Finger clubbing: do we require digital index quantitator?

Some diseases may underlie finger clubbing. However, there is a dearth of information about early stage of finger clubbing because only few researchers have shown interest in it. We determined the Digital Index of normal, healthy subjects by using thread and manual Vernier calipers, the time used for the procedure, and its interrater reliability. The value of Digital Index was 8.86 ± 0.29 (Mean ± SD) with a range of 8.15 to 9.41. Interrater reliability was excellent with Pearson's correlation coefficient of 0.966. Overall, the time taken to measure the Digital Index ranged from 21.93 to 68.80 minutes with an average of 35.97 ± 9.16 (Mean ± SD). Determining Digital Index need much time, but this can be overcome if we use Digital Index Quantitator (DIQ). Availability of DIQ in the hospital wards will be of much benefit. DIQ can also be used to accurately quantify the progression or regression of the clubbing process. This article proves that we need morphometry of digital clubbing as well as the correlation of the physical sign of clubbing with Digital Index.

In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI.

BACKGROUND AND PURPOSE: Duchenne muscular dystrophy is an X-linked disorder characterized by progressive muscle weakness and prominent nonmotor manifestations, such as a low intelligence quotient and neuropsychiatric disturbance. We investigated WM integrity in patients with Duchenne muscular dystrophy using DTI. MATERIALS AND METHODS: Fractional anisotropy and mean, axial, and radial diffusivity (DTI measures) were used to assess WM microstructural integrity along with neuropsychological evaluation in patients with Duchenne muscular dystrophy (n = 60) and controls (n = 40). Exon deletions in the DMD gene were confirmed using multiplex ligation-dependent probe amplification. Patients were classified into proximal (DMD Dp140+) and distal (DMD Dp140-) subgroups based on the location of the exon deletion and expression of short dystrophin Dp140 isoform. WM integrity was examined using whole-brain Tract-Based Spatial Statistics and atlas-based analysis of DTI data. The Pearson correlation was performed to investigate the possible relationship between neuropsychological scores and DTI metrics. RESULTS: The mean ages of Duchenne muscular dystrophy and control participants were 8.0 ± 1.2 years and 8.2 ± 1.4 years, respectively. The mean age at disease onset was 4.1 ± 1.8 years, and mean illness duration was 40.8 ± 25.2 months. Significant differences in neuropsychological scores were observed between the proximal and distal gene-deletion subgroups, with more severe impairment in the distal-deletion subgroup (P < .05). Localized fractional anisotropy changes were seen in the corpus callosum, parietal WM, and fornices in the patient subgroup with Dp140+, while widespread changes were noted in the Dp140- subgroup. The Dp140+ subgroup showed increased axial diffusivity in multiple WM regions relative to the Dp140- subgroup. No significant correlation was observed between clinical and neuropsychological scores and diffusion metrics. CONCLUSIONS: Widespread WM differences are evident in patients with Duchenne muscular dystrophy relative to healthy controls. Distal mutations in particular are associated with extensive WM abnormalities and poor neuropsychological profiles.

In vitro evaluation of fentanyl and meperidine for immunomodulatory activity.

Exposure to drugs, either ethical pharmaceuticals or illicit street drugs, often results in medical complications, including alterations in the immune system. Among the drugs associated with immunomodulatory potential are the analgesics fentanyl and meperidine. The purpose of this study was to determine the potential of these drugs to alter immunological parameters subsequent to in vitro exposure at a range of concentrations. This potential immunotoxicity was assessed using a series of in vitro assays measuring B-lymphocyte proliferation, cytokine production by T-helper lymphocytes, T-lymphocyte cytolytic function, natural killer (NK) cell function, and macrophage function. Exposure to these analgesics was associated with a differential suppression of interleukin-4 production by T-cells, as well as a more generalized suppression of cytokine production by macrophages. In addition, T-cell cytolytic activity was suppressed at high drug concentrations. B-cell proliferation and NK cell activity were also inhibited, but to a lesser degree than noted with T-cell function. Addition of naltrexone to the cultures did not reverse these alterations in immune function, suggesting that these changes are not mediated via opioid receptors.

Cellular enzyme-linked immunospecific assay (CELISA). I. A new micromethod that detects antibodies to cell-surface antigens.

