Detection of leukocytes stained with acridine orange using unique spectral features acquired from an image-based spectrometer

A leukocyte differential count can be used to diagnosis a myriad blood disorders, such as infections, allergies, and efficacy of disease treatments. In recent years, attention has been focused on developing point-of-care (POC) systems to provide this test in global health settings. Acridine orange (AO) is an amphipathic, vital dye that intercalates leukocyte nucleic acids and acidic vesicles. It has been utilized by POC systems to identify the three main leukocyte subtypes: granulocytes, monocytes, and lymphocytes. Subtypes of leukocytes can be characterized using a fluorescence microscope, where the AO has a 450 nm excitation wavelength and has two peak emission wavelengths between 525 nm (green) and 650 nm (red), depending on the cellular content and concentration of AO in the cells. The full spectra of AO stained leukocytes has not been fully explored for POC applications. Optical instruments, such as a spectrometer that utilizes a diffraction grating, can give specific spectral data by separating polychromatic light into distinct wavelengths. The spectral data from this setup can be used to create object-specific emission profiles. Yellow-green and crimson microspheres were used to model the emission peaks and profiles of AO stained leukocytes. Whole blood was collected via finger stick and stained with AO to gather preliminary leukocyte emission profiles. A MATLAB algorithm was designed to analyze the spectral data within the images acquired using the image-based spectrometer. The algorithm utilized watershed segmentation and centroid location functions to isolate independent spectra from an image. The output spectra represent the average line intensity profiles for each pixel across a slice of an object. First steps were also taken in processing video frames of manually translated microspheres. The high-speed frame rate allowed objects to appear in multiple consecutive images. A function was applied to each image cycle to identify repeating centroid locations. The yellow-green (515 nm) and crimson (645 nm) microspheres exhibited a distinct separation in colorimetric emission with a peak-to-peak difference of 36 pixels, which is related to the 130 nm peak emission difference. Two AO stained leukocytes exhibited distinct spectral profiles and peaks across different wavelengths. This could be due to variations in the staining method (incubation period and concentration) effecting the emissions or variations in cellular content indicating different leukocyte subtypes. The algorithm was also effective when isolating unique centroids between video frames. We have demonstrated the ability to extract spectral information from data acquired from the image-based spectrometer of microspheres, as a control, and AO stained leukocytes. We determined that the spectral information from yellow-green and crimson microspheres could be used to represent the wavelength range of AO stained leukocytes, thus providing a calibration tool. Also, preliminary spectral information was successfully extracted from yellow-green microspheres translated under the linear slit using stationary images and video frames, thus demonstrating the feasibility of collecting data from a large number of objects

Slow Breathing Reduces Markers of Stress in Response to a Virtual-Reality Active Shooter Training Drill

Law enforcement officers are expected to respond to potential life-threatening scenarios in high stress environments. Acute participation in virtual reality (VR) active shooter scenarios has been shown to increase markers of stress. Tactical occupations (i.e., military, law enforcement personnel) are trained to use slow breathing methods to aid in stress reduction, but there is no known evidence supporting the effectiveness of slow breathing in relation to a VR-active shooter training drill (VR-ASD). PURPOSE: To determine the effects of slow breathing on markers of stress in response to a VR-ASD. METHODS: A parallel between subjects design was used, during which, eighty-one (n=81) subjects performed five minutes of either slow breathing method 1 (SB1), slow breathing method 2 (SB2), or no modified breathing [normal breathing (NB)] immediately pre and post VR-ASD. SB1 (i.e., box breathing) involved a four second inhalation, two second pause, four second exhalation, and a two second pause. SB2 involved a four second inhalation, followed by a two second exhalation. The VR-ASD (~1 minute) included a single gunman and simulated victims. Subjects were fitted with a VR headset and equipped with a Glock 17 training pistol. Salivary samples and heart rate (HR) were collected thirty minutes pre, five minutes pre, five minutes post, and thirty minutes post VR-ASD. Saliva was analyzed for stress markers: α-amylase (AA) and secretory immunoglobulin-A (Sig-A). AA and SIgA were analyzed via 3x4 (treatment x timepoint) factorial ANOVAs. HR was analyzed via 2x4 factorial ANOVA. RESULTS: Both methods of slow breathing (SB1 and SB2) resulted in significantly lower AA concentrations at five (p \u3c 0.001), and thirty-minutes post VR-ASD (SB1: p= 0.008; SB2: p \u3c 0.001) compared to NB. In the NB condition, AA concentrations were significantly elevated five minutes post VR-ASD (p \u3c 0.001) compared to all other timepoints but did not change across time in SB1 or SB2 (p \u3e .05). A significant increase in SIgA concentrations was noted five minutes post VR-ASD compared to all the other time points (p \u3c 0.001), and significantly higher SIgA concentrations were found in the NB compared to SB1 and SB2 (p\u3c0.001). Finally, slow breathing resulted in a significant decrease in HR from pre to post VR-ASD (p \u3c 0.05). CONCLUSION: The VR-ASD resulted in a significant increase in stress markers AA and SIgA. Slow breathing (both SB1 and SB2) prevented a significant increase in AA concentrations and resulted in lower concentrations post VR-ASD. Future studies should investigate the effects of longitudinal participation in slow breathing methods on markers of stress in response to a VR-ASD

