Structural Insights into Transporter-Mediated Drug Resistance in Infectious Diseases

Infectious diseases present a major threat to public health globally. Pathogens can acquire resistance to anti-infectious agents via several means including transporter-mediated efflux. Typically, multidrug transporters feature spacious, dynamic, and chemically malleable binding sites to aid in the recognition and transport of chemically diverse substrates across cell membranes. Here, we discuss recent structural investigations of multidrug transporters involved in resistance to infectious diseases that belong to the ATP-binding cassette (ABC) superfamily, the major facilitator superfamily (MFS), the drug/metabolite transporter (DMT) superfamily, the multidrug and toxic compound extrusion (MATE) family, the small multidrug resistance (SMR) family, and the resistance-nodulation-division (RND) superfamily. These structural insights provide invaluable information for understanding and combatting multidrug resistance.     

Survey Insights into Weighting Environmental Damages: Influence of Context and Group

When one models impact pathways due to stressors that are caused by the provision of product systems, it results in indicators for environmental damages. These indicators are incommensurable and cannot be compared per se. For example, the statistical life years lost for a human population cannot necessarily be compared with the potentially affected fraction of species within an ecosystem. However, some decision makers who use life-cycle assessment (LCA) prefer a single index, because it facilitates interpretation better than a multi-indicator system. This requires a method for aggregating environmental damages of differing types, thereby confronting LCA with a valuation problem.
The article describes a nonmonetary approach to valuation in LCA that incorporates the findings of a survey among LCA practitioners and users. The survey focuses on the weighting of three safeguard subjects for Eco-indicator 99, a damage-oriented impact-assessment method: human health, ecosystem quality, and resources. Of particular interest here is what influence the context provided in the survey (framing) and an individual's characteristics have on his or her weighting of environmental damages. The results indicate that damages on the European level are easier to compare than damages on a micro level. Additionally, although only half of the survey participants could be classified unequivocally into one of three cultural perspectives, each perspective rated the damage categories presented to them significantly differently from the others. Our conclusions were that framing effects need to be more carefully considered in weighting procedures and that weighting preferences vary significantly according to a group's archetypical attitudes.     

Cost Resulting from Anti-Tuberculosis Drug Shortages in the United States: A Hypothetical Cohort Study

BackgroundFrom 2012 through 2014, the United States experienced acute shortages and price escalations of several first-line anti-tuberculosis (TB) medications. Because secondary TB drug regimens are longer and adverse events occur more frequently with them, we sought to conservatively estimate the cost, to patients and the health care system, of TB treatment and medication adverse events from alternative regimens during drug shortages.MethodsWe assessed the cost of treatment for TB disease in the absence of isoniazid (INH), rifampin (RIF), or pyrazinamide (PZA), or both INH and RIF. We simulated adverse events based on published probabilities using a monthly discrete-time stochastic model. For total costs, we summed costs of medications, routine testing, and treatment of adverse events using procedural terminology codes. We report average cost ratios of TB treatment during drug shortages to standard TB treatment.ResultsThe cost ratio of TB treatment without INH, RIF, or PZA to standard treatment was 1.7 (Range: 1.2, 2.3), 4.9 (Range: 3.2, 7.3), and 1.1 (Range: 0.7, 1.7) times higher, respectively. Without both INH and RIF, the cost ratio was 18.6 (Range: 10.0, 39.0) times higher. When the prices for INH, RIF and PZA were increased, the cost for standard treatment increased by a factor of 2.7 (Range: 1.9, 3.0). The percentage of patients experiencing at least one adverse event while taking standard therapy was 3.9% (Range: 1.3%, 11.8%). This percentage increased to 51.5% (Range: 20.1%, 83.8%) when RIF was unavailable, and increased to 82.5% (Range: 41.2%, 98.5%) when both INH and RIF were unavailable.ConclusionsOur conservative model illustrates that an interruption in first-line anti-TB medications leads to appreciable additional costs and adverse events for patients. The availability of these drugs in the United States should be ensured. Models that incorporate the effectiveness of alternative regimens, delays in treatment initiation, and TB transmission can provide broader perspectives on the impact of drug shortages.     

A Survey of Cardiac Infarctions: Hospital Experience

A study of patients with cardiac infarction, treated in hospital between 1950 and 1954 and followed up to the present, is reported. One hundred and forty-two patients suffered 169 attacks. In 95 attacks, the patients received anticoagulant therapy, with 15 acute deaths. Fifty-six were not so treated; among these there were 21 deaths. The rate of survival was best in younger patients with their first episode of infarction, without preexisting hypertension, cardiac failure, or systolic blood pressure persistently below 100. Angina preceding infarction disappeared in one-half of the subjects after the episode; half the survivors suffered recurrent myocardial infarction within five years. Moderate hypertension had no effect upon immediate or 10-year survival. No patient received long-term anticoagulant therapy. Of the survivors of acute infarction, 16 died in the first year after the acute attack, nine in the second year, nine in the third, six in the fourth and five in the fifth. At the end of five years, 51 subjects had survived 60 episodes. At the end of 10 years, 43 living patients had sustained 45 myocardial infarctions.     

