Each year, 800,000 children under 5 living in the developing world die from a disease that is usually considered a mere annoyance in the West diarrhea. But until now, there has been very little reliable data on the microbes behind all this death and their specific effects on the health of children worldwide. To fill these gaps, a team of scientists spent three years studying diarrheal diseases at seven sites in South Asia and Africa. The results were sobering: children with moderate to severe diarrhea (MSD) were 8.5 times more likely to die within 60 days children do not suffer from TMS, the researchers report today The Lancet . Moreover, children who have survived their battle with MSD showed signs of stunting that could affect their future development. Microbially, the team was surprised to discover that the majority of children cases of MDS were caused by only four pathogens: Rotavirus (photo), the parasite Cryptosporidium , a strain of the Escherichia coli bacteria called ST-ETEC, and bacteria Shigella. The fact that the rotavirus top of the list is actually good news, because efforts are already underway to vaccinate children at risk against the virus. But the appearance of Cryptosporidium is more disturbing, scientists had no idea of the parasite, which is usually observed in HIV patients for HIV was the cause of many cases of MSD childhood. They hope that this new study will be accelerated if necessary research on how to protect themselves against this bug understudied.
Finding Less Risky Ways to Make Medical Isotopes -
Nuclear medicine coverage for countries determined to acquire nuclear weapons? For years, this issue has clouded efforts to increase the production of medical radioisotopes, many of which are made in nuclear reactors that run on highly enriched uranium (HEU) -the fissile material in a bomb or use HEU as targets to generate radioisotopes. A report released today by AAAS, the publisher of Science Insider, highlights a growing range of alternative methods of producing radioisotopes that would make it harder for future proliferators to get hold of fissile materials.
The safer methods could help defuse tensions with neighboring nations nuclear ambitions, analysts say. Iran, for example, has been engaged in a decadelong standoff with the United States and its allies over its nuclear program and cited the need to produce medical isotopes and power as key justifications for his efforts. A measure of confidence building might be for Iran to explore the production of medical isotopes which avoids the use or production of fissile material. In this regard, if the negotiators of the United States Department of State "can sell the idea of Iran participating in advanced nuclear technologies [that steer clear of fissile material] something then maybe you have," said Mark Jansson, Director of special projects at the Federation of American scientists in Washington, DC by establishing alternative, the authors of the report, he said, "did a fantastic job."
radioisotopes are widely used in medical imaging and to irradiate certain types of tumors. They have long been considered a dividend of nuclear technology and have been an important reason that the nuclear powers of the world in the 1950s and 1960s have promoted the construction of research reactors worldwide. Medical isotopes can also be produced in cyclotrons or spallation neutron sources, for example, but specialized facilities were prohibitive until the great embrace a technology called positron emission (PE) scanning in the 1980 strong demand for medical isotopes used in acute PE tomography scanning has lowered the cost of ion accelerators in hospital. Consequently, "the technology of the accelerator is much less expensive and more capable than before," says the report, written by Derek and Seth A. Updegraff Hoedl the AAAS Center for Science, Technology and Policy . security
Their report focuses on the most widely used medical isotopes in the world: technetium-99m (Tc-99m), which is used in about 80% of all nuclear medicine procedures: 30 million procedures per year. 99m Tc in nuclear medicine is popular as it is easily incorporated into a variety of chemicals that can concentrate the radioisotope in various types of tissue for imaging. the hospitals using Tc-99m buy radioisotope its parent, the molybdenum-99 (Mo-99), which is a decay product of uranium-235. the main way as Mo-99 is now produced is to irradiate uranium targets in a reactor . this research does not have to be this way: the AAAS report notes that 99 MB can be created by a reaction on photonuclear MB-100 or Mo-99 can be totally ignored by the production of Tc-99m directly bombarding Mo-100 with protons. The latter approach is currently being tested by a cyclotron manufacturer in Canada, the report notes. "The risk of proliferation with accelerators is considerably weaker," said Updegraff.
Vicious vine. leafy, flowering vines called Aristolochia are used in a supplement herbal that can cause cancer.
Carsten Niehaus / Creative Commons
SHANGHAI, CHINA -Many people are turning to herbal supplements to improve their health. In China, the belief in traditional medicine is so strong that peddle pharmacies unprocessed herbs alongside modern pharmaceuticals. But an ingredient found in some supplements may also be cancerous than smoking, two new studies found.
The ingredient in question is aristolochic acid, a compound found in leafy, flowering vines called Aristolochia or Aristolochia. For centuries, Aristolochia was used in traditional medicine in China (and ancient Greece before that) to treat arthritis and ease childbirth, among other conditions. (The flower is shaped uterus). Today aristolochic acid pronounced "a laugh-to-LOW-stroke" is found in supplements for weight loss, menstrual symptoms, and rheumatism. It is widely used in Asia, where it is added to medicinal wine , ointments, and pills. one study found that between 1997 and 03, a third of Taiwanese have been prescribed Aristolochia supplements by a Chinese medicine practitioner.
Warnings on grass first emerged in the early 190s, when a scandal involving dozens of women in Belgium who had inadvertently taken for weight loss surfaced. as stated in the Lancet in 1993, several patients developed severe kidney failure.
Soon after, scientists discovered a link in the region's rural Danube River between kidney damage and wheat that had been contaminated with Aristolochia when the seeds of both plants mixed during harvest. in 01, the Food and Drug Administration issued an advisory note of consumers about the diet supplements and other products containing aristolochic acid, calling for its use to be interrupted. In 03, many countries, including Taiwan had banned the substance. The International Agency for Research on Cancer has classified based compounds derived from Aristolochia plants as a group 1 carcinogen, meaning there is sufficient evidence that it causes cancer in humans, not only animals.
But these supplements are available from Chinese traditional practitioners and the Internet, says Bin Tean Teh, a cancer researcher at the Singapore National Cancer Centre and National University of Singapore (NUS) and corresponding author on one of the new papers appearing in this week science Translational Medicine. and although some studies have shown a link between Aristolochia and is greater urinary tract cancer or kidney disease, they had only traced the mechanism provided that mutations in a gene P53 , a gene commonly associated with cancer. "I thought there should be more than that," said Teh, who has long been struck by the fact that Taiwan, with high use of supplements containing Aristolochia, also has the highest incidence of upper known cancer pathways urinary worldwide.
For a broader picture, Teh and his colleagues sequenced the tissues from nine Taiwanese patients with upper urinary tract cancer who took Aristolochia. From previous research, scientists know that carcinogens such as cigarette smoke leave DNA on the genome of a person, as characteristic alterations in the letters that make up DNA sometimes considered 'mistakes' spelling". Because cancer of the upper urinary tract occurs in the kidney, the researchers used the latest methods of gene sequencing to examine cancerous kidney tissue side by side with non-tumor tissue nearby. In malignant tissues, they found up to 1500 genes with higher-mutations than what has been found to be lung cancer in smokers or skin cancer in patients with high exposure to ultraviolet radiation. "People have always thought it was a gene" affected by Aristolochia, said Teh. "We found that it was thousands."
