COVID-19 Vaccine Hesitancy Among Pregnant Women

Background COVID-19 has struck the world severely and caused much damage, losses, and a massive impact on different aspects of life. It is an airborne disease that spreads rapidly among populations and can cause severe illness or death. The rapid nature of its spread led to significant challenges to control it. With the introduction of vaccines, strategies need to be developed to prioritize high-risk populations to lower complication rates, hospitalization, and death. Pregnant women are considered a group of high-risk populations. Misinformation about the vaccination efficacy or side effects contributed to general hesitancy, especially among pregnant women. Purpose This study aims to describe the drivers of COVID-19 vaccine hesitancy among pregnant women in Saudi Arabia. Methodology This is a cross-sectional study among pregnant women in the OB/Gyn clinic in King Abdulaziz Medical City, Riyadh, Ministry of National Guard Health Affairs (MNG-HA), using an online survey. Descriptive statistics (univariate analysis) was used to examine the population characteristics. The Chi-square test was used for categorical variables, and t-test for continuous variables. Further, we used the logistics regression model (multivariate analysis), adjusted for potential confounders, to examine factors associated with women's hesitancy to take the COVID-19 vaccine. All statistical tests were two-sided, and findings were considered statistically significant at p < 0.05. All analyses were conducted using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC). Result The study included 303 pregnant women. Nearly half of the respondents had their vaccine during their pregnancy (42.24%), believing that the current vaccines' effectiveness for the coronavirus is good (41.25%). More than 73% of participants have received their COVID-19 vaccine before pregnancy. The mean hesitancy and anxiety score was 2 (agree), which concluded that the respondents were hesitant and anxious to receive the COVID-19 vaccine. Conclusion The study showed a significant correlation between pregnant women's worries and the intention to take the vaccine. The concerns were mainly about the impact of the vaccine on themselves, their babies, and the pregnancy.

Spatio-temporal analysis of nanoparticles in live tumor spheroids impacted by cell origin and density

Nanoparticles hold great preclinical promise in cancer therapy but continue to suffer attrition through clinical trials. Advanced, three dimensional (3D) cellular models such as tumor spheroids can recapitulate elements of the tumor environment and are considered the superior model to evaluate nanoparticle designs. However, there is an important need to better understand nanoparticle penetration kinetics and determine how different cell characteristics may influence this nanoparticle uptake. A key challenge with current approaches for measuring nanoparticle accumulation in spheroids is that they are often static, losing spatial and temporal information which may be necessary for effective nanoparticle evaluation in 3D cell models. To overcome this challenge, we developed an analysis platform, termed the Determination of Nanoparticle Uptake in Tumor Spheroids (DONUTS), which retains spatial and temporal information during quantification, enabling evaluation of nanoparticle uptake in 3D tumor spheroids. Outperforming linear profiling methods, DONUTS was able to measure silica nanoparticle uptake to 10 μm accuracy in both isotropic and irregularly shaped cancer cell spheroids. This was then extended to determine penetration kinetics, first by a forward-in-time, center-in-space model, and then by mathematical modelling, which enabled the direct evaluation of nanoparticle penetration kinetics in different spheroid models. Nanoparticle uptake was shown to inversely relate to particle size and varied depending on the cell type, cell stiffness and density of the spheroid model. The automated analysis method we have developed can be applied to live spheroids in situ, for the advanced evaluation of nanoparticles as delivery agents in cancer therapy.

Nanoscape, a data-driven 3D real-time interactive virtual cell environment

Our understanding of cellular and structural biology has reached unprecedented levels of detail, and computer visualisation techniques can be used to create three-dimensional (3D) representations of cells and their environment that are useful in both teaching and research. However, extracting and integrating the relevant scientific data, and then presenting them in an effective way, can pose substantial computational and aesthetic challenges. Here we report how computer artists, experts in computer graphics and cell biologists have collaborated to produce a tool called Nanoscape that allows users to explore and interact with 3D representations of cells and their environment that are both scientifically accurate and visually appealing. We believe that using Nanoscape as an immersive learning application will lead to an improved understanding of the complexities of cellular scales, densities and interactions compared with traditional learning modalities.

