Linking classification and therapeutic management of vasculitides

Vasculitides are classified by the size, type and location of the predominantly involved vessels and by their primary or secondary nature. Their treatment depends on the type of vasculitis, its etiology (when known), and its severity and must be further adjusted by the individual characteristics and comorbidities of patients. In this paper, we review how the classification and definition of vasculitides have evolved over the past years and how it has affected therapeutic changes. As new genetic markers are being discovered and the pathogenesis of vasculitides continues to be elucidated, further modifications in classification and treatment can be expected.     

Microbial considerations in genetically engineered mouse research

Microbial infections have long been of concern to scientists using laboratory rodents because of their potential to confound and invalidate research. With the explosion of genetically engineered mice (GEM), new concerns over the impact of microbial agents have emerged because these rodents in many cases are more susceptible to disease than their inbred or outbred counterparts. Moreover, interaction between microbe and host and the resulting manifestation of disease conceivably differ between GEM and their inbred and outbred counterparts. As a result, infections may alter the GEM phenotype and confound interpretation of results and conclusions about mutated gene function. In addition, because GEM are expensive to produce and maintain, contamination by pathogens or opportunists has severe economic consequences. This review addresses how microbial infections may influence phenotype, how immunomodulation of the host as the result of induced mutations may modify host susceptibility to microbial infections, how novel host:microbe interactions have led to the development of new animal models for disease, how phenotype changes have led to the discovery of new pathogens, and new challenges associated with prevention and control of microbial infections in GEM. Although the focus is on naturally occurring infections, extensive literature on the use of GEM in studies of microbial pathogenesis also exists, and the reader is referred to this literature if microbial infection is a suspected culprit in phenotype alteration.     

Tiny terminological disagreements with far reaching consequences for global bird trends

Various combinations of data and expert opinion have been used to select species for indices of bird trends. Commonly these indices break species into groups based on their habitat preference such as woodland specialist, farmland specialist and generalist birds. It is unclear what influence differences in how species are allocated to these groups might have on trends in these indices. There is uncertainty surrounding reported trends in these bird groups with studies variously showing declines or increases in prevalence. This is usually attributed to ecological factors but if studies classify bird groups differently this variation may be due to inconsistency in classification. Disagreement about whether these bird groups are stable, increasing or declining has the potential to obscure important changes in bird prevalence and impede appropriate, timely conservation.We examined how consistently European and Australian researchers classified woodland, farmland and generalist birds, and whether this affected the trends in indices of these groups. Researchers from both regions classified species differently, and the population trends seen in these groups were strongly affected by differences in classification. While all classifications we studied suggest that populations are consistently declining for Australian woodland and European farmland birds and increasing for European woodland birds. European generalist and Australian farmland and generalist birds may be seen as increasing or decreasing in prevalence depending on classification.Our results question the current practice of idiosyncratically classifying indicators in scientific research and conservation. Current practice is making it more difficult to infer whether, when and how to preserve bird groups in Europe and Australia, potentially leading to sub-optimal biodiversity outcomes. We offer suggestions for building consensus on how to classify these bird groups in order to provide more reliable evidence to support conservation decisions.     

Schistosoma mansoni: description of the head gland of cercariae and schistosomules at the ultrastructural level.

The head gland of the cercaria of Schistosoma mansoni appears to be a relatively large unicellular entity consisting of a fundus tapering into a system of multiple ducts that opens into the integument at the anterior end of the oral sucker. The fundus is located in the posteriodorsal area of the oral sucker and contains most of the secretory granules. The ducts are usually narrow and devoid of secretory granules especially near their integumental junctions in the cercaria. In Schistosomules of S. mansoni the fundus is reduced and the ducts are distended as secretory granules move en masse into the integument during the penetration of cercaria into their host where they may provide material for repair of the integument of the oral sucker damaged during penetration. The head gland has a strong affinity for luxol fast blue and acid hematin stains which suggests the presence of phospholipids.     

Media Ion Composition Controls Regulatory and Virulence Response of Salmonella in Spaceflight

The spaceflight environment is relevant to conditions encountered by pathogens during the course of infection and induces novel changes in microbial pathogenesis not observed using conventional methods. It is unclear how microbial cells sense spaceflight-associated changes to their growth environment and orchestrate corresponding changes in molecular and physiological phenotypes relevant to the infection process. Here we report that spaceflight-induced increases in Salmonella virulence are regulated by media ion composition, and that phosphate ion is sufficient to alter related pathogenesis responses in a spaceflight analogue model. Using whole genome microarray and proteomic analyses from two independent Space Shuttle missions, we identified evolutionarily conserved molecular pathways in Salmonella that respond to spaceflight under all media compositions tested. Identification of conserved regulatory paradigms opens new avenues to control microbial responses during the infection process and holds promise to provide an improved understanding of human health and disease on Earth.     

