'Sharpshooter' in Botanic Garden: the tale of a rare plant-insect interaction

Here we report a unique plant-insect interaction between the leafhopper Aloka depressa (tribe Phlogisini) and the host liana, Diploclisia glaucescens, from a Botanic Garden located at the southern edge of Western Ghats in India. Field observations and SEM micrographs were employed to derive evidences on this rare plant-insect interaction. 20-Hydroxyecdysone (20E), insect moulting hormone, was detected and quantified in the host plant D. glaucescens using HPTLC-densitometry. 20E was isolated and characterized from D. glaucescens using column chromatography, 1H-, 13C-NMR and HR-MS. 20E was also detected in A. depressa excrement using HPTLC-densitometry. The leafhopper A. depressa is functioning as a 'sharpshooter' drawing nutrients from the host liana, D. glaucescens, and flinging the waste fluid as droplets through their tail ends. SEM micrographs of A. depressa revealed its external morphological features, characteristic of a sharpshooter. We quantified 20E (0.44-1.44%, dry wt.) in various parts of D. glaucescens. 20E (1.47%, dry wt.) was also detected in the excrement of A. depressa. This plant (D. glaucescens)-insect (A. depressa) association crucially is not damaging the host liana. Considering the diseases caused by sharpshooting leafhoppers in the Americas, this association and the survival of the host plant (D. glaucescens) is illustrating a unique plant-insect interaction.

Accelerated Epigenetic Aging Mediates the Association between Vitamin D Levels and Knee Pain in Community-Dwelling Individuals

OBJECTIVES

To examine the relationship between Vitamin D status and pain intensity and disability in individuals with and without knee pain, and to examine the role of epigenetics in this relationship.

DESIGN

Cross-sectional analysis of data from the UPLOAD-2 study (Understanding Pain and Limitations in OsteoArthritic Disease-2).

PARTICIPANTS

189 individuals aged 45-65 years and older.

MEASUREMENTS

Serum Vitamin D levels, pain related interference and characteristic pain intensity measures, and the epigenetic clock GrimAge derived from blood analyses.

RESULTS

Lower Vitamin D was associated with advanced epigenetic aging (AgeAccelGrim), greater pain and disability and that (AgeAccelGrim) mediated the relationship between Vitamin D status and self-reported pain (ab = -0.0799; CI [-0.1492, -0.0237]) and disability (ab = -0.0669; CI [-0.1365, -0.0149]) outcomes.

CONCLUSION

These data support the notion that lifestyle factors such as nutrition status play a key role in aging process, as well as the development and maintenance of age-related diseases such as pain. Modifying nutrition status could help promote healthy aging and reduce pain.

Immune signatures underlying post-acute COVID-19 lung sequelae

[Figure: see text].

An OX40/OX40L interaction directs successful immunity to hepatitis B virus

Depending on age of acquisition, hepatitis B virus (HBV) can induce a cell-mediated immune response that results in either cure or progressive liver injury. In adult-acquired infection, HBV antigens are usually cleared, whereas in infancy-acquired infection, they persist. Individuals infected during infancy therefore represent the majority of patients chronically infected with HBV (CHB). A therapy that can promote viral antigen clearance in most CHB patients has not been developed and would represent a major health care advance and cost mitigator. Using an age-dependent mouse model of HBV clearance and persistence in conjunction with human blood and liver tissue, we studied mechanisms of viral clearance to identify new therapeutic targets. We demonstrate that age-dependent expression of the costimulatory molecule OX40 ligand (OX40L) by hepatic innate immune cells is pivotal in determining HBV immunity, and that treatment with OX40 agonists leads to improved HBV antigen clearance in young mice, as well as increased strength of T cell responses in young mice and adult mice that were exposed to HBV when they were young and developed a CHB serological profile. Similarly, in humans, we show that hepatic OX40L transcript expression is age-dependent and that increased OX40 expression on peripheral CD4⁺ T cells in adults is associated with HBV clearance. These findings provide new mechanistic understanding of the immune pathways and cells necessary for HBV immunity and identify potential therapeutic targets for resolving CHB.

The In Vitro Association of Antihemophilic Factor and von Willebrand Factor

Considerable evidence, including results of gel chromatography, indicates that antihemophilic factor (AHF; factor VIII: C) is associated with von Willebrand factor (vWF; factor VIIIR: RC or VTIIR: Ag) in citrated plasma. The present study was undertaken to determine whether these factors are also associated in plasma with a physiologic calcium ion concentration, or in an artificial medium using purified antihemophilic factor and plasma as a source of vWF. When fresh BaS04-treated native normal plasma was passed through a column of Sepharose CL-4B that was equilibrated and eluted with fresh BaS04-treated plasma from a patient with severe von Willebrand’s disease, the AHF and vWF activities were found in the void volume. Thus, AHF remains associated with vWF on gel chromatography in the presence of physiological concentrations of all plasma constituents except the vitamin-K-dependent clotting factors. On the other hand, when to 200,000 X purified “vWF-free” AHF was chromatographed in buffered 4% albumin with 2 mM CaCl2, virtually all of it appeared in the included volume of the column with an apparent molecular weight between that of fibrinogen or factor V (340,000) and gamma globulin (160,000). The combination of the “vWF-free” AHF with the vWF in plasma was studied by adding the AHF to BaS04-treated plasma from normal subjects or patients with severe hemophilia or von Willebrand’s disease and chromatographing the mixture. The AHF activity appeared in the void volume in an amount that was inversely related to the ratio of the AHF to vWF activity. Thus, with 1-12 U of AHF per unit of vWF, virtually all of the AHF eluted in the void volume, with 30 and 500 units of AHF per unit of vWF, only about 50% and 10% of the AHF, respectively, eluted in the void volume, and in the absence of vWF, none of the AHF activity eluted in the void volume.

