Comparison of the Sensitivity and Specificity of Commercial Anti-Dengue Virus IgG Tests to Identify Persons Eligible for Dengue Vaccination.

The Advisory Committee on Immunization Practices (ACIP) recommended that dengue pre-vaccination screening tests for Dengvaxia administration have at least 98% specificity and 75% sensitivity. This study evaluates the performance of commercial anti-DENV IgG tests to identify tests that could be used for pre-vaccination screening. First, for 7 tests, we evaluated sensitivity and specificity in early convalescent dengue virus (DENV) infection, using 44 samples collected 7-30 days after symptom onset and confirmed by RT-PCR. Next, for the 5 best performing tests and two additional tests (with and without an external test reader) that became available later, we evaluated performance to detect past dengue infection among a panel of 44 specimens collected in 2018-2019 from healthy 9-16-year-old children from Puerto Rico. Finally, a full-scale evaluation was done with the 4 best performing tests using 400 specimens from the same population. We used virus focus reduction neutralization test and an in-house DENV IgG ELISA as reference standards. Of seven tests, five showed ≥75% sensitivity detecting anti-DENV IgG in early convalescent specimens with low cross-reactivity to Zika virus. For the detection of previous DENV infections the tests with the highest performance were the Euroimmun NS1 IgG ELISA (sensitivity 84.5%, specificity 97.1%) and CTK Dengue IgG rapid test R0065C with the test reader (sensitivity 76.2% specificity 98.1%). There are IgG tests available that can be used to accurately classify individuals with previous DENV infection as eligible for dengue vaccination to support safe vaccine implementation.

Macrophages use a bet-hedging strategy for antimicrobial activity in phagolysosomal acidification.

Microbial ingestion by a macrophage results in the formation of an acidic phagolysosome but the host cell has no information on the pH susceptibility of the ingested organism. This poses a problem for the macrophage and raises the fundamental question of how the phagocytic cell optimizes the acidification process to prevail. We analyzed the dynamical distribution of phagolysosomal pH in murine and human macrophages that had ingested live or dead Cryptococcus neoformans cells, or inert beads. Phagolysosomal acidification produced a range of pH values that approximated normal distributions, but these differed from normality depending on ingested particle type. Analysis of the increments of pH reduction revealed no forbidden ordinal patterns, implying that the phagosomal acidification process was a stochastic dynamical system. Using simulation modeling, we determined that by stochastically acidifying a phagolysosome to a pH within the observed distribution, macrophages sacrificed a small amount of overall fitness to gain the benefit of reduced variation in fitness. Hence, chance in the final phagosomal pH introduces unpredictability to the outcome of the macrophage-microbe, which implies a bet-hedging strategy that benefits the macrophage. While bet hedging is common in biological systems at the organism level, our results show its use at the organelle and cellular level.

Duration of the Presence of Infectious Zika Virus in Semen and Serum.

Zika virus (ZIKV) has recently caused a large epidemic in the Americas that is associated with birth defects. Although ZIKV is primarily transmitted by Aedes mosquitoes, ZIKV RNA is detectable in blood and semen of infected individuals for weeks or months, during which sexual and other modes of transmission are possible. However, viral RNA is usually detectable longer than infectious virus is present. We determined the frequency of isolation of infectious virus from semen and serum samples prospectively obtained from a cohort of patients in Puerto Rico. We confirmed isolation of infectious virus on the basis of a tissue culture cytopathic effect, an increase in virus genome copy equivalents (GCE), and positive results of immunofluorescence analysis; virus in infected cells was quantitated by flow cytometry. These criteria confirmed the presence of infectious virus in semen specimens from 8 of 97 patients for up to 38 days after initial detection when virus loads are >1.4 × 106 genome copy equivalents/mL. Two serum isolates were obtained from 296 patients. These findings can help guide important prevention guidelines for persons that may potentially be infectious and transmit ZIKV sexually.

The Capsule of Cryptococcus neoformans Modulates Phagosomal pH through Its Acid-Base Properties.