Meanwhile, a scientific team that was looking to sequences from a patient with liver cancer noticed a strikingly similar genetic fingerprint. Using the same procedure, the group found that Aristolochia may be responsible as well as the cancer the first time that the grass has been associated with liver cancer.
The study is the final nail in the coffin for Aristolochia, says Steven Rozen, genetics researcher cancer Graduate Medical School Duke-NUS in Singapore and Duke University Medical Center in Durham, North Carolina, and an author on the paper. "This is a pretty clear story," he said. "These plants are very dangerous."
The second paper, by another group of authors in the United States and Taiwan, arrived at similar results. After tissues from 19 Taiwanese patients with upper urinary tract cancer sequencing, the researchers found that a group of patients with cancer of the upper urinary tract, but no use of Aristolochia background check n has not shown the same pattern of mutations.
The work raises new possibilities for diagnosis, said Marc Ladanyi, a cancer researcher at Memorial Sloan Kettering Center in New York City-cancer. One day, the first clue that a patient has ingested Aristolochia might come not from the clinical history of the person, but powerful genetic fingerprint of the plant, he said. If found in patients living in areas not widely known to have a Aristolochia exposure, such a mark could be a sign that public health campaigns are needed.
Problems Mount for Novartis's Hypertension Drug in Japan -
Under control. a Japanese inquiry scrutinizes the potential involvement of Novartis handle clinical trial data on one of its drugs.
Novartis
A commission of inquiry under the Japanese Ministry of Health has confirmed that the data in scientific papers resulting from clinical trials of the blockbuster hypertension drug Novartis Diovan have been handled, several media reported today. In its interim report, the committee also called for further investigation to determine whether the use of Novartis data to promote drugs constitutes false advertising that is prohibited by pharmaceutical laws of Japan, according to NHK, the broadcaster quasi- national.
The Ministry of Health launched the investigation in August after Kyoto Prefectural University of Medicine, Kyoto, and the medical school of the Jikei University in Tokyo, reported finding evidence of manufacturing data in the documents reporting the results of clinical trials of Diovan, known generically as valsartan, driving after receiving marketing approval in Japan in 00 to control hypertension. These clinical trials have sought to investigate whether the drug has also helped to prevent angina and stroke. Both surveys found that a former employee Novartis helped the research teams from both universities with data analysis, although the link that person to the company was not disclosed in the newspapers. The investigations led to the retraction of several records of testing. The senior researcher at the Kyoto school has resigned; Chief of Jikei team was disciplined. Three other universities that hosted Diovan trials ongoing investigations.
As in previous probes, the panel of the Ministry of Health could not conclude bears ultimate responsibility for making data. Novartis officials, based in Basel, Switzerland, Novartis Pharma KK, the Japanese subsidiary, apologized and promised their cooperation in the investigation continues.
horseshoe Unlucky. bats in Chinese horseshoe like this carry a virus similar to SARS can infect human cells.
Libiao Zhang / Guangdong Entomological Institute / South China Institute of Endangered Animals
In November 02, a new deadly virus suddenly appeared in southern China. In less than a year, the disease has caused, known as SARS spread to 33 countries, sickening more than 8,000 people and killing more than 700. Then he disappeared. Now, researchers say they first isolated a virus closely related bats in China that can infect human cells. "This shows, that at this time in China, there are bats with a virus that can infect people directly, and cause another SARS pandemic," says Peter Daszak, one of the authors and President of EcoHealth Alliance in New York.
scientists have long suspected bats to be the natural reservoir of coronaviruses such as that responsible for SARS (severe acute respiratory syndrome). the animals were identified as the source of many dangerous viruses such as Nipah and Hendra, and have also been linked to Ebola and new coronavirus causing SARS-like illness, called MERS. in 05, Daszak and others have found viral DNA closely resembling the SARS virus in three bat species in Chinese horseshoe. However, while the sequences of these viral genomes were 88% to 92% identical to the SARS coronavirus, they showed marked differences in a region encoding said protein peak. In the SARS virus, this protein binds to a receptor on the surface of human cells mediating its input. The difference means that the bat virus would not be able to infect human cells. And because some palm civets were carriers of a virus almost identical to the human SARS virus, most researchers have come to believe that SARS spread from bats to civets-probably in a Chinese market where these and other animals come into close contact and then to humans.
Now, new research suggests that civets may not be necessary to start a SARS pandemic. For more than a year, China's scientists, Australia and the United States gathered anal swabs or faecal samples of horseshoe bats in a cave in Kunming in southern China. They found coronavirus RNA in 27 of the 117 sampled animals. Among the viruses were two new coronavirus strains that resemble the SARS closer than those previously identified in bats, particularly in the part of the genome encoding the major spike protein. Scientists have also isolated the virus living in one of the animals. In the experiments, reported online today in Nature , they showed that the virus has infected pig kidney cells and bats, and perhaps more importantly, cells lining the human lung.
The new results can not solve if the original SARS virus moved directly from bats to humans or through an intermediate host, said Columbia University virologist Ian Lipkin, who was not involved the work. But it shows that a similar coronavirus "has the potential to infect people without an intermediate host."
This should be a warning to everyone, said Daszak. Although the SARS virus blew to humans by civet cats, this stopover was not necessary, he said. Bats are still hunted and eaten in large numbers in China, it is concerned. "I think people should stop chasing bats and stop eating bats."
But Michael Osterholm, director of the Center for Research on Infectious Diseases and politics at the University of Minnesota, Twin Cities, said that scientists must be careful to distinguish between what is possible and what which is likely in nature. Bat rabies, for example, easily infects human tissues, and many bats carry the virus, he said. "If it was sufficient for transmission that we should all be dying of bats in the US" But the virus can be transmitted if an infected bat bites a human. This rarely happens and there are very few cases of bats in the United States.
Christian Drosten, a coronavirus expert at the University of Bonn in Germany, also warns against over-interpretation of the results. Laboratory experiments do not necessarily mean that the virus can actually infect humans, he said. "Receptors and cell culture studies are not everything. You should take this virus and see in animal testing if it can, for example, infect a primate. "
What fascinates Drosten more on paper is a parallel to the coronavirus causing MERS, a disease that was reported the first in the Middle East in 2012 and killed 62 people to date. that the virus has also been shown to infect cells of various species in cell culture. "We thought it was a particular feature of MERS, but now this virus shows a similar trend, "said Drosten. This suggests that coronaviruses found in bats and other animals differ in a way that can make them more or less likely to jump to humans. In trying to predict future pandemics, such characteristics can guide virologists most likely pathogens to cause a pandemic, he hopes, and could one day help prevent another SARS pandemic to occur.
ScienceShot: Studying Fur Seals Can Give Them a Heart Attack -
wildlife veterinarians working on distance Guafo island Chile discovered deadly heart damage, known as cardiomyopathy in five South American fur seal pups they had captured and placed in bags up to 30 minutes, a common practice to consider the smaller seals. As part of a biological survey during the island, researchers had caught and released fur seals for 4 years without deaths captivity, but the sudden cluster triggered an investigation. Necropsy revealed that the puppies had chronic hookworm infection, which worsened their immune system and sent their adrenal glands in hyperdrive. The adrenal glands produce stress hormones that speed up the heart, the team believes that the captivity and the trauma of bagging pushed the baby seals on the edge. The examinations, reported in Marine Mammal Science , revealed unmistakable lesions of cardiomyopathy in heart muscles of the puppies. Fur seals become the second marine mammals, after the dolphins, shown to develop heart disease after handling or captivity. Biologists suggest that field officers should look for signs of chronic infections in seals, such as discomfort or unusually rapid breathing before handling animals and risking further damage.