A novel, indirect immunoassay capable of detecting human anti-HLA antibody bound to lymphocytes has been developed. This cellular enzyme-linked immunospecific assay (CELISA) utilizes an antiglobulin covalently linked to alkaline phosphatase to quantitate the amount of anti-HLA antibody bound to cell-surface HLA antigens. During the CELISA, V-bottom polyvinyl microplates served as the receptacle in which as little as 5 microliters of sera and as few as 25,000 lymphocytes per well were incubated. We devised a rapid and simple technique to transfer the cells from the original V-bottom plate to a flat-bottom plate before adding the enzyme substrate. Using this strategy, background noise because of the nonspecific adsorption of the different protein immunoreactants to plastic was eliminated. This strategy, the identification of an optimal cell concentration and an optimal conjugate source and dilution, enabled us to detect the anti-HLA activity in sera diluted out 250-fold more than their maximum titer as determined by the microdroplet cytotoxicity test. Since this assay is capable of sensitively and objectively quantitating antibody bound to cell-surface antigens, it may be of value in the areas of transplantation, blood banking, autoimmune disease, tumor immunology, and the study of cell-surface differentiation and viral antigens.

Pesticide-induced immunotoxicity: are Great Lakes residents at risk?

Several organophosphate and organochlorine compounds, including pesticides commonly found in the Great Lakes basin, have the potential to induce immunotoxicity. Because of biomagnification and accumulation in the food chain, Great Lakes residents may inadvertently be exposed to these compounds and thus face increased risk of immune dysfunction. In spite of the laboratory animal data and evidence from occupational exposures that suggest immunotoxicity, there is no definitive evidence as yet that environmental exposure to these xenobiotics poses a significant threat to the human immune system that is sufficient to predispose residents of the Great Lakes basin to increased disease. However, uncertainties with regard to exposure levels, predictability of tests, suitability of the animal models, and immune reserve cannot be ruled out when making risk assessment decisions such as this.

Immunotoxicology: hazard identification and risk assessment.

In summary, immunotoxicology is a relatively new science that can be defined as the study of the consequences of exposure to drugs, chemicals, and environmental toxicants on the structure and function of the immune system. Laboratory animal studies over the last 20 years have clearly demonstrated as association between suppressed immune function and altered host defense. Furthermore, rodent-based screening approaches, even with their limitations, have been reasonably successful and have added to this knowledge base. The challenges for the future lie in using these data to design better prospective human exposure studies and to improve the basis for immunotoxicology risk assessment.

A comparative study of immunomodulation produced by in vitro exposure to delta opioid receptor agonist peptides.

The present study assessed the direct immunomodulatory effect of a panel of synthetic peptides exhibiting delta-opioid receptor agonist activity. Murine splenic lymphocytes and peritoneal macrophages were cultured in vitro with peptides at concentrations of 0.00001-10 microM. Assessment was made of B-cell function by quantitating cellular proliferation, T-cell function by measuring cytokine production, natural immunity by quantitating basal and cytokine-augmented natural killer (NK) cell activity, and macrophage function by production of IL-6. These peptides had minimal effects on B-cell proliferation at any concentration examined. In comparison, enhancement of cytokine production by T-helper cells occurred following exposure to several of the compounds, to a significant extent with DPDPE, DPDPE-trifluoroacetate, or deltorphin-1 and most pronounced at concentrations between 0.00001 and 0.1 microM. Likewise, IL-6 production by macrophages was significantly augmented by exposure to these three peptides. NK cell function was significantly enhanced by in vitro exposure to several of the peptides, with enhancement generally noted at concentrations between 0.00001 and 0.01 microM. However, some of the peptides (most notably DADLE) greatly suppressed NK cell activity. These data suggest that delta opioid agonists are broadly immunomostimulatory.

In vitro exposure to peptidic delta opioid receptor antagonists results in limited immunosuppression.

Previous studies by our group have demonstrated that in vitro exposure to delta-opioid receptor agonists results in a significant immunostimulation, whereas in vitro exposure to non-peptidic delta-opioid receptor antagonists results in significant suppression of various immune functions. The present study assessed potential immunomodulation by the peptidic delta-opioid receptor antagonists TIPP, D-TIPP, and ICI 174864 using a panel of in vitro immune function assays. Splenocytes from female B6C3F1 mice were cultured with the peptides at concentrations of 0.00001-10 microM. B cell proliferation was quantified following cellular activation, T cell function was assessed by cytokine production following stimulation with anti-CD3 monoclonal antibody, natural immunity was assessed by quantitating natural killer (NK) cell activity following a 24-h exposure, and macrophage function was assessed by quantification of interleukin-6 (IL-6) production. None of the peptides examined significantly affected B cell proliferation. Production of IL-2 by T cells was not consistently affected by exposure to either TIPP or D-TIPP, but was significantly suppressed at 10 microM ICI 174864. Production of IL-4, however, was significantly suppressed by low concentrations of either TIPP or D-TIPP, and by 10 microM ICI 174864. IL-6 production by macrophages was unaffected except for sporadic incidents of enhanced production in cells exposed to ICI 174864. NK cell function exhibited a differential pattern of suppression, with the greatest degree of suppression observed following exposure to TIPP and only slight suppression in cells exposed to either D-TIPP or ICI 174864. These data suggest that peptidic delta-opioid receptor antagonists do not exhibit the same pattern or degree of immunosuppressive activity as the non-peptidic antagonists at equivalent in vitro concentrations.

Effects of morphine tolerance and abstinence on cellular immune function.

Female B6C3F1 mice were rendered tolerant-dependent on morphine by a combination of injections and pellet implantation. Mice were injected with morphine sulfate (20 mg/kg, s.c.) twice a day on day 1. On day 2, they were implanted s.c. with a 75 mg morphine pellet for 3 days. On day 5, the pellets were either left intact (tolerant) or removed 8 h prior (abstinent) to carrying out the immune function tests. A high degree of tolerance to the analgesic and hypothermic effect of morphine developed as a result of this procedure. Similarly, physical dependence also developed as evidenced by the signs of the abrupt and naltrexone-precipitated abstinence syndrome. Implantation with morphine pellets resulted in a profound, statistically significant reduction in spleen and thymus weight and cellularities, with the greatest degree of reduction noted in abstinent animals. Morphine tolerance was associated with suppressed B-cell proliferation following in vitro stimulation, as well as interleukin-2 (IL-2) and interleukin-4 production by T-cells. NK cell activity was significantly reduced in morphine-tolerant, but not in morphine-abstinent, mice following a 24 h incubation in the presence or absence of IL-2. In comparison, the in vitro induction of cytotoxic T-cells was significantly depressed in morphine-abstinent, but not morphine-tolerant, animals. Exposure to morphine apparently had limited effect on macrophage function as assessed by production of tumor necrosis factor. These studies demonstrate a differential effect on immune effector and regulatory mechanisms in morphine tolerance and abstinence processes.

Effects of naltrexone on morphine-induced tolerance and physical dependence and changes in cellular immune function in mice.

The effects of naltrexone on tolerance/dependence, as well as alterations in cellular immune function induced by morphine administration, were determined. Mice were rendered tolerant to and physically dependent on morphine by subcutaneous implantation of pellets containing 75 mg of morphine. Implantation of naltrexone pellets (10 mg) blocked the development of tolerance to the analgesic action of morphine, as well as the development of physical dependence. Morphine suppressed lymphoid organ weights and cellularities, and this suppression was blocked by naltrexone. B-Cell proliferation was suppressed in morphine-tolerant but not in morphine-abstinent mice, and this suppression was exacerbated by naltrexone. Morphine tolerance and abstinence were associated with suppression of IL-2 production, which was completely blocked by naltrexone. NK cell activity was not significantly affected by either morphine or naltrexone exposure. The results suggest that the effects of morphine on the immune system are at least partially mediated through opioid receptors.

Effects of chronic administration of 7-benzylidene-7-dehydronaltrexone and naltriben on the antinociceptive actions of delta 1- and delta 2-opioid receptor agonists.

