Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

AB1205 MEDICAL AND PSYCHOLOGICAL COMORBIDITIES IN FIBROMYALGIA: A CROSS SECTIONAL STUDY

Background

Psychological disorders are commonly observed in fibromyalgia (FMS). Medical comorbidities are less well characterised in FMS. We sought to assess the prevalence of these disorders in an observational cohort of patients in a tertiary hospital in North India.

Objectives

The prevalence of medical and psychological comorbidities in FMS and the prevalence of these disorders in FMS subgroups classified according to different ACR classification criteria were assessed.

Methods

Patients satisfying either the 1990 ACR or the 2016 ACR Fibromyalgia criteria were included in a cross-sectional study between October’19 and December’21. All patients were assessed for prevalence of chronic fatigue syndrome (CFS), post-traumatic stress syndrome (PTSD), restless leg syndrome (RLS) and medical comorbidities including obesity, obstructive sleep apnoea, anemia, diabetes mellitus, hypertension and hypothyroidism.

Results

A total of 98 patients of median age 39 years (34 – 47) were included, of which 9 met only the 1990 ACR criteria (100% females), 30 met only 2016 ACR criteria (86% females) and 59 met both criteria (89% females). Widespread Pain index was significantly higher in the 1990 + 2016 group compared to subgroups which met only either of the criteria. Hypothyroidism (subclinical or clinical) was similarly higher in the 1990 + 2016 subgroup. At least one psychological comorbidity was seen in 41%, with CFS present in 30% and PTSD in 14%. The median systolic blood pressure was in the hypertensive range (146 mm Hg) in the 1990-only group, with hypertension being present in 1/3rd of the total cohort. Obesity was present in 59% and Diabetes in 11%. Iron deficiency anemia was seen in 20%.

Table 1.

Prevalence of comorbidities in different subgroups of Fibromyalgia

Clinical featuresFMS CohortACR 1990ACR 1990 + 2016 (N-59)ACR 2016p-value(N-98)(N-9)(N-30)F:M88:109:053:626:40.6Age (years)39 (34 – 47)38 (32 – 46)38 (34 – 45)44 (35 – 50)0.2Duration of symptoms (months)48 (24 – 84)48 (36 – 84)48 (24 – 78)60 (27 – 84)0.6WPI15 (12 – 17)14 (8 – 15)16 (14 – 18)13 (10 – 16)0.001SSS8 (6 – 10)3 (1 – 4)6 (7 – 10)8 (6 – 9)<0.000TP13 (9-16)13 (12 – 15)15 (13 – 16.5)6 (4 – 8)<0.000BMI (kg/m2)26 (23 – 28)23 (22 – 25)26 (24 – 28)26 (23 – 29)0.2Obese (BMI ≥ 25 kg/m2)58 (59%)3 (33%)37 (62%)18 (60%)0.08Prediabetes (HbA1c 5.7 – 6.5)21 (21%)016 (27%)5 (16%)0.8Diabetes (HbA1C ≥6.5)11 (11%)1(11%)9 (15%)1 (3%)0.2Systolic BP125(115–143)146 (117–148)120(114–137)127(116–143)0.1Diastolic BP80 (76 – 88)80 (76 – 83)82 (75 - 88)79 (76 – 88)0.8Hypertension (≥140/90 cm)37 (37%)6 (66%)20 (33%)11 (36%)0.2Hypothyroidism (TSH > 5 mIU/L)12 (12%)011 (22%)1 (3%)0.04Iron deficiency anemia (Serum Ferritin < 12 ng/ml)14 (20%) (n-67)3 (42%)9 (23%)2 (9%)0.1OSA (intermediate to high risk by STOPBANG questionnaire)32 (32%)1 (11%)17 (28%)140.1CFS30 (30%)1 (11%)22 (37%)7 (23%)0.1PTSD14 (14%)011 (18%)3 (10%)0.2RLS9 (9%)05 (8%)4 (13%)0.4

F female, M male, WPI widespread pain index, SSS symptoms severity score, TP tender points, BMI body mass index, BP blood pressure, OSA obstructive sleep apnoea, CFS chronic fatigue syndrome, PTSD post traumatic stress disorder, RLS restless leg syndrome

Figure 1.

Venn Diagram depicting Fibromyalgia subgroups having psychological comorbidities

Conclusion

There is a high prevalence of comorbidities in patients with fibromyalgia with nearly half having atleast one psychological comorbidity, and obesity, hypertension and iron deficiency anaemia being the common medical comorbidities. Those who met only the 1990 ACR criteria formed less than 10%.

References

[1]Ahmed S, Aggarwal A, Lawrence A. Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int. 2019 Aug;39(8):1397-1403.

[2]Wolfe F, Ablin J, Guymer EK, Littlejohn GO, Rasker JJ. The Relation of Physical Comorbidity and Multimorbidity to Fibromyalgia, Widespread Pain, and Fibromyalgia-related Variables. J Rheumatol. 2020 Apr;47(4):624-631.

