Metabolic Signature of Warburg Effect in Cancer: An Effective and Obligatory Interplay between Nutrient Transporters and Catabolic/Anabolic Pathways to Promote Tumor Growth

Aerobic glycolysis in cancer cells, originally observed by Warburg 100 years ago, which involves the production of lactate as the end product of glucose breakdown even in the presence of adequate oxygen, is the foundation for the current interest in the cancer-cell-specific reprograming of metabolic pathways. The renewed interest in cancer cell metabolism has now gone well beyond the original Warburg effect related to glycolysis to other metabolic pathways that include amino acid metabolism, one-carbon metabolism, the pentose phosphate pathway, nucleotide synthesis, antioxidant machinery, etc. Since glucose and amino acids constitute the primary nutrients that fuel the altered metabolic pathways in cancer cells, the transporters that mediate the transfer of these nutrients and their metabolites not only across the plasma membrane but also across the mitochondrial and lysosomal membranes have become an integral component of the expansion of the Warburg effect. In this review, we focus on the interplay between these transporters and metabolic pathways that facilitates metabolic reprogramming, which has become a hallmark of cancer cells. The beneficial outcome of this recent understanding of the unique metabolic signature surrounding the Warburg effect is the identification of novel drug targets for the development of a new generation of therapeutics to treat cancer.

Sigma Receptors: Novel Regulators of Iron/Heme Homeostasis and Ferroptosis

Sigma receptors are non-opiate/non-phencyclidine receptors that bind progesterone and/or heme and also several unrelated xenobiotics/chemicals. They reside in the plasma membrane and in the membranes of the endoplasmic reticulum, mitochondria, and nucleus. Until recently, the biology/pharmacology of these proteins focused primarily on their role in neuronal functions in the brain/retina. However, there have been recent developments in the field with the discovery of unexpected roles for these proteins in iron/heme homeostasis. Sigma receptor 1 (S1R) regulates the oxidative stress-related transcription factor NRF2 and protects against ferroptosis, an iron-induced cell death process. Sigma receptor 2 (S2R), which is structurally unrelated to S1R, complexes with progesterone receptor membrane components PGRMC1 and PGRMC2. S2R, PGRMC1, and PGRMC2, either independently or as protein-protein complexes, elicit a multitude of effects with a profound influence on iron/heme homeostasis. This includes the regulation of the secretion of the iron-regulatory hormone hepcidin, the modulation of the activity of mitochondrial ferrochelatase, which catalyzes iron incorporation into protoporphyrin IX to form heme, chaperoning heme to specific hemoproteins thereby influencing their biological activity and stability, and protection against ferroptosis. Consequently, S1R, S2R, PGRMC1, and PGRMC2 potentiate disease progression in hemochromatosis and cancer. These new discoveries usher this intriguing group of non-traditional progesterone receptors into an unchartered territory in biology and medicine.

Dyadic positive and negative religious coping among older Singaporean couples and marital satisfaction

Difficulties faced in life can affect marital relationships and such troubles may be dealt with in a multitude of ways, including coping religiously. The present study examined how religious coping, either in a positive or negative manner, may have an impact on marital satisfaction. Importantly, this association was studied dyadically in a sample of religiously diverse (Buddhists, 32.3%; Taoists, 17.6%; protestant Christians, 14.1%; and others who did not identify with a specific religion, 19.1%), married older Singaporean adults (N = 1928; 964 couples). Using actor-partner interdependence modeling, we found significant actor, partner, and combined actor-partner effects for positive and negative religious coping on marital satisfaction. Specifically, marital satisfaction was highest when both spouses reported high levels of positive religious coping and low levels of negative religious coping. Taken together, these findings suggest that it is the simultaneous act of either greater positive or lower negative religious coping by both spouses that is related to higher marital satisfaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Potent Inhibition of Macropinocytosis by Niclosamide in Cancer Cells: A Novel Mechanism for the Anticancer Efficacy for the Antihelminthic

