title: La France se dote d’une agence nationale de santé publique. Illustrations de ses principales missions et enjeux

text: SUMMARY In 2016, France has established a national public health agency: “Santé publique France”. Its missions are presented: epidemic intelligence, alert, surveillance, prevention and health promotion and response in the event of exceptional health situations. Four major challenges for this new agency are presented: the challenge of the continuum between its different public health functions in order to ensure the coherence of the merger of three public agencies ; The challenge of managing large databases; The challenge to give a new impetus to prevention — health promotion and finally the challenge of the presence of the Agency in all the metropolitan and overseas territories.


title: Specific Plasma Autoantibody Reactivity in Myelodysplastic Syndromes

text: Increased autoantibody reactivity in plasma from Myelodysplastic Syndromes (MDS) patients may provide novel disease signatures, and possible early detection. In a two-stage study we investigated Immunoglobulin G reactivity in plasma from MDS, Acute Myeloid Leukemia post MDS patients, and a healthy cohort. In exploratory Stage I we utilized high-throughput protein arrays to identify 35 high-interest proteins showing increased reactivity in patient subgroups compared to healthy controls. In validation Stage II we designed new arrays focusing on 25 of the proteins identified in Stage I and expanded the initial cohort. We validated increased antibody reactivity against AKT3, FCGR3A and ARL8B in patients, which enabled sample classification into stable MDS and healthy individuals. We also detected elevated AKT3 protein levels in MDS patient plasma. The discovery of increased specific autoantibody reactivity in MDS patients, provides molecular signatures for classification, supplementing existing risk categorizations, and may enhance diagnostic and prognostic capabilities for MDS.


title: Vox Sanguinis International Forum on Hospital Transfusion Services' Response to COVID‐19

text: Question 1 Demographics: a. Beer Yaakov, Israel. b. Large academic medical center. c. 956 beds. d. 9034 RBC units issued in 2019, approximately 9000. e. 4831 confirmed SARS‐CoV‐2 cases and 17 deaths (March 31, 2020, 12:40 pm, data from the Israeli Ministry of Health). f. 9,136,000 inhabitants. g. The spread of SARS‐CoV‐2 in Israel is still increasing, but as of yesterday the rate of increase is declining sharply (from almost 30% of samples tested per day at the peak to 12% yesterday).


title: 25 Hepatitis viruses and emerging viruses

text: Abstract: This chapter describes viruses that are enterically transmitted and cause systemic disease. These are recognized as important food and waterborne pathogens. The chapter first summarizes the general characteristics of the viruses, then describes their typical epidemiological patterns. The chapter then discusses methods to detect and to inactivate the viruses, with an emphasis on strategies that can be implemented for food safety.


title: Poor Outcome of Acute Respiratory Infection in Young Children with Underlying Health Condition in Brazil

text: Summary Objectives It is well established that respiratory viruses are an important cause of hospitalizations in young children worldwide, but data are limited on the contribution of specific viruses to severe illness in South America. We describe clinical and laboratory findings from prospective surveillance for acute respiratory infections at a tertiary hospital in São Paulo, Brazil. Methods We screened children < 2 years old with acute respiratory tract infections admitted to an urban tertiary hospital for respiratory viruses from March 2008 through February 2010, using polymerase chain reaction assays. Results Respiratory viruses were identified in 378 (53%) of the 715 samples analyzed. Respiratory syncytial virus was the most commonly identified virus (52%), followed by adenovirus (27%) and Human metapneumovirus (12%). More than one virus was identified in 19% of specimens. Almost half of the samples (46%) were from children with underlying health conditions. We demonstrated that compared to the previously healthy group, those with comorbidities had a worse outcome in terms of severity, with prolonged hospital stay and more need of intensive care. Conclusion Identification of this high-risk population along with strategies for fast diagnosis might each help to reduce morbidity and mortality in this group.


