Clinical mumps vaccine efficacy

From February 5 through April 23, 1982, 110 cases of mumps were reported among 357 students in a middle school in Ashtabula County, Ohio, an overall attack rate of 31%. Vaccine efficacy was calculated using a variety of case definitions, case surveillance systems, and vaccination-status ascertainment methods to evaluate their effects on the estimated vaccine efficacy. From data collected at the school for case ascertainment and vaccination status, clinical vaccine efficacy was initially estimated at 37%. By means of a uniform case definition (parotitis lasting two days or more) and only cases and vaccination status ascertained from parental questionnaires, estimated vaccine efficacy increased to 70%. From secondary attack rates in household members with provider-verified vaccination status, the vaccine efficacy further increased to 85%. This outbreak investigation confirms that the methods used to ascertain cases and determine vaccination status greatly affect estimates of vaccine efficacy. Studies relying solely on school records for case finding and determination of immunization status may provide misleadingly low estimates of vaccine efficacy for mumps vaccine as well as for other vaccines. Appropriate methods demonstrate that mumps vaccine is highly effective and support recommendations for its continued use.

Urinary phenylacetylglutamine as dosing biomarker for patients with urea cycle disorders

We have analyzed pharmacokinetic data for glycerol phenylbutyrate (also GT4P or HPN-100) and sodium phenylbutyrate with respect to possible dosing biomarkers in patients with urea cycle disorders (UCD).

STUDY DESIGN

These analyses are based on over 3000 urine and plasma data points from 54 adult and 11 pediatric UCD patients (ages 6-17) who participated in three clinical studies comparing ammonia control and pharmacokinetics during steady state treatment with glycerol phenylbutyrate or sodium phenylbutyrate. All patients received phenylbutyric acid equivalent doses of glycerol phenylbutyrate or sodium phenylbutyrate in a cross over fashion and underwent 24-hour blood samples and urine sampling for phenylbutyric acid, phenylacetic acid and phenylacetylglutamine.

RESULTS

Patients received phenylbutyric acid equivalent doses of glycerol phenylbutyrate ranging from 1.5 to 31.8 g/day and of sodium phenylbutyrate ranging from 1.3 to 31.7 g/day. Plasma metabolite levels varied widely, with average fluctuation indices ranging from 1979% to 5690% for phenylbutyric acid, 843% to 3931% for phenylacetic acid, and 881% to 1434% for phenylacetylglutamine. Mean percent recovery of phenylbutyric acid as urinary phenylacetylglutamine was 66.4 and 69.0 for pediatric patients and 68.7 and 71.4 for adult patients on glycerol phenylbutyrate and sodium phenylbutyrate, respectively. The correlation with dose was strongest for urinary phenylacetylglutamine excretion, either as morning spot urine (r = 0.730, p < 0.001) or as total 24-hour excretion (r = 0.791 p<0.001), followed by plasma phenylacetylglutamine AUC(24-hour), plasma phenylacetic acid AUC(24-hour) and phenylbutyric acid AUC(24-hour). Plasma phenylacetic acid levels in adult and pediatric patients did not show a consistent relationship with either urinary phenylacetylglutamine or ammonia control.

CONCLUSION

The findings are collectively consistent with substantial yet variable pre-systemic (1st pass) conversion of phenylbutyric acid to phenylacetic acid and/or phenylacetylglutamine. The variability of blood metabolite levels during the day, their weaker correlation with dose, the need for multiple blood samples to capture trough and peak, and the inconsistency between phenylacetic acid and urinary phenylacetylglutamine as a marker of waste nitrogen scavenging limit the utility of plasma levels for therapeutic monitoring. By contrast, 24-hour urinary phenylacetylglutamine and morning spot urine phenylacetylglutamine correlate strongly with dose and appear to be clinically useful non-invasive biomarkers for compliance and therapeutic monitoring.

