A numbers game: Mosquito-based arbovirus surveillance in two distinct geographic regions of Latin America

Aedes mosquitoes, as vectors of medically important arthropod-borne viruses (arboviruses), constitute a major public health threat that requires entomological and epidemiological surveillance to guide vector control programs to prevent and reduce disease transmission. In this study, we present the collaborative effort of one year of mosquito-based arbovirus surveillance in two geographically distinct regions of Latin America (Nicaragua and Ecuador). Adult female mosquitoes were collected using backpack aspirators in over 2,800 randomly selected households (Nicaragua, Ecuador) and 100 key sites (Nicaragua) from eight distinct communities (Nicaragua: 2, Ecuador: 6). A total of 1,358 mosquito female pools were processed for RNA extraction and viral RNA detection using real-time RT-PCR. Ten positive dengue virus (DENV) pools were detected (3 in Nicaragua and 7 in Ecuador), all of which were found during the rainy season and matched the serotypes found in humans (Nicaragua: DENV-1 and DENV-4; Ecuador: DENV-2). Infection rates ranged from 1.13 to 23.13, with the Nicaraguan communities having the lowest infection rates. Our results demonstrate the feasibility of detecting DENV-infected Aedes mosquitoes in low-resource settings and underscore the need for targeted mosquito arbovirus sampling and testing, providing valuable insights for future surveillance programs in the Latin American region.

Dengue severity by serotype in 19 years of pediatric clinical studies in Nicaragua

Background

Dengue virus, a major global health threat, consists of four serotypes (DENV1-4) that cause a range of clinical manifestations from mild to severe and potentially fatal disease.

Methods

This study, based on 19 years of data from the Pediatric Dengue Cohort Study and Pediatric Dengue Hospital-based Study in Managua, Nicaragua, investigates the influence of serotype and immune status on dengue severity. Study participants 6 months to 17 years old were followed during their hospital stay or as ambulatory patients, with dengue cases confirmed by molecular, serological, and/or virological methods.

Results

We enrolled a total of 14071 participants, of whom 2954 (21%) were positive for DENV infection. Of 2425 cases with serotype result by RT-PCR, 541 corresponded to DENV1, 996 to DENV2, 718 to DENV3 and 170 to DENV4. Severe disease was more prevalent among secondary DENV2 and DENV4 cases, while similar disease severity was observed in both primary and secondary DENV1 and DENV3 cases. According to the 1997 World Health Organization (WHO) severity classification, both DENV2 and DENV3 had a higher proportion of severe disease compared to other serotypes, whereas DENV3 had the greatest percentage of severity under the WHO-2009 classification. DENV2 was associated with pleural effusion and low platelet count, while DENV3 correlated with both hypotensive and compensated shock.

Conclusions

These findings emphasize the critical need for a dengue vaccine with balanced efficacy against all four serotypes, particularly as existing vaccines show variable efficacy by serotype and immune status, posing challenges for comprehensive protection, particularly in dengue-naïve individuals.

Primary exposure to Zika virus increases risk of symptomatic dengue virus infection with serotypes 2, 3, and 4 but not serotype 1

Infection with any of the four dengue virus serotypes (DENV1-4) can protect against or enhance subsequent dengue depending on pre-existing antibodies and the subsequent infecting serotype. Additionally, primary infection with the related flavivirus Zika virus (ZIKV) has been shown to increase DENV2 disease. Here, we measured how prior DENV and ZIKV immunity influenced risk of disease caused by all four serotypes in a pediatric Nicaraguan cohort. Of 3,412 participants in 2022, 10.6% experienced symptomatic DENV infections caused by DENV1 (n=139), DENV4 (n=133), DENV3 (n=54), DENV2 (n=9), or an undetermined serotype (n=39). Longitudinal clinical and serological data were used to define infection histories, and generalized linear and additive models adjusted for age, sex, time since the last infection, cohort year, and repeat measurements were used to predict disease risk. Compared to flavivirus-naïve participants, primary ZIKV infection increased disease risk of DENV4 (relative risk = 2.62, 95% confidence interval: 1.48-4.63) and DENV3 (2.90, 1.34-6.27) but not DENV1 (1.20, 0.72-1.99). Primary DENV infection or a DENV followed by ZIKV infection also increased DENV4 risk. We re-analyzed 19 years of cohort data and demonstrated that prior flavivirus-immunity and pre-existing antibody titer differentially affected disease risk for incoming serotypes, increasing risk of DENV2 and DENV4, protecting against DENV1, and protecting at high titers but enhancing at low titers against DENV3. We thus find that prior ZIKV infection, like prior DENV infection, increases risk of certain DENV serotypes. Cross-reactivity among flaviviruses should be carefully considered when assessing vaccine safety and efficacy.

Size structure of the coral Stylophora pistillata across reef flat zones in the central Red Sea

Demographic analyses offer insight into the state of a population. Here, we surveyed different reef flat zones (exposed, midreef and sheltered) of six reefs over a cross-shelf gradient to characterize the population structure of Stylophora pistillata, a coral species which dominates reef flats in the central Red Sea. Phototransects were conducted at each reef flat zone, and the density of S. pistillata, the planar area of each colony, and the occurrence of partial mortality were calculated using the program ImageJ. Each colony was also assigned a color morph (yellow, purple or mixed colors). Density and mean size were extremely variable, both among reef flat zones and reefs, but overall, both metrics were lower on the midshelf reefs. The yellow color morph accounted for nearly 90% of colonies surveyed and dominated most reef flats assessed, with the exception of one site where 81% of colonies were purple morphs. There were no spatial trends in the percentage of colonies suffering partial mortality, but overall there is a positive correlation with size class and proportion of colonies with partial mortality. Despite few trends emerging from assessing individual parameters, a PERMANOVA analysis revealed differences among reef flat zones in most of the reefs, highlighting the importance of multivariate analysis. The data presented here serve as a baseline for monitoring and may identify possible future demographic changes to this important coral species in a region increasingly affected by bleaching events.

Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

Background

While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C.

Methods

We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan.

Results

Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted.

Treatment

All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins.

Conclusion

Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation.

Funding Acknowledgement

Type of funding sources: None.

Developing Strategies for Onchocerciasis Elimination Mapping and Surveillance Through The Diagnostic Network Optimization Approach

Background

Onchocerciasis (river blindness) is a filarial disease targeted for elimination of transmission. However, challenges exist to the implementation of effective diagnostic and surveillance strategies at various stages of elimination programs. To address these challenges, we used a network data analytics approach to identify optimal diagnostic scenarios for onchocerciasis elimination mapping (OEM).

