| 1. |
- Pressler, Ronit M., et al.
(författare)
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Bumetanide for the treatment of seizures in newborn babies with hypoxic ischaemic encephalopathy (NEMO) : an open-label, dose finding, and feasibility phase 1/2 trial
- 2015
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Ingår i: Lancet Neurology. - 1474-4422 .- 1474-4465. ; 14:5, s. 469-477
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Tidskriftsartikel (refereegranskat)abstract
- Background Predinical data suggest that the loop-diuretic bumetanide might be an effective treatment for neonatal seizures. We aimed to assess dose and feasibility of intravenous bumetanide as an add-on to phenobarbital for treatment of neonatal seizures. Methods In this open-label, dose finding, and feasibility phase 1/2 trial, we recruited full-term infants younger than 48 h who had hypoxic ischaemic encephalopathy and electrographic seizures not responding to a loading-dose of phenobarbital from eight neonatal intensive care units across Europe. Newborn babies were allocated to receive an additional dose of phenobarbital and one of four bumetanide dose levels by use of a bivariate Bayesian sequential dose-escalation design to assess safety and efficacy. We assessed adverse events, pharmacokinetics, and seizure burden during 48 h continuous electroencephalogram (EEG) monitoring. The primary efficacy endpoint was a reduction in electrographic seizure burden of more than 80% without the need for rescue antiepileptic drugs in more than 50% of infants. The trial is registered with ClinicalTrials.gov, number NCT01434225. Findings Between Sept 1, 2011, and Sept 28, 2013, we screened 30 infants who had electrographic seizures due to hypoxic ischaemic encephalopathy. 14 of these infants (10 boys) were included in the study (dose allocation: 0.05 mg/kg, n=4; 0.1 mg/kg, n=3; 0. 2 mg/kg, n=6; 0.3 mg/kg, n=1). All babies received at least one dose of bumetanide with the second dose of phenobarbital; three were withdrawn for reasons unrelated to bumetanide, and one because of dehydration. All but one infant also received aminoglycosides. Five infants met EEG criteria for seizure reduction (one on 0.05 mg/kg, one on 0.1 mg/kg and three on 0.2 mg/kg), and only two did not need rescue antiepileptic drugs (ie, met rescue criteria; one on 0.05 mg/kg and one on 0.3 mg/kg). We recorded no short-term dose-limiting toxic effects, but three of 11 surviving infants had hearing impairment confirmed on auditory testing between 17 and 108 days of age. The most common non-serious adverse reactions were moderate dehydration in one, mild hypotension in seven, and mild to moderate electrolyte disturbances in 12 infants. The trial was stopped early because of serious adverse reactions and limited evidence for seizure reduction. Interpretation Our findings suggest that bumetanide as an add-on to phenobarbital does not improve seizure control in newborn infants who have hypoxic ischaemic encephalopathy and might increase the risk of hearing loss, highlighting the risks associated with the off-label use of drugs in newborn infants before safety assessment in controlled trials.
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| 2. |
- Rader, Erika, et al.
(författare)
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Preferably Plinian and Pumaceous : Implications of Microbial Activity in Modern Volcanic Deposits at Askja Volcano, Iceland, and Relevancy for Mars Exploration
- 2020
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Ingår i: ACS Earth and Space Chemistry. - : American Chemical Society (ACS). - 2472-3452. ; 4:9, s. 1500-1514
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Tidskriftsartikel (refereegranskat)abstract
- To search more efficiently for a record of past life on Mars, it is critical to know where to look and thus maximize the likelihood of success. Large-scale site selection for the Mars 2020 mission has been completed, but small (meter to 10 cm)-scale relationships of microenvironments will not be known until the rover reaches the surface. Over a 2 m transect at a modern volcanic deposit on the flank of Askja volcano in the barren highlands of Iceland, we compared two biological indicators (ATP activity and 16SrRNA amplicon sequence composition) to physical characteristics including bulk chemical composition, spectral signatures of mineralogy, and grain size. Using analytical instrumentation analogous to those available on Mars rovers, we were able to characterize the geological setting of the deposits and link physical parameters to microbial abundance and diversity. In general, methanogenesis, methanotrophy/methylotrophy, and nitrate reduction were the functional traits most associated with microbial community shift along the transect. Core microbiome members tended to be associated with nitrate reduction, and relative abundance of core microbes was strongly related to free water in the deposit. Community compositional shift of the rare microbiome was related to microenvironmental changes such as change in grain size, geochemistry, and age of deposit. These correlations lead us to suggest a sampling strategy that accounts for Martian geology, looking for undisturbed (not remobilized) explosive volcanic ash below pumice that could maximize diversity and abundance of different bioindicators. Our study also illustrates the importance of studying the variability across microenvironments in low biomass settings on earth.
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| 3. |
- Tan, George K., et al.
(författare)
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Spatial Variation in Results of Biosignature Analyses of Apparently Homogeneous Samples from Mars Analogue Environments in Iceland
- 2022
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Ingår i: ACS Earth and Space Chemistry. - : American Chemical Society (ACS). - 2472-3452. ; 6:6, s. 1472-1481
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Tidskriftsartikel (refereegranskat)abstract
- The search for signs of life on Mars and beyond is time consuming and labor-intensive; hence, it is critical to understand how to design sampling strategies that can maximize the likelihood of success. Two distinct Mars analogue environments in Iceland were selected to represent volcanic resurfacing and glacial environments where characterization of different biosignatures at various spatial scales (100 m, 10 m, 1 m, 10 cm) was performed. This study serves the twofold purposes of (1) understanding the different levels of biosignature distributions in these analogue environments and (2) the spatial distributions of biosignatures in these environments, with an overarching goal of drawing lessons from low biomass Mars analogue environments to inform the best sampling strategies for sample collection strategies on Mars. Our results show that samples should be collected for analysis at large (at least 100 m spacing) to capture most differences within an apparently homogeneous environment of the aged resurfaced volcanic region like Mælifellssandur, whereas a smaller spacing at 10 m scale is necessary for younger glacial–volcanic environments like Fimmvörduháls. This study also illustrates the importance of understanding the variability across spatial scales in sampling design for future planetary missions.
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