Niclosamide, a drug used to treat tapeworm infection, possesses anticancer effects by interfering with multiple signaling pathways. Niclosamide also causes intracellular acidification. We have recently discovered that the amino acid transporter SLC38A5, an amino acid-dependent Na+/H+ exchanger, activates macropinocytosis in cancer cells via amino acid-induced intracellular alkalinization. Therefore, we asked whether niclosamide will block basal and SLC38A5-mediated macropinocytosis via intracellular acidification. We monitored macropinocytosis in pancreatic and breast cancer cells using TMR-dextran and the function of SLC38A5 by measuring Li+-stimulated serine uptake. The peptide transporter activity was measured by the uptake of glycylsarcosine. Treatment of the cancer cells with niclosamide caused intracellular acidification. The drug blocked basal and serine-induced macropinocytosis with differential potency, with an EC50 of ~5 μM for the former and ~0.4 μM for the latter. The increased potency for amino acid-mediated macropinocytosis is due to direct inhibition of SLC38A5 by niclosamide in addition to the ability of the drug to cause intracellular acidification. The drug also inhibited the activity of the H+-coupled peptide transporter. We conclude that niclosamide induces nutrient starvation in cancer cells by blocking macropinocytosis, SLC38A5 and the peptide transporter. These studies uncover novel, hitherto unknown, mechanisms for the anticancer efficacy of this antihelminthic.

Unconventional Functions of Amino Acid Transporters: Role in Macropinocytosis (SLC38A5/SLC38A3) and Diet-Induced Obesity/Metabolic Syndrome (SLC6A19/SLC6A14/SLC6A6)

Amino acid transporters are expressed in mammalian cells not only in the plasma membrane but also in intracellular membranes. The conventional function of these transporters is to transfer their amino acid substrates across the lipid bilayer; the direction of the transfer is dictated by the combined gradients for the amino acid substrates and the co-transported ions (Na⁺, H⁺, K⁺ or Cl⁻) across the membrane. In cases of electrogenic transporters, the membrane potential also contributes to the direction of the amino acid transfer. In addition to this expected traditional function, several unconventional functions are known for some of these amino acid transporters. This includes their role in intracellular signaling, regulation of acid–base balance, and entry of viruses into cells. Such functions expand the biological roles of these transporters beyond the logical amino acid homeostasis. In recent years, two additional unconventional biochemical/metabolic processes regulated by certain amino acid transporters have come to be recognized: macropinocytosis and obesity. This adds to the repertoire of biological processes that are controlled and regulated by amino acid transporters in health and disease. In the present review, we highlight the unusual involvement of selective amino acid transporters in macropinocytosis (SLC38A5/SLC38A3) and diet-induced obesity/metabolic syndrome (SLC6A19/SLC6A14/SLC6A6).

An Unusual Association of Renal Cell Carcinoma and Renal Malakoplakia with Focal Segmental Glomerulosclerosis in an Elderly Patient

The association of malignancy and glomerulonephritis may be missed, especially in elderly patients. Here, we report a case of eosinophilic variant of renal cell carcinoma and renal parenchymal malakoplakia discovered on renal biopsy in a patient with steroid-dependent nephrotic syndrome. The presence of malakoplakia in our biopsy was probably due to systemic steroid therapy for glomerulonephritis, presence of concomitant asymptomatic urinary tract infection, and/or history of diabetes mellitus. The patient had remission of proteinuria following laparoscopic removal of the tumor, indicating probable remission of glomerulonephritis.

Interpretation of Kidney Biopsy in Indian Patients Older than 60 Years: A Tertiary Care Experience

The adult population above the age of 60 years has significantly increased in India, with a life expectancy of 68.4 years in 2016. Data regarding the renal histopathology in these patients are scarce though the number of native kidney biopsies done in this subset of population is increasing. The present study is a retrospective analysis of 231 biopsies from a total of 700 biopsies, from patients above 60 years of age (M = 65.8%; F = 34.2%) with a mean age of 64 ± 6.03 years. The indications for kidney biopsy included nephrotic syndrome (NS) (30.4%), nephritic syndrome (19.1%), rapidly progressive renal failure (11.7%), acute kidney injury (AKI) (15.7%), and acute worsening of preexisting chronic kidney disease (CKD) (23%). The median percentage of glomerulosclerosis was 22% (5%–45%), and interstitial fibrosis and tubular atrophy was 30% (10%–50%). The most common cause for nephrotic syndrome was membranous nephropathy (31.4%) and for nephritic syndrome was benign arterionephrosclerosis (22.7%). Postinfectious glomerulonephritis (29.6%) was the leading cause for rapidly progressive renal failure. Acute injury on CKD was notable in patients with diabetic nephropathy (30.2%). The predominant causes for AKI were acute tubulointerstitial nephritis (33.3%), acute tubular necrosis (22.2%), and acute pyelonephritis (19.4%). The biopsy proven histopathological features enabled us in tailoring the therapy. None of the patients developed life-threatening complications following ultrasonography-guided biopsy.

