When a unit of insulin is not a unit: Detemir dosing and insulin cost in type 2 diabetes mellitus

Background: Increasing acceptance of basal-bolus insulin therapy for the control of diabetes mellitus (DM) has led to newer formulations of basal insulin analogues. The newest one is detemir.Objectives: Clinical evidence suggests that patients with type 2 DM require higher doses of detemir than other basal insulins to achieve equivalent glycemic control. This study examines evidence for greater dosing requirements and the implications of higher doses on the cost of insulin treatment.Methods: We performed a MEDLINE search for randomized, prospective studies comparing detemir with other basal insulins in patients with type 2 DM that were published in English between January 2000 and November 2008. The mean daily doses of basal and bolus insulin and the mean total daily insulin doses were determined. Overall weighted mean doses of the insulins were used to estimate the mean total daily insulin doses required for a 100-kg patient, and published 2008 US retail prices were used to estimate the retail costs of basal-bolus and basal-only insulin regimens.Results: Seven trials involving 3311 patients were identified in the literature search. The mean total daily insulin dose was 0.80 unit/kg for detemir-based regimens and 0.58 unit/kg for comparison regimens. For basal-bolus regimens, the estimated retail cost of the mean total daily insulin dose was $11.24 for detemir-based regimens compared with $8.99 for glargine-based regimens and $6.41 for neutral protamine Hagedorn (NPH)-based insulins. For basal-only regimens, the estimated retail cost of the mean total daily insulin dose was $8.23 for detemir compared with $5.19 for glargine and $2.35 for NPH.Conclusions: It is important for health care providers and patients to know that patients with type 2 DM may require substantially higher doses of detemir than other basal insulins. This should be considered when titrating the dose as well as in cost-benefit analyses of detemir versus other insulins.     

Morphology of the egg shell and the developing embryo of the Red Palm Weevil,Rhynchophorus ferrugineus (Oliver)

The harvested eggs of Rhynchophorus ferrugineus are ovo-cylindrical shaped, averaged 1.09 mm in length and 0.43 mm in width, with ratio of L\W 4.42. The chorionic layer of electron dense material is seen covering the exochorion structure of the eggs. The egg main body chorion exhibits a polygonal pattern and architecture surface of the egg is supported by a system of irregular interconnecting grooves. The micropylar apparatus of the eggs of the Red Palm Weevil, R. ferrugineus is described in the present study for the first time. Two micropylar openings are found closed to the center of the posterior wide pole of the egg. Each micropylar opening presents a single small orifice and its surrounding chorion is porous and densely set with tiny projections allowing the spermatozoa to penetrate the egg. Respiratory aeropyles are distributed on the borders of reticulations in the area chorionic surface of egg capsule. The hatching region is detected on the anterior part at the opposite side of the egg. Changes in the appearance and shape of R. ferrugineus eggs as well as the incidence of embryonic development are observed.     

Population dynamic of the extinct European aurochs: genetic evidence of a north-south differentiation pattern and no evidence of post-glacial expansion

Background

Various evolutionary models have been proposed to interpret the fate of paralogous duplicates, which provides substrates on which evolution selection could act. In particular, domestication, as a special selection, has played important role in crop cultivation with divergence of many genes controlling important agronomic traits. Recent studies have indicated that a pair of duplicate genes was often sub-functionalized from their ancestral functions held by the parental genes. We previously demonstrated that the rice cell-wall invertase (CWI) gene GIF1 that plays an important role in the grain-filling process was most likely subjected to domestication selection in the promoter region. Here, we report that GIF1 and another CWI gene OsCIN1 constitute a pair of duplicate genes with differentiated expression and function through independent selection.

Results

Through synteny analysis, we show that GIF1 and another cell-wall invertase gene OsCIN1 were paralogues derived from a segmental duplication originated during genome duplication of grasses. Results based on analyses of population genetics and gene phylogenetic tree of 25 cultivars and 25 wild rice sequences demonstrated that OsCIN1 was also artificially selected during rice domestication with a fixed mutation in the coding region, in contrast to GIF1 that was selected in the promoter region. GIF1 and OsCIN1 have evolved into different expression patterns and probable different kinetics parameters of enzymatic activity with the latter displaying less enzymatic activity. Overexpression of GIF1 and OsCIN1 also resulted in different phenotypes, suggesting that OsCIN1 might regulate other unrecognized biological process.

