexate (MTX), using US Corrona registry data.MethodsThis observational cohort study included RA patients receiving tofacitinib (from 6 November 2012; N = 558) or TNFi (from 1 November 2001; N = 8014) with or without MTX until 31 July 2016. Efficacy outcomes at 6 months included modified American College of Rheumatology 20% responses, Clinical Disease Activity Index (CDAI) and Pain. Outcomes were compared between patients receiving TNFi and tofacitinib with or without MTX and by line of therapy. Outcomes within therapy lines were compared using propensity-score matching; between-group differences were estimated using mixed-effects regression models.ResultsPatients receiving tofacitinib had longer RA duration and a greater proportion had previously received biologics than those receiving TNFi; other baseline characteristics were comparable. In patients receiving second- and third-line TNFi therapy, CDAI low disease activity/remission response rates were significantly better with concomitant MTX. Too few patients received tofacitinib as second line for meaningful assessment. No significant differences were observed in outcomes between tofacitinib as monotherapy and tofacitinib with concomitant MTX.ConclusionsIn clinical practice, TNFi efficacy is improved with concomitant MTX in the second and third line. In the third/fourth line, patients are likely to achieve similar efficacy with tofacitinib monotherapy, or TNFi or tofacitinib in combination with MTX.FundingPfizer Inc

Objective. To compare the efficacy and tolerability of tofacitinib, an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), as monotherapy and combined with disease-modifying antirheumatic drugs (DMARDs) versus biological DMARDs (bDMARDs) and other novel DMARDs for second-line moderate-to-severe rheumatoid arthritis (RA) patients by means of a systematic literature review (SLR) and network meta-analysis (NMA). Methods. MEDLINE®, EMBASE®, and Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials (RCTs) published between 1990 and March 2015. Efficacy data based on American College of Rheumatology (ACR) response criteria, improvements in the Health Assessment Questionnaire Disability Index (HAQ-DI) at 6 months, and discontinuation rates due to adverse events were analyzed by means of Bayesian NMAs. Results. 45 RCTs were identified, the majority of which demonstrated a low risk of bias. Tofacitinib 5 mg twice daily (BID) and 10 mg BID monotherapy exhibited comparable efficacy and discontinuation rates due to adverse events versus other monotherapies. Tofacitinib 5 mg BID and 10 mg BID + DMARDs or methotrexate (MTX) were mostly comparable to other combination therapies in terms of efficacy and discontinuation due to adverse events. Conclusion. In most cases, tofacitinib had similar efficacy and discontinuation rates due to adverse events compared to biologic DMARDs.

Background Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period. Methods Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10 = M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period. Results Over 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital). Conclusions Between 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.

Introduction There is a need to compare efficacy and safety profiles of crisaborole ointment, 2%, versus other topical treatments across randomized clinical trials (RCTs). We performed this review/network meta-analysis to evaluate the comparative efficacy and safety of crisaborole versus other topical pharmacologic therapies for mild-to-moderate atopic dermatitis (AD) among patients aged ≥ 2 years. Methods Searches were conducted in MEDLINE, Embase, the Cochrane Collection Central Register of Clinical Trials, and the Database of Abstracts of Reviews of Effects using Ovid to identify English language articles reporting RCTs of topical anti-inflammatory agents in patients aged ≥ 2 years with mild-to-moderate AD published between inception and 10 March 2020. This review used a prespecified protocol with eligibility criteria for population, interventions, comparisons, outcomes, and study design. Efficacy was evaluated using the Investigator’s Static Global Assessment (ISGA) of clear (0) or almost clear (1) and expressed by hazard ratios (HR) with 95% credible intervals. Results Patients treated with crisaborole or tacrolimus ointment, 0.1% or 0.03%, versus vehicle alone were significantly more likely to achieve ISGA 0/1 at 28–42 days, with the greatest point estimate observed for the crisaborole comparison (hazard ratio: 2.07; 95% credible interval 1.76 to − 2.36; probability HR above 1 [ p better]: 100.0%). Patients were also more likely to achieve ISGA 0/1 with crisaborole than with pimecrolimus cream, 1% (HR: 1.62; 95% credible interval 1.04–2.48; p better: 98.3%). While network meta-analysis for safety was not feasible because of data limitations, crisaborole pivotal studies (AD-301/AD-302) showed crisaborole was well tolerated. Conclusions Crisaborole was shown to be superior to vehicle and pimecrolimus and comparable to tacrolimus, 0.1% or 0.03%, with respect to ISGA 0/1 at 28–42 days in patients aged ≥ 2 years with mild-to-moderate AD. This evaluation of comparative efficacy of crisaborole further supports use of crisaborole as an effective therapeutic option in this population.