[Results of a Questionnaire-Based Study on Guideline Adherence Regarding Adjuvant Treatment Recommendations for Patients with Non-Muscle-Invasive Bladder Cancer: Just a Disturbing Sidelight?]

BACKGROUND

The EAU guidelines on non-muscle-invasive bladder cancer (NMIBC) provide for risk stratification in low, intermediate and high risk based on infiltration depth, grading, concomitant carcinoma in situ, recurrence status, focality and tumour size. The aim of this study was to evaluate guideline adherence regarding risk stratification and risk-adapted treatment recommendations in NMIBC.

MATERIAL AND METHODS

An email-based survey distributed over the urological professional associations of Berlin, Brandenburg, Bremen, Hamburg, Mecklenburg-Western-Pomerania, Lower Saxony and Schleswig-Holstein assessed field of activity (doctor's office vs. clinic) and the presence of the additional qualification "Medical Tumour Therapy" (aqMtt). Also it inquired about the tools used for risk stratification in NMIBC. Finally, 3 scenarios were given, 2 of them corresponding to high-risk NMIBC and one corresponding to intermediate-risk NMIBC. Respondents were asked to provide a treatment recommendation. The results were presented comparatively for field of activity (doctor's office vs. clinic) and presence of aqMtt.

RESULTS

74 responses were received (response rate of 12.3%). 57 (77.0%) of respondents had aqMtt. 52 (70.3%) worked in doctor's offices or medical care centres, 12 (16.2%) in a urology clinic, and for 10 (13.5%) respondents this information was lacking. The most frequently used tool for risk stratification was the EAU guideline. Accordingly, treatment recommendations for the three scenarios were considered to be correct if according to EAU guideline. In high-risk NMIBC, an average 29.3% (19.3-37.5%) of adequate treatment recommendations were made depending on the comparison group. An average of 69.8% (62.5-77.2%) and 0.9% (0.0-3.9%) treatment recommendations would lead to under- or overtreatment, respectively. The corresponding values for intermediate-risk NMIBC were 56.8% (52.6-62.5%) for adequate treatment, 43.2% (37.5-47.4%) for undertreatment and 0.0% for overtreatment. Field of activity and the presence of aqMtt had no significant impact on the accuracy of treatment recommendations.

CONCLUSION

The results of our survey provide strong evidence of poor guideline adherence with a consecutive risk for undertreatment of patients with NMIBC. This requires joint efforts of all those involved in the treatment of NMIBC to improve quality of care.

Conservative management of twisted ischemic adnexa in early pregnancy

Diagnosis of adnexal torsion can be difficult, especially during pregnancy. Delay in diagnosis can lead to necrosis and loss of the affected ovary compromising the reproductive capacity, especially in young women. A 22-year-old primigravida presented to the emergency room at 10 weeks of gestation with acute onset left iliac fossa pain. Ultrasound examination showed a live intra-uterine gestation of 10 weeks, enlarged and edematous left ovary with a clear cyst of 76 mm × 63 mm with flow to the ovary. She underwent emergency surgery with a provisional diagnosis of torsion of left adnexa. Mini-laparotomy, detorsion of the twisted adnexa and ovarian cystectomy with reconstruction was performed thus conserving the tube and ovary. The pregnancy progressed normally; follow-up ultrasound scans showed normal functioning ovaries. Clinical appearance of torted adnexa does not correlate well with the residual function. Ovarian function can be preserved by untwisting, even if ovary appears necrotic.

Management of melioidosis osteomyelitis and septic arthritis

Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis.

We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse.

We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048).