The effects of chronic administration of 7-benzylidene-7-dehydronaltrexone, a delta 1-opioid receptor antagonist and naltriben, a delta 2-opioid receptor antagonist, on the antinociceptive responses to [D-Pen2, D-Pen5] enkephalin and [D-Ala2, Glu4]deltorphin II, delta 1- and delta 2-opioid receptor agonists, respectively, were determined in the mouse. Female B6C3F1 mice were given 7-benzylidene-7-dehydronaltrexone (3 mg/kg/day), naltriben (1 mg/kg/day) or the vehicle by subcutaneously implanted Alzet osmotic minipumps for 7 days. Both [D-Pen2, D-Pen5]enkephalin and [D-Ala2, Glu4]deltorphin II administered intracerebroventricularly (i.c.v.) produced antinociceptive as measured by the tail-flick test with ED50 values of 6.76 and 6.68 micrograms/mouse, respectively. Chronic administration of 7-benzylidene-7-dehydronaltrexone lowered the ED50 of [D-Pen2, D-Pen5]enkephalin but not of [D-Ala2, Glu4]deltorphin II. Chronic administration of naltriben lowered the ED50 of [D-Ala2, Glu4]deltorphin II but had no effect on the ED50 of [D-Pen2, D-Pen5]enkephalin. The binding of [3H][D-Pen2, D-Pen5]enkephalin to whole brain membranes of chronic 7-benzylidene-7-dehydronaltrexone-treated mice did not differ from chronic vehicle-treated mice. On the other hand, chronic administration of naltriben resulted in slight but reproducible elevation in the Bmax value of [3H][D-Pen2, D-Pen5]enkephalin to bind to whole brain membranes in comparison to vehicle-injected controls. The results suggest that chronic treatment with delta 1- and delta 2-opioid receptor antagonist cause behavioral supersensitivity to their agonists, respectively, and provides further evidence for the existence of delta-opioid receptor subtypes.

Suppression of immune function by non-peptidic delta opioid receptor antagonists.

Previous studies in this laboratory and elsewhere have provided evidence that compounds acting as delta opioid receptor agonists exhibit marked immunostimulatory potential. Conversely, the delta opioid receptor antagonists have previously been shown to demonstrate immunosuppressive effects as assessed by proliferation of T-cells following allogeneic or xenogeneic stimulation. The present study was performed to further characterize this immunosuppressive activity using the compounds benzylidene naltrexone (BNTX), naltrindole (NTI), and naltriben (NTB). In vitro exposure to BNTX resulted in an apparent dose-related suppression of B-cell proliferation, cytokine production by T-helper cells, and natural killer (NK) cell activity, with statistically significant suppression observed at concentrations between 1 and 10 microM. NTI was also immunosuppressive for all immune function parameters examined, although this compound was less active than BNTX. In vitro exposure to the structurally related compound NTB had no significant effect on any immune function examined in this study. In all cases, immunosuppression occurred in the absence of any detectable alteration in cellular viability, suggesting a specific immunosuppressive effect rather than overt toxicity.

Selective modulation of immune function resulting from in vitro exposure to methylenedioxymethamphetamine (Ecstasy).

Abuse of illicit analogs of methamphetamine (i.e., 'designer drugs') represents a growing problem. One of the most popular methamphetamine analogs is (+/-)-3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy. The authors demonstrated previously that in vitro exposure to methamphetamine results in modulation of immune functional parameters necessary for host defense. The current study was performed to assess the potential direct (in vitro) immunomodulatory effect of exposure to a modified methamphetamine. Splenocytes or peritoneal macrophages from B6C3F1 mice were cultured in vitro at MDMA concentrations of 0.0001-100 microM. T-cell regulatory function was assessed by anti-CD3-mediated production of IL-2 and IL-4, B-cell function was assessed by quantitating cellular proliferation, natural immunity was assessed by quantitating natural killer (NK) cell activity, T-cell effector function was evaluated as a function of cytotoxic T-lymphocyte (CTL) activity, and macrophage function was assessed by IL-6 tumor necrosis factor (TNF) production. In vitro exposure to MDMA had no effect on B-cell proliferation at any concentration tested. In comparison, in the absence of direct cellular toxicity, production of IL-2 was enhanced at concentrations as low as 0.0001 microM. IL-4 production was not affected by exposure to any concentration of MDMA examined, suggesting a differential alteration in T-helper cell function by this compound. Basal and augmented NK cell function were enhanced at MDMA concentrations between 0.0001 and 1.0 microM when examined at an effector:target ratio of 100:1. CTL induction was significantly suppressed at a concentration of 100 microM. Finally, macrophage production of TNF was slightly suppressed at 10 and 100 microM MDMA, although this inhibition was not statistically significant.

