Cyanobacteria use micro-optics to sense light direction.
Bacterial phototaxis was first recognized over a century ago, but the method by which such small cells can sense the direction of illumination has remained puzzling. The unicellular cyanobacterium Synechocystis sp. PCC 6803 moves with Type IV pili and measures light intensity and color with a range of photoreceptors. Here, we show that individual Synechocystis cells do not respond to a spatiotemporal gradient in light intensity, but rather they directly and accurately sense the position of a light source. We show that directional light sensing is possible because Synechocystis cells act as spherical microlenses, allowing the cell to see a light source and move towards it. A high-resolution image of the light source is focused on the edge of the cell opposite to the source, triggering movement away from the focused spot. Spherical cyanobacteria are probably the world's smallest and oldest example of a camera eye.


Microvessel density, endothelial-cell proliferation and carbonic anhydrase IX expression in haematological malignancies, bone-marrow metastases and monoclonal gammopathy of undetermined significance.
The aim of the study was to compare the angiogenic status, potential qualitative differences in microvessels and carbonic anhydrase IX expression in bone-marrow (BM) metastases and different haematological tumours at time of diagnosis. The microvessel density (MVD), endothelial-cell proliferation (ECP) and carbonic anhydrase IX (CA IX) immunoreactivity were determined on 210 trephine biopsies from 57 patients with multiple myeloma (MM), 13 with acute myeloid leukaemia (AML), 48 with chronic myeloproliferative syndrome (CMPS), 26 with chronic lymphocytic leukaemia (CLL), 25 with epithelial BM metastases, 18 with monoclonal gammopathy of undetermined significance (MGUS) and from a control group composed of 23 patients without haematological neoplasm. There was an increased MVD and ECP in epithelial BM metastases, MM, AML, CMPS and in a part of CLL. While an ECP greater than 0 was detected in 72% of MM, 75% of CMPS and 92% of AML, it was invariably observed (100%) in the BM metastases. The absence of ECP together with a MVD comparable with the control group in our MGUS cases supports the view that MGUS is a pre-angiogenic condition. Qualitative differences in microvessels were associated with growth patterns in MM and CLL and were observed between the different entities of CMPS. In one-third of the epithelial BM metastases, there was a focal CA IX immunoreactivity, which was never observed in the haematological diseases.


Long-range mapping of the gene for the human alpha 5(IV) collagen chain at Xq22-q23.
The X-linked kidney disorder known as Alport syndrome (AS) has been shown to be due to mutations in the gene for an alpha 5 chain of type IV collagen that maps to Xq22-23. Using overlapping cDNA clones that represent approximately 90% of this gene and pulsed-field gel electrophoresis, we have constructed a 2.4-Mb long-range restriction map around the locus. All of the cDNA clones lie within a 360-kb segment of DNA bounded by CpG islands that contain sites for the rare-cutting enzymes BssHII, MluI, NotI, NruI, SalI, and SfiI. High-resolution PFGE mapping with XhoI shows that the gene is at least 110 kb in size and is one of the largest collagen genes characterized to date. This map will prove useful in the characterization of mutations in individuals affected with AS and will also provide information as to the location of other genes in the region.


Computing Value from Quality and Quantity in Human Decision-Making.
How organisms learn the value of single stimuli through experience is well described. In many decisions, however, value estimates are computed "on the fly" by combining multiple stimulus attributes. The neural basis of this computation is poorly understood. Here we explore a common scenario in which decision-makers must combine information about quality and quantity to determine the best option. Using fMRI, we examined the neural representation of quality, quantity, and their integration into an integrated subjective value signal in humans of both genders. We found that activity within inferior frontal gyrus (IFG) correlated with offer quality, while activity in the intraparietal sulcus (IPS) specifically correlated with offer quantity. Several brain regions, including the anterior cingulate cortex (ACC), were sensitive to an interaction of quality and quantity. However, the ACC was uniquely activated by quality, quantity, and their interaction, suggesting that this region provides a substrate for flexible computation of value from both quality and quantity. Furthermore, ACC signals across subjects correlated with the strength of quality and quantity signals in IFG and IPS, respectively. ACC tracking of subjective value also correlated with choice predictability. Finally, activity in the ACC was elevated for choice trials, suggesting that ACC provides a nexus for the computation of subjective value in multiattribute decision-making.SIGNIFICANCE STATEMENT Would you prefer three apples or two oranges? Many choices we make each day require us to weigh up the quality and quantity of different outcomes. Using fMRI, we show that option quality is selectively represented in the inferior frontal gyrus, while option quantity correlates with areas of the intraparietal sulcus that have previously been associated with numerical processing. We show that information about the two is integrated into a value signal in the anterior cingulate cortex, and the fidelity of this integration predicts choice predictability. Our results demonstrate how on-the-fly value estimates are computed from multiple attributes in human value-based decision-making.


Validity and Reliability of Baseline Testing in a Standardized Environment.
The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline. Growing evidence suggests that this premise may not be accurate and a large contributor to invalid and unreliable baseline test scores may be the protocol and environment in which baseline tests are administered. This study examined the effects of a standardized environment and administration protocol on the reliability and performance validity of athletes' baseline test scores on ImPACT by comparing scores obtained in two different group-testing settings. Three hundred-sixty one Division 1 cohort-matched collegiate athletes' baseline data were assessed using a variety of indicators of potential performance invalidity; internal reliability was also examined. Thirty-one to thirty-nine percent of the baseline cases had at least one indicator of low performance validity, but there were no significant differences in validity indicators based on environment in which the testing was conducted. Internal consistency reliability scores were in the acceptable to good range, with no significant differences between administration conditions. These results suggest that athletes may be reliably performing at levels lower than their best effort would produce.


Texture analysis microscopy: quantifying structure in low-fidelity images of dense fluids.
Optical images are often corrupted by noise, low contrast, uneven illumination and artefacts, which may pose significant challenges to image analysis, particularly for dense fluids. Traditionally, noise removal and contrast enhancement are achieved by global arithmetic operations on the image as a whole, and/or by image convolution with various kernels. However, these methods work under very limited conditions and can compromise detail within the image. Here, we develop a new technique, texture analysis microscopy (TAM), to overcome these challenges based on the method of image correlation. TAM recasts an image by the statistical similarities between a raw image and a template feature (e.g. a Gaussian) that best approximates features in the image. We demonstrate the superiority of TAM by applying it to low-fidelity images under conditions where traditional methods fail or have deteriorative performance, for analyses including structural correlations, particle identification and sizing.


Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan.
Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan. Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated. The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality. Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.


The 17-gene ethanolamine (eut) operon of Salmonella typhimurium encodes five homologues of carboxysome shell proteins.
The eut operon of Salmonella typhimurium encodes proteins involved in the cobalamin-dependent degradation of ethanolamine. Previous genetic analysis revealed six eut genes that are needed for aerobic use of ethanolamine; one (eutR), encodes a positive regulator which mediates induction of the operon by vitamin B12 plus ethanolamine. The DNA sequence of the eut operon included 17 genes, suggesting a more complex pathway than that revealed genetically. We have correlated an open reading frame in the sequence with each of the previously identified genes. Nonpolar insertion and deletion mutations made with the Tn10-derived transposable element T-POP showed that at least 10 of the 11 previously undetected eut genes have no Eut phenotype under the conditions tested. Of the dispensable eut genes, five encode apparent homologues of proteins that serve (in other organisms) as shell proteins of the carboxysome. This bacterial organelle, found in photosynthetic and sulfur-oxidizing bacteria, may contribute to CO2 fixation by concentrating CO2 and excluding oxygen. The presence of these homologues in the eut operon of Salmonella suggests that CO2 fixation may be a feature of ethanolamine catabolism in Salmonella.


Late Pleistocene human skeleton and mtDNA link Paleoamericans and modern Native Americans.
Because of differences in craniofacial morphology and dentition between the earliest American skeletons and modern Native Americans, separate origins have been postulated for them, despite genetic evidence to the contrary. We describe a near-complete human skeleton with an intact cranium and preserved DNA found with extinct fauna in a submerged cave on Mexico's Yucatan Peninsula. This skeleton dates to between 13,000 and 12,000 calendar years ago and has Paleoamerican craniofacial characteristics and a Beringian-derived mitochondrial DNA (mtDNA) haplogroup (D1). Thus, the differences between Paleoamericans and Native Americans probably resulted from in situ evolution rather than separate ancestry.


The enhancing effects of Biobran/MGN-3, an arabinoxylan rice bran, on healthy old adults' health-related quality of life: a randomized, double-blind, placebo-controlled clinical trial.
The world's older population is growing rapidly and the need to find measures to combat age-associated decline of physical, mental, and cognitive functions and improve their health-related quality of life (HRQOL) is escalating. Biobran/MGN-3, an arabinoxylan rice bran, has been previously reported to improve the quality of life in cancer patients. The objective of the current study was to examine the effect of a low dose of Biobran/MGN-3 supplementation on the HRQOL in a healthy older adult population. Sixty apparently healthy subjects, 40 males and 20 females, over 56 years old were recruited and blindly randomized into two group receiving either placebo or Biobran/MGN-3 (250 mg/day for 3 months). Participants did not take any vitamins or medications during the study and their health was closely monitored. HRQOL was assessed at the initiation and termination of the study using the previously validated Arabic version of SF-12v2 questionnaire. For all measured HRQOL domains, there was no statistically significant difference in baseline scores between the two groups. Compared to baseline values and placebo-treated subjects, Biobran/MGN-3 supplementation significantly enhanced the levels of physical and mental component summary scores as well as role-physical, bodily pain, vitality, and social functioning subdomain scores. These results show that Biobran/MGN-3 is a promising psychoneuroimmune modulatory agent that could improve the HRQOL in healthy old adults.