Glaucoma classification based on intra-class and extra-class discriminative correlation and consensus ensemble classifier

Automatic classification of glaucoma from fundus images is a vital diagnostic tool for Computer-Aided Diagnosis System (CAD). In this work, a novel fused feature extraction technique and ensemble classifier fusion is proposed for diagnosis of glaucoma. The proposed method comprises of three stages. Initially, the fundus images are subjected to preprocessing followed by feature extraction and feature fusion by Intra-Class and Extra-Class Discriminative Correlation Analysis (IEDCA). The feature fusion approach eliminates between-class correlation while retaining sufficient Feature Dimension (FD) for Correlation Analysis (CA). The fused features are then fed to the classifiers namely Support Vector Machine (SVM), Random Forest (RF) and K-Nearest Neighbor (KNN) for classification individually. Finally, Classifier fusion is also designed which combines the decision of the ensemble of classifiers based on Consensus-based Combining Method (CCM). CCM based Classifier fusion adjusts the weights iteratively after comparing the outputs of all the classifiers. The proposed fusion classifier provides a better improvement in accuracy and convergence when compared to the individual algorithms. A classification accuracy of 99.2% is accomplished by the two-level hybrid fusion approach. The method is evaluated on the public datasets High Resolution Fundus (HRF) and DRIVE datasets with cross dataset validation.     

The role of solvent exclusion in the interaction between D124 and the metal site in SOD1: implications for ALS

Structural changes in the metal site of the copper–zinc superoxide dismutase (SOD1) are involved in the various mechanisms proposed for the pathogenesis of the SOD1-linked familial form of amyotrophic lateral sclerosis (ALS). Elucidating how the metal site of SOD1 can be disrupted by ALS-linked mutations is important for a better understanding of the pathogenesis of the disease and for developing more efficient treatments. Residue D124, a second-sphere ligand of the copper and zinc ions, is known from experimental studies to be essential for the integrity of the metal-site structure. In this work, we used density functional theory calculations and molecular dynamics simulations to elucidate which factors keep D124 attached to the metal site and how structural changes may disrupt the binding between D124 and the metal first-sphere ligands. The calculations show that D124 is kept attached to the metal site in a kinetic trap. The exclusion of solvent molecules by the electrostatic loop of the protein is found to create the binding of D124 to the metal site. The calculations also indicate that changes in the structure of the electrostatic loop of the protein can weaken the D124–metal site interaction, lowering the affinity of the zinc site for the metal. Destabilization of the electrostatic loop of SOD1 has been previously shown to be a common property of ALS-linked variants of the protein, but its role in the pathogenesis of SOD1-linked ALS has not been elucidated.     

Endotoxins and their significance for murine trypanosomiasis

The study of endotoxins is complicated by their heterogenous nature, their multiple effects and the complex methodologies required for their identification. In this brief review, Vic Pentreath summarizes how the substances have been implicated in the pathogenesis of several diseases caused by parasitic protozoa, and how the parasites (eg. Plasmodium falciparum and Trypanosoma cruzi) may themselves contain endotoxin-like materials. Recent studies have shown that, during T. b. brucei infection in mice, serum endotoxin levels become markedly elevated and that endotoxin-like substances are also present in the purified parasite extracts.     

Changes in gastric endocrine cells in Balb/c mice bearing CT-26 carcinoma cells: an immunohistochemical study

The distribution and density of gastric endocrine cells in Balb/c mice bearing CT-26 carcinoma cells were studied immunohistochemically employing specific antisera against serotonin, somatostatin, glucagon, gastrin, cholecystokinin (CCK)-8 and human pancreatic polypeptide (hPP). The animals were divided into two groups, a non-implanted sham group and a CT-26 carcinoma cell-implanted group. Samples were collected from two regions of the stomach (fundus and pylorus) at 28 days after implantation of the medium or the CT-26 cells (1x10(5) cells/mouse). Five of the 6 types of immunoreactive (IR) cells were identified, with only the hPP IR cells not being detected. The regional distribution of the gastric endocrine cells in the CT-26 implanted group was similar to that of the non-implanted sham group. However, the endocrine cells were significantly decreased in the CT-26-implanted group as compared to those of the non-implanted sham group. Serotonin- and somatostatin-IR cells in the fundus and pylorus , and gastrin- and CCK-8-IR cells in the pylorus of the CT-26 implanted groups were significantly decreased compared to those of the sham group. In addition, glucagon-IR cells were restricted only to the fundus of the sham animals. hPP-IR cells were not detected in either the T-26 implanted- or the non-implanted group. Since endocrine cells are the anatomical units responsible for the production of gut hormones, a change in their density may reflect a change in their capacity to produce such hormones. Implantation of the tumor cell mass induced severe quantitative changes in gastric endocrine cell density, an abnormality which may contribute to the development of gastrointestinal symptoms, such as anorexia and indigestion, frequently encountered in cancer patients.     

