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Rational and computation-assisted engineering of a compact and efficient CRISPR-Cas12f genome editor.

The CRISPR-Cas12f system is an ultracompact genome-editing platform, yet only a few orthologs exhibit robust activity in mammalian cells. Here, we systematically screened 23 Cas12f orthologs and identified two active nucleases, PspCas12f1 and TcCas12f1, capable of genome editing in human cells. Single guide RNA (sgRNA) scaffold optimization enhanced the basal activity of PspCas12f1. To further improve its performance, we combined structure-guided rational design with protein language model-assisted filtering. Candidate mutations predicted by SaProt were further screened based on structural proximity to the DNA-binding interface and electrostatic compatibility. This integrative strategy identified Q100R and E293R, whose combination yielded the optimized variant enPspCas12f1. enPspCas12f1 achieved genome-editing efficiencies comparable to SpCas9 across multiple endogenous loci while maintaining high specificity. Collectively, our results demonstrate that integrating protein language model-assisted filtering with structure-guided rational design provides an effective strategy for engineering PspCas12f1 and may facilitate the optimization of additional compact CRISPR nucleases.

CRISPR-Cas12f↗

Rational suicide among patients who are terminally ill.

Patients' end-of-life decisions challenge nurses. Often, aggressive, life prolonging strategies create ethical dilemmas for nurses when patients decide to stop treatment. In Oregon, assisted suicide is legal and will have a profound effect on nursing practice. When a patient considers suicide, nurses need to examine the patient's mental health, symptom management, and rational decision-making ability. Evaluation of suicide risk is a priority. Nurses need to recognize that medical land psychological symptoms often trigger thoughts of suicide, but prompt treatment of pain and symptoms also reduces suicide risk. Ethical issues and guidelines for management of patients considering suicide and evaluation of rationality are presented.

Aged↗

[Rational management of antibiotherapy in ORL infections in children: critical review of the best scientific evidences].

INTRODUCTION: Upper respiratory tract infections are the more prevalent infections in childhood and it is important to know the use and overuse of antibiotics. The objective of this article is to make a systematic and critical review of the best scientific evidence in bibliography in order to use antibiotics rationally in otorhinolaryngology (ORL) infections. MATERIAL AND METHODS: Systematic and structured review of the articles regarding antibiotherapy in ORL infections (pharyngitis, tonsillitis, otitis, sinusitis and laryngitis) in childhood published in secondary (Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc.) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). DATA SELECTION: study design, population, intervention, outcomes, main results and applicability in clinical practice. RESULTS: The main secondary information is found in The Cochrane Library and in Clinical practice guideline clearinghouses. The documents in Cochrane Library are, basically, clinical trials, systematic reviews and/or meta-analysis, mainly about otitis (13 documents), sinusitis/rhinosinusitis (6), pharyngitis/tonsillitis (3) and nasopharyngitis (3). We found 17 guidelines, mainly for otitis (8 guidelines), pharyngitis/tonsillitis (5), sinusitis (3) and laryngitis (1). Also, we found some relevant articles in Pubmed database, complementary to secondary publications. CONCLUSIONS: There are a high number of quality scientific studies who support an evidence-based decision making in clinical practice about the rational use of antibiotics in ORL infections in childhood, mainly in otitis, tonsillitis and sinusitis. Every decision in this field will have to be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources available. Doctor's knowledge (mainly in otorhinolaryngologists and pediatricians) of systematic and critical review of the current literature can help to modify prescribing habits about overuse and misuse of antibiotics in ORL infections.

Anti-Bacterial Agents↗

Rational design and engineering of delivery systems for therapeutics: biomedical exercises in colloid and surface science.