Differences in sensitivity between earthworms and enchytraeids exposed to two commercial fungicides

The use of pesticides in crop fields may have negative effects on soil Oligochaeta Annelida, i.e., earthworms and enchytraeids, and thus affect soil quality. The aim of this study was to assess the effects of two commercial fungicide formulations on the earthworm Aporrectodea caliginosa and the enchytraeid Enchytraeus albidus in a natural soil. The fungicides were Cuprafor micro® (copper oxychloride), commonly used in organic farming, and Swing Gold® (epoxiconazole and dimoxystrobin), a synthetic fungicide widely used in conventional farming to protect cereal crops. Laboratory experiments were used to assess the survival, biomass loss and avoidance behaviour. No lethal effect was observed following exposure to the copper fungicide for 14 days, even at 5000mgkg^-1 of copper, i.e. 650 times the recommended dose (RD). However, a significant decrease in biomass was observed from 50mgkg^-1 of copper (6.5 times the RD) for A. caliginosa and at 5000mgkg^-1 of copper (650 times the RD) for E. albidus. These sublethal effects suggest that a longer period of exposure would probably have led to lethal effects. The EC50 avoidance for the copper fungicide was estimated to be 51.2mgkg^-1 of copper (6.7 times the RD) for A. caliginosa, and 393mgkg^-1 of copper (51 times the RD) for E. albidus. For the Swing Gold® fungicide, the estimated LC50 was 7.0 10^-3mLkg^-1 (6.3 times the RD) for A. caliginosa and 12.7 10^-3mLkg^-1 (11.0 times the RD) for E. albidus. No effect on biomass or avoidance was observed at sublethal concentrations of this synthetic fungicide. It was concluded that enchytraeids were less sensitive than earthworms to the two commercial fungicides in terms of mortality, biomass loss and avoidance behaviour. Therefore we discuss the different strategies possibly used by the two Oligochaeta species to cope with the presence of the pesticides were discussed, along with the potential consequences on the soil functions.

Predicting Mixture Effects over Time with Toxicokinetic-Toxicodynamic Models (GUTS): Assumptions, Experimental Testing, and Predictive Power

Current methods to assess the impact of chemical mixtures on organisms ignore the temporal dimension. The General Unified Threshold model for Survival (GUTS) provides a framework for deriving toxicokinetic-toxicodynamic (TKTD) models, which account for effects of toxicant exposure on survival in time. Starting from the classic assumptions of independent action and concentration addition, we derive equations for the GUTS reduced (GUTS-RED) model corresponding to these mixture toxicity concepts and go on to demonstrate their application. Using experimental binary mixture studies with Enchytraeus crypticus and previously published data for Daphnia magna and Apis mellifera, we assessed the predictive power of the extended GUTS-RED framework for mixture assessment. The extended models accurately predicted the mixture effect. The GUTS parameters on single exposure data, mixture model calibration, and predictive power analyses on mixture exposure data offer novel diagnostic tools to inform on the chemical mode of action, specifically whether a similar or dissimilar form of damage is caused by mixture components. Finally, observed deviations from model predictions can identify interactions, e.g., synergism or antagonism, between chemicals in the mixture, which are not accounted for by the models. TKTD models, such as GUTS-RED, thus offer a framework to implement new mechanistic knowledge in mixture hazard assessments.

How to analyse and account for interactions in mixture toxicity with toxicokinetic-toxicodynamic models

