Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.

BACKGROUND Giant cell arteritis is an immune-mediated disease of medium and large-sized arteries that affects mostly people older than 50 years of age. Treatment with glucocorticoids is the gold-standard and prevents severe vascular complications but is associated with substantial morbidity and mortality. Tocilizumab, a humanised monoclonal antibody against the interleukin-6 receptor, has been associated with rapid induction and maintenance of remission in patients with giant cell arteritis. We therefore aimed to study the efficacy and safety of tocilizumab in the first randomised clinical trial in patients with newly diagnosed or recurrent giant cell arteritis. METHODS In this single centre, phase 2, randomised, double-blind, placebo-controlled trial, we recruited patients aged 50 years and older from University Hospital Bern, Switzerland, who met the 1990 American College of Rheumatology criteria for giant cell arteritis. Patients with new-onset or relapsing disease were randomly assigned (2:1) to receive either tocilizumab (8 mg/kg) or placebo intravenously. 13 infusions were given in 4 week intervals until week 52. Both groups received oral prednisolone, starting at 1 mg/kg per day and tapered down to 0 mg according to a standard reduction scheme defined in the study protocol. Allocation to treatment groups was done using a central computerised randomisation procedure with a permuted block design and a block size of three, and concealed using central randomisation generated by the clinical trials unit. Patients, investigators, and study personnel were masked to treatment assignment. The primary outcome was the proportion of patients who achieved complete remission of disease at a prednisolone dose of 0·1 mg/kg per day at week 12. All analyses were intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01450137. RESULTS Between March 3, 2012, and Sept 9, 2014, 20 patients were randomly assigned to receive tocilizumab and prednisolone, and ten patients to receive placebo and glucocorticoid; 16 (80%) and seven (70%) patients, respectively, had new-onset giant cell arteritis. 17 (85%) of 20 patients given tocilizumab and four (40%) of ten patients given placebo reached complete remission by week 12 (risk difference 45%, 95% CI 11-79; p=0·0301). Relapse-free survival was achieved in 17 (85%) patients in the tocilizumab group and two (20%) in the placebo group by week 52 (risk difference 65%, 95% CI 36-94; p=0·0010). The mean survival-time difference to stop glucocorticoids was 12 weeks in favour of tocilizumab (95% CI 7-17; p<0·0001), leading to a cumulative prednisolone dose of 43 mg/kg in the tocilizumab group versus 110 mg/kg in the placebo group (p=0·0005) after 52 weeks. Seven (35%) patients in the tocilizumab group and five (50%) in the placebo group had serious adverse events. INTERPRETATION Our findings show, for the first time in a trial setting, the efficacy of tocilizumab in the induction and maintenance of remission in patients with giant cell arteritis. FUNDING Roche and the University of Bern.

Antibiotic-Resistant Neisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners.

The sexually transmitted bacterium Neisseria gonorrhoeae has developed resistance to all antibiotic classes that have been used for treatment and strains resistant to multiple antibiotic classes have evolved. In many countries, there is only one antibiotic remaining for empirical N. gonorrhoeae treatment, and antibiotic management to counteract resistance spread is urgently needed. Understanding dynamics and drivers of resistance spread can provide an improved rationale for antibiotic management. In our study, we first used antibiotic resistance surveillance data to estimate the rates at which antibiotic-resistant N. gonorrhoeae spread in two host populations, heterosexual men (HetM) and men who have sex with men (MSM). We found higher rates of spread for MSM (0.86 to 2.38 y-1, mean doubling time: 6 months) compared to HetM (0.24 to 0.86 y-1, mean doubling time: 16 months). We then developed a dynamic transmission model to reproduce the observed dynamics of N. gonorrhoeae transmission in populations of heterosexual men and women (HMW) and MSM. We parameterized the model using sexual behavior data and calibrated it to N. gonorrhoeae prevalence and incidence data. In the model, antibiotic-resistant N. gonorrhoeae spread with a median rate of 0.88 y-1 in HMW and 3.12 y-1 in MSM. These rates correspond to median doubling times of 9 (HMW) and 3 (MSM) months. Assuming no fitness costs, the model shows the difference in the host population's treatment rate rather than the difference in the number of sexual partners explains the differential spread of resistance. As higher treatment rates result in faster spread of antibiotic resistance, treatment recommendations for N. gonorrhoeae should carefully balance prevention of infection and avoidance of resistance spread.