Analogies in 3D molecular visualisations: development of a cell biology animation 'How cells move - a new interpretation of old data'

Cell biology and imaging technology have vastly improved over the past decades, enabling scientists to dissect the inner workings of a cell. In addition to technical limits on spatial and temporal resolution, which obscure the picture at the molecular level, the sheer density and complexity of information impede clear understanding. 3D molecular visualisation has therefore blossomed as a way to translate molecular data in a more tangible form. Whilst the molecular machinery involved in cell locomotion has been extensively studied, existing narratives describing how cells generate the forces that drive movement remain unclear. Polymerisation of a protein called actin is clearly essential. The general belief in the cell migration field is that actin polymerisation's main role is to push the leading edge of the cell forwards, while the rest of the cell follows passively. The cell migration & chemotaxis group at the CRUK Beatson Institute propose an alternative hypothesis, in which actin filaments constitute cables. Motor proteins pull on these cables, causing them to behave like the treads of a tank and drive cell movement. This article describes the development of a 3D animation that uses analogical reasoning to contrast the 'tank' hypothesis for cell locomotion with the current dogma.

Rehabilitation doxa and practitioner judgment. An analysis of symbolic violence on health care provision in the Scottish prison system

This paper presents an analysis of the symbolic conditions which govern health care provision in the Scottish prison system. The paper considers the wider context of Scottish prisons, where health care provision follows a similar structure both in juvenile and adult prisons. Our intention is to provoke a debate about the doxa (Bourdieu, 1977), which underlies decision making in respect of health care in prison, in a political environment where pragmatism, allied to the 'pathologisation' of social policies, health and criminal justice has been a hegemonic force.

Journey to the centre of the cell: Virtual reality immersion into scientific data

Visualization of scientific data is crucial not only for scientific discovery but also to communicate science and medicine to both experts and a general audience. Until recently, we have been limited to visualizing the three-dimensional (3D) world of biology in 2 dimensions. Renderings of 3D cells are still traditionally displayed using two-dimensional (2D) media, such as on a computer screen or paper. However, the advent of consumer grade virtual reality (VR) headsets such as Oculus Rift and HTC Vive means it is now possible to visualize and interact with scientific data in a 3D virtual world. In addition, new microscopic methods provide an unprecedented opportunity to obtain new 3D data sets. In this perspective article, we highlight how we have used cutting edge imaging techniques to build a 3D virtual model of a cell from serial block-face scanning electron microscope (SBEM) imaging data. This model allows scientists, students and members of the public to explore and interact with a "real" cell. Early testing of this immersive environment indicates a significant improvement in students' understanding of cellular processes and points to a new future of learning and public engagement. In addition, we speculate that VR can become a new tool for researchers studying cellular architecture and processes by populating VR models with molecular data.

A benchmarking method to evaluate the accuracy of a commercial proton monte carlo pencil beam scanning treatment planning system

AcurosPT is a Monte Carlo algorithm in the Eclipse 13.7 treatment planning system, which is designed to provide rapid and accurate dose calculations for proton therapy. Computational run-time in minimized by simplifying or eliminating less significant physics processes. In this article, the accuracy of AcurosPT was benchmarked against both measurement and an independent MC calculation, TOPAS. Such a method can be applied to any new MC calculation for the detection of potential inaccuracies. To validate multiple Coulomb scattering (MCS) which affects primary beam broadening, single spot profiles in a Solidwater^® phantom were compared for beams of five selected proton energies between AcurosPT, measurement and TOPAS. The spot Gaussian sigma in AcurosPT was found to increase faster with depth than both measurement and TOPAS, suggesting that the MCS algorithm in AcurosPT overestimates the scattering effect. To validate AcurosPT modeling of the halo component beyond primary beam broadening, field size factors (FSF) were compared for multi-spot profiles measured in a water phantom. The FSF for small field sizes were found to disagree with measurement, with the disagreement increasing with depth. Conversely, TOPAS simulations of the same FSF consistently agreed with measurement to within 1.5%. The disagreement in absolute dose between AcurosPT and measurement was smaller than 2% at the mid-range depth of multi-energy beams. While AcurosPT calculates acceptable dose distributions for typical clinical beams, users are cautioned of potentially larger errors at distal depths due to overestimated MCS and halo implementation.

