PE_PGRS Antigens of Mycobacterium tuberculosis Induce Maturation and Activation of Human Dendritic Cells

Mycobacterium tuberculosis, the causative agent of pulmonary tuberculosis, infects one-third of the world's population. Activation of host immune responses for containment of mycobacterial infections involves participation of innate immune cells, such as dendritic cells (DCs). DCs are sentinels of the immune system and are important for eliciting both primary and secondary immune responses to pathogens. In this context, to understand the molecular pathogenesis of tuberculosis and host response to mycobacteria and to conceive prospective vaccine candidates, it is important to understand how cell wall Ags of M.tuberculosis and, in particular, the proline-glutamic acid-polymorphicguanine-cytosine-rich sequence (PE_PGRS) family of proteins modulate DC maturation and function. In this study, we demonstrate that two cell wall-associated/secretory PE_PGRS proteins, PE_PGRS 17 (Rv0978c) and PE_PGRS 11 (Rv0754), recognize TLR2, induce maturation and activation of human DCs, and enhance the ability of DCs to stimulate CD4(+) T cells. We further found that PE_PGRS protein-mediated activation of DCs involves participation of ERK1/2, p38 MAPK, and NF-kappa B signaling pathways. Priming of human DCs with IFN-gamma further augmented PE_PGRS 17 or PE_PGRS 11 Ag-induced DC maturation and secretion of key proinflammatory cytokines. Our results suggest that by activating DCs, PE_PGRS proteins, important mycobacterial cell wall Ags, could potentially contribute in the initiation of innate immune responses during tuberculosis infection and hence regulate the clinical course of tuberculosis. The Journal of Immunology, 2010, 184: 3495-3504.

Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials

Background We aimed to assess the effect of afatinib on overall survival of patients with EGFR mutation-positive lung adenocarcinoma through an analysis of data from two open-label, randomised, phase 3 trials. Methods Previously untreated patients with EGFR mutation-positive stage IIIB or IV lung adenocarcinoma were enrolled in LUX-Lung 3 (n=345) and LUX-Lung 6 (n=364). These patients were randomly assigned in a 2:1 ratio to receive afatinib or chemotherapy (pemetrexed-cisplatin [LUX-Lung 3] or gemcitabine-cisplatin [LUX-Lung 6]), stratified by EGFR mutation (exon 19 deletion [del19], Leu858Arg, or other) and ethnic origin (LUX-Lung 3 only). We planned analyses of mature overall survival data in the intention-to-treat population after 209 (LUX-Lung 3) and 237 (LUX-Lung 6) deaths. These ongoing studies are registered with ClinicalTrials.gov, numbers NCT00949650 and NCT01121393. Findings Median follow-up in LUX-Lung 3 was 41 months (IQR 35–44); 213 (62%) of 345 patients had died. Median follow-up in LUX-Lung 6 was 33 months (IQR 31–37); 246 (68%) of 364 patients had died. In LUX-Lung 3, median overall survival was 28·2 months (95% CI 24·6–33·6) in the afatinib group and 28·2 months (20·7–33·2) in the pemetrexed-cisplatin group (HR 0·88, 95% CI 0·66–1·17, p=0·39). In LUX-Lung 6, median overall survival was 23·1 months (95% CI 20·4–27·3) in the afatinib group and 23·5 months (18·0–25·6) in the gemcitabine-cisplatin group (HR 0·93, 95% CI 0·72–1·22, p=0·61). However, in preplanned analyses, overall survival was significantly longer for patients with del19-positive tumours in the afatinib group than in the chemotherapy group in both trials: in LUX-Lung 3, median overall survival was 33·3 months (95% CI 26·8–41·5) in the afatinib group versus 21·1 months (16·3–30·7) in the chemotherapy group (HR 0·54, 95% CI 0·36–0·79, p=0·0015); in LUX-Lung 6, it was 31·4 months (95% CI 24·2–35·3) versus 18·4 months (14·6–25·6), respectively (HR 0·64, 95% CI 0·44–0·94, p=0·023). By contrast, there were no significant differences by treatment group for patients with EGFR Leu858Arg-positive tumours in either trial: in LUX-Lung 3, median overall survival was 27·6 months (19·8–41·7) in the afatinib group versus 40·3 months (24·3–not estimable) in the chemotherapy group (HR 1·30, 95% CI 0·80–2·11, p=0·29); in LUX-Lung 6, it was 19·6 months (95% CI 17·0–22·1) versus 24·3 months (19·0–27·0), respectively (HR 1·22, 95% CI 0·81–1·83, p=0·34). In both trials, the most common afatinib-related grade 3–4 adverse events were rash or acne (37 [16%] of 229 patients in LUX-Lung 3 and 35 [15%] of 239 patients in LUX-Lung 6), diarrhoea (33 [14%] and 13 [5%]), paronychia (26 [11%] in LUX-Lung 3 only), and stomatitis or mucositis (13 [5%] in LUX-Lung 6 only). In LUX-Lung 3, neutropenia (20 [18%] of 111 patients), fatigue (14 [13%]) and leucopenia (nine [8%]) were the most common chemotherapy-related grade 3–4 adverse events, while in LUX-Lung 6, the most common chemotherapy-related grade 3–4 adverse events were neutropenia (30 [27%] of 113 patients), vomiting (22 [19%]), and leucopenia (17 [15%]). Interpretation Although afatinib did not improve overall survival in the whole population of either trial, overall survival was improved with the drug for patients with del19 EGFR mutations. The absence of an effect in patients with Leu858Arg EGFR mutations suggests that EGFR del19-positive disease might be distinct from Leu858Arg-positive disease and that these subgroups should be analysed separately in future trials.