Disclosure of Interests

None declared

CARE Score on Chest Radiograph at Diagnosis Predicts Early and Late Outcomes Among Lung Transplant Patients with COVID-19

Purpose

To assess the ability of an objective radiographic scoring system to predict outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19).

Methods

We included all LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021; n=54; median age: 60, 20-73 years; M:F 37:17) in our program. Patient characteristics and laboratory values during the acute illness were reviewed. Chest radiographs at time of COVID-19 diagnosis were scored by extent of ground-glass opacity and consolidation using the CARE score (0-18 for each lung). The CARE score was calculated using only the allograft in single LT and the average of both lungs in bilateral LT. Primary outcome was six-month survival after COVID-19. Hospital complications and one-month survival were secondary outcomes.

Results

A minority of patients had a clear allograft (CARE=0, n=12, 22.2%) at presentation. The median score was 2 (interquartile range 0.5-4.625), indicating mild abnormalities. Demographics, underlying diagnosis, comorbidities, symptoms, and spirometry changes were not associated with the baseline CARE score. Baseline CARE score >5 was strongly associated with development of respiratory failure (91.7% vs 35.7%; OR, 95% CI: 19.8, 2.3-168.7; p=0.001), ICU admission (p<0.001), need for ventilator support (p<0.001), and one-month mortality (41.7% vs 2.4%; OR, 95% CI: 29.4, 2.96-333.3; p=0.001). Overall six-month survival was 81.5%. The CARE score was significantly higher among non-survivors (7.7±4.1 vs 2.2±2.7; p=0.002). Patients with a CARE score>5 at diagnosis were significantly less likely to survive at six-month follow-up (41.7%.vs 92.3%; p<0.001). The CARE score had an excellent area under the curve (86.8%, 74.4%-99.2%; p<0.001) on the Receiver operating characteristic curve for predicting six-month survival after COVID-19.

Conclusion

The CARE score at time of COVID-19 diagnosis provides useful prognostic information among patients with LT.

Assessing the Risks to Bats from Plant Protection Products: A Review of the Recent European Food Safety Authority Statement Regarding Toxicity and Exposure Routes

Wild birds and mammals that feed in agricultural habitats are potentially exposed to pesticides through various routes. Until recently, it has been implicitly assumed that the existing European Union risk assessment scheme for birds and mammals also covered bats (Chiroptera). However, recent publications raised concerns and, in 2019, a scientific statement was published by the European Food Safety Authority (EFSA) that concluded that bats were not adequately covered by the current risk assessment scheme. We review the evidence presented and assumptions made in the EFSA bat statement relating to toxicity, bioaccumulation, and exposure pathways (oral, dermal, and inhalation), in terms of their relevance for bats potentially foraging in agricultural areas in the European Union; we highlight where uncertainties remain and how these could be addressed. Based on our review, it is clear that there is still much uncertainty with regard to the appropriateness of the assumptions made in the EFSA bat statement. Significantly more information needs to be gathered to answer fundamental questions regarding bat behavior in agricultural landscapes, together with the relative sensitivity of bats to pesticide exposure. Given the current critical information gaps, it is recommended that quantitative risk assessments for bats not be performed for pesticides until more robust, reliable, and relevant data are available. The risk to bats can then be compared with that for birds and ground-dwelling mammals, to determine the protectiveness of the existing scheme and thus whether a bat scenario is indeed required and under what circumstances. Environ Toxicol Chem 2021;40:2978-2989. © 2021 Cambridge Environmental Assessments, part of RSK ADAS Ltd. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Fetal lung interstitial tumor: Prenatal presentation of a rare fetal malignancy

Fetal lung interstitial tumor (FLIT) is a rare fetal malignancy that is typically diagnosed in the postnatal period, or, if recognized prenatally can mimic a benign lesion such as congenital pulmonary airway malformation. We present the earliest case of a FLIT tumor described by ultrasound and MRI at 26 weeks of gestation. Our case highlights features suggestive of FLIT including presentation later in gestation in combination with findings on fetal MRI such as a solid appearance with radiating curved bands of high signal within and along the periphery of the lesion (not as intensely high signal as the typical CPAM), possibly detailing a radiographic signature for these tumors. The role of betamethasone for these tumors is not known.

AB0581 HIGH PREVALENCE OF TUBERCULOSIS IN ADULTS AND CHILDREN WITH IIM AS COMPARED WITH SLE: RETROSPECTIVE DATA REVIEW FROM A LARGE COHORT AT A TERTIARY CARE CENTER IN INDIA

Background:

Infections are the most common cause of morbidity and mortality in idiopathic inflammatory myositis (IIM). India is endemic for Tuberculosis (TB) with a prevalence of 2.3 cases per thousand population.