Methods

The diagnostic network optimization (DNO) method was used to model the implementation of the old Ov16 rapid diagnostic test (RDT) and of new RDTs in development for OEM under different testing strategy scenarios with varying testing locations, test performance and disease prevalence. Environmental suitability scores (ESS) based on machine learning algorithms were developed to identify areas at risk of transmission and used to select sites for OEM in Bandundu region in the Democratic Republic of Congo (DRC) and Uige province in Angola. Test sensitivity and specificity ranges were obtained from the literature for the existing RDT, and from characteristics defined in the target product profile for the new RDTs. Sourcing and transportation policies were defined, and costing information was obtained from onchocerciasis programs. Various scenarios were created to test various state configurations. The actual demand scenarios represented the disease prevalence at IUs according to the ESS, while the counterfactual scenarios (conducted only in the DRC) are based on adapted prevalence estimates to generate prevalence close to the statistical decision thresholds (5% and 2%), to account for variability in field observations. The number of correctly classified implementation units (IUs) per scenario were estimated and key cost drivers were identified.

Results

In both Bandundu and Uige, the sites selected based on ESS had high predicted onchocerciasis prevalence >10%. Thus, in the actual demand scenarios in both Bandundu and Uige, the old Ov16 RDT correctly classified all 13 and 11 IUs, respectively, as requiring CDTi. In the counterfactual scenarios in Bandundu, the new RDTs with higher specificity correctly classified IUs more cost effectively. The new RDT with highest specificity (99.8%) correctly classified all 13 IUs. However, very high specificity (e.g., 99.8%) when coupled with imperfect sensitivity, can result in many false negative results (missing decisions to start MDA) at the 5% statistical decision threshold (the decision rule to start MDA). This effect can be negated by reducing the statistical decision threshold to 2%. Across all scenarios, the need for second stage sampling significantly drove program costs upwards. The best performing testing strategies with new RDTs were more expensive than testing with existing tests due to need for second stage sampling, but this was offset by the cost of incorrect classification of IUs.

Conclusion

The new RDTs modelled added most value in areas with variable disease prevalence, with most benefit in IUs that are near the statistical decision thresholds. Based on the evaluations in this study, DNO could be used to guide the development of new RDTs based on defined sensitivities and specificities. While test sensitivity is a minor driver of whether an IU is identified as positive, higher specificities are essential. Further, these models could be used to explore the development and optimization of new tools for other neglected tropical diseases.

Biological Approaches in Polyhydroxyalkanoates Recovery

Polyhydroxyalkanoates (PHA) are bio-based polymers with the potential of replace petrochemical plastics. Nevertheless, PHA commercialization is still low, due to the high production cost associated with industrial-scale development. The most cost/efficient PHA recovery strategies use organochlorine compounds or harsh reagents implying a high environmental impact. Therefore, the importance of developing an economical and efficient recovery strategy cannot be overestimated. Thus, new approaches have been reported that look for creating a sustainable production process, such as biological recovery, PHA secretion or predator bacteria. Moreover, if bioplastics would become the plastics of the future, it must be necessary to replace the traditional PHA extraction methods by environmentally friendly options. Hence, the aim of this review is to analyze trends in the development of efficient technologies for the sustainable recovery of polyhydroxyalkanoates (PHA) produced by microorganisms.

SoxB1 Activity Regulates Sensory Neuron Regeneration, Maintenance, and Function in Planarians

SoxB1 genes play fundamental roles in neurodevelopmental processes and maintaining stem cell multipotency, but little is known about their function in regeneration. We addressed this question by analyzing the activity of the SoxB1 homolog soxB1-2 in the planarian Schmidtea mediterranea. Expression and functional analysis revealed that soxB1-2 marks ectodermal-lineage progenitors, and its activity is required for differentiation of subsets of ciliated epidermal and neuronal cells. Moreover, we show that inhibiting soxB1-2 or its candidate target genes leads to abnormal sensory neuron regeneration that causes planarians to display seizure-like movements or phenotypes associated with the loss of sensory modalities. Our analyses highlight soxB1-2-regulated genes that are expressed in sensory neurons and are homologous to factors implicated in epileptic disorders in humans and animal models of epilepsy, indicating that planarians can serve as a complementary model to investigate genetic causes of epilepsy.

Differences in Transmission and Disease Severity Between 2 Successive Waves of Chikungunya

Background

Chikungunya, an arboviral disease, caused massive epidemics in Central and South America in 2014-2016. In a prospective pediatric cohort study, we examined the introduction of chikungunya in a naive population and investigated transmission and clinical characteristics.

Methods

Children presenting to the study health center with a chikungunya-like illness or undifferentiated fever were tested for chikungunya virus (CHIKV) infection by reverse transcriptase-polymerase chain reaction (RT-PCR) and serological assays. Inapparent CHIKV infections in the intervening year were determined by seroconversion in healthy blood samples collected annually.

Results

A total of 4353 children participated in the cohort study from March 2014 to February 2016 during the 2 epidemic waves of chikungunya. A total of 539 cases of chikungunya were documented, for an incidence rate of 80.2 cases per 1000 person-years (95% confidence interval [CI]: 73.7, 87.2); and a total of 893 CHIKV infections were documented, for an incidence rate of 137.1 infections per 1000 person-years (95% CI: 128.4, 146.4). The seroprevalence of anti-CHIKV antibodies increased linearly with age, with seroprevalence of >45% in 14-year-old children at the end of Epidemic 2. Symptom presentation varied between the epidemics, with Epidemic 2 exhibiting both a higher symptomatic-to-inapparent ratio (1:1.20 in Epidemic 1 vs. 1:0.65 in Epidemic 2) and more severe clinical presentation among cases. The mean reproduction number was also greater in Epidemic 2 than in Epidemic 1.

Conclusions

The intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.