Engineering delivery systems of therapeutic agents has grown into an independent field, transcending the scope of traditional disciplines and capturing the interest of both academic and industrial research. At the same time, the acceleration in the discovery of new therapeutic moieties (chemical, biological, genetic and radiological) has led to an increasing demand for delivery systems capable of protecting, transporting, and selectively depositing those therapeutic agents to desired sites. The vast majority of delivery systems physically reside in the colloidal domain, while their surface properties and interfacial interactions with the biological milieu critically determine the pharmacological profiles of the delivered therapeutic agents. Interestingly though, the colloidal and surface properties of delivery systems are commonly overlooked in view of the predominant attention placed on the therapeutic effectiveness achieved. Moreover, the development and evaluation of novel delivery systems towards clinical use is often progressed by serendipity rather than a systematic design process, often leading to failure. The present article will attempt to illustrate the colloid and interfacial perspective of a delivery event, as well as exemplify the vast opportunities offered by treating, analysing and manipulating delivery systems as colloidal systems. Exploring and defining the colloid and surface nature of the interactions taking place between the biological moieties in the body and an administered delivery vehicle will allow for the rational engineering of effective delivery systems. A design scheme is also proposed on the way in which the engineering of advanced delivery systems should be practiced towards their transformation from laboratory inventions to clinically viable therapeutics. Lastly, three case studies are presented, demonstrating how rational manipulation of the colloidal and surface properties of delivery systems can lead to newly engineered systems relevant to chemotherapy, gene therapy and radiotherapy.

Biomedical Engineering↗

Rational design of lipid molecular structure: a case study involving the C19:1c10 monoacylglycerol.

The phase properties of lipids have far-reaching consequences in membrane biology. Their influence ranges from domain formation in intact biomembranes to membrane protein reconstitution and crystallization. To exploit phase behavior in the spirit of rational design, it is imperative that the rules relating lipid molecular structure and liquid crystal or mesophase behavior be established. Phase behavior is quantitatively and concisely represented in the form of temperature-composition phase diagrams. A somewhat limited number of phase diagrams exists for the monoacylglycerols. The objective of the current study was to determine the quality of phase behavior prediction for a specific monoacylglycerol based on an analysis of the existing phase diagrams for related chain homologs. To this end, a phase diagram for the monononadecenoin (19:1c10)/water system was predicted in the temperature range from -15 degrees C to 120 degrees C and from 0% to 80% (w/w) water. The prediction was tested by constructing the corresponding phase diagram using low- and wide-angle x-ray diffraction, differential scanning calorimetry, and polarized light microscopy. The results show that the predicted and experimental phase diagrams agree remarkably well. They also highlight the need for additional phase studies of the type described to enlarge the data bank of phase diagrams and to strengthen the foundations of the rational design approach.

Calorimetry, Differential Scanning↗

Single neuron local rational arithmetic revealed in phase space of input conductances.

We present a phase space analysis to explore the potential of single neuron local arithmetic operations on its input conductances. This analysis was conducted first by deriving a rational function model of local spatial summation by using the equivalent circuits for steady-state membrane potentials. It is shown that developed functional phases exist in the space of input conductances, where a single neuron's local operation on input conductances can be described in terms of a set of well-defined arithmetic functions. It is further suggested that this single neuron local rational arithmetic is programmable, in the sense that the selection of these functional phases can be effectively instructed by presynaptic activities. This programmability adds the degree of freedom in a single neuron's ability to process the input information.

Cell Compartmentation↗

Teleological reasoning in infancy: the infant's naive theory of rational action. A reply to Premack and Premack.

We argue that Premack and Premack's criticism of our demonstration (Gergely et al., 1995) of interpreting goal-directed action in one year-olds in terms of the principle of rationality are ill-founded, and their suggested alternative test for goal-attribution is open to lower level interpretations. We show that the alterative model they propose for our data in terms of 'appropriate' change of means action is but a somewhat imprecise restatement of our account of the infant's naive theory of rational action. Finally, we elaborate and clarify our model of the teleological stance in infancy which we suggest is an as yet nonmentalistic precursor of the young child's later emerging causal theory of mind.

Child Development↗

Differential algebra methods for the study of the structural identifiability of rational function state-space models in the biosciences.

