title: Transmissible enteritis of turkeys: experimental inoculation studies with tissue-culture-adapted turkey and bovine coronaviruses.

text: Four Quebec isolates of turkey enteric coronaviruses (TCVs) and three isolates of bovine enteric coronaviruses (BCVs) were serially propagated in HRT-18 and compared for their pathogenicity in turkey embryos and turkey poults. By immunoelectron microscopy, hemagglutination-inhibition, and Western immunoblotting assays, tissue-culture-adapted Quebec TCV isolates were found to be closely related to the reference Minnesota strain of TCV and the Mebus strain of BCV. Genomic relationships between TCV isolates and the reference BCV strain were confirmed by hybridization assays with BCV-specific radiolabeled recombinant plasmids containing sequences of the N and M genes. Only TCV isolates could be propagated by inoculation in the amniotic cavity of chicken and turkey embryonating eggs, and induced clinical disease in turkey poults. Nevertheless, coronavirus particles or antigens were detected by electron microscopy or indirect enzyme-linked immunosorbent assay in the clarified intestinal contents of BCV-infected poults up to day 14 PI, and genomic viral RNA was detected by slot-blot hybridization using BCV cDNA probes.


title: Novel coronavirus: the challenge of communicating about a virus which one knows little about.

text: Following the severe acute respiratory syndrome (SARS) event in 2002/2003, the Worl Health Organization (WHO) developed outbreak communications guidelines. With the emergence in September 2012 of a novel coronavirus, WHO's public communications response was initiated and planned in light of these guidelines and 5 principles of trust, transparency, announcing early, listening and planning. This review describes WHO's communication response to the novel coronavirus event'and its efforts to provide early, accurate information via various media to keep the public appraised of the situation, and its commitment to continued communication on an ongoing basis.


title: Enteric infections with coronaviruses and toroviruses.

text: Many enteric viruses are difficult or impossible to propagate in tissue culture. Coronaviruses and toroviruses are large, enveloped, plus-strand RNA viruses in the order Nidovirales that cause enteric disease in young pigs, cows, dogs, mice, cats and horses. Two different serogroups of mammalian coronaviruses cause frequent respiratory infections in humans, and coronaviruses and toroviruses have been implicated in human diarrhoeal disease by immunoelectron microscopy. However, there is as yet no consensus about the importance of these enveloped viruses in human diarrhoea, and little is known about their genetic variability. The large spike (S) glycoprotein is an important determinant of species specificity, tissue tropism and virulence of coronavirus infection. To infect enterocytes, both S glycoproteins and the viral envelope must resist degradation by proteases, low and high pH, and bile salts. One specific site on the S glycoprotein of bovine coronavirus must be cleaved by an intracellular protease or trypsin to activate viral infectivity and cell fusion. S glycoprotein binds to specific receptors on the apical membranes of enterocytes, and can undergo a temperature-dependent, receptor-mediated conformational change that leads to fusion of the viral envelope with host membranes to initiate infection. Analysing spike-receptor interactions may lead to new ways to propagate these enteric viruses as well as new strategies for development of novel antiviral drugs.


title: Sensitivity and specificity of a nested polymerase chain reaction for detection of lentivirus infection in lions (Panthera leo).

text: Feline immunodeficiency virus (FIV) is a lentivirus in the Retroviridae family that causes lifelong infection in domestic cats. The lentivirus of African lions (Panthera leo), referred to as FIVple, is endemic in certain lion populations in eastern and southern Africa. Lentivirus infection leads to immunologic dysfunction and immunosuppressive disease in domestic cats; however, little is known about the pathogenic effects of infection in lions, nor about the epidemiologic impact on free-ranging and captive populations. Whole blood and serum samples were collected opportunistically from free-ranging lions in Kruger National Park, Republic of South Africa (RSA). Whole blood and serum samples were also collected from captive wild lions in the RSA. A nested polymerase chain reaction (PCR) assay for detection of FIV was performed on all whole blood samples. In addition, serum samples were tested for cross-reactive antibodies to domestic feline lentivirus antigens and puma lentivirus synthetic envelope peptide antigen. The PCR assay successfully amplified the lion lentivirus from African lions. The relative sensitivity and relative specificity were 79% and 100%, respectively, and the positive and negative predictive values were 100% and 67%, respectively. This research represents the first study to compare genetic material with antibody-based methods of lentivirus detection on lions in RSA. Using PCR as an additional diagnostic test for FIV in lions will increase screening sensitivity and will allow viral characterization among circulating isolates and monitoring of changes in the viral epidemiology within geographic regions and populations over time.


title: CD13/APN regulates endothelial invasion and filopodia formation.

text: CD13/aminopeptidase N is a transmembrane peptidase that is induced in the vasculature of solid tumors and is a potent angiogenic regulator. Here, we demonstrate that CD13 controls endothelial cell invasion in response to the serum peptide bradykinin by facilitating signal transduction at the level of the plasma membrane. Inhibition of CD13 abrogates bradykinin B(2) receptor internalization, leading to the attenuation of downstream events such as bradykinin-induced activation of Cdc42 and filopodia formation, and thus affects endothelial cell motility. Investigation into mechanisms underlying this block led us to focus on B(2)R internalization via membrane-dependent mechanisms. Membrane disruption by depletion of cholesterol or trypsinization halts B(2)R internalization, invasion, and filopodia formation, which can be recovered with addition of cholesterol. However, this functional recovery is severely impaired in the presence of CD13 antagonists, and the distribution of membrane proteins is disordered in treated cells, suggesting a role for CD13 in plasma membrane protein organization. Finally, exogenous expression of wild-type but not mutant CD13 further alters protein distribution, suggesting peptidase activity is required for CD13's regulatory activity. Therefore, CD13 functions as a novel modulator of signal transduction and cell motility via its influence on specific plasma membrane organization, thus regulating angiogenesis.


title: Protecting human and ecological health under viral threats in Asia.

text: Severe acute respiratory syndrome (SARS) outbroke in 2003, and the avian influenza A (H5N1) also outbroke in 2003 and continued to 2004. These pandemic viral diseases originated in South East Asia. Many human and animal lives were lost. Economic damages due to the pandemics were also very large. The question arises of why did the pandemics originate from South East Asian areas. Human influenza A consists of many sub-types of coronaviruses including the SARS virus and the avian influenza (H5N1) that are all variants of RNA of avian coronavirus. Variants are formed during infection of a coronavirus through not only birds but also mammals, including human beings. There are hot spots where viral infection rates are accelerated among birds, mammals and human beings. Suspicious areas are in South East Asia, where living conditions of birds, mammals and human beings are so close that there are always risks of viral infection. When we see the living conditions of farmers in southern China, northern Vietnam, Laos and northern Myanmar, they commonly raise ducks/chickens with pigs sharing ponds into which they discharge household wastewater, including human excreta, and pig excreta that are significant carriers of viruses. Bird faeces are also key carriers of the viruses. In the ponds, they raise ducks and conduct fish culture. Other important players are migrating birds from North Asia, which are principal vectors of avian influenza viruses. There is an urgent necessity of improving human and ecological health in South East Asia to control viral infection among birds, mammals and human beings. We can hinder the vicious cycle of virus infection through water contamination in ponds by providing good human, pig and chicken sanitation. It is easy to provide good sanitation practices for human, pigs and chickens, introducing collection and treatment of excreta. Our modern water technology can find good solutions for the problem.


Structure and expression of the bovine coronavirus hemagglutinin protein.


title: Apical plasma membrane proteins are not obligatorily stored in secretory granules in exocrine cells.

text: Exocrine cells are epithelial cells in which secretory granules undergo fusion with the apical plasma membrane upon secretagogue stimulation. Several apical plasma membrane proteins have been found in secretory granules in cells from pancreas and salivary glands raising the possibility that incorporation into secretory granules followed by exocytosis of the granules accounts for their insertion into the apical plasma membrane. To test this hypothesis, we have expressed the influenza hemagglutinin (HA) in pancreatic AR42J cells, which make zymogen-like granules upon incubation with dexamethasone. The influenza virus HA is known to be specifically targeted to the apical plasma membrane of epithelial cells that lack a regulated pathway and is also known to be excluded from secretory granules in virally-infected pituitary AtT20 cells. Localization of the protein by immunofluorescence microscopy revealed that it accumulated at the plasma membrane of the transfected AR42J cells. HA was not observed in the amylase-rich secretory granules. By immunolabeling of ultrathin cryosections of the transfected cells, HA was also found exclusively on the cell surface, with label over secretory granules not exceeding that seen in control, untransfected cells. In addition, in cell fractionation experiments performed on radiolabeled AR42J cell transformants, HA was not detectable in the secretory granule fractions. These results indicate that HA is not efficiently stored in mature secretory granules and is likely to reach the cell surface via constitutive transport pathways.


title: Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.

text: BACKGROUND Outbreak of severe acute respiratory syndrome (SARS) in Taipei has been associated with Taiwanese back from Guangdong, China. We report 4 probable SARS cases with different severity and propose optimal treatment. METHODS Four probable SARS cases were enrolled. Two cases were due to outbreak of SARS in our hospital and two cases were transferred from other hospitals. All patients received standard treatment: ribavirin 1000 mg orally daily for 10 days, Levofloxacin 500 mg orally daily for 7 days, and intravenous immunoglobulin (IVIG) 1 g/kg/day for 2 day after the onset of symptoms. If severe hypoxia (PaO2/FiO2 < 200) occurred, protective strategy of mechanical ventilation and methylprednisolone 2 mg/kg/day were given. The clinical pictures and treatment outcome were discussed. RESULTS Fever, dyspnea, diarrhea, malaise, dizziness and dry cough were initially more common symptoms. Initially chest patterns included focal consolidation, interstitial infiltration or normal. Common laboratory findings were lymphopenia, and elevated serum levels of lactate dehydrogenase and C-reactive protein. No mortality was found. CONCLUSIONS Highly alert and stringent infection control of SARS cases are required. Otherwise, SARS easily induces hospital-acquired first then community-acquired infection. Initial presentation of radiographic patterns includes normal, interstitial or airspace shadowing. Fever and lymphopenia are occasionally followed by rapidly progressive respiratory compromise. The standard treatment might be beneficial for decreasing the mortality rate.