Zika virus infection in Nicaraguan households

Zika virus (ZIKV) infection recently caused major epidemics in the Americas and is linked to congenital birth defects and Guillain-Barré Syndrome. A pilot study of ZIKV infection in Nicaraguan households was conducted from August 31 to October 21, 2016, in Managua, Nicaragua. We enrolled 33 laboratory-confirmed Zika index cases and their household members (109 contacts) and followed them on days 3–4, 6–7, 9–10, and 21, collecting serum/plasma, urine, and saliva specimens along with clinical, demographic, and socio-economic status information. Collected samples were processed by rRT-PCR to determine viral load (VL) and duration of detectable ZIKV RNA in human bodily fluids. At enrollment, 11 (10%) contacts were ZIKV rRT-PCR-positive and 23 (21%) were positive by IgM antibodies; 3 incident cases were detected during the study period. Twenty of 33 (61%) index households had contacts with ZIKV infection, with an average of 1.9 (range 1–6) positive contacts per household, and in 60% of these households, ≥50% of the members were positive for ZIKV infection. Analysis of clinical information allowed us to estimate the symptomatic to asymptomatic (S:A) ratio of 14:23 (1:1.6) among the contacts, finding 62% of the infections to be asymptomatic. The maximum number of days during which ZIKV RNA was detected was 7 days post-symptom onset in saliva and serum/plasma and 22 days in urine. Overall, VL levels in serum/plasma, saliva, and urine specimens were comparable, with means of 5.6, 5.3 and 4.5 log₁₀ copies/ml respectively, with serum attaining the highest VL peak at 8.1 log₁₀ copies/ml. Detecting ZIKV RNA in saliva over a similar time-period and level as in serum/plasma indicates that saliva could potentially serve as a more accessible diagnostic sample. Finding the majority of infections to be asymptomatic emphasizes the importance of silent ZIKV transmission and helps inform public health interventions in the region and globally.

Zika virus (ZIKV) infection has become a major concern due to its association with congenital birth defects and Guillain-Barré Syndrome. We enrolled 33 laboratory-confirmed Zika cases (index cases) and their household members (109 contacts) in Managua, Nicaragua, and followed them for three weeks, collecting serum/plasma, urine and saliva specimens along with clinical, demographic, and socio-economic status information. We found that 61% of the index households had contacts with ZIKV infection, with an average of 1.9 (range 1–6) positive contacts per household, and in 60% of these households, ≥50% of the members were ZIKV-positive. Analysis of clinical information allowed estimating the symptomatic to asymptomatic (S:A) ratio of 14:23 (1:1.6) among the contacts. Finding 62% of the infections to be asymptomatic emphasizes the importance of silent transmission. Evaluating the maximum number of days during which ZIKV RNA was detectable showed that ZIKV was found up to 7 days post-symptom onset in serum/plasma and saliva and 22 days post-symptom onset in urine. Finding ZIKV RNA in saliva over a similar time period and concentration as serum/plasma indicates that saliva could potentially serve as a more accessible diagnostic sample. Overall, these data increase our understanding of ZIKV transmission and help inform public health interventions in the region and globally.

Comparison of Four Serological Methods and Two Reverse Transcription-PCR Assays for Diagnosis and Surveillance of Zika Virus Infection

Zika virus (ZIKV) is a mosquito-borne flavivirus that is responsible for recent explosive epidemics in the Americas. Notably, ZIKV infection during pregnancy has been found to cause congenital birth defects, including microcephaly, and ZIKV has been associated with Guillain-Barré syndrome in adults. Diagnosis and surveillance of Zika in the Americas have been challenging due to similar clinical manifestations and extensive antibody cross-reactivity with endemic flaviviral diseases, such as dengue. We evaluated four serological and two reverse transcription-PCR (RT-PCR) methods in acute-phase (mean day, 1.8), early-convalescent-phase (mean day, 16.7), and late-convalescent-phase (mean, ~7 months) samples from the same individuals in a long-term pediatric cohort study in Nicaragua. Well-characterized samples from 301 cases of Zika, dengue, or non-Zika, nondengue febrile illnesses were tested. Compared to a composite reference, an in-house IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) and the NIAID-Biodefense and Emerging Infections (BEI) MAC-ELISA measuring IgM yielded sensitivities of 94.5% and 70.1% and specificities of 85.6% and 82.8%, respectively. The NS1 blockade-of-binding ELISA measuring anti-ZIKV NS1 antibody levels yielded sensitivities of 85.0% and 96.5% and specificities of 91.4% and 92.6% at early and late convalescence, respectively. An inhibition ELISA detecting total anti-ZIKV antibodies had sensitivity and specificity values of 68.3% and 58.3% for diagnosis and 94.0% and 98.6% for measuring annual infection incidence. Finally, the ZCD and Trioplex real-time RT-PCR assays detecting Zika, chikungunya, and dengue viruses both yielded a sensitivity of 96.1% and specificity of 100%. Together, these assays resolve the urgent need for diagnostic and surveillance tools for countries affected by Zika virus infections.

CD14+CD16+ monocytes are the main target of Zika virus infection in peripheral blood mononuclear cells in a paediatric study in Nicaragua

The recent Zika pandemic in the Americas is linked to congenital birth defects and Guillain-Barré syndrome. White blood cells (WBCs) play an important role in host immune responses early in arboviral infection. Infected WBCs can also function as 'Trojan horses' and carry viruses into immune-sheltered spaces, including the placenta, testes and brain. Therefore, defining which WBCs are permissive to Zika virus (ZIKV) is critical. Here, we analyse ZIKV infectivity of peripheral blood mononuclear cells (PBMCs) in vitro and from Nicaraguan Zika patients and show CD14+CD16+ monocytes are the main target of infection, with ZIKV replication detected in some dendritic cells. The frequency of CD14+ monocytes was significantly decreased, while the CD14+CD16+ monocyte population was significantly expanded during ZIKV infection compared to uninfected controls. Viral RNA was detected in PBMCs from all patients, but in serum from only a subset, suggesting PBMCs may be a reservoir for ZIKV. In Zika patients, the frequency of infected cells was lower but the percentage of infected CD14+CD16+ monocytes was significantly higher compared to dengue cases. The gene expression profile in monocytes isolated from ZIKV- and dengue virus-infected patients was comparable, except for significant differences in interferon-γ, CXCL12, XCL1, interleukin-6 and interleukin-10 levels. Thus, our study provides a detailed picture of the innate immune profile of ZIKV infection and highlights the important role of monocytes, and CD14+CD16+ monocytes in particular.

Interest in Family Medicine Among US Medical Students and Its Association With a Community College Academic Pathway

BACKGROUND AND OBJECTIVES

One-third of all medical students attend a community college (CC) on their path to medical school. The objective of this study was to examine the association between CC participation and initial specialty of interest among US allopathic medical students.

