Focus: Personalized Medicine: Precision in Addiction Care: Does It Make a Difference?

This perspective article explores the possibilities of precision in addiction care — even better individually fitted or tailor-made care — and examines what changes we need to make in order to realize sensible progress in epidemiological key figures. The first part gives a short review on the development of addiction care and tries to answer the question of where we stand now and what has been achieved in addiction science through the development and evaluation of interventions in the past decades. Following this analysis, attention will be paid to what lies ahead. This second part focuses on the question of how addiction care can deal with the consequences of the emerging paradigm of personalized or precision medicine, which is based on the fundamental assumption that individual differences matter. Finally, some limitations and conditions as well as tasks and goals for progress are raised. In conclusion, it is argued that integration of addiction care in (mental) health care in the future is desirable.     

Does It Make Sense to Restore Wildland Fire in Changing Climate?

Forest restoration guided by historical reference conditions of fire regime, forest structure, and composition has been increasingly and successfully applied in fire‐adapted forests of western North America. But because climate change is expected to alter vegetation distributions and foster severe disturbances, does it make sense to restore the ecological role of wildland fire through management burning and related activities such as tree thinning? I suggest that some site‐ and date‐specific historical conditions may be less relevant, but reference conditions in the broad sense are still useful. Reference conditions encompass not only the recent past but also evolutionary history, reflecting the role of fire as a selective force over millennia. Taking a long‐term functional view of historical reference conditions as the result of evolutionary processes can provide insights into past forest adaptations and migrations under various climates. As future climates change, historical reference data from lower, southerly, and drier sites may be useful in places that are higher, northerly, and currently wetter. Almost all models suggest that the future will have substantial increases in wildfire occurrence, but prior to recent human‐caused fire exclusion, fire‐adapted pine forests of western North America were among the most frequently burned in the world. Restoration of patterns of burning and fuels/forest structure that reasonably emulate historical conditions prior to fire exclusion is consistent with reducing the susceptibility of these ecosystems to catastrophic loss. Priorities may include fire and thinning treatments of upper elevation ecotones to facilitate forest migration, whereas vulnerable low‐elevation forests may merit less management investment.     

Early Antenatal Care: Does It Make a Difference to Outcomes of Pregnancy Associated with Syphilis? A Systematic Review and Meta-Analysis

Objective

Despite an increase in the proportion of women who access antenatal care, mother-to-child transmission of syphilis continues to be a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis. We reviewed evidence on the optimal timing of antenatal interventions to prevent mother-to-child transmission of syphilis and its associated adverse outcomes.

Design

Systematic review and meta-analysis of published literature. English-language articles were included if they (1) reported the gestational age at which the mother was screened or tested for syphilis; (2) reported on pregnancy outcome. No publication date limits were set.

Results

We identified a total of 1,199 publications, of which 84 were selected for further review and five were included. All showed a lower prevalence of any adverse outcome among women who received an intervention (to include screening and treatment) in the first and second trimesters of pregnancy compared to the third trimester. The overall odds ratio for any adverse outcome was 2.24 (95% CI 1.28, 3.93). All sub-analyses by type of outcome presented important heterogeneity between studies, except for those studies reporting an infected infant (odds ratio 2.92, 95% CI 0.66, 12.87; I² = 48.2%, p = 0.165).

Conclusions

Our review has shown that the timing of antenatal care interventions makes a significant difference in the risk of having an adverse outcome due to syphilis. Women who sought care in the first two trimesters of their pregnancy, and received the appropriate intervention, were more likely to have a healthy infant, compared to women screened and treated in the third trimester. Encouraging ALL pregnant women to seek care in the first two trimesters of their pregnancy should be a priority for health programmes. For interventions to be effective within these health programmes, health systems and community engagement programmes need to be strengthened to enable pregnant women to seek antenatal care early.     

The Social Bayesian Brain: Does Mentalizing Make a Difference When We Learn?

When it comes to interpreting others'' behaviour, we almost irrepressibly engage in the attribution of mental states (beliefs, emotions…). Such "mentalizing" can become very sophisticated, eventually endowing us with highly adaptive skills such as convincing, teaching or deceiving. Here, sophistication can be captured in terms of the depth of our recursive beliefs, as in "I think that you think that I think…" In this work, we test whether such sophisticated recursive beliefs subtend learning in the context of social interaction. We asked participants to play repeated games against artificial (Bayesian) mentalizing agents, which differ in their sophistication. Critically, we made people believe either that they were playing against each other, or that they were gambling like in a casino. Although both framings are similarly deceiving, participants win against the artificial (sophisticated) mentalizing agents in the social framing of the task, and lose in the non-social framing. Moreover, we find that participants'' choice sequences are best explained by sophisticated mentalizing Bayesian learning models only in the social framing. This study is the first demonstration of the added-value of mentalizing on learning in the context of repeated social interactions. Importantly, our results show that we would not be able to decipher intentional behaviour without a priori attributing mental states to others.     

Brain Switches Utilitarian Behavior: Does Gender Make the Difference?

