Understanding dengue virus evolution to support epidemic surveillance and counter-measure development.

Dengue virus (DENV) causes a profound burden of morbidity and mortality, and its global burden is rising due to the co-circulation of four divergent DENV serotypes in the ecological context of globalization, travel, climate change, urbanization, and expansion of the geographic range of the Ae.aegypti and Ae.albopictus vectors. Understanding DENV evolution offers valuable opportunities to enhance surveillance and response to DENV epidemics via advances in RNA virus sequencing, bioinformatics, phylogenetic and other computational biology methods. Here we provide a scoping overview of the evolution and molecular epidemiology of DENV and the range of ways that evolutionary analyses can be applied as a public health tool against this arboviral pathogen.

[Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"]. / Verbesserung der Notarztausbildung durch Simulatortraining. Betrachtung anhand des Modellprojekts "NASimSaar25"

BACKGROUND: Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician. This needs to be improved because on-the-job training does not generally represent the whole spectrum of emergency medicine and a good and structured training under on call conditions is nearly impossible. AIM: The subject of the model project described was whether practical training for emergency physicians can be achieved by participation in simulation training instead of real emergency situations. MATERIAL AND METHODS: After modification of the Saarland regulations on medical education it was possible to replace up to 25 participations in emergency missions by simulation training. The concept of the course NASimSaar25 requires participants to complete 25 simulator cases in 3 days in small training groups. Emergency situations from all medical disciplines need to be treated. A special focus is on the treatment of life-threatening and rare diseases and injuries. Modern simulators and actors are used. The debriefings are conducted by experienced tutors based on approved principles. Medical contents, learning targets from the field of crew resource management (CRM) and soft skills are discussed in these debriefings. RESULTS: Education in the field of emergency medicine can be improved by simulator-based learning and training. However, practical work under a tutor in real and clinical experience cannot be completely replaced by simulation. Simulator training can only be successful if theoretical knowledge has already been acquired. CONCLUSION: A simulator-based course concept can result in an improvement of emergency medical education. The model project NASimSaar25 was well received by the target audience and mostly very well evaluated in terms of learning and reality. If this project becomes established the demand on simulation-based training will increase. The training should achieve a consistent standard of quality.

Tissue-specific regulation of S6K1 by insulin in chickens divergently selected for growth.

In chickens, insulin injection leads to the activation of the early steps of insulin receptor signaling in liver but not in muscles. Paradoxically, muscle p70 S6 kinase (S6K1), a kinase controlling protein synthesis and growth, was markedly activated in response to insulin. The aim of this study was to further investigate S6K1 regulation and activation using chickens divergently selected for growth, i.e. fast- (FGL) and slow- (SGL) growing lines. In the Pectoralis major muscle, insulin stimulated S6K1 phosphorylation on T389 in FGL and SGL chickens, whereas S6K1 phosphorylation on T421/S424 was increased by insulin only in FGL chickens. Moreover, insulin-related increase in muscle S6K1 activity was greater in FGL chickens than in SGL chickens. Surprisingly, liver S6K1 was insulin insensitive in the two genotypes. Such difference of regulation between tissues and between genotypes was not observed for the protein kinase B, which is involved in insulin signaling upstream of S6K1, or for eukaryotic initiation factor 4E-binding protein. Interestingly, insulin-activated a S6K1 downstream target, the ribosomal protein S6, irrespective of tissue, suggesting that a pathway different of the S6K1 cascade may be involved in S6 phosphorylation in chicken liver. In conclusion, the regulation of S6K1 differs between the liver and muscle and between chickens divergently selected for growth. Our results suggest a potential involvement of S6K1 in the control of muscle growth and an open issue concerning S6K1 function in chicken liver.

Mycoplasma hominis osteitis in an immunocompetent man.

Mycoplasma hominis has been associated with pelvic inflammatory illness, postpartum and neonatal infections and respiratory tract diseases. It is rarely isolated from patients with other infections. Reported here is a case of tibial osteitis that occurred in a 16-year-old immunocompetent man. Clinical and laboratory findings improved under treatment with clindamycin and fluoroquinolones.