Further evidence that the serotonin receptor in the rat stomach fundus is not 5HT1A or 5HT1B

The nature of the receptor mediating serotonin contraction in the rat stomach fundus has not been clearly associated with either 5HT1 or 5HT2 receptors. We have explored the possibility that such receptors in the rat fundus may better correlate with 5HT1A or 5HT1B receptor subtypes as defined by radiolabeled ligand binding studies with brain cortical membranes. Meta chlorophenylpiperazine (CPP) and meta trifluoromethylphenylpiperazine (TFMPP), selective ligands for the 5HT1B receptor and LY165163, a selective ligand for the 5HT1A receptor, have been evaluated for their agonist and antagonist activity at serotonin receptors in the rat stomach fundus. CPP and TFMPP were partial agonists in the rat stomach fundus whereas LY165163 showed no agonist activity in this smooth muscle in concentrations up to 10(-4)M. All three phenylpiperazines antagonized serotonin-induced contractions in the rat stomach fundus. The affinity for serotonin receptors in the rat fundus was similar for all three phenylpiperazines in spite of the reported selectivity of MCPP and TFMPP for 5HT1B and of LY165163 for 5HT1A receptors. Furthermore, the affinity of these agents for serotonin receptors in the rat stomach fundus did not agree with their reported affinity for either 5HT1A or 5HT1B binding sites in rat cortical membranes. Thus, the similarity in affinities of these phenylpiperazine derivatives for serotonin receptors mediating contraction in the rat fundus along with their different affinities for 5HT1A and 5HT1B binding sites argues against the possibility that the serotonin receptor in the rat fundus is of the 5HT1A or 5HT1B subtype of serotonin receptor.     

Association between Blood Lead Levels and Age-Related Macular Degeneration

Purpose

To investigate the association between blood lead levels and prevalence of age-related macular degeneration (AMD).

Methods

A nationwide population-based cross-sectional study included 4,933 subjects aged over 40 years who participated in the 2008–2012 Korean National Health and Nutrition Examination Survey, and for whom fundus photographs were available. All participants underwent a standardized interview, evaluation of blood lead concentration, and a comprehensive ophthalmic examination. Digital fundus photographs (45°) were taken of both eyes under physiological mydriasis. All fundus photographs were graded using an international classification and grading system.

Results

Mean blood lead levels were 3.15 μg/dL in men and 2.27 μg/dL in women (P < 0.001). After adjusting for potential confounders including age, gender, smoking status, total cholesterol levels, triglyceride levels, heart problems and strokes, the adjusted odds ratio (OR) in women for any AMD was 1.86 (95% Confidence Interval [CI], 1.03–3.36) and for early AMD was 1.92 (95% CI, 1.06–3.48), for those in the highest quintile of lead level compared with the lowest quintile. In men, however, blood lead level was not significantly associated with AMD.

Conclusions

Blood lead levels were higher in men, but were only associated with AMD in women. Increased levels of blood lead may be involved in the pathogenesis of AMD development in women.     

S1 pocket of a bacterially derived subtilisin-like protease underpins effective tissue destruction

The ovine footrot pathogen, Dichelobacter nodosus, secretes three subtilisin-like proteases that play an important role in the pathogenesis of footrot through their ability to mediate tissue destruction. Virulent and benign strains of D. nodosus secrete the basic proteases BprV and BprB, respectively, with the catalytic domain of these enzymes having 96% sequence identity. At present, it is not known how sequence variation between these two putative virulence factors influences their respective biological activity. We have determined the high resolution crystal structures of BprV and BprB. These data reveal that that the S1 pocket of BprV is more hydrophobic but smaller than that of BprB. We show that BprV is more effective than BprB in degrading extracellular matrix components of the host tissue. Mutation of two residues around the S1 pocket of BprB to the equivalent residues in BprV dramatically enhanced its proteolytic activity against elastin substrates. Application of a novel approach for profiling substrate specificity, the Rapid Endopeptidase Profiling Library (REPLi) method, revealed that both enzymes prefer cleaving after hydrophobic residues (and in particular P1 leucine) but that BprV has more restricted primary substrate specificity than BprB. Furthermore, for P1 Leu-containing substrates we found that BprV is a significantly more efficient enzyme than BprB. Collectively, these data illuminate how subtle changes in D. nodosus proteases may significantly influence tissue destruction as part of the ovine footrot pathogenesis process.     