A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar

BACKGROUND

Visualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing.

RESULTS

Our final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions.

CONCLUSIONS

We have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.

Can theory be embedded in visual interventions to promote self-management? A proposed model and worked example

Nurses are increasingly involved in a range of strategies to encourage patient behaviours that improve self-management. If nurses are to be involved in, or indeed lead, the development of such interventions then processes that enhance the likelihood that they will lead to evidence that is both robust and usable in practice are required. Although behavioural interventions have been predominantly based on written text or the spoken word increasing numbers are now drawing on visual media to communicate their message, despite only a growing evidence base to support it. The use of such media in health interventions is likely to increase due to technological advances enabling easier and cheaper production, and an increasing social preference for visual forms of communication. However, the development of such media is often highly pragmatic and developed intuitively rather than with theory and evidence informing their content and form. Such a process may be at best inefficient and at worst potentially harmful. This paper performs two functions. Firstly, it discusses and argues why visual based interventions may be a powerful media for behaviour change; and secondly, it proposes a model, developed from the MRC Framework for the Development and Evaluation of Complex Interventions, to guide the creation of theory informed visual interventions. It employs a case study of the development of an intervention to motivate involvement in a lifestyle intervention among people with increased cardiovascular risk. In doing this we argue for a step-wise model which includes: (1) the identification of a theoretical basis and associated concepts; (2) the development of visual narrative to establish structure; (3) the visual rendering of narrative and concepts; and (4) the assessment of interpretation and impact among the intended patient group. We go on to discuss the theoretical and methodological limitations of the model.

Multimodal optical molecular image reconstruction with frequency domain measurements

Multimodality molecular imaging is becoming more and more important to understand both the structural and the functional characteristics of tissue, organs and tumors. So far, invasive nuclear methods utilizing ionizing radiation have been the "gold standard" of molecular imaging. We investigate non-contact, non-invasive, patient-tolerant and inexpensive near infrared (NIR) frequency domain optical tomography (FDOT) as a functional complement to structural X-ray computed tomography (CT) data. We show a novel multifrequency NIR FDOT approach both in transmission and reflectance mode and employ radiative transport equation (RTE) for 3D reconstruction of a target with novel fluorescent gold nanoshell indocyanine green (NS ICG) in an ex vivo nude mouse. The results demonstrate that gold NS ICG with multifrequency NIR FDOT is a promising fluorophore for multimodal optical molecular image reconstruction.

3-D visualization and animation technologies in anatomical imaging

This paper explores a 3-D computer artist's approach to the creation of three-dimensional computer-generated imagery (CGI) derived from clinical scan data. Interpretation of scientific imagery, such as magnetic resonance imaging (MRI), is restricted to the eye of the trained medical practitioner in a clinical or scientific context. In the research work described here, MRI data are visualized and interpreted by a 3-D computer artist using the tools of the digital animator to navigate image complexity and widen interaction. In this process, the artefact moves across disciplines; it is no longer tethered to its diagnostic origins. It becomes an object that has visual attributes such as light, texture and composition, and a visual aesthetic of its own. The introduction of these visual attributes provides a platform for improved accessibility by a lay audience. The paper argues that this more artisan approach to clinical data visualization has a potential real-world application as a communicative tool for clinicians and patients during consultation.

Feasibility of a multigroup deterministic solution method for three-dimensional radiotherapy dose calculations

PURPOSE

To investigate the potential of a novel deterministic solver, Attila, for external photon beam radiotherapy dose calculations.

METHODS AND MATERIALS

Two hypothetical cases for prostate and head-and-neck cancer photon beam treatment plans were calculated using Attila and EGSnrc Monte Carlo simulations. Open beams were modeled as isotropic photon point sources collimated to specified field sizes. The sources had a realistic energy spectrum calculated by Monte Carlo for a Varian Clinac 2100 operated in a 6-MV photon mode. The Attila computational grids consisted of 106,000 elements, or 424,000 spatial degrees of freedom, for the prostate case, and 123,000 tetrahedral elements, or 492,000 spatial degrees of freedom, for the head-and-neck cases.