title: Stem-loop IV in the 5' untranslated region is a cis-acting element in bovine coronavirus defective interfering RNA replication.

text: The 210-nucleotide (nt) 5' untranslated region (UTR) in the positive-strand bovine coronavirus (BCoV) genome is predicted to contain four higher-order structures identified as stem-loops I to IV, which may function as cis-acting elements in genomic RNA replication. Here, we describe evidence that stem-loop IV, a bulged stem-loop mapping at nt 186 through 215, (i) is phylogenetically conserved among group 2 coronaviruses and may have a homolog in groups 1 and 3, (ii) exists as a higher-order structure on the basis of enzyme probing, (iii) is required as a higher-order element for replication of a BCoV defective interfering (DI) RNA in the positive but not the negative strand, and (iv) as a higher-order structure in wild-type (wt) and mutant molecules that replicate, specifically binds six cellular proteins in the molecular mass range of 25 to 58 kDa as determined by electrophoretic mobility shift and UV cross-linking assays; binding to viral proteins was not detected. Interestingly, the predicted stem-loop IV homolog in the severe acute respiratory syndrome (SARS) coronavirus appears to be group 1-like in that it is in part duplicated with a group 1-like conserved loop sequence and is not group 2-like, as would be expected by the SARS coronavirus group 2-like 3' UTR structure. These results together indicate that stem-loop IV in the BCoV 5' UTR is a cis-acting element for DI RNA replication and that it might function through interactions with cellular proteins. It is postulated that stem-loop IV functions similarly in the virus genome.


title: [Comparative study of clinical characteristics and prognosis of clinically diagnosed SARS patients with positive and negative serum SARS coronavirus-specific antibodies test].

text: OBJECTIVE To investigate clinical characteristics and long-term effects of SARS. METHODS Clinical characteristics of 197 SARS patients in Xiao Tang-shan hospital were analyzed retrospectively, and prognosis of them were analyzed prospectively. RESULTS Among the 197 patients, 153 patients (77.7%) have positive results of serum SARS coronavirus-specific antibodies test, and 44 patients (22.3%) have negative results. The average age of SARS and non-SARS patients were (40 +/- 12) and (31 +/- 12) years, male/female ratio were 1.0:1.6 and 2.1:1.0, average body temperature were (38.5 degrees C +/- 0.3 degrees C) and (38.1 degrees C +/- 0.4 degrees C), median of fever length were 7.0 d (0.4 approximately 50 d) and 2.3 d (0.3 approximately 37 d) respectively. The occurrence of dyspnea, malaise and gastrointestinal symptom were more often in SARS patient than in non-SARS patients. Some patients have residual symptoms (such as cough, fatigue, dyspnea, abnormality of liver function, hyperglycemia and hyperglyceridemia), and only few patients have lung fibrosis. CONCLUSION Some patients with other respiratory diseases were misdiagnosed as SARS. There were several obvious differences of clinical characteristics between SARS patient and non-SARS patients. Prognosis of most patients were preciously well, and few still had abnormality of lung function. Residual symptoms of SARS and side effects of drugs used to treat SARS should be discriminated.


title: Iodine Concentration and Optimization in Computed Tomography Angiography: Current Issues.

text: Computed tomography (CT) technology has seen a dramatic evolution in the recent past that has deeply changed the face of this diagnostic modality. Since the early days of helical single-slice and then multislice CT, CT angiography (CTA) has been one of the most technically demanding applications, both in terms of scanning technique and contrast medium (CM) injection protocol, due to the need to acquire a large amount of high-resolution data over a limited period corresponding to the peak contrast enhancement of the arterial system. Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs. Our aim is to provide an up-to-date overview of the existing evidence on how changing iodine concentration can have an impact on CTA performance, especially with the use of state-of-the-art CT and power injector technology, in the perspective of improving patient care while minimizing overall exposure to iodinated CM and ionizing radiation.


Clinical data marshalled to treat HIV.


title: Epitope specificity of protective lactogenic immunity against swine transmissible gastroenteritis virus.

text: The epitope specificity of the protective immune response against swine transmissible gastroenteritis (TGE) has been investigated by using circulating and secretory antibodies. This study was carried out with sows vaccinated with TGEV or the antigenically related porcine respiratory coronavirus (PRCV). TGEV vaccination of sows resulted in greater lactogenic protection of suckling piglets against TGEV challenge and a higher secretory immune response than PRCV vaccination did. These differences in the immune response were conditioned by the route of antigen presentation as a result of the different tropism of each virus. Epitopes on S protein, and in particular those contained in its antigenic site. A, were more immunogenic than epitopes on N and M proteins in both groups of vaccinated sows, as determined by a competitive radioimmunoassay. Minor differences in antibody response against the previously defined antigenic subsites Aa, Ab, and Ac were also detected, with subsite Ab being the most antigenic in both TGEV- and PRCV-immune sows. These findings suggest that antigenic site A on S protein, involved in virus neutralization, is the immunodominant site in pregnant sows that confer lactogenic protection. They also validate, in experiments with secretory antibodies, the antigenic maps made with murine monoclonal antibodies. Therefore, this antigenic site should be considered for vaccine or diagnostic development.


title: Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide.

text: Obesity is a common disease affecting adults and children. The incidence of obesity in Canada is increasing. Laparoscopic sleeve gastrectomy (LSG) is a relatively new and effective procedure for weight loss. Owing to an increase in the number of bariatric surgical procedures, general surgeons should have an understanding of the complications associated with LSG and an approach for dealing with them. Early postoperative complications following LSG that need to be identified urgently include bleeding, staple line leak and development of an abscess. Delayed complications include strictures, nutritional deficiencies and gastresophageal reflux disease. We discuss the principles involved in the management of each complication.


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title: Are virtual communities good for our health?


title: Human coronavirus NL63 in children: epidemiology, disease spectrum, and genetic diversity.

text: 1. Human coronaviruses (HCoVs)were detected in 2.5% of 2982 local children hospitalised for acute respiratory infections in 2005 to 2007. 2. Using the 'pancoronavirus' reverse transcription-polymerase chain reaction assay, detection rates were 0.6% for HCoVNL63,1.2% for HCoV-OC43,0.5% for HCoV-HKU1, and 0.2% for HCoV-229E. Notably, HCoV-NL63 infections were significantly more common among children hospitalised in 2006/2007 (1.2%) than in 2005/2006 (0.3%).3. The peak season for HCoVNL63 infection was autumn(September to October). 4. HCoV-NL63 infection was associated with younger age,croup, febrile convulsion, and acute gastroenteritis. Such disease associations were not found with the other three HCoVs. 5. Most local HCoV-NL63 isolates were closely related to the prototype strain in Netherlands(NL496), but a few were phylogenetically distinct from the major cluster.


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title: Optimizing the control of disease infestations at the landscape scale.

text: Using a contact-process model for the spread of crop disease over a regional scale, we examine the importance of the time scale for control with respect to the cost of the epidemic. The costs include the direct cost of treating infected sites as well as the indirect costs incurred through lost yield. We first use a mean-field approximation to derive analytical results for the optimal treatment regimes that minimize the total cost of the epidemic. We distinguish short- and long-term epidemics. and show that seasonal control (short time scale) requires extreme treatment, either treating all sites or none or switching between the two at some stage during the season. The optimal long-term strategy requires an intermediate level of control that results in near eradication of the disease. We also demonstrate the importance of incorporating economic constraints by deriving a critical relationship between the epidemiological and economic parameters that determine the qualitative nature of the optimal treatment strategy. The set of optimal strategies is summarized in a policy plot, which can be used to determine the nature of the optimal treatment regime given prior knowledge of the epidemiological and economic parameters. Finally, we test the robustness of the analytical results, derived from the mean-field approximation, on the spatially explicit contact process and demonstrate robustness to implementation errors and misestimation of crucial parameters.


title: Non-specific interstitial pneumonia (NIP): immunohistologic screening of etiologic agents.

text: Non-specific interstitial pneumonia (NIP) occurs frequently in patients with HIV-infection. To elucidate the etiology of this pulmonary disorder, we searched for 13 different microorganisms in transbronchial biopsies from 15 patients with NIP, 15 patients with Pneumocystis carinii pneumonia (PCP) and 20 patients with lung diseases not related to HIV-infection using monoclonal antibodies and the APAAP- or PAP-technique for immunostaining. Chlamydia trachomatis and parainfluenza III were detected frequently and in great number. Adenovirus, influenza B, varicella zoster and cytomegalovirus were also found frequently, but not in great number. Measles virus, respiratory syncytial virus, influenza A and herpesviruses 1&2 were not found. Also not found were parainfluenza I, mycoplasma pneumoniae and coronavirus. In seven out of fifteen NIP patients at least one organism was shown, compared to nine out of fifteen patients with PCP and eight out of twenty patients in the control group.


title: Expression of murine coronavirus recombinant papain-like proteinase: efficient cleavage is dependent on the lengths of both the substrate and the proteinase polypeptides.

text: Proteolytic processing of the replicase gene product of mouse hepatitis virus (MHV) is essential for viral replication. In MHV strain A59 (MHV-A59), the replicase gene encodes two predicted papain-like proteinase (PLP) domains, PLP-1 and PLP-2. Previous work using viral polypeptide substrates synthesized by in vitro transcription and translation from the replicase gene demonstrated both cis and trans cleavage activities for PLP-1. We have cloned and overexpressed the PLP-1 domain in Escherichia coli by using a T7 RNA polymerase promoter system or as a maltose-binding protein (MBP) fusion protein. With both overexpression systems, the recombinant PLP-1 exhibited trans cleavage activity when incubated with in vitro-synthesized viral polypeptide substrates. Subsequent characterization of the recombinant PLP-1 revealed that in vitro trans cleavage is more efficient at 22 degrees C than at higher temperatures. Using substrates of increasing lengths, we observed efficient cleavage by PLP-1 requires a substrate greater than 69 kDa. In addition, when PLP-1 was expressed as a polypeptide that included additional viral sequences at the carboxyl terminus of the predicted PLP-1 domain, a fivefold increase in proteolytic activity was observed. The data presented here support previous data suggesting that in vitro and in vivo cleavage of the ORF 1a polyprotein by PLP-1 can occur in both in cis and in trans. In contrast to the cleavage activity demonstrated for PLP-1, no in vitro cleavage in cis or in trans could be detected with PLP-2 expressed either as a polypeptide, including flanking viral sequences, or as an MBP fusion enzyme.