President's Bioethics Panel Weighs in on How U.S. Should Handle Incidental Findings -
jump into the fray with a controversial topic, the Presidential Commission for the Study of Bioethical Issues published a report this afternoon on how to handle incidental findings, discovered on the DNA of an individual, and other information related to health that arise during the hunt for something else. These potentially problematic results could include an individual's risk of certain cancers, the chances of transmitting a deadly disease to his children, or a chromosomal abnormality that could cause infertility. Incidental findings have attracted increasing attention and concern of late, particularly in genetics, where large genome scans turn unexpected information that nobody really knows what to do with.
The bioethics commission, chaired by Amy Gutmann, president of the University of Pennsylvania, says that doctors, researchers and companies selling DNA tests need to reframe the way they think all this: of course, nobody knows what will be buried in a given gene sequence, that ancillary conclusions can be part should hardly be a surprise. Practitioners, the Commission contends, should be prepared to discuss this possibility with patients or research subjects. Gutmann wrote an article in this week's issue of Science summarizing the rationale for the recommendations.
The commission has left some of the stickier details to others, who conclusions to return, for example, and if biobanks have an obligation to provide fortuitous discoveries to people whose DNA they store and share. In general, the commission recommended that researchers, doctors and companies describe the findings to potential beneficiaries that might occur; that beneficiaries have a say if they get these results back; and research continues on incidental findings to determine how common certain variants of DNA, for example, could be in the general population. A full list of recommendations can be seen here with the full report.
The Committee suggests that the researchers had the right to exclude studies of people who do not want potentially lifesaving results returned to them and wondered if the researchers have a legal obligation to return some conclusions and can be sued if they do not.
The new report is the latest in a pile more and more to try to clarify the issue. This spring, a group of geneticists urged laboratories to actively seek incidental findings, as some genes predisposing to breast cancer and ovarian cancer, and return the results if people want it or not. That's something the bioethics commission did not support. As science that picks incidental findings moves fast, decision makers do what they can to follow.
Novartis's Japan Unit Faces Criminal Probe for Hypertension Drug Marketing -
The Japanese Ministry of Health, Labour and Welfare today asked prosecutors to investigate a possible violation criminal laws on the marketing of the drug by the Japanese subsidiary of the Swiss pharmaceutical giant Novartis. The department says the company may have exaggerated the benefits of its hypertension drug valsartan.
Last July, Novartis Pharma has admitted that a former employee has created a conflict of interest in participating in clinical studies of valsartan, sold under the trade name Diovan led by five Japanese medical schools while concealing his affiliation with the company. Several studies have been retracted after investigations by the medical schools and the Ministry of Health turned to the manipulation of data which skewed the results. Novartis Pharma ads emphasized studies showing that the use of Diovan reduces risk of heart attack and stroke in patients better than hypertension replacement drugs. According to Japanese media reports, the potential fines could be just $ 20,000, but there is a small chance executives could face prison sentences.
Also today, Novartis Japan issued a statement in Japanese on its website acknowledging the investigation and apology "to patients, their families, health workers and citizens to have caused great anxiety and trouble. " As in previous statements, Novartis has pledged to cooperate fully with the authorities but did not acknowledge any wrongdoing.
Live Chat: Can Alternative and Conventional Medicine Get Along? -
[Please hit refresh on this page if the video is not playing and it is after 3 p.m. EDT. Leave your questions in the comment section at the bottom of the page. Our moderator will address them during the chat.]
Alternative medicine is a broad label that includes everything? herbal? remedies and acupuncture to massage and meditation. Although very popular, many of these potential therapies are poorly understood. There is much interest in combining alternative therapies with conventional medicine, but the best ways to do this are not clear. Researchers and doctors are making progress in the study of alternative therapies that can be combined with conventional treatments and ways to combine them to deal more effectively with a range of different diseases. What are the current plans for the integration of alternative and conventional medicine? What are the most promising alternative therapies being studied today? And are there alternative practices that are specifically known to be harmful in combination with conventional therapies?
Join us on Thursday, February 6 at 15 pm EST on this page for a live video chat with experts that reviews the recent progress at the intersection of alternative medicine and conventional.
Breaking the cycle. A GSK744 injection can cause infection for months by inhibiting the integration of HIV.
G.Grullón / Science
Antiretroviral drugs can protect people against infection with HIV. But so-called pre-exposure prophylaxis, or PrEP, only works if people take pills daily, which studies show they have trouble doing. Now the monkey experiments with an integrase inhibitor that is injected show how one shot protects against the AIDS virus for 11 weeks on average. The drug lasts even longer in humans, which may provide a promising new approach for PrEP.
For the complete story, see this week's issue of Science .
sounds good. New auditory neurons increased in Guinea pig deaf since DNA for a growth factor ( above ), but not in the untreated ears of the same animal.
Translational Neuroscience Facility UNSW
Many people with profound hearing loss were helped by devices called cochlear implants, but their audience is still far from normal. They often have trouble distinguishing different music sites, for example, or to hear a conversation in a noisy room. Now researchers have found a clever way to use cochlear implants to deliver new genes into the ear therapy which, in guinea pigs, significantly improves hearing.
The most common cause of hearing loss is the loss of tiny hair cells inside the cochlea, a spiral hollow structure in the inner ear that converts sound into nerve impulses. Hearing aids, which simply amplify sounds do not help people who have lost these hair cells. Thus, since the 1970s, more than 320,000 children and adults around the world who are deaf or severely hearing impaired have received cochlear implants. Instead of relying on hair cells, the device converts the sounds into electrical impulses and then uses electrodes to transmit these signals to the auditory nerve to the brain. But because the auditory nerve is buried in the tissue, the implants do not work as well as they could if the electrodes were closer to the nerve.
Some researchers have stimulated new neurons to grow inside the cochlea using a protein known as a growth factor. They injected growth factor in the inner ear, or a virus used to deliver a gene encoding it into cells. But growth factor pumped-in does not work for long, unless it is replenished. And viral gene therapy still not put the gene in the right cells, and has risks, as a reaction of the immune system to the virus.
Graduate student Jeremy Pinyon and colleagues in the laboratory of neurosciences Gary Housley at the University of New South Wales in Sydney, Australia, tested another type of gene therapy to deaf guinea pigs made with a drug that kill the hair cells in the cochlea. The researchers created DNA encoding a gene loops of a neurotrophic factor called brain-derived growth factor (BDNF). Upon insertion of a cochlear implant in animals, the team injected the cochlea with a solution of BDNF DNA and then used electrical impulses from the device to create pores in the cells that line the cochlea and cajole DNA to enter the cells. The loops also included a gene for green fluorescent protein so that the scientists could see whether the inserted DNA was taken up by the cells and translated into protein.
