Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE2AT IPD)

INTRODUCTION

Globally, recognition is growing of the harmful impacts of high ambient temperatures (heat) on health in pregnant women and children. There remain, however, major evidence gaps on the extent to which heat increases the risks for adverse health outcomes, and how this varies between settings. Evidence gaps are especially large in Africa. We will conduct an individual participant data (IPD) meta-analysis to quantify the impacts of heat on maternal and child health in sub-Saharan Africa. A detailed understanding and quantification of linkages between heat, and maternal and child health is essential for developing solutions to this critical research and policy area.

METHODS AND ANALYSIS

We will use IPD from existing, large, longitudinal trial and cohort studies, on pregnant women and children from sub-Saharan Africa. We will systematically identify eligible studies through a mapping review, searching data repositories, and suggestions from experts. IPD will be acquired from data repositories, or through collaboration with data providers. Existing satellite imagery, climate reanalysis data, and station-based weather observations will be used to quantify weather and environmental exposures. IPD will be recoded and harmonised before being linked with climate, environmental, and socioeconomic data by location and time. Adopting a one-stage and two-stage meta-analysis method, analytical models such as time-to-event analysis, generalised additive models, and machine learning approaches will be employed to quantify associations between exposure to heat and adverse maternal and child health outcomes.

ETHICS AND DISSEMINATION

The study has been approved by ethics committees. There is minimal risk to study participants. Participant privacy is protected through the anonymisation of data for analysis, secure data transfer and restricted access. Findings will be disseminated through conferences, journal publications, related policy and research fora, and data may be shared in accordance with data sharing policies of the National Institutes of Health.

PROSPERO REGISTRATION NUMBER

CRD42022346068.

Multivisceral echinococcosis: concept, diagnosis, management

INTRODUCTION

Hydatid disease is in a come-back period. In Romania the incidence is cited at 5-6 cases per 100,000 inhabitants.

MATERIAL AND METHOD

In this study we define the concept of multivisceral echinococcosis, which is a more serious form of the hydatid disease with implications of diagnosis, treatment,morbidity and mortality. Multivisceral echinococcosis must be differentiated from multiple echinococcosis. The latter is defined as the localization of multiple hydatid cysts in the same organ. In case of multiple echinococcosis, we can describe double echinococcosis (two hydatid cysts located in the same organ), triple, etc. The etiology of multivisceral echinococcosis is similar to mono-visceral echinococcosis.Regarding the pathogenic mechanism, we appreciate that there are two distinct mechanisms: primary infection (most of them) and secondary infection.

DISCUSSION

We propose a classification of multivisceral echinococcosis based on the anatomical compartment involved.The diagnosis of this condition is easy to establish using classicor more recent investigations (CT, MRI). Compared to monovisceral echinococcosis, the symptomatology is louder because of the involvement of several organs and its association with different other conditions.

CONCLUSIONS

We wish this study to bring more information about hydatid disease, but especially about multivisceral echinococcosis.

Two soluble pyrophosphatases in Vibrio cholerae: Transient redundancy or enduring cooperation?

Soluble pyrophosphatases (PPases), which are essential for cell life, comprise two evolutionarily unrelated families (I and II). Prokaryotic genomes generally contain a single PPase gene encoding either family I or family II enzyme. Surprisingly, four Vibrionales species, including the human pathogen Vibrio cholerae, contain PPase genes of both families. Here we show that both genes are transcriptionally active in V. cholerae, and encode functional PPases when expressed in Escherichia coli. In contrast, only the family I PPase protein is detected in V. cholerae under our experimental conditions. Phylogenetic analyses indicate that family II enzymes are not native to gamma-proteobacteria, but are of benefit to the marine species of this bacterial class. In this context, we favor the hypothesis that in the course of evolution, family II PPase was laterally transferred to the Vibrionales ancestor and partially degenerated due to functional redundancy, but nevertheless remained fixed as an adjunct to the family I enzyme.

Selective retension of active cells employing low centrifugal force at the medium change during suspension culture of Chinese hamster ovary cells producing tPA

The effect of centrifugal force applied for cell separation at the medium change on the growth, metabolism and tissue plasminogen activator (tPA) productivity of Chinese hamster ovary (CHO) cells suspension culture was investigated. The viability of the precipitated cells increased exponentially as the centrifugal force decreased. However, the cell recovery was lower than 91% when centrifugal forces applied for 5 min was less than 67 x g. In cultures incubated for 474 h with 7 medium changes employing centrifugal forces ranging from 67 to 364 x g, a centrifugal force lower than 119 x g resulted in higher specific rates of growth, glucose consumption, and lactate and tPA production during the whole culture period. On the other hand, daily centrifugation at 67 to 537 x g without discarding the supernatant had no effect on the specific rates. The cultures inoculated with cells precipitated at a centrifugal force of 67 x g showed apparently higher specific rates of metabolism compared to those inoculated with cells in the supernatant. The cells in the supernatant and the precipitate obtained following centrifugation at 67 x g have average diameters of 15.5 and 17.4 microm, respectively. The intracellular contents of amino acids, especially nonessential amino acids, of the precipitated cells were markedly higher than those of the cells in the supernatant. These results indicate that large cells with high amino acid content and metabolic activity were selectively retained in the culture by means of centrifugation at low forces such as 67 x g. Consequently, application of a low centrifugal force is recommended for medium change in order to maintain higher specific productivity of suspended mammalian cells in perfusion culture.

The "open" and "closed" structures of the type-C inorganic pyrophosphatases from Bacillus subtilis and Streptococcus gordonii

Recently, a new class of soluble inorganic pyrophosphatase (type-C PPase) has been described that is not homologous in amino acid sequence or kinetic properties to the well-studied PPases (types A and B) found in many organisms from bacteria to humans and thought to be essential to the cell. Structural studies of the type-C PPases from Streptococcus gordonii and Bacillus subtilis reveal a homodimeric structure, with each polypeptide folding into two domains joined by a flexible hinge. The active site, formed at the interface between the N and C-terminal domains, binds two manganese ions approximately 3.6 A apart in a conformation resembling binuclear metal centres found in other hydrolytic enzymes. An activated water molecule bridging the two metal ions is likely poised for nucleophilic attack of the substrate. Importantly, the S. gordonii and B. subtilis enzymes have crystallised in strikingly different conformations. In both subunits of the S. gordonii crystal structure (1.5 A resolution) the C-terminal domain is positioned such that the active site is occluded, with a sulphate ion bound in the active site. In contrast, in the B. subtilis structure (3.0 A resolution) the C-terminal domain is rotated by about 90 degrees, leaving the active site wide open and accessible for substrate binding.