Objectives:

Thus, we studied the prevalence of TB in our cohort of IIM patients and compared with that in systemic lupus erythematosus (SLE).

Methods:

Medical records from paper charts and electronic medical records were reviewed for adults and juvenile patients with SLE (ACR criteria 1997) and IIM (Bohan and Peter criteria 1975) first presented at a tertiary care hospital in India from 1989 to 2016. Clinical variables including disease characteristics variables, the frequency, site, duration and complication of active TB as well as dose of corticosteroids and other immunosuppressive drugs were extracted retrospectively from the medical records. Descriptive statistics were used to describe the cohort and TB characteristics. Chi-square and t-test were used to evaluate association of TB with clinical diagnosis as well as medication data.

Results:

There were 167 (132 adults and 35 juvenile) IIM and 280 (131 adults and 149 juvenile) SLE in our cohort. Active TB occurred in 24 (14.4%) of all IIM cases (18, 13.6% adults; 6, 17.1% juvenile) as compared to 18 (6.4%) of all SLE cases (8, 6.1% adults; 10, 6.7% juvenile, p value < 0.01). Of all the TB in myositis, most often it was seen in Dermatomyositis (n=11, 45.8%) followed by Polymyositis (5, 20.8%), and occasionally in Overlap myositis (3, 12.5) and juvenile dermatomyositis (1,4.1%).

Considering an annual TB rate of 211 per 100,000 of the general population, the risk of developing active TB was 62-fold higher in patients with IIM and 27-fold higher in those with lupus. Patients with IIM had higher odds of developing TB as compared with Lupus [odds ratio 2.86 (CI 1.5-5.47), p=0.007).

Amongst 24 IIM patients with TB, 10 had pulmonary TB and 14 had extra-pulmonary TB. The median glucocorticoid dose at the diagnosis of TB was 0.25 (0-1.5) mg/kg/day. Half the cases of active TB occurred during inactive myositis. Seventeen patients with active TB were followed up over 27 months (8-184), with remission of TB in all cases but required prolonged courses of Anti-Tuberculous Therapy (ATT) in 25% cases with 10 ATT related adverse events in 8 patients and 5 patients with relapse of myositis due to lowering of immunosuppression.

Conclusion:

Patients with IIM have higher prevalence of active TB as compared with SLE patients. The risk is highest in patients with Dermatomyositis possibly related to high doses of steroids. Extra-pulmonary forms of TB are more common, and patients commonly require prolonged course of ATT and may suffer relapses of myositis during ATT. Screening for latent TB may be useful in IIM patients before prescribing steroids and other immunosuppressive drugs.

References:

[1]TB Statistics India | National, treatment outcome & state statistics [Internet]. TB Facts | TB, tests, drugs, statistics. [cited 2019 Jun 13]. Available from:https://www.tbfacts.org/tb-statistics-india/

[2]Muhammed H, Gupta L, Zanwar A, Misra DP, Lawrence A, Agarwal V, Aggarwal A, Misra R;OPC0243: Infections are leading cause of in-hospital mortality in patients with inflammatory myositis; Indian J Rheumatol 2018;13, Suppl S2:93-241

[3]Gaitonde S, Pathan E, Sule A, Mittal G, Joshi VR. Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment. Ann Rheum Dis. 2002 Mar;61(3):251–3.

[18]He D, Bai F, Zhang S, Jiang T, Shen J, Zhu Q, et al. High incidence of tuberculosis infection in rheumatic diseases and impact for chemoprophylactic prevention of tuberculosis activation during biologics therapy. Clin Vaccine Immunol CVI. 2013 Jun;20(6):842–7.

Figure 1.

(A) Prevalence and (B) sites of tuberculosis

Table 1.

Table 2.

Clinical profile of patients with Tuberculosis

Disclosure of Interests:

Latika Gupta: None declared, Abhishek Zanwar: None declared, Rohit Aggarwal Grant/research support from: Pfizer, Genentech, BMS, Mallinckrodt, Consultant of: Pfizer, Genentech, BMS, Mallinckrodt, Bristol Myers-Squibb, octapharma, CSL Behring, AstraZeneca, Corbus, Kezar, Abbvie, Able Lawrence: None declared, Durga Misra: None declared, Vikas Agarwal: None declared, Ramnath Misra: None declared, Amita Aggarwal: None declared

SAT0230 MACROPHAGE ACTIVATION SYNDROME IN SLE AND SYSTEMIC ONSET JIA: SIMILAR OR DISSIMILAR

Background:

Macrophage activation syndrome (MAS) is a serious complication in rheumatic disease. Fever and hyperferritinemia are common in systemic onset JIA and cytopenias are common in SLE thus recognising MAS in them is a challenge.

Objectives:

We compared clinical, laboratory parameters, various classification criteria for MAS, and its outcome in SLE and sJIA.