Phagosomal acidification is a critical cellular mechanism for the inhibition and killing of ingested microbes by phagocytic cells. The acidic environment activates microbicidal proteins and creates an unfavorable environment for the growth of many microbes. Consequently, numerous pathogenic microbes have developed strategies for countering phagosomal acidification through various mechanisms that include interference with phagosome maturation. The human-pathogenic fungus Cryptococcus neoformans resides in acidic phagosomes after macrophage ingestion that actually provides a favorable environment for replication, since the fungus replicates faster at acidic pH. We hypothesized that the glucuronic acid residues in the capsular polysaccharide had the capacity to affect phagosomal acidity through their acid-base properties. A ratiometric fluorescence comparison of imaged phagosomes containing C. neoformans to phagosomes containing beads showed that the latter were significantly more acidic. Similarly, phagosomes containing nonencapsulated C. neoformans cells were more acidic than those containing encapsulated cells. Acid-base titrations of isolated C. neoformans polysaccharide revealed that it behaves as a weak acid with maximal buffering capacity around pH 4 to 5. We interpret these results as indicating that the glucuronic acid residues in the C. neoformans capsular polysaccharide can buffer phagosomal acidification. Interference with phagosomal acidification represents a new function for the cryptococcal capsule in virulence and suggests the importance of considering the acid-base properties of microbial capsules in the host-microbe interaction for other microbes with charged residues in their capsules.IMPORTANCECryptococcus neoformans is the causative agent of cryptococcosis, a devastating fungal disease that affects thousands of individuals worldwide. This fungus has the capacity to survive inside phagocytic cells, which contributes to persistence of infection and dissemination. One of the major antimicrobial mechanisms of host phagocytes is to acidify the phagosomal compartment after ingestion of microbes. This study shows that the capsule of C. neoformans can interfere with full phagosomal acidification by serving as a buffer.

The Outcome of the Cryptococcus neoformans-Macrophage Interaction Depends on Phagolysosomal Membrane Integrity.

Cryptococcus neoformans is a fungal pathogen with worldwide distribution. C. neoformans resides within mature phagolysosomes where it often evades killing and replicates. C. neoformans induces phagolysosomal membrane permeabilization (PMP), but the mechanism for this phenomenon and its consequences for macrophage viability are unknown. In this study, we used flow cytometry methodology in combination with cell viability markers and LysoTracker to measure PMP in J774.16 and murine bone marrow-derived macrophages infected with C. neoformans Our results showed that cells manifesting PMP were positive for apoptotic markers, indicating an association between PMP and apoptosis. We investigated the role of phospholipase B1 in C. neoformans induction of PMP. Macrophages infected with a C. neoformans Δplb1 mutant had reduced PMP compared with those infected with wild-type and phospholipase B1-complemented strains, suggesting a mechanism of action for this virulence factor. Capsular enlargement inside macrophages was identified as an additional likely mechanism for phagolysosomal membrane damage. Macrophages undergoing apoptosis did not maintain an acidic phagolysosomal pH. Induction of PMP with ciprofloxacin enhanced macrophages to trigger lytic exocytosis whereas nonlytic exocytosis was common in those without PMP. Our results suggest that modulation of PMP is a critical event in determining the outcome of C. neoformans-macrophage interaction.

Cryptococcus neoformans urease affects the outcome of intracellular pathogenesis by modulating phagolysosomal pH.

Cryptococcus neoformans is a facultative intracellular pathogen and its interaction with macrophages is a key event determining the outcome of infection. Urease is a major virulence factor in C. neoformans but its role during macrophage interaction has not been characterized. Consequently, we analyzed the effect of urease on fungal-macrophage interaction using wild-type, urease-deficient and urease-complemented strains of C. neoformans. The frequency of non-lytic exocytosis events was reduced in the absence of urease. Urease-positive C. neoformans manifested reduced and delayed intracellular replication with fewer macrophages displaying phagolysosomal membrane permeabilization. The production of urease was associated with increased phagolysosomal pH, which in turn reduced growth of urease-positive C. neoformans inside macrophages. Interestingly, the ure1 mutant strain grew slower in fungal growth medium which was buffered to neutral pH (pH 7.4). Mice inoculated with macrophages carrying urease-deficient C. neoformans had lower fungal burden in the brain than mice infected with macrophages carrying wild-type strain. In contrast, the absence of urease did not affect survival of yeast when interacting with amoebae. Because of the inability of the urease deletion mutant to grow on urea as a sole nitrogen source, we hypothesize urease plays a nutritional role involved in nitrogen acquisition in the environment. Taken together, our data demonstrate that urease affects fitness within the mammalian phagosome, promoting non-lytic exocytosis while delaying intracellular replication and thus reducing phagolysosomal membrane damage, events that could facilitate cryptococcal dissemination when transported inside macrophages. This system provides an example where an enzyme involved in nutrient acquisition modulates virulence during mammalian infection.