title: Effects of cyclosporin A on the immune responses and pathogenesis of a virulent strain of Mycoplasma gallisepticum in chickens.

text: Immune responses to the virulent S6 strain of Mycoplasma gallisepticum in immunocompetent and cyclosporin A (CsA)-treated specific pathogen free chickens were investigated, and pathogenesis of the M. gallisepticum strain was also examined. Ten-day-old specific pathogen free chickens were inoculated by eye-drop with M. gallisepticum, and a control uninfected group was inoculated with mycoplasma broth. Blood was collected weekly for 4 weeks from five birds in each group and whole blood lymphocyte transformation assayed against concanavalin A and lipopolysaccharide. Blood samples were also collected at intervals for serological assays. Live body weight, clinical signs and lesions were monitored, and recovery of M. gallisepticum was attempted from choanal cleft of live birds and also from various sites at necropsy. In parallel to the aforementioned groups, another set of two groups of chicks treated with CsA was infected with M. gallisepticum S6 or mycoplasma broth. These groups were subjected to the same experimental procedures. In the immunocompetent chickens, M. gallisepticum caused temporary T-cell suppression at 2 weeks post-infection. Comparison of the clinical signs and macroscopic lesions produced in immunocompetent and CsA-treated chickens indicated that T cells may not play an active role in disease development. The percentage of birds with mycoplasma isolation and the load of mycoplasmas suggested that T cells may have some role in resisting mycoplasma colonization or in the elimination of the infection.


title: Rewiring the severe acute respiratory syndrome coronavirus (SARS-CoV) transcription circuit: engineering a recombination-resistant genome.

text: Live virus vaccines provide significant protection against many detrimental human and animal diseases, but reversion to virulence by mutation and recombination has reduced appeal. Using severe acute respiratory syndrome coronavirus as a model, we engineered a different transcription regulatory circuit and isolated recombinant viruses. The transcription network allowed for efficient expression of the viral transcripts and proteins, and the recombinant viruses replicated to WT levels. Recombinant genomes were then constructed that contained mixtures of the WT and mutant regulatory circuits, reflecting recombinant viruses that might occur in nature. Although viable viruses could readily be isolated from WT and recombinant genomes containing homogeneous transcription circuits, chimeras that contained mixed regulatory networks were invariantly lethal, because viable chimeric viruses were not isolated. Mechanistically, mixed regulatory circuits promoted inefficient subgenomic transcription from inappropriate start sites, resulting in truncated ORFs and effectively minimize viral structural protein expression. Engineering regulatory transcription circuits of intercommunicating alleles successfully introduces genetic traps into a viral genome that are lethal in RNA recombinant progeny viruses.


Virus 'quasispecies': making a mountain out of a molehill?


title: Mouse hepatitis virus strain A59 is released from opposite sides of different epithelial cell types.

text: Coronaviruses infect humans and animals through epithelial cells of the gastrointestinal and respiratory tracts that serve as their primary target. When studying infections in cultured polarized epithelial cells, we found previously that coronaviruses are released from specific plasma-membrane domains; thus, mouse hepatitis virus (strain A59; MHV-A59) leaves murine epithelial kidney cells from the basolateral surface, whereas release of transmissible gastroenteritis virus from porcine epithelial kidney cells is confined to the apical membrane. This observation begged the question whether a particular coronavirus is consistently shed through the same membrane, irrespective of the nature of the epithelial cell. We therefore extended our studies with MHV-A59 to Madin-Darby canine kidney (MDCK) strain I and human colon carcinoma (Caco-2) cells, both of which are naturally refractory to MHV-A59 but were made susceptible to infection by transfection with recombinant MHV receptor cDNA. The release of MHV-A59 from Caco(MHVR) cells occurred preferentially from the basolateral side, consistent with our previous observations. In contrast, release from MDCK(MHVR) cells occurred almost exclusively from the apical surface. Because of this difference, we studied MHV-A59 infection of MDCK(MHVR) cells in more detail. The virus entered the cells preferentially from the apical side, a situation similar to that in murine epithelial cells, where the highest density of MHV receptor glycoprotein was found. The results from this and previous studies show that targeting of vesicles containing MHV-A59 to a specific side of epithelial cells may vary in different epithelial cell types.


title: Single-photon emission computed tomographic imaging of the early time course of therapy-induced cell death using technetium 99m tricarbonyl His-annexin A5 in a colorectal cancer xenograft model.

text: As apoptosis occurs over an interval of time after administration of apoptosis-inducing therapy in tumors, the changes in technetium 99m ((99m)Tc)-tricarbonyl (CO)₃ His-annexin A5 (His-ann A5) accumulation over time were examined. Colo205-bearing mice were divided into six treatment groups: (1) control, (2) 5-fluorouracil (5-FU; 250 mg/kg), (3) irinotecan (100 mg/kg), (4) oxaliplatin (30 mg/kg), (5) bevacizumab (5 mg/kg), and (6) panitumumab (6 mg/kg). (99m)Tc-(CO)₃ His-ann A5 was injected 4, 8, 12, 24, and 48 hours posttreatment, and micro-single-photon emission computed tomography was performed. Immunostaining of caspase-3 (apoptosis), survivin (antiapoptosis), and LC3-II (autophagy marker) was also performed. Different dynamics of (99m)Tc-(CO)₃ His-ann A5 uptake were observed in this colorectal cancer xenograft model, in response to a single dose of three different chemotherapeutics (5-FU, irinotecan, and oxaliplatin). Bevacizumab-treated mice showed no increased uptake of the radiotracer, and a peak of (99m)Tc-(CO)₃ His-ann A5 uptake in panitumumab-treated mice was observed 24 hours posttreatment, as confirmed by caspase-3 immunostaining. For irinotecan-, oxaliplatin-, and bevacizumab-treated tumors, a significant correlation was established between the radiotracer uptake and caspase-3 immunostaining (r = .8, p < .05; r = .9, p < .001; r = .9, p < .001, respectively). For 5-FU- and panitumumab-treated mice, the correlation coefficients were r = .7 (p = .18) and r = .7 (p = .19), respectively. Optimal timing of annexin A5 imaging after the start of different treatments in the Colo205 model was determined.


title: War on SARS: a Singapore experience.

text: On Mar. 12, 2003, the World Health Organization issued a global alert regarding cases of a severe atypical pneumonia termed "severe acute respiratory syndrome" (or SARS). In Singapore alone, there have been 238 SARS cases and 33 deaths, including 5 health care workers. With modern global inter-connectivity, SARS rapidly spread to become a worldwide phenomenon. This article describes the Singapore "war on SARS" from an emergency physician's perspective, focusing on the "prevent, detect and isolate" strategy. Notable innovations include the use of home quarantine orders, mass temperature screening using thermal imaging, modular systems of hospital staffing, "virtual" hospital visits, and innovations in emergency department design. Most emergency departments, hospitals and health care systems appear to be psychologically and logistically unprepared for a massive infectious disease outbreak. In light of recent natural and terrorism-related threats, emergency care providers around the world must adopt a new paradigm. The current SARS outbreak may be merely a taste of things to come.


title: Retina and retinal pigment epithelial cell autoantibodies are produced during murine coronavirus retinopathy.

text: The murine coronavirus, mouse hepatitis virus (MHV), JHM strain, induces a biphasic retinal disease in adult BALB/c mice. In the early phase of the disease, day 1 to 7, a retinal vasculitis is noted and is associated with the presence of virus particles. In the late phase of the disease, day 10 to 140, a retinal degeneration is observed and is associated with the absence of both virus particles and inflammatory cells. We show that the retinal degenerative process is also associated with the presence of antiretinal autoantibodies. In total, 22 of 23 sera collected from 10 to 70 days after JHM virus inoculation contained antiretinal autoantibodies. These autoantibodies are not found in sera from normal or mock-injected mice. Antibodies to retinal tissue were identified as two distinct patterns of immunoperoxidase staining on frozen sections of normal rat eyes, retinal autoantibodies and retinal pigment epithelium (RPE) autoantibodies. The antiretinal autoantibodies first appeared as IgM class antibodies that shifted to IgG class autoantibodies. The anti-RPE cell autoantibodies were predominantly of the IgG class. Sera that were positive for these autoantibodies did not stain with liver or kidney sections but 2 of 3 did react with rat brain sections. A second mouse strain, CD-1, was also evaluated because these animals respond to JHM virus inoculation by developing only the early phase of this disease, i.e. vasculitis. On day 10 postinoculation, the retina architecture has a normal appearance. In these mice, which are free of a retinal degeneration, antiretinal autoantibodies are not produced. However, just as is noted in the BALB/c mice, antivirus neutralizing antibodies are produced in the infected CD-1 mice. These findings suggest a role for autoimmunity in the pathogenesis of murine coronavirus induced retinal degeneration. This study establishes an animal model for the study of humoral autoimmune responses in human retinal degenerations.


title: [Amyand's hernia: a report of two cases and review of the bibliography].

text: BACKGROUND Presence of the vermiform appendix in an inguinal hernia sac is an uncommon finding (1%), exceptionally rare if it's inflamed (0.13%). Clinically simulating incarcerated inguinal hernia and proper preoperative diagnosis is exceptional. We present two unusual cases of Amyand's hernia, and review of the bibliography. CLINICAL CASES 1. Male patient 78 year old with an incarcerated right inguinal hernia which was performed preoperatively the diagnosis of Amyand's hernia by abdominal Computed Tomography. Clinical case 2. Female patient 82 year old with symptoms of an incarcerated right femoral hernia that finally showed an Amyand's hernia through a right inguinal hernia. CONCLUSIONS Amyand's hernia is a rare entity whose preoperative diagnosis is uncommon, that it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia.


title: Functional characterization of heptad repeat 1 and 2 mutants of the spike protein of severe acute respiratory syndrome coronavirus.

text: To understand the roles of heptad repeat 1(HR1) and HR2 of the spike (S) protein of the severe acute respiratory syndrome coronavirus (SARS-CoV) in virus-cell interactions, the conserved Leu or Ile residues located at positions 913, 927, 941, and 955 in HR1 and 1151, 1165, and 1179 in HR2 were individually replaced with an alpha-helix-breaker Pro residue. The 913P mutant was expressed mainly as a faster-migrating, lower-molecular-weight S(L) form, while the wild type and all other mutants produced similar levels of both the S(L) form and the slower-migrating, higher-molecular-weight S(H) form. The wild-type S(L) form was processed to the S(H) form, whereas the S(L) form of the 913P mutant was inefficiently converted to the S(H) form after biosynthesis. None of these mutations affected cell surface expression or binding to its cognate ACE2 receptor. In a human immunodeficiency virus type 1/SARS S coexpression study, all mutants except the 913P mutant incorporated the S(H) form into the virions as effectively as did the wild-type S(H) form. The mutation at Ile-1151 did not affect membrane fusion or viral entry. The impaired viral entry of the 927P, 941P, 955P, and 1165P mutants was due to their inability to mediate membrane fusion, whereas the defect in viral entry of the 1179P mutant occurred not at the stage of membrane fusion but rather at a postfusion stage. Our study demonstrates the functional importance of HR1 and HR2 of the SARS-CoV spike protein in membrane fusion and viral entry.


title: [Histone acetylation modulates influenza virus replicative intermediate dsRNA-induced interleukin-6 expression in A549 cells].

text: OBJECTIVE To investigate the role of histone acetylation in regulating influenza virus replicative intermediate double-stranded RNA (dsRNA)-induced interleukin-6 (IL-6) expression in A549 cells. METHODS A549 cells were treated with influenza virus replicative intermediate dsRNA, histone deacetylase (HDAC) inhibitor trichostatin A (TSA), or HADC small interfering RNA (siRNA). The changes in the cellular IL-6 promoter activities were detected by dual-luciferase assay, and IL-6 mRNA and protein expressions in the cells were determined using real-time RT-PCR and ELISA, respectively. RESULTS Influenza virus replicative intermediate dsRNA obviously up-regulated IL-6 expression in the cells. HDAC inhibitor TSA significantly enhanced the activity of IL-6 promoter and increased IL-6 mRNA expression in A549 cells, and HDAC3 may play an important role in this process. HDAC inhibitor TSA and DNMT inhibitor DAC showed no synergic effect in regulating IL-6 expression. CONCLUSIONS Influenza virus replicative intermediate dsRNA-induced IL-6 expression in A549 cells is regulated by histone acetylation.


Hong Kong virus spreads worldwide.


The Impact of Hospital Visiting Hour Policies on Pediatric and Adult Patients and Families.


title: [Coronavirus and COVID-19 : focus on a galopping pandemic].

text: The international community is currently facing a pandemic of acute respiratory syndrome caused by a new coronavirus, SARS-CoV-2. This syndrome has been named COVID-19 for CoronaVIrus Disease 2019 by the World Health Organization. The starting point of the epidemic is the city of Wuhan (China), where the virus is said to have been transmitted from animals to humans before inter-human transmission. This is the third epidemic caused by a coronavirus after those of severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) started in 2012. COVID-19 has rapidly spread to China and is currently spreading all over the world. The infection mainly affects patients over 40 years of age and mortality is increased in the presence of comorbidities. Children are pauci- or asymptomatic. The diagnosis is most often based on the detection of the viral genome in the nasopharynx by molecular biology methods. In the absence of specific anti-viral molecules, treatment is currently mainly symptomatic. It is clear that the COVID-19 pandemic is more difficult to control than what the first data suggested. The key strategy to SARS-CoV-2 is to limit its transmission. Preventive measures are mainly based on the application of adequate hand hygiene measures and disinfection of the environment, as well as measures of social distance aimed at limiting contacts in the population and protecting populations at risk.


title: Bovine arsenic toxicosis.

text: A ranch in central South Dakota had a number of dead calves because of arsenic poisoning. The clinical picture included diarrhea, central nervous system signs, and death. Gross necropsy findings included adequate body fat, stomachs full of normal-appearing ingesta, and large amounts of greenish brown watery fluid in the intestine and colon. Microscopically there was severe lymphoid tissue necrosis in the mesenteric lymph nodes and gut-associated lymphoid tissue. Chemical analysis of kidneys showed no significant amounts of lead; however, kidney arsenic concentrations were 25 to 44 ppm. The source was a small pile of Paris Green (common name for cupric acetoarsenite) found in an old dump site in the pasture.


title: Fracture Blisters After Primary Total Knee Arthroplasty.

text: Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed.


title: [Effects of surveillance system and preventive measures on the control of severe acute respiratory syndrome in a university in Guangdong Province of China].

text: OBJECTIVE To evaluate the influence of the surveillance system and preventive measurements on the control of severe acute respiratory syndrome (SARS) in a university in Guangdong Province. METHODS A university with more than thirty thousand undergraduates, staff and their relatives was retrospectively studied, from which information regarding the status of epidemic, organization of leadership, disease control strategies and measures were collected and analyzed. RESULTS The construction of the surveillance system in such a model as "individual-dormitory/home-class/unite-faculty and institute-university" largely contributed to the achievement of the goals of low incidence, no secondary, no epidemic, and no death. A series of control measures benefited the early diagnosis, effective isolation, prevention, and treatment of SARS control. CONCLUSION SARS could be effectively controlled in university only if strict surveillance system is built up, and all-round preventions, including early isolation of both confirmed or suspected cases and close contacted persons, are carried out.


title: The Use of Polymerase Chain Reaction Amplification for the Detection of Viruses and Bacteria in Severe Community-Acquired Pneumonia.

text: BACKGROUND Pathogens are often not identified in severe community-acquired pneumonia (CAP), and the few studies using polymerase chain reaction (PCR) techniques for virus detection are from temperate countries. OBJECTIVE This study assesses if PCR amplification improves virus and bacteria detection, and if viral infection contributes to mortality in severe CAP in a tropical setting, where respiratory pathogens have less well-defined seasonality. METHODS In this cohort study of patients with severe CAP in an intensive care unit, endotracheal aspirates for intubated patients and nasopharyngeal swabs for non-intubated patients were sent for PCR amplification for respiratory viruses. Blood, endotracheal aspirates for intubated patients, and sputum for non-intubated patients were analysed using a multiplex PCR system for bacteria. RESULTS Out of 100 patients, using predominantly cultures, bacteria were identified in 42 patients; PCR amplification increased this number to 55 patients. PCR amplification identified viruses in 32 patients. In total, only bacteria, only viruses, and both bacteria and viruses were found in 37, 14, and 18 patients, respectively. The commonest viruses were influenza A H1N1/2009 and rhinovirus; the commonest bacterium was Streptococcus pneumoniae. Hospital mortality rates for patients with no pathogens, bacterial infection, viral infection, and bacterial-viral co-infection were 16.1, 24.3, 0, and 5.6%, respectively (p = 0.10). On multivariable analysis, virus detection was associated with lower mortality (adjusted odds ratio 0.12, 95% confidence interval 0.2-0.99; p = 0.049). CONCLUSIONS Viruses and bacteria were detected in 7 of 10 patients with severe CAP with the aid of PCR amplification. Viral infection appears to be independently associated with lower mortality.


title: The effect of fostering on the genetic expression of locomotor sensitivity to alcohol.

text: Steps were taken to eradicate endemic mouse coronavirus from a colony that was part of a behavioral project characterizing the genetics of alcohol sensitivity. This behavioral study was conducted to determine whether changing the uterine or rearing environment (as is integral to common rederivation methods) would have a significant effect on the expression of the behavioral traits in question. Selected breeding pairs of the affected lines were divided into four treatment groups: 1) transfer of embryos to pseudopregnant B6D2F1 female mice, 2) fostering offspring to B6D2F1 dams, 3) fostering offspring to a different dam of the same line, and 4) offspring raised by the birth dam. Embryo transfers were successful only in one affected line. At approximately 50 days of age, the offspring were tested for locomotor behavior after intraperitoneal administration of ethanol or normal saline. There were no statistically significant effects of embryo transfer on the ethanol phenotype (ethanol-induced locomotor depression). Fostering significantly reduced the stimulant response to ethanol of only one mouse line selectively bred for high sensitivity to ethanol-induced stimulation, although the stimulant response of the fostered groups was still quite robust. Overall, the results of this study showed that eradication efforts involving fostering of offspring have a modest impact on the stimulant response to ethanol, but there were insufficient data to draw conclusions regarding the use of embryo transfer.


title: Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination.

text: BACKGROUND There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients. METHODS Consecutive patients with a temperature of >38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003-2006. Nasal pharyngeal samples were tested for influenzavirus A and B, respiratory syncytial virus, and human metapneumovirus using real-time multiplex polymerase chain reaction assays. Paired acute- and convalescent-phase serum samples were tested for respiratory viruses by complement fixation. RESULTS Fifty patients (90% of whom were receiving HAART) were included in the study (median CD4(+) T cell count, 325 cells/microL; median HIV RNA level, <50 copies/mL). A causative pathogen was identified in 25 patients (50%). Even though 76% of subjects had received influenza vaccine, viral infections were diagnosed in 21 patients (42%), as follows: influenza A, 10 patients; influenza B, 10; and parainfluenza virus type 3 infection, 1. Patients with and those without viral infection had similar demographic characteristics and HIV statuses. No patients with influenza and 23% of patients with other conditions had radiography-confirmed pneumonia (P=.07). Antibiotic prescriptions were common: 70% of patients received antibiotics. No patients with influenza required hospitalization, compared with 21% of other patients (P=.03). CONCLUSIONS Although illness was mild, influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance. Vaccination alone was insufficient to prevent infection. Thus, specific identification and management of influenza should be performed in HIV-infected outpatients who present with fever and respiratory symptoms.


title: Serosurvey of infectious disease agents of carnivores in captive red pandas (Ailurus fulgens) in China.

text: The future of the endangered red panda (Ailurusfulgens) depends in part on the development of protective measures against infectious diseases. The present study is a first step toward improved understanding of infectious diseases in the species' home regions. Serum samples obtained from 73 red pandas in 10 captive facilities in southwest, east, and northeast China from October to December 2004 were tested for antibodies against nine common infectious pathogens of carnivores. Antibody titers against canine distemper virus (CDV), canine parvovirus (CPV), and canine adenovirus (CAV) in the three facilities in which red pandas were vaccinated were highly variable. The CAV titer in one vaccinated red panda was high enough to suggest infection with the field virus following vaccination. Together with anecdotal reports of vaccine-associated morbidity and mortality, our results suggest that the Chinese vaccine is not suitable for this species. In the seven unvaccinated groups, CDV titers were low and occurred in 20-100% of the animals; antibody titers against CPV were found in seven of eight areas. Only one of 61 and two of 61 unvaccinated red pandas had CAV and canine coronavirus titers, respectively, and these titers were all low. Positive titers to Toxoplasma gondii were found in four locations (33-94% seropositive); the titers in 52% of seropositive individuals were of a magnitude consistent with active disease in other species (1:1,024 to > or = 1:4,096). One red panda in each of three locations was seropositive for Neospora caninum. Antibodies against canine herpesvirus and Brucella canis were not detected in any of the samples. Only one of the 73 red pandas had a weak positive influenza A titer. The results of this study emphasize the need for research on and protection against infectious diseases of red pandas and other endangered species in China.


title: [The epidemiologic characteristics of patients with severe acute respiratory syndrome (SARS)].

text: OBJECTIVE To study the epidemiologic characteristics of patients with Severe Acute Respiratory Syndrome (SARS) and to investigate the transmission way of the disease. METHODS A total of 80 clinically diagnosed SARS patients was enrolled in this study. RESULTS The result showed that 72/80 patients had exposed to SARS patient, and the least contact time was only 20 minutes, the average incubation period was (7.6 +/- 4.3) days (range 2 to 20 days); 53 (66.3%) subjects were hospital stuffs in this group, and 92.5% hospital stuffs (49/53) and 85.2% non-hospital stuffs (23/27) had the history of direct contact with SARS patients, respectively. The incubation period for the hospital stuffs and non-hospital stuffs were similar. More nurses (54.7%) were infected than doctors (34%) and nurse assistance (11.3%). The lack of isolation and self-protection was the most important factor for the hospital infection, and early isolation could efficiently prevent the spread of the disease. CONCLUSION Close exposure was the most important way for the transmission of SARS and the aggregation of the disease is common. The incubation period was around 7 days. The efficient isolation and self-protection could reduce the infection and prevent the spread of the disease.


A probe into a suspected severe acute respiratory syndrome epidemic in Akola Village.


title: Induction of interferon in human leukocyte cultures by natural pathogenic respiratory viruses.

text: Some common viruses responsible for respiratory disease have been reported to be poor inducers of interferon (IFN). Therefore, we have studied the induction of IFN in cultures of human leukocytes exposed under standardized conditions to various concentrations of adenovirus type 7A, coronavirus 229E, an influenza type A virus (H3N2), a rhinovirus, and respiratory syncytial virus (RSV). All five viruses induced substantial amounts of IFN at a multiplicity of infection of one infectious unit per cell or less. Leukocyte cultures from 50 healthy children were exposed to a standard concentration of each of the viruses. IFN was induced almost without an exception, but the amounts produced varied extensively according to both the virus and the individual leukocyte donor.


title: Preliminary clinical description of severe acute respiratory syndrome.

text: Severe acute respiratory syndrome (SARS) is a condition of unknown etiology that has been described in patients in Asia, North America, and Europe. This report summarizes the clinical description of patients with SARS based on information collected since mid-February 2003 by the World Health Organization (WHO), Health Canada, and CDC in collaboration with health authorities and clinicians in Hong Kong, Taiwan, Bangkok, Singapore, the United Kingdom, Slovenia, Canada, and the United States. This information is preliminary and limited by the broad and necessarily nonspecific case definition.


title: Personal protection during resuscitation of casualties contaminated with chemical or biological warfare agents--a survey of medical first responders.

text: INTRODUCTION The threat of mass casualties caused by an unconventional terrorist attack is a challenge for the public health system, with special implications for emergency medicine, anesthesia, and intensive care. Advanced life support of patients injured by chemical or biological warfare agents requires an adequate level of personal protection. The aim of this study was to evaluate the personal protection knowledge of emergency physicians and anesthetists who would be at the frontline of the initial health response to a chemical/biological warfare agent incident. METHODS After institutional review board approval, knowledge of personal protection measures among emergency medicine (n = 28) and anesthetics (n = 47) specialty registrars in the South Thames Region of the United Kingdom was surveyed using a standardized questionnaire. Participants were asked for the recommended level of personal protection if a chemical/biological warfare agent(s) casualty required advanced life support in the designated hospital resuscitation area. RESULTS The best awareness within both groups was regarding severe acute respiratory syndrome, and fair knowledge was found regarding anthrax, plague, Ebola, and smallpox. In both groups, knowledge about personal protection requirements against chemical warfare agents was limited. Knowledge about personal protection measures for biological agents was acceptable, but was limited for chemical warfare agents. CONCLUSIONS The results highlight the need to improve training and education regarding personal protection measures for medical first receivers.


title: Vinegar: medicinal uses and antiglycemic effect.

text: Vinegar folklore is as colorful as it is practical. Legend states that a courtier in Babylonia (c. 5000 BC) "discovered" wine, formed from unattended grape juice, leading to the eventual discovery of vinegar and its use as a food preservative. Hippocrates (c. 420 BC) used vinegar medicinally to manage wounds. Hannibal of Carthage (c. 200 BC), the great military leader and strategist, used vinegar to dissolve boulders that blocked his army's path. Cleopatra (c. 50 BC) dissolved precious pearls in vinegar and offered her love potion to Anthony. Sung Tse, the 10th century creator of forensic medicine, advocated hand washing with sulfur and vinegar to avoid infection during autopsies. Based on the writings of US medical practitioners dating to the late 18th century, many ailments, from dropsy to poison ivy, croup, and stomachache, were treated with vinegar, and, before the production and marketing of hypoglycemic agents, vinegar "teas" were commonly consumed by diabetics to help manage their chronic aliment. This review examines the scientific evidence for medicinal uses of vinegar, focusing particularly on the recent investigations supporting vinegar's role as an antiglycemic agent. Epidemiologic studies and clinical trials were identified by a MEDLINE title/abstract search with the following search terms: vinegar, glucose; vinegar, cancer; or vinegar, infection. All relevant randomized or case-control trials were included in this review.


title: Development of one-step real-time reverse transcriptase-PCR-based assays for the rapid and simultaneous detection of four viruses causing porcine diarrhea.

text: Porcine diarrhea caused by viruses is a major problem of the pig farming industry and can result in substantial losses of revenue. Thus, diagnosing the infectious agents is important to prevent and control diseases in pigs. We developed novel one-step real-time quantitative RT-PCR (qPCR) assays that can detect four porcine diarrheal viruses simultaneously: porcine epidemic diarrhea virus (PEDV), transmissible gastroenteritis virus (TGEV), porcine deltacoronavirus (PDCoV), and porcine group A rotavirus (PRVA). The qPCR analysis takes only 75 minutes to detect the presence of the four viruses. The limits of detection of our new assays for PEDV, TGEV, PDCoV, and PRVA were 100, 10, 10 and 10 copies per reaction, respectively. The sensitivity of qPCR was 1-1000 times higher than that of published gel-based RT-PCR. We used our qPCR method to successfully diagnose clinical samples from infected pigs, and no false positive results were obtained. In conclusion, qPCR can drastically reduce the diagnostic time to detect viruses compared to currently employed methods. We predict that the qPCR assays will become a useful tool for detecting viral infections that cause diarrhea and other complications in pigs.


title: Molecular characterization of attenuated vaccine strains of transmissible gastroenteritis virus.

text: Previous studies in our laboratory demonstrated that 2 attenuated strains of transmissible gastroenteritis virus (TGEV) contain deletions affecting messenger (m) RNAs 2, 3, or 4. In this report, we have compared mRNAs of four modified-live virus vaccines for TGEV with the virulent Miller PP3 isolate to determine whether any transcriptional patterns are shared among attenuated strains. Using northern blot analysis, all vaccine viruses expressed mRNAs indistinguishable in size from those of Miller PP3. However, using S1 nuclease protection experiments, alterations in the regions of the genome from which mRNAs 2 and 3 are transcribed were detected in 2 of the vaccine strains. When genomic cDNA fragments derived from the coding region for mRNA 2 were sequenced, a 6-nucleotide deletion, also found in the attenuated strain Purdue-115, was discovered. The product of mRNA 2, a spike glycoprotein, was visualized by western blotting for each vaccine strain, and no profound differences in mobility were detected relative to Miller PP3. Alterations in the region of the genome from which mRNA 3 is transcribed appear to be identical or very similar to sequence alterations already described in this region for Purdue-115, one of which is likely to alter the polypeptide product of mRNA 3. Insertions or deletions in mRNAs 2 or 3 may contribute to attenuation but are not a prerequisite for this phenotype. The S1 nuclease protection analysis is a sensitive tool for differentiating particular strains of TGEV.


docid: cflpgfkd

title: [Lessons from SARS: a new potential therapy for acute respiratory distress syndrome (ARDS) with angiotensin converting enzyme 2 (ACE2)].

text: During several months of 2002, severe acute respiratory syndrome (SARS) caused by SARS-coronavirus (SARS-CoV) spread rapidly from China throughout the world causing more than 800 deaths due to the development of acute respiratory distress syndrome (ARDS). Interestingly, a novel homologue of angiotensin converting-enzyme (ACE), termed angiotensin converting enzyme 2 (ACE2) has been identified as a receptor for SARS-CoV. ACE and ACE2 share homology in their catalytic domain and provide different key functions in the renin-angiotensin system. ACE cleaves angiotensin I to generate angiotensin II that is a key effector peptide of the system and exerts multiple biological functions, whereas ACE2 reduces angiotensin II levels and thus is a negative regulator of the system. Importantly, our recent studies using ACE2 knockout mice have demonstrated that ACE2 protects murine lungs from ARDS. Furthermore, SARS-CoV infections and the Spike protein of the SARS-CoV reduce ACE2 expression. Notably, injection of SARS-CoV Spike into mice worsens acute lung failure in vivo that can be attenuated by blocking the renin-angiotensin pathway, suggesting the activation of pulmonary RAS influences the pathogenesis of ARDS and SARS.


Laparoscopic-assisted and laparoscopic prophylactic gastropexy: indications and techniques.


title: Appendectomy with single-port laparoscopic transumbilical surgery.

text: PURPOSE Acute appendicitis is among the most common emergency conditions in surgical practice and appendectomy is the most common treatment. Single-port (SP) laparoscopic transumbilical surgery has emerged in clinical practice. The aim of this study is to describe SP laparoscopic transumbilical surgery procedure performed in three patients undergoing appendectomy. METHODS Three patients diagnosed with acute appendicitis were operated with SP laparoscopic transumbilical surgery technique. Patient's gender, age, BMI, operation time and length of hospital stay were recorded. RESULTS Three patients (2 female, 1 male) with a mean age of 38 (range 28-48) years underwent appendectomy. The mean postoperative length of stay was 1 day. The mean operative time was 35 minutes (range 30-45 minutes). No scar formation was observed and incisions were nearly invisible in the umbilicus in all patients. CONCLUSION SP laparoscopic transumbilical appendectomy is a safe, effective and reliable technique leading potentially scarless abdominal surgery. Even though SP laparoscopic transumbilical surgery cannot substitute laparoscopic appendectomy for the moment, it is assumed that this procedure will become widespread by putting novel instruments into practice.


Dysplasia epiphysealis hemimelica of the ankle in children.


title: ACE I/D but not AGT (-6)A/G polymorphism is a risk factor for mortality in ARDS.

text: The intrapulmonary renin-angiotensin system via tissue concentration of angiotensin II or bradykinin may have multiple effects on pulmonary pathophysiology. Therefore, it was investigated whether the presence of the D allele of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism or the A allele of angiotensinogen (AGT) promoter polymorphism (-6)A/G are independent risk factors for 30-day survival in acute respiratory distress syndrome (ARDS) patients. In a prospective study, adults (Germans of Caucasian ethnicity) with ARDS (n = 84) were recruited from the current authors' intensive care unit and genotyped for the ACE I/D and the AGT (-6)A/G polymorphisms, as were 200 healthy Caucasian controls. Mortality was increased in the ACE DD genotype compared with the I allele, and the ACE I/D polymorphism was an independent prognostic factor for 30-day survival. Patients with a homozygous DD genotype were at highest risk for death (hazard ratio 5.7; 95% confidence interval 1.7-19.2) compared with the II genotype. In contrast, the AGT (-6)A/G polymorphism was neither associated with an increased risk for development of ARDS nor with outcome. In patients with acute respiratory distress syndrome, the angiotensin-converting enzyme insertion/deletion polymorphism but not the angiotensinogen (-6)A/G promoter polymorphism is an independent risk factor with a pronounced effect on 30-day survival.


title: [Objective evaluation of the immunogenic effectiveness of polyvalent vaccines against enteral infections of newborn calves under enzootic conditions].

text: For evaluating the protective effect of polyvalent vaccine against diarrhoea in new born calves caused by rotaviruses, coronaviruses and enterotoxigenic E. coli the method was selected of mathematical and statistical analysis of the set of data characterizing the most important clinical symptoms of the disease during the first three weeks after birth. In two large-scale breeds with a mass occurrence of diarrhoea of the known etiology the state of health of calves before the vaccine application was compared with the state of health of calves born in the period after the vaccination. The following traits were selected for evaluating the severity of the disease: the age of calf at the beginning of the disease, character and intensity of diarrhoea, length of disease and results of treatment. In all the selected indicators, statistically significant differences were determined pointing to the fact that the vaccine used for increasing the immunity against enteropathogenic viruses and bacteria, applied in high pregnant cows and heifers before parturition, protected the sucking calves and calves fed the milk of their mothers against the disease in the first week after birth. The diarrhoea, occurring in the calves of the vaccinated cows and heifers mostly during the second week of age was easy to treat therapeutically and ended in most cases after a short period of a tea diet. After the vaccination, the death loss in both localities decreased more than eight times.


title: Ceacam1a-/- mice are completely resistant to infection by murine coronavirus mouse hepatitis virus A59.

text: CEACAM1a glycoproteins are members of the immunoglobulin (Ig) superfamily and the carcinoembryonic antigen family. Isoforms expressing either two or four alternatively spliced Ig-like domains in mice have been found in a number of epithelial, endothelial, or hematopoietic tissues. CEACAM1a functions as an intercellular adhesion molecule, an angiogenic factor, and a tumor cell growth inhibitor. Moreover, the mouse and human CEACAM1a proteins are targets of viral or bacterial pathogens, respectively, including the murine coronavirus mouse hepatitis virus (MHV), Haemophilus influenzae, Neisseria gonorrhoeae, and Neisseria meningitidis, as well as Moraxella catarrhalis in humans. We have shown that targeted disruption of the Ceacam1a (MHVR) gene resulting in a partial ablation of the protein in mice (p/p mice) led to reduced susceptibility to MHV-A59 infection of the modified mice in the BALB/c background. We have now engineered and produced a Ceacam1a-/- mouse that exhibits complete ablation of the CEACAM1a protein in every tissue where it is normally expressed. We report that 3-week-old Ceacam1a-/- mice in the C57BL/6 genetic background are fully resistant to MHV-A59 infection by both intranasal and intracerebral routes. Whereas virus-inoculated wild-type +/+ C57BL/6 mice showed profound liver damage and spinal cord demyelination under these conditions, Ceacam1a-/- mice displayed normal livers and spinal cords. Virus was recovered from liver and spinal cord tissues of +/+ mice but not of -/- mice. These results indicate that CEACAM1a is the sole receptor for MHV-A59 in both liver and brain and that its deletion from the mouse renders the mouse completely resistant to infection by this virus.


title: [Clinical analysis of patients with severe acute respiratory syndrome in Beijing area].

text: OBJECTIVE To study the epidemiological, clinical and laboratory characteristics, treatment and prognosis of patients with severe acute respiratory syndrome (SARS). METHODS Clinical data from 250 patients with SARS were retrospectively analyzed. RESULTS The age of the patients were 36 +/- 16, 44.0% (n = 110) were male, and 56.0% (n = 140) were female. The incubation period was 8 +/- 7 days. The most common symptom were fever (100. 0%), cough (72.8%), and fatigue (70.0%). 27.2% of the patients had decreased white blood cell counts. 64.2% of the patients had decreased lymphocytes. 91.4% and 80.6% of the patients had decreased CD(4)(+) and CD(8)(+) cell counts, respectively. 162 patients (64.8%) had decreased SaO(2). Serum ALT, AST, LDH and CK were elevated in 45.2%, 29.4%, 42.1%, and 18.3% of the patients respectively. Serum IgG to SARS virus was positive in 69.9% of the patients at recovery stage. General combination therapy including antibiotics, anti-viral agents, glucocorticoids and immunity-enhancing agents, was used. Artificial ventilation was used in 196 patients including 8 for whom invasive mechanical ventilation was used Eighty-one (32.4%) were diagnosed as having severe type of SARS. 25 patients died of SARS. CONCLUSIONS SARS is a highly communicable disease and mostly affects youth and people in their prime of life. It has characteristic clinical manifestations. Combination therapy can be very effective for most patients.


title: Incidence of metachronous visible lesions in patients referred for radiofrequency ablation (RFA) therapy for early Barrett's neoplasia: a single-centre experience.

text: OBJECTIVE Evaluate the incidence of metachronous visible lesions (VLs) in patients referred for radiofrequency ablation (RFA) for early Barrett's neoplasia. DESIGN This study was conducted as part of the service evaluation audit. SETTING Tertiary referral centre. PATIENTS All patients with dysplastic Barrett's oesophagus referred for RFA were included for analysis. White light high-resolution endoscopy (HRE), autofluorescence imaging and narrow band imaging were sequentially performed. Endoscopic mucosal resection (EMR) was performed for all VL. Three to six months after EMR, all patients underwent initial RFA and then repeat RFA procedures at three monthly intervals. INTERVENTIONS All endoscopy reports and final staging by EMR/surgery were evaluated and included for analysis. RESULTS Fifty patients were analysed; median age 73 years, 84% men. 38/50 patients (76%) had a previous EMR due to the presence of VL before referred for ablation; twelve patients had no previous treatment. In total, 151 ablation procedures were performed, median per patient 2.68. Twenty metachronous VL were identified in 14 patients before the first ablation or during the RFA protocol; incidence was 28%. All metachronous lesions were successfully resected by EMR. Upstaging after rescue EMR compared with the initial histology was observed in four patients (28%). CONCLUSIONS In total, 28% of patients enrolled in the RFA programme were diagnosed to have metachronous lesions. This high-incidence rate highlights the importance of a meticulous examination to identify and resect any VL before every ablation session. RFA treatment for early Barrett's neoplasia should be performed in tertiary referral centres with HRE and EMR facilities and expertise.


docid: wcjcmcfb

title: Detection of severe acute respiratory syndrome coronavirus RNA in plasma during the course of infection.

text: We examined severe acute respiratory syndrome-associated coronavirus (SARS-CoV) RNA in plasma of 32 patients (probable SARS cases) by a quantitative real-time reverse transcription-PCR assay and reported that the highest detection rate, 75%, was found between day 5 and day 7 of illness, followed by rates of 64, 50, and 38% found between day 8 and day 11, day 2 and day 4, and day 12 and day 16, respectively. Analysis of sequential SARS-CoV load in plasma from six cases revealed different patterns of viremia, with the peak between day 4 and day 8. Our findings of the high detection rate of SARS-CoV RNA in plasma before day 11, together with the relative convenience of collecting and handling plasma, suggest that plasma can be used for early diagnosis of SARS.


