Accuracy of Tongue Swab Testing Using Xpert MTB-RIF Ultra for Tuberculosis Diagnosis.

Tongue dorsum swabs have shown promise as alternatives to sputum for detecting Mycobacterium tuberculosis (MTB) in patients with pulmonary tuberculosis (TB). Some of the most encouraging results have come from studies that used manual quantitative PCR (qPCR) to analyze swabs. Studies using the automated Cepheid Xpert MTB/RIF Ultra qPCR test (Xpert Ultra) have exhibited less sensitivity with tongue swabs, possibly because Xpert Ultra is optimized for testing sputum, not tongue swab samples. Using two new sample preprocessing methods that demonstrated good sensitivity in preliminary experiments, we assessed diagnostic accuracy and semi-quantitative signals of Xpert Ultra performed on tongue swabs collected from 183 adults with presumed TB in Kampala, Uganda. Relative to a sputum Xpert Ultra reference standard, the sensitivity of tongue swab Xpert Ultra was 77.8% (95% confidence interval [CI] 64.4-88.0) and specificity was 100.0% (95% CI, 97.2-100.0). When compared to a microbiological reference standard (MRS) incorporating both sputum Xpert Ultra and sputum mycobacterial culture, sensitivity was 72.4% (95% CI, 59.1-83.3) and specificity remained the same. Semi-quantitative Xpert Ultra results were generally lower with tongue swabs than with sputum, and cycle threshold values were higher. None of the eight sputum Xpert Ultra "trace" or "very low" results were detected using tongue swabs. Tongue swabs should be considered when sputum cannot be collected for Xpert Ultra testing, or in certain mass-screening settings. Further optimization of tongue swab analysis is needed to achieve parity with sputum-based molecular testing for TB.

The transition to Xpert MTB/RIF ultra: diagnostic accuracy for pulmonary tuberculosis in Kampala, Uganda.

BACKGROUND: The World Health Organization (WHO) has endorsed the next-generation Xpert MTB/RIF Ultra (Ultra) cartridge, and Uganda is currently transitioning from the older generation Xpert MTB/RIF (Xpert) cartridge to Ultra as the initial diagnostic test for pulmonary tuberculosis (TB). We assessed the diagnostic accuracy of Ultra for pulmonary TB among adults in Kampala, Uganda. METHODS: We sampled adults referred for Xpert testing at two hospitals and a health center over a 12-month period. We enrolled adults with positive Xpert and a random 1:1 sample with negative Xpert results. Expectorated sputum was collected for Ultra, and for solid and liquid culture testing for Xpert-negative patients. We measured sensitivity and specificity of Ultra overall and by HIV status, prior history of TB, and hospitalization, in reference to Xpert and culture results. We also assessed how classification of results in the new "trace" category affects Ultra accuracy. RESULTS: Among 698 participants included, 211 (30%) were HIV-positive and 336 (48%) had TB. The sensitivity of Ultra was 90.5% (95% CI 86.8-93.4) and specificity was 98.1% (95% CI 96.1-99.2). There were no significant differences in sensitivity and specificity by HIV status, prior history of TB or hospitalization. Xpert and Ultra results were concordant in 670 (96%) participants, with Ultra having a small reduction in specificity (difference 1.9, 95% CI 0.2 to 3.6, p=0.01). When "trace" results were considered positive for all patients, sensitivity increased by 2.1% (95% CI 0.3 to 3.9, p=0.01) without a significant reduction in specificity (- 0.8, 95% CI - 0.3 to 2.0, p=0.08). CONCLUSIONS: After 1 year of implementation, Ultra had similar performance to Xpert. Considering "trace" results to be positive in all patients increased case detection without significant loss of specificity. Longitudinal studies are needed to compare the benefit of greater diagnoses to the cost of overtreatment.

Accuracy and incremental yield of urine Xpert MTB/RIF Ultra versus Determine TB-LAM for diagnosis of pulmonary tuberculosis.