In this paper methods from differential algebra are used to study the structural identifiability of biological and pharmacokinetics models expressed in state-space form and with a structure given by rational functions. The focus is on the examples presented and on the application of efficient, automatic methods to test for structural identifiability for various input-output experiments. Differential algebra methods are coupled with Gröbner bases, Lie derivatives and the Taylor series expansion in order to obtain efficient algorithms. In particular, an upper bound on the number of derivatives needed for the Taylor series approach for a structural identifiability analysis of rational function models is given.

Algorithms↗

Rational identification of new antibacterial drug targets that are essential for viability using a genomics-based approach.

In the last two decades, the search for completely novel antibacterial agents has acquired a new sense of urgency due to the remarkable rise of antibiotic resistance among key bacterial pathogens. More recently, the advent of bacterial genomics has provided investigators with the data and bioinformatic tools to rationally identify novel antibacterial targets and the genome-scaled methodologies to validate them. Only 6 years have elapsed since the publication of the first complete bacterial genome sequence, but more than 50 complete microbial genome sequences are now available. This review will discuss the advantages and limitations of the existing bacterial genome dataset for the rational identification of novel antibacterial targets. Since the ability to rapidly identify essential genes where loss of function is coincident with loss of viability is the most important task of genomics-based target validation, essentiality testing methodologies (in which molecular genetic techniques are used to determine whether or not a gene product is required for viability of the parent cell) will be surveyed and their amenability to genome-scaled analysis assessed. Finally, we will discuss the impact of bacterial genomics to date on the development of novel and effective antibiotics.

Anti-Infective Agents↗

New approaches to rational drug design.

Rational drug design has emerged as a powerful technique. In this review, three new developments in rational drug design are explored. These developments include new methods to find binding sites for small molecules on the surface of a protein, the suggestion that the protein environment may change the shape of a protein sufficiently to alter drug design, and the use of data emerging from structural genomics in drug design. Although these are three new and distinct areas, the insights derived from these studies suggest a reason for the observation that similar drugs do not always bind to a protein in the same manner.

Binding Sites↗

6-Phosphofructo-2-kinase/fructose-2,6-bisphosphatase gene expression is regulated by diet composition and ration size in liver of gilthead sea bream, Sparus aurata.

Modulation of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase (6PF-2-K/Fru-2,6-P(2)ase) gene expression by diet composition and ration size was studied in the liver of gilthead sea bream, Sparus aurata. From five different types of diet supplied to fish, those with either high carbohydrate/low protein or high carbohydrate/low lipid content stimulated 6PF-2-K/Fru-2,6-P(2)ase expression at the levels of mRNA, immunodetectable protein and kinase activity as well as promoting higher fructose-2,6-bisphosphate (Fru-2,6-P(2)) values. The expression of the bifunctional enzyme and Fru-2,6-P(2) levels showed also direct dependence on the quantity of diet supplied. These findings demonstrate for the first time nutritional regulation of 6PF-2-K/Fru-2,6-P(2)ase at mRNA level by diet composition and ration size and suggest that the carnivorous fish S. aurata can adapt its metabolism, by stimulation of liver glycolysis, to partial substitution of protein by carbohydrate in the diet. In addition, the expression of 6PF-2-K/Fru-2,6-P(2)ase can be used as an indicator of nutritional condition.

Animals↗

Focusing on changing clinical practice to enhance rational prescribing--collaboration and networking enable comprehensive approaches.

Most western societies are enhancing rational pharmacotherapy to get best value for the constantly increasing expenditure on drugs. Government bodies and the medical profession took joint responsibility for the education programme for rational prescribing, launched in Finland at the end of the 1990s. The goals were to enhance critical thinking, and when appropriate, change prescribing behaviour. Various approaches that included evidence-based continuing medical education (CME), implementing clinical guidelines, delivering information, and providing prescribing feedback were used simultaneously. The commitment of the stakeholders and participants has been strong and the approaches have succeeded even though there is no clear outcome measure. The Government has recently decided to continue and widen the process, which started as a pilot programme, on a tight budget.

Cooperative Behavior↗

[Impact of various objectives related to the rational use of medication in a primary care area].

