Challenges of loss to follow-up in tuberculosis research

Background

In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined.

Methods

In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up.

Results

Being treated for active TB in the DOTS program (OR: 4.14; 95% CI:1.99–8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence.

Conclusion

Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol.     

Challenges facing drug development for malaria

Malaria is a significant cause of morbidity and mortality in the developing world. Until recently malaria was winning but with increase in funding particularly from philanthropic groups the ability to control malaria is again possible. There are still many challenges to developing the next generations of anti-malarials. This article will briefly discuss the challenges and the advance that are being made.     

Metabolomics for phytomedicine research and drug development

Metabolomics, including both targeted and global metabolite profiling strategies, is fast becoming the approach of choice across a broad range of sciences including systems biology, drug discovery, molecular and cell biology, and other medical and agricultural sciences. New analytical and bioinformatics technologies and techniques are continually being created or optimized, significantly increasing the crossdisciplinary capabilities of this new biology. The metabolomes of medicinal plants are particularly a valuable natural resource for the evidence-based development of new phytotherapeutics and nutraceuticals. Comparative metabolomics platforms are evolving into novel technologies for monitoring disease development, drug metabolism, and chemical toxicology. An efficient multidisciplinary marriage of these emerging metabolomics techniques with agricultural biotechnology will greatly benefit both basic and applied medical research.     

对研发新型结核病疫苗的分析和展望

结核病是公共卫生当前面临的重要问题。由于BCG预防效果不佳,研究和开发新型结核病疫苗显得必须且急迫。新型结核病疫苗的研究开发路径和观念也经历了变迁,当前主流的研发路径有重组BCG或重组结核菌、重组痘病毒或重组腺病毒载体疫苗、蛋白质亚单位或重组融合蛋白质亚单位疫苗三类,它们在疫苗效力前景,抗原选型、配方、剂型,免疫应答,疫苗生产,疫苗质量控制,临床前研究动物试验,临床试验和使用,对结核病公共卫生政策的影响等方面各有优劣。新型结核病疫苗的成功研发,还需要病原学、发病机制、免疫学和疫苗研发科学的进一步努力。     

Multi-target drugs: the trend of drug research and development

Summarizing the status of drugs in the market and examining the trend of drug research and development is important in drug discovery. In this study, we compared the drug targets and the market sales of the new molecular entities approved by the U.S. Food and Drug Administration from January 2000 to December 2009. Two networks, namely, the target-target and drug-drug networks, have been set up using the network analysis tools. The multi-target drugs have much more potential, as shown by the network visualization and the market trends. We discussed the possible reasons and proposed the rational strategies for drug research and development in the future.     

从文献计量看海洋药物研发趋势的变化

本文对Science Citation Index Expanded （SCI-E）以及Medline数据库1998—2007年收录的海洋药物相关文章进行文献讨一量分析,统计了发文量居前10位的国家或地区、研究机构、作者以及他们各自对应文章的总被引频次和平均被引频次等数据,数据库中所收录的文献的附加关键词和主题词分布等,以反映近年来海洋药物研发趋势的变化。     

Challenges,achievements and opportunities in allelopathy research

Abstract

Allelopathy is defined as the suppression of any aspect of growth and/or development of one plant by another through the release of chemical compounds. Although allelopathic interference has been demonstrated many times using in vitro experiments, few studies have clearly demonstrated allelopathy in natural settings. This difficulty reflects the complexity in examining and demonstrating allelopathic interactions under field conditions. In this paper we address a number of issues related to the complexity of allelopathic interference in higher plants: These are: (i) is a demonstrated pattern or zone of inhibition important in documenting allelopathy? (ii) is it ecologically relevant to explain the allelopathic potential of a species based on a single bioactive chemical? (iii) what is the significance of the various modes of allelochemical release from the plant into the environment? (iv) do soil characteristics clearly influence allelopathic activity? (v) is it necessary to exclude other plant interference mechanisms?, and (vi) how can new achievements in allelopathy research aid in solving problems related to relevant ecological issues encountered in research conducted upon natural systems and agroecosystems? A greater knowledge of plant interactions in ecologically relevant environments, as well as the study of biochemical pathways, will enhance our understanding of the role of allelopathy in agricultural and natural settings. In addition, novel findings related to the relevant enzymes and genes involved in production of putative allelochemicals, allelochemical persistence in the rhizosphere, the molecular target sites of allelochemicals in sensitive plant species and the influence of allelochemicals upon other organisms will likely lead to enhanced utilization of natural products for pest management or as pharmaceuticals and nutraceuticals. This review will address these recent findings, as well as the major challenges which continue to influence the outcomes of allelopathy research.     