The performance of urine Xpert MTB/RIF Ultra (Xpert Ultra) for pulmonary TB diagnosis is unknown. HIV-positive and HIV-negative adults were enrolled at two health facilities in Kampala, Uganda. We compared the accuracy of urine Xpert Ultra and Determine TB-LAM in reference to sputum-based testing (positive Xpert MTB/RIF or culture), and assessed incremental yield. Urine Xpert Ultra had low sensitivity (17.2%, 95% CI 12.3-23.2) but high specificity (98.1%, 95% CI 94.4-99.6). Sensitivity reached 50.0% (95% CI 28.2-71.8) among HIV-positive patients with CD4 <100 cells/µL. Compared to Determine TB-LAM, urine Xpert Ultra was 9.4% (95% CI 3.8-14.9, P = 0.01) more sensitive, and 17.2% (95% CI 4.5-29.8, P = 0.01) more sensitive among HIV-positive patients. However, the incremental sensitivity of urine Xpert Ultra relative to sputum Xpert MTB/RIF was only 1% (95% CI -0.9 to 2.8). Urine Xpert Ultra could be an alternative for patients with advanced HIV infection unable to produce sputum.

Caspase-8 regulation of TRAIL-mediated cell death.

Research on TNF-related apoptosis-inducing ligand (TRAIL) and TRAIL receptors has advanced tremendously over the past 17 years. Initial observations of TRAIL and TRAIL receptor-mediated tumor cell toxicity led to enthusiasm of exploiting this selective, malignant cell killing for cancer therapy. Further examination revealed aberrant TRAIL signaling in some cancer cells leading to protection from TRAIL-mediated cell death. Mechanisms of TRAIL resistance often involve decreased expression or activity of initiator caspase-8, crucial for complete TRAIL signal transduction. Caspase-8 mutations, epigenetic silencing, decrease in stability, and incomplete activation have been reported. This article reviews the discovery of TRAIL and TRAIL receptors and subsequent studies that reveal how expression and function of caspase-8 are central to TRAIL-mediated cell death. This article is part of a Special Issue entitled "Apoptosis: Four Decades Later".

Cytosine arabinoside rapidly activates Bax-dependent apoptosis and a delayed Bax-independent death pathway in sympathetic neurons.

Cytosine arabinoside (ara-C) is a nucleoside analog used in the treatment of hematologic malignancies. One of the major side effects of ara-C chemotherapy is neurotoxicity. In this study, we have further characterized the cell death induced by ara-C in sympathetic neurons. Similar to neurons undergoing trophic factor deprivation-induced apoptosis, ara-C-exposed neurons became hypometabolic before death and upregulated c-myb, c-fos, and Bim. Bax deletion delayed, but did not prevent, ara-C toxicity. Neurons died by apoptosis, indicated by the release of mitochondrial cytochrome-c and caspase-3 activation. p53-deficient neurons demonstrated decreased sensitivity to ara-C, but neither p53 nor multiple p53-regulated genes were induced. Mature neurons showed increased ara-C resistance. These results demonstrate that molecular mechanisms underlying ara-C-induced death are similar to those responsible for trophic factor deprivation-induced apoptosis. However, substantial differences in neuronal death after these two distinct stress stimuli exist since ara-C toxicity, unlike the developmental death, can proceed in the absence of Bax.

Glycogen synthase kinase-3 beta activity is critical for neuronal death caused by inhibiting phosphatidylinositol 3-kinase or Akt but not for death caused by nerve growth factor withdrawal.

Numerous studies reveal that phosphatidylinositol (PI) 3-kinase and Akt protein kinase are important mediators of cell survival. However, the survival-promoting mechanisms downstream of these enzymes remain uncharacterized. Glycogen synthase kinase-3 beta (GSK-3 beta), which is inhibited upon phosphorylation by Akt, was recently shown to function during cell death induced by PI 3-kinase inhibitors. In this study, we tested whether GSK-3 beta is critical for the death of sympathetic neurons caused by the withdrawal of their physiological survival factor, the nerve growth factor (NGF). Stimulation with NGF resulted in PI 3-kinase-dependent phosphorylation of GSK-3 beta and inhibition of its protein kinase activity, indicating that GSK-3 beta is targeted by PI 3-kinase/Akt in these neurons. Expression of the GSK-3 beta inhibitor Frat1, but not a mutant Frat1 protein that does not bind GSK-3 beta, rescued neurons from death caused by inhibiting PI 3-kinase. Similarly, expression of Frat1 or kinase-deficient GSK-3 beta reduced death caused by inhibiting Akt. In NGF-maintained neurons, overexpression of GSK-3 beta caused a small but significant decrease in survival. However, expression of neither Frat1, kinase-deficient GSK-3 beta, nor GSK-3-binding protein inhibited NGF withdrawal-induced death. Thus, although GSK-3 beta function is required for death caused by inactivation of PI 3-kinase and Akt, neuronal death caused by NGF withdrawal can proceed through GSK-3 beta-independent pathways.