In the coming days, the cells began pumping BDNF, which, in turn, stimulated the growth of neurons long bristled at the electrodes. Two weeks after treatment, the researchers tested the sensitivity of the brain of animals were sounds of different frequencies. The results were closer to those of normal animals and much better than those seen in animals that had only a cochlear implant.
"We closed the neural gap," said Housley. Although it is difficult to accurately measure sound perception in guinea pigs, if applied in humans, "we hope that the tonal colors and the wealth will be improved," says Housley, whose team's report appears today ' hui in Science Translational Medicine .
One caveat is that the improved hearing did not last long cells stopped producing BDNF after about 6 weeks and new nerves began to die. DNA loops must be modified to work longer in the cells, Housley said. another potential problem is he does not know how long the cells that received DNA last before dying and ability of BDNF-how is lost. Housley believes that these problems can be solved, however, and he hopes to start a small clinical trial to test the procedure in people within 2 years.
"idea [of using BDNF] was around. But this study is the first to put this idea in collaboration with cochlear implants, "says neuroscientist Jeffrey Holt Hospital Medical School and Harvard Boston Children. The technique is "smart", says researcher hear Yehoash Raphael of the University of Michigan, Ann Arbor, the group used a virus to insert the gene BDNF in the cochlear cells. Housley hope other implanted devices could also offer gene therapy, such as small electrical appliances sometimes inserted into the brain of patients with Parkinson's disease to relieve their symptoms.
New Guidelines Reinforce Value of Anti-HIV Pills for Prevention -
Great fanfare accompanied the results of several large studies in recent years anti-HIV pill a day can keep the virus far. The interim guidelines of the Centers for Disease and Prevention supported the approach known as pre-exposure prophylaxis (PrEP) for individuals at high risk of being infected, and the US Food and Drug Administration also approved the strategy in 2012. But PrEP has not had much traction with young gays men, one of the highest risk groups in the US and elsewhere. And the number of new infections per year in the US has remained stubbornly at around 50,000 people for more than a decade.
now, the public health service of the United States released clinical guidelines finalized it hopes to carry out more widespread use of PrEP, many of the same so many take statins to reduce the risk of heart disease. The guidelines recommend daily use of the drug Truvada, which combines two antiretroviral-for sexually active men who have sex with men, heterosexual "at high risk" of infection "(including those with an infected partner HIV), and people who inject drugs. Although daily doses of Truvada costs about $ 13,000 per year, insurance plans generally cover the expense. the company that makes Truvada, Gilead Sciences Inc. of Foster City , California, also help the uninsured.
NIH Gears Up for a Closer Look at the Human Placenta -
Placenta you and every person ever born for 9 months supported, for your lungs and kidneys and hormones while pumping you developed in the womb. Problems with this fabric disk-shaped mass can contribute to everything from premature births to diseases of middle age. But when a baby is born, hospitals usually throw away the placenta.
"It is the least understood human body," explains Alan Guttmacher, director of the National Child Health and Human Development Institute (NICHD) in Bethesda, Maryland. "Much of the scientific community never think the placenta at all. "He and others hope to change that, however, by researchers and rallying donors, including other parts of the National Institutes of Health (NIH), around a effort to better understand the organ underestimated. At a workshop of NICHD-sponsored last week, some 70 researchers prepared their ideas for what NICHD called human placenta Project, including ways to better monitor the placenta during pregnancy, and medications to strengthen when it moved.
forms of human placenta primarily from cells that develop from the outer layer of fetal cells that surround an early embryo. In early pregnancy, these trophoblasts invade the uterine wall and later develop a complex network of tiny projections called villi, which contain fetal blood vessels. This tree structure of the villi absorbs oxygen and nutrients from the maternal blood; waste from the fetus and carbon dioxide in the interval broadcast in maternal blood. Other specialized cells connect the placenta that develops on the umbilical cord. To avoid rejection by the immune system of the mother, the placenta uses various tricks, like not the expression of certain proteins. The role of the placenta during pregnancy is "an incredibly interesting biological time" that offers lessons for everything from cancer to organ transplantation, says physician-researcher Kimberly Leslie University of Iowa in Iowa City.
a malfunction, too small, or low placenta attached can kill the fetus of hunger, its growth stunted, and can also contribute to preeclampsia, or pregnancy-related high blood pressure, a condition that occurs in up to 6% of pregnancies and may necessitate premature delivery of a baby. adult diseases, too, from cardiovascular disease with insulin resistance, appear to be related to the morphology of the abnormal placenta poorly understood reasons.
during the recent strategic planning at the NICHD, the researchers concluded that the placenta deserved further study. "He came several times," said Guttmacher. He hopes that the Human Placenta project will focus on the understanding of both normal and abnormal placenta in real time during pregnancy. It will also look at possible interventions for example, a drug that stimulates the growth of an abnormally small placenta.
Some of the workshop hope adapt ultrasound and magnetic imaging resonance techniques now used to study the heart and brain to measure blood flow and oxygenation in the placenta. Inject tracers, however, can be a sensitive ethical territory. "People are very afraid to do things for pregnant women," said researcher placenta Nicholas Illsley, Hackensack University Medical Center in New Jersey, at the meeting. Another idea is to search the bloodstream of the mother for cells and nucleic acids made by the placenta as a window into the function of the organ.
the researchers also thought to create a "placenta on a chip" that mimic the tissue in the laboratory or the development of molecular sensors that could monitor the placenta during pregnancy. "It sounds like science fiction, but if you show me an iPhone it 20 years ago, I would have said this was science fiction," said Yoel Sadovsky, of the Research Institute Magee- Women in Pittsburgh, Pennsylvania, at the meeting.
participants described some immediate objectives. one is to come up with standard definitions of normal and abnormal placenta. placenta morphology varies greatly, and those of a healthy pregnancy can still have visible defects, while those sick babies often look completely normal, says Brian Cox systems biologist at the University of Toronto in Canada. Even before the NICHD meeting, the international community the placenta researchers had begun to coordinate their efforts by planning a site that list biobanks placenta and help match existing employees.
when the budget NICHD is flat, the money could be a limiting factor for human Placenta project, Guttmacher hopes will fund its first grants in 2016 and go for a decade or more. It provides that, in addition to set aside new money for the project, NICHD can give extra weight to high-quality grant applications focused on the placenta. NICHD's own contribution can only be "in the millions" of dollars, said Guttmacher. But he said that eight other NIH institutes have expressed interest in contributing, as the March of Dimes, an organization long focused on maternal and child health. After a long, a disposable body may get the attention it deserves
* Clarification, June 3, 2:25 p.m. :. An earlier version of this item incorrectly reported that NICHD do not expect to set aside funding Human Placenta project.
the increased prevalence in men in Australia who have sex with men raises questions about treatment as prevention.
special section on HIV
Only 1253 people were diagnosed with HIV in Australia in 2012, shows nearly 3 decades of prevention efforts aggressive. But there is a troubling development Guard: The number of new diagnoses has jumped 10% over the previous year, and cases have steadily increased since 1999. And 70% of new infections among men who have sex with men (MSM)
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Every country in the world has struggled to slow the spread among MSM. But the growing problem in Australia has highlighted the limits of one of the most promising new prevention tools. A 2011 historic study showed that if infected people took their faithfully (ARVs) for antiretroviral drugs and had viral levels undetectable on standard tests, the risk of transmission through heterosexual sex has been almost eliminated, down 96% ( Science , 23 December 2011, p. 1628). Hopes rose that the addition of treatment as prevention to the arsenal of proven interventions could bring AIDS epidemics in the communities stopped.