The sentinel chicken revisited: the impact of West Nile virus infection on transplant patients.


docid: ggzbuhut

title: Macrotiter assay for coronavirus-neutralizing activity in cats using a canine continuous cell line (A-72).

text: A heterologous neutralization assay for feline infectious peritonitis virus serology was developed using a single continuous cell line of canine origin, A-72, which is susceptible to cytopathic infection with both transmissible gastroenteritis virus of pigs and canine coronavirus. Of several coronavirus isolates tested, the 1-71 isolate of canine coronavirus demonstrated the most effective neutralization by serum and body fluids of cats with histopathologically confirmed feline infectious peritonitis.


docid: qryvnyiq

title: Is the Coronavirus (COVID-19) Pandemic an Indication to Temporarily Modify Dermatological Management Plans?


title: Australian general practice and pandemic influenza: models of clinical practice in an established pandemic.

text: To minimise the health impact of pandemic influenza, general practice will need to provide influenza-related and non-influenza primary health care, as well as contribute to the public health goal of disease control. Through interviews and workshops with general practitioners, nurses and policy leaders between March and July 2006, and literature analysis, we identified potential models of general practice in an established pandemic, and assessed their strengths and weaknesses. Three possible clinical models were identified: a default model of no change to service delivery; a streamed services model, where general practices reorganise themselves to take on either influenza-specific care or other clinical services; and a staff-determined mixed model, where staff move between different types of services. No single model or set of strategies meets the needs of all general practices to deliver and sustain the essential functions of primary health care during an established pandemic. Governments, general practice and the relevant peak professional bodies should decide before a pandemic on the suite of measures needed to support the models most suitable in their regions. Effective participation by general practice in a pandemic requires supplementary infrastructure support, changes to financial and staffing patterns, a review of legislation on medicolegal implications during an emergency, and intensive collaboration between general practices.


title: Interesting in- and outpatient attendances at Hogwarts Infirmary and St Mungo's Hospital for magical maladies.

text: Ailments afflicting wizarding folk are underreported in the muggle world. The recent integration of muggles and magical folk with the return of You-Know-Who (aka He Who Must Not Be Named) may result in a similar affliction of inhabitants of both worlds. We describe interesting maladies afflicting muggles and wizarding folk alike, arising from the use and misuse of magic. We also provide a basic glossary of magical ailments, and describe their muggle corollaries. Further studies will hopefully result in the development of immunity against the unforgivable curses.


title: Chemokine response in children with SARS.

text: The chemokine response of eight children with serologically confirmed severe acute respiratory syndrome (SARS) was longitudinally monitored. All had raised plasma interferon gamma inducible protein (IP-10) concentrations, which suggested an active type 1 T-helper lymphocyte mediated immune response. High circulating IP-10 levels could facilitate viral clearance and might play a role in assisting the recovery of the patients.


title: Spontaneous diabetes in the gnotobiotic BB/W rat.

text: To determine the influence of infectious agents on the initiation of diabetes in the spontaneously diabetic Bio-Breeding/Worcester (BB/W) rat, susceptible rats were raised in a germ-free environment. Between 2 and 3 mo of age, 3 of 12 pups became diabetic. Histologic examination of the pancreas revealed insulitis or end-stage islets. Culture and smears from various tissues were negative for bacteria or parasites. Serum vital antibody titers for all known rat viruses were undetectable. These data suggest that the diabetic syndrome of the BB/W rat is not dependent on recognized infectious agents.


Zika in Singapore: implications for Saudi Arabia.


title: Daily Situation Report on Coronavirus disease (COVID-19) in Iran; March 16, 2020.

text: After detection of the first confirmed cases of COVID-19 in Iran, the National Committee on COVID-19 Epidemiology in Ministry of Health and Medical Education was established. This Committee is official source of gathering, analyzing, and reporting the COVID-19 data in Iran. The data of all sources in the country including, medical care monitoring center (MCMC), Hospitals' Information Systems (HIS), Laboratory portal, the data of the center for communicable disease control (MOH), as well as the data from community health centers are integrated and used in this regards. This factsheet contain daily situation report on coronavirus disease (covid-19) in Iran; March 16, 2020.


title: Status of obstetric epidural analgesia services in Hong Kong public hospitals: postal questionnaire survey.

text: OBJECTIVE To examine the status of obstetric epidural analgesia services in Hong Kong public hospitals in 2001, and to compare findings with those from a similar survey conducted in 1995. DESIGN Postal questionnaire survey. SETTING Hospital Authority hospitals in Hong Kong offering an obstetric and delivery service. PARTICIPANTS Chiefs of Service of departments of anaesthesia and coordinators of obstetric anaesthesia and analgesia service. MAIN OUTCOME MEASURES The availability of an obstetric epidural analgesia service, specialist staff allocation to the service, existence of clinical protocols, rate of epidural analgesia, techniques of epidural administration, obstetric outcome or mode of delivery, and the incidence of adverse events associated with the use of epidural analgesia. RESULTS Between 1 January and 31 December 2001, all eight Hospital Authority hospitals with an obstetric service provided epidural analgesia for labour pain relief, but only six (75%) offered a 24-hour service. A dedicated anaesthetist provided obstetric anaesthesia and analgesia during office hours in all units, but after hours in only three. This level of service provision compared favourably with that available in 1995, when only 82% of public maternity units provided epidural analgesia and only 36% offered a 24-hour service. The median epidural analgesia rate was 15% (range, 8%-20%) compared with 10% in 1995. The incidence of adverse events and complications was very low. Formal written protocols for the conduct of epidural analgesia for labour were used in six units. All units used mixtures of local anaesthetic combined with opioid, administered as intermittent boluses, continuous epidural infusion, or patient-controlled epidural analgesia. CONCLUSIONS Although there has been progress and improvement in the provision of obstetric epidural analgesia services in our public hospitals, the rate is still relatively low and the provision of services after hours is limited. Further progress will likely be hindered by current or future cutbacks in public hospital budgets.


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title: [SARS prevention and nursing in traditional Chinese medicine].

text: This study adopts the concept of the three levels of prevention from traditional Chinese medicine to discuss Severe Acute Respiratory Syndrome (SARS) prevention and nursing. The emphasis in traditional Chinese medicine is on primary and tertiary prevention. The study presents nursing interventions based on traditional Chinese medicine (TCM), including daily care, diets, massage care, exercise, and Chinese psychosocial care. This course of interventions is designed for the consideration of nurses caring for SARS patients and to bolster their ability to fight the disease.


title: Environmental effects on parasitic disease transmission exemplified by schistosomiasis in western China.

text: Environmental effects on the transmission of many parasitic diseases are well recognized, but the role of specific factors like climate and agricultural practices in modulating transmission is seldom characterized quantitatively. Based on studies of Schistosoma japonicum transmission in irrigated agricultural environments in western China, a mathematical model was used to quantify environmental impacts on transmission intensity. The model was calibrated by using field data from intervention studies in three villages and simulated to predict the effects of alternative control options. Both the results of these interventions and earlier epidemiological findings confirm the central role of environmental factors, particularly those relating to snail habitat and agricultural and sanitation practices. Moreover, the findings indicate the inadequacy of current niclosamide-praziquantel strategies alone to achieve sustainable interruption of transmission in some endemic areas. More generally, the analysis suggests a village-specific index of transmission potential and how this potential is modulated by time-varying factors, including climatological variables, seasonal water-contact patterns, and irrigation practices. These time-variable factors, a village's internal potential, and its connectedness to its neighbors provide a framework for evaluating the likelihood of sustained schistosomiasis transmission and suggest an approach to quantifying the role of environmental factors for other parasitic diseases.


title: Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines.

text: Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.


title: Sequence of the 3'-terminal end (8.1 kb) of the genome of porcine haemagglutinating encephalomyelitis virus: comparison with other haemagglutinating coronaviruses.

text: A cytopathogenic coronavirus, serologically identified as porcine haemagglutinating encephalomyelitis virus (HEV), has recently been associated with acute outbreaks of wasting and encephalitis in nursing piglets from pig farms in southern Québec and Ontario, Canada. The 3'-terminal end of the genome of the prototype HEV-67N strain and that of the recent Québec IAF-404 field isolate, both propagated in HRT-18 cells, were sequenced. Overall, sequencing data indicated that HEV has remained antigenically and genetically stable since its first isolation in North America in 1962. Compared with the prototype strain of bovine enteropathogenic coronavirus (BCoV), HEV, as well as the human respiratory coronavirus (HCoV-OC43) showed a major deletion in their ORF4 gene. Deduced amino acid sequences for both HEV strains revealed 89/88, 80, 93/92 and 95/94% identities with the structural proteins HE, S, M and N of BCoV and HCoV-OC43, respectively. Major variations were observed in the S1 portion of the S gene of both HEV strains, with only 73/71% amino acid identities compared with those of the two other haemagglutinating coronaviruses.


title: In vitro detection of Shiga toxin using porcine alveolar macrophages.

text: Porcine alveolar macrophages were found to be highly susceptible to the cytolytic effects of a toxin (Shiga toxin [Stx]) produced by certain strains of Escherichia coli and sometimes associated with clinical disease in pigs and other animals. In comparison with the cells that are most commonly used for Stx detection and titration in vitro (namely, Vero cells), porcine alveolar macrophages appeared to be generally more sensitive and test results could be obtained in less time. Moreover, unlike Vero cells, porcine alveolar macrophages need not be continuously propagated to ensure immediate availability. They can simply be removed from a low-temperature repository, thawed, seeded, and shortly thereafter exposed to the sample in question. These characteristics suggest that porcine alveolar macrophages may be useful in developing a highly sensitive and timely diagnostic test for Stx.


title: Antiviral effects of antisense morpholino oligomers in murine coronavirus infection models.