The survival of sympathetic neurons promoted by potassium depolarization, but not by cyclic AMP, requires phosphatidylinositol 3-kinase and Akt.

Phosphatidylinositol (PI) 3-kinase and Akt protein kinase mediate trophic factor-dependent survival in certain neurons. However, a role for these enzymes in neuronal survival promoted by other agents is unclear. We have tested PI 3-kinase and Akt for their role in survival promoted by membrane-depolarizing concentrations of extracellular potassium and the cell-permeable cyclic AMP analogue 8-(4-chlorophenylthio)cyclic AMP (cpt-cAMP). Depolarization of sympathetic neurons resulted in an increase in the activities of both PI 3-kinase and Akt. In addition, the PI 3-kinase inhibitor LY294002 was a potent inducer of cell death in depolarized neurons. Stimulation with cpt-cAMP resulted in relatively small increases in PI 3-kinase and Akt activities, and neurons maintained with cpt-cAMP were more resistant to LY294002-induced death than were depolarized neurons. Expression of either dominant-negative PI 3-kinase or dominant-negative Akt blocked survival promoted by depolarization but not by cpt-cAMP. These results indicate that a PI 3-kinase/Akt pathway is required for survival of sympathetic neurons mediated by depolarization but not by cpt-cAMP. Thus, the survival of sympathetic neurons can be maintained through PI 3-kinase/Akt-dependent and -independent pathways.

Expression of the SM-20 gene promotes death in nerve growth factor-dependent sympathetic neurons.

Sympathetic neurons undergo apoptosis when deprived of nerve growth factor (NGF). Inhibitors of RNA or protein synthesis block this death, suggesting that gene expression is important for apoptosis in this system. We have identified SM-20 as a new gene that increases in expression in sympathetic neurons after NGF withdrawal. Expression of SM-20 also increases during neuronal death caused by cytosine arabinoside or the phosphatidylinositol 3-kinase inhibitor LY294002. In addition, SM-20 protein synthesis is elevated in NGF-deprived neurons compared with neurons maintained with NGF. Importantly, expression of SM-20 in sympathetic neurons causes cell death in the presence of NGF. These results suggest that SM-20 may function to regulate cell death in neurons.

Phosphatidylinositol 3-kinase and Akt protein kinase are necessary and sufficient for the survival of nerve growth factor-dependent sympathetic neurons.

Recent studies have suggested a role for phosphatidylinositol (PI) 3-kinase in cell survival, including the survival of neurons. We used rat sympathetic neurons maintained in vitro to characterize the potential survival signals mediated by PI 3-kinase and to test whether the Akt protein kinase, a putative effector of PI 3-kinase, functions during nerve growth factor (NGF)-mediated survival. Two PI 3-kinase inhibitors, LY294002 and wortmannin, block NGF-mediated survival of sympathetic neurons. Cell death caused by LY294002 resembles death caused by NGF deprivation in that it is blocked by a caspase inhibitor or a cAMP analog and that it is accompanied by the induction of c-jun, c-fos, and cyclin D1 mRNAs. Treatment of neurons with NGF activates endogenous Akt protein kinase, and LY294002 or wortmannin blocks this activation. Expression of constitutively active Akt or PI 3-kinase in neurons efficiently prevents death after NGF withdrawal. Conversely, expression of dominant negative forms of PI 3-kinase or Akt induces apoptosis in the presence of NGF. These results demonstrate that PI 3-kinase and Akt are both necessary and sufficient for the survival of NGF-dependent sympathetic neurons.

Neuritic plaques in the Lewy body variant of Alzheimer disease lack paired helical filaments.

The Lewy body variant of Alzheimer disease (LBV) is a distinct category of dementia which, unlike pure diffuse Lewy body disease (DLBD), meets clinical and neuropathologic criteria for Alzheimer disease (AD) but differs from pure AD in having a neocortical predominance of diffuse and neuritic plaques (NP), with very few neurofibrillary tangles (NFT). We investigated the immunoreactivity of NP with a monoclonal antibody against paired helical filaments (PHF) composed of phosphorylated microtubule associated protein tau. With routine thioflavin-S preparations, 12 LBV and 14 AD cases had similar numbers of NP, but the LBV had significantly (P < 0.05) fewer NFT per microscopic field in the midfrontal cortex. Among subjects with midfrontal NFT, 81-84% of NP in AD and LBV were anti-PHF positive. Among subjects without midfrontal NFT, 52% of NP in AD but only 12% of NP in LBV cases were anti-PHF positive (P < 0.05). LBV differs from AD in that its NP generally do not contain PHF, unless they are accompanied by neocortical NFT.