More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

Cite this article: Bone Joint J 2015;97-B:277–82.

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy.

A clinicopathological study of women with adnexal masses presenting with acute symptoms

Background:

Abdominal pain is one of the most common presentations of adnexal pathology in gynecology. Early diagnosis and intervention is essential especially in adolescent girls and reproductive age group women to conserve reproductive function.

Aim:

The purpose of the following study is to assess the clinicopathologic outcome of women with adnexal masses presenting with acute pain.

Subjects and Methods:

A retrospective study of women with adnexal masses who had surgical intervention for acute symptoms from June 2007 to May 2012 was undertaken. During the study period, a total of 57 women were operated for adnexal masses as emergency.

Results:

Of the 57 women operated for adnexal masses as emergency, the most common pathology was teratoma 26% (15/57) followed by corpus luteal hemorrhage (16%) and endometriosis (14%). Laparoscopy was the initial surgical approach in just over 50% of patients, but surgery was completed laparoscopically only in about one-third of patients. Conservative surgery in the form of ovarian cystectomy was possible in 70% of patients.

Conclusion:

Complications of adnexal masses such as torsion and hemorrhage are common causes of acute abdominal pain. Timely diagnosis of the adnexal pathology and surgical intervention will help to preserve the reproductive outcome. Conservative surgery was possible in 70% of our study group.

Reversible acute kidney injury due to bilateral papillary necrosis in a patient with leptospirosis and diabetes mellitus

A 60-year-old lady with type 2 diabetes mellitus and hypertension was referred for fever, bilateral loin pain, and renal failure. Investigations showed severe acute renal failure, bilateral renal papillary necrosis (RPN), urinary tract infection (E. coli), and infection with leptospirosis: Leptospira icterohemorrhagica; serovar hardjo. Renal biopsy showed tubulointerstitial nephritis with mesangial proliferation. The diagnosis was bilateral RPN in a diabetic lady with acute renal failure due to leptospirosis. The patient was successfully treated with hemodialysis, injection ceftriaxone, and benzyl penicillin.

A multicenter cross-sectional study of mental and physical health depression in MHD patients

Depression is ranked fourth among the disabling diseases affecting people worldwide and is the most common psychological problem in patients with End Stage Renal Disease (ESRD). The aim of this study is to assess the physical and emotional health status of renal dialysis patients, based on the SF-36 scale in relation to their economic status. Sixty maintenance hemodialysis patients, with a mean age of 40±13 years were included in this cross-sectional study using the SF-36 scale. It comprises 36 questions regarding physical and mental functions, body pain, vitality, etc. An SF-36 score of 50 or less was considered as moderate to severe depression and 51–100 as mild depression to good health. 56.81% of the patients who are below poverty line under dialysis had moderate to severe depression with regard to their health status. A physical health score of up to 50 was seen in 63.63% of patients below poverty line 63.63% (P= 0.16). A mental health score of 0–50 was observed in 61.63% of the cohort studied (P = 0.22). Among the patient with diabetes (28.33%) 55.56% had depression. Dialysis duration was directly associated with deteriorating physical health status and inversely proportional to their mental health status (P<0.05). There are problems in other regular activities due to depressed physical and mental health. The factors that were identified in this study that influence depression such as poverty status, increasing age, vintage and frequency of dialysis and treatment with erythropoietin dosage should be addressed and treated accordingly to improve the quality of life. Improving self-esteem with fruitful employment opportunities, concerted rehabilitation by professionals and easing of economic burden by private–public partnership is an achievable goal.

VIM-4 carbapenemase-producing Enterobacter cloacae in the United Arab Emirates

Screening 34 carbapenem non-susceptible Enterobacteriaceae recovered in Abu Dhabi hospitals identified an Enterobacter cloacae strain carrying bla(VIM-4) , bla(CMY-4) and bla(CTX-M-15) . It was isolated from the urine of an Egyptian patient repeatedly hospitalized and treated with broad-spectrum antibiotics, including carbapenems, in the United Arab Emirates. The bla(VIM-4) coding class I integron, highly similar to In416, was carried on a 175-kilobase non-conjugative incA/C type plasmid also hybridizing with the bla(CMY-4) probe. This is the first detailed report on the isolation of a Verona integron-encoded metallo-β-lactamase (VIM) -producing enteric bacterium in the Arabian Peninsula with characteristics suggestive of spreading from the Mediterranean region.