Models of respiratory rhythm generation in the pre-Bötzinger complex. II. Populations Of coupled pacemaker neurons.
We have proposed models for the ionic basis of oscillatory bursting of respiratory pacemaker neurons in the pre-Bötzinger complex. In this paper, we investigate the frequency control and synchronization of these model neurons when coupled by excitatory amino-acid-mediated synapses and controlled by convergent synaptic inputs modeled as tonic excitation. Simulations of pairs of identical cells reveal that increasing tonic excitation increases the frequency of synchronous bursting, while increasing the strength of excitatory coupling between the neurons decreases the frequency of synchronous bursting. Low levels of coupling extend the range of values of tonic excitation where synchronous bursting is found. Simulations of a heterogeneous population of 50-500 bursting neurons reveal coupling effects similar to those found experimentally in vitro: coupling increases the mean burst duration and decreases the mean burst frequency. Burst synchronization occurred over a wide range of intrinsic frequencies (0.1-1 Hz) and even in populations where as few as 10% of the cells were intrinsically bursting. Weak coupling, extreme parameter heterogeneity, and low levels of depolarizing input could contribute to the desynchronization of the population and give rise to quasiperiodic states. The introduction of sparse coupling did not affect the burst synchrony, although it did make the interburst intervals more irregular from cycle to cycle. At a population level, both parameter heterogeneity and excitatory coupling synergistically combine to increase the dynamic input range: robust synchronous bursting persisted across a much greater range of parameter space (in terms of mean depolarizing input) than that of a single model cell. This extended dynamic range for the bursting cell population indicates that cellular heterogeneity is functionally advantageous. Our modeled system accounts for the range of intrinsic frequencies and spiking patterns of inspiratory (I) bursting cells found in the pre-Bötzinger complex in neonatal rat brain stem slices in vitro. There is a temporal dispersion in the spiking onset times of neurons in the population, predicted to be due to heterogeneity in intrinsic neuronal properties, with neurons starting to spike before (pre-I), with (I), or after (late-I) the onset of the population burst. Experimental tests for a number of the model's predictions are proposed.


Methods and Challenges in a Cohort Study of Infants and Toddlers With Craniofacial Microsomia: The Clock Study.
The Craniofacial microsomia: Longitudinal Outcomes in Children pre-Kindergarten (CLOCK) study is a longitudinal cohort study of neurobehavioral outcomes in infants and toddlers with craniofacial microsomia (CFM). In this article, we review the data collection and methods used to characterize this complex condition and describe the demographic and clinical characteristics of the cohort. Craniofacial and otolaryngology clinics at 5 study sites. Infants with CFM and unaffected infants (controls) ages 12 to 24 months were recruited from the same geographical regions and followed to age 36 to 48 months. Phenotypic, neurodevelopmental, and facial expression assessments were completed during the first and third waves of data collection (time 1 and time 3, respectively). Medical history data were taken at both of these time points and during an intermediate parent phone interview (time 2). Our cohort includes 108 cases and 84 controls. Most cases and controls identified as white and 55% of cases and 37% of controls identified as Hispanic. Nearly all cases had microtia (95%) and 59% had mandibular hypoplasia. Cases received extensive clinical care in infancy, with 59% receiving care in a craniofacial clinic and 28% experiencing at least one surgery. Study visits were completed at a study site (92%) or at the participant's home (8%). The CLOCK study represents an effort to overcome the challenges of characterizing the phenotypic and neurodevelopmental outcomes of CFM in a large, demographically and geographically diverse cohort.


Concentration of latanoprost ophthalmic solution after 4 to 6 weeks' use in an eye clinic setting.
To determine the concentration of latanoprost in bottles of latanoprost ophthalmic solution 0.005% after 4 or 6 weeks of use in patients in an eye clinic setting. Patients treated with latanoprost for open-angle glaucoma or ocular hypertension were randomly assigned to refill their prescriptions either at the Doheny Eye Institute clinic or a local pharmacy. Patients who used latanoprost binocularly were asked to return bottles to the clinic after 4 weeks of use and nonrefrigerated storage, and those who used latanoprost monocularly were asked to return used bottles after 6 weeks. Patients were then interviewed to determine bottle storage information and doses missed. Latanoprost concentration in residual solution was analyzed in a masked fashion, by reversed-phase high-performance liquid chromatography (HPLC). In all, 110 patients were enrolled and 89 returned their bottles. Sixty-nine bottles had sufficient residual volume to conduct HPLC analysis. All patients reported that bottles were stored at room temperature (average high from 70-95 degrees F during the daytime). The mean +/- SD latanoprost concentration measured in the residual solutions was 48.31 +/- 2.31 microg/mL. Ninety-four percent of the bottles had concentrations within 90% to 110% of the labeled amount. No difference in latanoprost concentrations was found between the bottles used for 4 weeks versus those used for 6 weeks. In an eye clinic setting, latanoprost ophthalmic solution 0.005% remains stable after 4 or 6 weeks of patient use from the same bottle when stored at room temperature.


Total knee arthroplasty of the stiff knee: three hundred and four cases.
The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness. Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction. At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17%). Pain and residual stiffness were the most common complications. TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.


Motor Control After Human SCI Through Activation of Muscle Synergies Under Spinal Cord Stimulation.
Spinal cord stimulation (SCS) has enabled motor recovery in paraplegics with motor complete spinal cord injury (SCI). However, the physiological mechanisms underlying this recovery are unknown. This paper analyzes muscle synergies in two motor complete SCI patients under SCS during standing and compares them with muscle synergies in healthy subjects, in order to help elucidate the mechanisms that enable motor control through SCS. One challenge is that standard muscle synergy extraction algorithms, such as non-negative matrix factorization (NMF), fail when applied to SCI patients under SCS. We develop a new algorithm-rShiftNMF-to extract muscle synergies in these cases. We find muscle synergies extracted by rShiftNMF are significantly better at interpreting electromyography (EMG) activity, and resulting synergy features are more physiologically meaningful. By analyzing muscle synergies from SCI patients and healthy subjects, we find that: 1) SCI patients rely significantly on muscle synergy activation to generate motor activity; 2) interleaving SCS can selectively activate an additional muscle synergy that is critical to SCI standing; and 3) muscle synergies extracted from SCI patients under SCS differ substantially from those extracted from healthy subjects. We provide evidence that after spinal cord injury, SCS influences motor function through muscle synergy activation.


Web searching for systematic reviews: a case study of reporting standards in the UK Health Technology Assessment programme.
Identifying literature for a systematic review requires searching a variety of sources. The main sources are typically bibliographic databases. Web searching using search engines and websites may be used to identify grey literature. Searches should be reported in order to ensure transparency and reproducibility. This study assesses the reporting of web searching for systematic reviews carried out by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (UK). The study also makes recommendations about reporting web searching for systematic reviews in order to achieve a reasonable level of transparency and reproducibility. Systematic reviews were identified by searching the HTA database via the Centre for Reviews and Dissemination (CRD) website. Systematic reviews were included in the study if they made reference to searching the web using either search engines or websites. A data-extraction checklist was designed to record how web searching was reported. The checklist recorded whether a systematic review reported: the names of search engines or websites; the dates they were searched; the search terms; the results of the searches; and, in the case of websites, whether a URL was reported. 554 HTA reports published between January 2004 and December 2013 were identified. 300 of these reports are systematic reviews, of which 108 report web searching using either a search engine or a website. Overall, the systematic reviews assessed in the study exhibit a low standard of web search reporting. In the majority of cases, the only details reported are the names of websites (n = 54) or search engines (n = 33). A small minority (n = 6) exhibit the highest standard of web search reporting. Most web search reporting in systematic reviews carried out on the UK HTA programme is not detailed enough to ensure transparency and reproducibility. Transparency of reporting could be improved by adhering to a reporting standard such as the standard detailed in the CRD systematic reviews methods guidance. Reproducibility is harder to achieve due to the frequency of changes to websites and search engines.


Nephrops fisheries in European waters.
This review focuses on the Norway lobster (Nephrops norvegicus) as a resource, describing how the fishery has developed from the 1960s to the present day to become one of the most economically important fisheries in Europe. In 2010, the total landings were 66,500 tonnes, of which UK fishers landed a significant part (58.1%). The Nephrops fishery is also important for countries such as Ireland (11.7% of the total) and Sweden (1.9%) where it is of regional importance. Some are also taken in the Mediterranean, where Italian, Spanish and Greek fishers together take approximately 7% of the total landing. More than 95% of Nephrops are taken using single- or multi-rig trawlers targeting Nephrops or in mixed species fisheries. In regions such as Western Scotland and the Swedish West Coast, creel fisheries account for up to a quarter of the total landings. Across the range, a small proportion (<5%) is taken using traps in a fishery characterised by larger sized animals that gain a higher price and have lower discard and by-catches of ground fish with low mortalities. The trawling sector, however, is reducing the by-catches of ground fish with the aid of technical measures, such as square-mesh panels and grids and national systems of incentives. Assessments for Nephrops are operated via the 34 functional units (FUs) regarded as stocks. Changes in management procedures have arisen as a result of the advisory input from underwater TV fishery-independent stock surveys. The total allowable catch does not follow FUs but is agreed upon per management area.


Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement.
Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included "emergency surgery", "laparotomy", "surgical site infection", "midline incision" and "wound bundle". Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39-1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57-1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle's ability to potentially improve outcome after emergency laparotomy.


Differentiation of thymocytes during human ontogeny: stage-specific DNA ligase in relation to terminal deoxynucleotidyl transferase, cell size and surface antigen.
The activities of two forms (7.5 and 5.5 S) of DNA ligase and of terminal deoxynucleotidyl transferase (TdT) have been studied in human thymocytes at different ages from 20 weeks pre-natal to 37 years after birth. Thymocytes have been selected on the basis of relative size and antigenicity (CD3, OKT3 immunofluorescence) with the cell sorter. For DNA ligases, three kinds of cells can be distinguished: (i) large antigenically negative cells of 20-week fetus, expressing only the 7.5 S enzyme; (ii) large antigenically positive cells without ligase activity; (iii) smaller antigenically positive cells, expressing only the 5.5 S enzyme. This last form of enzyme is found after birth. With respect to TdT expressed in OKT3- 5 micron cells and to OKT3+ thymocytes, it is observed that 5.5 S DNA ligase is found in a thymocyte population distinct from cells expressing TdT. Therefore, these results allow us to consider the 5.5 S DNA ligase activity as an additional functional marker for thymocyte maturation in humans.


Counterfeiting of drugs in Brazil.
To identify the main counterfeit drugs seized by the Brazilian Federal Police and the states where seizures have been made. A retrospective descriptive study on expert reports produced by criminal investigators of the Federal Police between January 2007 and September 2010, in relation to counterfeit drugs, was carried out. The drugs with greatest numbers of seizures were selective phosphodiesterase-5 inhibitors that are used for treating male erectile dysfunction (Cialis® and Viagra®, mean = 66% ), followed by anabolic steroids (Durateston® and Hemogenin®: 8.9% and 5.7%, respectively). The greatest proportions of the counterfeit drugs were seized in the states of Paraná, Santa Catarina (both Southeastern Brazil) and São Paulo (Southeastern), and the number of non-authentic drugs sent for investigation increased by more than 200% over the study period. There were increases in seizures of smuggled drugs found together with counterfeit drugs: 67% of the seizures included at least one smuggled drug. Counterfeiting of drugs is a severe public health problem. Identification of the classes of counterfeit drugs present in Brazil and the main Brazilian states with this problem may facilitate future preventive and suppressive actions by the Brazilian bodies responsible for such actions.


Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array.
This work presents the design and preliminary evaluation of a new laterally mounted phased-array MRI-guided high-intensity focused ultrasound (MRgHIFU) system with an integrated 11-channel phased-array radio frequency (RF) coil intended for breast cancer treatment. The design goals for the system included the ability to treat the majority of tumor locations, to increase the MR image's signal-to-noise ratio (SNR) throughout the treatment volume and to provide adequate comfort for the patient. In order to treat the majority of the breast volume, the device was designed such that the treated breast is suspended in a 17-cm diameter treatment cylinder. A laterally shooting 1-MHz, 256-element phased-array ultrasound transducer with flexible positioning is mounted outside the treatment cylinder. This configuration achieves a reduced water volume to minimize RF coil loading effects, to position the coils closer to the breast for increased signal sensitivity, and to reduce the MR image noise associated with using water as the coupling fluid. This design uses an 11-channel phased-array RF coil that is placed on the outer surface of the cylinder surrounding the breast. Mechanical positioning of the transducer and electronic steering of the focal spot enable placement of the ultrasound focus at arbitrary locations throughout the suspended breast. The treatment platform allows the patient to lie prone in a face-down position. The system was tested for comfort with 18 normal volunteers and SNR capabilities in one normal volunteer and for heating accuracy and stability in homogeneous phantom and inhomogeneous ex vivo porcine tissue. There was a 61% increase in mean relative SNR achieved in a homogeneous phantom using the 11-channel RF coil when compared to using only a single-loop coil around the chest wall. The repeatability of the system's energy delivery in a single location was excellent, with less than 3% variability between repeated temperature measurements at the same location. The execution of a continuously sonicated, predefined 48-point, 8-min trajectory path resulted in an ablation volume of 8.17 cm(3), with one standard deviation of 0.35 cm(3) between inhomogeneous ex vivo tissue samples. Comfort testing resulted in negligible side effects for all volunteers. The initial results suggest that this new device will potentially be suitable for MRgHIFU treatment in a wide range of breast sizes and tumor locations.


Foodborne diseases do not respect borders: Zoonotic pathogens and antimicrobial resistant bacteria in food products of animal origin illegally imported into the European Union.
Globalisation, international trade and the ever-growing flow of goods and people enable animal diseases and zoonotic pathogens to travel worldwide. The risk of reintroducing previously eradicated animal diseases into the European Union is omnipresent as considerable amounts of food products of animal origin (POAO) from endemic countries are continuously imported legally and illegally into the EU. Additionally, these products may be potential vectors for emerging foodborne zoonoses, which are of public health concern due to their significant morbidity and mortality rates. This review summarises the legal background of veterinary public health measures and provides a critical overview on recent epidemiological studies, which analysed 1577 illegally imported POAO for major foodborne zoonotic pathogens and antimicrobial resistance in indicator bacteria. The samples rarely exceeded microbiological contamination levels of domestic products for Salmonella, Verotoxin-producing Escherichia coli and thermophilic Campylobacter spp. However, Listeria monocytogenes and Staphylococcus aureus were the most frequently detected pathogens in illegally imported meat and meat products (5% and 4.3%, respectively) and S. aureus in milk and milk products (7.4%). The most likely source of those zoonotic pathogens in illegally imported POAO are cross contamination and improper hygiene measures while handling, processing and storage. Moreover, uncommon and genetically distant variants including antimicrobial resistant foodborne pathogens such as methicillin-resistant S. aureus or extended-spectrum β-lactamase-producing Enterobacteriaceae were discovered. The introduction of POAO poses a largely underestimated threat, both to animal and public health.


Quality of life among boys with adrenoleukodystrophy following hematopoietic stem cell transplant.
Hematopoietic stem cell transplant (HSCT) is the only accepted treatment capable of halting the progression of X-linked cerebral adrenoleukodystrophy (CALD). While survival and neurological outcomes have been described, there is little information regarding the quality of life (QoL) of transplanted patients with CALD. This analysis is a cross-sectional study of QoL in 16 males diagnosed with CALD who underwent HSCT at a single institution. Each child or parent proxy completed subscales from the Neuro-QoL and the PROMIS Pediatric Profile Instrument representing physical, mental, and social health domains. Descriptive statistics summarized the demographic characteristics and QoL subscale T-scores, Spearman Rho correlations identified the relationships among the variables, and Mann-Whitney tests examined group differences between those with pre-HSCT Loes scores <10 and those with pre-HSCT Loes scores ≥10. The median age of respondents at the time of transplant was 8 years at HSCT (5-14) with a median of 5 years since HSCT (0.5-11). Scores from the selected QoL subscales were similar to healthy peers, though those with pre-HSCT Loes scores ≥10 had lower mobility, upper extremity function, peer interaction, and higher scores for anxiety. Although HSCT has the capability of halting progression of CALD, those with pre-HSCT Loes scores ≥10 after HSCT are at-risk for poor QoL. Longitudinal monitoring is necessary to further appreciate the factors affecting QoL among boys with CALD after HSCT, and how this may be improved.


Gestational respiratory infections interacting with offspring HLA and CTLA-4 modifies incident β-cell autoantibodies.
β-cell autoantibodies against insulin (IAA), GAD65 (GADA) and IA-2 (IA-2A) precede onset of childhood type 1 diabetes (T1D). Incidence of the first appearing β-cell autoantibodies peaks at a young age and is patterned by T1D-associated genes, suggesting an early environmental influence. Here, we tested if gestational infections and interactions with child's human leukocyte antigen (HLA) and non-HLA genes affected the appearance of the first β-cell autoantibody. Singletons of mothers without diabetes (n = 7472) with T1D-associated HLA-DR-DQ genotypes were prospectively followed quarterly through the first 4 years of life, then semiannually until age 6 years, using standardized autoantibody analyses. Maternal infections during pregnancy were assessed via questionnaire 3-4.5 months post-delivery. Polymorphisms in twelve non-HLA genes associated with the first appearing β-cell autoantibodies were included in a Cox regression analysis. IAA predominated as the first appearing β-cell autoantibody in younger children (n = 226, median age at seroconversion 1.8 years) and GADA (n = 212; 3.2 years) in children aged ≥2 years. Gestational infections were not associated with the first appearing β-cell autoantibodies overall. However, gestational respiratory infections (G-RI) showed a consistent protective influence on IAA (HR 0.64, 95% CI 0.45-0.91) among CTLA4-(AG, GG) children (G-RI*CTLA4 interaction, p = 0.002). The predominant associations of HLA-DR-DQ 4-8/8-4 with IAA and HLA-DR-DQ 3-2/3-2 with GADA were not observed if a G-RI was reported (G-RI*HLA-DR-DQ interaction, p = 0.03). The role of G-RI may depend on offspring HLA and CTLA-4 alleles and supports a bidirectional trigger for IAA or GADA as a first appearing β-cell autoantibody in early life.