Australia has universal health care and access to ARVs last, and most people who learn they are infected quickly begin treatment. In a study published in the July 2012 issue PLOS Medicine , epidemiologist David Wilson of the Kirby Institute for Infection and Immunity in society in Sydney noted that up to 75% of MSM in Australia said get tested HIV each year, and 70% of those infected received ARVs. In 0% of people, viral levels have been completely removed. But this did not prevent the increase in new cases among MSM. "Why is there a disconnect with" test and treat? "Ask David Cooper, who heads the Kirby Institute.
One possible answer is that treatment as prevention does not work just as well with MSM. Anal intercourse has a probability 18 times higher HIV transmission than vaginal intercourse, according to a study in 2010. MSM also tend to have more partners, which increases the chance that the virus spreads.
Wilson, a mathematical modeler and Chief Kirby monitoring division, also notes that more treatment means more people with HIV survive that can potentially spread infection, as some undoubtedly remain infectious. treated people can also indulge in behaviors more risk that, in a sense of the people, overwhelming benefits of drugs. and the virus is often transmitted by recently infected people who have yet to develop enough high levels of antibodies to detect on standard tests.
MSM-targeted Fear Direct Less More shows
IMAGE :. Australian AIDS FEDERATION OF ORGANIZATIONS / The NATIONAL ASSOCIATION OF PEOPLE LIVING WITH HIV / AIDS
Clearly, if every infected person has taken ARVs every day and had undetectable viral levels, the transmission would likely fall in MSM communities. But this is unrealistic. So Wilson and his team published an online modeling exercise on February 7 in Sexual Health who explored what it would take to lower HIV infection rates in the MSM population of Australia . The researchers studied the impact of early detection of infection and early treatment. But the factor that stands out the most was the treatment effect on the transmission.
If ARVs indeed lower the risk of transmission among MSM 96% -as much as it does for heterosexual and treat 0% of people would reduce new infections by 55% in 5 years. On the other hand, if ARVs are a simple protection of 26% among MSM, the same scenario would avoid a meager 9% of infections. "The jury is still out regarding the amount of treatment reduces infectiousness with male-male sex," says Wilson.
Even if it works as well for MSM, which Kirby Institute is studying, the country needs to increase significantly the number of people on ARVs and it is notoriously difficult to improve success.
Q&A: Is politics influencing marijuana research? -
This week, a team from the National Institute on Drug Abuse (NIDA) reports that heavy marijuana use can damage the pleasure center of the brain ?. Meanwhile, UK researchers say they understand why pot makes you paranoid. But to focus research on the "wrong side" of cannabis give little attention to drugs? Science spoke to Ian Mitchell, an emergency physician at the University of Southern Medical Program of British Columbia in Kamloops, Canada, and author of the blog Cannabis clinical context in which said research the influences of politics in this controversial area. As a doctor recommends medical marijuana to patients, it follows the drug research and often critical studies he believes are based on outdated information or are made with a bias of anti-cannabis.
This interview was edited for clarity and brevity.
Q: What do you think of the NIDA study?
A: They said they were given Ritalin abusers of marijuana and nothing happens. One of the ways you could interpret that's OK, these pleasure centers are damaged. But you could also say, perhaps marijuana decreases the effects of [Ritalin] on people. It would also be right to interpret
Q:.? Why do we hear more about studies that show negative effects of marijuana
A: NIDA cannabis is the research center in America. And mandate, clearly, is to study drug abuse. So they mostly fund studies that address abuse. In America, if you want to perform a study that showed a benefit of cannabis, we could not do that because NIDA could not give you samples to use. So there was no testing [on potential medical benefits] did. For example, there has not been a good test to study the potential of marijuana to treat post-traumatic stress disorder. They could not get it done, because of all these political obstacles
Q :. Laws change for Comment example, legalization in Colorado and Washington Uruguay [1945006?] -influencing research on marijuana
A: research on marijuana is flowering. States like Colorado are allocating portions of revenues from marijuana sales for research. This will be very useful, because this money [unlike NIDA funding] will be free to apply to the search of benefits. There are certainly a lot more interest, and the political situation, I think has improved significantly.
I think it's also very important to monitor social data on recreational use. Now, Washington and Colorado, they are monitoring data on traffic accidents and deaths, pedestrian accidents, suicide, homicide rates, that kind of thing. This is an extremely large amount of data that has not really been followed so far. Now that recreational use is legal in these areas, it is much easier to study. In areas where it is illegal, you can not really ask people what kind of behavior because they do not want to get arrested
Q :. Is there a danger that research into the medical benefits of marijuana will be politicized, too? Sometimes you will hear anecdotal evidence of marijuana shrinking tumors , for example
A :. Absolutely, and I think that is a big concern. But this is why research must be done, because we have all these little stories of people saying, "I am this and my cancer better." And it is far from good enough evidence to start changing convenient.
there is a lot of criticism in search of cannabis in all, and I expect to continue. Thus, studies should be good. They must be of excellent quality, and they must be examined. And I'm sure they will, very closely.
hookworms, roundworms, and other parasitic worms known as helminths species thrived in mammals for millions of years. Despite modern advances in sanitation, helminth infections still have a devastating impact on human health and welfare, particularly in developing regions. This week Science has two research papers that explore how parasitic infections can compromise the immune system by awakening latent viruses and prevent the antiviral defenses.
The worms in this slideshow are responsible for some of the worst helminth infections in the world and cause a global burden of disease outweighs the best known infections such as malaria and tuberculosis. For more information, see this week's issue of Science
Fixed August 1, 11:58 :. Because of the mislabeled image of the source of photo T. solium was wrongly identified as Taenia saginata . In addition, a photo of a cat tapeworm misidentified as Ancylostoma braziliense was withdrawn.
WHO ponders treating Ebola-infected people with blood of survivors -
Like the Ebola outbreaks raging in West Africa, the World Health Organization (WHO) desperate for a way to help people infected, is to reconsider a potential treatment Ebola tried in 1976, after the first documented outbreak of the deadly viral disease using the blood of people who have recovered from an infection to treat those who are still fighting against the virus. "Convalescent Serum is high on our list of potential therapies and has been used in other homes (eg in China during SARS)," the WHO said in a written statement to Science Insider . "There is a long history of use, a lot of experience of what needs to be done, that the standards and norms must be respected."
