Predictive value and efficiency of hematology data

Laboratory test results and procedures can be evaluated at four levels:1. Analytic analysis of laboratory test: precision, technical sensitivity, technical specificity; 2. Diagnostic analysis of laboratory test: diagnostic sensitivity, diagnostic specificity, Youden index, likelihood ratio, etc.; 3. Operational analysis of laboratory test: predictive value of positive result, predictive value of negative result, efficiency, discriminant function, etc.; 4. Medical decision-making analysis of laboratory test: threshold probability, cost-benefit analysis, solving the decision tree. Analysis of results or selection of tests can occur at any level, without knowledge of the test's evaluation or performance at the remaining levels. Alternatively, the development of new laboratory tests can proceed from level 1 to level 4, or vice versa. Unfortunately, the former is usually the case and most of the tests in use today have never been evaluated at the medical decision-making level (level 4). Recent efforts at developing automated WBC differential counters represent a disproportionate amount of time and energy expended at level 1, and typify our backward approach to laboratory medicine. In thinking about the development of new diagnostic tests, we should begin at level 4 to characterize the properties and specifications that the test must meet. As an example, an in vitro test for the diagnosis of pulmonary embolism could be characterized in this fashion with criteria specified at each of the lower levels. Returning to the question of "How good should a laboratory test be?", we can see that the answer must come from an analysis of the benefit-cost equation (level 4). Figure 2 is a plot of the net benefit and cost of treatment versus the threshold probability. Since the threshold probability defines how certain one must be of the diagnosis before proceeding with treatment, it serves as a minimum probability which should be exceeded by the predictive value of the test. When the benefit--cost ratio is low, a test with a very high predictive value is required to exceed the threshold probability. On the other hand, when the benefit--cost ratio is high, even a test with a low predictive value would be of use to the physician in making the decision to treat the patient. Within this framework, a number of clinical situations could be evaluated and problems requiring the development of highly predictive laboratory tests (low benefit--cost ratios) could be identified. Too much emphasis in laboratory medicine has been placed on the "laboratory" and not enough on the "medicine". How important is the coefficient of variation when the benefit--cost ratio is high? Tests can not be developed or selected appropriately in a therapeutic vacuum.     

Role of IFN-gamma in regulating T2 immunity and the development of alternatively activated macrophages during allergic bronchopulmonary mycosis

Pulmonary Cryptococcus neoformans infection of C57BL/6 mice is an established model of a chronic pulmonary fungal infection accompanied by an "allergic" response (T2) to the infection, i.e., a model of an allergic bronchopulmonary mycosis. Our objective was to determine whether IFN-gamma plays a role in regulating the pulmonary T2 immune response in C. neoformans-infected C57BL/6 mice. Long-term pulmonary fungistasis was lost in IFN-gamma knockout (KO) mice, resulting in an increased pulmonary burden of fungi at wk 3. IFN-gamma was required for the early influx of leukocytes into the lungs but was not required later in the infection. By wk 3, eosinophil and macrophage numbers were elevated in the absence of IFN-gamma. The inducible NO synthase to arginase ratio was lower in the lungs of IFN-gamma KO mice and the macrophages had increased numbers of intracellular cryptococci and YM1 crystals, indicative of alternatively activated macrophages in these mice. There was evidence of pulmonary fibrosis in both wild-type and IFN-gamma KO mice by 5 wk postinfection. IFN-gamma production was not required for the development of T2 cytokine (IL-4, IL-5, IL-13) producing cells in the lungs and lung-associated lymph nodes or induction of an IgE response. At a number of time points, T2 cytokine production was enhanced in IFN-gamma KO mice. Thus, in the absence of IFN-gamma, C57BL/6 mice develop an augmented allergic response to C. neoformans, including enhanced generation of alternatively activated macrophages, which is accompanied by a switch from a chronic to a progressive pulmonary cryptococcal infection.     

Bleomycin-induced E prostanoid receptor changes alter fibroblast responses to prostaglandin E2

Although PGE(2) is a potent inhibitor of fibroblast function, PGE(2) levels are paradoxically elevated in murine lungs undergoing fibrotic responses. Pulmonary fibroblasts from untreated mice expressed all four E prostanoid (EP) receptors for PGE(2). However, following challenge with the fibrogenic agent, bleomycin, fibroblasts showed loss of EP2 expression. Lack of EP2 expression correlated with an inability of fibroblasts from bleomycin-treated mice to be inhibited by PGE(2) in assays of proliferation or collagen synthesis and blunted cAMP elevations in response to PGE(2). PGE(2) was similarly unable to suppress proliferation or collagen synthesis in fibroblasts from EP2(-/-) mice despite expression of the other EP receptors. EP2(-/-), but not EP1(-/-) or EP3(-/-) mice, showed exaggerated fibrotic responses to bleomycin administration in vivo as compared with wild-type controls. EP2 loss on fibroblasts was verified in a second model of pulmonary fibrosis using FITC. Our results for the first time link EP2 receptor loss on fibroblasts following fibrotic lung injury to altered suppression by PGE(2) and thus identify a novel fibrogenic mechanism.     

