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Ziel der vorliegenden Arbeit war es, höhervalente Imido- und Amidoverbindungen des Niobs und Tantals zu synthetisieren und deren Reaktivität gegenüber Phosphoryliden zu untersuchen. Klassische Phosphorylid-Komplexe des Typs [LnM-CHR-PR'3] (R = Alkyl, Aryl, etc.) sind in der Literatur zahlreiche beschrieben. Metall-substituierte Phosphorylide, so genannte a-Phosphoniomethyliden-Komplexe der Art [LnM=CH-PR3] sind dagegen vergleichsweise wenig untersucht, wobei sich die Arbeiten vor allem mit tetravalenten Metallocenderivaten der 4. Gruppe, des Urans sowie im eigenen Arbeitskreis mit den Elementen der VI. Nebengruppe und des Rheniums beschäftigen. Vertreter von Imidoyl-substituierten Ylidkomplexen des Niobs und Tantals, die isolobal zu den Metallocenen der IV. Nebengruppe und der Diimide der VI. Nebengruppe sind, waren dagegen zu Beginn dieser Studien gänzlich unbekannt. Im Vergleich zu den im eigenen Arbeitskreis hergestellten Molybdän- und Wolframverbindungen der allgemeinen Zusammensetzung [M(NtBu)2(CHPR3)R'] sollten Komplexe der 5. Gruppe [(h5-C5R5)M(NtBu)(CHPR3)R'] noch stärker polare und daher reaktivere Metall-Kohlenstoff-Bindungen enthalten. Diese galt es zu synthetisieren und in ihrer Reaktivität zu untersuchen. Die in dieser Arbeit beschriebenen Verbindungen umfassen Halbsandwichkomplexe des Typs [(h5-C5R5)M(NtBu)R'2] (M = Nb, Ta; R = H, Me), Metallocen-Imide [(h5-C5H5)2M(NtBu)Cl], Imido-verbrückten d1-Dimere [(h5-C5H5)M(m-NtBu)Cl]2, a-Phosphonio(methyliden)-Komplexe, den Bis-a-phosphonio(methyliden)-Komplex [(h5-C5Me5)Nb(NtBu)(CHPPh2Me)2], Ylid-Addukte [(h5-C5Me5)MCl4(CH2PPh3)], h2-Iminoacyl-, h2-Acyl-, Carboxylato-, Dithiocarboxylato-Komplexe gebildet durch Insertionsreaktionen an Ylid- und Amido-Komplexen, Biaryl-Metallacyclen durch Insertion von Ylid- und Amidokomplexen in diastereotope Biaryllactone, Bisimido-Tantalmetallate, Imido-Amido-Pyridin-Addukte [M(NtBu)(NHtBu)Cl2py2], der tris-Phosphonio(methyliden)-Komplex [Ta(NtBu)(CHPPh3)3.
Objectives
Dengue virus (DENV) detection by polymerase chain reaction (PCR) facilitates diagnosis of dengue fever, which is the most frequent arboviral disease globally. Two studies were performed in countries with high dengue incidence, to assess the diagnostic performance of different PCR techniques.
Methods/Results
Two hundred and seventy‐nine acute phase blood samples from febrile patients were analyzed for DENV by the RealStar Dengue RT‐PCR kit (Altona Diagnostics) as gold standard in comparison with the Tropical Fever Core multiplex PCR (Fast Track Diagnostics). In total, 102 samples collected in Savannakhet Province (Lao PDR, Southeast Asia) in 2013 and 35 samples from Valledupar (Colombia, South America) tested positive for DENV by RealStar RT‐PCR. In comparison, the Tropical Fever Core multiplex PCR detected 65.0% (65/102) and 68.6% (24/35) of these samples as positive for DENV in Savannakhet and Valledupar, respectively. Diagnostic sensitivity of the multiplex PCR strongly correlated with viral load. A subset of DENV PCR‐confirmed samples was additionally tested by BNITM in house Dengue Type RT‐PCR in comparison with two commercial test kits (RealStar Dengue Type RT‐PCR [Altona Diagnostics], Dengue differentiation PCR [Fast Track Diagnostics]). The leading dengue serotype in Savannakhet was DENV‐3 (58% [29/50]), while DENV‐1 (53.8% [14/26]) was the predominant serotype found in samples collected in Valledupar by BNITM‐type PCR. However, three DENV serotypes were circulating in Valledupar and in Savannakhet. In 2015, additional studies found predominantly DENV‐4 (71% [12/17]) in Savannakhet.
Conclusions
Both studies emphasized that routine diagnostics in both regions will benefit from an expanded use of highly sensitive pan‐dengue PCRs.
The gastrointestinal tract is abundantly colonized by microbes, yet the translocation of oral species to the intestine is considered a rare aberrant event, and a hallmark of disease. By studying salivary and fecal microbial strain populations of 310 species in 470 individuals from five countries, we found that transmission to, and subsequent colonization of, the large intestine by oral microbes is common and extensive among healthy individuals. We found evidence for a vast majority of oral species to be transferable, with increased levels of transmission in colorectal cancer and rheumatoid arthritis patients and, more generally, for species described as opportunistic pathogens. This establishes the oral cavity as an endogenous reservoir for gut microbial strains, and oral-fecal transmission as an important process that shapes the gastrointestinal microbiome in health and disease.
Background
Pemphigus vulgaris and pemphigus foliaceus are potentially life-threatening autoimmune disorders triggered by IgG autoantibodies against mucosal and epidermal desmogleins. There is an unmet need for fast-acting drugs that enable patients to achieve early sustained remission with reduced corticosteroid reliance.
Objectives
To investigate efgartigimod, an engineered Fc fragment that inhibits the activity of the neonatal Fc receptor, thereby reducing serum IgG levels, for treating pemphigus.
Methods
Thirty-four patients with mild-to-moderate pemphigus vulgaris or foliaceus were enrolled in an open-label phase II adaptive trial. In sequential cohorts, efgartigimod was dosed at 10 or 25 mg kg\(^{-1}\) intravenously with various dosing frequencies, as monotherapy or as add-on therapy to low-dose oral prednisone. Safety endpoints comprised the primary outcome. The study is registered at ClinicalTrials.gov (identifier NCT03334058).
Results
Adverse events were mostly mild and were reported by 16 of 19 (84%) patients receiving efgartigimod 10 mg kg\(^{-1}\) and 13 of 15 (87%) patients receiving 25 mg kg−1, with similar adverse event profiles between dose groups. A major decrease in serum total IgG and anti-desmoglein autoantibodies was observed and correlated with improved Pemphigus Disease Area Index scores. Efgartigimod, as monotherapy or combined with prednisone, demonstrated early disease control in 28 of 31 (90%) patients after a median of 17 days. Optimized, prolonged treatment with efgartigimod in combination with a median dose of prednisone 0·26 mg \(^{-1}\) per day (range 0·06–0·48) led to complete clinical remission in 14 of 22 (64%) patients within 2–41 weeks.
Conclusions
Efgartigimod was well tolerated and exhibited an early effect on disease activity and outcome parameters, providing support for further evaluation as a therapy for pemphigus.