First-Line Immunotherapy with Check-Point Inhibitors: Prospective Assessment of Cognitive Function.

Approximately 40% of patients with cancer are eligible for check-point inhibitor (CPI) therapy. Little research has examined the potential cognitive impact of CPIs. First-line CPI therapy offers a unique research opportunity without chemotherapy-related confounders. The purpose of this prospective, observational pilot was to (1) demonstrate the feasibility of prospective recruitment, retention, and neurocognitive assessment for older adults receiving first-line CPI(s) and (2) provide preliminary evidence of changes in cognitive function associated with CPI(s). Patients receiving first-line CPI(s) (CPI Group) were assessed at baseline (n = 20) and 6 months (n = 13) for self-report of cognitive function and neurocognitive test performance. Results were compared to age-matched controls without cognitive impairment assessed annually by the Alzheimer's Disease Research Center (ADRC). Plasma biomarkers were measured at baseline and 6 months for the CPI Group. Estimated differences for CPI Group scores prior to initiating CPIs (baseline) trended to lower performance on the Montreal Cognitive Assessment-Blind (MOCA-Blind) test compared to the ADRC controls (p = 0.066). Controlling for age, the CPI Group's 6-months MOCA-Blind performance was lower than the ADRC control group's 12-months performance (p = 0.011). No significant differences in biomarkers were detected between baseline and 6 months, although significant correlations were noted for biomarker change and cognitive performance at 6 months. IFNγ, IL-1ß, IL-2, FGF2, and VEGF were inversely associated with Craft Story Recall performance (p < 0.05), e.g., higher levels correlated with poorer memory performance. Higher IGF-1 and VEGF correlated with better letter-number sequencing and digit-span backwards performance, respectively. Unexpected inverse correlation was noted between IL-1α and Oral Trail-Making Test B completion time. CPI(s) may have a negative impact on some neurocognitive domains and warrant further investigation. A multi-site study design may be crucial to fully powering prospective investigation of the cognitive impact of CPIs. Establishment of a multi-site observational registry from collaborating cancer centers and ADRCs is recommended.

Detection of Intestinal Protozoa in Trichrome-Stained Stool Specimens by Use of a Deep Convolutional Neural Network.

Intestinal protozoa are responsible for relatively few infections in the developed world, but the testing volume is disproportionately high. Manual light microscopy of stool remains the gold standard but can be insensitive, time-consuming, and difficult to maintain competency. Artificial intelligence and digital slide scanning show promise for revolutionizing the clinical parasitology laboratory by augmenting the detection of parasites and slide interpretation using a convolutional neural network (CNN) model. The goal of this study was to develop a sensitive model that could screen out negative trichrome slides, while flagging potential parasites for manual confirmation. Conventional protozoa were trained as "classes" in a deep CNN. Between 1,394 and 23,566 exemplars per class were used for training, based on specimen availability, from a minimum of 10 unique slides per class. Scanning was performed using a 40× dry lens objective automated slide scanner. Data labeling was performed using a proprietary Web interface. Clinical validation of the model was performed using 10 unique positive slides per class and 125 negative slides. Accuracy was calculated as slide-level agreement (e.g., parasite present or absent) with microscopy. Positive agreement was 98.88% (95% confidence interval [CI], 93.76% to 99.98%), and negative agreement was 98.11% (95% CI, 93.35% to 99.77%). The model showed excellent reproducibility using slides containing multiple classes, a single class, or no parasites. The limit of detection of the model and scanner using serially diluted stool was 5-fold more sensitive than manual examinations by multiple parasitologists using 4 unique slide sets. Digital slide scanning and a CNN model are robust tools for augmenting the conventional detection of intestinal protozoa.

Diverse Helotiales associated with the roots of three species of Arctic Ericaceae provide no evidence for host specificity.

Ericoid mycorrhizal fungi differ in their abilities to use nitrogen sources and may be integral to maintaining fungal and plant diversity in ecosystems in which Ericaceae occur. In this study, we tested whether the fungal communities differ among three species of co-occurring Ericaceae. Fungi colonizing Cassiope tetragona, Empetrum nigrum and Vaccinium vitis-idaea roots in the Arctic tundra were characterized via culture-dependent and culture-independent techniques. The cultured fungi were tested for their ability to colonize Vaccinium uliginosum in laboratory-based assays. The pure-cultured Helotiales were grouped into eight clades and dominated by the Phialocephala-Acephala complex. Representatives of these clades, plus an unknown basidiomycete with affinity to the genus Irpex (Polyporales), colonized V. uliginosum intracellularly. The Helotiales detected by direct PCR, cloning and sequencing were assigned to 14 clades and dominated by members of the Rhizoscyphus ericae complex. Ordination analyses indicated that culture-dependent and culture-independent assays provided distinct views of root fungal communities, but no evidence for host specificity. These data suggest that ericaceous roots host diverse fungal communities dominated by the Helotiales. However, these fungal communities are unlikely to be controlled by fungal host preferences. The mechanisms maintaining high diversity in root-symbiotic communities remain to be elucidated.

