The European General Practice Research Network Presents the Translations of Its Comprehensive Definition of Multimorbidity in Family Medicine in Ten European Languages

Background

Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review.

Objective

To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research.

Method

Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached

Results

229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved.

Conclusion

A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.     

Continuous removal of endocrine disruptors by versatile peroxidase using a two‐stage system

The oxidant Mn³⁺‐malonate, generated by the ligninolytic enzyme versatile peroxidase in a two‐stage system, was used for the continuous removal of endocrine disrupting compounds (EDCs) from synthetic and real wastewaters. One plasticizer (bisphenol‐A), one bactericide (triclosan) and three estrogenic compounds (estrone, 17β‐estradiol, and 17α‐ethinylestradiol) were removed from wastewater at degradation rates in the range of 28–58 µg/L·min, with low enzyme inactivation. First, the optimization of three main parameters affecting the generation of Mn³⁺‐malonate (hydraulic retention time as well as Na‐malonate and H₂O₂ feeding rates) was conducted following a response surface methodology (RSM). Under optimal conditions, the degradation of the EDCs was proven at high (1.3–8.8 mg/L) and environmental (1.2–6.1 µg/L) concentrations. Finally, when the two‐stage system was compared with a conventional enzymatic membrane reactor (EMR) using the same enzyme, a 14‐fold increase of the removal efficiency was observed. At the same time, operational problems found during EDCs removal in the EMR system (e.g., clogging of the membrane and enzyme inactivation) were avoided by physically separating the stages of complex formation and pollutant oxidation, allowing the system to be operated for a longer period (～8 h). This study demonstrates the feasibility of the two‐stage enzymatic system for removing EDCs both at high and environmental concentrations. © 2015 American Institute of Chemical Engineers Biotechnol. Prog., 31:908–916, 2015     

Detection of Innate Immune Response Modulating Impurities in Therapeutic Proteins

Therapeutic proteins can contain multiple impurities, some of which are variants of the product, while others are derived from the cell substrate and the manufacturing process. Such impurities, even when present at trace levels, have the potential to activate innate immune cells in peripheral blood or embedded in tissues causing expression of cytokines and chemokines, increasing antigen uptake, facilitating processing and presentation by antigen presenting cells, and fostering product immunogenicity. Currently, while products are tested for host cell protein content, assays to control innate immune response modulating impurities (IIRMIs) in products are focused mainly on endotoxin and nucleic acids, however, depending on the cell substrate and the manufacturing process, numerous other IIRMI could be present. In these studies we assess two approaches that allow for the detection of a broader subset of IIRMIs. In the first, we use commercial cell lines transfected with Toll like receptors (TLR) to detect receptor-specific agonists. This method is sensitive to trace levels of IIRMI and provides information of the type of IIRMIs present but is limited by the availability of stably transfected cell lines and requires pre-existing knowledge of the IIRMIs likely to be present in the product. Alternatively, the use of a combination of macrophage cell lines of human and mouse origin allows for the detection of a broader spectrum of impurities, but does not identify the source of the activation. Importantly, for either system the lower limit of detection (LLOD) of impurities was similar to that of PBMC and it was not modified by the therapeutic protein tested, even in settings where the product had inherent immune modulatory properties. Together these data indicate that a cell-based assay approach could be used to screen products for the presence of IIRMIs and inform immunogenicity risk assessments, particularly in the context of comparability exercises.     

Environmental filtering determines community patterns in temporary wetlands: a multi-taxon approach

Climate characteristics appear to play a key role in filtering organisms based on their biological traits. If this trait filtering by climate indeed occurs, it should have effects on the composition, dynamics, taxonomic relatedness and co-occurrence patterns of local assemblages, regardless of the taxonomic group considered. This preliminary study aimed to assess the extent to which environmental variables might determine these patterns in local communities and to evaluate whether the ultimate cross-taxon congruence relationships are consistent across, or dependent on, the selected region. To this end, we studied the bryophyte, macrophyte, macroinvertebrate, and amphibian communities in two clusters of temporary wetlands on the NE Iberian Peninsula under mesothermal and semiarid climates. We observed effects of environmental filtering, with the communities differing between the climatic regions not only in their compositions but also in their dynamics and taxonomic relatedness patterns. Although the cross-taxon congruence in terms of species richness was high in the mesothermal climate, most of the congruent relationships were disrupted in the semiarid environment. Overall, because climate-dependent patterns appear to prevail over climate-consistent ones, we suggest that the use of surrogate taxa may be of limited value when aiming to assess wetland biodiversity across large areas.     