METHODS

We performed a national cross-sectional study of allopathic medical students who completed the 2012 Association of American Medical Colleges' Matriculating Student Questionnaire. Bivariate and logistic regression analyses were conducted.

RESULTS

A total of 9,885 medical student respondents were included in the study sample, consisting of 7,035 (71%) non-CC pathway, and 2,850 (29%) CC pathway participants. CC pathway participants were more likely to express intent to specialize in family medicine (272/2,850 [10%] vs 463/7,035 [7%], P<.001), compared to those on the non-CC path. CC pathway participants had higher odds of intent to specialize in family medicine (adjusted odds ratio [AOR]=1.32; 95% CI 1.13-1.56, P<0.001), compared to those on the non-CC path. Women, independent of college pathway, were nearly two times more likely to express an intention to specialize in family medicine, and three times more likely to express an intention to specialize in pediatrics than men.

CONCLUSIONS

Medical students who used a CC pathway are more likely to have intentions to specialize in family medicine, compared to those on the non-CC path.

Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis

Background

Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults.

Methods

Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations.

Results

The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a “natural” versus “invasive” procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making.

Conclusion

Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.

Strengthening the Community College Pathway to Medical School: A Study of Latino Students in California

BACKGROUND AND OBJECTIVES

One third of Latino medical students begin their premedical undergraduate education at a community college (CC) or 2-year college, compared to a 4-year university. This study explored the academic and personal experiences Latino premedical students commonly encounter at the CC.

METHODS

In 2013, five focus groups with Latino premedical and medical students (n=45) were conducted in Los Angeles and San Jose, CA. All students were enrolled or attended a CC. In addition, 20 CC key informants participated in semi-structured interviews to further describe the Latino CC premedical experience. The focus group and key informant transcripts were transcribed and analyzed for common themes using qualitative methods.

RESULTS

Content analysis of 2,826 distinct comments identified major themes: (1) Personal health-related experiences in underserved communities, (2) CC relevant premedical guidance, (3) Limited preparation in navigating the pathways to medical school, and (4) Competing demands and college affordability.

CONCLUSIONS

Early CC enrichment programs with direct ties to health professions advising programs, 4-year universities, medical schools, and physician mentors are needed to support Latino pre-medical students.

Community college pathways: improving the U.S. physician workforce pipeline

PURPOSE

To examine the association between participation in a community college (CC) pathway, medical school admission, and intentions to practice in underserved communities or work with minority populations.

METHOD

The authors performed cross-sectional analyses of the 2012 Association of American Medical Colleges matriculant and applicant files and the Matriculating Student Questionnaire to assess associations between student characteristics and participation in a CC pathway. They used logistic regression to estimate the association among CC pathway and acceptance to medical school, intention to practice in underserved areas, or intention to work with minority populations.

RESULTS

There were 40,491 applicants and 17,518 matriculants to U.S. MD-granting schools; about one-third used a CC. A higher proportion of underrepresented minority (URM) matriculants used CC pathways compared with whites. Applicants who attended a CC after high school and before a four-year university (First-CC) had lower odds of acceptance into medical school (adjusted odds ratio [AOR] = 0.68; 95% CI 0.61-0.75; P < .05). Compared with medical students who never attended a CC, First-CC matriculants were more likely to have parents without a college education (304/895 [34%] versus 1,683/12,598 [13%], P < .001) and higher odds of intentions to practice in underserved communities (AOR = 1.26; 95% CI 1.04-1.53; P < .05), after adjusting for covariates.

CONCLUSIONS

There is both high representation of URM students and higher prevalence of intention to work with underserved communities among CC pathway participants. These findings may be of interest to those seeking to enhance diversity in the physician workforce.

Failure to replicate the structure of a Spanish-language brief Wisconsin Inventory of Smoking Dependence Motives across three samples of Latino smokers

BACKGROUND

Research in smoking is hindered by a lack of validated measures available in languages other than English. Availability of measures in languages other than English is vital to the inclusion of diverse groups in smoking research. To help address this gap, this study attempted to validate a Spanish-language version of the brief Wisconsin Inventory of Smoking Dependence Motives (Brief WISDM).

METHODS

Data from 3 independent, diverse samples of Spanish-speaking Latino smokers seeking cessation counseling were utilized. Confirmatory factor analyses of 3 known structures of the Brief WISDM were examined for fit within each sample. A separate analysis was also conducted with the 3 samples combined. A post-hoc exploratory factor analyses with the combined sample was also conducted.

RESULTS

Across 12 confirmatory factor analyses, none of the 3 structures demonstrated good fit in any of the samples independently or in the combined sample. Across the 3 samples, high intercorrelations (>.90) were found among the Loss of Control, Craving, Tolerance, and Cue Exposure scales, suggesting great redundancy among these scales. An exploratory factor analyses (EFAs) further supported these high intercorrelations. Some subscales remained intact in the EFA but accounted for little variance.

CONCLUSIONS

Overall, this study was unable to replicate the structure of a Spanish-language Brief WISDM in 3 independent samples of smokers. Possible explanations include inadequate translation of the measure and/or true and meaningful differences in the construct of dependence among Spanish-speaking Latino smokers. Both possibilities merit further research.

Domestic dog health worsens with socio-economic deprivation of their home communities

Dogs play an important role in infectious disease transmission as reservoir hosts of many zoonotic and wildlife pathogens. Nevertheless, unlike wildlife species involved in the life cycle of pathogens, whose health status might be a direct reflection of their fitness and competitive abilities, dog health condition could be sensitive to socio-economic factors impacting the well-being of their owners. Here, we compare several dog health indicators in three rural communities of Panama with different degrees of socio-economic deprivation. From a total of 78 individuals, we collected blood and fecal samples, and assessed their body condition. With the blood samples, we performed routine hematologic evaluation (complete blood counts) and measured cytokine levels (Interferon-γ and Interleukin-10) through enzyme-linked immunosorbent assays. With the fecal samples we diagnosed helminthiases. Dogs were also serologically tested for exposure to Trypanosoma cruzi and canine distemper virus, and molecular tests were done to assess T. cruzi infection status. We found significant differences between dog health measurements, pathogen prevalence, parasite richness, and economic status of the human communities where the dogs lived. We found dogs that were less healthy, more likely to be infected with zoonotic pathogens, and more likely to be seropositive to canine distemper virus in the communities with lower economic status. This study concludes that isolated communities of lower economic status in Panama may have less healthy dogs that could become major reservoirs in the transmission of diseases to humans and sympatric wildlife.