Ultrafast probing of magnetic field growth inside a laser-driven solenoid

We report on the detection of the time-dependent B-field amplitude and topology in a laser-driven solenoid. The B-field inferred from both proton deflectometry and Faraday rotation ramps up linearly in time reaching 210 ± 35 T at the end of a 0.75-ns laser drive with 1 TW at 351 nm. A lumped-element circuit model agrees well with the linear rise and suggests that the blow-off plasma screens the field between the plates leading to an increased plate capacitance that converts the laser-generated hot-electron current into a voltage source that drives current through the solenoid. ALE3D modeling shows that target disassembly and current diffusion may limit the B-field increase for longer laser drive. Scaling of these experimental results to a National Ignition Facility (NIF) hohlraum target size (∼0.2cm^{3}) indicates that it is possible to achieve several tens of Tesla.

Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes

The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base.

LEVEL OF EVIDENCE

Level IV.

Experimental Transmission and Induction of Ranaviral Disease in Western Ornate Box Turtles (Terrapene ornata ornata) and Red-Eared Sliders (Trachemys scripta elegans)

An experimental transmission study was designed to determine whether a causal relationship exists between a Ranavirus (BSTRV) isolated from a Burmese star tortoise that died and the lesions observed in that tortoise. A pilot study was performed with 3 box turtles ( Terrapene ornata ornata) and 3 red-eared sliders (RESs; Trachemys scripta elegans) to assess their suitability in a larger study. Based on the outcome of this study, RESs were selected, and 2 groups of 4 RESs received either an oral (PO) or intramuscular (IM) inoculum containing105 50% Tissue Culture Infecting Dose (TCID50) of a BSTRV-infected cell lysate. One turtle each was mock inoculated PO or IM with the same volume of uninfected cell lysate. Three of four IM-inoculated RESs developed clinical signs (nasal and ocular discharge [3 of 3], oral plaques [1 of 3], conjunctivitis and hyphema [1 of 3] and extreme lethargy [3 of 3]). A Ranavirus was isolated from kidney homogenates of 3 euthanatized turtles; DNA sequences of a portion of the major capsid protein gene were amplified by polymerase chain reaction. Consistent histologic lesions were observed only in IM-inoculated turtles and included fibrinoid vasculitis centered on splenic ellipsoids, multifocal hepatic necrosis, and multicentric fibrin thrombi in a variety of locations, including hepatic sinusoids, glomerular capillary loops, and pulmonary capillaries. Virions compatible with Ranavirus were observed within necrotic cells of the spleen of 1 IM-inoculated turtle using transmission electron microscopy. This study fulfills Koch's postulates, confirming a causal relationship between BSTRV and the clinical and histologic changes in chelonians infected with this virus.

Intranuclear Coccidiosis in Tortoises: Nine Cases

Chelonian intranuclear coccidiosis has been reported once, in two radiated tortoises ( Geochelone radiata), and is apparently rare. We describe intranuclear coccidiosis diagnosed histologically in two radiated tortoises, three Travancore tortoises ( Indotestudo forstenii), two leopard tortoises ( Geochelone pardalis), one bowsprit tortoise ( Chersina angulata), and one impressed tortoise ( Manouria impressa). Infection was systemic and involved alimentary, urogenital, respiratory, lymphoid, endocrine, and integumentary systems. Trophozoites, meronts, merozoites, macrogametocytes, microgametocytes, and nonsporulated oocysts were seen histologically or by electron microscopy. intracytoplasmic and extracellular stages of parasite development also were identified histologically. Sequencing of a coccidial 18S rRNA consensus polymerase chain reaction (PCR) product revealed a novel sequence that provided phylogenetic information and may be useful for further diagnostic test design. intranuclear coccidiosis was associated with variable degrees of inflammation in all cases, was considered the cause of death in six tortoises, and was a substantial contributing factor to the cause of death in two tortoises.

Carbon dioxide emission from bamboo culms

Bamboos are one of the fastest growing plants on Earth, and are widely considered to have high ability to capture and sequester atmospheric carbon, and consequently to mitigate climate change. We tested this hypothesis by measuring carbon dioxide (CO2 ) emissions from bamboo culms and comparing them with their biomass sequestration potential. We analysed diurnal effluxes from Bambusa vulgaris culm surface and gas mixtures inside hollow sections of various bamboos using gas chromatography. Corresponding variations in gas pressure inside the bamboo section and culm surface temperature were measured. SEM micrographs of rhizome and bud portions of bamboo culms were also recorded. We found very high CO2 effluxes from culm surface, nodes and buds of bamboos. Positive gas pressure and very high concentrations of CO2 were observed inside hollow sections of bamboos. The CO2 effluxes observed from bamboos were very high compared to their carbon sequestration potential. Our measurements suggest that bamboos are net emitters of CO2 during their lifespan.

Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). We characterized the clinical and molecular epidemiology of MRSA strains colonizing NICU patients. Nasal MRSA isolates (n = 250, from 96 NICU patients) recovered through active surveillance from 2009 to 2014 were characterized with staphylococcal cassette chromosome mec (SCCmec) typing and detection of mupA (marker of high-level mupirocin resistance) and qacA/B (marker associated with chlorhexidine resistance). Factors associated with community-associated (CA-) or healthcare-associated (HA-) MRSA were evaluated. The overall prevalence of MRSA nasal colonization was 3.9%. Of 96 neonates in our retrospective cohort, 60 (63%) were colonized with CA-MRSA strains and 35 (36%) were colonized with HA-MRSA strains. Patients colonized with HA-MRSA were more likely to develop MRSA infections than patients colonized with CA-MRSA (13/35, 37% versus 8/60, 13%; p 0.007), although the interval from colonization to infection was shorter in CA-MRSA-colonized infants (median 0 days, range -1 to 4 versus HA-MRSA-colonized infants, 7 days, -1 to 43; p 0.005). Maternal peripartum antibiotics were associated with CA-MRSA colonization (adjusted odds ratio (aOR) 8.7; 95% CI 1.7-45.0); intubation and surgical procedures were associated with HA-MRSA colonization (aOR 7.8; 95% CI 1.3-47.6 and aOR 6.0; 95% CI 1.4-24.4, respectively). Mupirocin- and chlorhexidine-resistant MRSA was isolated from four and eight patients, respectively; carriage of a mupirocin-resistant strain precluded decolonization. CA-MRSA strains are prominent in the NICU and associated with distinct risk factors. Given community reservoirs for MRSA acquisition and transmission, novel infection prevention strategies are needed.