The assessment of chemical mixture toxicity is one of the major challenges in ecotoxicology. Chemicals can interact, leading to more or less effects than expected, commonly named synergism and antagonism respectively. The classic ad hoc approach for the assessment of mixture effects is based on dose-response curves at a single time point, and is limited to identifying a mixture interaction but cannot provide predictions for untested exposure durations, nor for scenarios where exposure varies in time. We here propose a new approach using toxicokinetic-toxicodynamic modelling: The General Unified Threshold model of Survival (GUTS) framework, recently extended for mixture toxicity assessment. We designed a dedicated mechanistic interaction module coupled with the GUTS mixture model to i) identify interactions, ii) test hypotheses to identify which chemical is likely responsible for the interaction, and finally iii) simulate and predict the effect of synergistic and antagonistic mixtures. We tested the modelling approach experimentally with two species (Enchytraeus crypticus and Mamestra brassicae) exposed to different potentially synergistic mixtures (composed of: prochloraz, imidacloprid, cypermethrin, azoxystrobin, chlorothalonil, and chlorpyrifos). Furthermore, we also tested the model with previously published experimental data on two other species (Bombus terrestris and Daphnia magna) exposed to pesticide mixtures (clothianidin, propiconazole, dimethoate, imidacloprid and thiacloprid) found to be synergistic or antagonistic with the classic approach. The results showed an accurate simulation of synergistic and antagonistic effects for the different tested species and mixtures. This modelling approach can identify interactions accounting for the entire time of exposure, and not only at one time point as in the classic approach, and provides predictions of the mixture effect for untested mixture exposure scenarios, including those with time-variable mixture composition.

An energy-based model to analyze growth data of earthworms exposed to two fungicides

The pesticide risk assessment for earthworms is currently performed using standardized tests, the model species Eisenia fetida, and the analyses of the data obtained are performed with ad hoc statistical tools. We assessed the impact of two fungicides on the entire growth pattern of the earthworm species Aporrectodea caliginosa, which is highly representative of agricultural fields. Individuals of three different ages (from hatching to 56 days old) were exposed to Cuprafor micro® (copper oxychloride) and Swing® Gold (dimoxystrobin and epoxiconazole). Data were analyzed with an energy-based toxicodynamic model coupled with a toxicokinetic model. The copper fungicide caused a drastic growth inhibition once the no effect concentration (NEC), estimated at 65 mg kg^-1 of copper, was exceeded. The Swing® Gold negatively affected the growth with NEC values estimated at 0.387 mg kg^-1 and 0.128 mg kg^-1 for the dimoxystrobin and the epoxiconazole in this fungicide formulation, respectively. The time-profile of the effects on A. caliginosa individuals was fully accounted for by the model, whatever their age of exposure. Furthermore, toxicity data analyses, supported by measurements of fungicide concentrations in earthworm at the end of the experiment, allowed bettering understanding of the mechanisms of action of the fungicides towards earthworm growth.

Chapitre B-5 B - Dérivation cutanée non continente en neuro-urologie

Non-continent urinary diversions can be proposed temporarily in neurological patients or at end-stage. They are especially proposed in patients in chronic retention in whom intermittent catheterization cannot be performed for anatomical or practical reasons (severity of neurological handicap). In this study, the authors present the various non-continent urinary diversions reported in the literature, describing the technical modalities of each diversion, their main complications and their short-term, medium-term and long-term results.

Earthworms Mitigate Pesticide Effects on Soil Microbial Activities

Earthworms act synergistically with microorganisms in soils. They are ecosystem engineers involved in soil organic matter degradation and nutrient cycling, leading to the modulation of resource availability for all soil organisms. Using a soil microcosm approach, we aimed to assess the influence of the earthworm Aporrectodea caliginosa on the response of soil microbial activities against two fungicides, i.e., Cuprafor Micro® (copper oxychloride, a metal) and Swing® Gold (epoxiconazole and dimoxystrobin, synthetic organic compounds). The potential nitrification activity (PNA) and soil enzyme activities (glucosidase, phosphatase, arylamidase, and urease) involved in biogeochemical cycling were measured at the end of the incubation period, together with earthworm biomass. Two common indices of the soil biochemistry were used to aggregate the response of the soil microbial functioning: the geometric mean (Gmean) and the Soil Quality Index (SQI). At the end of the experiment, the earthworm biomass was not impacted by the fungicide treatments. Overall, in the earthworm-free soil microcosms, the two fungicides significantly increased several soil enzyme and nitrification activities, leading to a higher GMean index as compared to the non-treated control soils. The microbial activity responses depended on the type of activity (nitrification was the most sensitive one), on the fungicide (Swing® Gold or Cuprafor Micro®), and on the doses. The SQI indices revealed higher effects of both fungicides on the soil microbial activity in the absence of earthworms. The presence of earthworms enhanced all soil microbial activities in both the control and fungicide-contaminated soils. Moreover, the magnitude of the fungicide impact, integrated through the SQI index, was mitigated by the presence of earthworms, conferring a higher stability of microbial functional diversity. Our results highlight the importance of biotic interactions in the response of indicators of soil functioning (i.e., microbial activity) to pesticides.