Conservation of Intracellular Pathogenic Strategy among Distantly Related Cryptococcal Species.

The genus Cryptococcus includes several species pathogenic for humans. Until recently, the two major pathogenic species were recognized to be Cryptococcus neoformans and Cryptococcus gattii We compared the interaction of murine macrophages with three C. gattii species complex strains (WM179, R265, and WM161, representing molecular types VGI, VGIIa, and VGIII, respectively) and one C. neoformans species complex strain (H99, molecular type VNI) to ascertain similarities and differences in the yeast intracellular pathogenic strategy. The parameters analyzed included nonlytic exocytosis frequency, phagolysosomal pH, intracellular capsular growth, phagolysosomal membrane permeabilization, and macrophage transcriptional response, assessed using time-lapse microscopy, fluorescence microscopy, flow cytometry, and gene expression microarray analysis. The most striking result was that the intracellular pathogenic strategies of C. neoformans and C. gattii species complex strains were qualitatively similar, despite the species having separated an estimated 100 million years ago. Macrophages exhibited a leaky phagolysosomal membrane phenotype and nonlytic exocytosis when infected with either C. gattii or C. neoformans Conservation of the intracellular strategy among species that separated long ago suggests that it is ancient and possibly maintained by similar selection pressures through eons.

Life Science's Average Publishable Unit (APU) Has Increased over the Past Two Decades.

Quantitative analysis of the scientific literature is important for evaluating the evolution and state of science. To study how the density of biological literature has changed over the past two decades we visually inspected 1464 research articles related only to the biological sciences from ten scholarly journals (with average Impact Factors, IF, ranging from 3.8 to 32.1). By scoring the number of data items (tables and figures), density of composite figures (labeled panels per figure or PPF), as well as the number of authors, pages and references per research publication we calculated an Average Publishable Unit or APU for 1993, 2003, and 2013. The data show an overall increase in the average ± SD number of data items from 1993 to 2013 of approximately 7±3 to 14±11 and PPF ratio of 2±1 to 4±2 per article, suggesting that the APU has doubled in size over the past two decades. As expected, the increase in data items per article is mainly in the form of supplemental material, constituting 0 to 80% of the data items per publication in 2013, depending on the journal. The changes in the average number of pages (approx. 8±3 to 10±3), references (approx. 44±18 to 56±24) and authors (approx. 5±3 to 8±9) per article are also presented and discussed. The average number of data items, figure density and authors per publication are correlated with the journal's average IF. The increasing APU size over time is important when considering the value of research articles for life scientists and publishers, as well as, the implications of these increasing trends in the mechanisms and economics of scientific communication.

Macrophage mitochondrial and stress response to ingestion of Cryptococcus neoformans.

Human infection with Cryptococcus neoformans, a common fungal pathogen, follows deposition of yeast spores in the lung alveoli. The subsequent host-pathogen interaction can result in eradication, latency, or extrapulmonary dissemination. Successful control of C. neoformans infection is dependent on host macrophages, but macrophages display little ability to kill C. neoformans in vitro. Recently, we reported that ingestion of C. neoformans by mouse macrophages induces early cell cycle progression followed by mitotic arrest, an event that almost certainly reflects host cell damage. The goal of the present work was to understand macrophage pathways affected by C. neoformans toxicity. Infection of macrophages by C. neoformans was associated with alterations in protein translation rate and activation of several stress pathways, such as hypoxia-inducing factor-1-α, receptor-interacting protein 1, and apoptosis-inducing factor. Concomitantly we observed mitochondrial depolarization in infected macrophages, an observation that was replicated in vivo. We also observed differences in the stress pathways activated, depending on macrophage cell type, consistent with the nonspecific nature of C. neoformans virulence known to infect phylogenetically distant hosts. Our results indicate that C. neoformans infection impairs multiple host cellular functions and undermines the health of these critical phagocytic cells, which can potentially interfere with their ability to clear this fungal pathogen.