Differential expression of candidate salivary effector proteins in field collections of Hessian fly, Mayetiola destructor

Evidence is emerging that some proteins secreted by gall-forming parasites of plants act as effectors responsible for systemic changes in the host plant, such as galling and nutrient tissue formation. A large number of secreted salivary gland proteins (SSGPs) that are the putative effectors responsible for the physiological changes elicited in susceptible seedling wheat by Hessian fly, Mayetiola destructor (Say), larvae have been documented. However, how the genes encoding these candidate effectors might respond under field conditions is unknown. The goal of this study was to use microarray analysis to investigate variation in SSGP transcript abundance amongst field collections from different geographical regions (southeastern USA, central USA, and the Middle East). Results revealed significant variation in SSGP transcript abundance amongst the field collections studied. The field collections separated into three distinct groups that corresponded to the wheat classes grown in the different geographical regions as well as to recently described Hessian fly populations. These data support previous reports correlating Hessian fly population structure with micropopulation differences owing to agro-ecosystem parameters such as cultivation of regionally adapted wheat varieties, deployment of resistance genes and variation in climatic conditions.

Regional and temporal variations of Leptospira seropositivity in dogs in the United States, 2000-2010

BACKGROUND

Previous studies have reported a seasonal increased risk for leptospirosis, but there is no consistent seasonality reported across regions in the United States.

OBJECTIVES

To evaluate and compare seasonal patterns in seropositivity for leptospirosis in dogs for 4 US regions (northeast [NE], midwest [MW], south-central [SC], and California-southern west coast [CS]).

ANIMALS

Forty four thousand nine hundred and sixteen canine serum samples submitted to a commercial laboratory for microscopic agglutination tests (MAT) from 2000 through 2010.

METHODS

In this retrospective study, positive cases were defined as MAT titers ≥1 : 3,200 for at least one of 7 tested serovars. Four geographic regions were defined, and MAT results were included in regional analyses based on hospital zipcode. A seasonal-trend decomposition method for times series was utilized for the analysis. Monthly variation in the seropositive rate was evaluated using a seasonal cycle subseries plot and logistic regression.

RESULTS

Two thousand and twelve of 44,916 (4.48%) samples were seropositive. Compared to seropositive rates for February, significantly higher monthly rates occurred during the 2nd half of the year in the MW (OR 3.92-6.35) and NE (OR 2.03-4.80) regions, and only in January (OR 2.34) and December (OR 1.74) in the SC region. Monthly seropositive rates indicative of seasonality were observed earlier in the calendar year for both CS and SC regions.

CONCLUSIONS AND CLINICAL IMPORTANCE

Seasonal patterns for seropositivity to leptospires differed by geographic region. Although risk of infection in dogs can occur year round, knowledge of seasonal trends can assist veterinarians in formulating differential diagnoses and evaluation of exposure risk.

Signalment changes in canine leptospirosis between 1970 and 2009

BACKGROUND

Previous studies have identified large breed, male, outdoor dogs of herding or working groups to be at increased risk for Leptospira infection. Exposure risk factors may change over time, altering the signalment of dogs most commonly diagnosed with leptospirosis.

OBJECTIVES

The objectives of this study were to evaluate possible signalment changes by decade in canine leptospirosis cases diagnosed at university veterinary hospitals in the United States and Canada using reports to the Veterinary Medical DataBase (VMDB) over a 40-year period (1970-2009).

ANIMALS

One thousand and ninety-one dogs with leptospirosis diagnosed among 1,659,146 hospital visits.

METHODS

Hospital prevalence of leptospirosis by decade was determined by age, sex, weight, and breed groups. Multivariable logistic regression models were created to evaluate the association between variables and the odds of disease for each decade.

RESULTS

Veterinary Medical DataBase hospital prevalence of leptospirosis in dogs, after a marked decrease in the 1970s and low rates in the 1980s, began increasing in the 1990s. Hospital prevalence significantly increased in dogs between 2 and 9.9 years of age (P < .05) and in male dogs (P < .05) in each decade since the 1980s. Among weight groups in the most recent decade (2000-2009), dogs weighing <15 pounds had the greatest odds of being diagnosed with leptospirosis (P = .003).

CONCLUSIONS AND CLINICAL IMPORTANCE

Hospital prevalence rates by age, weight, sex, and breed groups differed by decade. These changes may reflect changes in exposure risk, Leptospira vaccination practices for dogs, or both.

Fluorescent prey traps in carnivorous plants

Carnivorous plants acquire most of their nutrients by capturing ants, insects and other arthropods through their leaf-evolved biological traps. So far, the best-known attractants in carnivorous prey traps are nectar, colour and olfactory cues. Here, fresh prey traps of 14 Nepenthes, five Sarracenia, five Drosera, two Pinguicula species/hybrids, Dionaea muscipula and Utricularia stellaris were scanned at UV 366 nm. Fluorescence emissions of major isolates of fresh Nepenthes khasiana pitcher peristomes were recorded at an excitation wavelength of 366 nm. N. khasiana field pitcher peristomes were masked by its slippery zone extract, and prey capture rates were compared with control pitchers. We found the existence of distinct blue fluorescence emissions at the capture spots of Nepenthes, Sarracenia and Dionaea prey traps at UV 366 nm. These alluring blue emissions gradually developed with the growth of the prey traps and diminished towards their death. On excitation at 366 nm, N. khasiana peristome 3:1 CHCl3–MeOH extract and its two major blue bands showed strong fluorescence emissions at 430–480 nm. Masking of blue emissions on peristomes drastically reduced prey capture in N. khasiana pitchers. We propose these molecular emissions as a critical factor attracting arthropods and other visitors to these carnivorous traps. Drosera, Pinguicula and Utricularia prey traps showed only red chlorophyll emissions at 366 nm.

