Fifty reviews published during June 1985 to June 1986 in four major medical journals were assessed in a study of the methods of current review articles. Assessments were based on eight explicit criteria adapted from published guidelines for information syntheses. Of the 50 articles, 17 satisfied three of the eight criteria; 32 satisfied four or five criteria; and 1 satisfied six criteria. Most reviews had clearly specified purposes (n = 40) and conclusions (n = 37). Only one had clearly specified methods of identifying, selecting, and validating included information. Qualitative synthesis was often used to integrate information included in the review (n = 43); quantitative synthesis was rarely used (n = 3). Future research directives were mentioned in 21. These results indicate that current medical reviews do not routinely use scientific methods to identify, assess, and synthesize information. The methods used in this systematic assessment of reviews are proposed to improve the quality of future review articles.

The Medical Review Article: State of the Science

https://www.cell.com/cell/pdf/0092-8674(94)90346-8.pdf

The FET3 gene of S. cerevisiae encodes a multicopper oxidase required for ferrous iron uptake.

Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.

Acute Septic Arthritis

In large metropolitan areas, which typically have the highest rates of gonorrhea, the identification of chains of transmission by use of partner notification is problematic, and there is an increasing interest in applying molecular approaches, which would require new discriminatory high-throughput procedures for recognizing clusters of indistinguishable gonococci, procedures that identify local chains of transmission. Sequencing of internal fragments of 2 highly polymorphic loci, from 436 isolates recovered in London during a 3-month period, identified clusters of antibiotic-resistant and antibiotic-susceptible isolates with indistinguishable genotypes, the vast majority of which were also identical or closely related by other methods, and defined groups of individuals who typically had similar demographic characteristics. This discriminatory sequence-based approach produces unambiguous data that easily can be compared via the Internet and appears to be suitable for the identification of linked cases of gonorrhea and the timely identification of transmission of antibiotic-resistant strains, even within large cities.

Rapid Sequence-Based Identification of Gonococcal Transmission Clusters in a Large Metropolitan Area

The classic progression of the development of periodontitis with its associated formation of an inflammatory lesion is characterized by a highly reproducible microbiological progression of a Gram-positive microbiota to a highly pathogenic Gram-negative one. While this Gram-negative microbiota is estimated to consist of at least 300 different microbial species, it appears to consist of a very limited number of microbial species that are involved in the destruction of periodontal diseases. Among these "putative periodontopathic species" are members of the genera Porphyromonas, Bacteroides, Fusobacterium, Wolinella, Actinobacillus, Capnocytophaga, and Eikenella. While members of the genera Actinomyces and Streptococcus may not be directly involved in the microbial progression, these species do appear to be essential to the construction of the network of microbial species that comprise both the subgingival plaque matrix. The temporal fluctuation (emergence/disappearance) of members of this microbiota from the developing lesion appears to depend upon the physical interaction of the periodontal pocket inhabitants, as well as the utilization of the metabolic end-products of the respective species intimately involved in the disease progression. A concerted action of the end-products of prokaryotic metabolism and the destruction of host tissues through the action of a large number of excreted proteolytic enzymes from several of these periodontopathogens contribute directly to the periodontal disease process.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors in virulence expression and their role in periodontal disease pathogenesis.

Human beings are the only reservoir for the gonococcus. In spite of public health efforts to control this pathogen, and the availability of adequate antibiotic therapy for 40 years, close to a mill...

Gonococcal infection: a model of molecular pathogenesis.

Thirty-three Neisseria gonorrhoeae isolates from 15 persons infected multiple times with the same serovar were compared using por gene sequencing, opa-typing, and arbitrarily primed-polymerase chain reaction. All three molecular techniques were more discriminatory than serotyping and identified differences between some isolates belonging to the same serovar. Although there were differences among Por sequences within some serovars, 10 of 15 subjects became reinfected with gonococci expressing identical Por proteins. Sequence analysis of por genes revealed evidence of horizontal genetic exchange and point mutations in potential surface-exposed regions during passage in the community.

https://www.jstor.org/stable/info/30117277

Molecular Typing of Neisseria gonorrhoeae Causing Repeated Infections: Evolution of Porin during Passage within a Community

/pdf/mucosal-infection-with-neisseria-gonorrhoeae-bacterial-j9yl7pe2v7.pdf

Mucosal infection with Neisseria gonorrhoeae. Bacterial adaptation and mucosal defenses.

The quinone antibiotic streptonigrin is believed to kill bacteria by promoting formation of oxygen radicals. This antibiotic has also been used to select resistant bacterial mutants, some of which vary in iron utilization. We examined the effects of streptonigrin on Neisseria gonorrhoeae and several types of gonococcal mutants. Streptonigrin (0.025 microgram/ml) efficiently killed gonococcal strain FA1090, and this effect depended on iron. Streptonigrin-resistant mutant FA6271 had normal iron uptake but was moderately deficient in total iron. Resistance most likely resulted from failure of FA6271 to divert electrons to streptonigrin, as demonstrated by a reduction in KCN-insensitive respiration (a hallmark of the action of quinones) and superoxide formation. Other mutants selected for inability to use human iron-binding proteins (strains FA6273 and FA6275) had no increase in streptonigrin MIC and no decrease in KCN-insensitive respiration. Mutants did not demonstrate an increase in superoxide dismutase or catalase. Streptonigrin killing of gonococci depended on a reaction(s) in which extracellular iron was important, presumably because iron was required for catalysis of hydroxyl radical. The results suggest that a membrane component may be a target for the actions of streptonigrin.

Role of extracellular iron in the action of the quinone antibiotic streptonigrin: mechanisms of killing and resistance of Neisseria gonorrhoeae.

The in vitro susceptibility of penicillinase-producing and intrinsically resistant Neisseria gonorrhoeae strains to 13 antimicrobial agents was tested. Regardless of the type of resistance, these organisms remained quite susceptible to newer cephalosporin agents, including moxalactam, cefoperazone, cefotaxime, and ceftazidime.

P. F. Sparling

Papers

Gonococcal infection: a model of molecular pathogenesis.

Molecular Typing of Neisseria gonorrhoeae Causing Repeated Infections: Evolution of Porin during Passage within a Community

Mucosal infection with Neisseria gonorrhoeae. Bacterial adaptation and mucosal defenses.

Role of extracellular iron in the action of the quinone antibiotic streptonigrin: mechanisms of killing and resistance of Neisseria gonorrhoeae.

In vitro antimicrobial susceptibility of penicillinase-producing and intrinsically resistant Neisseria gonorrhoeae strains.