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1.
Mol Cell ; 81(2): 281-292.e8, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-33296676

RESUMO

Rho is a general transcription termination factor playing essential roles in RNA polymerase (RNAP) recycling, gene regulation, and genomic stability in most bacteria. Traditional models of transcription termination postulate that hexameric Rho loads onto RNA prior to contacting RNAP and then translocates along the transcript in pursuit of the moving RNAP to pull RNA from it. Here, we report the cryoelectron microscopy (cryo-EM) structures of two termination process intermediates. Prior to interacting with RNA, Rho forms a specific "pre-termination complex" (PTC) with RNAP and elongation factors NusA and NusG, which stabilize the PTC. RNA exiting RNAP interacts with NusA before entering the central channel of Rho from the distal C-terminal side of the ring. We map the principal interactions in the PTC and demonstrate their critical role in termination. Our results support a mechanism in which the formation of a persistent PTC is a prerequisite for termination.


Assuntos
RNA Polimerases Dirigidas por DNA/química , Proteínas de Escherichia coli/química , Escherichia coli/genética , Regulação Bacteriana da Expressão Gênica , Fatores de Alongamento de Peptídeos/química , Fatores de Transcrição/química , Terminação da Transcrição Genética , Fatores de Elongação da Transcrição/química , Sequência de Aminoácidos , Sítios de Ligação , Clonagem Molecular , Microscopia Crioeletrônica , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , RNA Polimerases Dirigidas por DNA/genética , RNA Polimerases Dirigidas por DNA/metabolismo , Escherichia coli/metabolismo , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Vetores Genéticos/química , Vetores Genéticos/metabolismo , Modelos Moleculares , Fatores de Alongamento de Peptídeos/genética , Fatores de Alongamento de Peptídeos/metabolismo , Ligação Proteica , Conformação Proteica em alfa-Hélice , Conformação Proteica em Folha beta , Domínios e Motivos de Interação entre Proteínas , Subunidades Proteicas/química , Subunidades Proteicas/genética , Subunidades Proteicas/metabolismo , RNA Bacteriano/química , RNA Bacteriano/genética , RNA Bacteriano/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Fatores de Elongação da Transcrição/genética , Fatores de Elongação da Transcrição/metabolismo
2.
Proc Natl Acad Sci U S A ; 119(1)2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34969836

RESUMO

Defining the denatured state ensemble (DSE) and disordered proteins is essential to understanding folding, chaperone action, degradation, and translocation. As compared with water-soluble proteins, the DSE of membrane proteins is much less characterized. Here, we measure the DSE of the helical membrane protein GlpG of Escherichia coli (E. coli) in native-like lipid bilayers. The DSE was obtained using our steric trapping method, which couples denaturation of doubly biotinylated GlpG to binding of two streptavidin molecules. The helices and loops are probed using limited proteolysis and mass spectrometry, while the dimensions are determined using our paramagnetic biotin derivative and double electron-electron resonance spectroscopy. These data, along with our Upside simulations, identify the DSE as being highly dynamic, involving the topology changes and unfolding of some of the transmembrane (TM) helices. The DSE is expanded relative to the native state but only to 15 to 75% of the fully expanded condition. The degree of expansion depends on the local protein packing and the lipid composition. E. coli's lipid bilayer promotes the association of TM helices in the DSE and, probably in general, facilitates interhelical interactions. This tendency may be the outcome of a general lipophobic effect of proteins within the cell membranes.


Assuntos
Bicamadas Lipídicas/química , Bicamadas Lipídicas/metabolismo , Proteínas de Membrana/química , Proteínas de Membrana/metabolismo , Conformação Proteica , Biotinilação , Membrana Celular , Microscopia Crioeletrônica , Proteínas de Ligação a DNA , Endopeptidases , Escherichia coli , Proteínas de Escherichia coli/química , Modelos Moleculares , Desnaturação Proteica , Dobramento de Proteína , Estreptavidina
3.
Org Biomol Chem ; 22(24): 4940-4949, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38809109

RESUMO

The synthesis of a biologically relevant 2-amino-N3-alkylamido 4-quinazolinone has been accomplished in four steps from commercially available materials using design principles from both modular and divergent synthesis. N3-Alkylation of 2-chloro-4(3H)-quinazolinone using methyl bromoacetate, followed by C2-amination produced a suitable scaffold for introducing molecular diversity. Optimization of alkylation conditions afforded full regioselectivity, enabling exclusive access to the N-alkylated isomer. Subsequent C2-amination using piperidine, pyrrolidine, or diethylamine, followed by amide bond formation using variously substituted phenethylamines, generated fifteen unique 4-quinazolinones bearing C2-amino and N3-alkylamido substituents. These efforts highlight the reciprocal influence of C2 and N3 substitution on functionalization at either position, establish an effective synthetic pathway toward 2,N3-disubstituted 4-quinazolinones, and enable preliminary bioactivity studies while providing an experiential learning opportunity for undergraduate student researchers.