Autoimmune Hepatitis Induced by Syngeneic Liver Cytosolic Proteins Biotransformed by Alcohol Metabolites

Aldehydes that are produced following the breakdown of ethanol (acetaldehyde) and lipid peroxidation of membranes (malondialdehyde) have been shown to bind (adduct) proteins. Additionally, these two aldehydes can combine (MAA) on non-syngeneic and syngeneic proteins to initiate numerous immune responses to the unmodified part of the protein in the absence of an adjuvant. Therefore, these studies provide a potential mechanism for the development of antigen-specific immune responses resulting in liver damage should syngeneic liver proteins be adducted with MAA

Implications of Incidental Germline Findings Identified In the Context of Clinical Whole Exome Sequencing for Guiding Cancer Therapy

PURPOSE Identification of incidental germline mutations in the context of next-generation sequencing is an unintended consequence of advancing technologies. These data are critical for family members to understand disease risks and take action. PATIENTS AND METHODS A retrospective cohort analysis was conducted of 1,028 adult patients with metastatic cancer who were sequenced with tumor and germline whole exome sequencing (WES). Germline variant call files were mined for pathogenic/likely pathogenic (P/LP) variants using the ClinVar database and narrowed to high-quality submitters. RESULTS Median age was 59 years, with 16% of patients ≤ 45 years old. The most common tumor types were breast cancer (12.5%), colorectal cancer (11.5%), sarcoma (9.3%), prostate cancer (8.4%), and lung cancer (6.6%). We identified 3,427 P/LP variants in 471 genes, and 84% of patients harbored one or more variant. One hundred thirty-two patients (12.8%) carried a P/LP variant in a cancer predisposition gene, with BRCA2 being the most common (1.6%). Patients with breast cancer were most likely to carry a P/LP variant (19.2%). One hundred ten patients (10.7%) carried a P/LP variant in a gene that would be recommended by the American College of Medical Genetics and Genomics to be reported as a result of clinical actionability, with the most common being ATP7B (2.7%), BRCA2 (1.6%), MUTYH (1.4%), and BRCA1 (1%). Of patients who carried a P/LP variant in a cancer predisposition gene, only 53% would have been offered correct testing based on current clinical practice guidelines. Of 471 mutated genes, 231 genes had a P/LP variant identified in one patient, demonstrating significant genetic heterogeneity. CONCLUSION The majority of patients undergoing clinical cancer WES harbor a pathogenic germline variation. Identification of clinically actionable germline findings will create additional burden on oncology clinics as broader WES becomes common

A quantitative risk assessment of waterborne infectious disease in the inundation area of a tropical monsoon region