Methods:

Clinical and laboratory data were extracted from clinician diagnosed cases of MAS with SLE/sJIA who were admitted between 2004-2018 at a tertiary care hospital. Percentage of patients satisfying Ravelli, International consensus, HLH 2004 and criteria proposed by Parodi et al1were calculated.

Results:

Among 33 patients (18 females) with MAS 19 had SLE and 14 had sJIA. MAS was more likely to be the presenting manifestation of disease in SLE as compared to sJIA (p<0.05). There were no differences in the clinical features among these two diseases. EBV and CMV were identified in 2 patients each as the trigger for MAS.

Patients with SLE had lower baseline TLC and platelet whereas patients with sJIA-MAS had significantly higher median CRP (p = 0.002), fall in TLC (p=0.012) and delta ESR/CRP ratio (p=0.02) and lower fibrinogen level (p=0.006). Neutrophil to lymphocyte ratio, Ferritin/CRP ratio and number of patients with Ferritin/ESR >80 were similar. Bone Marrow hemophagocytosis was seen in only in 21% of patients.

Only 6/33 fulfilled HLH criteria but criteria meant for sJIA or SLE performed well for both diseases and majority of patients could be diagnosed using them. Treatment included steroids(100%), cyclosporine(30%), Tacrolimus(21%), cyclophosphamide(21%), etoposide(3%) and thalidomide(12%). Mortality was similar in both groups.

Table 1.

Agreement amongst MAS/HLH criteria in SLE and sJIA MAS

SLE-MASHLHRavelli et alConsensusParodi et alHLH4444Ravelli et al4191918Consensus4191918Parodi et al4181818sJIA-MASHLHRavelli et alConsensusParodi et alHLH2222Ravelli et al2121112Consensus2111212Parodi et al2121214Table 2.

Comparison with various other cohorts

Minoia et alsJIAn (%)Our studysJIA, n (%)Our Study SLE, n (%)SLE, n (%) Ai-Chun Liu et alJuvenile SLE n (%)Parodi et alNumber36214193238MAS as presenting feature (%)80 (22)4 (28)12 (63)NA24 (63)Most common manifestation (%)Fever (96)Fever (100)Fever (89)Fever (96)Fever (89)Most common triggerDisease activityDisease activityDisease activityDisease activityDisease activityBM done251 (72.3)8 (57)12 (63)32 (96)38 (100)BM hemophagocytosis150 (60.7)2 (25)5 (41)32 (100)20 (52)Mortality28 (8)2 (14)2 (10.5)4 (12.5)4 (11.4)Patients meeting JIA criteria %NA-100NA100Patients meeting HLH criteria %NA1419NA66

Conclusion:

MAS is more likely to be presenting manifestation in SLE compared to sJIA. Though lab parameters are significantly different in MAS associated with SLE & sJIA, criteria meant for MAS in sJIA or SLE MAS performed equally well in both diseases.

References:

[1]Parodi A et al, Macrophage activation syndrome in juvenile systemic lupus erythematosus: a multinational multicenter study of thirty-eight patients. Arthritis Rheum. 2009 Nov;60(11):3388-99.

Disclosure of Interests:

None declared

Reaching out to reduce health inequities for Māori youth

AIM

This paper describes an initiative facilitating comprehensive assessment and delivery of brief interventions for Māori youth in Northland, New Zealand.

BACKGROUND

The population in Northland is predominantly Māori and is one of New Zealand's most deprived populations. Māori youth have the highest youth suicide rate in the developed world and elevated numbers of youth displaying mental health issues and/or risk behaviours are of grave national concern. Like Indigenous peoples worldwide, inequities persist for Māori youth accessing and engaging with healthcare services.

DESCRIPTION

Taking services out to Māori youth in remote and isolated areas, Northland's youth specialist nurses are reducing some barriers to accessing health care. The youth version of the Case-finding and Help Assessment Tool is a New Zealand-developed, e-screening tool for youth psychosocial issues, facilitating comprehensive assessment and brief intervention delivery.

DISCUSSION

Early detection of, and timely intervention for, mental health and risk behaviours can significantly improve health outcomes in youth. However, for this to happen barriers preventing youth from accessing appropriate care need to be overcome.

CONCLUSION

Youth specialist nurses could improve access to care for youth from ethnic minorities, rural and isolated regions, and areas of high deprivation without overwhelming the medical profession.

IMPLICATIONS FOR NURSING POLICY

Specialist nurses are trained and empowered to practice at the top of their scope. With general practitioner oversight and standing order sign off specialist nurses can work autonomously to improve access to health services, without increasing the workload of doctors.

IMPLICATIONS FOR NURSING PRACTICE

Encouraging continuous self-reflection of the nurse's effectiveness in meeting patient needs, holistically and culturally, facilitates the provision of accessible care that is patient-centred and culturally safe.