There are no official plans to administer the convalescent serum sick, but WHO said it will assess whether the treatment approach was "safe and feasible" and was already working with officials in areas affected by Ebola to strengthen blood banking systems there. These movements are as scientists debate the mixed results of past use of convalescent serum. "The jury is still out" on the approach, said Daniel Bausch, an Ebola expert at Tulane University in New Orleans, Louisiana. However, he and others believe that therapy should be explored. "I think we have a moral imperative to push forward with all scientifically plausible manner, "said Bausch.
the Ebola virus has sickened at least 2,127 people and killed in 1145 them Sierra Leone, Guinea, Liberia and Nigeria. These figures can "significantly underestimate the scale of the epidemic," WHO warned Thursday. It is already the largest Ebola outbreak ever recorded and the unprecedented number of deaths has led to calls to try experimental therapies that are in the early stages of development. on Tuesday, an ethics committee of the wHO said it was ethics in the particular case using unapproved treatments such as Ebola zmapp, a mixture of antibodies that has been tested in animals and has been given to both the US health care workers who fell ill in Liberia. Other experts advocate the use of drugs that are approved to treat other diseases, but they can help patients with Ebola, too. And Nigeria would explores a controversial treatment called Nano Silver.
As for convalescent serum used to treat patients, it is an attractive option for a number of reasons, says Bausch. Get blood transfusions became commonplace; no approval bodies such as the United States Food and Drug Administration or European Medicines Agency is required and affected countries in West Africa many people survived Ebola, which means it can be a serum supply. In fact, the therapy has already been tried in the current epidemic. One of two health workers from the United States that has been treated with zmapp, Kent Brantly, earlier received a transfusion of blood of a boy of 14, he had treated and who had survived Ebola.
But as the other treatments being discussed, it is far from proven that the convalescence serum will help patients Ebola. The idea is simple: Because survivors are usually developed antibodies to fight the virus, the transfer of their blood could help patients. In the past, the strategy was used to treat people with SARS, and Lassa fever, viral hemorrhagic fever, such as Ebola. David Heymann, an epidemiologist at the London School of Hygiene & Tropical Medicine and a former executive director of communicable diseases at WHO, said that the use of the therapy in 1976 is encouraging. Heymann, who was part of a team investigating the outbreak in Zaire, stayed for 2.5 months collecting a unit of blood each week to survivors, he said. The epidemic ended before the serum could be used in Africa, but some of it was given later that year to a researcher in the UK who accidentally pricked himself infected while transferring the blood of a Guinea pig infected with Ebola virus. He survived. "The blood was stored in South Africa and the CDC in Atlanta, but I do not know what happened," says Heymann.
serum
of Convalescent tried again in 1995 in an epidemic of Ebola in Kikwit in the Democratic Republic of Congo. Kikwit General hospital doctors treated eight Ebola patients with blood donated by five people who survived their infections. Seven of those receiving the serum also survived. A reanalysis later however, concluded that the patients survived long enough their infection before receiving the serum they would probably have recovered without it. And a study in rhesus macaques, published in 07, found no benefit of transferring blood convalescent monkeys. "There are a lot of variables and quality of immune blood or serum may vary considerably from one person to another," said Thomas Geisbert, a researcher at the University of Texas Medical Branch in Galveston and one of the authors of this study.
WHO clinical Filovirus working group, convened in response to the current outbreak, reviewed the evidence on the serum of convalescents at a meeting in Geneva, Switzerland, at the end of July says Bausch, part of the group. A plan has been proposed to steal the blood of Ebola survivors in the United States and Geisbert or Heinz Feldmann, a researcher at the National Institute of Allergy and Infectious Diseases, try the therapy in non-human primates, says Bausch. But Geisbert, in an e-mail, notes that there are "no current plans to test this in non-human primates" and there was "no formal request from any agency" if he and Heinz "are both willing and ready to do whatever is necessary to support the response. "Tom Solomon, director of the Research Unit of the Health Protection UK in emerging infections based at the University of Liverpool, he said he is also considering a therapy trial in humans." We are in discussions with WHO and an international group of partners to develop a test and looking both convalescent plasma and new therapies ", he said. If the serum is tested on humans, check to advance that can neutralize the virus, said Stephan Günther, a virologist at the Bernhard Nocht Institute for tropical medicine, who is now in Nigeria. "Otherwise, you do not have to give serum." neutralization could be measured in the cell culture with a real virus or a virus of the recombinant vaccine expressing Ebola area virus protein, Günther said.
Although work therapy, there are challenges. the first is the risk of infecting patients with other pathogens such as HIV or hepatitis C. Get the blood of patients cured in the first place can also be a problem, says Bausch. "Blood is an entity that people pay much attention to West Africa. When people feel like they are losing blood, which is an important thing and bad, "he said. Yet try the therapy in non-human primates and then implement in affected countries in West Africa is logical, says Bausch. "It's going to be complicated, it will be difficult to do, but at some point, we'll just try to dive and move forward." Robert Colebunders, a clinical infectious diseases at the University of Antwerp in Belgium , who was involved in treating Ebola patients in the home in 1995, said that if there are survivors willing to donate blood, doctors should try therapy. "And then they need to follow up scientifically, so we learn something. "
However, the WHO warned today in a statement, focus on untested therapies is" creating unrealistic expectations. ... The public needs to understand that these medical products are under investigation. They have not yet been tested in humans and are not approved by regulatory authorities, beyond the use for compassionate care. "
Focusing on therapies is also distracted what really needs to be done, said Steven Riley, an infectious disease epidemiologist disease at Imperial College London. "We do not need to export drugs. We need to export the gold standard public health process, "he said. Infectious disease experts agree that monitoring of those who have been in contact with an infected person and isolate is the key containing the deadly virus
* Ebola files :. given the current Ebola outbreak unprecedented in terms of the number of people killed and the rapid geographic spread, science and science Translational Medicine made a collection of research articles and news on the viral disease available for researchers and the general public.
Disease modelers project a rapidly rising toll from Ebola -
Alessandro Vespignani hopes his latest book will prove to be false. In July, the physicist at Northeastern University in Boston began modeling how the deadly Ebola virus can spread in West Africa. Extrapolating current trends, the number of sick and dying quickly rises of more than 3000 cases tolls current and 1500 deaths at about 10,000 cases before September 24, and hundreds of thousands in the following months. "The numbers are really scary," he said, although he stressed that the model assumes control efforts are not strengthened. "We all hope to see what is not happening," Vespigani wrote in an e-mail .
Vespignani is not alone in trying to predict how the unprecedented epidemic will progress. last week, the World health Organization (WHO) estimates that the number of cases could ultimately exceed 20,000. and scientists around the world are scrambling to create computer models that accurately describe the spread of the deadly virus. all of them seem not quite as dark as Vespignani of. But all modelers agree that current efforts to fight against the epidemic are not enough to stop the deadly pathogen in its tracks.
the computer models "are incredibly helpful" in the fight against an epidemic, says researcher of infectious diseases Jeremy Farrar, who leads the Wellcome Trust research organization in London. They can help organizations such as WHO predict medical supplies and personnel they need and can indicate what interventions will be better contain the epidemic. Christian Althaus mathematical epidemiologist at the University of Bern, which is also built models of Ebola, says WHO and Samaritan's Purse, a relief organization fight against Ebola, contacted him to learn about its projections.