Insight into the sharing of medical images: physician, other health care providers, and staff experience in a variety of medical settings

BACKGROUND

Scant knowledge exists describing health care providers' and staffs' experiences sharing imaging studies. Additional research is needed to determine the extent to which imaging studies are shared in diverse health care settings, and the extent to which provider or practice characteristics are associated with barriers to viewing external imaging studies on portable media.

OBJECTIVE

This analysis uses qualitative data to 1) examine how providers and their staff accessed outside medical imaging studies, 2) examine whether use or the desire to use imaging studies conducted at outside facilities varied by provider specialty or location (urban, suburban, and small town) and 3) delineate difficulties experienced by providers or staff as they attempted to view and use imaging studies available on portable media.

METHODS

Semi-structured interviews were conducted with 85 health care providers and medical facility staff from urban, suburban, and small town medical practices in North Carolina and Virginia. The interviews were audio recorded, transcribed, then systematically analyzed using ATLAS.ti.

RESULTS

Physicians at family and pediatric medicine practices rely primarily on written reports for medical studies other than X-rays; and thus do not report difficulties accessing outside imaging studies. Subspecialists in urban, suburban, and small towns view imaging studies through internal communication systems, internet portals, or portable media. Many subspecialists and their staff report experiencing difficulty and time delays in accessing and using imaging studies on portable media.

CONCLUSION

Subspecialists have distinct needs for viewing imaging studies that are not shared by typical primary care providers. As development and implementation of technical strategies to share medical records continue, this variation in need and use should be noted. The sharing and viewing of medical imaging studies on portable media is often inefficient and fails to meet the needs of many subspeciality physicians, and can lead to repeated imaging studies.

Biological and molecular characterization of Hessian fly (Diptera: Cecidomyiidae) from Israel

Samples of a dipteran pest of wheat were tested to confirm identity, describe local populations and suggest the use of deploying resistance (R) genes in wheat cultivars for control of Mayetiola destructor, Hessian fly (HF). Morphological evaluation of adults and a free-choice oviposition preference test documenting that females overwhelmingly preferred to oviposit on wheat instead of barley supported they were HF. Using the cytochrome c oxidase subunit I (coxI), the Barcoding Region, nine haplotypes were revealed. Two were found only in the Israeli collections and averaged 3% sequence divergence compared to the other seven haplotypes found in the United States, Israel and Syria. In evaluations of virulence, the Israeli HF in culture was virulent to 11 of the 19 (R) genes tested, and complementation analysis documented that, for four of the R genes tested, the Israeli HF shared loci for virulence with HF from the United States. Levels of HF infestation at seven Israeli fields were at least at the 5-8% level, which historically has indicated a significant yield loss. Microsatellite genotyping of the five HF collections from Israel revealed mixed populations in Israel that are distinctly separate from the single population in Syria.

Seroprevalence of Japanese encephalitis virus and risk factors associated with seropositivity in pigs in four mountain districts in Nepal

Japanese encephalitis was recently reported from individuals in the mountain districts of Nepal without travel history to Japanese encephalitis virus (JEV) endemic areas. We performed a cross-sectional study to estimate the seroprevalence of JEV in pigs and subsequently conducted a survey of farmers to identify risk factors associated with seropositivity. In July and August, 2010, 454 pig serum samples were collected and tested by competitive ELISA. Data from a 35-question survey of 109 pig owners were analysed using multivariate logistic regression. Seventy-six (16.7, 95% CI 13.6-20.4) pigs tested positive for anti-JEV antibodies, none of which had been vaccinated against JEV or sourced from JEV endemic areas. Risk factors associated with JEV seropositivity were 'summer abortion', 'wells as a water source', 'urban location', 'reported presence of mosquitoes' and 'lower elevation'. Our results suggest that JEV is likely circulating in the mountain districts of Nepal, and that locally acquired JEV should be considered a risk for residents and travellers in these areas.

Does MR perfusion imaging impact management decisions for patients with brain tumors? A prospective study

BACKGROUND AND PURPOSE

MR perfusion imaging can be used to help predict glial tumor grade and disease progression. Our purpose was to evaluate whether perfusion imaging has a diagnostic or therapeutic impact on clinical management planning in patients with glioma.

MATERIALS AND METHODS

Standard MR imaging protocols were interpreted by a group of 3 NRs in consensus, with each case being interpreted twice: first, including routine sequences; and second, with the addition of perfusion imaging. A multidisciplinary team of treating physicians assessed tumor status and created hypothetical management plans, on the basis of clinical presentation and routine MR imaging and then routine MR imaging plus perfusion MR imaging. Physicians' confidence in the tumor status assessment and management plan was measured by using Likert-type items.

RESULTS

Fifty-nine consecutive subjects with glial tumors were evaluated; 50 had known pathologic diagnoses. NRs and the treatment team agreed on tumor status in 45/50 cases (κ = 0.81). With the addition of perfusion, confidence in status assessment increased in 20 (40%) for NRs and in 28 (56%) for the treatment team. Of the 59 patient-care episodes, the addition of perfusion was associated with a change in management plan in 5 (8.5%) and an increase in the treatment team's confidence in their management plan in 34 (57.6%). NRs and the treatment team found perfusion useful in most episodes of care and wanted perfusion included in future MR images for >80% of these subjects.

CONCLUSIONS

Perfusion imaging appears to have a significant impact on clinical decision-making and subspecialist physicians' confidence in management plans for patients with brain tumor.