OBJECTIVES: To evaluate the impact of the application of objectives relating to the rational use of medication and to assess the possible effect of these objectives on pharmaceutical expenditure. DESIGN: A non-randomised intervention study with control. SETTING: Santiago de Compostela Primary Care (PC) Area. PATIENTS AND OTHER PARTICIPANTS: After the inclusion and exclusion criteria were applied, both the intervention group (IG) and the control group (CG) consisted of 31 doctors. Those in the IG belonged to the reformed PC model, whereas those in the CG did not. INTERVENTIONS: Four blocks of objectives on the rational use of medication were included in the Pact signed by reformed-model doctors and the management. The study lasted three years (1996-1998) for the objective of lowering the prescription of low-therapeutic-utility (LTU) drugs, and two years (1997-1998) for lowering the prescription of antihypertensives, Triflusal and quinolones. MEASUREMENTS AND MAIN RESULTS: The difference between both groups was 1.7 fewer packs of LTU drugs per 1000 users and per day in the IG (95% CI, 0.9-2.6) and 1768 pesetas less (95% CI, 801-2733). These differences were still greater among pensioners. The difference between the two groups in terms of total pharmaceutical cost was 7379 pesetas less in the IG (95% CI, 708-14,049) than in the CG. The differences between the groups for the remaining objectives (antihypertensives, Triflusal and quinolones) in no case reached statistical significance. CONCLUSIONS: The pharmaceutical objectives of the pact were partly achieved: a drop in LTU drug prescription was seen, with an indirect reduction in overall expenditure, but no differences were found in the prescription of antihypertensives, triflusal or quinolones.

Antihypertensive Agents↗

[Usefulness of patients' reports in monitoring rational use of medicines].

OBJECTIVES: To determine the usefulness of patients' reports in constructing indicators of the rational use of medicines and to analyse these reports' benefits and limitations in comparison with the medical records. DESIGN: Cross-sectional multi-centred study. SETTING: Eight primary care health centres. PATIENTS: For each centre a randomised sample, stratified by medical list, was selected of 125 subjects over 18 who had attended on some occasion the medical clinic in the previous 12 months (1000 subjects in all). MEASUREMENTS AND MAIN RESULTS: A < > questionnaire was designed and distributed (with questions referring to objective concrete experiences), in which information was gathered on various aspects of the use of medicines. In addition, these data were checked against the medical records of the subjects who answered the questionnaire. The reply rate was 43.7% for the questionnaire as a whole. It fluctuated between 92.0% and 46.0% in different specific items. The age of the patient, the number of consultations and suffering a chronic illness all affected the level of response to the questionnaire. Nevertheless, the users provided between 2 and 5 times more information than the medical record, with moderate-to-high reliability. Concordance between what was reported and what was recorded varied between 72.0% and 82.0%. CONCLUSIONS: The user's report can be useful, as a substitute for and as a complement to other sources of information, to construct indicators of the rational use of medication from an integrated perspective.

Adult↗

[Economic impact of rationalized antibiotic therapy in a general hospital].

PURPOSE: To evaluate the economic impact and the bacterial resistance rates after 2 years of a rationalized antibiotic prescription program in a 502-bed hospital. CURRENT KNOWLEDGE AND KEY POINTS: Prescribing protocols were established by consensus in 1998 and were reinforced a year later by nominative dispensing of the most costly antibiotics. The impact of the program was assessed in terms of changes in the overall cost of antibiotics and in the pattern of bacterial resistance among pathogens isolated in the institution, during the period prior to the onset of the program (1997) and its realization (1998 and 1999). FUTURE AND PROJECTS: The expenses for antibiotic drugs decreased by 46% in 2 years. Resistance rates among the different pathogens studied have remained stable. No increase of mortality was observed. Our rational policy in antibiotic therapy had a positive economic impact. However, new additional measures should be encouraged to prevent antimicrobial resistance.

Anti-Bacterial Agents↗

Rational development of prophylactic HIV vaccines based on structural and regulatory proteins.

