B19 parvovirus replicates in circulating cells of acutely infected patients

B19 parvovirus is the etiologic agent of fifth disease and transient aplastic crisis. In natural infections, B19 antigen and DNA have been detected in sera early in the course of aplastic crisis and only rarely in fifth disease. We have found B19 DNA in circulating cells of infected patients by DNA dot blot with a virus-specific probe: in four of four sickle cell patients with aplastic crisis, in one asymptomatic sibling, and in one normal adult with fifth disease. Only two of the sera showed B19 DNA. High-molecular weight intermediate forms were detected by Southern analysis of DNA extracted from cells, thus indicating active replication of virus in cells rather than passive adsorption to their surface membranes. Separation of cells into high- and low-density fractions resulted in a concentration of the virus DNA in the granulocytic fraction.     

A minimally disruptive method for measuring water potential in planta using hydrogel nanoreporters

Leaf water potential is a critical indicator of plant water status, integrating soil moisture status, plant physiology, and environmental conditions. There are few tools for measuring plant water status (water potential) in situ, presenting a critical barrier for developing appropriate phenotyping (measurement) methods for crop development and modeling efforts aimed at understanding water transport in plants. Here, we present the development of an in situ, minimally disruptive hydrogel nanoreporter (AquaDust) for measuring leaf water potential. The gel matrix responds to changes in water potential in its local environment by swelling; the distance between covalently linked dyes changes with the reconfiguration of the polymer, leading to changes in the emission spectrum via Förster Resonance Energy Transfer (FRET). Upon infiltration into leaves, the nanoparticles localize within the apoplastic space in the mesophyll; they do not enter the cytoplasm or the xylem. We characterize the physical basis for AquaDust’s response and demonstrate its function in intact maize (Zea mays L.) leaves as a reporter of leaf water potential. We use AquaDust to measure gradients of water potential along intact, actively transpiring leaves as a function of water status; the localized nature of the reporters allows us to define a hydraulic model that distinguishes resistances inside and outside the xylem. We also present field measurements with AquaDust through a full diurnal cycle to confirm the robustness of the technique and of our model. We conclude that AquaDust offers potential opportunities for high-throughput field measurements and spatially resolved studies of water relations within plant tissues.