What Is on the Outside Matters-Surface Charge and Dissolve Organic Matter Association Affect the Toxicity and Physiological Mode of Action of Polystyrene Nanoplastics to C. elegans

To better understand nanoplastic effects, the potential for surface functionalization and dissolve organic matter eco-corona formation to modify the mechanisms of action and toxicity of different nanoplastics needs to be established. Here, we assess how different surface charges modifying functionalization (postive (+ve) aminated; neutral unfunctionalized; negative (-ve) carboxylated) altered the toxicity of 50 and 60 nm polystyrene nanoplastics to the nematode Caenorhabditis elegans. The potency for effects on survival, growth, and reproduction reduced in the order +ve aminated > neutral unfunctionalized ≫ -ve carboxylated with toxicity >60-fold higher for the +ve than -ve charged forms. Toxicokinetic-toxicodynamic modeling (DEBtox) showed that the charge-related potency was primarily linked to differences in effect thresholds and dose-associated damage parameters, rather than to toxicokinetic parameters. This suggests that surface functionalization may change the nature of nanoplastic interactions with membrane and organelles leading to variations in toxicity. Eco-corona formation reduced the toxicity of all nanoplastics indicating that organic molecule associations may passivate surfaces. Between particles, eco-corona interactions resulting in more equivalent effects; however, even despite these changes, the order of potency of the charged forms was retained. These results have important implications for the development of future grouping approaches.

[The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]

OBJECTIVES

Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients.

METHODS

A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia".

RESULTS

LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients.

CONCLUSION

Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.

Short-term effects of two fungicides on enchytraeid and earthworm communities under field conditions

Because of the wide use of pesticides in agriculture, there is still a need of higher-tier field studies to assess ecotoxicological effects of commercial formulations on a wider variety of non-target soil organisms such as soil annelids. We here tested the effects of different concentrations of two fungicide formulations, i.e., Cuprafor Micro^® (composed of 500 g kg^-1 copper oxychloride) and Swing Gold^® (composed of 50 g l^-1 epoxiconazole and 133 g l^-1 dimoxystrobin) on two families of terrestrial oligochaetes (Lumbricidae and Enchytraeidae) after 1 month of exposure. We also assessed the feeding activity of soil organisms using the bait lamina method. Along with the feeding activity, the enchytraeid density, diversity and communities were not different in the control and the contaminated plots. By contrast, epigeic earthworms were absent and earthworm diversity and densities of anecic species decreased significantly in the plots contaminated at ten times the recommended dose of the Swing Gold^® formulation. The copper fungicide (at 0.75 and 7.5 kg Cu ha^-1) and the treatment with the pesticide mixture (Cuprafor Micro^® at 0.75 kg Cu ha^-1 and Swing Gold^® at the recommended dose) did not affect Oligochaeta communities compared with the control, except the Shannon index for earthworms in the mixture of both fungicides. Responses of the two annelid families to the tested pesticides were different with higher effects observed on the diversity and the community structure of earthworms compared with enchytraeids. This study allowed detecting early changes on oligochaete populations after pesticide application.