Conclusion

How gene duplication and divergence contribute to genetic novelty and morphological adaptation has been an interesting issue to geneticists and biologists. Our discovery that the duplicated pair of GIF1 and OsCIN1 has experienced sub-functionalization implies that selection could act independently on each duplicate towards different functional specificity, which provides a vivid example for evolution of genetic novelties in a model crop. Our results also further support the established hypothesis that gene duplication with sub-functionalization could be one solution for genetic adaptive conflict.     

Antioxidants protect keratinocytes against M. ulcerans mycolactone cytotoxicity

Background

Mycobacterium ulcerans is the causative agent of necrotizing skin ulcerations in distinctive geographical areas. M. ulcerans produces a macrolide toxin, mycolactone, which has been identified as an important virulence factor in ulcer formation. Mycolactone is cytotoxic to fibroblasts and adipocytes in vitro and has modulating activity on immune cell functions. The effect of mycolactone on keratinocytes has not been reported previously and the mechanism of mycolactone toxicity is presently unknown. Many other macrolide substances have cytotoxic and immunosuppressive activities and mediate some of their effects via production of reactive oxygen species (ROS). We have studied the effect of mycolactone in vitro on human keratinocytes—key cells in wound healing—and tested the hypothesis that the cytotoxic effect of mycolactone is mediated by ROS.

Methodology/Principal Findings

The effect of mycolactone on primary skin keratinocyte growth and cell numbers was investigated in serum free growth medium in the presence of different antioxidants. A concentration and time dependent reduction in keratinocyte cell numbers was observed after exposure to mycolactone. Several different antioxidants inhibited this effect partly. The ROS inhibiting substance deferoxamine, which acts via chelation of Fe²⁺, completely prevented mycolactone mediated cytotoxicity.

Conclusions/Significance

This study demonstrates that mycolactone mediated cytotoxicity can be inhibited by deferoxamine, suggesting a role of iron and ROS in mycolactone induced cytotoxicity of keratinocytes. The data provide a basis for the understanding of Buruli ulcer pathology and the development of improved therapies for this disease.     

Dinoflagellate phylogeny as inferred from heat shock protein 90 and ribosomal gene sequences

Background

Interrelationships among dinoflagellates in molecular phylogenies are largely unresolved, especially in the deepest branches. Ribosomal DNA (rDNA) sequences provide phylogenetic signals only at the tips of the dinoflagellate tree. Two reasons for the poor resolution of deep dinoflagellate relationships using rDNA sequences are (1) most sites are relatively conserved and (2) there are different evolutionary rates among sites in different lineages. Therefore, alternative molecular markers are required to address the deeper phylogenetic relationships among dinoflagellates. Preliminary evidence indicates that the heat shock protein 90 gene (Hsp90) will provide an informative marker, mainly because this gene is relatively long and appears to have relatively uniform rates of evolution in different lineages.

Methodology/Principal Findings

We more than doubled the previous dataset of Hsp90 sequences from dinoflagellates by generating additional sequences from 17 different species, representing seven different orders. In order to concatenate the Hsp90 data with rDNA sequences, we supplemented the Hsp90 sequences with three new SSU rDNA sequences and five new LSU rDNA sequences. The new Hsp90 sequences were generated, in part, from four additional heterotrophic dinoflagellates and the type species for six different genera. Molecular phylogenetic analyses resulted in a paraphyletic assemblage near the base of the dinoflagellate tree consisting of only athecate species. However, Noctiluca was never part of this assemblage and branched in a position that was nested within other lineages of dinokaryotes. The phylogenetic trees inferred from Hsp90 sequences were consistent with trees inferred from rDNA sequences in that the backbone of the dinoflagellate clade was largely unresolved.

Conclusions/Significance

The sequence conservation in both Hsp90 and rDNA sequences and the poor resolution of the deepest nodes suggests that dinoflagellates reflect an explosive radiation in morphological diversity in their recent evolutionary past. Nonetheless, the more comprehensive analysis of Hsp90 sequences enabled us to infer phylogenetic interrelationships of dinoflagellates more rigorously. For instance, the phylogenetic position of Noctiluca, which possesses several unusual features, was incongruent with previous phylogenetic studies. Therefore, the generation of additional dinoflagellate Hsp90 sequences is expected to refine the stem group of athecate species observed here and contribute to future multi-gene analyses of dinoflagellate interrelationships.     

Effect of site-specific bronchial radon progeny deposition on the spatial and temporal distributions of cellular responses

Inhaled short-lived radon progenies may deposit in bronchial airways and interact with the epithelium by the emission of alpha particles. Simulation of the related radiobiological effects requires the knowledge of space and time distributions of alpha particle hits and biological endpoints. Present modelling efforts include simulation of radioaerosol deposition patterns in a central bronchial airway bifurcation, modelling of human bronchial epithelium, generation of alpha particle tracks, and computation of spatio-temporal distributions of cell nucleus hits, cell killing and cell transformation events. Simulation results indicate that the preferential radionuclide deposition at carinal ridges plays an important role in the space and time evolution of the biological events. While multiple hits are generally rare for low cumulative exposures, their probability may be quite high at the carinal ridges of the airway bifurcations. Likewise, cell killing and transformation events also occur with higher probability in this area. In the case of uniform surface activities, successive hits as well as cell killing and transformation events within a restricted area (say 0.5 mm²) are well separated in time. However, in the case of realistic inhomogeneous deposition, they occur more frequently within the mean cycle time of cells located at the carinal ridge even at low cumulative doses. The site-specificity of radionuclide deposition impacts not only on direct, but also on non-targeted radiobiological effects due to intercellular communication. Incorporation of present results into mechanistic models of carcinogenesis may provide useful information concerning the dose–effect relationship in the low-dose range.     

The effects of pad geometry and material properties on the biomechanical effectiveness of 26 commercially available hip protectors

Wearable hip protectors (padded garments) represent a promising strategy to decrease impact force and hip fracture risk during falls, and a wide range of products are currently marketed. However, little is known about how design features of hip protectors influence biomechanical effectiveness. We used a mechanical test system (simulating sideways falls) to measure the attenuation in femoral neck force provided by 26 commercially available hip protectors at three impact velocities (2, 3, and 4m/s). We also used a materials testing machine to characterize the force-deflection properties of each device. Regression analyses were performed to determine which geometric (e.g., height, width, thickness, volume) and force-deflection properties were associated with force attenuation. At an impact velocity of 3m/s, the force attenuation provided by the various hip protectors ranged between 2.5% and 40%. Hip protectors with lower stiffness (measured at 500N) provided greater force attenuation at all velocities. Protectors that absorbed more energy demonstrated greater force attenuation at the higher impact velocities (3 and 4m/s conditions), while protectors that did not directly contact (but instead bridged) the skin overlying the greater trochanter attenuated more force at velocities of 2 and 3m/s. At these lower velocities, the force attenuation provided by protectors that contacted the skin overlying the greater trochanter increased with increasing pad width, thickness, and energy dissipation. By providing a comparison of the protective value of a large range of existing hip protectors, these results can help to guide consumers and researchers in selecting hip protectors, and in interpreting the results of previous clinical trials. Furthermore, by determining geometric and material parameters that influence biomechanical performance, our results should assist manufacturers in designing devices that offer improved performance and clinical effectiveness.     

XRCC4 protein interactions with XRCC4-like factor (XLF) create an extended grooved scaffold for DNA ligation and double strand break repair

The XRCC4-like factor (XLF)-XRCC4 complex is essential for nonhomologous end joining, the major repair pathway for DNA double strand breaks in human cells. Yet, how XLF binds XRCC4 and impacts nonhomologous end joining functions has been enigmatic. Here, we report the XLF-XRCC4 complex crystal structure in combination with biophysical and mutational analyses to define the XLF-XRCC4 interactions. Crystal and solution structures plus mutations characterize alternating XRCC4 and XLF head domain interfaces forming parallel super-helical filaments. XLF Leu-115 ("Leu-lock") inserts into a hydrophobic pocket formed by XRCC4 Met-59, Met-61, Lys-65, Lys-99, Phe-106, and Leu-108 in synergy with pseudo-symmetric β-zipper hydrogen bonds to drive specificity. XLF C terminus and DNA enhance parallel filament formation. Super-helical XLF-XRCC4 filaments form a positively charged channel to bind DNA and align ends for efficient ligation. Collective results reveal how human XLF and XRCC4 interact to bind DNA, suggest consequences of patient mutations, and support a unified molecular mechanism for XLF-XRCC4 stimulation of DNA ligation.