A left cerebral hemisphere's superiority in processing spatial-categorical information in a non-verbal semantic format.
It has been shown that the left and right cerebral hemispheres (LH and RH) respectively process qualitative or "categorical" spatial relations and metric or "coordinate" spatial relations. However, categorical spatial information could be thought as divided into two types: semantically-coded and visuospatially-coded categorical information. We examined whether a LH's advantage in processing semantic-categorical information is observed in a non-verbal format, and also whether semantic- and visuospatial-categorical processing are differentially lateralized. We manipulated the colors and positions of the standard traffic light sign as semantic- and visuospatial-categorical information respectively, and tested performance with the divided visual field method. In the semantic-categorical matching task, in which the participants judged if the semantic-categorical information of a successive cue and target was the same, a right visual field advantage was observed, suggesting a LH's preference for processing semantic-categorical information in a non-verbal format. In the visuospatial-categorical matching task, in which the participants judged if the visuospatial-categorical information of a successive cue and target was identical, a left visual field advantage was obtained. These results suggest that the processing of semantic-categorical information is lateralized in LH, and we discuss the dissociation between the two types of categorical information.


Vascular Calcification Markers and Hemodialysis Vascular Access Complications.
Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10-0.94]) for fetuin-A, 3.84 (95% CI 1.16-12.74) for OPN, and 3.49 (95% CI 1.16-10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11-58.57 for OPN and aHR 2.55; 95% CI 1.08-6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.


Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study.
Anorexia nervosa is difficult to treat and no treatment is supported by robust evidence. As it is uncommon, it has been recommended that new treatments should undergo extensive preliminary testing before being evaluated in randomized controlled trials. The aim of the present study was to establish the immediate and longer-term outcome following "enhanced" cognitive behaviour therapy (CBT-E). Ninety-nine adult patients with marked anorexia nervosa (body mass index ≤ 17.5) were recruited from consecutive referrals to clinics in the UK and Italy. Each was offered 40 sessions of CBT-E over 40 weeks with no concurrent treatment. Sixty-four percent of the patients were able to complete this outpatient treatment and in these patients there was a substantial increase in weight (7.47 kg, SD 4.93) and BMI (2.77, SD 1.81). Eating disorder features also improved markedly. Over the 60-week follow-up period there was little deterioration despite minimal additional treatment. These findings provide strong preliminary support for this use of CBT-E and justify its further evaluation in randomized controlled trials. As CBT-E has already been established as a treatment for bulimia nervosa and eating disorder not otherwise specified, the findings also confirm that CBT-E is transdiagnostic in its scope.


[The Impact of Prices and Taxes on the Use of Tobacco Products in Latin America and the Caribbean].
We examined the impact of tobacco prices or taxes on tobacco use in Latin America and Caribbean countries. We searched MEDLINE, EconLit, LILACS, unpublished literature, 6 specialty journals, and reviewed references. We calculated pooled price elasticities using random-effects models. The 32 studies we examined found that cigarette prices have a negative and statistically significant effect on cigarette consumption. A change in price is associated with a less than proportional change in the quantity of cigarettes demanded. In most Latin American countries, own-price elasticity for cigarettes is likely below -0.5 (pooled elasticities, shortrun: -0.31; 95% confidence interval = -0.39, -0.24; longrun: -0.43; 95% CI = -0.51, -0.35). Tax increases effectively reduce cigarette use. Lack of studies using household- or individual-level data limits research's policy relevance.


Amino acid substitution(s) in the stem-anchor region of langat virus envelope protein attenuates mouse neurovirulence.
The identification of variants that are unable to bind membrane receptor preparations (MRPs) has previously been shown to select attenuated yellow fever and Japanese encephalitis viruses. In this study, this methodology has been extended to the tick-borne serocomplex of flaviviruses. Langat (LGT) virus strain TP21 was bound to mouse or human brain MRPs and viruses that escaped binding were isolated and characterized. In addition, variant viruses escaping neutralization by the monoclonal antibody (MAb) 9F9 were also isolated. All of the variant viruses were attenuated for mouse neurovirulence (> or =13-fold). Sequence analysis of the prM/E region of the variant viruses identified mutations within the stem-anchor region of the E protein in variants isolated following incubation with mouse or human brain MRPs at a pH > or = 7.0. The MAb 9F9 variants and MRP variants isolated at pH 5.0, which should induce a conformational shift in the viral E protein, had nearly identical mutations in the prM/M protein immediately N-terminal to the prM/E cleavage site. MAb 9F9 neutralized none of the variant viruses and hemagglutination inhibition assays suggest that the variant virus surface proteins have slightly different conformations compared to the parental virus. These data support previous work indicating that the stem-anchor region of the E protein is important to the surface architecture of the tick-borne flaviviruses. In addition, this study demonstrates that the M protein is at least partially solvent accessible on the virion surface and that the M protein plays a role in maintaining the conformation of the M/E surface complex.


Event-related potentials and recognition memory for low- and high-frequency words.
Event-related potentials (ERPs) were recorded while subjects made recognition judgments on high- and low-frequency words, half of which had previously been presented in an incidental study task. Compared to high-frequency items, low-frequency words were associated with superior recognition performance, and attracted a higher proportion of confident judgments. In the case of the low-frequency words only, the region of the ERPs post-500 msec evoked by correctly classified, previously studied (old) words was more positive-going than was the same region of the EWs to nonstudied (new) words. These "old/new" ERP differences were larger from electrodes over the left than over the right hemisphere. This old/new by frequency interaction held when EWs were formed only from words that attracted confident judgments. It is argued that these data are consistent with the ideas that (1) post-500 msec "old/ new" EW differences in recognition memory tasks reflect differences in old and new words' levels of relative familiarity, and (2) the recognition memory advantage for low-frequency words results, at least in part, from the higher level of relative familiarity engendered at test by previously studied low-frequency items. The data are interpreted as providing support for "two-process" models of recognition memory.


Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design.
Given that the etiology of chronic fatigue syndrome (CFS) is believed to be multidimensional, interventions generally have been nonspecific and typically produce only mild to moderate effects. In medical practice, treatment for CFS remains largely symptomatic. Preliminary evidence of the efficacy of acupuncture for CFS is available, but the field has lacked high-quality trials. The research team conducted the study to determine the efficacy of acupuncture for CFS. A two-arm, randomized, controlled, singleblinded design was adopted. The study took place in a teaching laboratory at the School of Chinese Medicine at the University of Hong Kong, Hong Kong, China. Recruited through press publicity in Hong Kong, 127 individuals--40 men and 87 women--participated in the study. Intervention Through careful implementation of sham acupuncture in the control group (CG), the study blinded all participants with regard to their experimental or control status. The treatment regime was 2 sessions/wk for 4 consecutive wk. Measures of fatigue (Chalder's Fatigue Scale), health-related quality of life (SF-12), and general mental health (GH Q-12) were taken at baseline and upon completion of treatment. Ninety-nine participants completed the interventions, with 50 and 49 participants in the experimental group (EG) and CG respectively. Repeated measures ANOVA revealed a significant decrease in physical (F(1,93) = 4.327; P = .040) and mental fatigue (F(1,96) = 10.451; P = .002) and improvement in the physical component score of SF-12 (F(1,93) = 4.774; P = .031). Considerable effects with Cohen's d were observed in the sham-control group: 0.92, 0.78, and 0.38 for the three scores, respectively. These positive effects could have included some therapeutic effects due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects. The EG showed moderate net effect sizes with Cohen's d: 0.52, 0.63, and 0.54 for the three outcome measures, respectively. Despite considerable positive effects for the CG, the EG demonstrated significant net-effect sizes at a moderate magnitude in physical and mental fatigue and in the physical component of health-related quality of life. The impacts on general mental health outcomes appeared to be smaller.


The feeding mechanism of avian malarial parasites.
Electron microscope studies of the erythrocytic forms, including gametocytes and asexual schizonts, of the protozoa Plasmodium fallax, P. lophurae, and P. cathemerium, have revealed a "cytostome," a specialized organelle of the pellicular membrane which is active in the ingestion of host cell cytoplasm. In material fixed in glutaraldehyde and postfixed in OsO(4), the cytostome appears in face view as a pore limited by two dense circular membranes and having an inside diameter of approximately 190 mmicro. In cross-section, the cytostome is a cavity bounded on each side by two dense segments corresponding to the two dense circles observed in face view; its base consists of a single unit membrane. In the process of feeding, the cytostome cavity enlarges by expansion of its membrane, permitting a large quantity of red cell cytoplasm to come into contact with the cytostome wall. Subsequent digestion of erythrocyte cytoplasm occurs exclusively in food vacuoles which emanate from the cytostome invagination. As digestion progresses, the food vacuoles initially stain more densely and there is a marked build-up of hemozoin granules. In the final stage of digestion, a single membrane surrounds a cluster of residual pigment particles and very little of the original host cell cytoplasm remains. The cytostome in exoerythrocytic stages of P. fallax has been observed only in merozoites and does not seem to play the same role in the feeding mechanism.