text: The recent emergence of novel pathogenic human and animal coronaviruses has highlighted the need for antiviral therapies that are effective against a spectrum of these viruses. We have used several strains of murine hepatitis virus (MHV) in cell culture and in vivo in mouse models to investigate the antiviral characteristics of peptide-conjugated antisense phosphorodiamidate morpholino oligomers (P-PMOs). Ten P-PMOs directed against various target sites in the viral genome were tested in cell culture, and one of these (5TERM), which was complementary to the 5' terminus of the genomic RNA, was effective against six strains of MHV. Further studies were carried out with various arginine-rich peptides conjugated to the 5TERM PMO sequence in order to evaluate efficacy and toxicity and thereby select candidates for in vivo testing. In uninfected mice, prolonged P-PMO treatment did not result in weight loss or detectable histopathologic changes. 5TERM P-PMO treatment reduced viral titers in target organs and protected mice against virus-induced tissue damage. Prophylactic 5TERM P-PMO treatment decreased the amount of weight loss associated with infection under most experimental conditions. Treatment also prolonged survival in two lethal challenge models. In some cases of high-dose viral inoculation followed by delayed treatment, 5TERM P-PMO treatment was not protective and increased morbidity in the treated group, suggesting that P-PMO may cause toxic effects in diseased mice that were not apparent in the uninfected animals. However, the strong antiviral effect observed suggests that with further development, P-PMO may provide an effective therapeutic approach against a broad range of coronavirus infections.


title: Health policy in interwar Greece: the intervention by the League of Nations Health Organisation.

text: The first serious attempts to deal with public health problems in Greece were undertaken between 1925 and 1935. This period also witnessed setbacks to developments in public health, caused by the lack of welfare infrastructure for social relief, as well as extensive health problems brought about by the settlement in Greece of 1,300,000 refugees from Asia Minor. In 1928 following the example set by other European countries, the Liberal Government appealed to international health organisations for support in order to effectively deal with these problems. This contribution constitutes a case study addressing the following issues: a) the impact the League of Nations Health Organisation intervention had on the establishment of public health services; b) the framework for a collaboration of the Rockefeller Foundation and the League of Nations Health Organisation; and c) the factors that led to the failure of the health care reorganisation.


title: Etiology of Acute Respiratory Infections in Infants: A Prospective Birth Cohort Study.

text: BACKGROUND There is paucity of studies on etiology of acute respiratory infections (ARI) in infants. The objective of this study is to document incidence and etiology of ARI in infants, their seasonal variability and association of clinical profile with etiology. METHODS A birth cohort was followed for the first year of life; for each episode of ARI, nasopharyngeal aspirates were collected to identify the causative respiratory virus(es) using multiplex real-time polymerase chain reaction assay. For lower respiratory tract infections blood culture, serum procalcitonin, serum antibodies to Mycoplasma and Chlamydia and urinary Streptococcus pneumoniae antigen were also assayed. RESULTS A total of 503 ARI episodes were documented in 310 infants for an incidence rate of 1.8 episodes per infant per year. Of these, samples were processed in 395 episodes (upper respiratory tract infection: 377; lower respiratory tract infection: 18). One or more viruses were detected in 250 (63.3%) episodes and viral coinfections in 72 (18.2%) episodes. Rhinovirus was the most common virus [105 (42%)] followed by respiratory syncytial virus [50 (20%)], parainfluenza virus [42 (16.8%)] and coronavirus [44 (17.6%)]. In lower respiratory tract infections, viral infections were detected in 12 (66.7%) episodes, bacterial infections in 17 (94.4%) episodes and mixed bacterial-viral infections in 8 (44.4%) episodes. Peak incidence of viruses was observed during February-March and September-November. There was no significant difference in symptom duration with virus types. CONCLUSION In this cohort of infants, ARI incidence was 1.8 episodes per year per infant; 95% were upper respiratory tract infections. Viruses were identified in 63.3% episodes, and the most common viruses detected were rhinovirus, respiratory syncytial virus and parainfluenza virus.


title: [A study of the architectural factors and the infection rates of healthcare workers in isolation units for severe acute respiratory syndrome].

text: OBJECTIVE To investigate measures to prevent the outbreak of severe acute respiratory syndrome (SARS) in healthcare workers in isolation units. METHODS The architectural factors and the infection of healthcare workers in different wards in our hospital between 30 January 2003 and 30 March 2003 were analyzed. RESULTS Four kinds of isolation wards were evaluated, including the ward where the thirty-first bed lied in on the twelfth floor, the laminar flow ward in the intensive care unit (ICU) where the tenth bed lied in on the fifteenth floor, the ward where the twenty-seventh bed lied in on the thirteenth floor of Building A, and thirty wards on the fourteenth to eighteenth floors of Building B. The ratios (m2/m3) of the area of the ventilation windows to the volume of the room were 0, 0, 1:95 and 1:40, respectively. Numbers of SARS cases in the wards mentioned above were 1, 1, 1 and 96, respectively. The total lengths (hour) of hospitalization were 43, 168, 110 and 1,272, respectively. The infection rates of the healthcare workers in the areas mentioned above were 73%, 32%, 28% and 2%, respectively. The difference of the infection rates was of statistical significance. CONCLUSION In addition to strict personal protective measures, isolation of SARS cases in wards with high ratio of the area of ventilation windows to the volume of the room and good ventilation may be the key to preventing the outbreak of SARS in healthcare workers in isolation units.


title: High-efficiency detection of severe acute respiratory syndrome virus genetic material.

text: A Taqman amplicon targeting the nucleocapsid gene of severe acute respiratory syndrome coronavirus (SARS-CoV) is 5 log(10) times more sensitive for SARS-CoV target RNA extracted from infected cells and 2.79 log(10) times more sensitive for RNA extracted from patient material of the index case in Frankfurt than an amplicon targeting the polymerase gene.


Pseudomembranous colitis after treatment with metronidazole.


title: [Analysis on the characteristics of blood serum Ab-IgG detective result of severe acute respiratory syndrome patients in Guangzhou, China].

text: OBJECTIVE To probe blood serum Ab-IgG characteristics of severe acute respiratory syndrome (SARS) patients in Guangzhou and investigate the related factors. METHODS The serum of such population diagnosed as SARS convalescent patients, non-SARS patients, family consanguineous contraction persons, wild animal and vegetable salesman and community common people was collected. The lab detective method of ELISA was adopted for these serum samples. And the epidemic investigations for the SARS patients were also carried out. RESULTS Of these populations, the detective rate of Ab-IgG for the clinic diagnosed SARS patients, which was 53.7%; That for the wild animal salesman and community common people were 16.7% and 0.9%, respectively. Among the clinic diagnosed SARS patients, the positive antibody detective rate was 90.4% for those which had specific contact history or infectivity, which was higher than that for other population. Among the specific contact history or infectivity cases, the antibody positive rate for the young and the old was lower than that for the adult. Meanwhile the difference did not exist among other cases. The antibody positive rate was identical between the male and the female. And the antibody detective rate was decreased by the month. CONCLUSION As a whole SARS-CoV Ab-IgG detective rate for the clinic diagnosed SARS patients was 53.7% only. The reasons for that mainly lie in the wrong clinic diagnosis besides these factors such as age, hormone use and reagent and so on. The combination of lab detection results and epidemic investigation was propitious to the diagnosis veracity. It was impossible for the sub-clinic infection of SARS-CoV virus. The importance in the virus transmitting course need to be further studied.


title: Strange Bedfellows: Native American Tribes, Big Pharma, and the Legitimacy of Their Alliance.

text: Lost in the cacophony surrounding the debate about high drug prices is the fundamental principle that pharmaceutical innovation will not occur without the prospect of outsized returns enabled through market exclusivity. Biopharmaceutical patents are currently under siege, subject to challenge both in inter partes review ("IPR") proceedings and in Hatch-Waxman actions. These twin assaults threaten to eliminate the incentives necessary for biotechnological innovation--particularly for discoveries made upstream in the innovation pipeline--thus imperiling the development of new drug therapies. But a fascinating solution has emerged: invoking tribal immunity to shield pharmaceutical patents from IPR before the Patent Trial and Appeal Board ("PTAB"). This serves two critically important objectives: promoting tribal self-sufficiency, and encouraging investment in life-saving and life-improving new drugs. Contractual partnerships between Native American tribes and pharmaceutical companies not only provide the tribes with a steady stream of royalty revenue, but also insulate biopharmaceutical patents from challenge in IPR proceedings through the invocation of long-established principles of tribal sovereign immunity. This Note is the first piece of scholarship to comprehensively analyze, and advocate for, the right to invoke tribal sovereign immunity in IPR proceedings.


title: Neuromuscular sequelae of critical illness.

text: PURPOSE OF REVIEW To investigate the impact of critical illness polyneuropathy and critical illness myopathy on short-term and long-term patient outcome. RECENT FINDINGS In the acute-care setting, critical illness polyneuropathy and critical illness myopathy are important causes of acute paralysis in critically ill comatose patients, and may cause inappropriately pessimistic prognoses. Duration of weaning from artificial ventilation is 2 to 7 times greater in patients with critical illness polyneuropathy than in patients without critical illness polyneuropathy. After intensive care unit and hospital discharge, many patients diagnosed with critical illness polyneuropathy or critical illness myopathy are reported to complain of profound muscle weakness. Chronic disability was a common finding among them. Complete functional recovery with patients regaining the ability to breathe spontaneously and to walk independently was reported in 180 of 263 patients (68.4%); severe disability with tetraparesis, tetraplegia, or paraplegia was reported in 74 patients (28.1%). Persisting milder disabilities were common even in patients with complete functional recovery, and included reduced or absent deep tendon reflexes, stocking and glove sensory loss, muscle atrophy, painful hyperesthesia, and foot drop. An association of critical illness polyneuropathy and critical illness myopathy with increased intensive care unit and hospital mortality has been demonstrated only in selected intensive care unit populations; data are insufficient to demonstrate any association with long-term mortality. SUMMARY Intensive care unit-acquired critical illness polyneuropathy and critical illness myopathy influence the evaluation of acutely ill comatose patients and may instigate unreasonably pessimistic prognosis. Critical illness polyneuropathy and critical illness myopathy are an important cause of difficult weaning of patients from the ventilator and of persisting muscle weakness and disability after intensive care unit discharge.