Evidence for the role of agonist binding frequency in receptor -mediated activation of adenylate cyclase

$\beta$-adrenergic receptor-mediated activation of adenylate cyclase exhibits an agonist-specific separation between the dose/response curve (characterized by the EC$\sb{50}$) and the dose/binding curve (characterized by the K$\sb{\rm d}$). Cyclase activity can be near-maximal when receptor occupancy is quite low (EC$\sb{50}$ $\ll$ K$\sb{\rm d}$). This separation between the binding and response curves can be explained by the assumption that the rate of cyclase activation is proportional to the concentration of agonist-bound receptors, since the receptor is mobile and can activate more than one cyclase (the Collision Coupling Model of Tolkovsky and Levitzki). Here it is established that agonist binding frequency plays an additional role in adenylate cyclase activation in S49 murine lymphoma cells. Using epinephrine (EC$\sb{50}$ = 10 nM, K$\sb{\rm d}$ = 2 $\mu$M), the rate of cyclase activation decreased by 80% when a small (1.5%) receptor occupancy was restricted (by addition of the antagonist propranolol) to a small number (1.5%) of receptors rather than being proportionally distributed among the cell's entire population of receptors. Thus adenylate cyclase activity is not proportional to receptor occupancy in all circumstances. Collisions between receptor and cyclase pairs apparently occur a number of times in rapid sequence (an encounter); the high binding frequency of epinephrine ensures that discontiguous regions of the cell surface experience some period of agonist-bound receptor activity per small unit time minimizing "wasted" collisions between activated cyclase and bound receptor within an encounter. A contribution of agonist binding frequency to activation is thus possible when: (1) the mean lifetime of the agonist-receptor complex is shorter than the mean encounter time, and (2) the absolute efficiency (intrinsic ability to promote cyclase activation per collision) of the agonist-receptor complex is high. These conclusions are supported by experiments using agonists of different efficiencies and binding frequencies. These results are formalized in the Encounter Coupling Model of adenylate cyclase activation, which takes into explicit account the agonist binding frequency, agonist affinity for the $\beta$-adrenergic receptor, agonist efficiency, encounter frequency and the encounter time between receptor and cyclase. ^

Physical oceanography from the TRACTOR project

Primary Objectives - Describe and quantify the present strength and variability of the circulation and oceanic processes of the Nordic Seas regions using primarily observations of the long term spread of a tracer purposefully released into the Greenland Sea Gyre in 1996. - Improve our understanding of ocean processes critical to the thermaholine circulation in the Nordic Seas regions so as to be able to predict how this region may respond to climate change. - Assess the role of mixing and ageing of water masses on the carbon transport and the role of the thermohaline circulation in carbon storage using water transports and mixing coefficients derived from the tracer distribution. Specific Objectives Perform annual hydrographic, chemical and SF6 tracer surveys into the Nordic regions in order to: - Measure lateral and diapycnal mixing rates in the Greenland Sea Gyre and in the surrounding regions. - Document the depth and rates of convective mixing in the Greenland Sea using the SF6 and the water masses characteristics. - Measure the transit time and transport of water from the Greenland Sea to surrounding seas and outflows. Document processes of water mass transformation and entrainment occurring to water emanating from the central Greenland Sea. - Measure diapycnal mixing rates in the bottom and margins of the Greenland Sea basin using the SF6 signal observed there. Quantify the potential role of bottom boundary-layer mixing in the ventilation of the Greenland Sea Deep Water in absence of deep convection. Monitor the variability of the entrainment of water from the Greenland Sea using time series auto-sampler moorings at strategic positions i.e., sill of the Denmark Strait, Labrador Sea, Jan Mayen fracture zone and Fram Strait. Relate the observed variability of the tracer signal in the outflows to convection events in the Greenland Sea and local wind stress events. Obtain a better description of deepwater overflow and entrainment processes in the Denmark Strait and Faeroe Bank Channel overflows and use these to improve modelling of deepwater overflows. Monitor the tracer invasion into the North Atlantic using opportunistic SF6 measurements from other cruises: we anticipate that a number of oceanographic cruises will take place in the north-east Atlantic and the Labrador Sea. It should be possible to get samples from some cruises for SF6 measurements. Use process models to describe the spread of the tracer to achieve better parameterisation for three-dimensional models. One reason that these are so resistant to prediction is that our best ocean models are as yet some distance from being good enough, to predict climate and climate change.