PE_PGRS Antigens of Mycobacterium tuberculosis Induce Maturation and Activation of Human Dendritic Cells

Mycobacterium tuberculosis, the causative agent of pulmonary tuberculosis, infects one-third of the world's population. Activation of host immune responses for containment of mycobacterial infections involves participation of innate immune cells, such as dendritic cells (DCs). DCs are sentinels of the immune system and are important for eliciting both primary and secondary immune responses to pathogens. In this context, to understand the molecular pathogenesis of tuberculosismand host response to mycobacteria and to conceive prospective vaccine candidates, it is important to understand how cell wall Ags of M. tuberculosis and, in particular, the proline-glutamic acid-polymorphic guanine-cytosine-rich sequence (PE_PGRS) family of proteins modulate DC maturation and function. In this study, we demonstrate that two cell wall-associated/secretory PE_PGRS proteins, PE_PGRS 17 (Rv0978c) and PE_PGRS 11 (Rv0754), recognize TLR2, induce maturation and activation of human DCs, and enhance the ability of DCs to stimulate CD4(+) T cells. We further found that PE_PGRS protein-mediated activation of DCs involves participation of ERK1/2, p38 MAPK, and NF-kappa B signaling pathways. Priming of human DCs with IFN-gamma further augmented PE_PGRS 17 or PE_PGRS 11 Ag-induced DC maturation and secretion of key proinflammatory cytokines. Our results suggest that by activating DCs, PE_PGRS proteins, important mycobacterial cell wall Ags, could potentially contribute in the initiation of innate immune responses during tuberculosis infection and hence regulate the clinical course of tuberculosis. The Journal of Immunology, 2010, 184: 3495-3504.

Parallel and antiparallel aggregation of alpha-helices. Crystal structures of two apolar decapeptides X-Trp-Ile-Ala-Aib-Ile-Val-Aib-Leu-Aib-Pro-OMe (X = Boc, Ac)