Single-reaction, multiplex, real-time rt-PCR for the detection, quantitation, and serotyping of dengue viruses

Background

Dengue fever results from infection with one or more of four different serotypes of dengue virus (DENV). Despite the widespread nature of this infection, available molecular diagnostics have significant limitations. The aim of this study was to develop a multiplex, real-time, reverse transcriptase-PCR (rRT-PCR) for the detection, quantitation, and serotyping of dengue viruses in a single reaction.

Methodology/Principal Findings

An rRT-PCR assay targeting the 5′ untranslated region and capsid gene of the DENV genome was designed using molecular beacons to provide serotype specificity. Using reference DENV strains, the assay was linear from 7.0 to 1.0 log₁₀ cDNA equivalents/µL for each serotype. The lower limit of detection using genomic RNA was 0.3, 13.8, 0.8, and 12.4 cDNA equivalents/µL for serotypes 1–4, respectively, which was 6- to 275-fold more analytically sensitive than a widely used hemi-nested RT-PCR. Using samples from Nicaragua collected within the first five days of illness, the multiplex rRT-PCR was positive in 100% (69/69) of specimens that were positive by the hemi-nested assay, with full serotype agreement. Furthermore, the multiplex rRT-PCR detected DENV RNA in 97.2% (35/36) of specimens from Sri Lanka positive for anti-DENV IgM antibodies compared to just 44.4% (16/36) by the hemi-nested RT-PCR. No amplification was observed in 80 clinical samples sent for routine quantitative hepatitis C virus testing or when genomic RNA from other flaviviruses was tested.

Conclusions/Significance

This single-reaction, quantitative, multiplex rRT-PCR for DENV serotyping demonstrates superior analytical and clinical performance, as well as simpler workflow compared to the hemi-nested RT-PCR reference. In particular, this multiplex rRT-PCR detects viral RNA and provides serotype information in specimens collected more than five days after fever onset and from patients who had already developed anti-DENV IgM antibodies. The implementation of this assay in dengue-endemic areas has the potential to improve both dengue diagnosis and epidemiologic surveillance.

Dengue, or break-bone fever, is the most common mosquito-borne viral disease of humans with over half the world's population at risk for infection. Dengue has a wide spectrum of clinical manifestations, from self-limited febrile illness to fatal hypovolemic shock, and because of this, dengue is difficult to distinguish from many other infections based on clinical characteristics alone. Diagnostic testing is therefore critical to accurately identify dengue virus (DENV)-infected patients and also rule out dengue in patients with undifferentiated fever. Unfortunately, current diagnostics for early DENV detection consist of point-of-care or laboratory-based antigen tests that lack sensitivity or molecular assays that are laborious to perform or lack the test characteristics necessary for routine use. To address these limitations, we developed a single-reaction, multiplex, real-time RT-PCR for the detection, quantitation, and serotyping of dengue viruses from patient serum or plasma. We demonstrate that this diagnostic test is more analytically sensitive than a commonly used reference molecular assay, and is able to detect viral RNA and provide serotype information in specimens collected more than 5 days after fever onset and from patients who had already developed anti-DENV IgM antibodies. This unique combination of sensitivity and serotyping capability in a simple, single-reaction format represents a step forward in dengue diagnostics.

Prenatal Tobacco Smoke Exposure and Genomewide Methylation in Adulthood

Genomic DNA demethylation, including demethylation of repetitive elements (which comprise 45% of the human genome), has been linked to increased risk of breast and other cancers. Genomic DNA methylation can be altered prenatally and throughout life and may be a mechanism through which the environment alters disease risk. There is evidence that prenatal tobacco smoke exposure has a persistent impact on genomic DNA methylation; however, no study to date has assessed the association between prenatal smoke exposure and adult repetitive element methylation. We measured repetitive element methylation of Alu, LINE-1, and Sat2 using MethyLight in 92 members of the New York Women's Birth Cohort, a follow-up of former female participants of the New York site of the U.S. National Collaborative Perinatal Project (mean age at blood draw = 43.5, SD = 1.8). Prenatal smoke exposure was reported prospectively. We estimated associations using multivariable linear regression, and used the natural log of Alu, LINE-1, and Sat2 methylation level. Thirty-one (36%) participants were exposed to prenatal smoke. These participants were more likely to smoke at the time of interview (P &lt; 0.01). Prenatal smoke exposure was inversely associated with genomic DNA methylation of Sat2 and Alu, adjusted for age, childhood environmental tobacco smoke exposure (ETS) and adult smoking status (exposed vs. unexposed to prenatal smoke: Sat2: β = −0.20, 95% CI = −0.39, −0.02; Alu: β = −0.09, 95% CI = −0.26, 0.08). In multivariable models, childhood ETS had a positive, borderline significant association with Sat2 methylation (β = 0.17, 95% CI −0.02, 0.37). If replicated in larger studies, these results suggest that prenatal smoke exposure may have a persistent impact on genomic DNA demethylation of Sat2 and Alu in adulthood, and thus may be a pathway through which prenatal smoke exposure impacts adult disease. Results are strengthened by the fact that prenatal smoke exposure data were collected prospectively in the early 1960s, before there was a stigma associated with maternal smoking during pregnancy. These results are consistent with the one study assessing this relation in children. Further studies are needed to confirm this finding and to investigate the underlying biological mechanism.

Strategies for increasing mammography screening in primary care in Chile: results of a randomized clinical trial

BACKGROUND

Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.

METHODS

We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results.

RESULTS

Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact.

CONCLUSION

A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.

IMPACT

A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.

'If I feel something wrong, then I will get a mammogram': understanding barriers and facilitators for mammography screening among Chilean women

BACKGROUND

Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women.

OBJECTIVE

To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50-70.

METHODS

Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews.

RESULTS

The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results.

CONCLUSIONS

Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.