Plant life depends on water availability. In managing this demand, irrigated agriculture accounts for 70% of all human water use (1). Physiologically, the process of transpiration (E) dominates this demand for water (Fig. 1A): Solar thermal radiation and the unsaturated relative humidity in the atmosphere drive evaporation from the wet internal surfaces of leaves; this water loss pulls water up through the plant’s vascular tissue (xylem) and out of the soil. This flow occurs along a gradient in the chemical potential of water, or water potential, ψ [MPa] (2). Studies of water relations and stress physiology over the past decades have found that values of ψ along the path of E (the soil–plant–atmosphere continuum [SPAC]) correlate with plant growth, crop yield and quality, susceptibility to disease, and the balance between water loss due to E and the uptake and assimilation of carbon dioxide (water-use efficiency) (3–5).Open in a separate windowFig. 1.AquaDust as an in situ reporter of water potential (ψ). (A) Schematic representation of a maize plant undergoing transpiration (E) in a dynamic environment driven by solar thermal radiation (Qrad) and photosynthetically active radiation (PAR), wind speed (u), temperature (T), vapor pressure deficit (VPD), and soil water potential (ψsoil). Water flows through the plant (blue arrows) along a gradient in water potential (∇→ψ). Zones on the leaves infiltrated with AquaDust serve as reporters of the local leaf water potential, ψleaf, via a short (∼30 s), minimally invasive measurement of FRET efficiency (ζ) with a leaf clamp. (B) Schematic representations of infiltration of a suspension of AquaDust and of the distribution of AquaDust within the cross-section of a leaf. AquaDust passes through the stomata and localizes in the apoplastic spaces within the mesophyll; the particles are excluded from symplastic spaces and the vascular bundle. (C) Schematic diagrams showing mechanism of AquaDust response: The swollen, “wet” state when water potential in its local environment, ψenv=0 (i.e., no stress condition), results in low FRET between donor (green circles) and acceptor (yellow circles) dye (Upper); and the shrunken, “dry” state when ψenv<0 (i.e., stressed condition) results in high FRET between fluorophores, thereby altering the emission spectra (Lower). (D) Fluorescent dyes were chosen to minimize reabsorption of AquaDust emission from chlorophyll; comparison of representative fluorescent emission from AquaDust (donor peak at 520 nm and acceptor peak at 580 nm) with the absorption spectra of chlorophyll and autofluorescence of maize leaf.Due to the recognized importance of water potential in controlling plant function, plant scientists have spent considerable effort devising accurate and reliable methods to measure water potential of the soil, stem, and leaf (6). Of these, plant water potentials, and particularly leaf water potential (ψleaf), represent valuable indicators of plant water status because they integrate both environmental conditions (e.g., soil water availability and evaporative demand) and plant physiological processes (e.g., root water uptake, xylem transport, and stomatal regulation) (7, 8). To date, techniques to measure ψleaf remain either slow, destructive, or indirect. The current tools (e.g., Scholander pressure chamber, psychrometer, and pressure probe) involve disruption of the tissue, the microenvironment, or both (9–11). For example, the widely used pressure chamber requires excision of leaves or stems for the measurement of ψleaf. Other techniques, such as stem and leaf psychrometry, require intimate contact with the tissue, and accurate and repeatable measurements are difficult to obtain (9, 12). These limitations have hindered the study of spatiotemporal water-potential gradients along the SPAC and the development of high-throughput strategies to phenotype based on tissue water potential (13). Additionally, current methods for measuring ψleaf provide averages over tissues in the leaf. This characteristic makes the dissection of water relations on subleaf scales challenging, such that important questions remain, for example, about the partitioning of hydraulic resistances within leaves between the xylem and mesophyll (14–16).These outstanding challenges in the measurement of water status in planta motivated us to develop the measurement strategy presented here, AquaDust, with the following characteristics: 1) Minimally disruptive: Compatible with simple, rapid measurements on intact leaves. Fig. 1A presents our approach, in which AquaDust reporters infiltrated into the mesophyll of the leaf provide an externally accessible optical signal that correlates with the local water potential. 2) Localized: allowing for access to the values of water potential at a well-defined location along the path of transpiration in the leaf tissue. Fig. 1B shows a schematic representation of AquaDust particles localized in the apoplastic volume within the mesophyll, at the end of the hydraulic path for liquid water within the plant. 3) Sensitive and specific: capable of resolving water potentials across the physiologically relevant range (∼−3<ψ<0 MPa) and with minimal sensitivity to other physical (e.g., temperature) and chemical (e.g., pH) variables. Fig. 1C presents a schematic representation of an AquaDust particle formed of hydrogel, a highly tunable material that undergoes a structural response to changes in local water potential (swollen when wet; collapsed when dry). We couple the swelling behavior of the particle to an optical signal via the incorporation of fluorescence dyes (green and yellow circles in Fig. 1C) that undergo variable Förster Resonance Energy Transfer (FRET) as a function of spatial separation. Fig. 1D presents typical AquaDust spectra at high (wet; green curve) and low (dry; yellow curve) water potentials. A change in water potential leads to a change in the relative intensity of the two peaks in the AquaDust spectrum, such that the relative FRET efficiency, ζ=f(ID,IA), can serve as a measure of water potential. 4) Inert: nondisruptive of the physiological properties of the leaf (e.g., photosynthetic capacity, transpiration rate, etc.).In this paper, we present the development, characterization, and application of AquaDust. We show that AquaDust provides a robust, reproducible response of its fluorescence spectra to changes in leaf water potential in situ and across the usual physiological range. We apply our approach to quantify the spatial gradients of water potential along individual leaves undergoing active transpiration and across a range of soil water potentials. With these measurements, we show that the localization of AquaDust in the mesophyll allows us to quantify the importance of hydraulic resistances outside the xylem. We further use AquaDust to measure the diurnal dynamics of ψleaf under field conditions, with repeated measurements on individual, intact leaves. These measurements demonstrate the field-readiness of our techniques and validate the leaf hydraulic model we have developed. We conclude that AquaDust offers a powerful basis for tracking, spatially and temporally, water potential in planta to study the mechanisms by which it couples to both biological and physical processes to define plant function.     

Eosinophil autofluorescence and its use in isolation and analysis of human eosinophils using flow microfluorometry

Unstained human eosinophils exhibit unusually bright autofluorescence, which allows them to be distinguished from other leukocytes using fluorescence microscopy. Eosinophil fluorescence is associated with the cytoplasmic granules of the cells. Eosinophil granule extracts, containing an as-yet-undefined eosinophil fluorescence factor, exhibited excitation maxima at 370 nm and 450 nm, with maximum emission at 520 nm. Eosinophils adhering to opsonized parasites in vitro deposit fluorescent material onto the parasite surface. Eosinophil fluorescence was of sufficient intensity to allow the preparation of viable, highly enriched (greater than or equal to 98%), eosinophil suspensions from peripheral blood of normal and eosinophilic donors using a fluorescence- activated cell sorter. Quantitative studies of eosinophil autofluorescence were performed using flow microfluorometry. Fluorescence intensity of blood eosinophils from normal volunteers and eosinophilic patients varied inversely with the log of the donor's absolute eosinophil count regardless of clinical diagnosis.     