Decision often implies a utilitarian choice based on personal gain, even at the expense of damaging others. Despite the social implications of utilitarian behavior, its neurophysiological bases remain largely unknown. To assess how the human brain controls utilitarian behavior, we delivered transcranial direct current stimulation (tDCS) over the ventral prefrontal cortex (VPC) and over the occipital cortex (OC) in 78 healthy subjects. Utilitarian judgment was assessed with the moral judgment task before and after tDCS. At baseline, females provided fewer utilitarian answers than males for personal moral dilemmas (p = .007). In males, VPC-tDCS failed to induce changes and in both genders OC-tDCS left utilitarian judgments unchanged. In females, cathodal VPC-tDCS tended to decrease whereas anodal VPC-tDCS significantly increased utilitarian responses (p = .005). In males and females, reaction times for utilitarian responses significantly decreased after cathodal (p<.001) but not after anodal (p = .735) VPC-tDCS. We conclude that ventral prefrontal tDCS interferes with utilitarian decisions, influencing the evaluation of the advantages and disadvantages of each option in both sexes, but does so more strongly in females. Whereas cathodal tDCS alters the time for utilitarian reasoning in both sexes, anodal stimulation interferes more incisively in women, modifying utilitarian reasoning and the possible consequent actions. The gender-related tDCS-induced changes suggest that the VPC differentially controls utilitarian reasoning in females and in males. The gender-specific functional organization of the brain areas involved in utilitarian behavior could be a correlate of the moral and social behavioral differences between the two sexes.     

How Many Parameters Does It Take to Describe Disease Tolerance?

The study of infectious disease has been aided by model organisms, which have helped to elucidate molecular mechanisms and contributed to the development of new treatments; however, the lack of a conceptual framework for unifying findings across models, combined with host variability, has impeded progress and translation. Here, we fill this gap with a simple graphical and mathematical framework to study disease tolerance, the dose response curve relating health to microbe load; this approach helped uncover parameters that were previously overlooked. Using a model experimental system in which we challenged Drosophila melanogaster with the pathogen Listeria monocytogenes, we tested this framework, finding that microbe growth, the immune response, and disease tolerance were all well represented by sigmoid models. As we altered the system by varying host or pathogen genetics, disease tolerance varied, as we would expect if it was indeed governed by parameters controlling the sensitivity of the system (the number of bacteria required to trigger a response) and maximal effect size according to a logistic equation. Though either the pathogen or host immune response or both together could theoretically be the proximal cause of pathology that killed the flies, we found that the pathogen, but not the immune response, drove damage in this model. With this new understanding of the circuitry controlling disease tolerance, we can now propose better ways of choosing, combining, and developing treatments.     

Sexual Behaviour: Do a Few Dead Neurons Make the Difference?

Why do males and females behave so differently? Sexually dimorphic neural circuitry has just been found in parts of the fly's brain thought to control mating behaviour. Might this explain why males and females have such distinct sexual behaviours?     

How Long Does It Take to Establish a Morphogen Gradient?

A morphogen gradient is defined as a concentration field of a molecule that acts as a dose-dependent regulator of cell differentiation. One of the key questions in studies of morphogen gradients is whether they reach steady states on timescales relevant for developmental patterning. We propose a systematic approach for addressing this question and illustrate it by analyzing several models that account for diffusion and degradation of locally produced chemical signals.     

Nebulin: Does It Measure up as a Ruler?

A recent study has shown that the giant protein nebulin maintains the lengths of actin filaments in striated muscle cells. Although on the surface, nebulin looks like a molecular ruler, it may be playing a more complex role in regulating dynamics at the pointed end of actin filaments in striated muscle.     

Does the Clock Make the Poison? Circadian Variation in Response to Pesticides

Background

Circadian clocks govern daily physiological and molecular rhythms, and putative rhythms in expression of xenobiotic metabolizing (XM) genes have been described in both insects and mammals. Such rhythms could have important consequences for outcomes of chemical exposures at different times of day. To determine whether reported XM gene expression rhythms result in functional rhythms, we examined daily profiles of enzyme activity and dose responses to the pesticides propoxur, deltamethrin, fipronil, and malathion.

Methodology/Principal Findings

Published microarray expression data were examined for temporal patterns. Male Drosophila were collected for ethoxycoumarin-O-deethylase (ECOD), esterase, glutathione-S-transferase (GST), and, and uridine 5′-diphosphoglucosyltransferase (UGT) enzyme activity assays, or subjected to dose-response tests at four hour intervals throughout the day in both light/dark and constant light conditions. Peak expression of several XM genes cluster in late afternoon. Significant diurnal variation was observed in ECOD and UGT enzyme activity, however, no significant daily variation was observed in esterase or GST activity. Daily profiles of susceptibility to lethality after acute exposure to propoxur and fipronil showed significantly increased resistance in midday, while susceptibility to deltamethrin and malathion varied little. In constant light, which interferes with clock function, the daily variation in susceptibility to propoxur and in ECOD and UGT enzyme activity was depressed.

Conclusions/Significance

Expression and activities of specific XM enzymes fluctuate during the day, and for specific insecticides, the concentration resulting in 50% mortality varies significantly during the day. Time of day of chemical exposure should be an important consideration in experimental design, use of pesticides, and human risk assessment.     

