Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

U.S. POLICY TOWARD IRAN AFTER THE NUCLEAR DEAL

Created as part of the 2016 Jackson School for International Studies SIS 495: Task Force.While the landmark Joint Comprehensive Plan of Action will be the cornerstone of U.S.-Iran relations for years to come, a new set of policies for engagement between the U.S. and Iran is both possible and necessary if the U.S. wishes to help bring Iran into the international community as a more pragmatic actor. To prevail in this, Washington will need a new, more balanced approach that recognizes Tehran’s saber-rattling for what it is, and a groundbreaking cooperative agenda that balances the strategic interests of its allies in the Middle East with the U.S.’ overarching objective of stability in the region – both of which Iran is integral to. This is not to say that the U.S. should at any point overlook Tehran’s history of fomenting violence and discord in the region for the sake of compromise; such antagonistic policies must be systematically opposed wherever Tehran seeks to implement them. But at this critical juncture where tensions between Iran and the Arab states are at a fever pitch, Iran will be more likely to sit at the table if the U.S. can convince its allies that their security is best served through diplomatic measures. Moreover, if Iran can be shown that its more aggressive tendencies do more harm than good to its national interests, it may yet shift its attention inward to more cooperative and prosperous endeavors worthy of the regional power it aspires to be. Reintegrating Iran into the international community will be by no means easy, and hopes for swift reform must be tempered even as a new generation of young Iranians begins to exert a more moderate influence on domestic politics. But if the following U.S. policies can be implemented to deter Iranian actions that destabilize the region, demonstrate commitment to regional allies, and incentivize acceptable behavior from Iran with opportunities for economic and diplomatic integration, ideology may give way to reveal instances of progress toward a more beneficial state of relations between the U.S. and Iran

Comprehensive review of safety in Experimental Human Pneumococcal Challenge.

IntroductionExperimental Human Pneumococcal Challenge (EHPC) involves the controlled exposure of adults to a specific antibiotic-sensitive Streptococcus pneumoniae serotype, to induce nasopharyngeal colonisation for the purpose of vaccine research. The aims are to review comprehensively the safety profile of EHPC, explore the association between pneumococcal colonisation and frequency of safety review and describe the medical intervention required to undertake such studies.MethodsA single-centre review of all EHPC studies performed 2011-2021. All recorded serious adverse events (SAE) in eligible studies are reported. An unblinded meta-analysis of collated anonymised individual patient data from eligible EHPC studies was undertaken to assess the association between experimental pneumococcal colonisation and the frequency of safety events following inoculation.ResultsIn 1416 individuals (median age 21, IQR 20-25), 1663 experimental pneumococcal inoculations were performed. No pneumococcal-related SAE have occurred. 214 safety review events were identified with 182 (12.85%) participants presenting with symptoms potentially in keeping with pneumococcal infection, predominantly in pneumococcal colonised individuals (colonised = 96/658, non-colonised = 86/1005, OR 1.81 (95% CI 1.28-2.56, P = DiscussionNo SAEs were identified directly relating to pneumococcal inoculation. Safety review for symptoms was infrequent but occurred more in experimentally colonised participants. Most symptoms were mild and resolved with conservative management. A small minority required antibiotics, notably those serotype 3 inoculated.ConclusionOutpatient human pneumococcal challenge can be conducted safely with appropriate levels of safety monitoring procedures in place

Disruption prediction with artificial intelligence techniques in tokamak plasmas

In nuclear fusion reactors, plasmas are heated to very high temperatures of more than 100 million kelvin and, in so-called tokamaks, they are confined by magnetic fields in the shape of a torus. Light nuclei, such as deuterium and tritium, undergo a fusion reaction that releases energy, making fusion a promising option for a sustainable and clean energy source. Tokamak plasmas, however, are prone to disruptions as a result of a sudden collapse of the system terminating the fusion reactions. As disruptions lead to an abrupt loss of confinement, they can cause irreversible damage to present-day fusion devices and are expected to have a more devastating effect in future devices. Disruptions expected in the next-generation tokamak, ITER, for example, could cause electromagnetic forces larger than the weight of an Airbus A380. Furthermore, the thermal loads in such an event could exceed the melting threshold of the most resistant state-of-the-art materials by more than an order of magnitude. To prevent disruptions or at least mitigate their detrimental effects, empirical models obtained with artificial intelligence methods, of which an overview is given here, are commonly employed to predict their occurrence—and ideally give enough time to introduce counteracting measures

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present