Aspectos biológicos y poblacionales de Sipha Maydis (Passerini) y Schizaphis Graminum (Rondani) en cebada

El objetivo del presente estudio fue obtener los parámetros bioetológicos de Sipha maydis (Passerini) y Schizaphis graminum (Rondani) sobre cebada, Hordeum vulgare L. cv. Pampa. Los pulgones se criaron en condiciones de laboratorio a 20±1 °C, 14:10 horas de fotofase y una humedad relativa del 50-70 %. Se obtuvieron cohortes a partir de poblaciones de estos áfidos, sobre las que se realizó el registro diario de los cambios de estado, número de individuos muertos y los nacimientos una vez alcanzado el estado adulto. Se analizaron las curvas de supervivencia por edades (lx) y fecundidad (mx) y los siguientes estadísticos vitales: tasa reproductiva neta (Ro); tasa intrínseca de crecimiento natural (rm); tiempo generacional medio (T) y tiempo de duplicación (D). Para la comparación de las rm se obtuvieron las rm estimadas junto con su error standard mediante el procedimiento <jackknife». Si bien el pulgón verde de los cereales S. graminum posee mayor eficiencia reproductiva, S. maydis presenta valores de supervivencia y fecundidad de importancia, que indicaría que este áfido podría constituirse en una plaga potencial de gramíneas cultivadas.

Environmental observations from Station Ssagastyr during the first International Polar Year 1882/83 (digitized tables)

Vorliegender Band enthält die für alle internationalen Polarstationen obligatorischen meteorologischen Beobachtungen der russischen Polarstation an der Lenamündung für den Zeitraum vom 1. September 1882 bis 31. August 1883 und vom 1. September 1883 bis zum 6. Juli 1884.

234Th and particulate fluxes in the Kara Sea in October 1993

The mean residence time of 234Th associated with suspended matter in the Kara Sea was calculated from distributions of dissolved and suspended 234Th. Integral particulate fluxes at different levels were estimated for two stations. The flux increases only in the pycnocline; below it changes insignificantly. Two maxima of differential fluxes are noted in vertical profiles: in the surface layer where primary production is maximal, and in the interface layer where zooplankton realizing active transport of suspended matter is usually concentrated. Differential fluxes were determined at 10 stations; their space distribution is controlled by primary production, which depends usually on turbidity of river water in estuaries.

Antagonistic interactions between the african weaver ant Oecophylla longinoda and the parasitoid Anagyrus pseudococci potentially limits suppression of the invasive mealybug Rastrococcus iceryoides

The ant Oecophylla longinoda Latreille forms a trophobiotic relationship with the invasive mealybug Rastrococus iceryoides Green and promotes the latter's infestations to unacceptable levels in the presence of their natural enemies. In this regard, the antagonistic interactions between the ant and the parasitoid Anagyrus pseudococci Girault were assessed under laboratory conditions. The percentage of parasitism of R. iceryoides by A. pseudococci was significantly higher on "ant-excluded" treatments (86.6% ± 1.27%) compared to "ant-tended" treatments (51.4% ± 4.13%). The low female-biased sex-ratio observed in the "ant-tended" treatment can be attributed to ants' interference during the oviposition phase, which disrupted parasitoids' ability to fertilize eggs. The mean foraging time, host handling time and number of successful oviposition in "ant-excluded" treatment were significantly higher compared to "ant-tended" treatments. When ant workers were allowed access to sterilized sand grains, mummified and unmummified R. iceryoides, they selectively removed the mummified mealybugs, indicating that they recognized the mummies as potential foods (1.2 ± 0.46 to 7.8 ± 1.17 mummies at 10 min intervals for 2 h). Percentage emergence from mummified R. iceryoides removed by the ants was significantly lower compared to emergence from mummies not exposed to ants. Although, host seeking parasitoids frequently evaded attacks, some were killed by the foraging ant workers (2.0 ± 0.38 to 6.0 ± 0.88 at 10 min intervals for 2 h). These results suggest for the first time that the presence of O. longinoda has a detrimental effect on the abundance, reproductive success and possibly oviposition strategy of female parasitoids, which might be a delimiting factor in field conditions if both natural enemies are to be recommended for use within the same agro-ecosystem.