The severity of the AIDS epidemic clearly emphasises the urgent need to expedite HIV vaccine candidates into clinical trials. Prophylactic HIV vaccine candidates have been evaluated in non-human primates. Based on specific proof of principle studies the first phase III clinical studies have recently begun in humans. However, a truly effective HIV vaccine is not yet at hand and many problems related to specific properties of the virus remain to be overcome. Previously proven empirical approaches have largely failed and now rational thinking based on an understanding of immunity to lentiviral infections is needed. This review addresses the scientific problems and complications facing the development of an HIV vaccine as well as the possible strategies currently available to overcome these problems. Recent attention has focussed on identifying the immune correlates and mechanisms of protection from either HIV infection or protection from disease progression. Based on these observations, the logic and rational behind the development of multiple component vaccine strategies are highlighted.

AIDS Vaccines↗

Protein catabolic rate over lean body mass ratio: a more rational approach to normalize the protein catabolic rate in dialysis patients.

Protein catabolic rate (PCR), equivalent to dietary protein intake in "stable" dialysis patients, is widely accepted as a marker of their protein nutritional status. PCR is usually established from urea generation rate using urea kinetic modeling (UKM), but the normalizing factor is still a matter of controversy. By convention, PCR is expressed in grams of protein degraded daily divided by the dry body weight (BW) (nPCRBW). To be valid, this implies that dry BW is close to ideal BW and that body composition is preserved with a lean body mass (LBM) over BW ratio near 0.73. Such conditions being infrequently found in dialysis patients, it has been proposed to normalize PCR to ideal BW or to total body water, but these correction factors are not really appropriate. A more rational approach would be to express PCR as the ratio of protein degraded to the kilograms of LBM (nPCRLBM), thus offering the main advantage of directly coupling PCR to changes in protein or nitrogen reserve. In this study, we developed a combined kinetic model of urea and creatinine applied to the midweek dialysis cycle in 66 end-stage renal disease (ESRD) patients. UKM provided Kt/V and PCR, whereas creatinine kinetic modeling (CKM) was used to calculate LBM. Thirty-four patients with a preserved LBM (LBM/dry BW ratio equal to or greater than 0.70; mean ratio, 0.81 +/- 0.11) and with a dry/ideal BW ratio of 1.01 +/- 0.16 had a mean PCR of 1.14 +/- 0.30 g/kg/24 h when normalized to BW (nPCRBW) and of 1.40 +/- 0.30 g/kg/24 h when normalized to LBM (nPCRLBM). In the 32 patients with a reduced LBM (LBM/dry BW ratio, below 0.70; mean ratio, 0.60 +/- 0.09) and dry/ideal BW ratio of 1.11 +/- 0.23, the mean nPCRBW was 0.99 +/- 0.31 g/kg/24 h, whereas nPCRLBM was 1.62 +/- 0.32 g/kg/24 h. For both subgroups, Kt/V was similar, with mean values of 1.76 +/- 0.34 and 1.69 +/- 0.27. Normalizing PCR to LBM offers a double benefit: it compensates for the error induced by abnormal body composition (eg, obese patients) and permits PCR to be adjusted for the decrease in LBM that occurs with age. We propose nPCRLBM as a more rational index to express PCR in dialysis patients.

Aged↗

The rational management of fibromyalgia patients.

The exponential increase in pain research over the last 10 years has established fibromyalgia (FM) as a common chronic pain syndrome with similar neurophysiologic aberrations to other chronic pain states. As such, the pathogenesis is considered to involve an interaction of augmented sensory processing (central sensitization) and peripheral pain generators. The notion, that FM symptomatology results from an amplification of incoming sensory impulses, has revolutionized the contemporary understanding of this enigmatic problem and provided a more rational approach to treatment. To date, the management of FM has been mainly palliative, with the aims of reducing pain, improving sleep, maintaining function, treating psychologic distress and diminishing the impact of associated syndromes. The rapidly evolving neurophysiologic, psychophysiologic and molecular biologic basis for chronic pain states has already opened up new avenues for management which should be applicable to this difficult group of patients. Indeed, it is now possible to think about a "rational" approach to managing FM patients that was unthinkable just a few years ago.

Fibromyalgia↗