Y not introgress? Insights into the genetics of speciation in European rabbits

Hybridization between genetically divergent populations is common in nature. By comparing the rate of gene flow throughout the genome, loci that impede genetic mixing, and therefore underlie reproductive isolation, can be identified, providing key insights into the process of speciation. In a previous issue of Molecular Ecology , Geraldes et al . (2008) report the geographical distribution of Y chromosome lineages in wild populations of rabbits from across the Iberian Peninsula and southern France. Y chromosomes showed a high level of differentiation between rabbit subspecies on either side of a hybrid zone, despite clear evidence for gene flow at other loci. This provocative result suggests a role for the Y chromosome in reproductive isolation, and adds to a growing list of nascent species with mosaic patterns of differentiation across their genomes.     

Insights into spawning behavior and development of the European amphioxus (Branchiostoma lanceolatum)

The cephalochordate amphioxus (Branchiostoma sp.) is an important animal model for studying the evolution of chordate developmental mechanisms. Obtaining amphioxus embryos is a key step for these studies. It has been shown that an increase of 3-4 degrees C in water temperature triggers spawning of the European amphioxus (Branchiostoma lanceolatum) in captivity, however, very little is known about the natural spawning behavior of this species in the field. In this work, we have followed the spawning behavior of the European amphioxus during two spawning seasons (2004 and 2005), both in the field and in captivity. We show that animals in the field spawn approximately from mid-May through early July, but depending on the year, they show different patterns of spawning. Thus, even if temperature has a critical role in the induction of the spawning in captivity, it is not the major factor in the field. Moreover, we report some improvements on the methodology for inducing spawning in captivity (e.g. in maintenance, light cycle control and induction of spawning in a laboratory without running sea water system). These studies have important implications for amphioxus animal husbandry and for improving laboratory techniques to develop amphioxus as an experimental animal model.     

A Qualitative Approach to a Better Understanding of the Problems Underlying Drug Shortages,as Viewed from Belgian,French and the European Union’s Perspectives

The problem of drug shortages has been reported worldwide, gaining prominence in multiple domains and several countries in recent years. The aim of the study was to analyze, characterise and assess this problem in Belgium and France, while also adopting a wider perspective from the European Union. A qualitative methodological approach was employed, including semi-structured interviews with the representatives of respective national health authorities, pharmaceutical companies and wholesalers, as well as hospital and community pharmacists. The research was conducted in early 2014. Four themes, which were identified through the interviews, were addressed in the paper, i.e. a) defining drug shortages, b) their dynamics and perception, c) their determinants, d) the role of the European and national institutions in coping with the problem. Three groups of determinants of drug shortages were identified throughout this study: manufacturing problems, distribution and supply problems, and problems related to economic aspects. Currently, the Member States of the European Union are striving to resolve the problem very much on their own, although a far more focused and dedicated collaboration may well prove instrumental in coping with drug shortages throughout Europe more effectively. To the best of the authors’ knowledge, this is the first qualitative study to investigate the characteristics, key determinants, and the problem drivers of drug shortages, focusing on this particular group of countries, while also adopting the European Union’s perspective.     

Hospital Junior Doctors: Survey at Northampton General Hospital

A survey of hospital junior doctors made in 1967–8 showed that there were many features of their work with which they were not content. These included career prospects, hours of work, and salaries. It is suggested that reorganization of the career structure and the provision of better-organized ancillary help would do much to improve the lives of hospital junior doctors.     

Food Choices and Consequences for the Nutritional Status: Insights into Nutrition Transition in an Hospital Community

Introduction

Although economic development is generally accompanied by improvements in the overall nutritional status of the country’s population the ‘nutritional transition’ often involves a shift to high energy diets and less exercise with negative consequences. This pilot study was done to examine if education of parents operates at the household level to influence dietary choices and the nutritional status of children in a small community of hospital workers.

Material and Methods

3 groups of persons with varying skill and education levels participated. Weighed food logs were used in all households to calculate ‘adult equivalent’ per-capita-consumption. Nutrients were calculated using nutrients calculator software. BMI was used to classify children as underweight, normal weight and overweight.

Results

128 individuals participated from 30 families included 47 children. 10 children (21%) were underweight, 29 (62%) were normal and 8 (17%) were overweight. Energy consumption was highest in families with overweight children 2692 +/-502 compared to 2259 +/-359 in families with normal weight and 2031+/-354 in the family of underweight children. These differences were statistically significant. 42% underweight children belonged to Class 1 at the lowest skill level and there were no overweight children in this group. Most of the overweight children belonged to Class 2. In Class 3 there were no underweight children and the majority was normal weight children.

Conclusion

Underweight children came from the poorer households. Per capita intake of the family as a whole correlated well with BMI in the children. There was increased obesity in middle income families belonging to Class 2—probably in families who move up the scale from deprivation. Nutritional status in children correlated mostly with maternal education status.     