Flooding and inundation are annual events that occur during the rainy season in Cambodia, and inundation has a strong relationship with human health. This study simulated the coliform bacteria distribution using a hydraulic model and estimated the impact of inundation on public health using a dose–response model. The model parameters were calibrated using field survey data from Cambodia and obtained good agreement with the coliform group count distribution. The results suggest that the impact of inundation on human health is most noticeable in residential areas. The annual average risk of infection during medium-sized flood events is 0.21. The risk due to groundwater use ranges from 0.12 to 0.17 in inundation areas and reaches as high as 0.23 outside the inundation areas. The risk attributed to groundwater use is therefore higher than that for surface water use (0.02–0.06), except in densely populated areas at the city center. There is a high risk for infection with waterborne disease in residential areas, and the annual average risk during small flood events is 0.94. An assessment of possible countermeasures to reduce the risk shows that the control of inundation may bring more risk to public health in Cambodia. Shallower inundation water (<0.3 m) leads to a higher risk of infection, but if the depth is greater than 2 m, the risk is low in residential areas.The simulated results explain the spatial distributions of infection risk, which are vitally important for determining the highest priority places with relatively high risk and will be helpful for decision makers when considering the implementation of countermeasures

TU Tau B: The Peculiar 'Eclipse' of a possible proto-Barium Giant

TU Tau (= HD 38218 = HIP 27135) is a binary system consisting of a C-N carbon star primary and an A-type secondary. We report on new photometry and spectroscopy which tracked the recent disappearance of the A-star secondary. The dimming of the A-star was gradual and irregular, with one or more brief brightenings, implying the presence of nonhomogeneities in the carbon star outflow. We also present evidence that the A-star is actively accreting s-process enriched material from the carbon star and suggest that it will therefore eventually evolve into a Barium giant. This is an important system as well because the A-type star can serve as a probe of the outer atmosphere of the carbon star.Comment: 9 pages, 9 figures, 4 tables, a number of amateur observatories made significant contributions to this research. Paper accepted for publication in The Astronomical Journa

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Leveraging structure determination with fragment screening for infectious disease drug targets: MECP synthase from Burkholderia pseudomallei

As part of the Seattle Structural Genomics Center for Infectious Disease, we seek to enhance structural genomics with ligand-bound structure data which can serve as a blueprint for structure-based drug design. We have adapted fragment-based screening methods to our structural genomics pipeline to generate multiple ligand-bound structures of high priority drug targets from pathogenic organisms. In this study, we report fragment screening methods and structure determination results for 2C-methyl-D-erythritol-2,4-cyclo-diphosphate (MECP) synthase from Burkholderia pseudomallei, the gram-negative bacterium which causes melioidosis. Screening by nuclear magnetic resonance spectroscopy as well as crystal soaking followed by X-ray diffraction led to the identification of several small molecules which bind this enzyme in a critical metabolic pathway. A series of complex structures obtained with screening hits reveal distinct binding pockets and a range of small molecules which form complexes with the target. Additional soaks with these compounds further demonstrate a subset of fragments to only bind the protein when present in specific combinations. This ensemble of fragment-bound complexes illuminates several characteristics of MECP synthase, including a previously unknown binding surface external to the catalytic active site. These ligand-bound structures now serve to guide medicinal chemists and structural biologists in rational design of novel inhibitors for this enzyme

Temporal and tissue-specific variability of SMN protein levels in mouse models of spinal muscular atrophy

textabstractSpinal muscular atrophy (SMA) is a progressive motor neuron disease caused by deleterious variants in SMN1 that lead to a marked decrease in survival motor neuron (SMN) protein expression. Humans have a second SMN gene (SMN2) that is almost identical to SMN1. However, due to alternative splicing the majority of SMN2 messenger ribonucleic acid (mRNA) is translated into a truncated, unstable protein that is quickly degraded. Because the presence of SMN2 provides a unique opportunity for therapy development in SMA patients, the mechanisms that regulate SMN2 splicing and mRNA expression have been elucidated in great detail. In contrast, how much SMN protein is produced at different developmental time points and in different tissues remains under-characterized. In this study, we addressed this issue by determining SMN protein expression levels at three developmental time points across six different mouse tissues and in two distinct mouse models of SMA ('severe' Taiwanese and 'intermediate' Smn2B/mice). We found that, in healthy control mice, SMN protein expression was significantly influenced by both age and tissue type.When comparing mouse models of SMA, we found that, despite being transcribed from genetically different alleles, control SMN levels were relatively similar. In contrast, the degree of SMN depletion between tissues in SMA varied substantially over time and between the two models. These findings offer an explanation for the differential vulnerability of tissues and organs observed in SMA and further our understanding of the systemic and temporal requirements for SMN with direct relevance for developing effective therapies for SMA