Adrenal function recovery after durable oral corticosteroid sparing with benralizumab in the PONENTE study

Background Oral corticosteroid (OCS) dependence among patients with severe eosinophilic asthma can cause adverse outcomes, including adrenal insufficiency. PONENTE's OCS reduction phase showed that, following benralizumab initiation, 91.5% of patients eliminated corticosteroids or achieved a final dosage ≤5 mg·day-1 (median (range) 0.0 (0.0-40.0) mg). Methods The maintenance phase assessed the durability of corticosteroid reduction and further adrenal function recovery. For ~6 months, patients continued benralizumab 30 mg every 8 weeks without corticosteroids or with the final dosage achieved during the reduction phase. Investigators could prescribe corticosteroids for asthma exacerbations or increase daily dosages for asthma control deteriorations. Outcomes included changes in daily OCS dosage, Asthma Control Questionnaire (ACQ)-6 and St George's Respiratory Questionnaire (SGRQ), as well as adrenal status, asthma exacerbations and adverse events. Results 598 patients entered PONENTE; 563 (94.1%) completed the reduction phase and entered the maintenance phase. From the end of reduction to the end of maintenance, the median (range) OCS dosage was unchanged (0.0 (0.0-40.0) mg), 3.2% (n=18/563) of patients experienced daily dosage increases, the mean ACQ-6 score decreased from 1.26 to 1.18 and 84.5% (n=476/563) of patients were exacerbation free. The mean SGRQ improvement (-19.65 points) from baseline to the end of maintenance indicated substantial quality-of-life improvements. Of patients entering the maintenance phase with adrenal insufficiency, 32.4% (n=104/321) demonstrated an improvement in adrenal function. Adverse events were consistent with previous reports. Conclusions Most patients successfully maintained maximal OCS reduction while achieving improved asthma control with few exacerbations and maintaining or recovering adrenal function

Overview of the MOSAiC expedition—Atmosphere

With the Arctic rapidly changing, the needs to observe, understand, and model the changes are essential. To support these needs, an annual cycle of observations of atmospheric properties, processes, and interactions were made while drifting with the sea ice across the central Arctic during the Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition from October 2019 to September 2020. An international team designed and implemented the comprehensive program to document and characterize all aspects of the Arctic atmospheric system in unprecedented detail, using a variety of approaches, and across multiple scales. These measurements were coordinated with other observational teams to explore cross-cutting and coupled interactions with the Arctic Ocean, sea ice, and ecosystem through a variety of physical and biogeochemical processes. This overview outlines the breadth and complexity of the atmospheric research program, which was organized into 4 subgroups: atmospheric state, clouds and precipitation, gases and aerosols, and energy budgets. Atmospheric variability over the annual cycle revealed important influences from a persistent large-scale winter circulation pattern, leading to some storms with pressure and winds that were outside the interquartile range of past conditions suggested by long-term reanalysis. Similarly, the MOSAiC location was warmer and wetter in summer than the reanalysis climatology, in part due to its close proximity to the sea ice edge. The comprehensiveness of the observational program for characterizing and analyzing atmospheric phenomena is demonstrated via a winter case study examining air mass transitions and a summer case study examining vertical atmospheric evolution. Overall, the MOSAiC atmospheric program successfully met its objectives and was the most comprehensive atmospheric measurement program to date conducted over the Arctic sea ice. The obtained data will support a broad range of coupled-system scientific research and provide an important foundation for advancing multiscale modeling capabilities in the Arctic