Phencyclidine exposure alters in vitro cellular immune response parameters associated with host defense.

Phencyclidine hydrochloride (PCP) was tested for its ability to alter a variety of immune effector and regulatory functions in vitro. B6C3F1 murine splenic lymphocytes or elicited peritoneal macrophages were cultured in vitro with medium only or medium containing 10(-10)-10(-4) M PCP. Macrophages cultured with or without PCP were stimulated with lipopolysaccharide, and production of interleukin 6 (IL-6) and tumor necrosis factor (TNF) was assessed by bioassay. Cytotoxic T-cell effector function was determined following 5-day lymphocyte co-culture with tumor stimulator cells in the presence of PCP. In addition, the ability of T-lymphocytes to produce specific immunoregulatory cytokines IL-2 and IL-4 in the presence of PCP was quantitated by bioassay. B-lymphocyte function was determined by quantitating lymphocyte proliferation following stimulation with anti-IgM antibody and murine IL-4. Natural immunity was assessed by culturing lymphocytes with or without PCP for 24 h, then quantitating basal and IL-2 augmented natural killer (NK) cell activity. In the absence of effects on cell viability, significant suppression of IL-2 production by T-cells was noted at pharmacologically relevant PCP concentrations (1 microM). In vitro concentrations of 10 microM suppressed the generation of specifically sensitized cytotoxic T-cells. In addition, PCP significantly suppressed both IL-2-augmented NK function as well as B-lymphocyte proliferation. By comparison, macrophage IL-6 production was not affected by any concentration of PCP examined in this study.

Reproducibility of seasonal effects in antibody formation and host resistance in the outbred mouse.

The purpose of this study was to assess the reproducibility of any seasonal effects in the outbred CD1 mouse of antibody production to sheep red blood cells (SRBCs) and host resistance to the bacterium Listeria monocytogenes. A marked seasonal effect on antibody production was seen when 5- to 6-week-old female CD1 mice were studied on a weekly basis for a period of 2 years. Maintained on a 12:12 h light:dark schedule, animals were held for 12 days prior to experiment to insure physical condition and acclimatization to the lighting regimen. Beginning at 4 h after lights on (HALO) for day 1 and 2 HALO thereafter, groups of mice were (a) not treated, (b) administered a vehicle (corn oil, 1% methylcellulose, or distilled water) by oral gavage for 5 days, or (c) not treated, but given an intraperitoneal injection of cyclophosphamide 24 h prior to assay. On the fifth day, mice were injected with SRBCs intravenously. Four days later, antibody formation against SRBCs was measured using spleen cells. Circannual and seasonal rhythms were displayed by each group of animals, with greatest antibody production, indicated by the number of plaque-forming cells (PFCs)/million viable cells, in the Spring (range of double amplitude = 36-108%). The timing of these rhythms was reproducible from one year to the next. In contrast, the magnitude of the response in year 1 was significantly different from year 2 for animals given vehicle or not treated. Cyclophosphamide-treated mice had consistently low numbers of plaque-forming cells. Host resistance was studied in separate mice treated with vehicles at the same time as the antibody assay. On the third day of dosing, mice were injected intravenously with Listeria monocytogenes (LM) and monitored for death for 10 days. When analyzed by Kruskal-Wallis life table analysis, there was no overall effect of vehicle on survival for 1987 but there was an effect for 1988 and when data from both years were combined. Distilled water-treated mice had lower survival rates than the other two vehicles. Mice treated with distilled water displayed a circannual rhythm for survival for 1988 and for both years combined, in contrast to the other two vehicles. When each vehicle was analyzed separately for seasonal effect, a significant effect of season occurred for corn oil- and distilled water-treated animals. The greatest survival rate and longest survival time generally occurred in the months between July and December.

Evidence for genetic basis of seasonal differences in antibody formation between two mouse strains.