4.
Nature ; 560(7719): 447-452, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30111839

RESUMO

The olfactory system must recognize and discriminate amongst an enormous variety of chemicals in the environment. To contend with such diversity, insects have evolved a family of odorant-gated ion channels comprised of a highly conserved co-receptor (Orco) and a divergent odorant receptor (OR) that confers chemical specificity. Here, we present the single-particle cryo-electron microscopy structure of an Orco homomer from the parasitic fig wasp Apocrypta bakeri at 3.5 Å resolution, providing structural insight into this receptor family. Orco possesses a novel channel architecture, with four subunits symmetrically arranged around a central pore that diverges into four lateral conduits that open to the cytosol. The Orco tetramer has few inter-subunit interactions within the membrane and is bound together by a small cytoplasmic anchor domain. The minimal sequence conservation among ORs maps largely to the pore and anchor domain, shedding light on how the architecture of this receptor family accommodates its remarkable sequence diversity and facilitates the evolution of odour tuning.


Assuntos
Microscopia Crioeletrônica , Insetos/ultraestrutura , Receptores Odorantes/química , Receptores Odorantes/ultraestrutura , Motivos de Aminoácidos , Animais , Sítios de Ligação , Sequência Conservada , Interações Hidrofóbicas e Hidrofílicas , Fragmentos Fab das Imunoglobulinas/química , Fragmentos Fab das Imunoglobulinas/ultraestrutura , Insetos/química , Insetos/classificação , Ativação do Canal Iônico , Modelos Moleculares , Filogenia , Multimerização Proteica , Estrutura Quaternária de Proteína , Receptores Odorantes/metabolismo , Alinhamento de Sequência
5.
Environ Sci Technol ; 57(7): 2779-2791, 2023 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-36758188

RESUMO

Recently, roadway releases of N,N'-substituted p-phenylenediamine (PPD) antioxidants and their transformation products (TPs) received significant attention due to the highly toxic 6PPD-quinone. However, the occurrence of PPDs and TPs in recycled tire rubber products remains uncharacterized. Here, we analyzed tire wear particles (TWPs), recycled rubber doormats, and turf-field crumb rubbers for seven PPD antioxidants, five PPD-quinones (PPDQs), and five other 6PPD TPs using liquid chromatography-tandem mass spectrometry. PPD antioxidants, PPDQs, and other TPs were present in all samples with chemical profiles dominated by 6PPD, DTPD, DPPD, and their corresponding PPDQs. Interestingly, the individual [PPDQ]/[PPD] and [TP]/[PPD] ratios significantly increased as total concentrations of the PPD-derived chemical decreased, indicating that TPs (including PPDQs) dominated the PPD-derived compounds with increased environmental weathering. Furthermore, we quantified 15 other industrial rubber additives (including bonding agents, vulcanization accelerators, benzotriazole and benzothiazole derivatives, and diphenylamine antioxidants), observing that PPD-derived chemical concentrations were 0.5-6 times higher than these often-studied additives. We also screened various other elastomeric consumer products, consistently detecting PPD-derived compounds in lab stoppers, sneaker soles, and rubber garden hose samples. These data emphasize that PPD antioxidants, PPDQs, and related TPs are important, previously overlooked contaminant classes in tire rubbers and elastomeric consumer products.