Slug promotes survival during metastasis through suppression of Puma-mediated apoptosis.

Tumor cells must overcome apoptosis to survive throughout metastatic dissemination and distal organ colonization. Here, we show in the Polyoma Middle T mammary tumor model that N-cadherin (Cdh2) expression causes Slug (Snai2) upregulation, which in turn promotes carcinoma cell survival. Slug was dramatically upregulated in metastases relative to primary tumors. Consistent with a role in metastasis, Slug knockdown in carcinoma cells suppressed lung colonization by decreasing cell survival at metastatic sites, but had no effect on tumor cell invasion or extravasation. In support of this idea, Slug inhibition by shRNA sensitized tumor cells to apoptosis by DNA damage, resulting in caspase-3 and PARP cleavage. The prosurvival effect of Slug was found to be caused by direct repression of the proapoptotic gene, Puma (Bbc3), by Slug. Consistent with a pivotal role for a Slug-Puma axis in metastasis, inhibition of Puma by RNA interference in Slug-knockdown cells rescued lung colonization, whereas Puma overexpression in control tumor cells suppressed lung metastasis. The survival function of the Slug-Puma axis was confirmed in human breast cancer cells, where Slug knockdown increased Puma expression and inhibited lung colonization. This study demonstrates a pivotal role for Slug in carcinoma cell survival, implying that disruption of the Slug-Puma axis may impinge on the survival of metastatic cells.

La satisfacción del usuario: instrumento para valorar el resultado del proceso asistencial en un servicio de urgencias de atención primaria / No disponible

No disponible

[Primary care urgent service. Study of patient perceived quality and satisfaction in the Altamira health (Spain) catchment area]. / Servicio de urgencias de atención primaria. Estudio de calidad percibida y satisfacción de los usuarios de la zona básica de salud Altamira.

OBJECTIVE: User satisfaction is useful tool to assess the care process, as it provides information on the perceived quality, and can be included as a measurement in the improvement of quality. The Cantabrian Service of Health created the primary care urgent service (PCUS) in 2005, to provide a better service for emergencies, by the rational use of material and human resources, and to satisfy the needs of the population. After a year of its introduction, the Altamira PCUS developed this study, as a means of analysing the opinions of the health users, and to find out their opinions as regards satisfaction and perceived quality, and to see if the needs for which the service was created are satisfied. METHOD: Descriptive cross-sectional study performed during March, 2006. The subjects were patients seen in the PCUS. The research technique used was a self-administered questionnaire, based on SERVQUAL and SERVQHOS, sent by post; the outcomes were considered to be the satisfaction and confidence in the PCUS, and independent variables the sociodemographic characteristics of the users. RESULTS: The patients (81.8%) were generally satisfied with the PCUS service, and 72.5% had confidence in it as a whole. CONCLUSIONS: The setting up of a PCUS has led to an improvement for patients in the Altamira catchment area. This service meets expectations and provides adequate care, as demonstrated by the opinions of the users in the questionnaire, with a high degree of satisfaction (81.8%).

Servicio de urgencias de atención primaria. Estudio de calidad percibida y satisfacción de los usuarios de la zona básica de salud Altamira / Primary care urgent service. Study of patient perceived quality and satisfaction in the Altamira health (Spain) catchment area