Patient Satisfaction and Glycemic Control After 1 Year With Inhaled Insulin (Exubera) in Patients With Type 1 or Type 2 Diabetes Julio Rosenstock , MD 1 , Joseph C. Cappelleri , PHD, MPH 2 , Björn Bolinder 3 and Robert A. Gerber , PHARMD, MA 2 1 Dallas Diabetes and Endocrine Center, Dallas, Texas 2 Pfizer Global Research and Development, Groton, Connecticut 3 Aventis Pharmaceuticals, Bridgewater, New Jersey Address correspondence and reprint requests to Robert A. Gerber, PharmD, MA, Pfizer, MS 8260-208, Global ResearchDevelopment, Eastern Point Road, Groton, CT 06340. E-mail: robert_a_gerber{at}groton.pfizer.com Abstract OBJECTIVE —The aim of this study was to determine patient satisfaction in patients with type 1 or type 2 diabetes receiving an inhaled insulin or subcutaneous insulin regimen, as assessed by pooled analysis of two 12-week parent studies and 1-year extension studies. RESEARCH DESIGN AND METHODS —In the 12-week parent studies, patients with type 1 ( n = 70) or type 2 ( n = 51) diabetes were randomized to an inhaled insulin or subcutaneous insulin regimen. In the 1-year extension studies, patients were allowed to select either treatment regimen. Patient satisfaction was assessed at baseline, week 12, and 1 year using the Patient Satisfaction with Insulin Therapy questionnaire. RESULTS —Of the 60 patients who received inhaled insulin during the parent studies, 85.0% ( n = 51) chose to continue treatment, 13.3% ( n = 8) switched to subcutaneous insulin, and 1.7% ( n = 1) did not continue. Of the 61 patients who received subcutaneous insulin, 21.3% ( n = 13) chose to continue treatment, 75.4% ( n = 46) switched to inhaled insulin, and 3.3% ( n = 2) did not continue. From baseline (parent studies) to 1 year (extension studies), HbA 1c reductions of 0.8% were sustained, and greater improvements were observed in the inhaled insulin group compared with the subcutaneous insulin group in terms of overall satisfaction (37.9 vs. 3.1%; P < 0.01) and ease of use (43.2 vs. −0.9%; P < 0.01). CONCLUSIONS —Inhaled insulin was preferred over subcutaneous insulin, which resulted in greater patient satisfaction up to 1 year in patients with type 1 or type 2 diabetes with durable effects on HbA 1c levels. PSIT, patient satisfaction with insulin therapy Footnotes J.R. has received research grants from Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Novo Nordisk, Pfizer, Aventis, Novartis, Takeda, and Astra-Zeneca; has been a paid consultant for Aventis, Johnson and Johnson, GlaxoSmithKline, Takeda, and Novo Nordisk; and has been on speakers bureaus for Aventis, Bristol-Myers Squibb, Novo Nordisk, GlaxoSmithKline, and Takeda. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Accepted February 26, 2004. Received October 13, 2003. DIABETES CARE

Older patients who undergo coronary interventions are at greater risk of ischemic events and less likely to tolerate prolonged dual antiplatelet therapy (DAPT) due to bleeding risk. The COMBO biodegradable polymer sirolimus-eluting stent promotes rapid endothelialization through endothelial progenitor cell capture technology which may be advantageous in elderly patients. We compared 1-year clinical outcomes and DAPT cessation events in patients >75 versus ≤75 years from the MASCOT registry. MASCOT was a prospective, multicenter cohort study of all-comers undergoing attempted COMBO stenting. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, myocardial infarction (MI) not clearly attributed to a nontarget vessel or clinically driven target lesion revascularization. Bleeding was adjudicated using the Bleeding Academic Research Consortium criteria. Adjusted outcomes were analyzed using Cox regression methods. The study included 18% (n = 479) patients >75 years and 72% (n = 2,135) patients ≤75 years. One-year TLF occurred in 4.6% patients >75 years versus 3.1% patients ≤75years of age, p = 0.10; adj hazard ratio 1.36, 95% confidence intervals 0.77 to 2.38, p = 0.29. There were no significant differences in cardiac death (1.7% vs 1.3%, p = 0.55), MI (2.1% vs 1.2%, p = 0.14), target lesion revascularization (1.7% vs 1.4%, p = 0.60) and definite stent thrombosis (0.8% vs 0.4%, p = 0.19). Major Bleeding Academic Research Consortium 3,5 bleeding (3.1% vs 1.5%, p = 0.01) and DAPT cessation rates (32.4% vs 23.0%, p <0.001) were significantly higher in elderly patients. In conclusion, elderly patients >75 years treated with COMBO stents had similar TLF but significantly greater incidence of bleeding than younger patients and DAPT cessation in one-third of patients over 1 year.