RESULTS

For both cases, results demonstrate excellent agreement between Attila and EGSnrc in all areas, including the build-up regions, near heterogeneities, and at the beam penumbra. Dose agreement for 99% of the voxels was within the 3% (relative point-wise difference) or 3-mm distance-to-agreement criterion. Localized differences between the Attila and EGSnrc results were observed at bone and soft-tissue interfaces and are attributable to the effect of voxel material homogenization in calculating dose-to-medium in EGSnrc. For both cases, Attila calculation times were <20 central processing unit minutes on a single 2.2-GHz AMD Opteron processor.

CONCLUSIONS

The methods in Attila have the potential to be the basis for an efficient dose engine for patient-specific treatment planning, providing accuracy similar to that obtained by Monte Carlo.

Radiative transport-based frequency-domain fluorescence tomography

We report the development of radiative transport model-based fluorescence optical tomography from frequency-domain boundary measurements. The coupled radiative transport model for describing NIR fluorescence propagation in tissue is solved by a novel software based on the established Attila particle transport simulation platform. The proposed scheme enables the prediction of fluorescence measurements with non-contact sources and detectors at a minimal computational cost. An adjoint transport solution-based fluorescence tomography algorithm is implemented on dual grids to efficiently assemble the measurement sensitivity Jacobian matrix. Finally, we demonstrate fluorescence tomography on a realistic computational mouse model to locate nM to microM fluorophore concentration distributions in simulated mouse organs.

Radiative transport in fluorescence-enhanced frequency domain photon migration

Small animal optical tomography has significant, but potential application for streamlining drug discovery and pre-clinical investigation of drug candidates. However, accurate modeling of photon propagation in small animal volumes is critical to quantitatively obtain accurate tomographic images. Herein we present solutions from a robust fluorescence-enhanced, frequency domain radiative transport equation (RTE) solver with unique attributes that facilitate its deployment within tomographic algorithms. Specifically, the coupled equations describing time-dependent excitation and emission light transport are solved using discrete ordinates (SN) angular differencing along with linear discontinuous finite-element spatial differencing on unstructured tetrahedral grids. Source iteration in conjunction with diffusion synthetic acceleration is used to iteratively solve the resulting system of equations. This RTE solver can accurately and efficiently predict ballistic as well as diffusion limited transport regimes which could simultaneously exist in small animals. Furthermore, the solver provides accurate solutions on unstructured, tetrahedral grids with relatively large element sizes as compared to commonly employed solvers that use step differencing. The predictions of the solver are validated by a series of frequency-domain, phantom measurements with optical properties ranging from diffusion limited to transport limited propagation. Our results demonstrate that the RTE solution consistently matches measurements made under both diffusion and transport-limited conditions. This work demonstrates the use of an appropriate RTE solver for deployment in small animal optical tomography.

The declining prevalence of hepatitis B virus infection among Asian and Pacific Islander children

PURPOSE

This article provides a review of the literature on the decline of hepatitis B virus (HBV) infection in Asian and Pacific nations having universal hepatitis B immunization programs.

METHODS

Papers on the epidemiology of HBV infection and hepatitis B immunization programs in Asian and Pacific nations were located by searching MEDLINE and libraries for publications in English, and by contacting hepatitis B experts.

PRINCIPAL FINDINGS

High endemicity for HBV in Asian and Pacific nations was partly caused by a cycle of high infectiousness, perinatal transmission, and chronic infection from early ages. Higher prevalence of infection has been found in men, some families, communities, and ethnic groups, and in people with high risk behaviors and situations, such as attending day care, getting injections, or sharing personal items. Incidence of acquisition of infection is about 2%-5% per year. Prevalence of HBV infection was declining in some nations before commencing hepatitis B immunization programs, probably because of improvements in medical practices and living conditions. Twenty-seven of 34 Pacific and East and Southeast Asian nations have attained >70% hepatitis B vaccination coverage in infants, and twelve have documented reducing infection or liver cancer to fractions of their former rates. But the immunization programs may be causing natural selection of mutant hepatitis B viruses, necessitating study of the mutants, and modification of serological tests and vaccines.