title: Survey of infectious and parasitic diseases in stray cats at the Lisbon Metropolitan Area, Portugal

text: A survey of infectious and parasitic diseases of stray cats was carried out using biological samples collected from animals captured during a catch-neuter-release programme in four counties of the Lisbon Metropolitan Area. The main objective was to investigate the potential threat of stray cats for animal and public health. Samples of blood, stool, hair and auricular swabs were collected from 231 cats in 27 colonies. Anti-Toxoplasma gondii antibodies were detected in 47/194 samples (24.2%); anti-Leishmania infantum antibodies in 1/180 cats (0.6%); intestinal parasites in 23/74 samples (Toxocara cati, Isospora felis, Ancylostoma tubaeforme, Dipylidium caninum, Uncinaria stenocephala, Toxascaris leonina) and Otodectes cynotis in 4/182 cats (2.2%); dermatophyte fungi were isolated in 40/136 samples (29.4%); feline immunodeficiency virus antibodies were detected in 23/226 samples (10.2%); feline leukaemia virus antigen in 14/198 samples (7.1%); and feline coronavirus RNA in 9/127 samples (7.1%). Our results revealed that zoonotic agents, namely dermatophyte fungi and Toxocara cati were present in stray cat colonies in the investigated counties. Overall the low frequency of major pathogens suggests a balanced relationship between host and agents.


title: Chapter 1 A Brief History of Cheetah Conservation

text: Abstract The cheetah, Acinonyx jubatus, is a charismatic, and iconic species that, due to its uniqueness and extreme popularity over the epochs, has been exploited to near extinction. Once found on three continents, this streamline carnivore is disappearing rapidly from its former range and faces a bleak future due to numerous factors, including, popularity by nobility as pets and hunting companions, human population growth, human-wildlife conflict, illegal trafficking, loss of genetic diversity, and many others. The conservation crisis this species is facing is overwhelming, yet a core of hard-working conservationists has been working diligently for decades to slow, and in some areas try to even reverse, their downward spiral. This narrative will give the reader an insight into the history of the conservation efforts for this species, what has been done to date, and what still needs to be developed to save this unique species.


Protocolo de actuación ante la epidemia de enfermedad por coronavirus en los pacientes de diálisis y trasplantados renales


title: Newsprint media representations of the introduction of the HPV vaccination programme for cervical cancer prevention in the UK (2005–2008)

text: Abstract In September 2008, the human papillomavirus (HPV) immunisation programme was introduced in the UK for schoolgirls aged between 12 and 18 years of age. The vaccine shows high efficacy in preventing infection against HPV types 16 and 18 responsible for 70% of cervical cancer. However, to be most effective, the vaccine needs to be administered before exposure to the viruses and therefore, ideally, before young people become sexually active. The introduction of any new vaccine, and perhaps particularly one given to young teenage girls to prevent a sexually transmitted cancer-causing virus, has the potential to attract a great deal of media attention. This paper reports on content analysis of 344 articles published between January 2005 and December 2008 in 15 UK newspapers. It includes both manifest and latent analysis to examine newsprint media coverage of the introduction of the HPV vaccination programme and its role in HPV advocacy. We concluded that the newspapers were generally positive towards the new HPV vaccination and that over the 4 years period the newsworthiness of the HPV vaccination programme increased. In 2008 two events dominated coverage, firstly, the introduction of the HPV programme in September 2008 and secondly, in August 2008 the diagnosis on camera of cervical cancer given to Jade Goody, a 27 year old mother of two, who gained fame and notoriety in the UK through her participation in several reality television shows. There are two conclusions from this study. Firstly, the positive media coverage surrounding the introduction of the HPV vaccination programme is to be welcomed as it is likely to contribute towards influencing public perceptions about the acceptability and need for HPV vaccination. Secondly, the focus on prevalence rates of HPV infection among women and on women's sexual behaviours, in relation to HPV vaccination ‘encouraging’ promiscuity, is an unhelpful aspect of media coverage.


