Chemokine receptor CXCR3 is required for lethal brain pathology but not pathogen clearance during cryptococcal meningoencephalitis

Cryptococcal meningoencephalitis (CM) is the major cause of infection-related neurological death, typically seen in immunocompromised patients. However, T cell-driven inflammatory response has been increasingly implicated in lethal central nervous system (CNS) immunopathology in human patients and murine models. Here, we report marked up-regulation of the chemokine receptor CXCR3 axis in human patients and mice with CM. CXCR3 deletion in mice improves survival, diminishes neurological deficits, and limits neuronal damage without suppressing fungal clearance. CD4+ T cell accumulation and TH1 skewing are reduced in the CNS but not spleens of infected CXCR3-/- mice. Adoptive transfer of WT, but not CXCR3-/- CD4+ T cells, into CXCR3-/- mice phenocopies the pathology of infected WT mice. Collectively, we found that CXCR3+CD4+ T cells drive lethal CNS pathology but are not required for fungal clearance during CM. The CXCR3 pathway shows potential as a therapeutic target or for biomarker discovery to limit CNS inflammatory damages.

Widespread Occurrence of the Aecial Stage of Sunflower Rust Caused by Puccinia helianthi in North Dakota and Minnesota in 2008

Sunflower rust caused by Puccinia helianthi (Schw.) is widespread in North America and occurs annually on cultivated sunflower (Helianthus annuus L.) and wild annual and perennial Helianthus spp., although severity on the U.S. sunflower crop has been increasing in recent years (2). P. helianthi is a autoecious, macrocyclic rust, but the aecial stage is rarely observed in the field (1,3,4). In most years, the earliest appearance of sunflower rust in North Dakota (ND) and surrounding states usually occurs in early August as the uredinial stage. Initial inoculum can result from urediniospores that overwinter in the Northern Great Plains, urediniospores blown in from areas south of North Dakota, or basidiospores completing the life cycle. However, aecia have been noted very infrequently and never widespread, indicating initial inoculum is usually urediniospores. Aecia of P. helianthi were first observed on 24 June 2008 in a commercial sunflower field (confection hybrid CHS 3126) near Mohall, ND. Aecia cups measuring 0.2 to 0.3 mm in diameter were observed in clusters that were 1 to 7 mm wide in diameter and containing as many as 150 cups. Aecia cups were bright orange but turned brown-black as they senesced. As many as 15 aecial clusters occurred on individual leaves or cotyledons. Aeciospores were ellipsoid, hyaline, and measured approximately 20 μm in diameter. On 4 July 2008, uredinia were first observed in the same Mohall, ND field. At that time, uredinia, aecia, and senesced aecia could all be found on the same leaves. In a non-fungicide-treated strip of the field, pustule coverage on the lower leaves was 10 to 20% by mid-July, pustule coverage on the upper four leaves of plants in the untreated strip was 56% by 27 August, and yield at harvest was less than 200 kg/ha. The rest of the field was sprayed twice with fungicides and yielded 1,571 kg/ha, which is similar to the statewide yield average of 1,573 kg/ha in 2008. To determine the prevalence of aecia in the primary growing regions of ND and Minnesota (MN), surveys were conducted in 75 sunflower fields in 18 counties between 22 and 24 July in ND and 34 fields in 8 counties between 17 and 31 July in MN. Incidence of aecia and uredinia were determined by visual observation of a minimum of 20 plants scouted in a 'W' pattern in the field. Rust was found in 31 and 53% of fields in ND and MN, respectively. In fields where rust was found, both aecia and uredinia were observed in 37% of the fields, aecia only in 29% of the fields, and uredinia only in 34% of the fields. Although it is uncertain why aecia were widespread in 2008, night temperatures in Mohall, ND, where aecia were first observed, reached the dew point temperature on 51 of 61 days in June and July, suggesting that dew or fog likely formed. Thus, favorable conditions for germination and infection early in the growing season indicate widespread occurrence of rust was likely a result of local inoculum sources. The early appearance of aecia is cause for concern for two reasons: significant yield loss can occur when rust appears early in the growing season; and the presence of aecia suggest that the pathogen completed its sexual cycle. When P. helianthi completes its life cycle it is likely that a greater diversity of races will result (4). References: (1) D. L. Bailey. Univ. Minn. Tech. Bull. 16:1, 1923. (2) D. Berglund. Natl. Sunflower Assoc. Online publication. /Berglund_2007_NSA_Survey_08. 2008. (3) H. S. Jackson. Mem. Torrey Bot. Club 18:1, 1931. (4) G. A. Kong et al. Australas. Plant Pathol. 28:320, 1999.

The model repository of the models of infectious disease agent study

The model repository (MREP) is a relational database management system (RDBMS) developed under the auspices of models of infectious disease agent study (MIDAS). The purpose of the MREP is to organize and catalog the models, results, and suggestions for using the MIDAS and to store them in a way to allow users to run models from an access-controlled disease MREP. The MREP contains source and object code of disease models developed by infectious disease modelers and tested in a production environment. Different versions of models used to describe various aspects of the same disease are housed in the repository. Models are linked to their developers and different versions of the codes are tied to Subversion, a version control tool. An additional element of the MREP will be to house, manage, and control access to a disease model results warehouse, which consists of output generated by the models contained in the MREP. The result tables and files are linked to the version of the model and the input parameters that collectively generated the results. The result tables are warehoused in a relational database that permits them to be easily identified, categorized, and downloaded.

Elimination of "lead time" bias in assessing the effect of early breast cancer diagnosis

The relationship between diagnosis of breast cancer in the localized stage of disease and improved prognosis for 234 female breast cancer patients aged 55 years and older was examined. Cause of death was used as an indicator of prognosis because, unlike measures of survival, it is unaffected by "lead time" bias. A three- to fourfold increase in the risk of death from breast cancer was observed among women diagnosed in the advanced stages of breast cancer relative to those diagnosed in the localized stage. The results indicate that diagnosis in the localized stage of breast cancer was associated with an improved prognosis, and that "lead time" bias cannot explain the observed association between stage at diagnosis and prognosis for female breast cancer patients aged 55 years and older.

Patient progress rounds on a university hospital cardiology service

The authors describe patient progress rounds, a weekly meeting of representatives of all disciplines associated with a university hospital cardiology service. The objective is coordination of treatment for all patients in the interest of providing comprehensive care. Each patient's clinical status is reviewed, but primary attention is given to psychosocial aspects. These rounds provide a medium for identifying and dealing with patients' needs, a cooperative teaching and learning venture for staff, a multidisciplinary team approach that increases quality of care, and an opportunity for doctors to confront the reality of their patients as psychosocial beings. Case vignettes illustrate the use and effectiveness of patient progress rounds.