Overview of the MOSAiC expedition - Atmosphere

With the Arctic rapidly changing, the needs to observe, understand, and model the changes are essential. To support these needs, an annual cycle of observations of atmospheric properties, processes, and interactions were made while drifting with the sea ice across the central Arctic during the Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition from October 2019 to September 2020. An international team designed and implemented the comprehensive program to document and characterize all aspects of the Arctic atmospheric system in unprecedented detail, using a variety of approaches, and across multiple scales. These measurements were coordinated with other observational teams to explore cross-cutting and coupled interactions with the Arctic Ocean, sea ice, and ecosystem through a variety of physical and biogeochemical processes. This overview outlines the breadth and complexity of the atmospheric research program, which was organized into 4 subgroups: atmospheric state, clouds and precipitation, gases and aerosols, and energy budgets. Atmospheric variability over the annual cycle revealed important influences from a persistent large-scale winter circulation pattern, leading to some storms with pressure and winds that were outside the interquartile range of past conditions suggested by long-term reanalysis. Similarly, the MOSAiC location was warmer and wetter in summer than the reanalysis climatology, in part due to its close proximity to the sea ice edge. The comprehensiveness of the observational program for characterizing and analyzing atmospheric phenomena is demonstrated via a winter case study examining air mass transitions and a summer case study examining vertical atmospheric evolution. Overall, the MOSAiC atmospheric program successfully met its objectives and was the most comprehensive atmospheric measurement program to date conducted over the Arctic sea ice. The obtained data will support a broad range of coupled-system scientific research and provide an important foundation for advancing multiscale modeling capabilities in the Arctic

Indacaterol provides sustained 24 h bronchodilation on once-daily dosing in asthma: a 7-day dose-ranging study.

BACKGROUND: Indacaterol is a novel, once-daily beta(2)-agonist in development for the treatment of asthma and chronic obstructive pulmonary disease. Studies were required to determine optimal dose(s) for continuing investigation. OBJECTIVE: A dose-ranging study was undertaken to evaluate efficacy and safety of indacaterol. METHODS: A total of 436 patients with persistent asthma receiving inhaled corticosteroids were randomized to 7 days treatment with once-daily indacaterol 50, 100, 200, or 400 microg via multi-dose dry-powder inhaler (MDDPI; Certihaler), indacaterol 400 microg via single-dose dry-powder inhaler (SDDPI), or placebo. Serial 24-h spirometry was performed on days 1 and 7. Vital signs, laboratory evaluations, and adverse events were monitored. RESULTS: All doses of indacaterol increased the mean time-standardized area under the curve of forced expiratory volume in 1 s (FEV(1)) from 22 to 24 h postdose (P <or= 0.001 vs placebo) on days 1 and 7, with clinically relevant treatment-placebo differences of 240, 260, 350, 300, and 380 ml on day 1 and 230, 220, 320, 250, and 270 ml on day 7 for indacaterol 50, 100, 200, and 400 microg via MDDPI and 400 microg via SDDPI, respectively. All doses increased mean FEV(1) (P < 0.05 vs placebo) from 5 min to 24 h postdose on days 1 and 7. All doses were well tolerated. Most adverse events were mild-to-moderate in severity: most frequently reported were respiratory, thoracic, and mediastinal disorders. CONCLUSION: Once-daily dosing with indacaterol provided sustained 24-h bronchodilation in patients with moderate-to-severe asthma, with a satisfactory overall safety profile. Indacaterol 200 microg appears the optimum dose, offering the best efficacy/safety balance

DensiProbe Spine: a novel instrument for intraoperative measurement of bone density in transpedicular screw fixation

STUDY DESIGN.: Cadaver study. OBJECTIVE.: To determine bone strength in vertebrae by measuring peak breakaway torque or indentation force using custom-made pedicle probes. SUMMARY OF BACKGROUND DATA.: Screw performance in dorsal spinal instrumentation is dependent on bone quality of the vertebral body. To date no intraoperative measuring device to validate bone strength is available. Destructive testing may predict bone strength in transpedicular instrumentations in osteoporotic vertebrae. Insertional torque measurements showed varying results. METHODS.: Ten human cadaveric vertebrae were evaluated for bone mineral density (BMD) measurements by quantitative computed tomography. Peak torque and indentation force of custom-made probes as a measure for mechanical bone strength were assessed via a transpedicular approach. The results were correlated to regional BMD and to biomechanical load testing after pedicle screw implementation. RESULTS.: Both methods generated a positive correlation to failure load of the respective vertebrae. The correlation of peak breakaway torque to failure load was r = 0.959 (P = 0.003), therewith distinctly higher than the correlation of indentation force to failure load, which was r = 0.690 (P = 0.040). In predicting regional BMD, measurement of peak torque also performed better than that of indentation force (r = 0.897 [P = 0.002] vs. r = 0.777 [P = 0.017]). CONCLUSION.: Transpedicular measurement of peak breakaway torque is technically feasible and predicts reliable local bone strength and implant failure for dorsal spinal instrumentations in this experimental setting