Life on the edge: adaptation versus environmentally mediated gene flow in the snow buttercup, Ranunculus adoneus

We used experimental transplant studies to understand how dispersal and habitat-specific selection interact to influence plant populations occupying heterogeneous environments. The snow buttercup (Ranunculus adoneus) occupies a steep ecological and flowering time gradient caused by persistent snowmelt differences within its snow bed habitat. We transplanted seeds, seedlings, and adults to learn about the potential interactions between dispersal and selection. We found that adaptive differentiation is not occurring along the snowmelt gradient, despite striking differences in microhabitat conditions and reproductive phenology between early- and latemelting sites. Instead, our results imply that environmentally based differences in seed quality are contributing to directional gene flow from early-melting locations toward latemelting locations. Emergence and early survival of seedlings is greater in late-melting sites in some years, but the larger seeds produced by maternal plants in early-melting locations consistently have a fitness advantage in all parts of the snow bed. Larger seeds survive longer in the soil and have a second peak of seedling emergence in their third year, but these late-emerging seedlings are successful only if dispersed to less vegetated, late-melting destinations. The longer growing season in earlymelting sites enhances vegetative growth at all life-history stages and increases fecundity of seedling transplants but also limits the opportunity for establishment from seed. Our demographic analysis suggests that maternal environmental effects on propagule quality can lead to directional gene flow from benign to marginal sites in populations occupying heterogeneous habitats.     

The reactivity of tetracarbonylnickel encapsulated in zeolite X. A case history of intrazeolite coordination chemistry.

Zeolite X shows a high capacity for tetracarbonylnickel (up to 28 weight percent) such that complete pore filling with ‘liquid like’ material takes place. The adsorbed material may be removed simply by evacuation at room temperature. Partial decomposition of the Ni(CO)₄ occurs on standing at room temperature under N₂. The resultant orange species is highly reactive and has spectroscopic properties consistent with a coordinatively unsaturated ‘Ni(CO)₃’. Complete and irreversible decomposition by heating to 200 °C in vacuo gives a black zeolite, with an undefined metal phase, which is unreactive towards carbon monoxide. Reaction of the zeolite supported Ni(CO)₄ with various phosphorus ligands is highly dependent on the original loading level as well as the physical size of the ligands involved. At low loadings two kinds of reactivity are observed: 1) With ligands too large to gain access to the zeolite crystal interior, reaction occurs only in solution and so drags the Ni(CO)₄ from the zeolite: 2) With smaller ligands, reaction takes place inside the zeolite cages leading to well-defined, encapsulated, ship-in-bottle complexes which have a stoichiometry dictated by the available space in the cages. At high loading levels, pore blocking phenomena lead to inhomogeneous distributions of encapsulated complexes wherein a complete shell of phosphorous ligand substituted nickel carbonyl species forms at the crystal surface layers and prevents further reaction deeper inside the crystal. The reactivity with large phosphines has been used to study the diffusion of Ni(CO)₄ from the zeolite. Monitoring the appearance of the Ni(CO)₃L (where L = phosphine) by 31-P NMR of the supernatant solution shows that Ni(CO)₄ leaves the zeolite with a first order rate constant of at least 2 × 10^?2 sec^?1 at 298 K.     

MEASURING POLLINATOR-MEDIATED SELECTION ON MORPHOMETRIC FLORAL TRAITS: BUMBLEBEES AND THE ALPINE SKY PILOT,POLEMONIUM VISCOSUM

Sweet-flowered plants of Polemonium viscosum in Colorado are visited by a fly-dominated pollinator fauna at timberline (krummholz), but almost exclusively by bumblebees in higher-elevation tundra habitats. Significant increases in flower size and height are associated with increasing elevation along this habitat gradient. This paper presents the results of an experiment designed to test whether bumblebees exert sufficient selection on morphometric floral phenotypes to account for the clinal shifts seen in natural populations. Two populations of sweet-flowered plants of krummholz origin were established: one randomly pollinated, the other solely bumblebee-pollinated. I tested the effects of two independent axes of floral variation, obtained by principal-components analysis, on mean seed set per flower of plants in each population. PC1, with strong correlations to corolla diameter, corolla length, and stem height, explained a significant amount of variance in seed set for bumblebee-pollinated plants but had no bearing on that of randomly pollinated plants. PC2, with strong correlation to flower number, did not influence seed set in either population. Bumblebee behavior was correlated with variation in PC1 scores of the selected population, yielding positive directional selection on morphometric floral traits associated with PC1. Selection coefficients for PC1, corolla length, corolla diameter, and inflorescence height were estimated, respectively, as 0.11, 0.09, 0.07, and 0.06 (P < 0.025 in all cases). These results support the hypothesis that pollinator-mediated selection can bring about changes in floral form, and can explain shifts in floral morphology of P. viscosum along natural habitat gradients.     