A post-epidemic study on awareness of vector habits of Chikungunya and vector indices in a rural area of Kerala

Chikungunya struck Kerala in a devastating form in the years 2006 and 2007 and its after effects continued to 2008. In May 2008, a post epidemic study of the awareness of vector habits and prevalence of the vectors was done. A cross sectional study was conducted in a randomly selected Panchayat affected by Chikungunya in a rural area of Kerala, India. 93.3% respondents were aware that mosquitoes spread Chikungunya though 31.3% knew the type of mosquito that spreads it. 69% knew that the vector breeds in artificial collections of water. Although three-fourths (73.6%) had good knowledge, only 39% had actually took control measures. Four of the six wards were high risk areas as per House Index and Breteau Index. All the larval samples collected were identified as Aedes albopictus. About 94.3% of the respondents used one or the other measure of personal protection against mosquito. An analysis of the high risk areas showed a significant association with education (p < .001) and information on control measures (p < .01). It therefore appears that integrated vector control is the key though converting vector control knowledge into practice by influencing human behaviour is the challenge.

Risk factors for tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol

Tumor lysis syndrome (TLS) has been described in over 40% of patients with chronic lymphocytic leukemia treated with the cyclin-dependent kinase inhibitor, flavopiridol. We conducted a retrospective analysis to determine predictive factors for TLS. In 116 patients, the incidence of TLS was 46% (95% CI: 36-55%). In univariable analysis, female gender, greater number of prior therapies, Rai stages III-IV, adenopathy ≥ 10 cm, splenomegaly, del(11q), decreased albumin and increased absolute lymphocyte count, white blood cell count (WBC), β2-microglobulin, and lactate dehydrogenase were associated (P < 0.05) with TLS. In multivariable analysis, female gender, adenopathy ≥ 10 cm, elevated WBC, increased β2-microglobulin, and decreased albumin were associated with TLS (P < 0.05). With respect to patient outcomes, 49 and 44% of patients with and without TLS, respectively, responded to flavopiridol (P = 0.71). In a multivariable analysis, controlling for number of prior therapies, cytogenetics, Rai stage, age and gender, progression-free survival (PFS) was inferior in patients with TLS (P = 0.01). Female patients and patients with elevated β2-microglobulin, increased WBC, adenopathy ≥ 10 cm and decreased albumin were at highest risk and should be monitored for TLS with flavopiridol. TLS does not appear to be predictive of response or improved PFS in patients receiving flavopiridol.

Comparative analysis of enzyme and pathway engineering strategies for 5FC-mediated suicide gene therapy applications

Bacterial- and yeast- encoded cytosine deaminases (bCD and yCD, respectively) are widely investigated suicide enzymes used in combination with the prodrug 5-fluorocytosine (5FC) to achieve localized cytotoxicity. Yet characteristics such as poor turnover rates of 5FC (bCD) and enzyme thermolability (yCD) preclude their full therapeutic potential. We previously applied regio-specific random mutagenesis and computational design to create novel bCD and yCD variants with altered substrate preference (bCD(1525)) or increased thermostability (yCD(double), yCD(triple)) to aid in overcoming these limitations. Others have utilized pathway engineering in which the microbial enzyme uracil phosphoribosyltransferase (UPRT) is fused with its respective CD, creating bCD/bUPRT or yCD/yUPRT. In this study, we evaluated whether the overlay of CD mutants onto their respective CD/UPRT fusion construct would further enhance 5FC activation, cancer cell prodrug sensitivity and bystander activity in vitro and in vivo. We show that all mutant fusion enzymes allowed for significant reductions in IC(50) values relative to their mutant CD counterparts. However, in vivo the CD mutants displayed enhanced tumor growth inhibition capacity relative to the mutant fusions, with bCD(1525) displaying the greatest tumor growth inhibition and bystander activity. In summary, mutant bCD(1525) appears to be the most effective of all bacterial or yeast CD or CD/UPRT enzymes examined and as such is likely to be the best choice to significantly improve the clinical outcome of CD/5FC suicide gene therapy applications.

Brain atrophy correlates with functional outcome in a murine model of multiple sclerosis

White matter (WM) lesions are the classic pathological hallmarks of multiple sclerosis (MS). However, MRI-based WM lesion load shows relatively poor correlation with functional outcome, resulting in the "clinico-radiological paradox" of MS. Unlike lesion based measures, volumetric MRI assessment of brain atrophy shows a strong correlation with functional outcome, and the presence of early atrophy predicts a worse disease course. While extensive literature exists describing MRI characteristics of atrophy in MS, the exact pathogenesis and the substrate of atrophy-gray vs. WM loss, axonal/neuronal damage vs. demyelination, or a combination of the above-remain unclear. Animal models of atrophy would allow for detailed investigations of the pathomechanism, and would contribute to an enhanced understanding of structural-functional connections in this complex disease. We now report that in the Theiler's Murine Encephalitis Virus (TMEV) model of MS in SJL/J mice, significant brain atrophy accompanies the development of the progressive MS-like disease. We conducted volumetric MRI studies in 8 cases and 4 age, gender- and strain-matched control mice. While in controls we did not detect any brain atrophy, significant atrophy developed as early as 3 months into the disease course, and reached its peak by 6 months, resulting in ventricular enlargement by 118% (p=0.00003). A strong correlation (r=-0.88) between atrophy and disability, as assessed by rotarod assay, was also demonstrated. We earlier reported another neurodegenerative feature in this model, the presence of deep gray matter T2 hypointensity in thalamic nuclei. Future studies utilizing this model will allow us to investigate key components of MRI detectable neurodegenerative feature development, their tissue correlations and associations with functional outcome measures. These studies are expected to pave the way to a better understanding of the substrate of disability in MS models.

Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review

BACKGROUND AND PURPOSE

To minimize diagnostic confusion, a CSF specimen should be free from traumatically introduced red blood cells (RBCs). The purpose of this research is to determine if patient age, sex, gauge of the lumbar puncture (LP) needle, or the level of LP is associated with an increased risk for traumatic fluoroscopy-guided LP.

