Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life

Background. Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. Methods. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5® daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. Results. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). Conclusion. This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binder

Patterns of nutrient exchange in a riverine mangrove forest in the Shark River Estuary, Florida, USA

This study aimed to evaluate tidal and seasonal variations in concentrations and fluxes of nitrogen (NH4 +, NO2+NO3, total nitrogen) and phosphorus (soluble reactive phosphorus, total phosphorus) in a riverine mangrove forest using the flume technique during the dry (May, December 2003) and rainy (October 2003) seasons in the Shark River Estuary, Florida. Tidal water temperatures during the sampling period were on average 29.4 (± 0.4) oC in May and October declining to 20 oC (± 4) in December. Salinity values remained constant in May (28 ± 0.12 PSU), whereas salinity in October and December ranged from 6‒21 PSU and 9‒25 PSU, respectively. Nitrate + nitrite (N+N) and NH4+ concentrations ranged from 0.0 to 3.5 μM and from 0 to 4.8 μM throughout the study period, respectively. Mean TN concentrations in October and December were 39 (±0.8) μM and 37 (±1.5) μM, respectively. SRP and N+N concentrations in the flume increased with higher frequency in flooding tides. TP concentrations ranged between 0.2‒2.9 μM with higher concentrations in the dry season than in the rainy season. Mean concentrations were \u3c1. 5 μM during the sampling period in October (0.75 ± 0.02) and December (0.76 ± 0.01), and were relatively constant in both upstream and downstream locations of the flume. Water residence time in the flume (25 m2) was relatively short for any nutrient exchange to occur between the water column and the forest floor. However, the distinct seasonality in nutrient concentrations in the flume and adjacent tidal creek indicate that the Gulf of Mexico is the main source of SRP and N+N into the mangrove forest

Reproducibility of exhaled nitric oxide measurements in overweight and obese adults

Exhaled nitric oxide is a noninvasive measure of airway inflammation that can be detected by a handheld device. Obesity may influence the reproducibility of exhaled nitric oxide measurements, by - for instance - decreased expiratory reserve volume. We analyzed triple exhaled nitric oxide measurements from 553 participants (aged 45 to 65 years with a body mass index ≥27 kg/m2) of the Netherlands Epidemiology of Obesity Study. The interclass correlation coefficient (single measurement reliability) was 0.965 (95% CI: 0.960, 0.970). We conclude that for assessment of exhaled nitric oxide in large cohorts of overweight and obese adults a single measurement suffice

MVA-based H5N1 vaccine affords cross-clade protection in mice against influenza A/H5N1 viruses at low doses and after single immunization.

Human infections with highly pathogenic avian influenza viruses of the H5N1 subtype, frequently reported since 2003, result in high morbidity and mortality. It is feared that these viruses become pandemic, therefore the development of safe and effective vaccines is desirable. MVA-based H5N1 vaccines already proved to be effective when two immunizations with high doses were used. Dose-sparing strategies would increase the number of people that can be vaccinated when the amount of vaccine preparations that can be produced is limited. Furthermore, protective immunity is induced ideally after a single immunization. Therefore the minimal requirements for induction of protective immunity with a MVA-based H5N1 vaccine were assessed in mice. To this end, mice were vaccinated once or twice with descending doses of a recombinant MVA expressing the HA gene of influenza virus A/Vietnam/1194/04. The protective efficacy was determined after challenge infection with the homologous clade 1 virus and a heterologous virus derived from clade 2.1, A/Indonesia/5/05 by assessing weight loss, virus replication and histopathological changes. It was concluded that MVA-based vaccines allowed significant dose-sparing and afford cross-clade protection, also after a single immunization, which are favorable properties for an H5N1 vaccine candidate

Antigenic maps of influenza A(H3N2) produced with human antisera obtained after primary infection

Background Antigenic characterization of influenza viruses is typically based on hemagglutination inhibition (HI) assay data for viral isolates tested against strain-specific postinfection ferret antisera. Here, similar virus characterizations were performed using serological data from humans with primary influenza A(H3N2) infection. Methods We screened sera collected between 1995 and 2011 from children between 9 and 24 months of age for influenza virus antibodies, performed HI tests for the positive sera against 23 influenza viruses isolated between 1989 and 2011, and measured HI titers of antisera against influenza A(H3N2) from 24 ferrets against the same panel of viruses. Results Of the 17 positive human sera, 6 had a high response, showing HI patterns that would be expected from primary infection antisera, while 11 sera had lower, more dispersed patterns of reactivity that are not easily explained. The antigenic map based on the high-response human HI data was similar to the map created using ferret data. Conclusions Although the overall structure of the ferret and human antigenic maps is similar, local differences in virus positions indicate that the human and ferret immune system might see antigenic properties of viruses differently. Further studies are needed to establish the degree of similarity between serological patterns in ferret and human data

Preferential HLA usage in the influenza virus-specific CTL response

To study whether individual HLA class I alleles are used preferentially or equally in human virus-specific CTL responses, the contribution of individual HLA-A and -B alleles to the human influenza virus-specific CTL response was investigated. To this end, PBMC were obtained from three groups of HLA-A and -B identical blood donors and stimulated with influenza virus. In the virus-specific CD8(+) T cell population, the proportion of IFN-gamma- and TNF-alpha-producing cells, restricted by individual HLA-A and -B alleles, was determined using virus-infected C1R cells expressing a single HLA-A or -B allele for restimulation of these cells. In HLA-B*2705- and HLA-B*3501-positive individuals, these alleles were preferentially used in the influenza A virus-specific CTL response, while the contribution of HLA-B*0801 and HLA-A*0101 was minor in these donors. The magnitude of the HLA-B*0801-restricted response was even lower in the presence of HLA-B*2705. C1R cells expressing HLA-B*2705, HLA-A*0101, or HLA-A*0201 were preferentially lysed by virus-specific CD8(+) T cells. In contrast, the CTL response to influenza B virus was mainly directed toward HLA-B*0801-restricted epitopes. Thus, the preferential use of HLA alleles depended on the virus studied