Identification of diverse arthropod associated viruses in native Australian fleas

Fleas are important vectors of zoonotic disease. However, little is known about the natural diversity and abundance of flea viruses, particularly in the absence of disease associations, nor the evolutionary relationships among those viruses found in different parasitic vector species. Herein, we present the first virome scale study of fleas, based on the meta-transcriptomic analysis of 52 fleas collected along the eastern coast of Australia. Our analysis revealed 18 novel RNA viruses belonging to nine viral families with diverse genome organizations, although the majority (72%) possessed single-stranded positive-sense genomes. Notably, a number of the viruses identified belonged to the same phylogenetic groups as those observed in ticks sampled at the same locations, although none were likely associated with mammalian infection. Overall, we identified high levels of genomic diversity and abundance of viruses in the flea species studied, and established that fleas harbor viruses similar to those seen to other vectors.

Outcomes in juvenile onset lupus: single center cohort from a developing country

Introduction

About 10–20% of systemic lupus erythematosus (SLE) patients have onset in childhood and have more severe organ involvement. Survival of juvenile SLE patients is improving worldwide. Long-term data of childhood onset SLE from developing countries is scarce.

Methods

Clinical and laboratory data at initial presentation and follow-up visits were retrieved from clinic files, hospital information system and personal interviews. Treatment received, complications, flares, outcomes and death were recorded. Survival was calculated using Kaplan–Meier survival curves and regression analysis was done for predictors of mortality.

Results

Children with SLE ( n = 273, 250 girls) had a median age at onset of 14 years and duration of illness prior to diagnosis at our hospital of 1 year. Fever and arthritis were the most common presenting manifestations. Renal disease was seen in 60.5% and central nervous system (CNS) disease in 29%. The median follow-up period in 248 patients was 3.5 years. Fourteen children died, and 10 of these had active disease at the time of death. The mean actuarial survival was 24.5 years and survival rates at 1, 5 and 10 years were 97.9%, 95% and 89% respectively. Fever, CNS disease, anti-dsDNA levels and serious infections predicted death on univariate and multivariate analysis. Infections were seen in 72 children (26.3%), and 38 of these infections were serious. One-third of the patients had damage on the last follow-up. Flares were seen in 120 children, the majority being major flares.

Conclusion

Outcomes of pediatric SLE in North Indian children are similar to those seen in developed countries. Infections pose a major challenge in these patients.

Cat fleas (Ctenocephalides felis) carrying Rickettsia felis and Bartonella species in Hong Kong

Fleas are commonly recorded on stray as well as domestic dogs and cats in Hong Kong. Fleas can be a major cause of pruritus in dogs and cats and also vectors of potentially zoonotic bacteria in the genera Rickettsia and Bartonella. Morphological examination of 174 fleas from dogs and cats living in Hong Kong revealed only cat fleas (Ctenocephalides felis). Cytochrome c oxidase subunit 1 gene (cox1) genotyping of 20 randomly selected specimens, revealed three cox1 haplotypes (HK-h1 to HK-h3). The most common haplotype was HK-h1 with 17 specimens (17/20, 85%). HK-h1 was identical to cox1 sequences of fleas in Thailand and Fiji. HK-h1 and HK-h2 form a distinct cat flea cox1 clade previously recognized as the Clade 3. HK-h3 forms a new Clade 6. A multiplex Bartonella and Rickettsia real-time PCR of DNA from 20 C. felis found Bartonella and Rickettsia DNA in three (15%) and ten (50%) C. felis, respectively. DNA sequencing confirmed the presence of R. felis, B. clarridgeiae and Bartonella henselae. This is the first reported study of that kind in Hong Kong, and further work is required to expand the survey of companion animals in the geographical region. The sampling of fleas on domestic cats and dogs in Hong Kong revealed them to be exclusively infested by the cat flea and to be harbouring pathogens of zoonotic potential.

Isolation of Novel Trypanosomatid, Zelonia australiensis sp. nov. (Kinetoplastida: Trypanosomatidae) Provides Support for a Gondwanan Origin of Dixenous Parasitism in the Leishmaniinae

