Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection

Although the concept of persistence in chlamydial infections has been recognized for about 80 years, there is still very little known about the mechanism by which this occurs. In this review, we revisit an old paradigm, long known to chlamydiologists and veterinarians, that in virtually all hosts of chlamydiae, including mammals and birds, chlamydiae reside in the gastrointestinal tract for long periods of time in the absence of clinical disease. Thus, if gastrointestinal infection occurs in most hosts, then it is very likely that gastrointestinal infection occurs in humans as well. We demonstrate that gastrointestinal infection does indeed occur in humans and propose that this anatomical site is the source of persistent infection in humans. The data in ruminants and animal models demonstrate that the immune system is unable to clear chlamydiae from the gut, so they can remain indefinitely, with continual shedding in feces. Clearly, many women become reinfected from an untreated partner; however, we propose that women, cured of genital infection, remain at risk for autoinoculation from the lower gastrointestinal tract. Moreover, there are substantial data demonstrating treatment failure of chlamydial infections, particularly with azithromycin. New data in the mouse model have shown that azithromycin is far less effective against chlamydial gastrointestinal infection than against genital infections. Therefore, it is possible that women cured of genital infection by antibiotics remain infected in the gastrointestinal tract and can become reinfected by autoinoculation from that site.     

服入式消化道生理参数检测胶囊的标定与试验

本研究介绍了一种无创式的全消化道生理参数检测的电子胶囊系统.对此电子胶囊进行了严格的标定,标定结果说明胶囊具有良好的检测性能.并且小规模的临床试验表明胶囊具有很好的在体工作效果.该电子胶囊有助于建立数字化消化道模型,检测和分析消化道功能.     

Diffuse Metastasis to the Thyroid: Unique Ultrasonographic Finding and Clinical Correlation

Cases of metastases to the thyroid gland seem to be increasing in recent years. The clinical and ultrasonographic findings of diffuse metastases have been sparsely reported. Thirteen cases of diffuse metastases to the thyroid gland were documented by thyroid ultrasonography-guided fine needle aspiration cytology between 2004 and 2013. We retrospectively reviewed the patients with diffuse thyroid metastases. The most common primary site was the lung (n=9), followed by unknown origin cancers (n=2), cholangiocarcinoma (n=1), and penile cancer (n=1). Eleven patients were incidentally found to have thyroid metastases via surveillance or staging FDG-PET. Other 2 patients were diagnosed during work-up for hypothyroidism and palpable cervical lymph nodes. On ultrasonography, the echogenicity of the enlarged thyroid gland was heterogeneously hypoechoic or isoechoic, and reticular pattern internal hypoechoic lines were observed without increased vascularity found by power Doppler ultrasonography (3 right lobe, 2 left lobe, and 8 both lobes). In the 8 patients who had involvement of both lobes, 3 had hypothyroidism. In conclusion, ultrasonographic finding of diffuse metastasis is a diffusely enlarged heterogeneous thyroid with reticular pattern internal hypoechoic lines. Thyroid function testing should be performed in all patients with diffuse thyroid metastases, especially those with bilateral lobe involvement.

Graphical Abstract

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Seeing right through you: applications of optical imaging to the study of the human brain

A new set of techniques allows for the study of brain function by near-infrared light, exploiting two optical phenomena: Changes in light absorption are determined by changes in the concentration of substances like oxy- and deoxyhemoglobin, and changes in light scattering occur as a consequence of variations of properties of membranes and corpuscles in the neural tissue. Methods based on light absorption can be used to study hemodynamic changes in the brain, whereas those based on light scattering can be used to study neuronal activity and to provide anatomical information at a cellular and subcellular level. Three optical imaging approaches can be used to study living tissue: reflection, optical coherence tomography (OCT), and photon migration. These three approaches vary in their penetration (from less than a millimeter for reflection to up to 3-5 cm for photon migration) and spatial resolution (from a micron level for reflection and OCT to a millimeter and centimeter level for photon migration). This issue includes a collection of articles reviewing applications of these technologies to the study of brain and other bodily functions in humans.     