Assuntos
Antioxidantes , Benzoquinonas , Fenilenodiaminas , Borracha , Antioxidantes/análise , Antioxidantes/química , Antioxidantes/classificação , Fenilenodiaminas/análise , Fenilenodiaminas/química , Fenilenodiaminas/classificação , Borracha/química , Benzoquinonas/análise , Benzoquinonas/química , Benzoquinonas/classificação , Espectrometria de Massa com Cromatografia Líquida , Espectrometria de Massas em Tandem
6.
Tetrahedron ; 1302023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36710952

RESUMO

Despite amazing advances in cross-coupling technologies over the past several decades, there is not a consistent definition of what a cross-coupling reaction is. Often, definitions rely on comparison to "traditional" palladium-catalyzed cross-couplings pioneered in the 1970s by chemists such as Suzuki, Negishi, and Heck. While these reactions provide a basis for a cross-coupling definition, they do not define this type of transformation, originally described by Linstead almost 20 years prior. Rather than modify and compartmentalize modern transformations to categorize them into either a synthetic or mechanistic definition, we make an argument for broadening the cross-coupling definition to the union of two distinct molecular entities in a covalent-bond-forming process, to encourage discussion around exploring novel reactivity and disconnections. In addition to making a case for a universal cross-coupling definition, we cite specific examples of reactions that break the mold of prior cross-coupling definitions. We believe this perspective will stimulate dialog around what it means to be a cross-coupling and in turn inspire future developments within this field.

7.
Behav Sleep Med ; 21(1): 33-44, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35156470

RESUMO

BACKGROUND: Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults. PARTICIPANTS: 49 undergraduates (Mage = 19.9 [SD = 1.5], 83.7% female). METHODS: Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded. RESULTS: We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations. CONCLUSIONS: Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.


Assuntos
Cronotipo , Distúrbios do Início e da Manutenção do Sono , Humanos , Feminino , Masculino , Estigma Social , Sono/fisiologia , Inquéritos e Questionários , Ritmo Circadiano/fisiologia
8.
Br J Sports Med ; 57(10): 595-601, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36878667

RESUMO

OBJECTIVES: To examine the internal consistency reliability and measurement invariance of a questionnaire battery designed to identify college student athletes at risk for mental health symptoms and disorders. METHODS: College student athletes (N=993) completed questionnaires assessing 13 mental health domains: strain, anxiety, depression, suicide and self-harm ideation, sleep, alcohol use, drug use, eating disorders, attention deficit hyperactivity disorder (ADHD), bipolar disorder, post-traumatic stress disorder (PTSD), gambling and psychosis. Internal consistency reliability of each measure was assessed and compared between sexes as well as to previous results in elite athletes. Discriminative ability analyses were used to examine how well the cut-off score on the strain measure (Athlete Psychological Strain Questionnaire) predicted cut-offs on other screening questionnaires. RESULTS: Strain, anxiety, depression, suicide and self-harm ideation, ADHD, PTSD and bipolar questionnaires all had acceptable or better internal consistency reliability. Sleep, gambling and psychosis questionnaires had questionable internal consistency reliability, although approaching acceptable for certain sex by measure values. The athlete disordered eating measure (Brief Eating Disorder in Athletes Questionnaire) had poor internal consistency reliability in males and questionable internal consistency reliability in females. CONCLUSIONS: The recommended mental health questionnaires were generally reliable for use with college student athletes. To truly determine the validity of the cut-off scores on these self-report questionnaires, future studies need to compare the questionnaires to a structured clinical interview to determine the discriminative abilities.


Assuntos
Atletas , Saúde Mental , Masculino , Feminino , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Estudantes
9.
J Stroke Cerebrovasc Dis ; 32(10): 107264, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37586218

RESUMO

BACKGROUND: Prior studies have elucidated a relationship between nonstenotic plaque in patients with cryptogenic embolic infarcts with a largely cortical topology, however, it is unclear if nonstenotic cervical internal carotid artery (ICA) plaque is relevant in subcortical cryptogenic infarct patterns. METHODS: A nested cohort of consecutive patients with anterior, unilateral, and subcortical infarcts without an identifiable embolic source were identified from a prospective stroke registry (September 2019 - June 2021). Patients with extracranial stenosis >50% or cardiac sources of embolism were excluded. Patients with computed tomography angiography were included and comparisons were made according to the infarct pattern being lacunar versus non-lacunar. Prevalence estimates for cervical internal carotid artery (ICA) plaque presence were estimated with 95% confidence intervals (CI), and differences in plaque thickness and features were compared between sides. RESULTS: Of the 1684 who were screened, 141 met inclusion criteria (n=80 due to small vessel disease, n=61 cryptogenic). The median age was 66y (interquartile range, IQR 58-73) and the National Institutes of Health Stroke Scale score was 3 (IQR 1-5). There was a higher probability of finding excess plaque ipsilateral to the stroke (41.1%, 95% CI 33.3-49.3%) than finding excess contralateral plaque (29.1%, 95% CI 22.2-37.1%; p=0.03), but this was driven by patients with non-lacunar infarcts (excess ipsilateral vs. contralateral plaque frequency of 49.2% vs. 14.8%, p<0.001) rather than lacunar infarcts (35.0% vs. 40.0%, p=0.51). CONCLUSIONS: The probability of finding ipsilateral, nonstenotic carotid plaque in patients with subcortical cryptogenic strokes exceeds the probability of contralateral plaque and is driven by larger subcortical infarcts, classically defined as being cryptogenic. Approximately 1 in 3 unilateral anterior subcortical infarcts may be due to nonstenotic ICA plaque.


Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Acidente Vascular Cerebral , Humanos , Idoso , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Infarto Cerebral/etiologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Artérias Carótidas
10.
J Infect Dis ; 223(3): 452-461, 2021 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-32614406

RESUMO

BACKGROUND: Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics. METHODS: We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data. RESULTS: From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%-100%) and 91.6% (88.8%-94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103-129) and 59 (51-67) ED visits per 10 000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively. CONCLUSIONS: In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.


Assuntos
Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Serviço Hospitalar de Emergência , Gastroenterite/epidemiologia , Gastroenterite/virologia , Norovirus , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta , Estudos de Casos e Controles , Criança , Fezes/virologia , Feminino , Genótipo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Norovirus/classificação , Norovirus/genética , Estações do Ano , Adulto Jovem
11.
J Am Chem Soc ; 143(41): 16890-16901, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34614361

RESUMO

Interest in therapeutic discovery typically drives the preparation of natural product analogs, but these undertakings contribute significant advances for synthetic chemistry as well. The need for a highly efficient and scalable synthetic route to a complex molecular scaffold for diversification frequently inspires new methodological development or unique application of existing methods on structurally intricate systems. Additionally, synthetic planning with an aim toward late-stage diversification can provide access to otherwise unavailable compounds or facilitate preparation of complex molecules with diverse patterns of substitution around a shared carbon framework. For these reasons among others, programs dedicated to the diversification of natural product frameworks and other complex molecular scaffolds have been increasing in popularity, a trend likely to continue given their fruitfulness and breadth of impact. In this Perspective, we discuss our experience using late-stage diversification as a guiding principle for the synthesis of natural product analogs and reflect on the impact such efforts have on the future of complex molecule synthesis.


Assuntos
Produtos Biológicos
12.
Histopathology ; 79(5): 768-778, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34036629

RESUMO

AIMS: Data regarding expression of intestinal markers in hepatocellular carcinoma (HCC) are limited. We determined the clinicopathological associations of cytokeratin (CK)19, a progenitor liver epithelial cell marker as well as biliary epithelial marker, and intestinal immunohistochemical markers expression in HCC and assessed their prognostic value. METHODS AND RESULTS: Tissue sections and/or tissue microarrays (TMAs) from 202 known HCCs were immunostained using CK19, CK20, CDH17, CDX2 and SATB2 antibodies. Haematoxylin and eosin (H&E)-stained slides were reviewed for tumour grading. Clinical and oncological outcomes were retrieved. Associations of staining with clinicopathological features and survival outcomes were evaluated. CK19, CK20, CDH17, CDX2 and SATB2 were positive in 12.8, 5.4, 10.3, 8.6 and 59.9%, respectively. All but SATB2 were strongly associated with higher tumour grade and AFP levels > 400 ng/ml (P < 0.05). CK19-positive HCC were more likely to express CDX2 (P = 0.001), CDH17 (P < 0.001) and/or CK20 (P = 0.012). CK20, CDX2 and CDH17 co-expression was seen in five cases (2.5%). CK19 and SATB2 positivity, tumour size ≥ 5 cm, background cirrhosis, AFP > 400 ng/ml and having no treatment were associated with decreased overall survival by log-rank test and univariable proportional hazards regression. However, in a multivariable model, CK19 and SATB2 positivity were not independent predictors of decreased survival while their association with known poor prognosticators in HCC was evident. CONCLUSIONS: HCC can express markers of intestinal differentiation. This phenotypical aberrancy correlates with variable clinicopathological parameters, some of which are independent predictors of poor survival.