title: Associations between maternal characteristics and health, survival, and performance of dairy heifers from birth through first lactation

text: ABSTRACT The objective of this study was to investigate whether health, survival, and performance of dairy heifers from birth through first lactation are associated with parity and health status of their dams. Holstein heifers (n = 1,811) derived from artificial insemination were categorized as (1) daughters of primiparous cows that, consequently, were nonlactating heifers during gestation (Prim-NoL; n = 787); (2) daughters of multiparous cows that did not have any clinical diseases in the previous lactation (Mult-NoCD; n = 638); and (3) daughters of multiparous cows that had at least one clinical disease in the previous lactation (Mult-CD; n = 386). Clinical diseases of the multiparous dams included retained placenta, metritis, mastitis, lameness, and digestive and respiratory problems. Data collected for evaluation of daughters included genotypic and phenotypic characteristics at birth, morbidity, reproductive performance, and culling from birth through 305 d in milk of first lactation. Orthogonal contrasts were used to evaluate the effect of the parity of the dam (Prim-NoL vs. Mult-NoCD + Mult-CD) and the effect of clinical disease occurrence in the previous lactation among multiparous dams (Mult-NoCD vs. Mult-CD). Compared with daughters of multiparous cows, daughters of Prim-NoL were lighter at birth (36 vs. 41 kg), had greater genetic merit for production traits (e.g., genomic estimated breeding value for milk yield: 875 vs. 746 kg), were less likely to leave the herd (17 vs. 28%) and to lose pregnancy as a heifer (9 vs. 14%), calved earlier (703 vs. 711 d old), were less likely to have clinical diseases as a first lactation cow (30 vs. 37%), and had reduced performance in the first lactation when considering their genetic merit (e.g., 305-d yield of energy-corrected milk: 11,270 vs. 11,539 kg). Compared with daughters of Mult-NoCD, daughters of Mult-CD were less likely to have digestive problems as a heifer (17 vs. 27%) and clinical disease as a first lactation cow (32 vs. 42%), but were also more likely to leave the herd as a heifer (32 vs. 25%) even though genetic merit for production traits were similar (e.g., genomic estimated breeding value for milk: 744 vs. 749 kg). In conclusion, both parity and health status of the dam in the previous lactation were associated with morbidity, survival, and performance of their daughters from birth through 305 d in milk of the first lactation and might represent factors affecting developmental programming of dairy heifers in utero.


title: A clinicopathological study of 8 patients with COVID‐19 pneumonia and a late‐onset exanthema

text: Our hospital diagnosed the two first non‐imported COVID‐19 cases in Spain on 26(th) February. Up to date, a total of 1177 COVID‐19 patients have been hospitalized. Eight of them were referred for dermatological examination. Due to the overwhelming situation, the incidence of cutaneous manifestations in our hospitalized COVID‐19 patients is probably greater than this 0.7%(1, 2).


title: A rapidly deployable individualized system for augmenting ventilator capacity

text: Strategies to split ventilators to support multiple patients requiring ventilatory support have been proposed and used in emergency cases in which shortages of ventilators cannot otherwise be remedied by production or procurement strategies. However, the current approaches to ventilator sharing lack the ability to individualize ventilation to each patient, measure pulmonary mechanics, and accommodate rebalancing of the airflow when one patient improves or deteriorates, posing safety concerns to patients. Potential cross-contamination, lack of alarms, insufficient monitoring, and inability to adapt to sudden changes in patient status have prevented widespread acceptance of ventilator sharing. We have developed an individualized system for augmenting ventilator efficacy (iSAVE) as a rapidly deployable platform that uses a single ventilator to simultaneously and more safely support two subjects. The iSAVE enables subject-specific volume and pressure control and the rebalancing of ventilation in response to improvement or deterioration in an individual’s respiratory status. The iSAVE incorporates mechanisms to measure pulmonary mechanics, mitigate cross-contamination and backflow, and accommodate sudden flow changes due to subject interdependencies within the respiratory circuit. We demonstrate these capacities through validation using closed- and open-circuit ventilators on linear test lungs. We show that the iSAVE can temporarily ventilate two pigs on one ventilator as efficaciously as each pig on its own ventilator. By leveraging off-the-shelf medical components, the iSAVE could rapidly expand the ventilation capacity of healthcare facilities during emergency situations such as pandemics.