CONCLUSIONS

Practical implications for U.S. health professionals are: increasing HBV screening and hepatitis B vaccination of adolescents and adults from Asian and Pacific nations can prevent many infections and disease cases; most children coming from high coverage Asian and Pacific nations will be immune and few infected; we can learn much from these successful programs; and we should still make efforts to immunize Asian and Pacific children in the United States, and help Asian and Pacific nations which do not yet have highly successful hepatitis B immunization programs.

Safety and predictability of laser in situ keratomileusis enhancement by flap reelevation in high myopia

PURPOSE

To evaluate the safety and predictability of laser in situ keratomileusis (LASIK) retreatment following primary procedures for high myopia and astigmatism.

SETTING

Corneal Diseases and Excimer Laser Research Unit, Department of Ophthalmology, University of Dundee, Dundee, United Kingdom.

METHODS

This prospective observational study of retreatment comprised a cohort of 109 eyes having primary LASIK for high myopia and astigmatism with a spherical equivalent (SE) of -9.70 diopters (D) +/- 4.06 (SD). Twenty-four eyes (22%) with an initial myopic SE of -9.83 +/- 3.50 D, a comparable subset of the entire group (P < .05), had retreatment for residual myopia (-3.02 +/- 2.17 D) to improve uncorrected visual acuity (UCVA) by reelevating the corneal flap and ablating the stromal bed.

RESULTS

The mean follow-up after retreatment was 12.8 +/- 5.1 months (range 1.5 to 24 months; 19 eyes >/=6 months, 13 eyes > or = 12 months). The mean myopic SE was reduced to +0.53 +/- 0.62 D at 1 week, +0.05 +/- 0.50 D at 1 month, +0.30 +/- 0.50 D at 6 months, and +0.18 +/- 0.42 D at the latest follow-up, 12.8 months. At the latest review, 62% of eyes were within +/-0.50 D of emmetropia and 100% were within +/-1.00 D. The mean refraction did not alter statistically between 1 week and subsequent times. The mean UCVA improved from 6/30 prior to retreatment to 6/9 at the latest follow-up. Uncorrected visual acuity of 6/6 or better, 6/9 or better, and 6/12 or better was achieved by 33.0%, 75.0%, and 95.8% of eyes, respectively. No significant complications that led to a loss of best corrected visual acuity were encountered, although retreatment procedures were more uncomfortable than primary procedures and self-limiting; epithelial ingrowth that did not threaten vision was common, and 2 patients complained of nighttime visual symptoms.

CONCLUSIONS

Retreatment of residual myopia by reelevating the flap was relatively safe and predictable, with a low risk of sight-threatening complications. However, longer term studies may be required to detect late complications.

Interleukin 12 and innate molecules for enhanced mucosal immunity

Recent strategies for understanding the mechanisms underlying mucosal immune responses and subsequent development of mucosal vaccines for induction of targeted immunity now include cytokines and molecules of innate immunity. These studies have shown that cytokines influencing the development of T helper (Th) cells differentially affect the outcome of mucosal vs. systemic immune responses to mucosal vaccines. Serum antigen-specific antibody (Ab) responses were enhanced when either IL-6 or IL-12 was mucosally administered with a protein antigen, while only IL-12 induced antigen-specific mucosal IgA Ab responses. Mucosal IL-6 and IL-12 also affected the type of Th cell responses induced by CD4+ T cells from mice that received IL-12 secreted larger amounts of IFN-gamma and IL-6 when compared with mice nasally treated with IL-6. Discrepancies in the ability to enhance mucosal or systemic immune responses were also observed when human neutrophil peptide (HNP) defensins or lymphotactin were nasally coadministered with protein antigens. Only lymphotactin promoted mucosal secretory IgA (S-IgA) Ab responses while both lymphotactin and defensins enhanced systemic immunity to mucosally co-administered protein antigens. Mixed antigen-specific Th1 -and Th2-type CD4+ T cell responses were induced in the systemic compartment by both lymphotactin and the mixture of HNP-1, HNP-2, and HNP-3 defensins. However, HNPs failed to significantly enhance cytokine secretion by mucosally derived, antigen-specific CD4+ T cells relative to those isolated from the systemic compartment. In summary, these studies clearly show that IL-12 and lymphotactin are able to trigger S-IgA Ab responses and provide new avenues for the design of safe and targeted mucosal vaccines.