Chapitre C - Troubles vésico-sphinctériens et sclérose en plaques

Multiple sclerosis (MS) is a neurological disease characterized by multiple demyelinating lesions disseminated throughout the central nervous system (nerve conduction block). The management of these patients requires a perfect knowledge of the natural history of the disease. In this article, the authors review the literature to identify the most frequent voiding disorders observed in this disease and then study the diagnostic and therapeutic modalities and the optimal modalities of follow-up in these patients, in view of the risk of various urological complications.

Aporrectodea caliginosa, a relevant earthworm species for a posteriori pesticide risk assessment: current knowledge and recommendations for culture and experimental design

Ecotoxicological tests with earthworms are widely used and are mandatory for the risk assessment of pesticides prior to registration and commercial use. The current model species for standardized tests is Eisenia fetida or Eisenia andrei. However, these species are absent from agricultural soils and often less sensitive to pesticides than other earthworm species found in mineral soils. To move towards a better assessment of pesticide effects on non-target organisms, there is a need to perform a posteriori tests using relevant species. The endogeic species Aporrectodea caliginosa (Savigny, 1826) is representative of cultivated fields in temperate regions and is suggested as a relevant model test species. After providing information on its taxonomy, biology, and ecology, we reviewed current knowledge concerning its sensitivity towards pesticides. Moreover, we highlighted research gaps and promising perspectives. Finally, advice and recommendations are given for the establishment of laboratory cultures and experiments using this soil-dwelling earthworm species.

A two years field experiment to assess the impact of two fungicides on earthworm communities and their recovery

Recent EFSA (European Food Safety Authority) reports highlighted that the ecological risk assessment of pesticides needed to go further by taking more into account the impacts of chemicals on biodiversity under field conditions. We assessed the effects of two commercial formulations of fungicides separately and in mixture, i.e., Cuprafor Micro® (containing 500 g kg^-1 copper oxychloride) at 4 (C1, corresponding to 3.1 mg kg^-1 dry soil of copper) and 40 kg ha^-1 (C10), and Swing® Gold (50 g L^-1 epoxiconazole EPX and 133 g L^-1 dimoxystrobin DMX) at one (D1, 5.81 10^-2 and 1.55 10^-1 mg kg^-1 dry soil of EPX and DMX, respectively) and ten times (D10) the recommended field rate, on earthworms at 1, 6, 12, 18 and 24 months after the application following the international ISO standard no. 11268-3 to determine the effects on earthworms in field situations. The D10 treatment significantly reduced the species diversity (Shannon diversity index, 54% of the control), anecic abundance (29% of the control), and total biomass (49% of the control) over the first 18 months of experiment. The Shannon diversity index also decreased in the mixture treatment (both fungicides at the recommended dose) at 1 and 6 months after the first application (68% of the control at both sampling dates), and in C10 (78% of the control) at 18 months compared with the control. Lumbricus terrestris, Aporrectodea caliginosa, Aporrectodea giardi, Aporrectodea longa, and Allolobophora chlorotica were (in decreasing order) the most sensitive species to the tested fungicides. This study not only addressed field ecotoxicological effects of fungicides at the community level and ecological recovery, but it also pinpointed some methodological weaknesses (e.g., regarding fungicide concentrations in soil and statistics) of the guideline to determine the effects on earthworms in field situations.

Usability of daily SF36 questionnaires to capture the QALD variation experienced after vaccination with AS03A-adjuvanted monovalent influenza A (H5N1) vaccine in a safety and tolerability study

BACKGROUND

This study aims to describe the short-term reactogenicity of the AS03-adjuvanted H5N1 vaccine expressed through adverse events (AEs) and quality-adjusted life-day (QALD) scores. The AEs are likely to be short-term and therefore the quality of life (QoL) questionnaire, SF-36v2, was administered daily to record changes over seven days. A more sensitive application of this instrument should allow for a better understanding of short-term tolerability of adjuvanted vaccines.