Spatial spread of COVID-19 outbreak in Italy using multiscale kinetic transport equations with uncertainty.
In this paper we introduce a space-dependent multiscale model to describe the spatial spread of an infectious disease under uncertain data with particular interest in simulating the onset of the COVID-19 epidemic in Italy. While virus transmission is ruled by a SEIAR type compartmental model, within our approach the population is given by a sum of commuters moving on a extra-urban scale and non commuters interacting only on the smaller urban scale. A transport dynamics of the commuter population at large spatial scales, based on kinetic equations, is coupled with a diffusion model for non commuters at the urban scale. Thanks to a suitable scaling limit, the kinetic transport model used to describe the dynamics of commuters, within a given urban area coincides with the diffusion equations that characterize the movement of non-commuting individuals. Because of the high uncertainty in the data reported in the early phase of the epidemic, the presence of random inputs in both the initial data and the epidemic parameters is included in the model. A robust numerical method is designed to deal with the presence of multiple scales and the uncertainty quantification process. In our simulations, we considered a realistic geographical domain, describing the Lombardy region, in which the size of the cities, the number of infected individuals, the average number of daily commuters moving from one city to another, and the epidemic aspects are taken into account through a calibration of the model parameters based on the actual available data. The results show that the model is able to describe correctly the main features of the spatial expansion of the first wave of COVID-19 in northern Italy.


Macrophage-tropic variants initiate human immunodeficiency virus type 1 infection after sexual, parenteral, and vertical transmission.
Macrophage-tropic, non-syncytium-inducing, HIV-1 variants predominate in the asymptomatic phase of infection and may be responsible for establishing infection in an individual exposed to the mixture of HIV-1 variants. Here, genotypical and phenotypical characteristics of virus populations, present in sexual, parenteral, or vertical donor-recipient pairs, were studied. Sequence analysis of the V3 domain confirmed the presence of a homogeneous virus population in recently infected individuals. Biological HIV-1 clones were further characterized for syncytium inducing capacity on the MT2 cell line and for macrophage tropism as defined by the appearance of proviral DNA upon inoculation of monocyte-derived macrophages. Both sexual and parenteral transmission cases revealed a selective outgrowth in the recipient of the most macrophage-tropic variant(s) present in the donor. In three out of five vertical transmission cases, more than one highly macrophage-tropic virus variant was present in the child shortly after birth, suggestive of transmission of multiple variants. In three primary infection cases, homogeneous virus populations of macrophage-tropic, non-syncytium-inducing variants were present prior to seroconversion, thus excluding humoral immunity as the selective pressure in favour of macrophage-tropic variants. These observations may have important implications for vaccine development.


Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study.
Artificial sweeteners are widely replacing caloric sweeteners. Data on long-term impact of artificially sweetened beverage (ASB) consumption during pregnancy on offspring obesity risk are lacking. We prospectively investigated intake of ASBs and sugar-sweetened beverages (SSBs) during pregnancy in relation to offspring growth through age 7 years among high-risk children born to women with gestational diabetes. In a prospective study of 918 mother-singleton child dyads from the Danish National Birth Cohort, maternal dietary intake was assessed by a food frequency questionnaire during pregnancy. Offspring body mass index z-scores (BMIZ) and overweight/obesity status were derived using weight and length/height at birth, 5 and 12 months and 7 years. Linear regression and Poisson regression with robust standard errors were used, adjusting for major risk factors. Approximately half of women reported consuming ASBs during pregnancy and 9% consumed daily. Compared to never consumption, daily ASB intake during pregnancy was positively associated with offspring large-for-gestational age [adjusted relative risk (aRR) 1.57; 95% CI: 1.05, 2.35 at birth], BMIZ (adjusted β 0.59; 95% CI: 0.23, 0.96) and overweight/obesity (aRR 1.93; 95% CI; 1.24, 3.01) at 7 years. Per-serving-per-day substitution of ASBs with water during pregnancy was related to a lower overweight/obesity risk at 7 years (aRR 0.83; 95% CI: 0.76, 0.91), whereas SSB substitution with ASBs was not related to a lower risk (aRR 1.14; 95% CI: 1.00, 1.31). Our findings illustrated positive associations between intrauterine exposure to ASBs and birth size and risk of overweight/obesity at 7 years. Data with longer follow-up are warranted.


Associations between tumor necrosis factor-α polymorphisms and susceptibility to pulmonary tuberculosis: meta-analysis.
The aim of this study was to determine whether tumor necrosis factor-α (TNF-α) polymorphisms are associated with susceptibility to pulmonary tuberculosis (PTB) in different ethnic populations. MEDLINE and Embase databases and manual searches were employed to identify articles in which TNF-α polymorphisms were determined in patients with PTB and controls. A meta-analysis was conducted on the associations of the TNF-α -308A/G, -238A/G, and -857T/C polymorphisms with PTB susceptibility. A total of 13 studies met the inclusion criteria, including 12, 6, and 4 studies on TNF-α -308A/G, -238A/G, and -857T/C polymorphisms, respectively. Meta-analysis showed no association between the TNF-α -308A allele and PTB susceptibility in all study subjects (odds ratio, OR = 1.182, 95%CI = 0.989-1.411, P = 0.066). After stratification by ethnicity, TNF-α -308A was not found to be associated with PTB in the European, Asian, or Middle East populations. No association was identified between PTB susceptibility and the TNF-α -238A allele in all study subjects (OR = 1.031, 95%CI = 0.741-1.436, P = 0.855), or in the European and Asian populations. However, TNF-α -857T was significantly associated with PTB susceptibility specifically in Asians (OR = 0.682, 95%CI = 0.550-0.846, P = 4.8 x 10(-5)). Meta-analysis using the dominant model, recessive model, or homozygote contrast showed the same pattern of results as for the TNF-α -857T allele. Overall, no correlation was noted between the TNF-α -308A/G and -238A/G polymorphisms and PTB susceptibility. However, the TNF-α -857T/C polymorphism was found to be associated with PTB susceptibility in the Asian population.


Environmental Burkholderia cepacia strain Cs5 acting by two analogous alkyl-quinolones and a didecyl-phthalate against a broad spectrum of phytopathogens fungi.
An environmental Burkholderia cepacia strain named Cs5 was isolated and identified first using API biochemical identification system and then with 16S rDNA and recA sequence homology search. This bacterium exhibited a broad spectrum of fungicidal activities against Alternaria alternata, Aspergillus niger, Fusarium culmorum, F. graminearum, F. oxysporum and Rhizoctonia solani. In the liquid conditions, the MIC of A. niger and R. solani were reached with, respectively, 1.25-2% of the Cs5 liquid culture supernatant. However, in the solid conditions, the same inhibition was caused in the presence of 3% of the Cs5 supernatant. The exhibition of these two fungi at low concentrations of supernatant Cs5 caused various morphological changes of their mycelia which were observed by confocal microscopy. Three antifungal compounds, named Cs5-255, Cs5-257 and Cs5-446, were purified from the Cs5 culture. The structural analysis of these molecules showed that Cs5-255 and Cs5-257 are analogous and belonged to the alkyl-quinolone family, while Cs5-446 was a didecyl-phthalate, isolated for the first time from a bacterium.


CD8(+) T cells can block herpes simplex virus type 1 (HSV-1) reactivation from latency in sensory neurons.
Recurrent herpes simplex virus type 1 (HSV-1) disease usually results from reactivation of latent virus in sensory neurons and transmission to peripheral sites. Therefore, defining the mechanisms that maintain HSV-1 in a latent state in sensory neurons may provide new approaches to reducing susceptibility to recurrent herpetic disease. After primary HSV-1 corneal infection, CD8(+) T cells infiltrate the trigeminal ganglia (TGs) of mice, and are retained in latently infected ganglia. Here we demonstrate that CD8(+) T cells that are present in the TGs at the time of excision can maintain HSV-1 in a latent state in sensory neurons in ex vivo TG cultures. Latently infected neurons expressed viral genome and some expressed HSV-1 immediate early and early proteins, but did not produce HSV-1 late proteins or infectious virions. Addition of anti-CD8alpha monoclonal antibody 5 d after culture initiation induced HSV-1 reactivation, as demonstrated by production of viral late proteins and infectious virions. Thus, CD8(+) T cells can prevent HSV-1 reactivation without destroying the infected neurons. We propose that when the intrinsic capacity of neurons to inhibit HSV-1 reactivation from latency is compromised, production of HSV-1 immediate early and early proteins might activate CD8(+) T cells aborting virion production.


The mechanism of aqueous humour formation.
Aqueous humour (AH) is an important intraocular fluid responsible for the supply of nutrients to and removal of metabolic wastes from the avascular tissues of the eye. It is also indispensable for the maintenance of the optical properties of the eye. The fluid dynamics of AH are frequently associated with the potentially blinding disease called glaucoma. Pharmacological treatment of glaucoma generally aims to lower the intraocular pressure by reducing AH formation. However, the mechanism underlying the formation of AH is still not well understood. Understanding the mechanism of AH formation and its regulation is paramount to develop rational and target specific drugs for the treatment of glaucoma. It is now generally believed that AH is formed mostly by active transport of ions and solutes across the ciliary epithelium. Many studies have been carried out in the past half a century to understand these transport processes. In the past several years, new information has emerged and a comprehensive review of these new developments is necessary. This review covers the ion transports in the ciliary epithelium, including the possible roles of sodium, chloride and bicarbonate ions as the driving forces. It also examines the current ionic models for AH formation and its regulation from a cellular transport perspective.