Application of fungistatics in soil reduces N uptake by an arctic ericoid shrub (Vaccinium vitis-idaea).

In arctic tundra soil N is highly limiting, N mineralization is slow and organic N greatly exceeds inorganic N. We studied the effects of fungistatics (azoxystrobin [Quadris] or propiconazole [Tilt]) on the fungi isolated from ericaceous plant roots in vitro. In addition to testing the phytotoxicity of the two fungistatics we also tested their effects on growth and nitrogen uptake of an ericaceous plant (Vaccinium uliginosum) in a closed Petri plate system without root-associated fungi. Finally, to evaluate the fungistatic effects in an in vivo experiment we applied fungistatics and nitrogen isotopes to intact tundra soil cores from Toolik Lake, Alaska, and examined the ammonium-N and glycine-N use by Vaccinium vitis-idaea with and without fungistatics. The experiments on fungal pure cultures showed that Tilt was more effective in reducing fungal colony growth in vitro than Quadris, which was highly variable among the fungal strains. Laboratory experiments aiming to test the fungistatic effects on plant performance in vitro showed that neither Quadris nor Tilt affected V. uliginosum growth or N uptake. In this experiment V. uliginosum assimilated more than an order of magnitude more ammonium-N than glycine-N. The intact tundra core experiment provided contrasting results. After 10 wk of fungistatic application in the growth chamber V. vitis-idaea leaf %N was 10% lower and the amount of leaf 15N acquired was reduced from labeled ammonium (33%) and glycine (40%) during the 4 d isotope treatment. In contrast to the in vitro experiment leaf 15N assimilation from glycine was three times higher than from 15NH4 in the treatments that received no-fungistatics. We conclude that the function of the fungal communities is essential to the acquisition of N from organic sources and speculate that N acquisition from inorganic sources is mainly inhibited by competition with complex soil microbial communities.

Comparison of total mercury and methylmercury cycling at five sites using the small watershed approach.

The small watershed approach is well-suited but underutilized in mercury research. We applied the small watershed approach to investigate total mercury (THg) and methylmercury (MeHg) dynamics in streamwater at the five diverse forested headwater catchments of the US Geological Survey Water, Energy, and Biogeochemical Budgets (WEBB) program. At all sites, baseflow THg was generally less than 1ng L(-1) and MeHg was less than 0.2ng L(-1). THg and MeHg concentrations increased with streamflow, so export was primarily episodic. At three sites, THg and MeHg concentration and export were dominated by the particulate fraction in association with POC at high flows, with maximum THg (MeHg) concentrations of 94 (2.56)ng L(-1) at Sleepers River, Vermont; 112 (0.75)ng L(-1) at Rio Icacos, Puerto Rico; and 55 (0.80)ng L(-1) at Panola Mt., Georgia. Filtered (<0.7microm) THg increased more modestly with flow in association with the hydrophobic acid fraction (HPOA) of DOC, with maximum filtered THg concentrations near 5ng L(-1) at both Sleepers and Icacos. At Andrews Creek, Colorado, THg export was also episodic but was dominated by filtered THg, as POC concentrations were low. MeHg typically tracked THg so that each site had a fairly constant MeHg/THg ratio, which ranged from near zero at Andrews to 15% at the low-relief, groundwater-dominated Allequash Creek, Wisconsin. Allequash was the only site with filtered MeHg consistently above detection, and the filtered fraction dominated both THg and MeHg. Relative to inputs in wet deposition, watershed retention of THg (minus any subsequent volatilization) was 96.6% at Allequash, 60% at Sleepers, and 83% at Andrews. Icacos had a net export of THg, possibly due to historic gold mining or frequent disturbance from landslides. Quantification and interpretation of Hg dynamics was facilitated by the small watershed approach with emphasis on event sampling.

Importance of unsaturated zone flow for simulating recharge in a humid climate.

Transient recharge to the water table is often not well understood or quantified. Two approaches for simulating transient recharge in a ground water flow model were investigated using the Trout Lake watershed in north-central Wisconsin: (1) a traditional approach of adding recharge directly to the water table and (2) routing the same volume of water through an unsaturated zone column to the water table. Areas with thin (less than 1 m) unsaturated zones showed little difference in timing of recharge between the two approaches; when water was routed through the unsaturated zone, however, less recharge was delivered to the water table and more discharge occurred to the surface because recharge direction and magnitude changed when the water table rose to the land surface. Areas with a thick (15 to 26 m) unsaturated zone were characterized by multimonth lags between infiltration and recharge, and, in some cases, wetting fronts from precipitation events during the fall overtook and mixed with infiltration from the previous spring snowmelt. Thus, in thicker unsaturated zones, the volume of water infiltrated was properly simulated using the traditional approach, but the timing was different from simulations that included unsaturated zone flow. Routing of rejected recharge and ground water discharge at land surface to surface water features also provided a better simulation of the observed flow regime in a stream at the basin outlet. These results demonstrate that consideration of flow through the unsaturated zone may be important when simulating transient ground water flow in humid climates with shallow water tables.