Stem cells: Insights into the secretome

Stem cells have been considered as possible therapeutic vehicles for different health related problems such as cardiovascular and neurodegenerative diseases and cancer. Secreted molecules are key mediators in cell–cell interactions and influence the cross talk with the surrounding tissues. There is strong evidence supporting that crucial cellular functions such as proliferation, differentiation, communication and migration are strictly regulated from the cell secretome. The investigation of stem cell secretome is accumulating continuously increasing interest given the potential use of these cells in regenerative medicine. The scope of the review is to report the main findings from the investigation of stem cell secretome by the use of contemporary proteomics methods and discuss the current status of research in the field. This article is part of a Special Issue entitled: An Updated Secretome.     

DNA Methylation: Insights into Human Evolution

A fundamental initiative for evolutionary biologists is to understand the molecular basis underlying phenotypic diversity. A long-standing hypothesis states that species-specific traits may be explained by differences in gene regulation rather than differences at the protein level. Over the past few years, evolutionary studies have shifted from mere sequence comparisons to integrative analyses in which gene regulation is key to understanding species evolution. DNA methylation is an important epigenetic modification involved in the regulation of numerous biological processes. Nevertheless, the evolution of the human methylome and the processes driving such changes are poorly understood. Here, we review the close interplay between Cytosine-phosphate-Guanine (CpG) methylation and the underlying genome sequence, as well as its evolutionary impact. We also summarize the latest advances in the field, revisiting the main literature on human and nonhuman primates. We hope to encourage the scientific community to address the many challenges posed by the field of comparative epigenomics.     

肠道菌群与病毒性肺炎关系的研究进展

在21世纪头20年里,呼吸道病毒造成的地区性乃至世界性的流行已经发生多次,而疫情的暴发严重威胁人类健康与生存,但临床上,仍缺乏针对病毒的特异性治疗手段。随着肠道微生态相关研究的广泛开展,肠道菌群在哮喘,纤维化及细菌性感染等多种肺部疾病的发病及防治中发挥着重要作用,成为"肠-肺轴"的关键枢纽。病毒性肺炎与肠道微生态间也存在着紧密的相互联系,通过改善肠道菌群,对呼吸病毒感染具有较好的防治作用。其内在机制主要涉及到:通过增强肠道黏膜屏障功能、减少继发性细菌的感染;通过菌体成分或者代谢产物如短链脂肪酸,色氨酸代谢产物等提高固有样淋巴细胞(Innate lymphoid cells,ILC)、单核-巨噬细胞、树突状细胞、自然杀伤细胞(Natural killer,NK)、粒细胞等固有免疫细胞的抗病毒免疫功能及调节Th17/Treg平衡抑制过度的炎症反应等。本文将系统回顾已发表的文章,对肠道菌群在病毒性肺炎方面的研究作系统的阐述,以求为研究者在病毒性肺炎的机制探究和防治方面提供帮助。     

A Survey of Hospital Infection in a Pediatric Hospital: Part I. Description of Hospital,Organization of Survey,Population Studied and Some General Findings

Of 17,836 children admitted in 1959, 6.5% developed infection following admission; most of these seemed to be hospital-acquired. Respiratory infections were commonest (2.7%), then gastroenteritis (1.3%), staphylococcal infections including miscellaneous and postoperative wounds (1.1%), pyrexias (0.5%), miscellaneous and post-operative wound infections due to other bacteria (0.4%), “communicable” diseases (0.3%) and monilial infections (0.2%). Incidences were highest in infants and on certain wards incapable of segregating all infected cases. Only 14.3% of infections were severe. They contributed to 16 deaths but not as the sole cause. Hospital infections made over 2070 extra patient-days necessary. Wound infection followed 3.1% of 5052 surgical operations-2.1% when considering only clean sites. Seventy per cent were staphylococcal; antibiograms suggested that some were not of hospital origin. Staphylococcal disease, present on admission or hospital-acquired, occurred in 2.6% of patients. None of these incidences seemed unduly high. Many varied factors underlie hospital infections, and complete control is unlikely with present knowledge and facilities.     

Insights into drought adaptation of two European oak species revealed by nucleotide diversity of candidate genes

Nucleotide diversity, correlations to environmental conditions, and deviations from standard neutral models were examined in eight candidate genes for drought response of European oaks Quercus petraea and Quercus robur. Baseline genetic parameters were calculated and deviation from neutrality was tested using Tajima’s D, and Fu and Li’s D and F statistics. Population structure was investigated using differentiation indices and Bayesian clustering. Similar values of total nucleotide diversity were found in both species with significant higher diversity at non-synonymous sites in Q. robur while the number of haplotypes was significantly higher in Q. petraea. Significant population differentiation was found for three genes in Q. petraea and for one gene in Q. robur. Within four genes, strong correlations were found between the local temperature–precipitation regime and the allele frequencies of six alleles, of which three were private to Q. petraea. Using various population genetic and Bayesian tests for neutrality, four outlier single nucleotide polymorphisms (SNPs) under putative selection were detected in two of the analyzed genes. Significant differentiation and strong allelic correlation to environmental conditions support preceding gene expression profiling experiments, where functional impact of candidate genes in drought response has been revealed. Q. petraea populations were found to be more differentiated as compared to Q. robur—this could be linked to the higher adaptive potential of this species under arid conditions.