METHODS

Participants (N = 50) received a 2-dose vaccination schedule. Solicited (collected daily: days 0 to 7 [post dose 1] and 21 to 28 [post dose 2]) and unsolicited (collected weekly until day 21) AEs were collected via diary cards. The QoL questionnaires were completed daily (days 0-6) and weekly (days 0, 6, 21, 27) after dose one. Questionnaire data were transformed into SF-6D scores to report QALDs. It was hypothesized post-hoc that the QALD and daily AEs scores should correlate if discrete QoL-changes were captured.

RESULTS

Pain (92%) and muscle ache (66%) were the most commonly reported solicited local and general AEs respectively, neither increased in intensity nor in frequency after dose 2. No safety concerns were identified during the study. A correlation between the daily AEs and QALD scores existed (correlation coefficient, - 0.97 (p < 0.001)). The impact of the AEs scores on the QALD was marginal (- 0.02 max for one day).

CONCLUSION

Similarly with other H5N1 studies, no safety concern was identified throughout the study. Some time-limited variations in QALD-scores were reported. Our results imply that daily administration of the SF-36v2 captures changes in QALD-scores.

TRIAL REGISTRATION

ClinicalTrials.gov . NCT01788228. Registered 11 February 2013.

[Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]

Confrontés à une crise d’une ampleur exceptionnelle liée à la pandémie à coronavirus COVID-19 responsable d’une saturation selon les régions des urgences et des places en réanimation, le Comité Lithiase de l’Association Française d’Urologie (CLAFU) a élaboré pour la première fois les recommandations de prise en charge des calculs urinaires durant cette crise sanitaire.

Effects of two common fungicides on the reproduction of Aporrectodea caliginosa in natural soil

The use of pesticides in agroecosystems can have negative effects on earthworms, which play key roles in soil functioning such as organic matter decomposition. The aim of this study was to assess the effects of two fungicides (Cuprafor micro^®, composed of copper oxychloride, and Swing Gold^®, composed of epoxiconazole (EPX) and dimoxystrobin (DMX)) on earthworm reproduction by exposing adults and cocoons. First, adult Aporrectodea caliginosa individuals were exposed for 28 days to 3.33, 10 and 30 times the recommended dose (RD) of Cuprafor micro^® corresponding to 25.8, 77.5 and 232.5 mg kg^-1 dry soil of copper, respectively, and 0.33, 1 and 3 times the RD of Swing Gold^® (corresponding to 5.2 × 10^-2 mg DMX kg^-1 + 1.94 × 10^-2 mg EPX kg^-1, 1.55 × 10^-1 mg DMX kg^-1 + 5.81 × 10^-2 mg EPX kg^-1 and 4.62 × 10^-1 mg DMX kg^-1 + 1.74 × 10^-1 mg EPX kg^-1 respectively), in addition to a control soil with no fungicide treatment. Cocoon variables (production, weight, hatching success, hatching time) were monitored. Second, "naïve" cocoons produced by uncontaminated earthworms were exposed to soils contaminated by the same concentrations of the two fungicides, and we assessed hatching success and hatching time. In the first experiment, cocoon production was halved at the highest copper concentration (232.5 mg Cu kg^-1 of dry soil) as compared to the control. Cocoons took 5 more days to hatch, and the hatching success decreased by 35% as compared to the control. In the Swing Gold^® treatments, cocoon production was reduced by 63% at 3 times the RD, and the hatching success significantly decreased by 16% at the RD. In the second experiment, only the hatching success of cocoons was impacted by Swing Gold^® at 3 times the RD (30% less hatching). It is concluded that the cocoon stock in the soil is crucial for the renewal of populations in the field. The most sensitive endpoint was the hatching success of the cocoons produced by exposed adults. This endpoint and the effects observed on the "naïve" cocoons could be taken into account in pesticide risk assessment.