The quantity of zinc absorbed from wheat in adult women is enhanced by biofortification

Biofortification of crops that provide major food staples to large, poor rural populations offers an appealing strategy for diminishing public health problems attributable to micronutrient deficiencies. The objective of this first-stage human study was to determine the increase in quantity of zinc (Zn) absorbed achieved by biofortifying wheat with Zn. Secondary objectives included evaluating the magnitude of the measured increases in Zn absorption as a function of dietary Zn and phytate. The biofortified and control wheats were extracted at high (95%) and moderate (80%) levels and Zn and phytate concentrations measured. Adult women with habitual diets high in phytate consumed 300 g of 95 or 80% extracted wheat as tortillas for 2 consecutive days using either biofortified (41 mg Zn/g) or control (24 mg Zn/g) wheat. All meals for the 2-d experiment were extrinsically labeled with Zn stable isotopes and fractional absorption of Zn determined by a dual isotope tracer ratio technique. Zn intake from the biofortified wheat diet was 5.7 mg/d (72%) higher at 95% extraction (P < 0.001) and 2.7 mg/d (68%) higher at 80% extraction compared with the corresponding control wheat (P = 0.007). Zn absorption from biofortified wheat meals was (mean +/- SD) 2.1 +/- 0.7 and 2.0 +/- 0.4 mg/d for 95 and 80% extraction, respectively, both of which were 0.5 mg/d higher than for the corresponding control wheat (P < 0.05). Results were consistent with those predicted by a trivariate model of Zn absorption as a function of dietary Zn and phytate. Potentially valuable increases in Zn absorption can be achieved from biofortification of wheat with Zn.

Chip interacts with diverse homeodomain proteins and potentiates bicoid activity in vivo

The Drosophila protein Chip potentiates activation by several enhancers and is required for embryonic segmentation. Chip and its mammalian homologs interact with and promote dimerization of nuclear LIM proteins. No known Drosophila LIM proteins, however, are required for segmentation, nor for expression of most genes known to be regulated by Chip. Here we show that Chip also interacts with diverse homeodomain proteins using residues distinct from those that interact with LIM proteins, and that Chip potentiates activity of one of these homeodomain proteins in Drosophila embryos and in yeast. These and other observations help explain the roles of Chip in segmentation and suggest a model to explain how Chip potentiates activation by diverse enhancers.

Poly(beta-hydroxybutyrate) production in oilseed leukoplasts of brassica napus

Polyhydroxyalkanoates (PHAs) comprise a class of biodegradable polymers which offer an environmentally sustainable alternative to petroleum-based plastics. Production of PHAs in plants is attractive since current fermentation technology is prohibitively expensive. The PHA homopolymer poly(beta-hydroxybutyrate) (PHB) has previously been produced in leaves of Arabidopsis thaliana (Nawrath et al., 1994, Proc Natl Acad Sci USA 91: 12760-12764). However, Brassica napus oilseed may provide a better system for PHB production because acetyl-CoA, the substrate required in the first step of PHB biosynthesis, is prevalent during fatty acid biosynthesis. Three enzymatic activities are needed to synthesize PHB: a beta-ketothiolase, an acetoacetyl-CoA reductase and a PHB synthase. Genes from the bacterium Ralstonia eutropha encoding these enzymes were independently engineered behind the seed-specific Lesquerella fendleri oleate 12-hydroxylase promoter in a modular fashion. The gene cassettes were sequentially transferred into a single, multi-gene vector which was used to transform B. napus. Poly(beta-hydroxybutyrate) accumulated in leukoplasts to levels as high as 7.7% fresh seed weight of mature seeds. Electron-microscopy analyses indicated that leukoplasts from these plants were distorted, yet intact, and appeared to expand in response to polymer accumulation.

Arabidopsis ovule is the target for Agrobacterium in planta vacuum infiltration transformation

The visual marker GUS has been utilized in this study to understand the Arabidopsis thaliana vacuum infiltration transformation process by Agrobacterium tumefaciens. High transformation frequencies of up to 394 transgenic seeds per infiltrated plant were achieved. The results showed that the majority of the transgenic seeds from single infiltrated plants were from independent transformation events based on Southern analysis, progeny segregation, distribution of transgenic seeds throughout the infiltrated plants and the microscopic analysis of GUS expression in ovules of infiltrated plants. GUS expression in mature pollen and anthers was monitored daily from 0 to 12 days post-infiltration. In addition, all ovules from a single infiltrated plant were examined every other day. GUS expression frequencies of up to 1% of pollen were observed 3-5 days post-infiltration, whereas frequencies of up to 6% were detected with ovules of unopened flowers 5-11 days post-infiltration. Most importantly, transgenic seeds were obtained only from genetic crosses using infiltrated plants as the pollen recipient but not the pollen donor, demonstrating Agrobacterium transformation through the ovule pathway.

Feelings and attitudes of gifted students

Differences between the self-perceptions of gifted high school freshmen (n = 62) and nongifted peers (n = 162) were assessed regarding intimacy with family and peers, social support, family responsibilities, self-esteem, depression, and risk-taking behavior. Gifted students perceived themselves as being more intimate with friends, assuming fewer family responsibilities, and taking more risks (both sports- and danger-related risks). Contrary to the literature suggesting delays in the social development of gifted students, these data indicate that gifted students may be socially precocious when compared with their nongifted peers. Gifted students and their teachers were also administered the Perceptions about Giftedness Scale. Gifted students reported feeling the same as, or better than, their peers about their academic and social skills, and their teachers closely agreed. However, the teachers rated the gifted students as being less happy than the students rated themselves.

Protein kinase C in rod outer segments: effects of phosphorylation of the phosphodiesterase inhibitory subunit

The inhibitory subunit (PDE gamma) of the cGMP phosphodiesterase (PDE alpha beta gamma 2) in rod outer segments (ROS) realizes its regulatory role in phototransduction by inhibition of PDE alpha beta catalytic activity. The photoreceptor G-protein, transducin, serves as a transducer from the receptor (rhodopsin) to the effector (PDE) and eliminates the inhibitory effect of PDE gamma by direct interaction with PDE gamma. Our previous study [Udovichenko, Cunnick, Gonzalez and Takemoto (1994) J: Biol. Chem. 269, 9850-9856] has shown that PDE gamma is a substrate for protein kinase C (PKC) from ROS and that phosphorylation by PKC increases the ability of PDE gamma to inhibit PDE alpha beta catalytic activity. Here we report that transducin is less effective in activation of PDE alpha beta (gamma p)2 (a complex of PDE alpha beta with phosphorylated PDE gamma, PDE gamma p) than PDE alpha beta gamma 2. PDE gamma p also increases the rate constant of GTP hydrolysis of transducin (from 0.16 S-1 for non-phosphorylated PDE gamma to 0.21 s-1 for PDE gamma p). These data suggest that phosphorylation of the inhibitory subunit of PDE by PKC may regulate the visual transduction cascade by decreasing the photoresponse.