Arctic winter 2005: Implications for stratospheric ozone loss and climate change

The Arctic polar vortex exhibited widespread regions of low temperatures during the winter of 2005, resulting in significant ozone depletion by chlorine and bromine species. We show that chemical loss of column ozone (deltaO3) and the volume of Arctic vortex air cold enough to support the existence of polar stratospheric clouds (V_PSC) both exceed levels found for any other Arctic winter during the past 40 years. Cold conditions and ozone loss in the lowermost Arctic stratosphere (e.g., between potential temperatures of 360 to 400 K) were particularly unusual compared to previous years. Measurements indicate DO3 = 121 ± 20 DU and that deltaO3 versus V_PSC lies along an extension of the compact, near linear relation observed for previous Arctic winters. The maximum value of V_PSC during five to ten year intervals exhibits a steady, monotonic increase over the past four decades, indicating that the coldest Arctic winters have become significantly colder, and hence are more conducive to ozone depletion by anthropogenic halogens

Chemical Evolution of the Exceptional Arctic Stratospheric Winter 2019/2020 Compared to Previous Arctic and Antarctic Winters

The winter 2019/2020 showed the lowest ozone mixing ratios ever observed in the Arctic winter stratosphere. It was the coldest Arctic stratospheric winter on record and was characterized by an unusually strong and long‐lasting polar vortex. We study the chemical evolution and ozone depletion in the winter 2019/2020 using the global Chemistry and Transport Model ATLAS. We examine whether the chemical processes in 2019/2020 are more characteristic of typical conditions in Antarctic winters or in average Arctic winters. Model runs for the winter 2019/2020 are compared to simulations of the Arctic winters 2004/2005, 2009/2010, and 2010/2011 and of the Antarctic winters 2006 and 2011, to assess differences in chemical evolution in winters with different meteorological conditions. In some respects, the winter 2019/2020 (and also the winter 2010/2011) was a hybrid between Arctic and Antarctic conditions, for example, with respect to the fraction of chlorine deactivation into HCl versus ClONO2, the amount of denitrification, and the importance of the heterogeneous HOCl + HCl reaction for chlorine activation. The pronounced ozone minimum of less than 0.2 ppm at about 450 K potential temperature that was observed in about 20% of the polar vortex area in 2019/2020 was caused by exceptionally long periods in the history of these air masses with low temperatures in sunlight. Based on a simple extrapolation of observed loss rates, only an additional 21–46 h spent below the upper temperature limit for polar stratospheric cloud formation and in sunlight would have been necessary to reduce ozone to near zero values (0.05 ppm) in these parts of the vortex.Key Points: The Arctic stratospheric winter 2019/2020 showed the lowest ozone mixing ratios ever observed and was one of the coldest on record. Chemical evolution of the Arctic winter 2019/2020 was a hybrid between typical Arctic and typical Antarctic conditions. Only an additional 21–46 h below PSC temperatures and in sunlight would have been necessary to reduce ozone to near zero locally.International Multidisciplinary Drifting Observatory for the Study of the Arctic Climate (MOSAiC

Near-Complete Local Reduction of Arctic Stratospheric Ozone by Severe Chemical Loss in Spring 2020

In the Antarctic ozone hole, ozone mixing ratios have been decreasing to extremely low values of 0.01–0.1 ppm in nearly all spring seasons since the late 1980s, corresponding to 95–99% local chemical loss. In contrast, Arctic ozone loss has been much more limited and mixing ratios have never before fallen below 0.5 ppm. In Arctic spring 2020, however, ozonesonde measurements in the most depleted parts of the polar vortex show a highly depleted layer, with ozone loss averaged over sondes peaking at 93% at 18 km. Typical minimum mixing ratios of 0.2 ppm were observed, with individual profiles showing values as low as 0.13 ppm (96% loss). The reason for the unprecedented chemical loss was an unusually strong, long-lasting, and cold polar vortex, showing that for individual winters the effect of the slow decline of ozone-depleting substances on ozone depletion may be counteracted by low temperatures