Physical and chemical oceanography in the Arctic Ocean

Data from sections across the Eurasian Basin of the Arctic Ocean occupied by the German Research Vessel Polarstern in 1987 and by the Swedish icebreaker Oden in 1991 are used to derive information on the freshwater balance of the Arctic Ocean halocline and on the sources of the deep waters of the Nansen, Amundsen and Makarov basins. Salinity, d18O and mass balances allow separation of the river-runoff and the sea-ice meltwater fractions contained in the Arctic halocline. This provides the basis for tracking the river-runoff signal from the shelf seas across the central Arctic Ocean to Fram Strait. The halocline has to be divided into at least three lateral regimes: the southern Nansen Basin with net sea-ice melting, the northern Nansen Basin and Amundsen Basin with net sea-ice formation and increasing river-runoff fractions, and the Canadian Basin with minimum sea-ice meltwater and maximum river-runoff fractions and water of Pacific origin. In the Canadian Basin, silicate is used as a tracer to identify Pacific water entering through Bering Strait and an attempt is made to quantify its influence on the halocline waters of the Canadian Basin. For this purpose literature data from the CESAR and LOREX ice camps are used. Based on mass balances and depending on the value of precipitation over the area of the Arctic Ocean the average mean residence time of the river-runoff fraction contained in the Arctic Ocean halocline is determined to be about 14 or 11 years. Water column inventories of river-runoff and sea-ice meltwater are calculated for a section just north of Fram Strait and implications for the ice export rate through Fram Strait are discussed. Salinity, tritium, 3He and the d18O ratio of halocline waters sampled during the 1987 Polarstern cruise to the Nansen Basin are used to estimate the mean residence time of the river-runoff component in the halocline and on the shelves of the Arctic Ocean. These estimates are done by comparing ages of the halocline waters based on a combination of tracers yielding different time information: the tritium 'vintage' age which records the time that has passed since the river-runoff entered the shelf and the tritium/3He age which reflects the time since the shelf waters left the shelf. The difference between the ages determined by these two methods is about 3 to 6 years. Correction for the initial tritium/3He age of the shelf waters (about 0.5 to 1.5 years) yields a mean residence time of the river-runoff on the shelves of about 3.5 ± 2 years. Comparison of the 18O/16O ratios of shelf water, Atlantic water and the deep waters of the Arctic Ocean indicate that the sources of the deep and bottom waters of the Eurasian Basin are located in the Barents and Kara seas.

Carbon pools and fluxes measured during a field campaign conducted in 2010 on the Tibetan Plateau at Kema

The Tibetan highlands host the largest alpine grassland ecosystems worldwide, bearing soils that store substantial stocks of carbon (C) that are very sensitive to land use changes. This study focuses on the cycling of photoassimilated C within a Kobresia pygmaea pasture, the dominating ecosystems on the Tibetan highlands. We investigated short-term effects of grazing cessation and the role of the characteristic Kobresia root turf on C fluxes and belowground C turnover. By combining eddy-covariance measurements with 13CO2 pulse labeling we applied a powerful new approach to measure absolute fluxes of assimilates within and between various pools of the plant-soil-atmosphere system. The roots and soil each store roughly 50% of the overall C in the system (76 Mg C/ha), with only a minor contribution from shoots, which is also expressed in the root:shoot ratio of 90. During June and July the pasture acted as a weak C sink with a strong uptake of approximately 2 g C/m**2/ in the first half of July. The root turf was the main compartment for the turnover of photoassimilates, with a subset of highly dynamic roots (mean residence time 20 days), and plays a key role for the C cycling and C storage in this ecosystem. The short-term grazing cessation only affected aboveground biomass but not ecosystem scale C exchange or assimilate allocation into roots and soil.

(Table 2) Horizontal ice flow velocities, azimuths (relative to true north), and vertical ice-particle velocities in the vicinity of Vostok Station, Antarctica

In the austral summer seasons 2001/02 and 2002/03, Global Positioning System (GPS) data were collected in the vicinity of Vostok Station to determine ice flow velocities over Lake Vostok. Ten GPS sites are located within a radius of 30 km around Vostok Station on floating ice as well as on grounded ice to the east and to the west of the lake. Additionally, a local deformation network around the ice core drilling site 5G-1 was installed. The derived ice flow velocity for Vostok Station is 2.00 m/a ± 0.01 m/a. Along the flowline of Vostok Station an extension rate of about 10**-5/a (equivalent to 1 cm/km/a) was determined. This significant velocity gradient results in a new estimate of 28700 years for the transit time of an ice particle along the Vostok flowline from the bedrock ridge in the southwest of the lake to the eastern shoreline. With these lower velocities compared to earlier studies and, hence, larger transit times the basal accretion rate is estimated to be 4 mm/a along a portion of the Vostok flowline. An assessment of the local accretion rate at Vostok Station using the observed geodetic quantities yields an accretion rate in the same order of magnitude. Furthermore, the comparison of our geodetic observations with results inferred from ice-penetrating radar data indicates that the ice flow may not have changed significantly for several thousand years.