Fundamento: La satisfacción del usuario es un instrumento útil para valorar el proceso asistencial, ya que proporciona información sobre la calidad percibida, y se puede incorporar como medida de mejora de la calidad. El Servicio Cántabro de Salud creó en2005 los servicios de urgencias de atención primaria (SUAP), para lograr mejor atención de las demandas urgentes, mediante uso racional de recursos materiales y humanos, y satisfacer las necesidades de la población. Tras un año de implantación, el SUAP Altamira desarrolló este estudio, mediante análisis de opinión de los usuarios asistidos, para conocer su valoración respecto a satisfacción y calidad percibida, y ver si las necesidades por las que se creó el servicio están cubiertas. Método: Estudio descriptivo transversal durante marzo de 2006. El objeto de análisis fueron los pacientes atendidos en el SUAP. La técnica de investigación fue un cuestionario autocumplimentado, basado en SERVQUAL y SERVQHOS, remitido por correo postal; se consideró variable resultado la satisfacción y la confianza en el SUAP, y variables independientes, las características sociodemográficas de los usuarios. Resultados: De forma general, el 81,8% de los usuarios han respondido estar satisfechos con el SUAP, y respecto a la confianza que refieren tener en el SUAP, el total es del72,5%. Conclusiones: La instauración del SUAP ha supuesto una mejora asistencial para los habitantes de la zona básica de salud Altamira. Este servicio cumple las expectativas y atención adecuada, así lo demuestra la opinión reflejada por los usuarios sobre los aspectos consultados, con un alto grado de satisfacción (81,8%) (AU)

Objective: User satisfaction is useful tool to assess the care process, as it provides information on the perceived quality, and can be included as a measurement in the improvement of quality. The Cantabrian Service of Health created the primary care urgent service (PCUS) in 2005, to provide a better service for emergencies, by the rational use of material and human resources, and to satisfy the needs of the population. After a year of its introduction, the Altamira PCUS developed this study, as a means of analyzing the opinions of the health users, and to find out their opinions as regards satisfaction and perceived quality, and to see if the needs for which the service was created are satisfied. Method: Descriptive cross-sectional study performed during March, 2006. The subjects were patients seen in the PCUS. The research technique used was a self-administered questionnaire, based on SERVQUAL and SERVQHOS, sent by post; the outcomes were considered to be the satisfaction and confidence in the PCUS, and independent variables the sociodemographic characteristics of the users. Results: The patients (81.8%) were generally satisfied with the PCUS service, and 72.5%had confidence in it as a whole. Conclusions: The setting up of a PCUS has led to an improvement for patients in the Altamira catchment area. This service meets expectations and provides adequate care, as demonstrated by the opinions of the users in the questionnaire, with a high degree of satisfaction (81.8%) (AU)

Actualizando el registro del proceso asistencial en urgencias de atención primaria. Mejora del informe clínico / No disponible

No disponible

Factores biosociales relacionados con la maternidad precoz, 2006 / Biosocial factors associated with precocius maternity, 2006

En la maternidad precoz están implícitos un grupo de factores biosociales que influyen en el adecuado desarrollo del embarazo y parto, los cuales inciden en el resultado peri natal, por lo antes expuesto realizamos un estudio correlacional, observacional de todas las mujeres con maternidad precoz residentes en el municipio Manzanillo, que tuvieron el parto en el hospital Fé del Valle Ramos en el período comprendido de Enero a Diciembre 2006 con el propósito de describir la presencia de factores biosociales, su frecuencia y la influencia sobre el producto de la concepción y su madre adolescente. La información se obtuvo realizando la revisión del libro estadístico de parto, historia clínica, carné obstétrico y encuesta que incluyó el consentimiento informado. Se identificaron factores biológicos y sociales que repercuten en la maternidad precoz, edad, escolaridad, estado conyugal, antecedentes obstétricos, patologías asociadas, procedencia y resultado del producto de la concepción. En el estudio realizado se observa que gestantes de 15-19 años constituyeron el mayor por ciento con un 96.7 por ciento, por otra parte la escolaridad de 7mo a 9no grado representó el 62,5 por ciento(AU)

In precocius maternity there is a group of biosocial factors that influence upon the pregnancy and labour development which influence of the perinatal result, a correlational-observational study was carried out to all women with precocious maternity in Fe del Valle Ramos hospital, Manzanillo, municipality, fron January to December 2006 to describe the presence of biosocial factors, its frequency and the influence over the product of the conception and its adolescent mother.The information was obtained Thorough The revisal of labour statistics book,clinical antecedents, obstetric-clinic card and a survey that included the adequated consent. There were biological and socials factors that repel in the precocious maternity, age, scholarship, marital status, obstetrics antecedent, associated pathologies, origin and results of the conception product.In the research it was observed that pregnants of 15-19 years old constituted the greatest parcent with 96,7 per cent. On the other hand the 7ta-9tth granders represent ed the 62,5 per cent(EU)