MATERIALS AND METHODS

Data were collected retrospectively for consecutive male and female patients of all ages (n = 756) who underwent a fluoroscopy-guided LP for a 2-year period. We defined traumatic LP as a CSF sample with an RBC count more than 500 cells/mm(3) without xanthochromia.

RESULTS

Rate of traumatic LP was 13.3%. The rate of traumatic LP at the L4-L5 level (19%) was significantly higher than at the L2-L3 (9%) or L3-L4 level (10%). Patients older than 80 years had higher traumatic LP rates (25.9%) compared with patients between ages 11 and 80 years (12.4%). Sex and gauge of the spinal needle were not associated with increased rate of traumatic LP. Patients younger than 1 year had failed LP rate of 58.8% compared with 3.2% failure rate in older patients.

CONCLUSIONS

Fluoroscopy-guided LP at the L4-L5 level is associated with nearly twice the risk for traumatic puncture compared with the L2-L3 or L3-L4 level. Rates of traumatic result are twice as high in adults older than 80 years compared with younger patients. Failure rates for fluoroscopy-guided LP are low except in children younger than 1 year, in whom failure occurs in most cases.

Raised levels of CD39 in leucocytosis result in marked inhibition of ADP-induced platelet aggregation via rapid ADP hydrolysis

We observed previously that the extent of ADP-induced platelet aggregation in blood from patients with leucocytosis is markedly reduced. We obtained evidence that this is via enhanced ADP metabolism consequent to the high leucocyte count, and speculated that ecto-NTPDase CD39 on leucocytes may be involved. Here we have investigated the association between ADP-induced platelet aggregation, ADP metabolism and expression of ecto-NTPDase CD39 on leucocytes in patients with leucocytosis. Six patients with leucocytosis were compared with six normal controls. Platelet aggregation was measured using platelet counting. ADP metabolism was analysed by HPLC. CD39 on leucocytes from each volunteer and patient was measured by flow cytometry and is presented as the CD39 fluorescence index (CD39FI, the sum of the product of CD39 median fluorescence and cell number for each leucocyte subtype). Compared with the controls, all patients displayed markedly reduced platelet aggregation to ADP in whole blood, markedly enhanced metabolism of ADP to AMP in whole blood, and increased leucocyte CD39FI. The increased CD39FI was due to either a high number of CD39+ve lymphocytes or a high number of CD39+ve neutrophils. In contrast, the measures of aggregation and ADP metabolism performed in platelet-rich plasma from the patients were similar to those obtained for the controls. There was an inverse correlation between ADP-induced aggregation in whole blood and CD39FI, and between the time taken to achieve complete removal of ADP from blood and CD39FI. For two patients with very high CD39FI (60,000 cf 1500 for controls) ADP-induced aggregation was abolished. Reduced aggregation, enhanced ADP metabolism and a raised CD39FI returned to normal in one patient following successful chemotherapy. It is concluded that ADP-induced platelet aggregation in leucocytosis is reduced as a result of enhanced ADP metabolism due to raised levels of leucocyte-associated CD39.

Neuroimaging of demyelination and remyelination models

Small-animal magnetic resonance imaging is becoming an increasingly utilized noninvasive tool in the study of animal models of MS including the most commonly used autoimmune, viral, and toxic models. Because most MS models are induced in rodents with brains and spinal cords of a smaller magnitude than humans, small-animal MRI must accomplish much higher resolution acquisition in order to generate useful data. In this review, we discuss key aspects and important differences between high field strength experimental and human MRI. We describe the role of conventional imaging sequences including T1, T2, and proton density-weighted imaging, and we discuss the studies aimed at analyzing blood-brain barrier (BBB) permeability and acute inflammation utilizing gadolinium-enhanced MRI. Advanced MRI methods, including diffusion-weighted and magnetization transfer imaging in monitoring demyelination, axonal damage, and remyelination, and studies utilizing in vivo T1 and T2 relaxometry, provide insight into the pathology of demyelinating diseases at previously unprecedented details. The technical challenges of small voxel in vivo MR spectroscopy and the biologically relevant information obtained by analysis of MR spectra in demyelinating models is also discussed. Novel cell-specific and molecular imaging techniques are becoming more readily available in the study of experimental MS models. As a growing number of tissue restorative and remyelinating strategies emerge in the coming years, noninvasive monitoring of remyelination will be an important challenge in small-animal imaging. High field strength small-animal experimental MRI will continue to evolve and interact with the development of new human MR imaging and experimental NMR techniques.

Which MR imaging sequences are necessary in determining the need for radiation therapy for cord compression? A prospective study

BACKGROUND AND PURPOSE

To determine which MR imaging sequences are necessary to assess for spinal metastases.

METHODS

Hypothetical MR imaging interpretations and management plans were made prospectively for consecutive adult cases acquired retrospectively. Standardized MR imaging protocols were independently interpreted by 2 neuroradiologists. MR imaging protocol types varied: 1) T1-weighted images only; 2) T1-weighted and T2-weighted images; 3) T1-weighted and postcontrast T1-weighted images; and 4) T1- and T2-weighted images and postcontrast T1-weighted images. Hypothetical management plans were created by 2 radiation oncologists. Logit model was used to investigate the effect of MR imaging protocol type on the probability of recommending radiation therapy (RT). Mixed effect models were used to investigate whether median spinal level or total number of spinal levels of planned RT was associated with MR imaging protocol type.

RESULTS

Thirty-one subjects were evaluated, each with multiple scan interpretations. Logit model showed that neither MR imaging protocol type nor neuroradiologist reader affected the probability that the oncologist would recommend RT (all P > .50). Mixed models showed that neither ML nor NL was affected by MR imaging protocol type or by neuroradiologist reader (all P > .12).

CONCLUSION

Although MR imaging is known to be the most useful diagnostic test in suspected spinal cord compression, which particular MR images are necessary remain unclear. Compared with T1-weighted images alone, the additional use of T2-weighted and/or postcontrast T1-weighted sequences did not significantly affect the probability that RT would be recommended or the levels that would be chosen for RT in our study. Our data suggest that unenhanced T1-weighted images may be sufficient for evaluation of possible cord compression.