Assuntos
Carcinoma Hepatocelular , Prognóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Fator de Transcrição CDX2/metabolismo , Caderinas/metabolismo , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Imuno-Histoquímica , Queratina-20/metabolismo , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologia , Masculino , Proteínas de Ligação à Região de Interação com a Matriz/metabolismo , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Fatores de Transcrição/metabolismo , Adulto Jovem
13.
Environ Sci Technol ; 55(20): 13869-13880, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34582191

RESUMO

Dienogest (DIE) and drospirenone (DRO) are two fourth-generation synthetic progestins widely used as oral contraceptives. Despite their increasing detection in wastewaters and surface waters, their fate during biological wastewater treatment is unclear. Here, we investigated DIE and DRO biotransformation with representative activated sludge batch incubations and identified relevant transformation products (TPs) using high-resolution mass spectrometry. DIE exhibited slow biotransformation (16-30 h half-life) and proceeded through a quantitative aromatic dehydrogenation to form TP 309 (molar yields of ∼55%), an aromatic TP ∼30% estrogenic as 17ß-estradiol. DRO experienced more rapid biotransformation (<0.5 h half-life), and 1,2-dehydrogenation formed the major TP 364 (molar yields of ∼40%), an antimineralocorticoid drug candidate named as spirorenone. Lactone ring hydrolysis was another important biotransformation pathway for DRO (molar yields of ∼20%) and generated pharmacologically inactive TP 384. Other minor pathways for DIE and DRO included hydroxylation, methoxylation, and 3-keto and C4(5) double-bond hydrogenation; distinct bioactivities are plausible for such TPs, including antigestagenic activity, antigonadotropic activity, and pregnancy inhibition effects. Thus, biotransformation products of DIE and DRO during wastewater treatment should be considered in environmental assessments of synthetic progestins, especially certain TPs such as the estrogenic TP 309 of DIE and the antimineralocorticoid spirorenone (TP 364) of DRO.


Assuntos
Progestinas , Esgotos , Androstenos , Biotransformação , Feminino , Humanos , Laboratórios , Nandrolona/análogos & derivados , Gravidez
14.
Clin Infect Dis ; 69(7): 1173-1182, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-30517612

RESUMO

BACKGROUND: The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool-testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated 6 leading gastroenteritis guidelines (eg, those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens. METHODS: Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children <18 years old who presented with ≥3 episodes of diarrhea and/or vomiting in a 24-hour period. All participants were tested for 9 bacterial enteropathogens: Aeromonas, Campylobacter, Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, Salmonella, Shigella, Vibrio, and Yersinia. Patient data gathered at the index visit were used to determine whether guidelines would recommend testing. Sensitivity and specificity to recommend testing for children with bacterial enteropathogens were calculated for each guideline. RESULTS: Outcome data were available for 2391 (97.7%) participants, and 6% (144/2391) of participants tested positive for a bacterial enteropathogen. Guideline sensitivity ranged from 25.8% (95% confidence interval [CI] 18.7-33.0%) to 66.9% (95% CI 59.3-74.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6-65.6%) to 96.5% (95% CI 95.7-97.2%). CONCLUSIONS: No guideline provided optimally balanced performance. The most sensitive guidelines missed one-third of cases and would drastically increase testing volumes. The most specific guidelines missed almost 75% of cases.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Técnicas Bacteriológicas , Testes Diagnósticos de Rotina , Fezes/microbiologia , Gastroenterite/diagnóstico , Gastroenterite/microbiologia , Doença Aguda , Adolescente , Algoritmos , Criança , Pré-Escolar , Gerenciamento Clínico , Feminino , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Sensibilidade e Especificidade
15.
J Clin Microbiol ; 57(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30944189