In order to confirm the presence of an acrophase difference based upon genotype in the seasonal expression of an immune competence end point, splenic plaque-forming cell (PFC) response to sheep red blood cells (SRBC), female B6C3F1 and CD1 mice were concurrently studied for PFC response during two studies performed in each season for 1 year. Mice were multiply housed, fed ad libitum, and standardized to light (06:00-18:00); dark (18:00-06:00). For each strain and study, subgroups were either naive (n = 10), received a vehicle (n = 10) or Cytoxan (n = 5). Challenge with SRBC occurred in early afternoon 4 days before harvesting of spleens and PFC assay. All other procedures were performed early in the daily light span. Analysis of variance and single cosinor analysis revealed a significant seasonal time effect for PFC in naive mice of both strains. Antibody formation was greatest in spring for CD1 mice and in summer for the B6C3F1 mice. These acrophases were consistent with earlier results for both strains and show the phenomena to be reproducible and genetically based.

An immunotoxicity assessment of food flavouring ingredients.

A rapid screening protocol incorporating key elements of the US National Toxicology Program's immunotoxicity tier testing strategy was used to evaluate the effects of 35 commonly used food flavouring ingredients on humoral and cell-mediated immune responses. The test compounds were administered intragastrically on a daily basis for 5 days at three dose levels to female CD-1 or B6C3F1 mice, 6-8 wk old. A host resistance assay (Listeria monocytogenes bacterial challenge) was conducted to assess cell-mediated immunity. Humoral immunity was measured by the antibody plaque-forming cell (PFC) response to sheep erythrocytes. Body weights, lymphoid organ weights and spleen cellularity were also measured. Cyclophosphamide (80 mg/kg) served as an immunosuppressive positive control agent. The results indicated that the majority of the flavouring ingredients tested did not modulate the cell-mediated or humoral immune response. However, at very high dose levels, two of the materials tested, peppermint oil and citral dimethyl acetal, did increase mortality rate and reduce survival time in the host resistance assay. Neither of these materials significantly altered the PFC response. This rapid, economical screening battery for potential immunotoxicants proved to be a useful means of evaluating a large number of structurally diverse compounds and mixtures to prioritize them for more definitive testing.

Immunotoxicologic effects of ethylene dibromide in the mouse and their modulation by the estrous cycle.

Estrous cycle modulation of immunologic sensitivity to ethylene dibromide (EDB) was studied in addition to toxicologic end points. Female B6C3F1 mice were injected intragastrically with 31.25, 62.5, or 125 mg/kg EDB for 5 days a week for 12 weeks. Vaginal smears determined the estrous cycle. At 125 mg/kg there were decreases in hemoglobin and hematocrit and longer estrous cycles (5.5 vs 4.3 days, p = 0.006), and increases in cholesterol, triglycerides, total protein, and albumin. The negative dose response seen for T- and B-cell mitogenesis around metestrus was absent for mice near estrus. The high dose of EDB prolonged intervals between estrus, was immunotoxic and immunosuppressive.

Ethylene dibromide: evidence of systemic and immunologic toxicity without impairment of in vivo host defenses.

Ethylene dibromide was administered intragastrically on 14 consecutive days to B6C3F1 female mice. Host resistance was not altered after challenge with B16F10 tumor cells, Listeria monocytogenes, influenza, or Herpes simplex viruses. In contrast, decreases were seen in relative thymus and spleen weights, red blood cells, hemoglobin, hematocrit, and in alveolar macrophage, natural killer cell, T-cell, and mixed lymphocyte culture responses. Increases occurred in relative kidney and liver weights, cholesterol, peripheral neutrophils, resident peritoneal exudate cells (with increased phagocytosis) and plaque-forming cells. There was little difference between the dose that caused immune modulation and that which produced significant toxicity.

In vitro oxygen consumption and motility of Cryptobia salmositica, Cryptobia bullocki, and Cryptobia catostomi (Sarcomastigophora: Kinetoplastida).

Cryptobia salmositica (pathogenic and vaccine strains), Cryptobia bullocki (pathogenic), and Cryptobia catostomi (nonpathogenic) have similar oxygen consumption rates (0.17 +/- 0.01 nm O2/10(6) parasites). Incubation with sodium azide (5 microliters of a 1-M solution to 1 ml of parasite suspension, i.e., a 5-mM final concentration) reduced the oxygen consumption by approximately 4.5-fold. Motility of the parasites was also greatly reduced in sodium azide. The oxygen consumption and motility of the parasites returned to preazide treatment levels when the azide was removed even after 24 hr of incubation in sodium azide. The activities of hexokinase, pyruvate kinase, and cytochrome C oxidase were not detected in the 3 species of Cryptobia.