Comparison of objective lenses for multiphoton microscopy in turbid samples

Optimization of illumination and detection optics is pivotal for multiphoton imaging in highly scattering tissue and the objective lens is the central component in both of these pathways. To better understand how basic lens parameters (NA, magnification, field number) affect fluorescence collection and image quality, a two-detector setup was used with a specialized sample cell to separate measurement of total excitation from epifluorescence collection. Our data corroborate earlier findings that low-mag lenses can be superior at collecting scattered photons, and we compare a set of commonly used multiphoton objective lenses in terms of their ability to collect scattered fluorescence, providing guidance for the design of multiphoton imaging systems. For example, our measurements of epi-fluorescence beam divergence in the presence of scattering reveal minimal beam broadening, indicating that often-advocated over-sized collection optics are not as advantageous as previously thought. These experiments also provide a framework for choosing objective lenses for multiphoton imaging by relating the results of our measurements to various design parameters of the objectives lenses used.OCIS codes: (110.0113) Imaging through turbid media, (180.2520) Fluorescence microscopy, (180.4315) Nonlinear microscopy, (180.6900) Three-dimensional microscopy     

Brassinosteroids inhibit pathogen-associated molecular pattern-triggered immune signaling independent of the receptor kinase BAK1

Plants and animals use innate immunity as a first defense against pathogens, a costly yet necessary tradeoff between growth and immunity. In Arabidopsis, the regulatory leucine-rich repeat receptor-like kinase (LRR-RLK) BAK1 combines with the LRR-RLKs FLS2 and EFR in pathogen-associated molecular pattern (PAMP)-triggered immunity (PTI) and the LRR-RLK BRI1 in brassinosteroid (BR)-mediated growth. Therefore, a potential tradeoff between these pathways mediated by BAK1 is often postulated. Here, we show a unidirectional inhibition of FLS2-mediated immune signaling by BR perception. Unexpectedly, this effect occurred downstream or independently of complex formation with BAK1 and associated downstream phosphorylation. Thus, BAK1 is not rate-limiting in these pathways. BRs also inhibited signaling triggered by the BAK1-independent recognition of the fungal PAMP chitin. Our results suggest a general mechanism operative in plants in which BR-mediated growth directly antagonizes innate immune signaling.     

Renal cell carcinoma metastases to gallbladder

A 74-year old man underwent a radical cholecystectomy for presumed gallbladder cancer. The histology of the resected specimen in fact revealed the lesion to be metastatic renal cell carcinoma from his resected right nephrectomy performed 14 years previously.     

Toxicity and biomedical imaging of layered nanohybrids in the mouse

Layered nanohybrids (LNH) are a promising nonviral system allowing controlled drug and DNA delivery. In order to test the toxicity of LNH consisting of a magnesium/aluminum core, mice were subjected to subcutaneous, intraperitoneal, and intravenous injections of these nanoparticles at three doses. Intravenous injections resulted in 8% (1 out of 12) lethality at doses 100 micro l and 200 micro l of 6.96 x 10(- 4) M solution, while all mice survived after LNH administration by any other routes. Histopathological alterations were limited to mild localized inflammatory lesions in the lungs and the dermis after intravenous and subcutaneous administration, respectively. LNH labeled with Lucifer Yellow were readily detectable in both locations by fluorescent microscopy. To test their potential for intravital imaging, LNH-Lucifer Yellow were injected into the ovarian bursa and successfully visualized by multiphoton microscopy within the ovarian surface epithelial cells. In similar experiments, the ovary and the ovarian bursa were readily detectable by magnetic resonance imaging after administration of modified LNH, where aluminum was substituted for gadolinium. Taken together, these results demonstrate minimal in vivo toxicity of LNH and illuminate their potential as multifunctional nanoscale particles suitable for combination of intravital biomedical imaging with controlled drug release.     

Health outcomes measurement and organizational readiness support quality improvement: a systematic review

Background

Using outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The second objective is to identify a) facilitators and/or barriers that contribute to the realization of QI efforts, and b) how outcomes are being used as a catalyst to change outcomes over time.

Methods

We searched the PubMed, EMBASE and Cochrane databases for relevant articles published between January 1995 and March 2017. We used a standardized data abstraction form. Studies were included when the following three criteria were fulfilled: 1) they relied on structural data collection, 2) when a structural and comprehensive QI intervention had been implemented and evaluated, and 3) impact on improving clinical and/or patient-reported outcomes was described. Data on QI strategies, QI initiatives and the impact on outcomes was extracted using standardized assessment tools.

Results

We included 21 articles, of which eight showed statistically significant improvements on outcomes using data from clinical registries. Out of these eight studies, the Chronic Care Model, IT application as feedback, benchmarking and the Collaborative Care Model were used as QI methods. Encouraging trends in realizing improved outcomes through QI initiatives were observed, ranging from improving teamwork, implementation of clinical guidelines, implementation of physician alerts and development of a decision support system. Facilitators for implementing QI initiatives included a high quality database, audits, frequent reporting and feedback, patient involvement, communication, standardization, engagement, and leadership.

Conclusion

This review suggests that outcomes collected in clinical registries are supportive to realize QI initiatives. Organizational readiness and an active approach are key in achieving improved outcomes.