Arginine enhances induction of T helper 1 and T helper 2 cytokine synthesis by Peyer's patch alpha beta T cells and antigen-specific mucosal immune response

The effects of arginine on cell proliferation and subsequent T helper (Th) 1 and Th 2 cytokine synthesis by murine Peyer's patch (PP) Th cells in vitro and the influence of arginine on the induction of antigen-specific mucosal and systemic immune responses in vivo were examined. When the PP T cells were stimulated with the anti-alpha beta T cell receptor (TCR) antibody in the presence of different concentrations of arginine, a higher proliferative response was observed in the culture with an optimal concentration of arginine compared with that with a minimum amount of this amino acid. The concentration of cytokines in the supernatant, the number of cytokine-producing cells and the cytokine-specific mRNA expression of PP T cells were also increased in a dose-dependent fashion. Furthermore, when mice fed on an arginine-supplemented liquid diet were orally immunized with tetanus toxoid plus cholera toxin as a mucosal adjuvant, a higher level of antigen-specific fecal IgA was observed when compared with the response in mice fed on an arginine-free diet. Taken together, these results suggest that arginine enhanced antigen-specific mucosal immune response resulting from the supporting activation of cell proliferation and subsequent cytokine synthesis of PP Th cells.

Treatment of intracranial gliomas in immunocompetent mice using herpes simplex viruses that express murine interleukins

This report describes a test of the hypothesis that the oncolytic effect of genetically engineered, replication competent herpes simplex viruses (HSV) depends both on cell destruction by the virus and an immune response to the tumor cells induced in an immunocompetent animal system. The oncolytic vector was a HSV recombinant virus in which both copies of the gamma 1 34.5 gene were replaced with the murine genes encoding the cytokine interleukin-4 (IL-4) or interleukin-10 (IL-10). The hypothesis predicted that if an immune response plays a role in survival following intratumoral treatment of tumor-bearing animals with HSV, expression of IL-4 should prolong survival whereas expression of IL-10 should reduce it. The results are that (1) these cytokines can be expressed by HSV in productively infected cells both in vitro and in vivo; (2) HSV-expressing IL-4 or IL-10 genes were able to infect and destroy glioma cells in vitro; (3) intracerebral inoculation of HSV expressing either IL-4 or IL-10 into syngeneic murine glioma GL-261 cells implanted in the brains of immunocompetent C57BL/6 mice produced dramatically opposite physiologic responses. The IL-4 HSV significantly prolonged survival of tumor bearers, whereas tumor-bearing mice that received the IL-10 HSV had a median survival that was identical to that of saline treated controls; (4) immunohistochemical analyses of mouse brains at 3 and 7 days after virus inoculation showed marked accumulation of inflammatory cells composed primarily of macrophages/microglia, with various proportions of CD8+ and CD4+ T cells, but few B lymphocytes. We conclude that the cytokines expressed from genes encoded in the viral genome influence HSV therapy of tumors and this is probably due to the host immune response. Thus, cytokine expression may be an important adjunct to tumor therapy utilizing genetically engineered HSV.

Optimization of live oral Salmonella-HIV-1 vaccine vectors for the induction of HIV-specific mucosal and systemic immune responses

Recent evidence suggests that live oral Salmonella-HIV vaccine vectors have the potential to elicit HIV-specific T cell-mediated immunity in both the mucosal and systemic compartments. We are using the mouse-typhoid model to identify Salmonella::HIV vaccine vector constructs that elicit HIV-specific mucosal and systemic immune responses. Oral immunization of mice with a Salmonella strain that expresses recombinant gp120 (rgp120) in the cytoplasm of the vector elicits a modest gp120-specific T cell proliferation response in the spleen. However, such Salmonella constructs did not stimulate the development of gp120-specific serum IgG or cytotoxic T lymphocytes (CTLs). Interestingly, the majority of cytoplasmically-expressed rgp120 forms inclusion bodies in Salmonella. We believe that in this form rgp120 is highly susceptible to protease degradation by the vector. As such, cytoplasmic rgp120 may not persist in the host after vaccination, resulting in the modest immunogenicity of rgp120 in these constructs. To circumvent this problem we constructed Salmonella strains that express rgp120 on the surface of the vector. Preliminary data suggest that surface-expressed rgp120 is significantly more immunogenic in both the mucosal and systemic compartments than cytoplasmic rgp120. These results, therefore, support the proposal that Salmonella vectors will be a safe and inexpensive means for delivery of HIV antigens to, and the elicitation of HIV-specific T cells in, the mucosal and systemic compartments.