Recognition of homo- and heterosubtypic variants of influenza A viruses by human CD8+ T lymphocytes

In the present study, the recognition of epitope variants of influenza A viruses by human CTL was investigated. To this end, human CD8(+) CTL clones, specific for natural variants of the HLA-B*3501-restricted epitope in the nucleoprotein (NP(418-426)), were generated. As determined in (51)Cr release assays and by flow cytometry with HLA-B*3501-peptide tetrameric complexes, CTL clones were found to be specific for epitopes within one subtype or cross-reactive with heterosubtypic variants of the epitope. Using eight natural variants of the epitope, positions in the 9-mer important for T cell recognition and involved in escape from CTL immunity were identified and visualized using multidimensional scaling. It was shown that positions 4 and 5 in the 9-mer epitope were important determinants of T cell specificity. The in vivo existence of CD8(+) cells cross-reactive with homo- and heterosubtypic variants of the epitope was further confirmed using polyclonal T cell populations obtained after stimulation of PBMC with different influenza A viruses. Based on the observed recognition patterns of the clonal and polyclonal T cell populations and serology, it is hypothesized that consecutive infections with influenza viruses containing different variants of the epitope select for cross-reactive T cells in vivo

The effects of a freshwater diversion of nekton species biomass distributions, food web pathways, and community structure in a Louisiana estuary

A current method to restore Louisiana’s estuaries includes reintroducing freshwater and sediments to wetlands that are hydrologically isolated from the Mississippi River due to the construction of levees. In this dissertation, I examined effects of the second largest freshwater diversion in Louisiana, the Caernarvon Freshwater Diversion (CFD), on estuarine nekton in Breton Sound. Before focusing on Breton Sound, I examined the status of nekton communities in the northern Gulf of Mexico (GOM), and Louisiana wetlands in particular, using the mean trophic level index (MTLI). I demonstrated that commercial targeting caused the previously reported low and declining MTLI from the GOM. Evaluation of Breton Sound alone showed an increasing MTLI, which is possibly a positive effect of hydrological restoration. With a Before-After-Control-Impact study, I demonstrated that nekton species biomass distributions (SBD) changed significantly after the opening of the CFD in 1991. The biomass of selected economically or ecologically important species showed an increase relative to the control (Micropterus salmoides, Micropogonias undulatus, Brevoortia patronus, Farfantepenaeus aztecus and Litopenaeus setiferus), one was not affected (Cynoscion nebulosus). In addition, nekton species richness, abundance and the proportion of smaller individuals increased, indicating increased nursery function. I identified salinity as the main environmental variable separating SBDs among study sites due to freshwater inflow, although seasonal variation had the greatest effect on SBD. The CFD did not change dissolved oxygen or turbidity to the extent that it had an effect on nekton in the areas examined. Applying stable isotope techniques, I identified a positive effect of freshwater inflow on trophic diversity and niche breath of the consumer community, and on the relative contribution of particulate organic matter in the food web, resulting in energy density increases in nekton species. Finally, I created an ecosystem model of Breton Sound, which I used to simulate changes in SBD under different salinity scenarios. This model can be used to evaluate future restoration projects. These various analyses, including the model predictions, revealed only neutral or positive effects of the CFD as currently operated on nekton communities in Breton Sound

The magnitude and specificity of influenza A virus-specific cytotoxic T-lymphocyte responses in humans is related to HLA-A and -B phenotype

The repertoire of human cytotoxic T-lymphocytes (CTL) in response to influenza A viruses has been shown to be directed towards multiple epitopes, with a dominant response to the HLA-A2-restricted M1(58-66) epitope. These studies, however, were performed with peripheral blood mononuclear cells (PBMC) of individuals selected randomly with respect to HLA phenotype or selected for the expression of one HLA allele without considering an influence of other HLA molecules. In addition, little information is available on the influence of HLA makeup on the overall CTL response against influenza viruses. Here, the influenza A virus-specific CTL response was investigated in groups of HLA-A and -B identical individuals. Between groups the individuals shared two or three of the four HLA-A and -B alleles. After in vitro stimulation of PBMC with influenza virus, the highest CTL activity was found in HLA-A2(+) donors. A similar pattern was observed for the precursor frequency of virus-specific CTL (CTLp) ex vivo, with a higher CTLp frequency in HLA-A2-positive donors than in HLA-A2-negative donors, which were unable to recognize the immunodominant M1(58-66) epitope. In addition, CTL activity and frequency of CTLp for the individual influenza virus epitopes were determined. The frequency of CTLp specific for the HLA-B8-restricted epitope NP(380-388) was threefold lower in HLA-B27-positive donors than in HLA-B27-negative donors. In addition, the frequency of CTLp specific for the HLA-A1-restricted epitope NP(44-52) was threefold higher in HLA-A1-, -A2-, -B8-, and -B35-positive donors than in other donors, which was confirmed by measuring the CTL activity in vitro. These findings indicate that the epitope specificity of the CTL response is related to the phenotype of the other HLA molecules. Furthermore, the