The genus Leishmania includes approximately 53 species, 20 of which cause human leishmaniais; a significant albeit neglected tropical disease. Leishmaniasis has afflicted humans for millennia, but how ancient is Leishmania and where did it arise? These questions have been hotly debated for decades and several theories have been proposed. One theory suggests Leishmania originated in the Palearctic, and dispersed to the New World via the Bering land bridge. Others propose that Leishmania evolved in the Neotropics. The Multiple Origins theory suggests that separation of certain Old World and New World species occurred due to the opening of the Atlantic Ocean. Some suggest that the ancestor of the dixenous genera Leishmania, Endotrypanum and Porcisia evolved on Gondwana between 90 and 140 million years ago. In the present study a detailed molecular and morphological characterisation was performed on a novel Australian trypanosomatid following its isolation in Australia’s tropics from the native black fly, Simulium (Morops) dycei Colbo, 1976. Phylogenetic analyses were conducted and confirmed this parasite as a sibling to Zelonia costaricensis, a close relative of Leishmania previously isolated from a reduviid bug in Costa Rica. Consequently, this parasite was assigned the name Zelonia australiensis sp. nov. Assuming Z. costaricensis and Z. australiensis diverged when Australia and South America became completely separated, their divergence occurred between 36 and 41 million years ago at least. Using this vicariance event as a calibration point for a phylogenetic time tree, the common ancestor of the dixenous genera Leishmania, Endotrypanum and Porcisia appeared in Gondwana approximately 91 million years ago. Ultimately, this study contributes to our understanding of trypanosomatid diversity, and of Leishmania origins by providing support for a Gondwanan origin of dixenous parasitism in the Leishmaniinae.

The genus Leishmania includes approximately 53 species, 20 of which cause human leishmaniais, a significant disease that has afflicted humans for millennia. But how ancient is Leishmania and where did it arise? Some suggest Leishmania originated in the Palearctic. Others suggest it appeared in the Neotropics. The Multiple Origins theory proposes that separation of certain Old World and Neotropical species occurred following the opening of the Atlantic. Others suggest that an ancestor to the Euleishmania and Paraleishmania appeared on Gondwana 90 to 140 million years ago (MYA). We performed a detailed molecular and morphological characterisation of a novel Australian trypanosomatid. This parasite is a sibling to the Neotropical Zelonia costaricensis, a close relative of Leishmania, and designated as Zelonia australiensis sp. nov. Assuming Z. costaricensis and Z. australiensis split when Australia and South America separated, their divergence occurred between 36 and 41 MYA. Using this event as a calibration point for a phylogenetic time tree, an ancestor of the dixenous Leishmaniinae appeared in Gondwana ~ 91 MYA. This study contributes to our understanding of trypanosomatid diversity by describing a unique Australian trypanosomatid and to our understanding of Leishmania evolution by inferring a Gondwanan origin for dixenous parasitism in the Leishmaniinae.

Outcome of lupus nephritis in childhood onset SLE in North and Central India: single-centre experience over 25 years

INTRODUCTION

Childhood SLE (cSLE) has a higher prevalence of lupus nephritis (LN), and there are ethnic variations in response to treatment as well as outcome of LN. There are limited data on long-term outcome of LN in cSLE from the Indian subcontinent.

METHODS

Retrospective analysis of case records of patients with cSLE (satisfying revised American College of Rheumatology (ACR) 1997 criteria for diagnosis) and age of onset <18 years was conducted from 1989 to 2013. Data on clinical features, renal involvement and biopsy findings, treatment, renal outcome, damage accrual and mortality were collected. End-stage renal disease (ESRD) was defined as the need for renal replacement therapy. Actuarial ESRD-free survival was studied as the primary outcome measure using Kaplan-Meier analysis.

RESULTS

Among 205 children with cSLE, 134 (121 girls) had evidence of LN. The mean age at disease onset was 13.7 ± 3.5 years and the mean disease duration at presentation was 1.9 ± 2.5 years. Kidney biopsy was available for 92 patients, and histology included: 13 (14.2%) Class II, 24 (26%) Class III, 43 (46.7%) Class IV and 12 (13.1%) Class V LN. The mean follow-up period was 6.75 ± 5.7 years. At last visit, 81 (60.4%) children were in complete remission, 28 (20.9%) were in partial remission, 15 (11.2%) still had active nephritis and 10 (7.4%) had progressed to ESRD. Almost two-thirds (62.9%) of patients experienced lupus flares, and mean flare rate was 0.09 flares/patient follow-up year. Fifty-six (43.8%) children accrued damage and the mean Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage score was 0.79 ± 1.13. Actuarial ESRD-free survival at five, 10 and 15 years was 91.1%, 79% and 76.2%, and five-, 10- and 15-year renal survival was 93.8%, 87.1% and 84%, respectively. Although multiple factors individually predicted poor outcome (death/ESRD), only raised serum creatinine at onset (R square = 0.65, p ≤ 0.0001) and damage accrual (R square = 0.62, p ≤ 0.0001) remained significant on multivariate analysis. Eleven (8.2%) children died during the follow-up period, and infections were the leading cause of mortality.

CONCLUSIONS

Long-term outcome of LN in cSLE in our cohort was better than previous reports from India. However, a high rate of major infection still remains the leading cause of mortality.

TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

While 30%-70% of RSV-infected infants develop bronchiolitis, 2% require hospitalization. It is not clear why disease severity differs among healthy, full-term infants; however, virus titers, inflammation, and Th2 bias are proposed explanations. While TLR4 is associated with these disease phenotypes, the role of this receptor in respiratory syncytial virus (RSV) pathogenesis is controversial. Here, we evaluated the interaction between TLR4 and environmental factors in RSV disease and defined the immune mediators associated with severe illness. Two independent populations of infants with RSV bronchiolitis revealed that the severity of RSV infection is determined by the TLR4 genotype of the individual and by environmental exposure to LPS. RSV-infected infants with severe disease exhibited a high GATA3/T-bet ratio, which manifested as a high IL-4/IFN-γ ratio in respiratory secretions. The IL-4/IFN-γ ratio present in infants with severe RSV is indicative of Th2 polarization. Murine models of RSV infection confirmed that LPS exposure, Tlr4 genotype, and Th2 polarization influence disease phenotypes. Together, the results of this study identify environmental and genetic factors that influence RSV pathogenesis and reveal that a high IL-4/IFN-γ ratio is associated with severe disease. Moreover, these molecules should be explored as potential targets for therapeutic intervention.

First Report of Kudzu (Pueraria montana) Infections by Tobacco ringspot virus in Mississippi

Virus-like symptoms were observed in several kudzu patches in Mississippi during a survey of viruses infecting soybean carried out in late summer/fall of 2013 as a part of a project funded by the Mississippi Soybean Promotion Board. Symptomatology consisted of chlorotic mottle and ringspots, vein-associated feathering, necrosis, and leaf deformation, which were often observed in combination on the same plant. In order to identify the virus(es) involved in the disease, young leaves from a symptomatic kudzu sample collected in Kemper County were crushed in 10 volumes of 0.1 M phosphate buffer (pH 7.2) and mechanically inoculated onto celite-dusted leaves of two soybean varieties (Asgrow AG4605 and AG4730), each represented by 10 plants. Sap from an asymptomatic kudzu sample from Oktibbeha County was used as a control. Both varieties reacted by systemic mottle, stunting, and apical leaf necrosis approximately 2 weeks after inoculation, while no symptoms could be observed in controls. Partially purified preparations from both symptomatic soybean cultivars exhibited the presence of putative intact and empty spherical virus particles ~30 nm in diameter. ELISA tests with antisera to several soybean viruses were performed on the original kudzu sample and inoculated AG4605 and AG4730 soybean plants. These tests revealed the presence of Tobacco ringspot virus (TRSV) in all symptomatic samples. In order to better understand the incidence of this virus in kudzu in Mississippi, a total of 127 samples from 28 counties were collected during October 2013 and tested using ELISA. A total of 11 samples collected in 8 different counties were positive for TRSV. To further confirm these results, one step RT-PCR test was performed on total nucleic extracts from all ELISA-positive and four negative kudzu samples using TRSV-specific primers (3). A specific PCR product of 766 bp was present in all ELISA-positive samples and positive controls, whereas no visible bands were present in negative samples. PCR products generated from samples, collected in Kemper, Tippah, and Jefferson Davis counties, were cloned and custom sequenced. Pair-wise comparisons indicated conserved nucleotide (95 to 98%) and amino acid (98 to 99%) contents among sequenced products. Kudzu isolates from Mississippi shared 91 to 96% and 98 to 99% conserved nucleotides and amino acids, with TRSV sequences currently available in the NCBI/GenBank database. This is the first report of TRSV infection of kudzu in Mississippi. The possible implications to the soybean industry are yet to be determined since kudzu occupies approximately 202,000 ha in Mississippi and TRSV has historically been reported associated with bud blight in soybean (1). Nonetheless, results of our study, along with the recent report from Louisiana (2), strongly suggest that kudzu, due to its widespread distribution in the region, may represent a major reservoir of TRSV in the southeastern United States. References: (1) G. L. Hartman et al. Compendium of Soybean Diseases. American Phytopathological Society, St. Paul, MN, 1999. (2) Khankhum et al. Plant Dis. 97:561, 2013. (3) S. Sabanadzovic et al. Plant Dis. 94:126, 2010.

FOOT CARE EDUCATION IN RENAL PATIENTS WITH DIABETES

Foot complications are said to be the primary cause of hospitalization for patients with diabetes, resulting in enormous personal and financial costs. It is reported that end-stage renal disease (ESRD) diabetic patients with peripheral vascular disease have a much higher incidence of foot complications and increased risk for amputation. However, despite the serious financial burden caused by diabetic foot ulcers and their complications, the importance of diabetic foot care is still not fully recognised or supported. There is increasing evidence to suggest that education on foot care is essential for patients with diabetes. Studies have shown that simple techniques such as identifying those at risk of developing foot ulcers, educating patients about foot care that is tailored to meet the requirements of individual patient needs, educational background and learning ability can be of obvious benefit to people with diabetes and is cost-effective.

