Caspofungin Increases Fungal Chitin and Eosinophil and γδ T Cell-Dependent Pathology in Invasive Aspergillosis

The polysaccharide-rich fungal cell wall provides pathogen-specific targets for antifungal therapy and distinct molecular patterns that stimulate protective or detrimental host immunity. The echinocandin antifungal caspofungin inhibits synthesis of cell wall β-1,3-glucan and is used for prophylactic therapy in immune-suppressed individuals. However, breakthrough infections with fungal pathogen Aspergillus fumigatus are associated with caspofungin prophylaxis. In this study, we report in vitro and in vivo increases in fungal surface chitin in A. fumigatus induced by caspofungin that was associated with airway eosinophil recruitment in neutropenic mice with invasive pulmonary aspergillosis (IA). More importantly, caspofungin treatment of mice with IA resulted in a pattern of increased fungal burden and severity of disease that was reversed in eosinophil-deficient mice. Additionally, the eosinophil granule proteins major basic protein and eosinophil peroxidase were more frequently detected in the bronchoalveolar lavage fluid of lung transplant patients diagnosed with IA that received caspofungin therapy when compared with azole-treated patients. Eosinophil recruitment and inhibition of fungal clearance in caspofungin-treated mice with IA required RAG1 expression and γδ T cells. These results identify an eosinophil-mediated mechanism for paradoxical caspofungin activity and support the future investigation of the potential of eosinophil or fungal chitin-targeted inhibition in the treatment of IA

Concert recording 2022-11-09

[Track 1]. Voyage for brass trio. I. Allegro moderato ; [Track 2]. II. Vivace ; [Track 3]. III. Andante molto ; [Track 4]. IV. Moderato ; [Track 5]. V. Adagio sostenuto ; [Track 6]. VI. Allegro ; [Track 7]. VII. Allegro non troppo / Robert Muczynski -- [Track 8]. Ad astra / Anthony O’Toole ; arr. David Slutsky -- [Track 9]. Fanfare for St. Edmundsbury / Benjamin Britten ; arr. David Slutsky – [Track 10]. Vivace from concerto no. 3 in D minor for two tubas / J.S. Bach -- [Track 11]. Concertino for trombone and woodwind. I. Soliloquy ; [Track 12]. II. Pastoral ; [Track 13]. III. Toccata / Raymond Eugene Premru -- [Track 14]. Myths and legends. I. Allegro ritmico ; [Track 15]. II. Adagio ; [Track 16]. III. [Track 17]. IV. Allegro vivace / Eric Ewazen -- [Track 18]. Yesterday / Paul McCartney

Concert recording 2022-11-09

[Track 1]. Voyage for brass trio. I. Allegro moderato ; [Track 2]. II. Vivace ; [Track 3]. III. Andante molto ; [Track 4]. IV. Moderato ; [Track 5]. V. Adagio sostenuto ; [Track 6]. VI. Allegro ; [Track 7]. VII. Allegro non troppo / Robert Muczynski -- [Track 8]. Ad astra / Anthony O’Toole ; arr. David Slutsky -- [Track 9]. Fanfare for St. Edmundsbury / Benjamin Britten ; arr. David Slutsky – [Track 10]. Vivace from concerto no. 3 in D minor for two tubas / J.S. Bach -- [Track 11]. Concertino for trombone and woodwind. I. Soliloquy ; [Track 12]. II. Pastoral ; [Track 13]. III. Toccata / Raymond Eugene Premru -- [Track 14]. Myths and legends. I. Allegro ritmico ; [Track 15]. II. Adagio ; [Track 16]. III. [Track 17]. IV. Allegro vivace / Eric Ewazen -- [Track 18]. Yesterday / Paul McCartney

Low-latency gravitational wave alert products and their performance in anticipation of the fourth LIGO-Virgo-KAGRA observing run

Multi-messenger searches for binary neutron star (BNS) and neutron star-black hole (NSBH) mergers are currently one of the most exciting areas of astronomy. The search for joint electromagnetic and neutrino counterparts to gravitational wave (GW)s has resumed with Advanced LIGO (aLIGO)'s, Advanced Virgo (AdVirgo)'s and KAGRA's fourth observing run (O4). To support this effort, public semi-automated data products are sent in near real-time and include localization and source properties to guide complementary observations. Subsequent refinements, as and when available, are also relayed as updates. In preparation for O4, we have conducted a study using a simulated population of compact binaries and a Mock Data Challenge (MDC) in the form of a real-time replay to optimize and profile the software infrastructure and scientific deliverables. End-to-end performance was tested, including data ingestion, running online search pipelines, performing annotations, and issuing alerts to the astrophysics community. In this paper, we present an overview of the low-latency infrastructure as well as an overview of the performance of the data products to be released during O4 based on a MDC. We report on expected median latencies for the preliminary alert of full bandwidth searches (29.5 s) and for the creation of early warning triggers (-3.1 s), and show consistency and accuracy of released data products using the MDC. This paper provides a performance overview for LVK low-latency alert structure and data products using the MDC in anticipation of O4

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely