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PubMed1997

Evaluation of Teknaf Enteric Agar (TEA): A modified MacConkey's Agar for the isolation of Shigella dysenteriae type 1 and Shigella flexneri.

To develop a better and selective medium for the isolation of Shigella spp., MacConkey's Agar (MAC) was modified by adding potassium tellurite (K2TeO3) at a concentration of 1 microgram/ml. The formulation designated Teknaf Enteric Agar (TEA) was studied for the inhibitory effect of potassium tellurite on the growth of different enteric bacteria, and as a medium for isolating Shigella spp. from clinical stool samples (n = 3125). We observed that the growth of E. coli was effectively inhibited on TEA with no effect on the growth of S. dysenteriae type 1 and S. flexneri. A total of 2019 Shigellae were isolated through the combined use of TEA, MAC, and Salmonella-Shigella Agar (SS). On TEA, 1921 S. dysenteriae type 1 and S. flexneri were isolated as compared to 1765 from the combined use of MAC and SS. A total of 194 of S. dysenteriae type 1 and S. flexneri were exclusively isolated from TEA as compared to 38 which were only made from MAC and SS. We conclude that TEA significantly increased the overall isolation rate of Shigella spp. as compared to the combined use of MAC and SS (P < 0.0001), although it is not suitable for the isolation of S. sonnei.

Agar↗
PubMed1993

Immunogenicity and efficacy of oral or intranasal Shigella flexneri 2a and Shigella sonnei proteosome-lipopolysaccharide vaccines in animal models.

Immunity against shigellosis has been shown to correlate with the presence of antibodies specific for Shigella lipopolysaccharide (LPS). We here propose a new candidate vaccine for shigellosis composed of purified Shigella flexneri 2a or Shigella sonnei LPS hydrophobically complexed with group C type 2b Neisseria meningitidis outer membrane protein proteosomes. Immunization of mice either orally or intranasally with this complex induced specific homologous anti-LPS antibodies in both intestinal and respiratory secretions as well as in sera. Strong anamnestic responses were found after two or three immunizations. LPS alone, alkaline-detoxified LPS, or alkaline-detoxified LPS complexed with proteosomes was not effective. Oral or intranasal immunization of guinea pigs with two or more doses of this proteosome-LPS vaccine elicited homologous protection against Shigella keratoconjunctivitis (Serény test). These data demonstrate that proteosomes can be used as an effective mucosal vaccine delivery system and that orally or intranasally administered acellular vaccines can protect against Shigella infections.

Administration, Intranasal↗
PubMed1989

Use of Shigella flexneri ipaC and ipaH gene sequences for the general identification of Shigella spp. and enteroinvasive Escherichia coli.

The products of the ipaB, ipaC, and ipaD genes are involved in the expression of the invasive phenotype in all species of Shigella and enteroinvasive Escherichia coli (EIEC). DNA probes derived from these genes are accurate indicators of the invasive phenotype (M. Venkatesan, J. M. Buysse, E. V. Vandendries, and D. J. Kopecko, J. Clin. Microbiol. 26:261-266, 1988); however, spontaneous loss of the invasion plasmid or selective deletion of invasion-associated genes may restrict the usefulness of such probes as general diagnostic tools. In this study, we report that laboratory-passaged strains of Shigella spp. and EIEC that were invasion and Sereny test negative were unable to hybridize to the ipaC DNA probe. However, a second DNA probe, derived from the Shigella flexneri ipaH gene, a multiple-copy element found on the chromosome and invasion plasmid that encodes a 60-kilodalton antigen, was more sensitive in its ability to detect virulent as well as avirulent shigellae and EIEC. Analysis of colony blots and stool blots from pediatric patients with diarrhea indicated that the ipaH probe was more effective in detecting shigellae and EIEC than was either the ipaC or 17-kilobase EcoRI fragment probe.

Antigens, Bacterial↗
PubMed2003

Antimicrobial effect of spices and herbs on Shigella sonnei and Shigella flexneri.

Of 17 spices and herbs tested at 1% (wt/vol) in Mueller-Hinton (MH) agar, only cloves, thyme, oregano, allspice, basil, rosemary, and marjoram showed antimicrobial effects on Shigella. The MICs of thyme, oregano, basil, and rosemary (as determined by the agar dilution method) ranged from 0.5 to 1% (wt/vol) depending on the Shigella strain used. With the use of various combinations of temperatures (12, 22, and 37 degrees C), pHs (5.0, 5.5, and 6.0), and NaCl concentrations (1, 2, 3, and 4%, wt/vol) and the inclusion or exclusion of thyme or basil at 1% (wt/vol) in an MH agar model system, it was established that basil or thyme can contribute to combination processing as a growth-inhibitory factor for Shigella spp. In the presence of basil and thyme, Shigella flexneri did not develop CFU during the 7-day incubation period for, respectively, 14 and 16 of the 18 tested combinations, while growth was noted in the corresponding temperature-pH-NaCl concentration combinations without basil or thyme. A growth-inhibitory effect on Shigella sonnei was also noted. The results of an orientation study involving the addition of basil and thyme to spaghetti sauce prior to autoclaving and S. sonnei inoculation indicated that basil and thyme contributed to the reduction of S. sonnei after 16 days at 12 degrees C but not at 4 degrees C.

Colony Count, Microbial↗
PubMed1981

Salmonella and shigella surveillance in Hungary, 1972-1976. II. Shigella surveillance.

Shigellae were isolated from 32 399 persons in the bacteriological laboratories of the Public Health Stations between 1972-1976. The number of isolations ranged between 5325 and 8237 yearly. As S. dysenteriae and S. boydii serotypes occurred only in about 1.5% of all isolations, the epidemiological situation was determined by the incidence of S. flexneri and S. sonnei. Except in 1973, S. sonnei constituted the majority in every year. S. sonnei predominance, observed first in the western regions of the country, showed a gradual eastward spread and became characteristic of all localities in 1975-1976. The July-September peak of shigella isolations was associated with S. sonnei, as S. flexneri was distributed practically evenly in every season. The incidence of shigella isolations per 100 000 inhabitants was the lowest in the middle and the highest in the northern parts of the country. Sporadic cases were somewhat more frequent than epidemic outbreaks. Shigellae were isolated in 64.1% from patients and in 35.9% from asymptomatic excreters. The patient : excreter ratio was higher for S. sonnei (70.2 : 29.8) than for S. flexneri (54.6 : 45.4). In the survey period, 14 692 isolations were made in the course of 3278 epidemics; out of these, 11 171 cases were involved in 574 extensive outbreaks. S. sonnei was responsible mainly for school and nursery outbreaks, whereas S. flexneri dysentery predominated in mental wards and in homes for the aged and for mentally retarded children. The prevalent types of S. flexneri were (serological/phage type): 2a/69, 3a/5, 3a/19, 4a/81, 4a/89d and 6/85. The prevalent epidemiological subunits of S. sonnei were (phage/colicin type): 2/0, 2/6, 2/12, 3/12, 6/0, 7/0, 65/0, 65/6 and 65/12.

Adult↗
PubMed1994

Identification of Shigella species in stool specimens by DNA amplification of different loci of the Shigella virulence plasmid.

The sensitivity and specificity of the polymerase chain reaction (PCR) for detection of DNA sequences specific to Shigella spp. and enteroinvasive Escherichia coli (EIEC) in stools was evaluated. Stool specimens were obtained from patients with acute gastroenteritis before and after antibiotic treatment. Fecal material was pre-incubated in phosphate-buffered saline, gram-negative broth or brain heart infusion (BHI) broth, and DNA was extracted and amplified. Primers complementary to the ial or the virF loci of the 140 MDa plasmid of Shigella were evaluated. The highest sensitivity for detection of Shigella DNA in stools (higher than that of culture) was reached by pre-incubation of the fecal material in BHI broth and use of virF primers for amplification. The specificity of this PCR protocol was documented by the negative results obtained with non-Shigella enteric organisms. These findings point out the important diagnostic and epidemiologic potential of the virF-specific PCR protocol in the investigation of Shigella infections.

Acute Disease↗
PubMed1995

Prevalence of Shigella enterotoxin 1 among Shigella clinical isolates of diverse serotypes.

Shigella enterotoxin 1 (ShET1) is a novel, iron-dependent, toxin encoded by chromosomal genes (set1). To determine the prevalence of this enterotoxin, 172 Shigella clinical isolates (and 10 enteroinvasive Escherichia coli [EIEC]) from distant areas worldwide, representing all 4 groups and 45 serotypes of Shigella, were screened for set1 by DNA colony hybridization and polymerase chain reaction amplification. set1 was present in all 22 Shigella flexneri 2a strains tested but was rare in isolates of other Shigella serotypes (3.3%, 5/150) and not found in EIEC (0/10). That ShET1 is found almost exclusively in S. flexneri 2a may help explain the epidemiologic predominance of this serotype in the developing world.

Bacterial Toxins↗
PubMed1971

Isolation of Shigellae. 8. Comparison of xylose lysine deoxycholate agar, hektoen enteric agar, Salmonella-Shigella agar, and eosin methylene blue agar with stool specimens.

Two enrichment broths and four plating media were compared for efficiency of detection of enteric pathogens from 1,597 stool specimens. Of 170 salmonellae isolated from the composite of all methods, direct streaking yielded but 54%, whereas enrichment in gram-negative broth found 87% and Selenite-F broth 97%. By contrast, gram-negative broth produced 100% of the 17 shigellae, Selenite-F broth but 77%, and direct streaking only 59%. Thus, enrichment methods produced almost twice the number of both pathogens as direct streaking. Comparison of the plating media revealed xylose lysine deoxycholate agar (XLD) and Hektoen enteric agar to be equal in their abilities to find both pathogens. Both were moderately better than Salmonella-Shigella agar and markedly superior to eosin methylene blue agar. XLD fround 83% of salmonellae produced by the composite of four media and 90% of the shigellae. Hektoen enteric agar found 80% of both. Salmonella-Shigella agar detected 74 and 68%, respectively, and eosin methylene blue agar only 42 and 63%. The numbers of false positives accruing to each medium, however, showed Hektoen enteric and Salmonella-Shigella agars to produce more than twice as many false-positive plates as XLD. Similarly, Selenite-F broth resulted in many more false-positives for all plating media than did gram-negative broth. Consequently, the index of validity, which equates successful isolation of pathogens with total pickings, favored XLD and gram-negative broth as the media of choice, with direct streaking the poorest method by all counts.

Aeromonas↗
PubMed1999

Safety and immunogenicity of Shigella sonnei and Shigella flexneri 2a O-specific polysaccharide conjugates in children.

O-specific polysaccharide conjugates of shigellae were safe and immunogenic in young adults, and a Shigella sonnei conjugate conferred protection [1-3]. Shigellosis is primarily a disease of children; therefore, the safety and immunogenicity of S. sonnei and Shigella flexneri 2a conjugates were studied in 4- to 7-year-old children. Local and systemic reactions were minimal. The first injection of both conjugates elicited significant rises in geometric mean levels of serum IgG only to the homologous lipopolysaccharide (LPS) (S. sonnei, 0.32-8.25 ELISA units [EU]; S. flexneri 2a, 1.15-20.5 EU; P<.0001). Revaccination at 6 weeks induced a booster response to S. flexneri 2a LPS (20.5-30.5 EU, P=.003). Six months later, the geometric mean levels of IgG anti-LPS for both groups were higher than the prevaccination levels (P<.0001). Similar, but lesser, rises were observed for IgM and IgA anti-LPS. The investigational Shigella conjugates were safe and immunogenic in children and merit evaluation of their efficacy.

Antibodies, Bacterial↗
PubMed1996

Detection of antibodies to Shigella lipopolysaccharide in urine after natural Shigella infection or vaccination.

The purpose of the present study was to explore the possibility of detecting antibodies to Shigella sonnei lipopolysaccharide (LPS) in urine after infection or vaccination. Urinary immunoglobulin A (IgA) and IgG antibodies and specific IgA secretory protein against S. sonnei LPS were measured by enzyme-linked immunosorbent assay (ELISA), after adjustment for urine concentration. A significant antibody level was defined as one above a cutoff value calculated from the geometric mean + 2 standard deviations of urinary anti-S. sonnei LPS levels in 43 healthy hepatitis B vaccinees (controls). Of 11 culture-proven cases of S. sonnei shigellosis, at convalescence 9 (82%) had significantly elevated levels of urinary antibodies to the homologous LPS. The S. sonnei conjugate vaccine, composed of S. sonnei O-specific polysaccharide covalently bound to recombinant exoprotein A of Pseudomonas aeruginosa, elicited a significant urine IgA or IgG anti-LPS response in 60% (6 of 10), 56% (9 of 16) 43% (16 of 37), and 14% (3 of 21) of the volunteers at 2 weeks, 6 weeks, 6 months, and 12 months after vaccination, respectively. The specificity of the urine antibody response to S. sonnei LPS was documented by the total lack of response in subjects who received parenteral Shigella flexneri 2a-recombinant exoprotein A conjugate (69 urine samples) or meningoccal tetravalent control vaccines (4 urine samples). All the volunteers who lacked a significant response to S. sonnei LPS in serum also lacked such response in urine samples. Seventy-four percent of the volunteers with a significant IgA or IgG anti-LPS response in serum at convalescence or 14 days after vaccination showed a similar response in urine. The ratio of the titer of secretory protein bound to IgA anti-S. sonnei LPS in urine to that in serum was 303 times higher than the ratio of anti-S. sonnei LPS total IgA titer in urine to that in serum, indicating that the urine IgA is of secretory origin. These findings suggest the possible use of urinary Shigella LPS antibodies as markers of systemic and secretory immune responses after natural infection or vaccination. At this stage, because of its limited sensitivity, the detection by ELISA of Shigella LPS antibodies in urine cannot replace the same assay in serum as a definitive test in an individual with a negative result.

Antibodies, Bacterial↗
PubMed1976

[ 771 Shigella strains isolated in a 15-year period from Americans living in Ankara. Comparisons with Shigella strains isolated from Turkish natives].

The author had worked as a bacteriologist in Ankara American Air Force Hospital from 1958 to 1972. During this period of time he was able to isolate 771 shigella strains from the American patients of the hospital. The amounts and the percentages of the subgroups are listed below together with the two other Ankara City Pediatric hospital results (see article). american community lived in Ankara for 15 years and shared many aspects which were important in shigella epidemiology like using city's tap water, shopping from the same green groceries to by fruits and vegetables so on. For shigella cases Ankara had seasonal alterations in July and August being the peak months. Americans, disease followed that course exactly. The big difference was being the local people of the city had those epidemics with the flexneri strains but Americans had them with the sonnei strains. To show the possible sources which could infect the community time to time and make sonnei predominant yielded negative result. All the patients stools were cultured. Sensitivity studies employing "plate disk diffusion" techniques were done. All patients treated accordingly. Stools checked for routine carriership exams. None become a chronic carrier. American installations had their shops, clubs, mess halls. The food handlers of these places had checked routinely by the preventive medicine office. None found infected. Only at 1963 the amount of flexneri isolations were higher than sonnei. All the remaining years sonnei were predominant. Antibiotic sensitivity studies showed no differences between subtypes. Except streptomycin and sulphamide strains stayed fairly sensitive to other antibiotics. Resistance factors contained maximum 6 markers. The little Americans community in Ankara consisted a unique and highly socioeconomic-wise developed group of the city. Many attempts to find the answer for the question is "who is infecting who" was always fruitless. That gives the impression as if the Americans were more sensitive to the shigella infections caused by sonnei strains for some reason. In another words Americans were more resistant to the infections other than sonnei.

Dysentery, Bacillary↗
PubMed1998

Shigellosis in children: a clinico-epidemiological comparison between Shigella dysenteriae type I and Shigella flexneri.

We reviewed the clinical and epidemiological features of 390 children under 5 years of age infected with either Shigella dysenteriae type I or Shigella flexneri attending a diarrhoea treatment centre from 1993 to 1995 in Dhaka, Bangladesh. Older age (24 months or more), underweight and wasting but not stunting were the host factors significantly more associated with Shigella dysenteriae type I infection than in Shigella flexneri-infected children. Moreover, use of antibiotics at home, use of water from tubewells or pipe-water for drinking and lack of sanitary facilities for defaecation were the behavioural and environmental factors strongly associated with S. dysenteriae type I infection. Children with diarrhoea due to S. flexneri presented with more watery/liquid stools and had a shorter duration of illness. Duration of diarrhoea for 4 or more days was typical of S. dysenteriae type I infection. Interventions to address malnutrition and to promote environmental hygiene would be predicted to offer greater protection against shigellosis due to S. dysenteriae than S. flexneri.

Bangladesh↗
PubMed2004

Deletion in the Shigella enterotoxin genes further attenuates Shigella flexneri 2a bearing guanine auxotrophy in a phase 1 trial of CVD 1204 and CVD 1208.

BACKGROUND: We created a live, attenuated, oral Shigella vaccine by constructing a lineage of guanine auxotrophs and conducted a double-blind, placebo-controlled trial to ascertain (1) the attenuation profile of Delta guaBA Shigella flexneri 2a, which harbors deletions in the guanine nucleotide synthesis pathway (CVD 1204); (2) additional attenuation conferred by deletions in set and sen genes encoding Shigella enterotoxins (ShETs) 1 and 2, respectively (CVD 1208); and (3) the relative immunogenicity of these constructs. METHODS: Inpatient volunteers received a single oral dose of CVD 1204, CVD 1208 (10(7), 10(8), or 10(9) cfu), or placebo. Clinical, immunologic, and microbiologic responses were evaluated. RESULTS: Reactogenicity occurred in 8 of 23 recipients of CVD 1204, characterized by diarrhea (30%), fever (22%), and/or dysentery (17%), but in only 1 (5%) of 21 recipients of CVD 1208 (brief fever) (P=.02, Fisher's exact test). Antilipopolysaccharide responses, as measured by antibody-secreting cell, serum, or fecal antibody levels, occurred in 67%, 71%, and 100% of recipients of CVD 1204 and in 86%, 43%, and 100% of recipients of CVD 1208 at doses of 10(7), 10(8), and 10(9) cfu, respectively. CONCLUSIONS: We conclude that 1 or both ShETs are virulence determinants in humans; their inactivation, in combination with Delta guaBA, leads to a well-tolerated and immunogenic Shigella vaccine candidate.

Administration, Oral↗
PubMed1991

Effect of prior infection with virulent Shigella flexneri 2a on the resistance of monkeys to subsequent infection with Shigella sonnei.

All virulent shigellae have large plasmids. Plasmid-associated genes encode the expression of membrane-associated proteins (MAP), some of which correlate with the ability to invade susceptible epithelial cells. These MAP are serologically related in all of the shigella serotypes and evoke an antibody response after infection. To determine whether the MAP have a significant role in protection, 24 monkeys were infected with virulent Shigella flexneri 2a. After recovery, one group (with controls) was rechallenged with S. flexneri 2a; another group (with controls) was fed Shigella sonnei. The animals that were rechallenged with S. flexneri 2a were protected, while those that were fed S. sonnei experienced the same incidence of disease as controls. No differences in serum immune response to MAP after primary infection with S. flexneri were detected in immunoblots using lysates of S. flexneri or S. sonnei or in ELISA using water extracts of these strains.

Animals↗
PubMed1972

Factors affecting virulence of Shigella flexneri: defective methionine synthesis in an Escherichia coli-Shigella hybrid.

An Escherichia coli-Shigella flexneri hybrid of intermediate virulence was studied to determine whether its shorter survival in host cells might be due to a metabolic defect. Investigation of its growth in minimal glucose medium showed that the hybrid, like its E. coli parent, had a longer lag phase and a slower growth rate than its virulent Shigella parent. Methionine was found to increase the growth rate of the hybrid. The Shigella parent of the hybrid can synthesize methionine normally, but the E. coli parent has a point mutation in its metA gene. Since it synthesizes enough methionine to grow slowly, it is postulated that the hybrid strain has a hybrid metA gene, that is, a gene composed partly of deoxyribonucleic acid (DNA) from E. coli, with the balance of the DNA from S. flexneri. Phage P1-mediated transduction, with the metA(-)E. coli parent as recipient and the Shigella parent as donor, yielded a few transductants that responded to methionine in the same way the hybrid did. Many more transductants of the hybrid type were produced when the hybrid strain was used as a donor. It is suggested that this poorly functioning gene acts synergistically with the hybrid strain's relaxed synthesis of ribonucleic acid to prevent its survival in the host.

Animals↗
PubMed2001

Characterization of cryptic flagellin genes in Shigella boydii and Shigella dysenteriae.

Flagellin (fliC) genes of 12 Shigella boydii and five Shigella dysenteriae strains were characterized. Though these strains are nonmotile, the cryptic fliCSB gene, cloned from S. boydii strain C3, is functional for expression of flagellin. It consists of 1,704 bp, and encodes 568 amino acid residues (57,918 Da). The fliCSD gene from S. dysenteriae strain 16 consists of 1,650 bp encoding 549 amino acid residues (57,591 Da) and contains an IS1 element inserted in its 3' end. The two genes are composed of the 5'-constant, central variable and 3'-constant sequences, like other known fliC genes. The two genes share high homology in nucleotide and amino acid sequences with each other and also with the Escherichia coli fliCE gene, indicating that both genes are closely related to the fliCE gene. Comparison of the central variable sequences of six different fliC genes showed that the fliCSB and fliCSD genes share low homology in amino acid sequence with the other fliC genes, suggesting that they encode antigenic determinants intrinsic to respective subgroups. However, Southern blotting using as probes the central variable sequences of several fliC genes showed that four of 12 S. boydii strains have a fliC gene similar to that of Shigella flexneri, and that among five fliC genes from S. dysenteriae strains, one is similar to that of S. flexneri, two are similar to that of S. boydii, and only one is unique to S. dysenteriae. Some of these variant alleles were verified by immunoblotting with flagellins produced from cloned fliC genes. The presence of variant fliC alleles in S. boydii and S. dysenteriae indicates that subdivision into subgroups does not reflect the ancestral flagella H antigenic relationships. These data will be useful in considering the evolutionary divergence of the Shigella spp..

Alleles↗
PubMed1995

A modified Shigella volunteer challenge model in which the inoculum is administered with bicarbonate buffer: clinical experience and implications for Shigella infectivity.

In the absence of a definitive immunologic correlate of protection against shigellosis, promising Shigella vaccine candidates have been selected based on their ability to confer resistance against experimental challenge with wild-type Shigella in healthy adult volunteers. A limitation of this model has been the low and often variable attack rate of illness among controls, necessitating repeated inpatient studies to demonstrate statistically significant results. In this study, the Shigella challenge model was modified by using bicarbonate buffer instead of skimmed milk as the delivery vehicle to enhance survival of the ingested challenge inoculum. To determine the ability of the modified model to detect protective efficacy, 11 veteran volunteers (previously challenged with S. flexneri 2a in bicarbonate buffer) and 12 immunologically naive control subjects were challenged with 1.4 x 10(3) c.f.u. S. flexneri 2a. Shigellosis occurred in 3 veterans and 11 control subjects (27 vs 92%, p = 0.003), yielding a protective efficacy of 70%. Dose response was evaluated in an additional seven naive subjects who were inoculated with a log lower (1.4 x 10(2) c.f.u.) S. flexneri 2a and had a significantly diminished attack rate of shigellosis (317 (43%) vs 11/12 (92%), p = 0.04). These findings indicate that the modified bicarbonate challenge model using an inoculum of 10(3) c.f.u. is a safe, repeatable, and valid method of selecting Shigella vaccines and other immunoprophylactic agents that are likely to confer protection against natural shigellosis.

Adolescent↗
PubMed1986

Serum immune response to Shigella protein antigens in rhesus monkeys and humans infected with Shigella spp.

The serum antibody response to proteins encoded by the virulence-associated plasmid of Shigella flexneri was determined in monkeys challenged with virulent S. flexneri serotype 2a. With water-extractable antigen in an enzyme-linked immunosorbent assay, a significant increase in antibody titer against proteins from a plasmid-carrying, virulent strain of S. flexneri serotype 5 could be demonstrated in convalescent sera. There were minimal antibody titers against proteins from an avirulent (plasmid-free) organism. Previously identified plasmid-coded polypeptides a, b, c, and d were predominant antigens recognized by a majority of the convalescent sera in immunoblots. An additional 140-megadalton plasmid-coded polypeptide was also recognized by half of the sera. Convalescent serum from an infected monkey recognized antigens on the bacterial surface in several different plasmid-containing Shigella species and in an enteroinvasive Escherichia coli strain. A survey of sera obtained from children 5 to 10 years of age who had been infected with S. flexneri or S. sonnei revealed high enzyme-linked immunosorbent assay titers in both acute and convalescent sera against a water extract from a virulent Shigella strain. In contrast, children under 3 years of age had no antibody titer in either acute or convalescent sera against the virulence-associated shigella proteins, while 3- to 4-year-old children mounted an immune response against these proteins only in convalescence.

Animals↗