Background: Cell wall of Malassezia restricta is involved in interactions with human skin. Results: Its core is composed of cross-linked polysaccharides such as chitin, chitosan, ␤-(1,3)-glucan and ␤-(1,6)-glucan. Conclusion: The composition of cell wall polysaccharides of M. restricta is unique in the fungal kingdom. Significance: The cell wall of M. restricta has evolved as a yeast that adapted to the skin microenvironment and host interactions.

Fungal PCR-based diagnostic methods are at risk of contamination. Sample collection containers were investigated for fungal DNA contamination using real-time PCR assays. Up to 18% of blood collection tubes were contaminated with fungal DNA, probably A. fumigatus. Lower proportions of contamination in other vessels were observed. The incidence of invasive aspergillosis (IA) is increasing amongst immunocompromised individuals with an estimated one million deaths worldwide (Maschmeyer and Haas 2008).The need for a universally applicable rapid and sensitive diagnostic method is pressing (Denning 1998). PCR based detection of Aspergillus nucleic acids provides a well explored diagnostic technique that could fulfil these criteria (Chen et al 2002, Perlin andZhao 2009). However, Aspergillus is ubiquitous in the environment and DNA contamination in a diagnostic assay can arise from dead or fragmented fungi. Given the costs and side effects of the preferred antifungal therapeutics (Menzin et al 2009), even very low levels of false positive results or contamination have serious consequences. The most convenient source of material for diagnosis is blood. An 8% contamination rate in over 3,000 fungal PCR assays performed on whole blood over 2 years has been reported (Loeffler et al 1999). Contaminating DNA from 12 different Aspergillus species caused a false positive rate of 19% with sources of contamination including DNA extraction and PCR reagents (Palmer et al 2001). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. We investigated the prevalence of fungal DNA contamination originating from blood collection tubes and a variety of other clinically relevant vessels from a range of manufacturers using a DNA extraction kit that has been proven free from fungal DNA (data not shown) (MycXtra ™ , Myconostica, Manchester, UK). Extracted DNA was tested using a quality controlled commercial molecular beacon (MB) real-time PCR assay that detects Aspergillus and Penicillium spp. (FXG:Resp (Asp+), Myconostica). Positive samples were screened using a second PCR assay with a TaqMan (TM) probe specific for Aspergillus fumigatus only. NIH Public AccessCollection vessels tested and rates of contamination detected are listed in table 1. To test for microbiological contamination, sterile PBS-Tween 80 (1mL) was added to each vessel and agitated on a vortex mixer for 1 minute. An aliquot (100μL) was then spread onto Sabouraud dextrose agar plates and incubated at 30°C for 2 weeks. To test for fungal DNA contamination, molecular grade sterile water (1mL) was added to each vessel and agitated on a ...

Background & Aims Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%. Methods French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs . ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs. Results Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective. Conclusions In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection. Lay summary The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.

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