[Evaluation of the information given to parents during the planned preanaesthetic consultation in a paediatric hospital]. / Evaluation de l'information donnée aux parents en consultation préanesthésique programmée dans un hôpital pédiatrique.

INTRODUCTION: Information given to the parents of paediatric patients during the preanaesthetic consultation (CS) must be understandable. OBJECTIVE: We have studied the impact of this information given during CS. METHODS: Prospective study over four months with a questionnaire completed by parents after CS and before the hospitalization. The Sfar information booklet was given to the parents before CS. The study evaluated whether the information had been given ("have you received the information on...?"), understood ("Did you understand...?"), and if CS had influenced anxiety of parents/child; on four items of information, anesthetic risk, transfusion, postoperative pain, and anesthetic technique. The questionnaire noted also the parents sociocultural level (NSC), and if they had read the Sfar booklet. Statistical analysis (descriptive, uni-, multivariate), p<0.05. RESULTS: Four hundred questionnaires were distributed, 334 were analyzed. The information on the four items was considered to have been given in 75%, understood 72%, and to have diminished anxiety 68%. These results were not influenced by whether or not (88%) parents had read the Sfar booklet. How much information was given was a function of the physician giving the information. Elevated NSC and amount if information given improved comprehension optimized. Diminution of anxiety was when all four items were understood, CS was performed by a senior physician and the parent's NSC was high. DISCUSSION: Information better adapted to NSC may improve the quality of CS. The Sfar booklet does not contribute to parents understanding in this context.

Do glycerolipids display lateral heterogeneity in the thylakoid membrane?

The lateral heterogeneity of lipids in the thylakoid membrane has been questioned for over 20 yrs. It is generally believed that glycerolipids are asymmetrically distributed within the plane of the membrane. In the present investigation, we isolated several thylakoid membrane domains by using sonication followed by separation in an aqueous dextran-polyethylene glycol two-phase system. This technique, which avoids detergent treatments, allowed us to obtain stroma and grana lamellae vesicles as well as grana central core and grana margin vesicles from thylakoids. The relative distribution of the four lipid classes, i.e., monogalactosyldiacylglycerol, digalactosyldiacylglycerol, sulfoquinovosyldiacylglycerol, and phosphatidylglycerol, was found to be statistically identical in all four thylakoid fractions and in whole thylakoids. Similarly, the relative amount of fatty acids in each individual lipid and the eight main phosphatidylglycerol molecular species was identical in all thylakoid membrane fractions tested as well as in the intact thylakoid membrane. Based on presently available procedures for obtaining thylakoid subfractions that are unable to discriminate microdomains within the membrane, it is concluded that glycerolipids are evenly distributed within the plane of the thylakoid membrane. These data are discussed in terms of "bulk" and "specific" lipids.

The topology of phosphatidylglycerol populations is essential for sustaining photosynthetic electron flow activities in thylakoid membranes.

The transmembrane distribution of phosphatidylglycerol (PG) was determined in rightside-out (RO) and inside-out vesicles (IO) obtained by fragmentation of spinach thylakoids in a Yeda press, followed by partition in an aqueous dextran-polyethyleneglycol two-phase system. Using the phospholipase A(2) from porcine pancreas to digest selectively PG molecules in the outer monolayer (exposed to the incubation medium) of the membrane, we found the molar outside/inside distribution to be 70/30+/-5 in RO and 40/60+/-3 in IO. The transmembrane distribution of PG in IO was the opposite of that in intact thylakoids (molar ratio 58/42+/-3). The phospholipid population which sustained most of the uncoupled photosystem II electron flow activity was localized in the inner monolayer (exposed to the thylakoid lumen) of both thylakoid and RO membranes. In contrast, the activity in IO membranes was highly dependent on the PG population located in the outer monolayer. This finding brings the first direct demonstration of the dependence of the photosynthetic electron flow activity on the integrity of the inner topological pool of PG in the thylakoid membrane.