Exploring visuomotor priming following biological and non-biological stimuli

Observation of human actions influences the observer's own motor system, termed visuomotor priming, and is believed to be caused by automatic activation of mirror neurons. Evidence suggests that priming effects are larger for biological (human) as opposed to non-biological (object) stimuli and enhanced when viewing stimuli in mirror compared to anatomical orientation. However, there is conflicting evidence concerning the extent of differences between biological and non-biological stimuli, which may be due to stimulus related confounds. Over three experiments, we compared how visuomotor priming for biological and non-biological stimuli was affected over views, over time and when attention to the moving stimulus was manipulated. The results indicated that the strength of priming for the two stimulus types was dependent on attentional location and load. This highlights that visuomotor priming is not an automatic process and provides a possible explanation for conflicting evidence regarding the differential effects of biological and non-biological stimuli.

Parental dietary effect on embryological development response to toxicants with the sea urchin Arbacia punctulata

The role of echinoid parental nutrition in early-life stage toxicity is not well understood. Arbacia punctulata were fed either a fresh diet consisting of organic lettuce and carrots or a dry feed. Embryos from parents fed the dry feed exhibited lower sensitivity to copper, whereas the opposite occurred with 1,3,5-trinitrobenzene and sodium dodecyl sulfate (SDS). EC(50) values for the dry and fresh feed treatments, respectively, were 41.0 and 29.9 microg/L for copper, 0.5 and 1.8 mg/L for 1,3,5-trinitrobenzene, and 3.5 and 5.6 mg/L for SDS. The data suggests that nutritional standardization for sea urchins in ecotoxicological laboratories needs to be addressed and further investigated.

First Report on Tobacco mild green mosaic virus in Calibrachoa Plants (Calibrachoa × hybrida) in Mississippi

Six calibrachoa plants displaying reduced growth, general chlorosis, and blistering on the foliage were purchased from a retail store in Starkville, MS in 2007 and tested for possible virus infections. Transmission electron microscope observations of leaf-dip preparations revealed the presence of rigid rod virions reminiscent of tobamoviruses in all samples. The virus was easily mechanically transmissible and induced systemic mosaic/mottling/necrosis symptoms in inoculated Nicotiana benthamiana, N. tabacum cvs. Xanthi and Turkish, N. rustica, N. clevelandii, and N. glutinosa plants as well as in pepper (Capsicum annuum cv. Sweet banana). In double antibody sandwich (DAS)-ELISA tests, the virus reacted slightly with antibodies to Tobacco mosaic virus and Tomato mosaic virus (Agdia Inc, Elkhart, IN) indicating a serological relationship with these two viruses. Final identification of the virus was done by cloning and sequencing a 450-bp-long portion of the viral genome spanning the carboxy terminus of the viral coat protein and 3' noncoding region from one of the original sources. Analyses showed that the virus in diseased calibrachoas is an isolate of Tobacco mild green mosaic virus (TMGMV) and shared 96 to 97% nucleotide identity with sequences of TMGMVCPR-18 (1) (Accession No. AF132908) and several other isolates of this virus available in GenBank. Furthermore, TMGMV was ascertained in all six calibrachoa in reverse transcription-PCR tests using virus-specific primers designed on the generated genomic region. To our knowledge, TMGMV has not been previously reported from calibrachoa plants or from Mississippi in general. In addition, our results stress the importance of the retail industry in the dissemination of viruses on the regional/national scale. Reference: (1) S. Bodaghi et al. J. Gen. Virol. 81:577, 2000.

Lactoferrin and desferrioxamine are ineffective in the treatment of Helicobacter pylori infection and may enhance H. pylori growth and gastric inflammation in mice

AIMS

To evaluate the efficacy of bovine lactoferrin (BLf), recombinant human lactoferrin (rHLf) and desferrioxamine against Helicobacter pylori in vitro and in mice and also to determine whether BLf or rHLf alter gastric inflammation.

METHODS AND RESULTS

In vitro: Broth dilution susceptibility tests were performed using different concentrations of desferrioxamine, BLf and rHLf. Murine trials: In the prevention trial, C57BL/6 female mice were treated with BLf or rHLF, and then infected with the SS1 strain of H. pylori. In the treatment trial, mice were gavaged with either BLf, rHLf or desferrioxamine. In addition, gastric myeloperoxidase activity (MPO) was measured to assess gastric inflammation. Desferoxamine was found to have a direct bactericidal effect, while BLf and rHLf only partially suppressed H. pylori growth in vitro. However, in both prevention and treatment trials all three forms of treatment failed to reduce H. pylori load in mice. Gastric MPO activity and H. pylori load were noted to be higher with lactoferrin treatments.

CONCLUSIONS

Our study does not support the use of BLf or rHLF in the treatment of human H. pylori infection. Interestingly, H. pylori growth and gastric inflammation appear to be enhanced by lactoferrin treatment.

SIGNIFICANCE AND IMPACT OF THE STUDY

The mouse model is ideal for testing novel H. pylori eradicating agents.