Acridine orange differential staining of total DNA and RNA in normal and galactosemic lens epithelial cells in culture using flow cytometry

The lens epithelial cells are a primary site of involvement in galactosemia. Changes in their size, shape and proliferative capacity have been observed upon exposure to high galactose. In this report, changes in the cell cycle pattern of normal and galactosemic lens epithelial cells were examined by use of flow cytometry. Both changes in DNA and RNA were observed using the fluorochrome, acridine orange. Under the appropriate conditions acridine orange can be used to differentiate double-stranded DNA from single-stranded RNA. Using this approach, the DNA and RNA of normal and galactosemic (1, 4, or 7 days) lens epithelial cells can be compared. The results indicate that lens epithelial cells, when exposed to 40 mM galactose media or 30 mM glucose for 7 days, are induced to enter mitosis. Mannitol did not mimic these results. Changes in the cell cycle pattern were not observed when the cells were treated for 1 or 4 days. Although higher numbers of cells in mitosis were observed after 7 days exposure to 40 mM galactose, a correlation between proliferation, as measured by 3H-thymidine uptake, and mitosis was not possible. Apoptosis was evaluated as a possible explanation for these results. The changes in the DNA staining pattern could be use to monitor lens epithelial cells during galactosemia.

Functional effect of phosphorylation of the photoreceptor phosphodiesterase inhibitory subunit by protein kinase C

In rod outer segments the light activation of cGMP phosphodiesterase (PDE alpha beta gamma 2) is accomplished by removal of the gamma inhibitory subunit (PDE gamma) from the PDE alpha beta catalytic subunits. A light activation of the inositol signaling pathway also occurs, but there is little information linking these two signal transduction pathways. Here we report that protein kinase C (PKC) purified from bovine rod outer segment phosphorylates the bovine PDE gamma with incorporation of 0.9 +/- 0.1 mol of phosphate/mol of PDE gamma. Phosphorylation of PDE gamma increases its ability to inhibit PDE alpha beta catalytic activity (trypsin-activated PDE, tPDE) with an IC50 for phosphorylated PDE gamma of 26 +/- 4 pM and an IC50 of 60 +/- 5 pM for unphosphorylated PDE gamma. Inhibition of tPDE by PDE gamma is characterized by two values of Kd, Kd1 = 34 pM and Kd2 = 760 pM. Phosphorylation of PDE gamma by PKC eliminates the functional heterogeneity of the PDE gamma population resulting in a single value of Kd = 23 pM. Free PDE gamma (without PDE alpha beta catalytic subunits) is a better substrate for PKC than PDE gamma in a complex with PDE alpha beta. Phosphorylation of free PDE gamma by PKC is characterized by a value of Vmax = 1,550 +/- 148 units/mg (Km = 21.0 +/- 1.9 microM). In contrast, phosphorylation of PDE gamma in PDE alpha beta gamma 2 complex has two values of Vmax, Vmax1 = 0.3 +/- 0.1 units/mg of PDE gamma (Km1 = 0.4 +/- 0.2 microM) and Vmax2 = 0.7 +/- 0.2 units/mg of PDE gamma (Km2 = 4.6 +/- 0.9 microM). ROS PKC phosphorylates Thr35 in PDE gamma. We have previously reported (Morrison, D. F., Rider, M. A., and Takemoto, D. J. (1987) FEBS Lett. 222, 266-270; Lipkin, V. M., Udovichenko, I. P., Bodarenko, V. A., Yurovskaya, A. A., Telnykh, E. V., and Skiba, N. P. (1990) Biomed. Sci. (Lond.) 1, 305-308) that the central fragment of PDE gamma (24-45) is responsible for binding to PDE catalytic subunits. The new data suggests that this region of PDE gamma also includes the site for phosphorylation by PKC and that phosphorylation increases the ability of PDE gamma to inhibit PDE catalytic activity. This altered regulation of visual transduction may play a role in desensitization or light adaptation.

Adolescents' perceptions of their risk-taking behavior

A questionnaire comprised of several self-report scales was administered to 440 adolescents to assess differences between high and low sports and danger risk takers on relationship and personality variables. Sports risk takers reported more danger-related risk taking and more drug use but higher self-esteem than did nonrisk takers. Danger risk takers reported greater sports-related risk taking and more drug use as well as less intimacy with their mothers, less family responsibility taking, and less depression than did their nonrisk-taking counterparts.

Identification of a binding site on retinal transducin alpha for the phosphodiesterase inhibitory gamma subunit

Transducin alpha (T alpha) activates retinal rod cyclic GMP phosphodiesterase (PDE) by interacting with and removing the inhibitory PDE gamma subunit. A T alpha-PDE gamma complex can be isolated in vitro, and our previous work [Morrison, Rider and Takemoto (1987) FEBS Lett. 222, 266-270; Morrison, Cunnick, Oppert and Takemoto (1989) J. Biol. Chem. 264, 11671-11681] has identified a region of PDE gamma, residues 24-45, that binds to T alpha. The C-terminal region of PDE gamma is the site that interacts with PDE alpha/beta and inhibits catalytic function. The site on T alpha that binds to the PDE gamma 24-45 region has not been identified. Synthetic peptides (15-mers) which span the bovine T alpha sequence were tested for binding to purified recombinant PDE gamma using a solid-phase assay. The peptides were also tested for ability to activate a PDE complex. We have identified a region, residues 250-275 of T alpha, which shows a high affinity of PDE gamma and for the PDE gamma (24-45) binding peptide. The peptide did not bind to the C-terminal residues 50-87 of PDE gamma. Likewise, a region of T alpha, 1-25 did not exhibit high-affinity binding to PDE gamma or to the 24-45 PDE gamma peptide. Specific binding of the 250-275 peptide to PDE gamma was confirmed by its ability to compete with T alpha binding to PDE gamma, although a higher concentration was required (10x). The T alpha-(250-275) peptide activated a fully inhibited PDE alpha beta gamma 2 complex in a dose-dependent manner. These results suggest that a region on T alpha that recognizes the PDE gamma-binding site is found within residues 250-275 of T alpha.