Very-Long-Chain Fatty Acids Are Involved in Polar Auxin Transport and Developmental Patterning in Arabidopsis

Very-long-chain fatty acids (VLCFAs) are essential for many aspects of plant development and necessary for the synthesis of seed storage triacylglycerols, epicuticular waxes, and sphingolipids. Identification of the acetyl-CoA carboxylase PASTICCINO3 and the 3-hydroxy acyl-CoA dehydratase PASTICCINO2 revealed that VLCFAs are important for cell proliferation and tissue patterning. Here, we show that the immunophilin PASTICCINO1 (PAS1) is also required for VLCFA synthesis. Impairment of PAS1 function results in reduction of VLCFA levels that particularly affects the composition of sphingolipids, known to be important for cell polarity in animals. Moreover, PAS1 associates with several enzymes of the VLCFA elongase complex in the endoplasmic reticulum. The pas1 mutants are deficient in lateral root formation and are characterized by an abnormal patterning of the embryo apex, which leads to defective cotyledon organogenesis. Our data indicate that in both tissues, defective organogenesis is associated with the mistargeting of the auxin efflux carrier PIN FORMED1 in specific cells, resulting in local alteration of polar auxin distribution. Furthermore, we show that exogenous VLCFAs rescue lateral root organogenesis and polar auxin distribution, indicating their direct involvement in these processes. Based on these data, we propose that PAS1 acts as a molecular scaffold for the fatty acid elongase complex in the endoplasmic reticulum and that the resulting VLCFAs are required for polar auxin transport and tissue patterning during plant development.     

The management of vegetation classifications with fuzzy clustering

Questions: Does fuzzy clustering provide an appropriate numerical framework to manage vegetation classifications? What is the best fuzzy clustering method to achieve this? Material: We used 531 relevés from Catalonia (Spain), belonging to two syntaxonomic alliances of mesophytic and xerophytic montane pastures, and originally classified by experts into nine and 13 associations, respectively. Methods: We compared the performance of fuzzy C‐means (FCM), noise clustering (NC) and possibilistic C‐means (PCM) on four different management tasks: (1) assigning new relevé data to existing types; (2) updating types incorporating new data; (3) defining new types with unclassified relevés; and (4) reviewing traditional vegetation classifications. Results: As fuzzy classifiers, FCM fails to indicate when a given relevé does not belong to any of the existing types; NC might leave too many relevés unclassified; and PCM membership values cannot be compared. As unsupervised clustering methods, FCM is more sensitive than NC to transitional relevés and therefore produces fuzzier classifications. PCM looks for dense regions in the space of species composition, but these are scarce when vegetation data contain many transitional relevés. Conclusions: All three models have advantages and disadvantages, although the NC model may be a good compromise between the restricted FCM model and the robust but impractical PCM model. In our opinion, fuzzy clustering might provide a suitable framework to manage vegetation classifications using a consistent operational definition of vegetation type. Regardless of the framework chosen, national/regional vegetation classification panels should promote methodological standards for classification practices with numerical tools.     

Enzymatic synthesis of poly-l-lactide and poly-l-lactide-co-glycolide in an ionic liquid

The syntheses of poly-l-lactide (PLLA) and poly-l-lactide-co-glycolide (PLLGA) is reported in the ionic liquid 1-hexyl-3-methylimidazolium hexafluorophosphate [HMIM][PF₆] mediated by the enzyme lipase B from Candida antarctica (Novozyme 435). The highest PLLA yield (63%) was attained at 90 °C with a molecular weight (M _n ) of 37.8 × 10³ g/mol determined by size exclusion chromatography. This procedure produced relatively high crystalline polymers (up to 85% PLLA) as determined by DSC. In experiments at 90 °C product synthesis also occurred without biocatalyst, however, PLLA synthesis in [HMIM][PF₆] at 65 °C followed only the enzymatic mechanism as ring opening was not observed without the enzyme. In addition, the enzymatic synthesis of PLLGA is first reported here using Novozyme 435 biocatalyst with up to 19% of lactyl units in the resulting copolymer as determined by NMR. Materials were also characterized by TGA, MALDI-TOF–MS, X-ray diffraction, polarimetry and rheology.     

Enzymatic synthesis of poly-l-lactide-co-glycolide in the ionic liquid 1-butyl-3-methylimidazolium hexafluorophosphate

This article reports the lipase-catalyzed ring-opening copolymerization of l-lactide (LLA) and glycolide using the commercially available ionic liquid 1-butyl-3-methylimidazolium hexafluorophosphate as solvent media. Candida antarctica lipase B, immobilized in an acrylic support was used as biocatalyst. The reaction temperature had a direct influence on yields and molecular weights of the copolymers as well as LLA incorporation. The materials presented semi-crystalline structures assessed by DSC and powder XR diffraction analyses.