Come in Out of the Cold: Alternatives to Freezing for Microbial Biorepositories

Biorepositories are “libraries” in which biospecimens, bacteria, or DNA and RNA extracts are stored for either clinical or research purposes. Such specimens enable modern molecular-based research and could support method verification, validation, quality control, and, in some cases, proficiency testing in clinical laboratories. Cryopreservation of extracted nucleic acids ensures the stability and longevity of DNA and RNA from patient samples, with the most common methods used for long-term storage of samples being the use of ?80°C freezers or liquid nitrogen. Frozen biospecimens are crucial for translational research as they contain well-preserved nucleic acids and protein; however, traditional ?80°C freezers consume both energy and space, with costs of maintenance and repairs reaching thousands of dollars annually to freeze and protect biospecimens. Additionally, liquid nitrogen is hazardous to work with, and failure to maintain adequate levels in storage containers can result in loss of specimens. Recently, new room temperature, or “green,” technology has been developed for dry storage of nucleic acids, ultimately reducing costs in terms of energy output and carbon footprint. This review compares and contrasts the use of dry-storage infrastructure with that of freezing samples, in terms of its use in clinical microbiology and highlights considerations to be made if implementing the technologies. Storage alternatives to freezers that equal or exceed their performance with regard to sample preservation and protection against degradation while at the same time reducing space requirements, costs, and energy consumption could be a financial and operational benefit if properly deployed and characterized. Perhaps it is time for laboratories to consider getting molecular quality control material and remnant extracted samples in from the cold and to evaluate the use of dry, room temperature storage technology for use in our microbial biorepositories.     

Capsule size of Cryptococcus neoformans: control and relationship to virulence.

Capsule size of five isolates of Cryptococcus neoformans was controlled by cultivation in media containing varying amounts of sugar. High concentrations of sugar (e.g., 16%) suppressed encapsulation whereas low concentrations (e.g., 1%) allowed maximal encapsulation. Suppression of capsule size was attributed at least in part to the increased osmolarity of the medium because a medium with low sugar concentration but having high osmolarity (by virtue of added sodium chloride) also produced cells having small capsules. The extent of control was more marked with certain of the isolates than with others. Mice were intravenously inoculated with cells of a single isolate cultivated so as to have either small or large capsules, and virulence was measured by comparing death rates. Results indicate that virulence after such an inoculation is a constant characteristic of an isolate and is not affected by size of the capsule of the cells in the inoculum.     

Seeing the invisible: the scope and limits of unconscious processing in binocular rivalry

When an image is presented to one eye and a very different image is presented to the corresponding location of the other eye, the two images compete for conscious representations, such that only one image is visible at a time while the other is suppressed. Called binocular rivalry, this phenomenon and its deviants have been extensively exploited to study the mechanism and neural correlates of consciousness. In this paper, we propose a framework - the unconscious binding hypothesis - to distinguish unconscious processing from conscious processing. According to this framework, the unconscious mind not only encodes individual features but also temporally binds distributed features to give rise to cortical representations; unlike conscious binding, however, unconscious binding is fragile. Under this framework, we review evidence from psychophysical and neuroimaging studies and come to two important conclusions. First, processing of invisible features depends on the "level" of the features as defined by their neural mechanisms. For low-level simple features, prolonged exposure to visual patterns (e.g. tilt) and simple translational motion can alter the appearance of subsequent visible features (i.e. adaptation). For invisible high-level features, complex spiral motion cannot produce adaptation, nor can objects/words enhance subsequent processing of related stimuli (i.e. priming). Yet images of tools can activate the dorsal pathway. Second, processing of invisible features has functional significance. Although invisible central cues cannot orient attention, invisible erotic pictures in the periphery can nevertheless guide attention, likely through emotional arousal; reciprocally, the processing of invisible information can be modulated by attention.     

Investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes: a European study

In order to confirm the validity of the Pneumonia Severity Index (PSI) for patients in Europe, data from adults with pneumonia who were enrolled in two prospective multicentre studies, conducted in France (Pneumocom-1, n = 925) and Spain (Pneumocom-2, n = 853), were compared with data from the original North American study (Pneumonia PORT, n = 2287). The primary outcome was 28-day mortality; secondary outcomes were subsequent hospitalisation for outpatients, and intensive care unit admission and length of stay for inpatients. All outcomes within individual risk classes, and mortality rates in low-risk (PSI I-III) and higher-risk patients, were compared across the three cohorts. Overall mortality rates were 4.7% in Pneumonia PORT, 6.3% in Pneumocom-2 and 10.6% in Pneumocom-1 (p <0.01), ranging from 0.4% to 1.6% (p 0.06) for low-risk patients and from 13.0% to 19.1% (p 0.24) for high-risk patients. Despite significant differences in baseline patient characteristics, none of the study outcomes differed within the low-risk classes. The sensitivity and negative predictive value of low-risk classification for mortality exceeded 93% and 98%, respectively. Thus, in two independent European cohorts, the PSI predicted patient outcomes accurately and reliably, particularly for low-risk patients. These findings confirm the validity of the PSI when applied to patients from Europe.     

Symptom Severity and Guideline-Based Treatment Recommendations for Depressed Patients: Implications of DSM-5's Potential Recommendation of the PHQ-9 as the Measure of Choice for Depression Severity

No abstract available.     

Gastrointestinal stromal tumor of the prostate: a case report and literature review

We report a case of gastrointestinal stromal tumor (GIST) of the prostate in a 75-year-old man with dysuria and urinary retention. Digital rectal examination revealed a markedly enlarged prostate. The serum level of prostate-specific antigen was 0.2 ng/dL. Imaging studies showed an expanded prostate, measuring 6.7 x 5.6 x 5.5 cm, with heterogeneity in contrast enhancement. No metastatic disease was found. The pathologic diagnosis of prostatic GIST was made based on characteristic morphological features, immunoprofiles, and molecular analysis. The possibility of secondary involvement by a rectal GIST was excluded by radiological and intraoperative findings. To our knowledge, this is the second case of a primary GIST of the prostate reported in the literature.     

ORIGINAL ARTICLE: Enhanced Maternal Anti‐Fetal Immunity Contributes to the Severity of Hypertensive Disorder Complicating Pregnancy

Citation Liu L‐P, Huang W, Lu Y‐C, Liao A‐H. Enhanced maternal anti‐fetal immunity contributes to the severity of hypertensive disorder complicating pregnancy. Am J Reprod Immunol 2010 Problem The aim of this study was to evaluate how fetal monocyte activation and maternal anti‐fetal antigen‐specific antibody‐secreting cells (ASC) affect the severity of hypertensive disorder complicating pregnancy (HDCP). Method of study Forty‐six healthy third‐trimester pregnant women and 20 patients with gestational hypertension, 20 with mild pre‐ecalmpsia and another 20 with severe pre‐eclampsia were included in the study. Interleukin‐6 (IL‐6) release from cord blood monocytes was examined by intracellular cytokine staining and flow cytometric analysis. Moreover, the maternal anti‐fetal antigen‐specific ASC were detected by enzyme‐linked immunospot assay. Results A significantly increased percentage of IL‐6‐positive monocytes were detected in the cord blood of study groups compared with the controls (P < 0.01). The percentage of IL‐6‐positive monocytes was increased as the disease progressed (P < 0.05). There were more anti‐fetal antigen‐specific ASC in the study groups than those in the controls (P < 0.001). Furthermore, the anti‐fetal antigen‐specific ASC showed difference in gestational hypertensive and severe pre‐eclamptic groups (P < 0.05). Conclusion We conclude that the fetal monocyte activation and the increase in maternal anti‐fetal antigen‐specific ASC were related to the incidence and severity of HDCP. These results provide both indirect and direct evidence for the occurrence of exaggerated maternal humoral immunity against the fetal antigens in HDCP.