Protein kinase C in galactosemic and tolrestat-treated lens epithelial cells

Using isozyme-specific anti-peptide antisera against peptides from the alpha-, beta-, gamma-, delta-, epsilon-, and zeta-isoforms of brain protein kinase C (PKC), we have identified proteins in bovine lens epithelial cells, in culture, that were reactive with these antisera. Western blots of lens epithelial cell homogenates showed that PKC-alpha antisera reacted with a major protein, and PKC-gamma antisera reacted with a minor protein. When the lens epithelial cells were cultured in media supplemented with 40 mM galactose, to model the conditions of sugar cataracts, a decrease in PKC-gamma, but not in PKC-alpha was observed. These were normalized if the cells were cultured in 40 mM galactose media supplemented with an inhibitor of aldose reductase, Tolrestat (10 microM). These results suggest that changes in PKC isoforms occur in the galactosemic diabetic state.

Retinal cyclic-GMP phosphodiesterase gamma-subunit: identification of functional residues in the inhibitory region

Previously, we have domain-mapped the 87 amino acid PDE gamma inhibitory subunit of the retinal phosphodiesterase (PDE) alpha beta gamma 2 complex using synthetic peptides. The PDE gamma subunit has a binding domain for transducin-alpha (T alpha) and for PDE alpha/beta within residues # 24-45 and an inhibitory region for PDE alpha/beta within residues # 80-87. In order to establish the role of individual amino acids in the function of the PDE gamma inhibitory subunit, peptides of PDE gamma # 63-87 and mutant peptides were synthesized and utilized in PDE inhibition assays. The following peptides exhibited a decreased ability to inhibit PDE alpha/beta: All were from PDE gamma # 63-87; PDE gamma Tyr 84----Gly, PDE gamma Phe 73----Gly and PDE gamma Gln 83----Gly.

Retinal cyclic-GMP phosphodiesterase gamma-subunit: use of mutant synthetic peptides to define function

Previously, we have domain-mapped the 87 amino acid PDE gamma inhibitory subunit of the retinal phosphodiesterase (PDE) alpha beta gamma 2 complex using synthetic peptides (1). The PDE gamma subunit has a binding domain for transducin-alpha (T alpha) and for PDE alpha/beta within residues #24-45. An inhibitory region for PDE alpha/beta is within residues #80-87. In order to establish the role of individual amino acids in the function of the PDE gamma inhibitory subunit, mutants were synthesized and utilized in PDE inhibition assays. The following mutants exhibited a decreased ability to inhibit PDE alpha/beta: Tyr84----Gly; Arg24----Gly; and Arg33----Pro. Sequence comparisons with cone PDE gamma indicate that there is identity within these functional regions.

Fibrinopeptide A reactive peptides and procoagulant activity in bronchoalveolar lavage: relationship to rheumatoid interstitial lung disease

Extravascular, primarily, alveolar fibrin deposition is commonly associated with the alveolitis of many interstitial lung diseases including the interstitial lung disease associated with rheumatoid arthritis (RA). We therefore hypothesized that coagulation pathways, which promote fibrin formation, would be activated in the alveolar lining fluids of patients with rheumatoid interstitial lung disease. To test this hypothesis, we studied the bronchoalveolar lavage (BAL) fluids from patients with rheumatoid interstitial lung disease (n = 7) and patients with RA unassociated with interstitial lung disease (n = 10) to characterize and quantitatively compare the BAL procoagulant material and levels of fibrinopeptide A (FPA), which is cleaved from fibrinogen by thrombin. FPA reactive peptide concentrations were significantly greater in rheumatoid interstitial lung disease than RA when normalized per ml of concentrated BAL fluid (p = 0.02), per mg BAL total protein (p = 0.01) or BAL albumin content (p = 0.03) and correlated with BAL antigenic neutrophil elastase concentrations (r = 0.87). Procoagulant activity was present in similar concentration of BAL of patients with RA and rheumatoid interstitial lung disease and was mainly attributable to tissue factor associated with factor VII (or VIIa). Our results demonstrate that tissue factor and factor VII are endogenous in the alveoli of subjects with RA and interstitial lung disease and could interact with distal coagulation substrates which may enter the alveoli in interstitial lung disease to locally promote fibrin deposition.(ABSTRACT TRUNCATED AT 250 WORDS)

Procoagulant activity in bronchoalveolar lavage in the adult respiratory distress syndrome. Contribution of tissue factor associated with factor VII

Alveolar fibrin deposition commonly occurs in the lungs of patients with the adult respiratory distress syndrome (ARDS). Bronchoalveolar lavage (BAL) from patients with ARDS, control patients with interstitial lung disease (ILD), congestive heart failure, or exposure to hyperoxia, and normal healthy subjects was studied to determine whether local alterations in procoagulant activity favor alveolar fibrin deposition in the lungs in ARDS. Procoagulant activity capable of shortening the recalcification time of plasma deficient in either factor VII or factor VIII was observed in unconcentrated BAL of all patients, but was significantly greater in BAL from patients with ARDS when compared with that of control subjects (p less than 0.001). Unconcentrated BAL from patients with ARDS shortened the recalcification time of plasma deficient in factor X, but no functional thrombin was detectable. BAL procoagulant from patients with ARDS was inhibited by concanavalin A, an inhibitor of tissue factor. The hydrolysis of purified human factor X by BAL from the ARDS and other patient groups was determined by measuring the amidolytic activity of generated factor Xa on its N-benzoyl-L-isoleucyl-L-glutamyl-glycyl-L-arginine-p-nitroanilide substrate. The procoagulant activity of BAL was associated with the development of amidolytic activity, indicating activation of factor X. BAL from patients with ARDS contained more factor X activating activity than did BAL from control groups (p less than 0.001). This activity was calcium dependent and was maximal at 1 mM ionized calcium. The BAL factor X activating activity was most active at neutral pH and was sedimented by ultracentrifugation at 100,000 x g.(ABSTRACT TRUNCATED AT 250 WORDS)

Rhinoentomophthoromycosis: report of the first two cases observed in Costa Rica (Central America), and review of the literature

The first two cases of rhinoentomophthoromycosis to be recognized in Costa Rica are reported. The first patient was a 32-year-old Caucasian male from the Pacific Coast, and the second, a 17-year-old Negro male from the Atlantic Coast. Both cases showed the typical involvement of the nasofacial skin with the formation of subcutaneous nodules. One patient also showed left maxillary sinus involvement. Both patients were in general good health, without any associated disease. Cultures from the second patient, taken from the glabellar nodule, were positive for Conidiobolus coronatus. These two cases represent the first documentation of this uncommon mycosis in Central America.