A Review of Transplantation Practice of the Urologic Organs: Is It Only Achievable for the Kidney?

Transplantation is a viable treatment option for failure of most major organs. Within urology, transplantation of the kidney and ureter are well documented; however, evidence supporting transplantation of other urologic organs is limited. Failure of these organs carries significant morbidity, and transplantation may have a role in management. This article reviews the knowledge, research, and literature surrounding transplantation of each of the urologic organs. Transplantation of the penis, testicle, urethra, vas deferens, and bladder is discussed. Transplantation attempts have been made individually with each of these organs. Penile transplantation has only been performed once in a human. Testicular transplantation research was intertwined with unethical lucrative pursuits. Interest in urethra, bladder, and vas deferens transplantation has decreased as a result of successful surgical reconstructive techniques. Despite years of effort, transplantations of the penis, testicle, urethra, vas deferens, and bladder are not established in current practice. Recent research has shifted toward techniques of reconstruction, tissue engineering, and regenerative medicine.Key words: Urology, Transplantation, Reconstruction, Tissue engineeringOrgan transplantation is still a relatively novel treatment modality; its practice only developed in the latter half of the 20th century, in part due to the advent of immunosuppressive drugs. Key questions driving progress in transplant surgery is how far this science can be pushed, and if any part of the human body can be transplanted.In urology, transplantation of the kidney was previously inconceivable, but is now well established, following the first successful renal transplant performed in 1950. However, there is minimal evidence in the scientific literature of the successful transplantation of other urologic organs.There has, in the past, been great interest in exploring this lesser-known area of urologic transplantation, as the morbidity for patients with failure or damage to urologic organs such as the penis, testicle, or bladder is considerable. There is renewed interest in recent years due to the increased prevalence of devastating injuries to the genitalia caused by improvised explosive devices among soldiers stationed in Afghanistan.¹ There is minimal evidence in the literature addressing how these injuries should be best managed or whether transplantation may have a role in helping such patients.Remarkable progress in transplantation surgery has allowed development of new strategies of treatment for many urologic patients. Greater insight into the practice of transplantation may lead to improved management of other urologic pathologies. We comprehensively reviewed the historical evidence for transplantation of those urologic structures for which the practice is not well established. To our knowledge, no such review exists in the literature.     

Granulomatous Inflammation in Tuberculosis and Sarcoidosis: Does the Lymphatic System Contribute to Disease?

A striking and unexplained feature of granulomatous inflammation is its anatomical association with the lymphatic system. Accumulating evidence suggests that lymphatic tracks and granulomas may alter the function of each other. The formation of new lymphatics, or lymphangiogenesis, is an adaptive response to tumor formation, infection, and wound healing. Granulomas also may induce lymphangiogenesis which, through a variety of mechanisms, could contribute to disease outcomes in tuberculosis and sarcoidosis. On the other hand, alterations in lymph node function and lymphatic draining may be primary events which attenuate the risk and severity of granulomatous inflammation. This review begins with an introduction of granulomatous inflammation and the lymphatic system. A role of the lymphatic system in tuberculosis and sarcoidosis is then hypothesized. With a focus on lymphangiogenesis in these diseases, and on the potential for this process to promote dissemination, parallels are established with the well‐established role of lymphangiogenesis in tumor biology.     

Obesity as an Obstetric Risk Factor: Does It Matter in a Perinatal Center?

Objectives: Obesity before and during pregnancy is associated with several obstetrics risk factors for both mother and fetus. The aim of this retrospective study was to analyze the influence of BMI before pregnancy on distinct perinatal parameters. Research Methods and Procedures: The study includes 5067 singleton pregnancies from 2001 to 2004 at the Department of Obstetrics and Gynecology, University of Leipzig. The study group was divided into BMI groups: <18.5, ≥18.5 to <25, ≥25 to <30, ≥30 to <35, ≥35 to <40, and ≥40 kg/m². Analysis of perinatal data included rate of intrauterine death, rate of cesarean section and shoulder dystocia, time of hospital stay for mother and newborn, and gestational age of delivery. Neonatal outcome variables included percentage of newborns weighing >4000 grams, rate of umbilical cord pH <7.10, and rate of 1‐, 5‐, and 10‐minute Apgar scores of <8. Results: There was no difference in the gestational age at delivery among the groups. In the group with BMI ≥30 kg/m², the cesarean section rate was significantly elevated to 25.1%, with a more dramatic increase up to 30.2% in the group with BMI ≥35 kg/m² and 43.1% in the group with BMI ≥40 kg/m², mainly because of a higher number of secondary cesarean sections. Although newborns of obese women showed worse initial neonatal adaptation, the 10‐minute Apgar values did not differ among the groups. The higher rate of operative deliveries and the trend to an increased rate of shoulder dystocia did not influence duration of the hospital stay for mothers and newborns or morbidity of both. Discussion: A high pre‐pregnancy BMI is clearly associated with a higher rate of cesarean section deliveries. However, under the compensating conditions of a tertiary perinatal center, overall morbidity of mothers and newborns seems not to be increased.