BACKGROUND: The beginning of 2020 was characterized by the COVID-19 pandemic. The world governments have adopted restrictive measures to reduce the spread of infection. These measures could affect the sexual function and quality of life of women living with their partner. AIM: The aim is to assess the impact of the social distancing measures caused by the COVID-19 pandemic on sexual function and quality of life of noninfected reproductive-age women, living with their sexual partner. METHODS: Observational analysis on sexually active women, living with their partner, and without COVID-19 infection was performed. The population previously answered FSFI, FSDS, and SF-36 questionnaires. 4 weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for an evaluation during the COVID-19 outbreak. MAIN OUTCOME MEASURES: The primary endpoint was the assessment of the women's sex function change during the social restriction period, by analyzing the FSFI and FSDS questionnaires. The secondary endpoint was the evaluation of the impact on the quality of life calculated by the SF-36 questionnaire. RESULTS: 89 patients were considered. The median age was 39 (28–50) years. Mean sexual intercourses/month decreased from 6.3 ± 1.9 to 2.3 ± 1.8, mean difference: −3.9 ± 1.2. FSFI decreased significantly (29.2 ± 4.2 vs 19.2 ± 3.3, mean difference: −9.7 ± 2.6) and FSDS increased significantly (9.3 ± 5.5 vs 20.1 ± 5.2, mean difference: 10.8 ± 3.4). The SF-36 showed a significant change from 82.2 ± 10.2 to 64.2 ± 11.8 4 weeks after the introduction of the restrictive measures; mean difference: −17.8 ± 6.7. The univariable analysis identified working outside the home, university educational level, and parity ≥1 as predictive factors of lower FSFI. In multivariable analysis, working outside the home and combination of working outside the home + university educational level + parity ≥1 were the independent factors of a lower FSFI. CLINICAL IMPLICATION: The negative impact of the COVID-19 epidemic period on sexual function and quality of life in women shows how acute stress might affect the psychological state. Thus, psychological or sexual support could be useful. STRENGTHS AND LIMITATIONS: To our knowledge, this study is the first that analyzes the change in sexual activity in women during the COVID-19 outbreak period. The limitations were the low number of the analyzed participants, psychological tests were not included, and no data were collected on masturbation, self-heroism, solitary, and nonpenetrative sex. CONCLUSION: The COVID-19 epidemic and the restrictive social distancing measures have negatively influenced the sexual function and quality of life in not-infected reproductive-age women who live with their sexual partners. Schiavi MC, Spina V, Zullo MA, et al. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women. J Sex Med 2020;XX:XXX–XXX.


title: Replacement of the heterologous 5′ untranslated region allows preservation of the fully functional activities of type 2 porcine reproductive and respiratory syndrome virus

text: Abstract The 5′ untranslated region (UTR) is believed to be vital for the replication of porcine reproductive and respiratory syndrome virus (PRRSV), yet its functional mechanism remains largely unknown. In this study, to define the cis-acting elements for viral replication and infectivity, The 5′ UTR swapping chimeric clones pTLV8 and pSHSP5 were constructed based on two different genotypes full-length infectious cDNA clone pAPRRS and pSHE backbones. Between them, vTLV8 could be rescued from pTLV8 and had similar virological properties to vAPRRS, including phenotypic characteristic and RNA synthesis level. However, pSHSP5 exhibited no evidence of infectivity. Taken together, the results presented here demonstrate that only the 5′ UTR of type 1 PRRSV did not affect the infectivity and replication of type 2 PRRSV in vitro. The 5′ UTR of type 2 PRRSV could be functionally replaced by its counterpart from type 1.


title: SARS–associated Coronavirus Replication in Cell Lines

text: Given the potential for laboratory-associated severe acute respiratory syndrome–associated coronavirus (SARS-CoV) infections, we must know which cell lines are susceptible to the virus. We investigated 21 cell lines routinely used for virus isolation or research. After infection with SARS-CoV, cells were observed for cytopathic effects, and quantitative real-time polymerase chain reaction was used to measure ongoing viral replication. An indirect immunofluorescence assay was also used as a confirmatory test. The study identified 10 new cell lines capable of supporting the replication of SARS-CoV and confirmed the susceptibility of 4 cell lines previously reported. This study shows that SARS-CoV can be isolated in several cell lines commonly used for diagnostic or research purposes. It also shows that SARS-CoV can achieve high titers in several cell lines, sometimes in the absence of specific cytopathic effects.