Temporal distinctiveness and modality.

It has been proposed that auditory stimuli are more temporally discriminable in memory than visual stimuli. Studies using the continual-distractor paradigm have provided both supporting and contradictory evidence for this hypothesis. The conflicting reports differed, however, in the modality of the interleaved distractor tasks. The present experiments manipulated both word and distractor-task modality. Results showed that aurally presented word lists were more sensitive to temporal schedules of presentation when the distractor task was auditory than when it was visual. The same effect was not consistently found for visually presented word lists. Such an interaction may help explain the previously reported disparate findings and suggests that the auditory modality, in the presence of silent distraction, can reduce participants' use of temporal-distinctiveness information at retrieval.

Distinctiveness and very short-term serial position effects.

The serial position function reflects better memory for the first and last few items in a list than for the middle items. Four experiments examined the effects of temporal spacing on the serial position function for five-item lists that took between 0.5 seconds and 1.1 seconds to present. As with recall of far longer-lasting lists, recency and other robust serial position effects were observed with both free and serial recall. We demonstrate that temporal schedules of presentation control recall probability in predictable ways, and conclude that very fleeting lists obey similar principles as do longer-lasting lists. We compare both sets of findings with predictions from the dimensional distinctiveness framework.

Reaction of trifluoroacetaldehyde with amino acids, nucleotides, lipid nucleophiles, and their analogs.

Trihaloacetaldehydes are used as sedatives, are key intermediates in the metabolism of 1,1,1,2-tetrahaloethanes, some of which are chlorofluorocarbon substitutes, and are metabolites of trihaloethanols, which are intestinal and bone marrow toxins. In the present study, trifluoroacetaldehyde was used as a model to examine the reactions of trihaloacetaldehydes with cellular nucleophiles, including amino acids, nucleotides, and lipid components. Reaction of trifluoroacetaldehyde hydrate (10 mM) with amino acids (100 mM) in buffer at pH 7.0 and 30 degrees C showed that only L-cysteine formed stable adducts, which were identified as (2R,4R)- and (2S,4R)-2-(trifluoromethyl)thiazolidine-4-carboxylic acid. The absolute stereochemistry of (2R,4R)- and (2S,4R)-2-(trifluoromethyl)thiazolidine-4-carboxylic acid was determined by homonuclear Overhauser effect experiments. The diastereoisomers were formed in a 2.8:1 ratio at 37 degrees C and in a 1:4.0 ratio at 80 degrees C. Trifluoroacetaldehyde also reacted with L-cysteine methyl ester and 2-mercaptoethylamine to form stable thiazolidine derivatives, but did not react with N-acetyl-L-cysteine. The reaction of trifluoroacetaldehyde with the amino groups of ATP, GMP, CMP, L-citrulline, and urea resulted in the formation of stable imines. TMP, which lacks an exocyclic amino group, did not react. Glutathione reacted with trifluoroacetaldehyde to form (2R,5R)- and (2S,5R)-5-amino-6-[carboxymethyl)imino]-2-(trifluoromethyl)-1,3- oxathiane, whose formation was accompanied by simultaneous cleavage of the glutamyl moiety. The reactivity of nucleophilic groups with trifluoroacetaldehyde follows the order SH > NH2 > OH. The results of the present study indicate that trifluoroacetaldehyde covalently modifies cellular nucleophiles. The biological significance of these reactions warrants further investigation. The reaction of trifluoroacetaldehyde with L-cysteine and glutathione may afford routes for the stereoselective synthesis of cysteine prodrugs and five- or six-membered heterocyclic compounds.

Megestrol acetate stimulates food and water intake in the rat: effects on regional hypothalamic neuropeptide Y concentrations.

Megestrol acetate, a synthetic progestogen, stimulates appetite through an unknown mechanism. We tested the hypothesis that it might act, at least in part, by stimulating the activity of hypothalamic pathways containing neuropeptide Y, a potent central appetite stimulant in rats. Administration of megestrol acetate (50 mg/kg/day, n = 8) for 9 days significantly increased food and water intake compared with untreated controls (n = 8). Treated rats showed significant (90-140%) increases in neuropeptide Y concentrations in the arcuate nucleus (where neuropeptide Y is synthesized), in the lateral hypothalamic area (through which arcuate neurones project) and in the medial preoptic area, ventromedial nucleus and dorsomedial nucleus. The latter are sites of neuropeptide Y release and sensitive to neuropeptide Y-induced hyperphagia. Megestrol acetate may therefore stimulate neuropeptide Y synthesis, transport and release, and this could contribute to its appetite-stimulating effects.