Metabolic Engineering of Microalgal Based Biofuel Production: Prospects and Challenges.
The current scenario in renewable energy is focused on development of alternate and sustainable energy sources, amongst which microalgae stands as one of the promising feedstock for biofuel production. It is well known that microalgae generate much larger amounts of biofuels in a shorter time than other sources based on plant seeds. However, the greatest challenge in a transition to algae-based biofuel production is the various other complications involved in microalgal cultivation, its harvesting, concentration, drying and lipid extraction. Several green microalgae accumulate lipids, especially triacylglycerols (TAGs), which are main precursors in the production of lipid. The various aspects on metabolic pathway analysis of an oleaginous microalgae i.e., Chlamydomonas reinhardtii have elucidated some novel metabolically important genes and this enhances the lipid production in this microalgae. Adding to it, various other aspects in metabolic engineering using OptFlux and effectual bioprocess design also gives an interactive snapshot of enhancing lipid production which ultimately improvises the oil yield. This article reviews the current status of microalgal based technologies for biofuel production, bioreactor process design, flux analysis and it also provides various strategies to increase lipids accumulation via metabolic engineering.


Development of genipin-crosslinked and fucoidan-adsorbed nano-hydroxyapatite/hydroxypropyl chitosan composite scaffolds for bone tissue engineering.
Hydroxypropyl chitosan (HPCS) has recently attracted increasing attention in biomedical applications because it has enhanced water solubility, excellent biocompatibility, and better antioxidant and antibacterial activities compared with chitosan. However, HPCS doesn't meet the mechanical strength requirement in bone tissue engineering and is not suitable for cell adhesion and growth because of its hydrophilic nature and low crystallinity. In this study, nano-scaled hydroxyapatite (n-HA) and HPCS were synthesized, respectively, and then n-HA/HPCS nanocomposite scaffolds were developed by incorporating n-HA into HPCS matrix accompanied with crosslinking of HPCS by a naturally occurring compound, genipin (GP), which in turn greatly altered the hydrophilicity and mechanical properties. The nanocomposite scaffolds showed an open structure with interconnected pores and a rough morphology with n-HA inserted in the GP-crosslinked HPCS matrix. The porosity, swelling capacity, compressive strength, fluorescence emission and degradation rate can be regulated by varying GP concentrations and n-HA contents. An osteoconductive and osteogenic marine algae polysaccharide, fucoidan, was further adsorbed to the composite scaffolds via electrostatic interactions. Incorporation of n-HA and adsorption of FD into the composite scaffolds increased ALP activity in 7F2 osteoblast cells and promoted their mineralization. The FD-adsorbed n-HA/HPCS composite scaffolds can be a potential biomaterial for BTE applications.


A canine model of human alpha-L-iduronidase deficiency.
A disease discovered in three Plott Hound littermates was found to be associated with a profound and specific deficiency of alpha-L-iduronidase (mucopolysaccharide alpha-L-iduronohydrolase; EC 188.8.131.52) in fibroblasts and leukocytes. The pedigree was consistent with autosomal recessive inheritance. A markedly increased amount of dermatan sulfate and heparan sulfate was excreted in urine. Fibroblasts cultured from the skin of the affected dogs accumulated excessive 35S-labeled mucopolysaccharide; this accumulation could be decreased to a normal level by exogenous human high-uptake alpha-L-iduronidase (Hurler corrective factor) as well as by secretions of normal human or canine fibroblasts. The correction was inhibited by mannose 6-phosphate. Maturation of alpha-L-iduronidase in normal canine fibroblasts followed the pathway previously observed in human fibroblasts; no cross-reactive material was observed in the cells or in secretions from the fibroblasts of the affected dogs. The canine disorder thus resembles mucopolysaccharidosis I in all biochemical parameters tested; the clinical appearance of the animals is closest to Hurler-Scheie syndrome, a form of alpha-L-iduronidase deficiency of intermediate severity. The animal model should prove valuable for therapeutic experiments.


Sleep-wake pattern of medical students: early versus late class starting time.
The sleep-wake cycle of students is characterized by delayed onset, partial sleep deprivation and poor sleep quality. Like other circadian rhythms, the sleep-wake cycle is influenced by endogenous and environmental factors. The aim of the present study was to determine the effects of different class starting times on the sleep-wake pattern of 27 medical students. The data were collected during two medical school semesters having different class starting times. All subjects answered the Portuguese version of the Horne and Ostberg Morningness/Eveningness Questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and kept a sleep diary for two weeks during each semester. Better sleep quality (PSQI = 5.3 vs 3.4), delayed sleep onset (23:59 vs 0:54 h) and longer sleep duration (6 h and 55 min vs 7 h and 25 min) were observed with the late schedule. We also found reduced sleep durations during weekdays and extended sleep durations during weekends. This pattern was more pronounced during the semester with the early class schedule, indicating that the students were more sleep deprived when their classes began earlier in the morning. These results require further investigation regarding the temporal organization of our institutions.


Gene-environment interaction and behavioral disorders: a developmental perspective based on endophenotypes.
It has been observed that 'No aspect of human behavioral genetics has caused more confusion and generated more obscurantism than the analysis and interpretation of various types of non-additivity and non-independence of gene and environmental action and interaction' (Eaves LJ et al 1977 Br J Math Stat Psychol 30:1-42). On the other hand, a bulk of newly published studies appear to speak in favour of common and frequent interplay--and possibly interaction--between identified genetic polymorphisms and specified environmental variables in shaping behavior and behavioral disorders. Considerable interest has arisen from the introduction of putative functional 'endophenotypes' which would represent a more proximate biological link to genes, as well as an obligatory intermediate of behavior. While explicit criteria to identify valid endophenotypes have been offered, a number of new 'alternative phenotypes' are now being proposed as possible 'endophenotypes' for behavioral and psychiatric genetics research, sometimes with less than optimal stringency. Nonetheless, we suggest that some endophenotypes can be helpful in investigating several instances of gene-environment interactions and be employed as additional tools to reduce the risk for spurious results in this controversial area.


Solvent-induced luminescence quenching: static and time-resolved X-ray absorption spectroscopy of a copper(I) phenanthroline complex.
We present a static and picosecond X-ray absorption study at the Cu K-edge of bis(2,9-dimethyl-1,10-phenanthroline)copper(I) ([Cu(dmp)2](+); dmp = 2,9-dimethyl-1,10-phenanthroline) dissolved in acetonitrile and dichloromethane. The steady-state photoluminescence spectra in dichloromethane and acetonitrile are also presented and show a shift to longer wavelengths for the latter, which points to a stronger stabilization of the excited complex. The fine structure features of the static and transient X-ray spectra allow an unambiguous assignment of the electronic and geometric structure of the molecule in both its ground and excited (3)MLCT states. Importantly, the transient spectra are remarkably similar for both solvents, and the spectral changes can be rationalized using the optimized ground- and excited-state structures of the complex. The proposed assignment of the lifetime shortening of the excited state in donor solvents (acetonitrile) to a metal-centered exciplex is not corroborated here. Molecular dynamics simulations confirm the lack of complexation; however, in both solvents the molecules come close to the metal but undergo rapid exchange with the bulk. The shortening of the lifetime of the title complex and nine additional related complexes can be rationalized by the decrease in the (3)MLCT energy. Deviations from this trend may be explained by means of the effects of the dihedral angle between the ligand planes, the solvent, and the (3)MLCT-(1)MLCT energy gap.


Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up in Moshi, Tanzania.
We evaluated changes in characteristics of clients presenting for voluntary counseling and testing (VCT) before and during care and treatment center (CTC) scale-up activities in Moshi, Tanzania, between November 2003 and December 2007. Consecutive clients were surveyed after pretest counseling, and rapid HIV antibody testing was performed. Trend tests were used to assess changes in seroprevalence and client characteristics over time. Multivariable logistic regression models were used to estimate the contribution of changes in sociodemographic and behavioral risk characteristics, and symptoms, to changes in seroprevalence before and during CTC scale-up. Data from 4391 first-time VCT clients were analyzed. HIV seroprevalence decreased from 26.2% to 18.9% after the availability of free antiretroviral therapy and expansion of CTCs beyond regional and referral hospitals. Seroprevalence decreased by 27 % for females (P = 0.0002) and 34% for males (P = 0.0125). Declines in seropositivity coincided with decreases in symptoms among males and females (P < 0.0001) and a more favorable distribution of sociodemographic risks among females (P = 0.002). No changes in behavioral risk characteristics were observed. Concurrent with the scale-up of CTCs, HIV seroprevalence and rates of symptoms declined sharply at an established freestanding VCT site in Moshi, Tanzania. If more HIV-infected persons access VCT at sites where antiretrovirals are offered, freestanding VCT sites may become a less cost-effective means for HIV case finding.


TRP channels as sensors of oxygen availability.
An ability to adapt to changes in oxygen availability is essential for survival in both prokaryotic and eukaryotic organisms. Recently, cation channels encoded by the transient receptor potential (trp) gene superfamily have been recognized as multimodal sensors of a wide variety of factors inside the cells and in the extracellular environment and also as transducers of electrical and chemical signals mediated by ions such as Ca(2+). The functional features of TRP channels enable the body to react and adapt to different forms of environmental changes, including oxygen levels. A subclass of TRP channels regulates various cellular processes in response to fluctuations in oxygen. In this article, we describe the physiological and pathological significance of the oxygen-sensitive TRP channels, which are heterogeneous in the cellular responses to acute changes in oxygen, by contrasting their oxygen monitoring function with that of other ion channels, transporters, and enzymes. We also discuss the physiological relevance of oxygen-sensitive TRP channels as a novel class of target proteins for pharmaceutical therapeutics.