title: Cross-protection studies between respiratory and calf diarrhea and winter dysentery coronavirus strains in calves and RT-PCR and nested PCR for their detection

text: A 1-step RT-PCR assay, targeting a 730 bp fragment of the nucleocapsid (N) gene of bovine coronavirus (BCV), and a nested PCR assay, targeting a 407 bp fragment of the N gene, were developed to detect BCV in nasal swab and fecal samples of calves experimentally exposed to BCV. Both 1-step RT-PCR and nested PCR recognized cell culture passaged isolates of 10 bovine respiratory coronavirus (BRCV), 5 calf diarrhea (CD) and 8 winter dysentery (WD) strains of BCV, but not transmissible gastroenteritis coronavirus or bovine rotavirus. The sensitivity of the 1-step RT-PCR and nested PCR was compared to that of an antigen-capture ELISA. The lowest detection limit of the 1-step RT-PCR and nested PCR as determined by using tenfold serial dilutions of the BRCV 255 and 440 strains in BCV negative nasal swab suspensions from preexposure gnotobiotic calves was 2 × 10(4) and 2 × 10(2) TCID(50)/0.1 ml for each strain, respectively. The lowest detection limit of the antigen-capture ELISA as determined by using the same serially diluted samples was 1 × 10(6) TCID(50)/0.1 ml for each strain. Therefore, the 1-step RT-PCR and nested PCR assays were 50 and 5000 times, respectively more sensitive than the antigen-capture ELISA to detect BRCV in nasal swab suspensions. To investigate in vivo cross-protection between the BRCV and CD or WD strains of BCV and to detect nasal and fecal shedding of BCV using the 1-step RT-PCR, nested PCR and antigen-capture ELISA, 6 colostrum-deprived and two gnotobiotic calves were inoculated with a BRCV, a CD or a WD strain of BCV and then challenged 3–4 weeks later with either BRCV, CD or WD strains of BCV. All calves developed diarrhea after inoculation and BCV antigen (ELISA) or RNA (RT-PCR) was detected in the diarrheic fecal samples or the corresponding nasal swab samples. In addition, low amounts of BCV were also detected only by nested PCR in the fecal and nasal swab samples before and after diarrhea. No respiratory clinical signs were observed during the entire experimental period, but elevated rectal temperatures were detected during diarrhea in the BCV-inoculated calves. All calves recovered from infection with the BRCV, CD, or WD strains of BCV were protected from BCV-associated diarrhea after challenge exposure with either a heterologous or homologous strain of BCV. However, all calves challenged with heterologous BCV strains showed subclinical BCV infection evident by detection of nasal and fecal shedding of BCV RNA detected only by nested PCR. Such results confirm field and experimental data documenting reinfection of the respiratory and enteric tracts of cattle, suggesting that, in closed herds, respiratory or enteric tract reinfections may constitute a source of BCV transmissible to cows (WD) or neonatal or feedlot calves. In addition, the present 1-step RT-PCR and nested PCR assays were highly sensitive to detect BCV in nasal swab and fecal specimens. Therefore, these assays should be useful to diagnose BCV infections in calves and adult cows.


title: Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China

text: The recent outbreak of COVID-19 in Mainland China was characterized by a distinctive subexponential increase of confirmed cases during the early phase of the epidemic, contrasting an initial exponential growth expected for an unconstrained outbreak. We show that this effect can be explained as a direct consequence of containment policies that effectively deplete the susceptible population. To this end, we introduce a parsimonious model that captures both, quarantine of symptomatic infected individuals as well as population-wide isolation practices in response to containment policies or behavioral changes and show that the model captures the observed growth behavior accurately. The insights provided here may aid the careful implementation of containment strategies for ongoing secondary outbreaks of COVID-19 or similar future outbreaks of other emergent infectious diseases.