A mutant pertussis toxin molecule that lacks ADP-ribosyltransferase activity, PT-9K/129G, is an effective mucosal adjuvant for intranasally delivered proteins

We examined the capacity of a genetically detoxified derivative of pertussis toxin (PTX), PT-9K/129G, to act as a mucosal adjuvant for an intranasally (i.n.) administered tetanus vaccine. Groups of mice were immunized i.n. with the nontoxic C-terminal 50-kDa portion of tetanus toxin (fragment C [Frg C]) either alone or mixed with PT-9K/129G, PTX, or cholera toxin (CT) or were immunized subcutaneously (s.c.) with an equivalent amount of Frg C adsorbed to alhydrogel. In response to a single immunization, mice receiving Frg C plus PT-9K/129G or CT i.n. and parenterally immunized mice developed high-titer (> 20,000) anti-Frg C antibodies, whereas mice immunized i.n. with Frg C plus PTX or with Frg C alone seroconverted only after being boosted. The serum anti-Frg C response was dominated by immunoglobulin G1 (IgG1) in mice immunized with Frg C plus PT-9K/129G, with Frg C plus PTX, or s.c. In contrast, IgG1, IgG2a, and IgG2b contributed almost equally to the Frg C response when CT was the adjuvant. Anti-Frg C IgE was detected only in the sera of mice immunized i.n. with Frg C plus PTX and immunized s.c. with Frg C plus alhydrogel. High levels of IgA antibodies were present in nasal lavage fluid from mice immunized i.n. with Frg C plus PT-9K/129G, PTX, or CT but not in that from mice given Frg C alone i.n. or parenterally. The mucosal adjuvanticity of PT-9K/129G was manifested in inbred as well as outbred mice. A single i.n. dose of Frg C plus either PT-9K/129G or PTX (with high specific activity) was sufficient to protect all immunized mice from tetanus toxin challenge, in contrast to the case for mice that received Frg C alone i.n. We conclude that the pertussis toxin analog PT-9K/129G, which is devoid of ADP-ribosyltransferase activity, is a potent mucosal adjuvant for vaccines delivered via the respiratory tract.

Development of a blood urea monitoring system for the closed loop control of dialysis

Optimal hemodialysis prescription through real-time blood urea (BU) monitoring and closed loop control of urea removal would be of significant clinical value. Progress toward a bedside BU analyzer and a control system is described here. An Amicon Minifilter inserted into the arterial bloodline provides a 1 ml/min stream of protein free ultrafiltrate for analysis. In vitro tests with bovine blood have shown excellent correlation between plasma (CP) and ultrafiltrate (CU) urea levels: CP = 0.961CU + 0.071, (n = 34, r = 0.998). In clinical hemodialysis studies, CU accurately represented the decay in CP. The BU analyzer uses a standard UV endpoint assay with a proportioning roller pump. The absorbance of the reacted mixture is read in a spectrophotometer after a 5 min incubation. For future control system design, the transfer function (TF) of the BU analyzer was measured using multifrequency binary testing. The data indicated that the analyzer may be modeled by a second order TF with a pure time delay. The same form of TF was also found to describe the Minifilter. Control of the removal rate of NaCl (substituted for urea) through automatic dialysate flow adjustment has been achieved with a simulated dialyzer-patient circuit (using a conductivity probe in place of the BU analyzer). A modified BU analyzer using computer controlled precision syringes for improved sample processing time and accuracy is also reported.