Study of tricarboxylic acid cycle flux changes in human visual cortex during hemifield visual stimulation using (1)H-[(13)C] MRS and fMRI.
The relationships between brain activity and accompanying hemodynamic and metabolic alterations, particularly between the cerebral metabolic rate of oxygen utilization (CMR(O2)) and cerebral blood flow (CBF), are not thoroughly established. CMR(O2) is closely coupled to the rate of tricarboxylic acid (TCA) cycle flux. In this study, the changes in glutamate labeling during (13)C labeled glucose administration were determined in the human brain as an index of alterations in neuronal TCA cycle turnover during increased neuronal activity. Two-volume (1)H-[(13)C] MR spectroscopy (MRS) of the visual cortex was combined with functional MRI (fMRI) at 4 Tesla. Hemifield visual stimulation was employed to obtain data simultaneously from activated and control regions located symmetrically in the two hemispheres of the brain. The results showed that the fractional change in the turnover rate of C4 carbon of glutamate was less than that of CBF during visual stimulation. The fractional changes in CMR(O2) (Delta CMR(O2)) induced by activation must be equal to or less than the fractional change in glutamate labeling kinetics. Therefore, the results impose an upper limit of approximately 30% for Delta CMR(O2) and demonstrate: 1) that fractional CBF increases exceed Delta CMR(O2) during elevated activity in the visual cortex, and 2) that such an unequal change would explain the observed positive blood oxygenation level dependent (BOLD) effect in fMRI. Magn Reson Med 45:349-355, 2001.


Micropenis and the AR Gene: mutation and CAG repeat-length analysis.
Various mutations of the AR gene and expanded CAG repeats at exon 1 of that gene have been reported in patients with hypospadias or genital ambiguity. However, the role of the AR gene has not been systemically studied in those with isolated micropenis lacking hypospadias or genital ambiguity. We studied 64 Japanese boys with isolated micropenis (age, 0-14 yr; median, 7 yr), whose stretched penile lengths were between -2.5 and -2.0 SD (borderline micropenis) in 31 patients (age, 0-13 yr; median, 8 yr) and below -2.5 SD (definite micropenis) in 33 patients (age, 0-14 yr; median, 6 yr). Mutation analysis of the AR gene was performed for exons 1-8 and their flanking introns, except for the CAG and GGC repeat regions at exon 1, by denaturing HPLC and direct sequencing, identifying a substitution of cytosine to thymine at a position -3 in the 3' splice site of intron 1 in a patient with definite micropenis. CAG repeat length at exon 1 was determined by electrophoresis with internal size markers and direct sequencing, revealing no statistically significant difference in the distribution of CAG repeat lengths [median (range) and mean +/- SE: total patients with isolated micropenis, 24 (14-34) and 23.5 +/- 0.38; patients with borderline micropenis, 24 (15-29) and 23.5 +/- 0.53; patients with definite micropenis, 23 (14-34) and 23.5 +/- 0.56; and 100 control males, 23 (16-32) and 23.5 +/- 0.29] or in the frequency of long CAG repeats (percentage of CAG repeats > or =26 and > or =28: total patients with isolated micropenis, 17.2 and 4.7%; patients with borderline micropenis, 19.4 and 6.5%; patients with definite micropenis, 15.2 and 3.0%; and 100 control males, 21.0 and 10.0%). These results suggest that an AR gene mutation is rare and that CAG repeat length is not expanded in children with isolated micropenis.


Use of a modified Bacteroides-Prevotella shuttle vector to transfer a reconstructed beta-1,4-D-endoglucanase gene into Bacteroides uniformis and Prevotella ruminicola B(1)4.
A carboxymethyl cellulase (CMCase) gene from Prevotella ruminicola B(1)4 was reconstructed by adding a cellulose binding domain from a Thermomonospora fusca cellulase and was conjugally transferred from Escherichia coli to Bacteroides uniformis 0061 by using a chloramphenicol and tetracycline resistance shuttle vector (pTC-COW). pTC-COW was specifically constructed to facilitate conjugal transfer of vectors from B. uniformis donors to P. ruminicola recipients. B. uniformis transconjugants containing CMCase constructs cloned into pTC-COW expressed Cmr, but they did not produce the reconstructed CMCase until a xylanase promoter from P. ruminicola 23 was added upstream of the CMCase (pTC-XRCMC). The xylanase promoter allowed the B. uniformis transconjugants to produce large amounts of the reconstructed CMCase, which was present on the outside surface of the cells. Although the reconstructed CMCase alone did not allow B. uniformis to grow on acid-swollen cellulose, rapid growth was observed when two exocellulases were added to the culture supernatant. Under these conditions, the reconstructed CMCase permitted faster growth than the wild-type CMCase. The frequency of transfer of pTC-XRCMC from B. uniformis to P. ruminicola B(1)4 was increased 100-fold when strictly anaerobic conditions, nitrocelluose filters (cell immobilization), and more stringent selections were employed. Although the P. ruminicola B(1)4 (pTC-XRCMC) transconjugates expressed Tcr and had DNA that hybridized with a probe to the shuttle vector, these transconjugants did not produce detectable levels of the reconstructed CMCase even when xylan was the carbon source. On the basis of these results, it appears that not all of the promoters recognized by B. uniformis and P. ruminicola 23 are functional in P. ruminicola B(1)4. However, the results with B. uniformis suggest that the introduction of a P. ruminicola B(1)4 promoter should allow expression of the reconstructed CMCase in P. ruminicola B(1)4.


Forest dynamics after successive spruce budworm outbreaks in mixedwood forests.
In order to assess the long-term spatiotemporal influence of the spruce budworm in sub-boreal mixedwood forests, we studied the effect of three successive outbreaks in a region of western Quebec, Canada. We used dendrochronology to detect past outbreaks in three areas (111-185 ha), based on the recruitment age of balsam fir (Abies balsamea) and on growth patterns of white spruce (Picea glauca), the two main host species of this defoliating insect. We also used a series of aerial photographs taken between 1935 and 2003 to evaluate overstory mortality and post-outbreak succession patterns in these same areas. Individual outbreaks had a spatially homogenous impact on host species throughout the region, but successive outbreaks differed in intensity: the two outbreaks around 1910 and 1980 caused widespread mortality in the overstory, but an outbreak around 1945 had little impact, probably because the forest mosaic had not yet recuperated from the 1910 outbreak. No clear outbreak was detected in the later part of the 19th century. In portions of the study areas where the 1910 outbreak had a major impact, between 36% and 50% of the stands were reoccupied by balsam fir stands in the period up to the 1980 outbreak (cyclic succession), the rest being at least partly replaced by nonhost species such as Betula spp. Changes in forest composition after the 1910 outbreak were mostly associated with upper-slope positions in all study areas. The 1980 outbreak also had a higher impact than earlier outbreaks in lower-slope positions dominated by black spruce (Picea mariana)-balsam fir mixtures. These results suggest that, at the regional scale, the abundance of mature or over-mature balsam fir stands does not determine the outbreak cycle. When an outbreak occurs, however, its impact will be strongly constrained by forest characteristics such as stand composition and structure, which are themselves influenced by previous disturbances and slope position.


Photophysics and photochemistry of a DNA-protein cross-linking model: a synergistic approach combining experiments and theory.
The photophysical and photochemical properties of 5-benzyluracil and 5,6-benzyluracil, the latter produced by photocyclization of the former through irradiation with femtosecond UV laser pulses, are investigated both experimentally and theoretically. The absorption spectra of the two molecules are compared, and the principal electronic transitions involved are discussed, with particular emphasis on the perturbation induced on the two chromophore species (uracil and benzene) by their proximity. The photoproduct formation for different irradiation times was verified with high-performance liquid chromatography and nuclear magnetic resonance measurements. The steady-state fluorescence demonstrates that the fluorescence is a distinctive physical observable for detection and selective identification of 5- and 5,6-benzyluracil. The principal electronic decay paths of the two molecules, obtained through TDDFT calculations, explain the features observed in the emission spectra and the photoreactivity of 5-benzyluracil. The order of magnitude of the lifetime of the excited states is derived with steady-state fluorescence anisotropy measurements and rationalized with the help of the computational findings. Finally, the spectroscopic data collected are used to derive the photocyclization and fluorescence quantum yields. In obtaining a global picture of the photophysical and photochemical properties of the two molecules, our findings demonstrates that the use of 5-benzyluracil as a model system to study the proximity relations of a DNA base with a close-lying aromatic amino acid is valid at a local level since the main characteristics of the decay processes from the excited states of the uracil/thymine molecules remain almost unchanged in 5-benzyluracil, the main perturbation arising from the presence of the close-lying aromatic group.


Tubular nitrogen-doped TiO2 samples with efficient photocatalytic properties based on long-lived charge separation under visible-light irradiation: synthesis, characterization and reactivity.
A nitrogen-doped TiO2 sample was prepared at 413 K by direct hydrothermal treatment of titanium isopropoxide in an aqueous solution of NH3. This new material has a large specific surface area of ca. 220 m2 g-1 because of its tubular structure and it exhibits a prominent absorption feature in the region between 400 and 650 nm. It responds strongly to light in the visible region, which is key to its potential performance as a photocatalyst that may improve the efficiency for utilization of solar energy. Actually, this sample exhibits very efficient activity in the decomposition of CH3COOH under visible light among the samples prepared. This effective photocatalysis of the present sample was substantiated by characteristic spectroscopic features, such as: (1) an optical absorption band with λ > 400 nm because of the doped nitrogen species; (2) the formation of EPR-active, long-lived N˙ and O2- species, as well as N2- species, under visible-light irradiation in the O2 or N2 adsorption process at 300 K by way of the monovalent nitrogen ions in the bulk (both substitutional and interstitial); (3) the existence of IR-active O2 species adsorbed on the nitrogen-doped TiO2 sample even without light irradiation; and (4) an XPS N1s band around 399.6 eV that is assignable to the N- species. The amounts of N˙ and O2- species formed in the nitrogen-doped TiO2 sample under visible-light irradiation correlated well with the levels of reactivity observed in the decomposition of CH3COOH on the samples with varying amounts and types of doped nitrogen species. We conclude that the photoactive N˙ and O2- species created in the present sample are responsible for the decomposition of organic materials assisted by visible light irradiation. These features may be attributable to the interface between the sample's tubular structure and anatase with poor crystallinity, which probably causes the resistance to the recombination of electron-hole pairs formed by irradiation.