RESUMO

Data are lacking regarding the impact of visible pigment on rectal swab diagnostic accuracy. We describe the test characteristics of rectal swabs with and without pigment in children with gastroenteritis. Between December 2014 and September 2017, children (age, <18 years) with ≥3 episodes of vomiting and/or diarrhea in a 24-h period and symptoms for <7 days were enrolled through two pediatric emergency departments and from a province-wide nursing telephone advice line in Alberta, Canada. Specimens were analyzed by employing nucleic acid amplification panels. The primary outcomes were the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the rectal swabs, with stool specimen results being used as the reference standard. An enteropathogen was detected in 76.0% (1,399/1,841) of the paired specimens. A total of 54.4% (1,001/1841) of the swabs had visible pigment. The respective enteropathogen detection characteristics of swabs with and without visible pigment were as follows: 92.2% (95% confidence interval [CI], 90.0%, 94.0%) versus 83.7% (95% CI, 80.5%, 86.4%) for sensitivity, 94.3% (95% CI, 90.5%, 96.6%) versus 91.2% (95% CI, 86.3%, 94.5%) for specificity, 97.9% (95% CI, 96.4%, 98.8%) versus 96.5% (95% CI, 94.5%, 97.8%) for PPV, and 80.9% (95% CI, 76.0%, 85.1%) versus 65.8% (95% CI, 60.0%, 71.1%) for NPV. Processing of swabs without visible pigment would increase the rate of identification of positive swabs from 50.0% (682/1,365) to 88.3% (1,205/1,365). There is a modest decrease in the reliability of a negative test on swabs without evidence of pigment, but the overall yield is significantly greater when they are not excluded from testing. Hence, rectal swabs without visible feces should not be routinely rejected from testing.


Assuntos
Enterocolite/diagnóstico , Enterocolite/etiologia , Fezes/microbiologia , Fezes/virologia , Pigmentos Biológicos , Reto/microbiologia , Reto/virologia , Alberta , Pré-Escolar , Diarreia/diagnóstico , Diarreia/etiologia , Feminino , Humanos , Lactente , Masculino , Técnicas Microbiológicas , Técnicas de Diagnóstico Molecular , Sensibilidade e Especificidade
16.
Eur J Clin Microbiol Infect Dis ; 38(12): 2371-2379, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502119

RESUMO

Little is known about the epidemiology and severity of gastroenteritis among children treated at home. We sought to compare illness severity and etiology between children brought for emergency department (ED) care to those managed at home (i.e., community). Prospective cohort study of children enrolled between December 2014 and December 2016 in two pediatric EDs in Alberta, Canada along with children treated at home after telephone triage (i.e., community). Primary outcomes were maximal frequency of vomiting and diarrhea in the 24-h pre-enrollment period; secondary outcomes included etiologic pathogens, dehydration severity, future healthcare visits, and treatments provided. A total of 1613 patients (1317 ED, 296 community) were enrolled. Median maximal frequency of vomiting was higher in the ED cohort (5 (3, 10) vs. 5 (2, 8); P < 0.001). Proportion of children with diarrhea and its 24-h median frequency were lower in the ED cohort (61.3 vs. 82.8% and 2 (0, 6) vs. 4 (1, 7); P < 0.001, respectively). In regression analysis, the ED cohort had a higher maximum number of vomiting episodes pre-enrollment (incident rate ratio (IRR) 1.25; 95% CI 1.12, 1.40) while the community cohort had higher maximal 24-h period diarrheal episodes (IRR 1.20; 95% CI 1.01, 1.43). Norovirus was identified more frequently in the community cohort (36.8% vs. 23.6%; P < 0.001). Children treated in the ED have a greater number of vomiting episodes; those treated at home have more diarrheal episodes. Norovirus is more common among children treated symptomatically at home and thus may represent a greater burden of disease than previously thought.


Assuntos
Serviço Hospitalar de Emergência , Gastroenterite/epidemiologia , Gastroenterite/terapia , Autocuidado , Doença Aguda , Alberta/epidemiologia , Infecções por Caliciviridae/epidemiologia , Canadá/epidemiologia , Pré-Escolar , Desidratação/epidemiologia , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/terapia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/patologia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Norovirus/isolamento & purificação , Estudos Prospectivos , Telefone , Triagem , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/terapia
17.
Nature ; 502(7471): 317-20, 2013 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-24132288

RESUMO

The US National Cancer Institute (NCI), in collaboration with scientists representing multiple areas of expertise relevant to 'omics'-based test development, has developed a checklist of criteria that can be used to determine the readiness of omics-based tests for guiding patient care in clinical trials. The checklist criteria cover issues relating to specimens, assays, mathematical modelling, clinical trial design, and ethical, legal and regulatory aspects. Funding bodies and journals are encouraged to consider the checklist, which they may find useful for assessing study quality and evidence strength. The checklist will be used to evaluate proposals for NCI-sponsored clinical trials in which omics tests will be used to guide therapy.