Dorsal motor nucleus of the vagus: a site for evoking simultaneous changes in crural diaphragm activity, lower esophageal sphincter pressure, and fundus tone

The sphincter mechanism at the esophagogastric junction includes smooth muscle of the lower esophagus and skeletal muscle of the crural diaphragm (CD). Smooth muscle is known to be under the control of the dorsal motor nucleus of the vagus (DMV), while central nervous system (CNS) control of the CD is unknown. The main purposes of our study were to determine the CNS site that controls the CD and whether simultaneous changes in lower esophageal sphincter (LES) pressure and CD activity occur when this site is activated. Experiments were performed on anesthetized male ferrets whose LES pressure, CD activity, and fundus tone were monitored. To activate DMV neurons, L-glutamate was microinjected unilaterally into the DMV at three areas: intermediate, rostral, and caudal. Stimulation of the intermediate DMV decreased CD activity (-4.8 +/- 0.1 bursts/min and -0.3 +/- 0.01 mV) and LES pressure (-13.2 +/- 2.0 mmHg; n = 9). Stimulation of this brain site also produced an increase in fundus tone. Stimulation of the rostral DMV elicited increases in the activity of all three target organs (n = 5). Stimulation of the caudal DMV had no effect on the CD but did decrease both LES pressure and fundus tone (n = 5). All changes in LES pressure, fundus tone, and some DMV-induced changes in CD activity (i.e., bursts/min) were prevented by ipsilateral vagotomy. Our data indicate that simultaneous changes in activity of esophagogastric sphincters and fundus tone occur from rostral and intermediate areas of the DMV and that these changes are largely mediated by efferent vagus nerves.     

Polycystic renal diseases: morphology and genetic counseling

The designation "polycystic kidneys" is vague and causes considerable confusion. This term comprises a number of affections, characterized by the presence of renal cysts. Cystic kidneys may be hereditary or sporadic. The defect may be isolated or occur as part of a syndrome. The identification of the exact nature of the lesion is therefore of paramount importance, not only for the prognosis of the propositus, but especially for the correct genetic counselling of the family. In this context, the perinatal autopsy represents an irreplaceable method of investigation. Since the pathogenesis of many, if not all, types of polycystic kidneys remains unknown, a practical classification must be based on gross and microscopic pathologic study, clinical features, and family history. Osathanondh and Potter (1964) distinguished four varieties, based on morphological findings, revealed by microdissection. Unfortunately, not all types of cystic kidneys are included in this classification. Moreover, their type III cystic kidney collects a number of clearly different entities. Nevertheless, once one is familiar with its deficiencies, the Osathanondh and Potter classification is still very useful.     

Classification, disease, and diagnosis

Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.     

CGH microarrays and cancer

Genetic alterations are a key feature of cancer cells and typically target biological processes and pathways that contribute to cancer pathogenesis. Array-based comparative genomic hybridization (aCGH) has provided a wealth of new information on copy number changes in cancer on a genome-wide level and aCGH data have also been utilized in cancer classification. More importantly, aCGH analyses have allowed highly accurate localization of specific genetic alterations that, for example, are associated with tumor progression, therapy response, or patient outcome. The genes involved in these aberrations are likely to contribute to cancer pathogenesis, and the high-resolution mapping by aCGH greatly facilitates the subsequent identification of these cancer-associated genes.     

Koebner's phenomenon in vitiligo: European position paper

Koebner's phenomenon (KP) has been observed in a number of skin diseases, including vitiligo. Its clinical significance in vitiligo with respect to disease activity and course is still debatable, while its relevance for surgical techniques has been demonstrated in some reports. We present a literature review on the currently known facts about KP in vitiligo, including details of clinical, experimental, and histopathological changes. The consensus view is that there are still no methods to define and assess KP in vitiligo. A new classification is proposed to allow an evaluation of KP in daily practice or in experimental studies. However, many unanswered questions still remain after redefining KP in patients with vitiligo. Active research focusing on KP in vitiligo may not only provide unexpected clues in the pathogenesis of vitiligo but also help to tailor novel therapies against this chronic and often psychologically devastating skin disease.