Late post transplant HIV infection with BK viremia and allograft tuberculosis in a renal transplant recipient with Kaposi sarcoma

In this report, we discuss a case of a 51-year-old African renal transplant who presented with metastatic Kaposi sarcoma 1 year after transplant. The Kaposi sarcoma was treated with a switch of immunosuppressants and chemotherapy. Six years after transplant, he presented with chronic allograft nephropathy, allograft tuberculosis, BK viremia, and was diagnosed to have contracted HIV infection.

Intracranial hypertension with delayed puberty: a rare presentation of juvenile onset systemic lupus erythematosus

An adolescent boy presented with headache, bilateral papilloedema, growth retardation and absent secondary sexual characteristics. The diagnosis of intracranial hypertension was confirmed by increased intracranial pressure and normal neuroimaging of the brain except for partial empty sella and prominent perioptic cerebrospinal fluid (CSF) spaces. Evaluation showed an erythrocyte sedimentation rate of 150 mm/hr, positive antinuclear antibody, anti-dsDNA and antiribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV-S (A), which confirmed the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methylprednisolone and cyclophosphamide normalised the patient's CSF pressure and symptoms. In cases of intracranial hypertension, SLE must be considered. Growth retardation and absence of secondary sexual characteristics could coexist and may be presenting features of SLE. These manifestations point to advanced grades of LN, which could be asymptomatic and may be missed without a renal biopsy.

Selective surgical management of penetrating anterior abdominal wounds at the Angau Memorial Hospital: a prospective study

Trauma is a leading cause of admissions to the surgical ward in Papua New Guinea (PNG), accounting for about 35% of cases. Of these, 15% of cases are abdominal injuries, of which 19% are penetrating injuries. Selective surgical management of patients with a low-velocity anterior abdominal wound (AAW) is beneficial in some patients.

AIM

To determine if selective surgical management is a viable therapeutic option in PNG.

METHODS

A non-random prospective study of consecutive cases was done on 60 patients with an AAW based entirely on clinical symptoms and signs. The outcome measures were length of hospital stay, morbidity and mortality. Data were analysed using SPSS 10.0 for Windows and Microsoft Excel.

RESULTS

Immediate laparotomy was done on 24 (40%) of cases and 36 (60%) had nonoperative conservative management, of which 6 (17%) failed and went on to have laparotomy on demand. The average hospital stay was 4 days shorter (p = 0.0001) for the nonoperative group, which had significantly fewer complications (p = 0.01). No deaths were recorded in either of the two groups of patients.

CONCLUSION

Selective nonoperative management of stable patients with an AAW with or without omental signs is a safe therapeutic option in PNG.

Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study

BACKGROUND

Malnutrition in human immunodeficiency virus (HIV)-infected individuals is associated with faster disease progression, higher mortality rates, and suboptimal response to antiretroviral therapy (ART).

METHODS

We conducted a prospective interventional study to evaluate the effects of an oral macronutrient supplement among HIV-infected adults in South India. Patients attending Tuberculosis Research Centre clinics from June 2005 through December 2007 had baseline nutritional assessment and laboratory investigations performed. Patients at 1 center received nutritional counseling and standard care, whereas patients at 2 centers additionally received a macronutrient providing 400 cal and 15 g of protein daily. Study outcomes were changes in anthropometry, body composition, blood chemistry, and immune status at 6 months.

RESULTS

In total, 636 ART-naive patients were enrolled in the study; 361 completed 6 months of follow-up (282 received supplements and 79 received standard care). Mean age +/- standard deviation (SD) was 31 +/- 7 years, mean weight +/- SD was 50 +/- 10 kg, and 42% were male. Significant increases in body weight, body mass index, midarm circumference, fat-free mass, and body cell mass were observed in the supplement group but not in the control group at 6 months; gains were greater in patients with CD4 cell counts <200 cells/microL. No changes were observed in lipid levels, whereas the CD4 cell count decreased in the control group. However, after adjusting for baseline differences, these changes were not statistically significantly different between the groups.