title: Personal View: Managing The Covid-19 Pandemic As A National Radiation Oncology Centre In Singapore

text: Abstract COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic in March 2020. It has impacted the world medically, financially, politically and socially, with countries such as China and Italy adopting a full lockdown of their cities to mitigate the transmission. The current mortality rate is 5.4%, with 1 056 159 people infected worldwide. The disease is reminiscent of SARS in 2002, from which the healthcare system of Singapore has garnered many lessons and applied them in the current climate. As a result of the high transmissibility of the virus, hospitals in Singapore have reduced clinic loads and elective treatments to halt propagation of the virus and also to allow redistribution of healthcare workforce to the frontline. Cancer patients, who are often immunocompromised, are at risk of contracting the disease and becoming seriously ill. At the same time, delaying treatment such as radiotherapy in cancer patients can be detrimental. Here, we describe our experience as a large radiation oncology department in Singapore, including the challenges we encountered and how we managed our patient flow.


Solitary foot mass on a Sprague-Dawley rat


docid: jxonslhh

title: Perceptions Related to Bird-to-Human Avian Influenza, Influenza Vaccination, and Use of Face Mask

text: BACKGROUND: H5N1 avian influenza may become pandemic in humans in the near future. According to the severe acute respiratory syndrome (SARS) experience, anticipation of the pandemic may have impact on behaviors related to influenza vaccination (IV) and relevant public health behaviors such as wearing a face mask when having influenza-like-illnesses (ILI), which would play an important role in the control of human avian influenza outbreaks. This paper investigated the prevalence and factors related to IV uptake and use of face mask in public venues when having ILI symptoms. METHODS: An anonymous cross-sectional population-based random telephone survey of 302 Hong Kong Chinese adults aged 18–60, using a structured questionnaire, was conducted in November 2005. RESULTS: In the last 3 months, 17.9% of the respondents received IV; 36.6% of those presenting ILI symptoms often used face mask in public venues. Anticipation of a bird-to-human H5N1 outbreak, perceptions that such an outbreak would be worse than SARS, that IV was efficacious in preventing bird-to-human avian influenza transmission were associated with the studied IV behavior (OR=2.64–3.97, p < 0.05). Exposure to live birds, perceived similar symptoms between influenza and bird-to-human H5N1 avian influenza, that bird-to-human avian influenza was more lethal than SARS were predictive use of face mask when having ILI symptoms (OR = 4.25–8.34, p < 0.05). CONCLUSION: The prevalence of IV and use of face mask in the study population may be increasing, which may be related to concerns of avian influenza. Perceptions related to human avian influenza were associated with IV and mask use behaviors. This can potentially be turned into opportunities of promoting desirable public health behaviors.


title: Comparing whole genomes using DNA microarrays

text: The rapid accumulation of complete genomic sequences offers the opportunity to carry out an analysis of inter- and intra-individual genome variation within a species on a routine basis. Sequencing whole genomes requires resources that are currently beyond those of a single laboratory and therefore it is not a practical approach for resequencing hundreds of individual genomes. DNA microarrays present an alternative way to study differences between closely related genomes. Advances in microarray-based approaches have enabled the main forms of genomic variation (amplifications, deletions, insertions, rearrangements and base-pair changes) to be detected using techniques that are readily performed in individual laboratories using simple experimental approaches.


title: Meta-analysis of outcomes of patients with COVID-19 infection with versus without gastrointestinal symptoms

text: This systematic review analyzed whether the presence or absence of gastrointestinal symptoms in patients with SARS-COV-2 infection is associated with adverse outcomes. Searching the Cochrane Center Register of Controlled Trials, we included any studies looking at patients with COVID-19 with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) compared to those with COVID-19 but without gastrointestinal manifestations as a control group. The final search yielded 186 articles, all of which were individually screened. Seven studies were identified but three were excluded: one due to lack of a control group without gastrointestinal symptoms, one reported as viral RNA in the stool, and one with only non-critically ill patients. Results of the meta-analysis showed a pooled odds ratio for mortality among those with COVID-19 and gastrointestinal symptoms of 0.91 (confidence interval 0.49–1.68) with heterogeneity of 0% and a pooled odds ratio for acute respiratory distress syndrome of 2.94 (confidence interval 1.17–7.40) with heterogeneity of 0%. In conclusion, gastrointestinal symptoms with COVID-19 are associated with a higher risk of acute respiratory distress syndrome, but do not increase the risk for mortality.