The mechanism of floral heliotropism in the snow buttercup, Ranunculus adoneus

We designed field experiments using solar-tracking Ranunculus adoneus flowers to determine where photoreception occurred, which organs responded, and how movement was achieved. Flower peduncles bend eastward in the morning and gradually unbend over the course of the day. Peduncles were found to bend significantly more frequently in the middle region near the floral bracts, 1–3 cm below the flower, than elsewhere on the peduncle. Because the peduncle tip continued to track the sun even after the flower itself was removed, our experiments concentrated on shielding (or conversely, exposing) various portions of peduncles from (or to) sunlight. Photoreception occurred primarily in the portion of the stem just beneath the floral receptacle. By following the position of landmarks applied to the stem, we found that 40% more growth occurred on the shaded side of bent peduncles, compared to the sunlit side. In contrast, top-shielded peduncles did not solar track well and grew only 25% more on the shaded side than on the sunlit side. This growth differential corresponded to differences in cell length on the two sides of bent peduncles, with significantly longer epidermal cells occurring on the shaded side than on the sunlit side.     

Un vivo depletion of murine CD8 positive T cells impairs survival during infection with a highly virulent strain ofCryptococcus neoformans

Cell-mediated immunity plays an important but incompletely understood role in host defense againstCryptococcus neoformans. Because of their multiple capacities as cytokine-secreting cells, cytotoxic cells, and antigen-specific suppressor cells, CD8 positive T lymphocytes could potentially either enhance or impair host defense againstC. neoformans. To determine whether CD8 T cells enhance or inhibit host defence during an infection with a highly virulent strain ofC. neoformans, we examined the effect of in vivo CD8 cell depletion on suNival and on the number of organisms in mice infected by either the intratracheal or intravenous routes. Adequacy of depletion was confirmed both phenotypically and functionally. Regardless of the route of infection, we found that survival of mice depleted of CD8 T cells was significantly reduced compared to undepleted mice. Surprisingly, however, CD8 depletion did not alter organism burden measured by quantitative CFU assay in mice infected by either route. These data demonstrate that CD8 positive T cells participate in the immune response to a highly virulent strain ofC. neoformans. By contrast to minimally virulent isolates that do not cause a life threatening infection, the immune response to a highly virulent isolate does not alter the burden of organisms, but does enhance host defense as it is necessary for the optimal survival of infected mice.Abbreviations ³H-TdR ³H-thmidine - CFU colony forming units - FITC Fluorescein isothiocyanate - MLR mixed lymphocyte reaction - PBS phosphate buffered saline     

Isolation, identification and determination of sulfamethoxazole and its known metabolites in human plasma and urine by high-performance liquid chromatography

From human urine the following metabolites of sulfamethoxazole (S) were isolated by preparative HPLC: 5-methylhydroxysulfamethoxazole (SOH), N₄-acetyl-5-methylhydroxysulfamethoxazole (N₄SOH) and sulfamethoxazole-N₁-glucuronide (Sgluc). The compounds were identified by NMR, mass spectrometry, infrared spectrometry, hydrolysis by β-glucuronidase and ratio of capacity factors. The analysis of S and the metabolites N₄-acetylsulfamethoxazole (N₄), SOH, N₄-hydroxysulfamethoxazole (N₄OH), N₄SOH, and Sgluc in human plasma and urine samples was performed with reversed-phase gradient HPLC with UV detection. In plasma, S and N₄ could be detected in high concentrations, while the other metabolites were present in only minute concentrations. In urine, S and the metabolites and conjugates were present. The quantitation limit of the compounds in plasma are respectively: S and N₄ 0.10 μg/ml; N₄SOH 0.13 μg/ml; N₄OH 0.18 μg/ml; SOH 0.20 μg/ml; and Sgluc 0.39 μg/ml. In urine the quantitation limits are: N₄ and N₄OH 1.4 μg/ml; S 1.5 μg/ml; N₄SOH 1.9 μg/ml; SOH 3.5 μg/ml; and Sgluc 4.1 μg/ml. The method was applied to studies with healthy subjects and HIV positive patients.