Volume of natural gas within gas-hydrate and free-gas occurrences in ODP Leg 164 sites

Leg 164 of the Ocean Drilling Program was designed to investigate the occurrence of gas hydrate in the sedimentary section beneath the Blake Ridge on the southeastern continental margin of North America. Sites 994, 995, and 997 were drilled on the Blake Ridge to refine our understanding of the in situ characteristics of natural gas hydrate. Because gas hydrate is unstable at surface pressure and temperature conditions, a major emphasis was placed on the downhole logging program to determine the in situ physical properties of the gas hydrate-bearing sediments. Downhole logging tool strings deployed on Leg 164 included the Schlumberger quad-combination tool (NGT, LSS/SDT, DIT, CNT-G, HLDT), the Formation MicroScanner (FMS), and the Geochemical Combination Tool (GST). Electrical resistivity (DIT) and acoustic transit-time (LSS/SDT) downhole logs from Sites 994, 995, and 997 indicate the presence of gas hydrate in the depth interval between 185 and 450 mbsf on the Blake Ridge. Electrical resistivity log calculations suggest that the gas hydrate-bearing sedimentary section on the Blake Ridge may contain between 2 and 11 percent bulk volume (vol%) gas hydrate. We have determined that the log-inferred gas hydrates and underlying free-gas accumulations on the Blake Ridge may contain as much as 57 trillion m**3 of gas.

Photosynthetically active radiation during the experiment, and lipid content of sub- and intertidal specimens of the endemic Antarctic red alga, Palmaria decipiens

In coastal waters, Antarctic rhodophytes are exposed to harsh environmental conditions throughout the year, like low water temperatures ranging from -1.8°C to 2°C and high light during the summer season. Photosynthetic performance under these conditions may be affected by slowed down enzymatic reactions and the increased generation of reactive oxygen species. The consequence might be a chronic photoinhibition of photosynthetic primary reactions related to increased fragmentation of the D1 reaction centre protein in photosystem II. It is hypothesized that changes in lipid composition of biomembranes may represent an adaptive trait to maintain D1 turnover in response to temperature variation. The interactive effects of high light and low temperature were studied on an endemic Antarctic red alga, Palmaria decipiens, sampled from two shore levels, intertidal and subtidal, and exposed to mesocosm experiments using two levels of natural solar radiation and two different temperature regimes (2-5°C and 5-10°C). During the experimental period of 23 days, maximum quantum yield of photosynthesis decreased in all treatments, with the intertidal specimens exposed at 5-10°C being most affected. On the pigment level, a decreasing ratio of phycobiliproteins to chlorophyll a was found in all treatments. A pronounced decrease in D1 protein concentration occurred in subtidal specimens exposed at 2-5°C. Marked changes in lipid composition, i.e. the ratio of saturated to unsaturated fatty acids, indicated an effective response of specimens to temperature change. Results provide new insights into mechanisms of stress adaptation in this key species of shallow Antarctic benthic communities.

Chlorofluorocarbons and noble gas measured on water bottle samples during three POLARSTERN cruises

We use a 27 year long time series of repeated transient tracer observations to investigate the evolution of the ventilation time scales and the related content of anthropogenic carbon (Cant) in deep and bottom water in the Weddell Sea. This time series consists of chlorofluorocarbon (CFC) observations from 1984 to 2008 together with first combined CFC and sulphur hexafluoride (SF6) measurements from 2010/2011 along the Prime Meridian in the Antarctic Ocean and across the Weddell Sea. Applying the Transit Time Distribution (TTD) method we find that all deep water masses in the Weddell Sea have been continually growing older and getting less ventilated during the last 27 years. The decline of the ventilation rate of Weddell Sea Bottom Water (WSBW) and Weddell Sea Deep Water (WSDW) along the Prime Meridian is in the order of 15-21%; the Warm Deep Water (WDW) ventilation rate declined much faster by 33%. About 88-94% of the age increase in WSBW near its source regions (1.8-2.4 years per year) is explained by the age increase of WDW (4.5 years per year). As a consequence of the aging, the Cant increase in the deep and bottom water formed in the Weddell Sea slowed down by 14-21% over the period of observations.