Assuntos
Ensaios Clínicos como Assunto/métodos , Genômica , Projetos de Pesquisa , Lista de Checagem , Ensaios Clínicos como Assunto/economia , Ensaios Clínicos como Assunto/ética , Ensaios Clínicos como Assunto/normas , Estudos de Avaliação como Assunto , Genômica/ética , Humanos , Modelos Biológicos , National Cancer Institute (U.S.)/economia , Medicina de Precisão/ética , Medicina de Precisão/métodos , Medicina de Precisão/normas , Projetos de Pesquisa/normas , Manejo de Espécimes , Estados Unidos
18.
Pediatr Emerg Care ; 35(1): 28-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28398938

RESUMO

OBJECTIVES: The objective of this study was to describe the quality of emergency department (ED) care for pediatric patients with anaphylaxis. The secondary objectives were to describe (1) the clinical presentation of pediatric patients with anaphylaxis including the proportion of patients meeting each of the National Institute of Allergy and Infectious Diseases (NIAID) consensus criteria and subcriteria and (2) the Interrater reliability (IRR) for applying the NIAID criteria. METHODS: We conducted a retrospective cross-sectional chart review of patients seen in a pediatric ED during a 2-year period. All charts were reviewed by a trained chart reviewer with 10% abstracted by a second reviewer. Data were analyzed using descriptive statistics including proportions, medians, and interquartile range. Interrater reliability was calculated using Cohen unweighted κ or percent agreement. RESULTS: Of the 250 charts reviewed, 84% (211) met the NIAID criteria for anaphylaxis (IRR, 1.0). Only 68% of patients received epinephrine in the ED or within 3 hours of the ED visit. Adherence was poor and IRR was variable, for measures reflecting documentation of discharge instructions and follow-up with a specialist. The IRR of reviewers for determining which patients met the NIAID criteria overall and for each subcriterion was high. CONCLUSIONS: Our findings highlight a gap between best practice and ED care. In addition, our results suggest that the NIAID criteria can reliably be used to retrospectively identify pediatric patients with anaphylaxis. Accurately identifying cases is a prerequisite for measuring gaps in management and developing interventions to improve care.


Assuntos
Anafilaxia/diagnóstico , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Anafilaxia/terapia , Criança , Pré-Escolar , Consenso , Estudos Transversais , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
J Org Chem ; 83(6): 3023-3033, 2018 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-29313681

RESUMO

The desire for maximally efficient transformations in complex molecule synthesis has contributed to a surge of interest in C-H functionalization methods development in recent years. In contrast to the steady stream of methodological reports, however, there are noticeably fewer studies comparing the efficacies of different C-H functionalization protocols on a single structurally intricate substrate. Recognizing the importance of heteroatom incorporation in complex molecule synthesis, this report discloses a comparative examination of diverse strategies for C-O, C-N, and C-X bond formation through late-stage C-H oxidation of the tricyclic cyanthiwigin natural product core. Methods for allylic C-H acetoxylation, tertiary C-H hydroxylation, tertiary C-H amination, tertiary C-H azidation, and secondary C-H halogenation are explored. These efforts highlight the robustness and selectivities of many well-established protocols for C-H oxidation when applied to a complex molecular framework, and the findings are relevant to chemists aiming to employ such strategies in the context of chemical synthesis.


Assuntos
Produtos Biológicos/química , Carbono/química , Diterpenos/química , Hidrogênio/química , Alcenos/química , Catálise , Hidroxilação , Oxirredução
20.
J Am Chem Soc ; 138(40): 13179-13182, 2016 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-27670712

RESUMO

A new strategy for the functionalization of sterically hindered terminal olefins is reported. Alkenes bearing quaternary carbons at the allylic or homoallylic position are readily oxidized to the corresponding aldehydes by palladium/copper/nitrite catalysis. A broad range of functional groups including esters, nitriles, silyl ethers, vinylogous esters, ketones, lactones, and ß-ketoesters are tolerated under the reaction conditions. The crude aldehyde products can be transformed further, enabling direct conversion of hindered terminal alkenes to various other synthetically useful functional groups, resulting in formal anti-Markovnikov hydroamination, among other transformations.

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