结核分枝杆菌及其L型耐药机制与茜草素作用的研究进展

结核分枝杆菌的细菌型与L型(细胞壁缺陷型)的耐药,尤其是多重耐药和泛耐药现象对现有的临床抗结核治疗提出了严峻挑战.本文对结核分枝杆菌细菌型和L型耐药机制,以及中草药茜草素的抗菌作用进行了分析,以期建立有效的抗结核治疗方法,提高临床抗结核治疗水平.     

Microdissection approaches in tuberculosis research

Mycobacterium tuberculosis, a globally significant pathogen, results in active or latent tuberculosis. The granuloma is the characteristic lesion that offers insight into host–pathogen interactions in these distinct states. Microdissection provides a way to isolate and consequently investigate specific tissue sections. We review various techniques available and in use.     

Challenges in microbial fuel cell development and operation

A microbial fuel cell (MFC) is a device that converts chemical energy into electricity through the catalytic activities of microorganisms. Although there is great potential of MFCs as an alternative energy source, novel wastewater treatment process, and biosensor for oxygen and pollutants, extensive optimization is required to exploit the maximum microbial potential. In this article, the main limiting factors of MFC operation are identified and suggestions are made to improve performance.     

Integrating research and development: the emergence of rational drug design in the pharmaceutical industry

Rational drug design is a method for developing new pharmaceuticals that typically involves the elucidation of fundamental physiological mechanisms. It thus combines the quest for a scientific understanding of natural phenomena with the design of useful technology and hence integrates epistemic and practical aims of research and development. Case studies of the rational design of the cardiovascular drugs propranolol, captopril and losartan provide insights into characteristics and conditions of this integration. Rational drug design became possible in the 1950s when theoretical knowledge of drug-target interaction and experimental drug testing could interlock in cycles of mutual advancement. The integration does not, however, diminish the importance of basic research for pharmaceutical development. Rather, it can be shown that still in the 1990s, linear processes of innovation and the close combination of practical and epistemic work were interdependent.     

Adjuvants in tuberculosis vaccine development

Tuberculosis remains a major public health problem around the world. Because the Mycobacterium bovis Bacilli–Calmette–Guerin (BCG) vaccine fails to protect adults from pulmonary tuberculosis, there is an urgent need for improved vaccine formulations. Unlike BCG, recombinant vaccines purified from bacterial expression vectors, as well as naked DNA, require an additional adjuvant. Recent improvements in our understanding of disease immunopathology, together with advances in biochemical and molecular techniques, have permitted the successful development of promising tuberculosis vaccine delivery and adjuvant combinations for human use. Here, we summarize the current state of adjuvant development and its impact on tuberculosis vaccine progress.     

空洞型肺结核组织样本耐药菌及相关基因检测的临床研究

目的:比较分析空洞型肺结*核组织样本与痰样本结核分枝杆菌培养的阳性率及检测的一致性,并基于rpoB基因及KatG基因突变检测在诊断耐多药结核分枝杆菌中的重要作用,探讨直接应用肺结核组织样本进行结核分枝杆菌耐药性检测的临床意义.方法:对肺结核实施肺部手术患者,在术前和术后分别进行痰及手术切除组织样本利用BacT ALERT 3D快速培养系统进行分枝杆菌培养,对培养阳性者进行菌种鉴定,对结核分枝杆菌分离株应用绝对浓度法进行异烟肼(H)、利福平(R)药物敏感性测定,比较分析二者的一致性;同时应用特异性引物对手术切除组织样本直接进行分枝杆菌rpoB、KatG基因扩增,并与其培养结果进行比较.结果:62例进入分析的病例中,术前痰培养阳性22例,阳性率35.5%(22/62),药敏试验耐药18例,耐异烟肼16例,耐利福平13例.二者均耐药12例,术中所取结核组织培养阳性34例,阳性率55%(34/62),耐药30例,耐H26例,耐R20例,二者均耐药17例,术中所取结核组织耐药基因检测与INH耐药性相关的KatG基因突变表现有22例,与RFP的耐药性相关的rpoB基因突变18例.二者同时有突变表现的16例.所有培养为结核敏感菌的组织检测中,无上述二基因突变表现.在相关的rpoB基因突变18例病例中有16例同时表现出KatG基因突(89%,16/18).结论:厚壁空洞肺结核患者肺部手术切除组织样本病原学检测与痰样本间具有较好的一致性,且结核菌培养的阳性率明显高于普通痰培养.同时可直接应用组织样本进行结核分枝杆菌rpoB基因、KatG基因检测,可更加及时、准确地用于指导临床术后抗结核的药物治疗.