An apolar helical decapeptide with different end groups, Boc- or Ac-, crystallizes in a completely parallel fashion for the Boc-analog and in an antiparallel fashion for the Ac-analog. In both crystals, the packing motif consists of rows of parallel molecules. In the Boc-crystals, adjacent rows assemble with the helix axes pointed in the same direction. In the Ac-crystals, adjacent rows assemble with the helix axes pointed in opposite directions. The conformations of the molecules in both crystals are quite similar, predominantly alpha-helical, except for the tryptophanyl side chain where chi 1 congruent to 60 degrees in the Boc- analog and congruent to 180 degrees in the Ac-analog. As a result, there is one lateral hydrogen bond between helices, N(1 epsilon)...O(7), in the Ac-analog. The structures do not provide a ready rationalization of packing preference in terms of side-chain interactions and do not support a major role for helix dipole interactions in determining helix orientation in crystals. The crystal parameters are as follow. Boc-analog: C60H97N11O13.C3H7OH, space group Pl with a = 10.250(3) A, b = 12.451(4) A, c = 15.077(6) A, alpha = 96.55(3) degrees, beta = 92.31(3) degrees, gamma = 106.37(3) degrees, Z = 1, R = 5.5% for 5581 data ([F] greater than 3.0 sigma(F)), resolution 0.89 A. Ac-analog: C57H91N11O12, space group P2(1) with a = 9.965(1) A, b = 19.707(3) A, c = 16.648(3) A, beta = 94.08(1), Z = 2, R = 7.2% for 2530 data ([F] greater than 3.0 sigma(F)), resolution 1.00 A.

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: A cross-sectional study

Objective: To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). Setting: Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. Participants: A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. Primary and secondary outcomes: A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. Results: A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). Conclusions: The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.

Suomalaiset lääkärit ja Suomen Lääkäriliitto osana hyvinvointivaltiota ja sen terveyspolitiikkaa

Tässä julkaisussa selvitetään Suomen Lääkäriliiton ideoita (makrotaso) ja lääkäreiden (mikrotaso) mielipiteitä hyvinvointivaltiosta ja sen terveyspolitiikasta. Makrotason aineiston muodostavat erilaiset julkiset dokumentit. Aineistot ovat pääosin vuosilta 1970–2007. Dokumentteja analysoidaan sekä määrällisen että laadullisen sisällönanalyysin tai erittelyn keinoin. Mikrotason aineiston muodostaa vuonna 2007 kerätty kyselyaineisto (n = 1 092). Sitä analysoidaan kuvailevin tilastollisin menetelmin ja logistisen regressioanalyysin keinoin. Tulosten perusteella Suomen Lääkäriliitto koki julkisen vallan puuttumisen uhkaksi rakennettaessa universaalia terveydenhuoltojärjestelmää. Uhka kuitenkin väheni julkisen sektorin jatkuvasti laajentuessa. Toisaalta jatkuvana vaatimuksena Lääkäriliiton dokumenteissa esiintyy 1970-luvulta lähtien yksityisen sektorin roolin lisäämisvaateet. 1990-luvun laman jälkeisenä aikana yksityiseen sektoriin liittyvät ideat ovat tulleet yhä selkeämmiksi ja konkreettisemmiksi. Argumenteissaan Lääkäriliitto ei tuo juurikaan esille omia taloudellisia intressejään vaan vetoaa useammin yleiseen hyvään. Kyselyaineistosta tehtyjen analyysien mukaan lääkärit kokevat sosiaaliturvan muuta väestöä useammin liian laajaksi. Lääkärit eivät kuitenkaan halua erityisen voimakkaasti markkinoistaa terveydenhuoltoa, jopa verrattaessa muuhun väestöön. Parhaiten lääkäreiden mielipiteitä sosiaaliturvasta ja terveydenhuoltojärjestelmästä selittävät poliittinen orientaatio ja työskentelysektori. Nuorten lääkäreiden mielipiteet sosiaaliturvasta ja terveydenhuoltojärjestelmästä eivät ole erityisen radikaaleja. Lopuksi tutkimuksessa verrattiin mikro- ja makrotasoa keskenään. Tulosten perusteella Suomen Lääkäriliitto on selvästi radikaalimpi näkemyksissään markkinoistumisesta kuin lääkärit keskimäärin.

Nutritional properties ofCorynebacterium laevaniformans

The nutritional profiles ofCorynebacterium laevaniformans and the other levan synthesizing coryneform organism isolated by Henis and Aschner (1954) have been studied.C. laevaniformans required biotin, thiamine and pantothenic acid for growth while the Henis and Aschner strain required the former two vitamins only. Two of the six strains ofC. laevaniformans had, in addition, a requirement for glutamate.C. laevaniformans has been shown to be able to degrade levan in growing cultures. Some properties of a cell-free levansucrase are described.