CONCLUSIONS

Macronutrient supplementation did not result in significantly increased weight gain compared with standard care (including nutritional counseling) among patients with moderately advanced HIV disease. The effect of supplementation on specific subsets of patients and on preserving immune function needs further research.

Is there an effect of perioperative blood pressure on intraoperative complications during phacoemulsification surgery under local anaesthesia?

PURPOSE

The practice of deferring phacoemulsification procedure on recording raised blood pressure (BP) in the immediate perioperative period is based on the perception of increased intraoperative risk. The significance of perioperative BP recordings on the surgical complications during phacoemulsification procedure was evaluated.

SETTING

Hairmyres Hospitals, Lanarkshire Acute Hospitals NHS Trust.

PATIENTS AND METHODS

Patients were classified as hypertensive on the basis of the British Hypertension Society Guidelines. BP recordings during preoperative assessment, admission, and 1-hour postoperatively were recorded in 734 hypertensives and 740 normotensives undergoing phacoemulsification procedure. In addition, BP recordings in the holding area before giving local anaesthesia were noted in the 734 hypertensives. Patient's peri- and intraoperative complications during the procedure were noted.

RESULTS

The mean age was 72+/-10.5 years and 74+/-11.6 years among the hypertensives and normotensives. There was a significant increase in the number of hypertensives who developed isolated systolic hypertension in the holding area (95% confidence interval=2.82, P<0.001) where the mean BP was 171.38/78.31 mm Hg (+/-30.55/16.29). A total of 21 hypertensives and 18 normotensives developed intraoperative complications during the phacoemulsification procedure. There was no significant difference (P=0.41) in the intraoperative complications between the hypertensives and normotensives.

CONCLUSION

Perioperative increase in BP noted in the holding area among hypertensives did not increase the risk of surgical complications during phacoemulsification procedure when compared with normotensives. We recommend that BP should not be routinely measured in the holding area before phacoemulsification surgery under local anaesthesia.

Splay bend elasticity of a bent-core nematic liquid crystal

We measured the splay (K11) and bend (K33) elastic constants in the nematic phase of a bent-core liquid crystal. In the vicinity of the nematic-isotropic transition temperature K33 is proportional to the square of the order parameter. In the nematic range K11 increases monotonically with decreasing temperature, whereas K33 is practically independent of temperature and is smaller than K11 . K33 exhibits a pretransitional slow divergence toward the transition temperature to the smectic phase and becomes slightly larger than K11. The small K33 is explained on the basis of strong coupling of the bent shape of the molecules with the bend distortion.

Treatment of Strongyloides stercoralis hyperinfection-associated septic shock and acute respiratory distress syndrome with drotrecogin alfa (activated) in a renal transplant recipient

We report a case of Strongyloides stercoralis hyperinfection syndrome in a renal transplant recipient complicated by septic shock, acute respiratory distress syndrome, and Klebsiella pneumoniae superinfection. The patient was treated successfully with drotrecogin alfa (activated), parenteral ivermectin, albendazole, and piperacillin/tazobactam. This outcome suggests that drotrecogin alfa (activated) may be useful therapy for transplant recipients who develop severe sepsis or septic shock secondary to potentially lethal opportunistic infections.

Decrease in laser ablation threshold for epithelial tissue microsurgery in a living Drosophila embryo during dorsal closure

In this work, we use a two-photon fluorescence microscope for combined imaging and laser tissue ablation of a living Drosophila Melanogaster embryo. By using tightly focused near-infrared femtosecond pulses at MHz repetition rate and of sub-nanojoule energy we are able to produce microsurgery on the epithelial tissue within a Drosophila embryo at the final stages of its embryonic development. Ablation was performed on labelled and unlabelled embryos during and after dorsal closure. We observed that ablation of GFP-labelled tissue required lower energy deposition than unlabelled tissue ensuring that the tissue ablation is mediated by multiphoton absorption of Green Fluorescent Protein (GFP). In addition, the energy deposition to produce ablation is further decreased during dorsal closure. These results show the presence of additional tensile forces on the tissue during dorsal closure. Furthermore, an increased activity of actin near the laser wounds was observed as the tissue heals.