Auditory recency in immediate memory.

Six experiments investigated the locus of the recency effect in immediate serial recall. Previous research has shown much larger recency for speech as compared to non-speech sounds. We compared two hypotheses: (1) speech sounds are processed differently from non-speech sounds (e.g. Liberman & Mattingly, 1985); and (2) speech sounds are more familiar and more discriminable than non-speech sounds (e.g. Nairne, 1988, 1990). In Experiments 1 and 2 we determined that merely varying the label given to the sets of stimuli (speech or non-speech) had no effect on recency or overall recall. We varied the familiarity of the stimuli by using highly trained musicians as subjects (Experiments 3 and 4) and by instructing subjects to attend to an unpracticed dimension of speech (Experiment 6). Discriminability was manipulated by varying the acoustic complexity of the stimuli (Experiments 3, 5, and 6) or the pitch distance between the stimuli (Experiment 4). Although manipulations of discriminability and familiarity affected overall level of recall greatly, in no case did discriminability or familiarity alone significantly enhance recency. What seems to make a difference in the occurrence of convincing recency is whether the items being remembered are undegraded speech sounds.

Short-term memory: where do we stand?

Two empirical challenges to the traditional "modal model" of short-term memory are that neither the Brown-Peterson distractor technique nor the recency effect in recall is well accommodated by that position. Additionally, the status of memory stores as such, has declined in response to proceduralist thinking. At the same time, the concept of coding, on which the modal model is silent, is increasingly central to memory theory. People need to remember things in the short term, but a dedicated store does not need to be the agency.

The role of spectral and dynamic cues in imagery for musical timbre.

The musical quality of timbre is based on both spectral and dynamic acoustic cues. Four 2-part experiments examined whether these properties are represented in the mental image of a musical timbre. Experiment 1 established that imagery occurs for timbre variations within a single musical instrument, using plucked and bowed tones from a cello. Experiments 2 and 3 used synthetic stimuli that varied in either spectral or dynamic properties only, to investigate imagery with strict acoustic control over the stimuli. Experiment 4 explored whether the dimension of loudness is stored in an auditory image. Spectral properties appear to play a much larger role than dynamic properties in imagery for musical timbre.

Stimulus order effects in vowel discrimination.

In same-different discrimination tasks employing isolated vowel sounds, subjects often give significantly more "different" responses to one order of two stimuli than to the other order. Cowan and Morse [J. Acoust. Soc. Am. 79, 500-507 (1986)] proposed a neutralization hypothesis to account for such effects: The first vowel in a pair is assumed to change its quality in memory in the direction of the neutral vowel, schwa. Three experiments were conducted using a variety of vowels and some initial support for the hypothesis was obtained, using a large stimulus set, but conflicting evidence with smaller stimulus sets. Rather than becoming more similar to schwa, the first vowel in a pair seems to drift toward the interior of the stimulus range employed in a given test. Several possible explanations are discussed for this tendency and its relation to presentation order effects obtained in other psychophysical paradigms is noted.

Physical interaction and association by contiguity in memory for the words and melodies of songs.

Three experiments were designed to investigate two explanations for the integration effect in memory for songs (Serafine, Crowder, & Repp, 1984; Serafine, Davidson, Crowder, & Repp, 1986). The integration effect is the finding that recognition of the melody (or text) of a song is better in the presence of the text (or melody) with which it had been heard originally than in the presence of a different text (or melody). One explanation for this finding is the physical interaction hypothesis, which holds that one component of a song exerts subtle but memorable physical changes on the other component, making the latter different from what it would be with a different companion. In Experiments 1 and 2, we investigated the influence that words could exert on the subtle musical character of a melody. A second explanation for the integration effect is the association-by-contiguity hypothesis, which holds that any two events experienced in close temporal proximity may become connected in memory such that each acts as a recall cue for the other. In Experiment 3, we investigated the degree to which simultaneous presentations of spoken text with a hummed melody would induce an association between the two components. The results gave encouragement for both explanations and are discussed in terms of the distinction between encoding specificity and independent associative bonding.