Human Gut Commensal Membrane Vesicles Modulate Inflammation by Generating M2-like Macrophages and Myeloid-Derived Suppressor Cells.
Immunomodulatory commensal bacteria modify host immunity through delivery of regulatory microbial-derived products to host cells. Extracellular membrane vesicles (MVs) secreted from symbiont commensals represent one such transport mechanism. How MVs exert their anti-inflammatory effects or whether their tolerance-inducing potential can be used for therapeutic purposes remains poorly defined. In this study, we show that MVs isolated from the human lactic acid commensal bacteria Pediococcus pentosaceus suppressed Ag-specific humoral and cellular responses. MV treatment of bone marrow-derived macrophages and bone marrow progenitors promoted M2-like macrophage polarization and myeloid-derived suppressor cell differentiation, respectively, most likely in a TLR2-dependent manner. Consistent with their immunomodulatory activity, MV-differentiated cells upregulated expression of IL-10, arginase-1, and PD-L1 and suppressed the proliferation of activated T cells. MVs' anti-inflammatory effects were further tested in acute inflammation models in mice. In carbon tetrachloride-induced fibrosis and zymosan-induced peritonitis models, MVs ameliorated inflammation. In the dextran sodium sulfate-induced acute colitis model, systemic treatment with MVs prevented colon shortening and loss of crypt architecture. In an excisional wound healing model, i.p. MV administration accelerated wound closure through recruitment of PD-L1-expressing myeloid cells to the wound site. Collectively, these results indicate that P. pentosaceus-derived MVs hold promise as therapeutic agents in management/treatment of inflammatory conditions.


Combination of dabrafenib plus trametinib for BRAF and MEK inhibitor pretreated patients with advanced BRAFV600-mutant melanoma: an open-label, single arm, dual-centre, phase 2 clinical trial.
Patients with BRAFV600-mutant melanoma benefit from treatment with the combination of BRAF and MEK inhibitors, but resistance and disease progression develops in most patients. Preclinical studies and case studies have indicated that acquired resistance to BRAF inhibition can be reversible. We aimed to assess the anti-tumour activity of rechallenge with BRAF plus MEK inhibition in a prospective clinical trial. In this open-label, single arm, dual-centre, phase 2 academic study in Belgium, patients aged 18 years or older with BRAFV600-mutant melanoma who had previously progressed on BRAF inhibitors (with or without MEK inhibitors) and were off-treatment for at least 12 weeks, were treated with dabrafenib 150 mg orally twice per day plus trametinib 2 mg orally once per day. The primary endpoint was the proportion of patients with investigator-assessed overall response at any time (defined as complete response or partial response according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 confirmed on two occasions, at least 28 days after the first response was recorded). Analyses were done in the intention-to-treat population. The study is ongoing but no longer recruiting patients. This trial is registered with ClinicalTrials.gov, number NCT02296996. Between April 5, 2014, and Feb 2, 2016, 25 patients were enrolled and initiated treatment in our study. A partial response was documented in eight (32%) of 25 patients (95% CI 15-54; six patients had progressed on previous treatment with dabrafenib plus trametinib and two patients had progressed on previous BRAF inhibitor monotherapy). Stable disease was noted in ten patients (40%; 95% CI 21-61). Rechallenge with dabrafenib plus trametinib was well tolerated. There were no unexpected or grade 4 or 5 treatment-related adverse events. Grade 3 adverse events occurred in two patients (8%; panniculitis [n=1] and pyrexia [n=1]). Serious adverse events which occurred on study were one patient with an Addison crisis triggered by grade 2 pyrexia symptoms that resolved after discontinuation of dabrafenib and trametinib. No patients died as a result of study treatment. Rechallenge with dabrafenib plus trametinib showed anti-tumour activity in patients who had previously progressed on BRAF inhibitors and as such, rechallenge represents a potential new treatment option for these patients. Vlaamse Liga Tegen Kanker, Novartis.


Prevalence and decay of maternal pneumococcal and meningococcal antibodies: A meta-analysis of type-specific decay rates.
At the time of an infant's initial vaccination at age ∼2 to 3months, some infants already have maternal antibodies against vaccine antigens and these can suppress the immune response to vaccination. Modelling the effects of maternal antibody and the timing of infant doses on the antibody response to vaccination, requires estimates of the rate of maternal antibody decay. Decay rates are not well characterised in the medical literature. We investigated variation in the prevalence of maternal anti-capsular pneumococcal and meningococcal antibodies in infants in 14 countries, and estimated type-specific half-lives. Individual participant serological data were obtained from clinical trials. Half-lives were estimated from antibody concentrations in infants who did not receive meningococcal or pneumococcal vaccines. The seroprevalence of maternal pneumococcal antibodies was highest for serotypes 14, and 19F (92% and 80% respectively) and lowest for serotypes 4 and 1 (30% and 34% respectively). Half-life estimates ranged from 38.7days (95% CI 36.6-41.0) for serotype 6B, to 48.3days (95% CI 46.7-50.2) for serotype 5. The overall half-life was 42.6days (95% CI 41.5-43.7). Seroprevalence was highest in Mali, Nigeria, India, and the Philippines, (all >65%) and lowest in the Czech Republic and Finland (both <45%). In studies of meningococcal vaccines, seroprevalence was 13% for group C (half-life 39.8days, 95% CI 33.4-49.4) and 43% for group A (half-life 43.1days 95% CI 39.8-47.2). Substantial proportions of infants in many countries have antibodies to vaccine serotypes of pneumococcus, however fewer infants have maternally acquired antibodies to groups A and C meningococcus. Passively-acquired antibodies to capsular polysaccharides decay with a half-life of approximately 6weeks. These estimates are useful for modelling the impact of proposed vaccination programmes, and consideration of schedules with a delayed start.


National plan for reliable tuberculosis laboratory services using a systems approach. Recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services.
Since the mid-1990s, public health laboratories have improved tuberculosis (TB) test performance, which has contributed to the resumption of the decline in TB incidence in the United States. However, to eliminate TB in the United States, further improvements are needed in laboratory services to support TB treatment, prevention, and control. A critical step is the development of an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials. Challenges to developing such a system include 1) establishing lines of communication among laboratorians, clinicians, and TB-control officials; 2) expediting reporting of laboratory results, which can avoid delayed or inappropriate treatment and missed opportunities to prevent transmission; 3) developing evidence-based recommendations for use of new laboratory technologies; 4) maintaining staff proficiency in light of declining numbers of specimens to test, workforce shortages, and loss of laboratory expertise; and 5) upgrading laboratory information systems and connecting all partners. The report of the Association of Public Health Laboratories Task Force presents a framework to improve the future of TB laboratory services and describes the role of the laboratory in TB treatment and control, Task Force processes, general principles and benchmarks, and steps for the dissemination of the Task Force recommendations. This MMWR expands on the Task Force report by describing specific actions and performance measures to guide development and implementation of an integrated system for providing TB laboratory services. CDC and the Association of Public Health Laboratories have developed these guidelines so that laboratorians, clinicians, public health officials, administrators, and funding entities can work together to ensure that health-care providers and TB-control officials have the information needed to treat TB patients, prevent TB transmission, and ultimately eliminate TB in the United States.


Consequences of organic farming and landscape heterogeneity for species richness and abundance of farmland birds.
It has been suggested that organic farming may benefit farmland biodiversity more in landscapes that have lost a significant part of its former landscape heterogeneity. We tested this hypothesis by comparing bird species richness and abundance during the breeding season in organic and conventional farms, matched to eliminate all differences not directly linked to the farming practice, situated in either homogeneous plains with only a little semi-natural habitat or in heterogeneous farmland landscapes with abundant field borders and semi-natural grasslands. The effect of farm management on species richness interacted with landscape structure, such that there was a positive relationship between organic farming and diversity only in homogeneous landscapes. This pattern was mainly dependent on the species richness of passerine birds, in particular those that were invertebrate feeders. Species richness of non-passerines was positively related to organic farming independent of the landscape context. Bird abundance was positively related to landscape heterogeneity but not to farm management. This was mainly because the abundance of passerines, particularly invertebrate feeders, was positively related to landscape heterogeneity. We suggest that invertebrate feeders particularly benefit from organic farming because of improved foraging conditions through increased invertebrate abundances in otherwise depauperate homogeneous landscapes. Although many seed-eaters also benefit from increased insect abundance, they may also utilize crop seed resources in homogeneous landscapes and conventional farms. The occurrence of an interactive effect of organic farming and landscape heterogeneity on bird diversity will have consequences for the optimal allocation of resources to restore the diversity of farmland birds.