Maternal and child health services utilization in married women of age 15- 45 years

A house-to-house survey was carried out in Edavanakad Panchayat in Ernakulam district of Kerala to study the utilization and satisfaction from the MCH services provided by the Government and private hospitals. In all 92 women of age 15-45 were selected for the study. The use of private hospital for delivery increased with education. Younger women (age <20 years) used equally both the Government and private hospitals. Overall Government hospital was preferred over private. Antenatal practices were very good with 99% of the women having visited a doctor at least 3 times during pregnancy and women who received TT injection (99%) & IFA tablets (98%) respectively were also very good. More housewives used Government services as compared to the workingwomen and found them convenient and satisfying. The further satisfaction in services may be increased by encouraging community participation.

Self reported morbidity and awareness regarding common cancers in elderly women

A study based on 198 women above 45 years of age was undertaken using interview methods in a house to house survey, to find the self reported morbidity and awareness regarding common cancers and screening tests. In this study the most commonly reported morbidity was due to reproductive system and related problems. Among reported problems the most common was visual (66.5%) followed by joint pains(58.9%). There was a highly significant relationship between Hypertension, Diabetes and age and also highly significant relationship between education and reported morbidity like low back ache, easy fatiguability, Hypertension and Diabetes. Women in the age group (45-55years) had a significantly better awareness about common cancers. 29.7% women were aware of breast self examination (BSE) and 20.6% practicing BSE. It was also found that women belonging to nuclear families were significantly more likely to practice BSE. Two thirds of the respondents did not know about the screening test for Breast Cancer and 83.7% were unaware of the test for cervical cancer.

Enhanced binding of low-affinity antibodies interacting simultaneously with targeted cell surface molecules and Fc receptor

The possibility that different forms of class I molecules might be expressed on the cell surface of lymphocytes has been investigated periodically over the past several decades. A series of major histocompatibility complex (MHC) class I-specific monoclonal antibodies, including the commonly used antibodies 64-3-7 and 25-D1.16, bind B cells differentially, suggesting the existence of differentially expressed class I-associated cell surface determinants on B lymphocytes. However, the ability of antibodies to bind cells is determined by the sum of interactions between the antibodies and the molecules expressed on the cell surface. The interactions of class I-specific antibodies with B cells were dissected, revealing dual specificity of the antibodies for the targeted class I molecules, as well as to Fc receptors preferentially expressed by B cells. We demonstrate that antibodies simultaneously bind targeted class I molecules and Fc receptors expressed on the surface of B cells. Simultaneous binding to two cell surface structures significantly enhances the class I-specific binding pattern of certain antibodies by increasing their avidity, leading to apparent cell-specific differences in MHC expression patterns. We conclude that no differences in MHC structures need be postulated to account for the observed binding patterns.

The language of mental health nursing reports: firing paper bullets?

A great deal of the caring work of nursing is accomplished and mediated through language. This paper attempts to characterize some of this language in quantitative and stylistic terms in an attempt to characterize the genre of nursing report language. Nursing students (n = 26) and graduate nurses (n = 3) viewed a videotape of a person being interviewed by a psychiatrist and produced written reports. These showed a large proportion of words relating to the person and to feelings and needs, compared to existing databases of the English language in general. The language produced by the participants also contained many modal or modifying words and is similar to spoken rather than written English in terms of the proportion of lexical content. There was much diversity in their descriptions and the vocabulary used to refer to the client. Graduate nurses showed more scepticism of the evidence provided by the video and advocated more investigation and questioning of the client. The use of standard forms and techniques of expression suggests that these reports were assembled on a language production line. Finally, we advocate a more systematic approach to educating nursing students about the power of the language they use.

Preservation of motor function by inhibition of CD8+ virus peptide-specific T cells in Theiler's virus infection

Central nervous system-infiltrating CD8+ T cells are potential mediators of neuropathology in models of multiple sclerosis induced by Theiler's murine encephalomyelitis virus (TMEV) infection. C57BL/6 mice mount a vigorous cytotoxic T lymphocyte (CTL) response against the immunodominant virus peptide VP2121-130 and clear TMEV infection. Interferon-g (IFN-g)R-/- mice also mount a strong CTL response against the VP2121-130 epitope, but because of genetic deficiencies in critical IFN-g signaling pathways, they do not clear TMEV infection and develop prominent neurological deficits within 6 wk. This pronounced disease process, coupled with a defined CTL response, provides an ideal model for evaluating the importance of antiviral CTL activity in the development of severe demyelination and loss of motor neuron function. By administering the VP2121-130 peptide before and during TMEV infection, 99% of the VP2121-130-specific CD8+ T cell response was inhibited. No decrease in virus infection was observed. Peptide treatment did result in significantly less motor dysfunction, even when no differences in levels of demyelination were observed. Although most investigators focus on the role of CD4+ T cells in demyelinating disease, these studies are the first to demonstrate a clear contribution of antiviral CD8+ T cells in neurological injury in a chronic-progressive model of multiple sclerosis.

Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey

BACKGROUND

In the summer of 1999, West Nile virus was recognised in the western hemisphere for the first time when it caused an epidemic of encephalitis and meningitis in the metropolitan area of New York City, NY, USA. Intensive hospital-based surveillance identified 59 cases, including seven deaths in the region. We did a household-based seroepidemiological survey to assess more clearly the public-health impact of the epidemic, its range of illness, and risk factors associated with infection.

METHODS

We used cluster sampling to select a representative sample of households in an area of about 7.3 km(2) at the outbreak epicentre. All individuals aged 5 years or older were eligible for interviews and phlebotomy. Serum samples were tested for IgM and IgG antibodies specific for West Nile virus.

