Immune response to functionalized mesoporous silica nanoparticles for targeted drug delivery

Multifunctional mesoporous silica nanoparticles (MSN) have attracted substantial attention with regard to their high potential for targeted drug delivery. For future clinical applications it is crucial to address safety concerns and understand the potential immunotoxicity of these nanoparticles. In this study, we assess the biocompatibility and functionality of multifunctional MSN in freshly isolated, primary murine immune cells. We show that the functionalized silica nanoparticles are rapidly and efficiently taken up into the endosomal compartment by specialized antigen-presenting cells such as dendritic cells. The silica nanoparticles showed a favorable toxicity profile and did not affect the viability of primary immune cells from the spleen in relevant concentrations. Cargo-free MSN induced only very low immune responses in primary cells as determined by surface expression of activation markers and release of pro-inflammatory cytokines such as Interleukin-6, -12 and -1β. In contrast, when surface-functionalized MSN with a pH-responsive polymer capping were loaded with an immune-activating drug, the synthetic Toll-like receptor 7 agonist R848, a strong immune response was provoked. We thus demonstrate that MSN represent an efficient drug delivery vehicle to primary immune cells that is both non-toxic and non-inflammagenic, which is a prerequisite for the use of these particles in biomedical applications

Saving transatlantic cooperation and the Iran nuclear deal: a view from Europe and the United States

Transatlantic differences over the future of the Iran nuclear deal - or the Joint Comprehensive Plan of Action (JCPOA) of July 2015 - are damaging a nuclear accord that all parties, except the United States, see as delivering on its purpose. They also increase the risk of Washington and European capitals working at cross-purposes vis-à-vis Iran and broader regional policies. To avoid such a scenario, the E3 (France, Germany, United Kingdom)/European Union (EU) and the United States need to set up new channels of communication to avoid a transatlantic rift, to attempt - if at all possible - to preserve the Iran deal, and to secure its benefits for regional and global security. (author's abstract

Measurement invariance in the social sciences: Historical development, methodological challenges, state of the art, and future perspectives

This review summarizes the current state of the art of statistical and (survey) methodological research on measurement (non)invariance, which is considered a core challenge for the comparative social sciences. After outlining the historical roots, conceptual details, and standard procedures for measurement invariance testing, the paper focuses in particular on the statistical developments that have been achieved in the last 10 years. These include Bayesian approximate measurement invariance, the alignment method, measurement invariance testing within the multilevel modeling framework, mixture multigroup factor analysis, the measurement invariance explorer, and the response shift-true change decomposition approach. Furthermore, the contribution of survey methodological research to the construction of invariant measurement instruments is explicitly addressed and highlighted, including the issues of design decisions, pretesting, scale adoption, and translation. The paper ends with an outlook on future research perspectives

Phenome-wide association analysis of LDL-cholesterol lowering genetic variants in PCSK9

Abstract: Background: We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9. Methods: Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration. Results: The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer’s disease – outcomes for which large-scale trial data were unavailable. Conclusions: Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate

Developing common protocols to measure tundra herbivory across spatial scales

Understanding and predicting large-scale ecological responses to global environmental change requires comparative studies across geographic scales with coordinated efforts and standardized methodologies. We designed, applied and assessed standardized protocols to measure tundra herbivory at three spatial scales: plot, site (habitat), and study area (landscape). The plot and site-level protocols were tested in the field during summers 2014-2015 at eleven sites, nine of them comprising warming experimental plots included in the International Tundra Experiment (ITEX). The study area protocols were assessed during 2014-2018 at 24 study areas across the Arctic. Our protocols provide comparable and easy-to-implement methods for assessing the intensity of invertebrate herbivory within ITEX plots and for characterizing vertebrate herbivore communities at larger spatial scales. We discuss methodological constraints and make recommendations for how these protocols can be used and how sampling effort can be optimized to obtain comparable estimates of herbivory, both at ITEX sites and at large landscape scales. The application of these protocols across the tundra biome will allow characterizing and comparing herbivore communities across tundra sites and at ecologically relevant spatial scales, providing an important step towards a better understanding of tundra ecosystem responses to large-scale environmental change.CGB was funded by the Estonian Research Council (grant IUT 20-28), and the European Regional Development Fund (Centre of Excellence EcolChange). JDMS was supported by the Research Council of Norway (262064). OG and LB were supported by the French Polar Institute (program “1036 Interactions”) and PRC CNRS Russie 396 (program “ICCVAT”). DSH, NL, MAG, JB and JDR were supported by the Natural Sciences and Engineering Research Council (Canada). NL, MAG, JB and JDR were supported by the Polar Continental Shelf Program. NL was supported by the Canada Research Chair program and the Canada Foundation for Innovation. NL and JB were supported by Environment Canada and Polar Knowledge Canada. NL and MAG were supported by the Government of Nunavut, the Igloolik Community, and Université de Moncton. NL, MAG and JB were supported by the Northern Scientific Training Program. JMA was funded by Carl Tryggers stiftelse för vetenskaplig forskning and Qatar Petroleum (QUEX-CAS-QP-RD-18_19). IHM-S was funded by the UK Natural Environmental Research Council Shrub Tundra (NE/M016323/1) grant. ISJ was funded by the University of Iceland Research Fund. Fieldwork in Yamal peninsula (Erkuta, Sabetta and Belyi) for DE, NS and AS was supported by the Russian Foundation for Basic Research (No: 18-05-60261 and No: 18-54-15013), Fram Centre project YaES (No: 362259), the Russian Center of Development of the Arctic, and the “Yamal-LNG” company. Fieldwork in Utqiaġvik was supported by the U.S. Fish and Wildlife Service. Fieldwork in Svalbard was supported by the Norwegian Research Council (AFG No: 246080/E10), the Norwegian Polar Institute, Climate-ecological Observatory for Arctic Tundra – COAT, the Svalbard Environmental protection fund (project number 15/20), and the University Centre in Svalbard (UNIS) and the AB-338/AB-838 students of 2018. Sampling at Billefjorden was supported by GACR 17- 20839S

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

ICARE MG (identification des caractéristiques des associations rompues en médecine générale, une étude qualitative à partir d'entretiens semi-directifs de médecins généralistes ayant vécu une rupture d'association)

LYON1-BU Santé (693882101) / SudocSudocFranceF

When the group practice breaks up : a qualitative study

International audienceGroup practices are increasingly common for primary care physicians worldwide. Although breakups are likely to happen frequently within group practices, their process has not been studied to date. The aims of this study were therefore to explore the reasons for breakups of group practices of general practitioners and to describe the associated feelings

Single dose efficacy evaluation of two partial benzodiazepine receptor agonists in photosensitive epilepsy patients : A placebo-controlled pilot study

Benzodiazepines (BZDs) are highly effective to suppress various types of seizures; however, their clinical use is limited due to adverse effects and tolerance and dependence liability. Drugs that act only as partial agonists at the BZD recognition site (initially termed "BZD receptor") of the GABAA receptor chloride ionophore complex or exhibit a GABAA receptor subtype-selectivity are thought to have advantages vs. full agonists such as diazepam and most other clinically used BZDs in that such compounds have less adverse effects and reduced or absent tolerance and dependence liability. One of such compounds, abecarnil, has been clinically evaluated as a novel anxiolytic drug, but, despite its potent preclinical anti-seizure activity, it has not yet been evaluated in patients with epilepsy. In the present proof-of-concept study, we performed a within-subject placebo-controlled, single oral dose study of abecarnil in patients with photosensitive epilepsy. Flumazenil, which is generally considered a BZD receptor antagonist, but has slight partial agonistic properties, was used for comparison. In total, 12 patients were enrolled in this study. Abecarnil, 5 or 10 mg, completely abolished the photo-paroxysmal EEG response, while flumazenil, 30, 60 or 100 mg, was less effective. The anti-epileptic effect of abecarnil was significantly different from both placebo and flumazenil. Sedative adverse effects were observed after abecarnil but not flumazenil. The study substantiates previous pre-clinical experiments that abecarnil exerts pronounced anti-seizure activity. Epilepsy is often associated with anxiety, so that the anxiolytic activity of abecarnil would be an added advantage when using this compound in epilepsy patients