Een patiënt met Legionairsziekte in Nederland

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View From Outside the Viewing Sphere

The ‘viewing sphere’, as defined by Euclid and explored by Gibson as the ‘optic array’, is generally thought of as wrapped around the eye. Can an observer step out of it? With currently popular photographic techniques, the spectator is forced to, because the viewing sphere is presented as a pictorial object. Then the question is whether human observers are able to use such pictorial representations in an intuitive manner. Can the spectator ‘mentally step into the interior’ of the pictorial viewing sphere? We explore this issue in a short experiment. Perhaps unsurprisingly, because the eye cannot see itself, the short answer is no

First-in-human administration of a live-attenuated RSV vaccine lacking the G-protein assessing safety, tolerability, shedding and immunogenicity: a randomized controlled trial

Background: Human respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in early infancy and in elderly. A pediatric vaccine against RSV would not only prevent morbidity and mortality amongst infants and young children but could also reduce transmission to elderly. The RSVDG vaccine consists of a live-attenuated RSV that lacks the G attachment protein. RSVDG is severely impaired in binding to host cells and exhibits reduced infectivity in preclinical studies. Intranasal immunization of cotton rats with RSVDG vaccine protected against replication of wildtype RSV, without inducing enhanced disease.Methods: We performed a first-in-human trial with primary objective to evaluate safety and shedding of RSV Delta G (6.5 log(10) CCID50) after intranasal administration. Healthy adults aged between 18 and 50, with RSV neutralizing serum titers below 9.6 log(2), received a single dose of either vaccine or placebo (n = 48, ratio 3:1). In addition to safety and tolerability, nasal viral load, and systemic and humoral immune responses were assessed at selected time points until 4 weeks after immunization.Results: Intranasal administration of RSV Delta G was well tolerated with no findings of clinical concern. No infectious virus was detected in nasal wash samples. Similar to other live-attenuated RSV vaccines, neutralizing antibody response following inoculation was limited in seropositive adults.Conclusions: A single dose of 6.5 log(10) CCID50 of RSV Delta G was safe and well-tolerated in seropositive healthy adults. RSV Delta G was sufficiently attenuated but there were no signs of induction of antibodies. Safety and immunogenicity can now be explored in children and eventually in seronegative infants. (C) 2020 The Author(s). Published by Elsevier Ltd.Host-parasite interactio

Phase I/II Study of Refametinib (BAY 86-9766) in Combination with Gemcitabine in Advanced Pancreatic cancer

Background Activating KRAS mutations are reported in up to 90% of pancreatic cancers. Refametinib potently inhibits MEK1/2, part of the MAPK signaling pathway. This phase I/II study evaluated the safety and efficacy of refametinib plus gemcitabine in patients with advanced pancreatic cancer. Methods Phase I comprised dose escalation, followed by phase II expansion. Refametinib and gemcitabine plasma levels were analyzed for pharmacokinetics. KRAS mutational status was determined from circulating tumor DNA. Results Ninety patients overall received treatment. The maximum tolerated dose was refametinib 50 mg twice daily plus standard gemcitabine (1000 mg/m2 weekly). The combination was well tolerated, with no pharmacokinetic interaction. Treatment-emergent toxicities included thrombocytopenia, fatigue, anemia, and edema. The objective response rate was 23% and the disease control rate was 73%. Overall response rate, disease control rate, progression-free survival, and overall survival were higher in patients without detectable KRAS mutations (48% vs. 28%, 81% vs. 69%, 8.8 vs. 5.3 months, and 18.2 vs. 6.6 months, respectively). Conclusion Refametinib plus gemcitabine was well tolerated, with a promising objective response rate, and had an acceptable safety profile and no pharmacokinetic interaction. There was a trend towards improved outcomes in patients without detectable KRAS mutations that deserves future investigation

A Constructive Framework for the Preventive Signalling Maintenance Crew Scheduling Problem in the Danish Railway system

In this paper we consider the problem of planning preventive maintenance of railway signals in Denmark. This case is particularly interesting, as the entire railway signalling system is currently being upgraded to the new European Railway Traffic Management System (ERTMS) standard. This upgrade has significant implications for signal maintenance scheduling in the system. We formulate the problem as a multidepot vehicle routing and scheduling problem with time windows and synchronisation constraints, in a multiday time schedule. The requirement that some tasks require the simultaneous presence of more than one engineer means that task synchronisation must be considered. A multi-stage constructive framework is proposed, which first distributes maintenance tasks using a clustering formulation. Following this, a Constraint Programming (CP) based approach is used to generate feasible monthly plans for large instances of practical interest. Experimental results indicate that the proposed framework can generate feasible solutions and schedule a monthly plan of up to 1000 tasks for eight crew members, in a reasonable amount of computational tim

Toxicity of abamectin to the terrestrial isopod Porcellio scaber (Isopoda, Crustacea).

To determine effects of the antiparasitic veterinary drug abamectin on the isopod Porcellio scaber, animals were exposed for 21 days to Lufa 2.2 soil spiked at concentrations of 3-300 mg/kg dry soil. After exposure, abamectin residues in the isopods were analysed using a novel analytical method. Toxicity was evaluated on different levels of biological organisation: biochemical, cellular and the individual organism. Measurements included glutathione S-transferase (GST) activity and stability of cell membranes in the digestive gland, animal mass gain or loss, food consumption, behaviour and mortality. LC50 for the effect of abamectin on survival of P. scaber was 71 mg/kg dry soil. The most obvious sublethal effects were reduced food consumption and decreased body mass (NOEC 3 mg/kg dry soil). Additionally, loss of digging activity and reduced GST activity (NOEC 30 mg/kg dry soil) and cell membrane destabilization (NOEC 10 mg/kg dry soil) were recorded. Abamectin only slightly accumulated in the isopods, with bioaccumulation factors always being <0.1. Based on these results and current information on environmental levels of abamectin, it is not likely that isopods will be affected by abamectin, but further studies with exposure through faeces are recommended. © 2010 Springer Science+Business Media, LLC

Untargeted Metabolomics Reveals a Lack Of Synergy between Nifurtimox and Eflornithine against Trypanosoma brucei

A non-targeted metabolomics-based approach is presented that enables the study of pathways in response to drug action with the aim of defining the mode of action of trypanocides. Eflornithine, a polyamine pathway inhibitor, and nifurtimox, whose mode of action involves its metabolic activation, are currently used in combination as first line treatment against stage 2, CNS-involved, human African trypanosomiasis (HAT). Drug action was assessed using an LC-MS based non-targeted metabolomics approach. Eflornithine revealed the expected changes to the polyamine pathway as well as several unexpected changes that point to pathways and metabolites not previously described in bloodstream form trypanosomes, including a lack of arginase activity and N-acetylated ornithine and putrescine. Nifurtimox was shown to be converted to a trinitrile metabolite indicative of metabolic activation, as well as inducing changes in levels of metabolites involved in carbohydrate and nucleotide metabolism. However, eflornithine and nifurtimox failed to synergise anti-trypanosomal activity in vitro, and the metabolomic changes associated with the combination are the sum of those found in each monotherapy with no indication of additional effects. The study reveals how untargeted metabolomics can yield rapid information on drug targets that could be adapted to any pharmacological situation