But modelers are hampered by the lack of data on the current epidemic and the lack of knowledge about how the Ebola virus spreads. The funerals of Ebola victims are known to spread the virus, for example, but how many people are infected in this way is not known. "Before that, we never had much of Ebola, so that epidemiology has not been well developed," says Ira Longini, a biostatistician at the University of Florida in Gainesville. "We are caught with our pants down."
To a mathematician, the fight against any epidemic is at its core a struggle to reduce a number: R e , the effective reproductive rate the pathogen, the number of people a person infected in turn infects on average. E R 1 above, and the disease spreads. Below 1, an epidemic will stall
The Outbreak models typically assume that there are four groups of people :. Those who are susceptible, those who were infected but not yet infectious, those who are sick and can transmit the virus, and those who have recovered. A model, in essence, describes the rate at which people move from one group to another. Thereof, R e can be calculated.
If the disease continues to spread as it has, most modellers Science spoke to say WHO estimate will prove to be conservative. "If the epidemic in Liberia should continue this until 1 December, the cumulative number of cases exceeds 100,000," Althaus predicted. These long-term forecasts are mistakes, he admits. But other modelers are not much more encouraging. Caitlin Rivers Institute and State University of Blacksburg Virginia Polytechnic to expect about 1,000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.
Vespignani analyzed the probability that the Ebola virus will spread to other countries. Using data on millions of air travelers and commuters and mobility patterns based on census data and mobile devices, he built a model of the world in which he can introduce the Ebola virus, then run hundreds of thousands of simulations. In general, the risk of spread beyond West Africa is small, Vespignani said, but the risk increases with the magnitude of the epidemic. Ghana, the United Kingdom and the United States are among the most likely to have a case presented country, depending on model. (Senegal, which reported its first case of Ebola last week, was in ten countries, too.)
The models are only as good as the data entered for them; up to three quarters of Ebola cases may go unreported. Modelers are also assuming that the key parameters, such as the incubation time of the virus are the same as previously occurred. "We could miss the boat and we have no signal to indicate that," said Martin Meltzer of the US Centers for Disease Control and Prevention in Atlanta.
The biggest uncertainty is how many doctors, nurses and others can slow the virus. There are several ways to push down R e , Farrar said hand washing, wearing masks, or quarantine of people, for example. "But given the complexity of the epidemic and limited resources, we need to know what are the two or three things that go help reduce infections," says Farrar, and that is where models can help. For example, would track all contacts all cases be more effective than monitoring the much smaller number that had some type of contact with a case, such as sharing a room?
evaluates Rivers current interventions such as increased use of protective equipment or campaigns to isolate infected people. in the most optimistic scenario, all the contacts of infected people is traced, and transmission in hospitals is reduced by 75 %. Even that, while significantly reducing the number of deaths from Ebola did not push R e below a.
the challenge varies by country, said Althaus . "in Guinea and Sierra Leone, R e is close to 1 and the epidemic could be stopped if the interventions improve a bit." in Liberia, R e was near 1.5 all the time. "This means that the work is just beginning here." But Meltzer says there is no reason to believe that the situation is better in Sierra Leone. "We see no change in the rate of accumulation of cases "he said.
as the models will better differentiate what happens in places, Rivers said," you might be able to stop lines around certain communities. "But these measures are highly controversial. When Liberia last week barricaded off West Point, a sprawling slum with probably more than 100,000 inhabitants, it attracted a largely negative response. "quarantines and curfews tend to instill fear and mistrust to the entire response, including health facilities, "said a representative of Médecins Sans Frontières Science . Paul Seabright, a researcher at the Toulouse School of economics in France, which studied these measures, said they are an incentive for people to keep a secret if they have been in contact with a patient. Liberia tough actions are "the last thing this epidemic needs," he said.
The people in West Africa will change behavior, Meltzer said. "We will not stop this epidemic only by building hospitals. There should be a change in how the community deals with the disease. "Modeling is easy enough, Vespignani said." I can reduce the transmission at the funeral of 40% easily in a model. It's a line of code. But in the area that is really hard "
* Ebola files :. Given the current Ebola epidemic, unprecedented in terms of the number of people killed and the rapid geographic spread, Science and Science Translational Medicine made a collection of research articles and news on the viral disease available for researchers and the general public.
How did the 'Berlin patient' rid himself of HIV? -
Researchers are closer to unraveling the mystery of Timothy Ray Brown, the only human cured of HIV, the virus defeated , according to a new study. Although the work does not provide a definitive answer, it excludes a possible explanation.
Brown remains one of the most studied case in the history of the HIV epidemic. In 06, after living with the virus for 11 years and control its infection with antiretroviral drugs (ARVs), he learned he had developed acute myelogenous leukemia. (Leukemia has no known relation to infection or HIV treatment.) The chemotherapy has failed, and the following year Brown, an American who lived in Berlin, received the first of two grafts has the common bone marrow treatment for cancer and has abandoned its ARVs. When people with HIV stop taking ARVs, HIV levels go up arrow usually within weeks. Yet researchers scouring the Brown's blood over the last 7 years have found that traces of viral genetic material, none can replicate.
Today, the researchers point out three factors that might independently or in combination have rid the body of HIV Brown. The first is the conditioning process, in which doctors destroyed the Brown immune system with chemotherapy and whole body irradiation to prepare him for his bone marrow transplant. His oncologist, Gero Hütter, who was then at the Free University of Berlin, also took an additional step that he thought might not just cure leukemia, but also help rid the body of HIV Brown. He found a bone marrow donor that has a rare mutation in a gene which paralyzes a key receptor on white blood cells of the virus uses to establish an infection. (For years, conscripts researchers Brown as the "Berlin patient".) The third possibility is his new immune system attacks the remains of his former which held cells infected with HIV, a process known as the graft against the host.
in the new study, a team led by immunologist Guido Silvestri of Emory University in Atlanta, developed a rare monkey experiment to test these possibilities.
bone marrow transplants work because of stem cells. Modern techniques effectively avoid sucking the bone marrow, and instead can sift through blood and pull the stem cells needed for transplantation to "graft". Thus, the researchers first drew blood from three rhesus macaque monkeys, removed the stem cells, and put them in storage cells. They were then infected animals and these three control monkeys with a hybrid virus, known under the name SHIV, which contains part of the human and simian AIDS virus. The six animals soon started receiving ARVs (which better meet SHIVs that SIV itself), and SHIV levels in the blood quickly dropped below the level of detection on standard tests as planned.
A few months later, the three monkeys who had stored stem cells underwent whole body irradiation to condition their bodies and had their own reinfused stem cells. After the grafted cells, a process that took a few months longer, the researchers stopped the ARV in the three animals and three controls. SHIV quickly came screaming back in the three controls and two transplanted animals. (A transplanted monkeys did not have the virus rebound, but his kidneys have failed and the researchers euthanized.)
The team, who published their work online in PLoS Pathogens today, concludes that conditioned by itself is not likely to rid the body of the AIDS virus. Silvestri explained that the monkey study was a validation of experience principle strictly isolated the effects of single package. "There is no way to do this in humans," he said.
"This is an important study, and it is a very useful model," said Daniel Kuritzkes of Brigham & Women's Hospital in Cambridge, Massachusetts, who was not connected to the research.