Seasonal dynamics of ectomycorrhizal fungus assemblages on oak seedlings in the southeastern Appalachian Mountains.

The potential for seasonal dynamics in ectomycorrhizal (EM) fungal assemblages has important implications for the ecology of both the host trees and the fungal associates. We compared EM fungus distributions on root systems of out-planted oak seedlings at two sites in mixed southeastern Appalachian Mountain forests at the Coweeta Hydrologic Laboratory in North Carolina, from samples taken in mid-July and early September. Species level EM fungus type specificity, and identification in some cases, was enabled by direct sequencing of the mycobionts from the seedling roots. Seventy-four EM fungal ITS types were documented, most of which occurred only in the midsummer or early-fall samples, respectively. Cenococcum geophilum (morphotyped) was ubiquitously present and accounted for the majority of root tips sampled. Abundance and relative frequency of types other than C. geophilum were significantly higher in the July samples, while C. geophilum was significantly more frequent and abundant in September. Several generalistic dominants were found fairly equally at both sites and on both sample dates. Other taxa with relatively high frequency were recovered from both sites and tree seedling species, but were reliable indicators occurring primarily in the July sample (e.g., Laccaria cf laccata). Notable shifts in mycobiont dominance were apparent in relation to sample date, including increases in Cortinarius spp. richness, decreases in Thelephoraceae richness, and the disappearance of Amanita spp. types in the early fall compared to midsummer samples. However, diversity and rarity were high and differences in overall community composition (other than C. geophilum) by season were not significant based on multi-response permutation procedures. Although these results based on a single growing season are preliminary, changes in abundance and frequency, detection of significant indicator species, and the apparent systematic affinities of shifting EM types support the potential for seasonal variability in EM associations in this system.

Hyperdiversity of ectomycorrhizal fungus assemblages on oak seedlings in mixed forests in the southern Appalachian Mountains.

Diversity of ectotrophic mycobionts on outplanted seedlings of two oak species (Quercus rubra and Quercus prinus) was estimated at two sites in mature mixed forests in the southern Appalachian Mountains by sequencing nuclear 5.8S rRNA genes and the flanking internal transcribed spacer regions I and II (ITS). The seedlings captured a high diversity of mycorrhizal ITS-types and late-stage fungi were well represented. Total richness was 75 types, with 42 types having a frequency of only one. The first and second order jackknife estimates were 116 and 143 types, respectively. Among Basidiomycetes, tomentelloid/thelephoroid, russuloid, and cortinarioid groups were the richest. The ascomycete Cenococcum geophilum was ubiquitously present. Dominant fungi included a putative Tuber sp. (Ascomycetes), and Basidiomycetes including a putative Craterellus sp., and Laccaria cf. laccata. Diversity was lower at a drier high elevation oak forest site compared to a low elevation mesic cove--hardwood forest site. Fungal specificity for red oak vs. white oak seedlings was unresolved. The high degree of rarity in this system imposes limitations on the power of community analyses at finer scales. The high mycobiont diversity highlights the potential for seedlings to acquire carbon from mycelial networks and confirms the utility of using outplanted seedlings to estimate ectomycorrhizal diversity.

Ectomycorrhizal sporophore distributions in a southeastern Appalachian mixed hardwood/conifer forest with thickets of Rhododendron maximum.

Sporophore abundance of putatively ectomycorrhizal fungi was compared in a mature mixed hardwood/conifer forest inside of (+) versus outside of (-) Rhododendron maximum thickets (RmT). Experimental blocks (1/4 ha) were established inside of (3) and outside of (3) RmT at the Coweeta Hydrologic Laboratory in Macon County, North Carolina, USA. Litter and organic layer substrates were removed, composited and redistributed among 90 2 × 2m plots within the blocks. Plots received either +RmT or -RmT litter, and either +RmT or -RmT organic layers, or were unmanipulated for controls. Sporophores of 67 putatively ectomycorrhizal species were collected from the blocks. Species diversity and overall community structure were similar inside of and outside of RmTs, and no grouping was detected by substrate type. Differences within the ectomycorrhizal fungus community were associated only weakly with environmental parameters, as indicated by ordination. In light of these results, recent observations of ectomycorrhizal suppression and strong shifts in the proportions of morphotypes on tree seedlings inside of RmT do not appear to be related to differences in sporophore distributions. The changes in seedling mycobiont dominance in relation to RmT and the influence this has on seedling health should be examined directly from root tips.