FINDINGS

677 individuals from 459 households participated. 19 were seropositive (weighted seroprevalence 2.6% [95% CI 1.2-4.1). Six (32%) of the seropositive individuals reported a recent febrile illness compared with 70 of 648 (11%) seronegative participants (difference 21% [0-47]). A febrile syndrome with fatigue, headache, myalgia, and arthralgia was highly associated with seropositivity (prevalence ratio 7.4 [1.5-36.6]). By extrapolation from the 59 diagnosed meningoencephalitis cases, we conservatively estimated that the New York outbreak consisted of 8200 (range 3500-13000) West Nile viral infections, including about 1700 febrile infections.

INTERPRETATION

During the 1999 West Nile virus outbreak, thousands of symptomless and symptomatic West Nile viral infections probably occurred, with fewer than 1% resulting in severe neurological disease.

Monomeric class I molecules mediate TCR/CD3 epsilon/CD8 interaction on the surface of T cells

Both CD8 and the TCR bind to MHC class I molecules during physiologic T cell activation. It has been shown that for optimal T cell activation to occur, CD8 must be able to bind the same class I molecule that is bound by the TCR. However, no direct evidence for the class I-dependent association of CD8 and the TCR has been demonstrated. Using fluorescence resonance energy transfer, we show directly that a single class I molecule causes TCR/CD8 interaction by serving as a docking molecule for both CD8 and the TCR. Furthermore, we show that CD3epsilon is brought into close proximity with CD8 upon TCR/CD8 association. These interactions are not dependent on the phosphorylation events characteristic of T cell activation. Thus, MHC class I molecules, by binding to both CD8 and the TCR, mediate the reorganization of T cell membrane components to promote cellular activation.

Phosphoinositide 3-kinase facilitates antigen-stimulated Ca(2+) influx in RBL-2H3 mast cells via a phosphatidylinositol 3,4,5-trisphosphate-sensitive Ca(2+) entry mechanism

This study presents evidence that phosphoinositide 3-kinase (PI3K) plays a concerted role with phospholipase Cgamma in initiating antigen-mediated Ca(2+) signaling in mast cells via a phosphatidylinositol 3,4,5-trisphosphate (PI(3,4,5)P(3))-sensitive Ca(2+) entry pathway. Exogenous PI(3,4,5)P(3) at concentrations close to its physiological level induces instantaneous Ca(2+) influx into RBL-2H3 cells. This PI(3,4,5)P(3)-induced intracellular Ca(2+) increase is independent of phospholipase C activity or the depletion of internal stores. Moreover, inhibition of PI3K by LY294002 or by overexpression of the dominant negative inhibitor Deltap85 suppresses the Ca(2+) response to the cross-linking of the high affinity receptor for IgE (FcepsilonRI). Concomitant treatment of RBL-2H3 cells with LY294002 or Deltap85 and 2-aminoethyl diphenylborate, a cell-permeant antagonist of D-myo-inositol 1,4,5-trisphosphate receptors, abrogates antigen-induced Ca(2+) signals, whereas either treatment alone gives rise to partial inhibition. Conceivably, PI(3,4,5)P(3)-sensitive Ca(2+) entry and capacitative Ca(2+) entry represent major Ca(2+) influx pathways that sustain elevated [Ca(2+)]i to achieve optimal physiological responses. This study also refutes the second messenger role of D-myo-inositol 1,3,4,5-tetrakisphosphate in regulating FcepsilonRI-mediated Ca(2+) response. Considering the underlying mechanism, our data suggest that PI(3,4,5)P(3) directly stimulates a Ca(2+) transport system in plasma membranes. Together, these data provide a molecular basis to account for the role of PI3K in the regulation of FcepsilonRI-mediated degranulation in mast cells.

Cone-beam tomography with a digital camera

We show that x-ray computer tomography algorithms can be applied with minimal alteration to the three-dimensional reconstruction of visible sources. Diffraction and opacity affect visible systems more severely than x-ray systems. For camera-based tomography, diffraction can be neglected for objects within the depth of field. We show that, for convex objects, opacity has the effect of windowing the angular observation range and thus blurring the reconstruction. For concave objects, opacity leads to nonlinearity in the transformation from object to reconstruction and may cause multiple objects to map to the same reconstruction. In x-ray tomography, the contribution of an object point to a line integral is independent of the orientation of the line. In optical tomography, however, a Lambertian assumption may be more realistic. We derive an expression for the blur function (the patch response) for a Lambertian source. We present experimental results showing cone-beam reconstruction of an incoherently illuminated opaque object.

Evaluation of a reduced MR imaging sequencing protocol in adult patients with stroke

PURPOSE

To compare a reduced (three-sequence) magnetic resonance (MR) imaging protocol with a full (eight- to 10-sequence) MR imaging protocol in adults suspected of having stroke.

MATERIALS AND METHODS

Six neuroradiologists interpreted a consecutive sample of 265 MR images in patients suspected of having stroke. Each read reduced-protocol images in a discrete series of 40 patients (one read images in only 15) and corresponding full-protocol images 1 month later (reduced/full protocol). Five of the readers each read images in 10 additional cases, five each as full/full and reduced/reduced protocol controls. kappa values between full and reduced protocols, reader assessment of protocol adequacy, confidence level, and need for additional sequences or examinations were evaluated.

RESULTS

In the reduced/full protocol, the kappa value for detecting ischemia was 0.797; and that for detecting any clinically important abnormality, 0.635. Statistically similar kappa values were found with the full/full control design (kappa = 0.802 and 0.715, respectively). The full protocol was judged more adequate than the reduced protocol (2.0 of 5.0 points vs 1.6, P <.001) and generated greater diagnostic confidence (8.6 of 10.0 points vs 8.9, P =.01), less need for additional sequences (2.7 of 6.0 points vs 1.5, P <.001), and more requests for additional examinations (28.4% vs 36.3%).

CONCLUSION

Disagreement between interpretations of reduced- and full-protocol images might be attributable to baseline-level intraobserver inconsistency, as demonstrated in control designs. A greater number of sequences did not lead to greater consistency.