Kuritzkes and his colleagues are particularly interested in the experience because two of their own patients infected with leukemia HIV received bone marrow transplants from donors who do not have cells resistant to HIV. for several months after discontinuation of ART, HIV has remained distance in men, raising hopes that resistant donor cells are not a factor. but the virus eventually returned in each patient. Kuritzkes suspect transplants have reduced the amount of HIV left in body-experienced patients under the name viral reservoir, but the virus has resurfaced because he continued to copy and finally overwhelmed the immune responses against him.
Although the study shows that the packaging itself probably can not eliminate HIV infection, the study leaves open the possibility that the disease of the graft against the host played a central role in Brown's healing. Unlike Kuritzkes Brown and two patients, the transplanted monkeys received their own stem cells, which do not trigger a response of the graft against the host. "At the end of the day, which could be an important element," says Silvestri. He also thought it could help reduce the size of the reservoir for treating monkeys with ARVs for more than a few months.
Silvestri hopes to make future monkey experiments that test the different variables, including the transplantation of the animals with the viral blood resistant cells that mimic those that Brown received. "the best scientific studies raise as many questions as answers to that," Steven said Deeks, researcher and clinician at the University of California, San Francisco, who has treated and studied Brown. "Unfortunately, the heroic efforts that went into this study failed to provide a definitive answer regarding the patient's enigmas of Berlin. The model will probably need to be optimized, and at the very least, macaques treated with antiretroviral therapy for longer periods of time. But I am convinced that the team will understand it "
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When a traveler Liberia came down with Ebola in Dallas on 24 September, it was a warning to the world: As the number cases in West Africa continues to increase, so does the risk of disease spread beyond Guinea, Sierra Leone and Liberia. The United States was the third country, after Nigeria and Senegal to catch a spark of fire more; it was followed by Spain, which reported the first case of Ebola contracted outside of Africa, October 6. The patient, a nurse, had taken care of a priest who became infected in Sierra Leone.
None of these cases has triggered a generalized epidemic, and most experts are convinced that rich nations can contain introduced cases. "My first reaction was: Well, it had to be somewhere better than Dallas Mumbai." Says Peter Sandman, risk communication consultant based in Brooklyn, New York, on the case of the United States. But developing countries may not be so lucky when Ebola arrives at their door. This could result in entirely new chapters in the spread of the disease.
On October 3, the World Health Organization (WHO) reported 7470 cases and 3431 deaths in the three affected countries. These figures suspected of gross underestimates, are rising exponentially, and the models show they could reach hundreds of thousands in a few months. But the models can not predict unpredictable things like viral mutations, changes in human behavior, the impact of new vaccines and drugs, or where and how the disease will then take root. So researchers are looking beyond the models and scenarios, to prepare for what might happen. Scientists are naturally reluctant to speculate, Sandman said, but "risk communication and crisis communication are what-if."
On the optimistic picture, an effective vaccine could finally check the rise in the classic control cases, something methods such as isolation and quarantine have failed to do. Without a vaccine, "I think the best we can hope for is that the spread slows down a bit," said Alessandro Vespignani, a physicist at Northeastern University in Boston who has modeled the spread of Ebola. "The increase in action public health will have a huge impact, but I think it got to the stage where we need a vaccine to stop this epidemic, "said Jeremy Farrar, an epidemiologist who heads the Wellcome Trust in London.
[vaccine
A candidate is already in phase I safety tests, and another will soon; at a meeting at the WHO on 29 and 30 September, experts discussed ways to accelerate the development of vaccines and how to deal with the thorny ethical problems involved in testing a vaccine for efficiency in affected countries (http://scim.ag/Ebolavac). But these tests are not likely to start until January, and they can not give results until April.
Meanwhile, some scientists fear the virus could mutate. In an op-ed piece in The New York Times September 11, Michael Osterholm, director of the Center for Research on Infectious Diseases and politics at the University of Minnesota, Twin Cities, has argued that Ebola could change in such a way "that just breathing would put a risk of getting" it. He was widely criticized for fear mongering. "I do not know of a viral infection whose mode of transmission has changed in this way," says Farrar. WHO issued a statement on October 6, calling the idea "speculation, unsupported by any evidence." Osterholm retorts that "it may be a very remote possibility, but we must be ready even for that."
DATA: MONSTER LAB, Northeastern University
which is more plausible, some researchers say, is a change that makes it less deadly virus, but also more difficult to dispose. the Ebola virus hides most likely in bats and monkeys sometimes spill over into the human population, probably when infected animals are hunted and eaten. Historically, outbreaks have tended to burn in the face aggressive containment efforts and sheer deadliness of Ebola. in essence, humans are dead ends for the virus. This could change if it becomes less fatal. "There's an evolutionary advantage to reduce the virulence and host adaptation," says Farrar. "What happened with many other diseases."
If this happens with Ebola, the only way to get rid of it this time could be a massive effort similar vaccination to those used in eradication campaigns against smallpox and polio. "We will review the vaccination of hundreds of millions of people in Africa," said Farrar.
Even if the virus does not change, the magnitude of the epidemic will lead to new challenges. As the number of beds in treatment units is far, more and more patients will be supported at home, where they are a major risk for the other. This could accelerate the spread of the Ebola virus and make it more difficult to trace its epidemiology . home care kits, which include basic protective equipment such as gloves and bleach, was never widely used before to fight against Ebola, but they could become important in the fight against infection. they must be accompanied by an education campaign, however, and nobody is sure how much protection they offer.
As health care systems already crippled in affected countries in the loop pressure, people are also more likely to die in a larger number of other diseases such as malaria, or during childbirth. "We must begin to look beyond Ebola," says Farrar. The food shortages may occur if crops are missed or commerce is paralyzed. "The whole region could become a failed state," says Osterholm.
Meanwhile, the risk of spreading beyond the three countries develop, said North Vespignani, which listed the most risky countries in an article published in PLOS Currents: Outbreak in September (see table). The three countries where the virus has since landed in Senegal, Nigeria and the United States-were-in the top 16. His most recent calculations also set during an event occurring in the vicinity of Ghana on October 24 nearly 50%, even with an expected 80% reduction in travel. Mali and Ivory Coast are at high risk, too. If the virus gains a new foot addition, a major effort would be needed to avoid a second storm, Osterholm said, even if it means diverting West African resources.
Scientists debate the use of travel bans, which worried many American citizens has asked the Dallas case. WHO and the Centers for Disease Control and Prevention strongly advised against closing borders because it would be difficult to get people and materials in the affected countries. The prohibitions are also difficult to implement, Vespignani said, because many countries should agree; otherwise carry Ebola could just fly to a country that does not impose restrictions and move from there. Those who manage to circumvent a ban could then be more likely to lie about their history of contact if they become ill. Ultimately, Vespignani said, travel bans would likely increase the risk for everyone.
But Sandman said the idea should not be dismissed completely. "It's perfectly reasonable for people to seek the best way to reduce the number of sparks out of Africa and threatening to ignite elsewhere," he said. The world may need to buy time to test vaccine candidates, so it should seek practical ways to reduce the number of travelers carrying Ebola in other places, Sandman said. "These are discussions that we need."