Selection criteria for waste management processes in manned space missions

Management of waste produced during manned space exploration missions will be an important function of advanced life support systems. Waste materials can be thrown away or recovered for reuse. The first approach relies totally on external supplies to replace depleted resources while the second approach regenerates resources internally. The selection of appropriate waste management processes will be based upon criteria which include mission and hardware characteristics as well as overall system considerations. Mission characteristics discussed include destination, duration, crew size, operating environment, and transportation costs. Hardware characteristics include power, mass and volume requirements as well as suitability for a given task. Overall system considerations are essential to assure optimization for the entire mission rather than for an individual system. For example, a waste management system designed for a short trip to the moon will probably not be the best one for an extended mission to Mars. The purpose of this paper is to develop a methodology to identify and compare viable waste management options for selection of an appropriate waste management system.

Hyperostosis frontalis interna, acromegaly and hyperprolactinaemia

The association between hyperostosis frontalis interna (HFI), acromegaly and hyperprolactinaemia was investigated. Thirty six acromegalic patients, of whom 19 had hyperprolactinaemia, were compared with 36 randomly-selected, age-sex matched controls. There was a higher prevalence of HFI in the skull X-rays of the acromegalic cohort (P = 0.0002) when compared to the control group. This difference was apparent in both men (P = 0.01) and women (P = 0.01). Acromegalic patients with hyperprolactinaemia also expressed HFI in a higher proportion of individuals than the control group (P = 0.0001). Intra- and interobserver variability was assessed and concordance with 100% and 97% in the moderate and severe HFI sub-groups. The following sub-group analysis was undertaken: acromegalics and those acromegalics with hyperprolactinaemia were compared with the controls and a highly significant distinction was confirmed (P = 0.0007 and P = 0.00001 respectively). A relationship between HFI severity and the patient's age was noted in both male and female acromegalics. Also, the severity of HFI appeared related to disease duration in female acromegalics. The cause of HFI remains unknown but appears to be strongly associated with acromegaly, particularly in the presence of co-existent hyperprolactinaemia. The association may have symptomatic significance and the presence of HFI should be confirmed or refuted in all patients with acromegaly.

Genetic factors in host resistance to urinary tract infection

In patients with recurrent pyelonephritis, the pathogenetic events proceed through intestinal colonization, spread to the urinary tract and persistence, seemingly uninterrupted by host defense mechanisms. The factors responsible for the deficient bacterial clearance from the kidneys of these patients, and the genetic control, have not been identified. The susceptibility to colonization has been linked to an increased receptivity for attaching bacteria of the uroepithelia, and to an overrepresentation of the P1 blood group phenotype. To evaluate the role of defects in host defense for the susceptibility to pyelonephritis, experimental UTI in mouse strains with known deficiencies was used. A highly significant increase in susceptibility was noted for C3H/HeJ compared to C3H/HeN mice. The bacterial recovery was inversely correlated to the mitogenic response to LPS. Back-cross analysis revealed a linkage of susceptibility to the Lpsd/Lpsd genotype. In contrast, T and B lymphocyte and complement (C5) defects had little effect on the clearance of Escherichia coli from the kidneys. It is concluded that the inflammatory mechanisms induced by LPS are essential for resistance to experimental pyelonephritis.

Genetic factors in host resistance to urinary tract infection

In patients with recurrent pyelonephritis, the pathogenetic events proceed through intestinal colonization, spread to the urinary tract and persistence, seemingly uninterrupted by host defense mechanisms. The factors responsible for the deficient bacterial clearence from the kidneys of these patients, and the genetic control, have not been identified. The susceptibility to colonization has been linked to an increased receptivity for attaching bacteria of the uroepithelia, and to an overrepresentation of the P1 blood group phenotype. To evaluate the role of defects in host defense for the susceptibility to pyelonephritis, experimental UTI in mouse strains with known deficiencies was used. A highly significant increase in susceptibility was noted for C3H/HeJ compared to C3H/HeN mice. The bacterial recovery was inversely correlated to the mitogenic response to LPS. Back-cross analysis revealed a linkage of susceptibility to the Lpsd/Lpsd genotype. In contrast, T and B lymphocyte and complement (C5) defects had little effect on the clearance of Escherichia coli from the kidneys. It is concluded that the inflammatory mechanisms induced by LPS are essential for resistance to experimental pyelonephritis.