Studies in the polarography of metal-amino acid complexes - Part I. Cadmium

1. A detailed polarographic study of cadmium has been made employing glycine, α-alanine, β-alanine, valine, aspartic acid, glutamic acid and asparagine as complexing agents at various pH values. The effect of incorporating sodium hydroxide, sodium carbonate and ammonium nitrate + ammonium hydroxide, on the polarographic behaviour of amino acid complexes of cadmium has also been investigated. 2. The reduction process has been found to be reversible in all systems. 3. The small shifts in the half-wave potentials noticed due to increase in the concentration of sodium hydroxide and sodium carbonate in presence of amino acids have been explained on the basis of formation of mixtures of pure and mixed amino acid complexes of cadmium. Mixed complexes have also been noticed in presence of ammonium hydroxide and ammonium nitrate and amino acids. 4. Polarographic evidence has been obtained for the formation of over 30 pure and mixed complexes. The dissociation constant Kd, the Δ F° value for the dissociation, and standard potential value for the formation, of each complex have been computed. 5. It has been found that cadmium can be polarographically estimated in amino acid solutions.

The change of complete symmetry of the crystals during the phase transitions in ferroelectrics and ferromagnetics

The extension of the superposition principle of the symmetries (P. Curie principle of symmetry) for the case of complete symmetry is given. The enumeration of all crystallographical groups of complete symmetry is presented, the number of elements having complete symmetry for each class of the crystals being indicated. The change of complete symmetry of the crystals under the phase transitions is obtained by superimposing the elements of complete symmetry of polar or axial vectors on the one hand, and the elements of complete symmetry of the crystals on the other. The tables of complete symmetry changes for the cubic, rhombic, monoclinic and triclinic crystals during the ferroelectric and ferromagnetic phase transitions are given.

A unified approach to bubble and drop formation

An approach, starting with the bubble formation model of Khurana and Khumar, has been presented, which is found to be reasonably applicable to the formation of both bubbles and drops from single submerged nozzles. The model treats both the phenomena jointly as the formation of a dispersed phase entity resulting from injection, whose size depends upon operating parameters and physical properties.

A preliminary survey of dermatomycoses in Bangalore

Clinical and mycological investigations were made on 225 cases of suspected dermatomycoses. Of these, 102 were microscopically positive. But only 63 were culturally positive, and these are analysed here with regard to clinical patterns and aetiological species, age, sex and occupational incidence and susceptibility to griseofulvin in vitro. As in most other parts of India, Trichophyton rubrum was the dominant species. A high proportion of Epidermophyton floccosum was an unusual feature seen. Of the clinical types, tinea cruris was the most common. The isolates were sensitive to griseofulvin at low concentrations of 1 to 5 μg per ml of agar medium, E. floccosum being the most sensitive.

Suomen sahateollisuuden supistumisen ja tulevaisuuden kuvien aluetaloudelliset vaikutukset