title: Ventricular Septal Rupture complicating delayed acute myocardial infarction presentation during the COVID-19 pandemic

text: Abstract: The rate of mechanical complications of acute myocardial infarction has declined. Recent publications raised concerns over the reduction in cardiac catheterization laboratory activation for STEMI during COVID-19 Pandemic. We present 2 recent cases of ventricular septal rupture in patients who presented to our institution with delayed STEMI.


title: Genetic diversity and correlation with feline infectious peritonitis of feline coronavirus type I and II: A 5-year study in Taiwan

text: Abstract The outcomes of feline coronavirus (FCoV) infection vary greatly from asymptomatic or mild enteric infection to fatal feline infectious peritonitis (FIP). On the basis of in vitro neutralization tests, FCoVs can be divided into two serotypes. To explore the correlation between different types of FCoV and FIP, clinical specimens collected from 363 naturally infected cats during 2003–2007 were analyzed. Amplification of a portion of the S gene from the FCoV was performed and a total of 222 cases were differentiated. Among them, 197 (88.7%) cats were type I-positive, 13 (5.9%) were type II-positive, and 12 (5.4%) were positive for both types. Irrespective of the predominance of type I FCoV infection in Taiwan, type II FCoV demonstrated a significantly higher correlation with FIP (p <0.01). Analysis of partial S gene sequences of the local type I and II FCoVs strains revealed that type I viruses were more genetically divergent (6.2–11.7%) than type II viruses (0.6–3.2%) within the 5-year study period. The higher genetic diversity of type I FCoVs might be due to the larger infected cat population and to the long period of viral persistence in asymptomatic cats in comparison to type II viruses.


Expected and Unexpected Features of the Newly Discovered Bat Influenza A-like Viruses


Pediatric Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection – UAE


title: WU and KI Polyomaviruses in Respiratory Samples from Allogeneic Hematopoietic Cell Transplant Recipients

text: Data are limited regarding 2 new human polyomaviruses, KI polyomavirus (KIPyV) and WU polyomavirus (WUPyV), in immunocompromised patients. We used real-time PCR to test for these and 12 respiratory viruses in 2,732 nasal wash samples collected during the first year after allogeneic hematopoietic cell transplantation from 222 patients. Specimens were collected weekly until day 100; then at least every 3 months. One year after hematopoietic cell transplantation, the cumulative incidence estimate was 26% for KIPyV and 8% for WUPyV. Age <20 years predicted detection of KIPyV (hazard ratio [HR] 4.6) and WUPyV (HR 4.4), and detection of a respiratory virus in the previous 2 weeks predicted KIPyV detection (HR 3.4). Sputum production and wheezing were associated with detection of KIPyV in the past week and WUPyV in the past month. There were no associations with polyomavirus detection and acute graft versus host disease, cytomegalovirus reactivation, neutropenia, lymphopenia, hospitalization, or death.


title: Acute complicated type B aortic dissection during the New York City COVID‐19 surge

text: The impact of the coronavirus disease 2019 (COVID‐19) pandemic in New York City (NYC) is dramatic. COVID‐19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID‐19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.


title: Chilblains in children in the time of Covid‐19: new evidence with serology assay

text: In a previous report in Pediatric Dermatology, we described chilblains‐like lesions in four pediatric patients. From April 18 to May 10, 2020, 45 children presented to our Pediatric Dermatology department with similar acral lesions. The clinical appearance ranged from red to violaceous macules and dusky, purpuric plaques on the heels, soles and lateral margin of the feet, often accompanied by painful edema, consistent with chilblains.


title: Chapter 8 Determining the Reliability and Validity and Interpretation of a Measure in the Study Populations

text: Publisher Summary For proper interpretation of study results, further reliability assessment is required to determine the variability from repeated samples from the same individual, and variation among individuals. Repeated samples from the same individual will indicate if the measure varies with time of day, menstrual cycle, or consumption of food or liquids. The extent that this impacts the reliability will dictate if the protocol should stipulate timing of specimen collection. The dynamics of colonization of human body sites by microbes are essentially unknown. Currently there are few estimates in the literature of how frequently there is a change in the bacterial strains (or other colonizing microbes) that commonly colonize the human gut, mouth, vaginal cavity, and skin. Also unknown is the average duration of carriage. There are some estimates for group B Streptococcus; colonization is very dynamic, with an average duration of carriage of ∼14 weeks among women. This suggests that assessments of reliability must be done over a short time, and that loss over 2-week period could as easily reflect true loss as sampling error.