Sahateollisuuden tuotantokapasiteetti on vähentynyt viime vuosina paljon. Syvä lama on leikannut vientiä ja myös rakentaminen on hiljentynyt. Tämä on pakottanut sopeuttamistoimiin samaan tapaan kuin massa- ja paperiteollisuuden kohdalla. Mikäli tällekin vuodelle suunnitellut toimet toteutuvat, yhteensä yksitoista sahaa ja seitsemän jalostetehdasta on suljettu. Kapasiteetin leikkaukset koskevat yhteensä kahtatoista maakuntaa ja viittätoista seutukuntaa. Puolet leikkauksista kohdistuu pieniin seutukuntiin, joka lisää aluetalouden sopeutumishaastetta. Tutkimuksessa on selvitetty sahojen ja jalostetehtaiden sulkemisten aluetaloudellisia vaikutuksia seutukuntien taloudelliseen kasvuun ja työllisyyteen. Sahateollisuuden menetyksiä verrattiin maakuntatasolla massa- ja paperiteollisuuden vastaaviin. Lisäksi tarkasteltiin alan kolmea tulevaisuuden kuvaa Suomen tasolla. Laskelmat suoritettiin alueellisella yleisen tasapainon RegFinDyn-simulointimallilla. Tarkasteluperiodi oli sulkemisten osalta vuodet 2004–2013 ja vuodet 2010–2014 tulevaisuuden kuvien kohdalla. Sulkemisten vaikutus seutukuntien taloudelliseen kasvuun näyttäisi jäävän suhteellisen pieneksi. Aluetalous sopeutuisi uuteen tilanteeseen muiden alojen kompensoidessa osan menetyksistä. Talouskasvun menetykset ovat yhteensä 173,8 miljoonaa euroa, jos Varkauden sahaa ei suljeta ja 184,7 miljoonaa, jos sulkeminen tapahtuu. Tilanne näyttäisi samalta työllisyyden suhteen. Työllisyyden menetykset ovat vastaavasti yhteensä 2 693 henkilötyövuotta tai 3 031. Menetysten osuus maakuntien yhteenlasketusta BKT:sta ja työllisyydestä on 0,3 %. Tämä on vähemmän kuin massa- ja paperiteollisuudessa. Ongelmalliseksi tilanteen tekee se, että molemmat alat ovat menettäneet talouskasvua ja työllisyyttä viidessä maakunnassa. ETLA:n sahateollisuuden ja rakentamisen tuotantoennusteiden samoin kuin PTT:n hintaennusteiden mukaan tulevaisuus näyttäisi valoisammalta. Laman pohjan saavuttamisen jälkeen sekä tuotanto että kv-hinnat alkaisivat vahvistua tästä vuodesta lähtien. Tulevaisuuden kuvat muodostettiin näiden suhdanne-ennusteiden pohjalta. Mikäli myönteinen kehitys toteutuisi, Suomen BKT voisi kasvaa yhteensä 300–900 miljoonalla eurolla vuoden 2014 loppuun mennessä. Työllisyys voisi vahvistua 1 000–5 000 henkilötyövuodella. Sahateollisuuden sopeuttaminen tulee jatkumaan, mikäli lama ei kohta hellitä. Alan kehitystä seurataan yleisellä tasolla, mutta myös sopeuttamisen aluetaloudellisten vaikutusten arviointia olisi syytä jatkaa.

Political Risk in Credit Evaluation: Empirical Studies and Survey Results

Financing trade between economic agents located in different countries is affected by many types of risks, resulting from incomplete information about the debtor, the problems of enforcing international contracts, or the prevalence of political and financial crises. Trade is important for economic development and the availability of trade finance is essential, especially for developing countries. Relatively few studies treat the topic of political risk, particularly in the context of international lending. This thesis explores new ground to identify links between political risk and international debt defaults. The core hypothesis of the study is that the default probability of debt increases with increasing political risk in the country of the borrower. The thesis consists of three essays that support the hypothesis from different angles of the credit evaluation process. The first essay takes the point of view of an international lender assessing the credit risk of a public borrower. The second investigates creditworthiness assessment of companies. The obtained results are substantiated in the third essay that deals with an extensive political risk survey among finance professionals in developing countries. The financial instruments of core interest are export credit guaranteed debt initiated between the Export Credit Agency of Finland and buyers in 145 countries between 1975 and 2006. Default events of the foreign credit counterparts are conditioned on country-specific macroeconomic variables, corporate-specific accounting information as well as political risk indicators from various international sources. Essay 1 examines debt issued to government controlled institutions and conditions public default events on traditional macroeconomic fundamentals, in addition to selected political and institutional risk factors. Confirming previous research, the study finds country indebtedness and the GDP growth rate to be significant indicators of public default. Further, it is shown that public defaults respond to various political risk factors. However, the impact of the risk varies between countries at different stages of economic development. Essay 2 proceeds by investigating political risk factors as conveivable drivers of corporate default and uses traditional accounting variables together with new political risk indicators in the credit evaluation of private debtors. The study finds links between corporate default and leverage, as well as between corporate default and the general investment climate and measeures of conflict in the debtor country. Essay 3 concludes the thesis by offering survey evidence on the impact of political risk on debt default, as perceived and experienced by 103 finance professionals in 38 developing countries. Taken together, the results of the thesis suggest that various forms of political risk are associated with international debt defaults and continue to pose great concerns for both international creditors and borrowers in developing countries. The study provides new insights on the importance of variable selection in country risk analysis, and shows how political risk is actually perceived and experienced in the riskier, often lower income countries of the global economy.