title: Attenuation of Infectious Bronchitis Virus in Eggs Results in Different Patterns of Genomic Variation across Multiple Replicates

text: The gammacoronavirus infectious bronchitis virus (IBV) causes an acute, highly contagious respiratory disease of poultry. Live attenuated vaccines are traditionally generated by serial passage of a virulent strain in embryonated chicken eggs; however, the molecular mechanism of attenuation is unknown. M41-CK, a virulent lab-adapted strain of IBV, was egg passaged over 100 times in four parallel independent replicates. All four final egg-passaged viruses were attenuated in vivo and exhibited similar growth phenotypes in adult chicken kidney cells and ex vivo tracheal organ cultures. The virus populations were sequenced by 454 pyrosequencing at the end of passaging, and the results showed that overall sequence diversity in the IBV population increased but the four replicates only had between 11 and 17 consensus-level single nucleotide polymorphisms (SNPs). Although hot spots of variation were identified in spike and nucleocapsid structural proteins as well as the 3ʹ untranslated region, each attenuated virus possessed a different pattern of genomic variation. Overall, only a small number of consensus-level SNPs were acquired during egg passage, leaving a potentially short route back to virulence. These results highlight the unpredictable nature of attenuation by serial egg passage and the need to develop mechanisms to rationally attenuate IBV for the next generation of effective vaccines. IMPORTANCE Infectious bronchitis remains a major problem in the global poultry industry, despite the existence of many different vaccines. IBV vaccines are currently developed by serial passage of a virulent strain on embryonated hen’s eggs until attenuation; however, little is known about the evolution of the viral population during the process of attenuation. High-throughput sequencing of four replicates of a serially egg-passaged IBV revealed a different pattern of genomic variation in each attenuated replicate and few consensus-level SNPs. This raises concerns that only a small number of genomic mutations are required to revert to a virulent phenotype, which may result in vaccine breakdown in the field. The observed hot spots of variation in the attenuated viruses have the potential to be used in the rational attenuation of virulent IBV for next-generation vaccine design.


COVID‐19, pulmonary mast cells, cytokine storms, and beneficial actions of luteolin


title: Consensus on Pre-examination and Triage in Clinic of Dermatology During Outbreak of COVID-19 From Chinese Experts(#)

text: The 2019 novel coronavirus infection has brought a great challenge in prevention and control of the national epidemic of coronavirus disease 2019 (COVID-19) in China. During the fight against the epidemic of COVID-19, properly carrying out pre-examination and triage for patients with skin lesions and fever has been a practical problem encountered in hospitals for skin diseases as well as clinics of dermatology in general hospitals. Considering that certain skin diseases may have symptom of fever, and some of the carriers of 2019 novel coronavirus and patients with COVID-19 at their early stage may do not present any symptoms of COVID-19, to properly deal with the visitors to clinics of dermatology, the Chinese Society of Dermatology organized experts to formulate the principles and procedures for pre-examination and triage of visitors to clinics of dermatology during the epidemic of COVID-19.


Time to revisit national response to pandemics


title: ICU and Ventilator Mortality Among Critically Ill Adults With Coronavirus Disease 2019

text: To determine mortality rates among adults with critical illness from coronavirus disease 2019. DESIGN: Observational cohort study of patients admitted from March 6, 2020, to April 17, 2020. SETTING: Six coronavirus disease 2019 designated ICUs at three hospitals within an academic health center network in Atlanta, Georgia, United States. PATIENTS: Adults greater than or equal to 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease who were admitted to an ICU during the study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 217 critically ill patients, mortality for those who required mechanical ventilation was 35.7% (59/165), with 4.8% of patients (8/165) still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 30.9% (67/217) and 60.4% (131/217) patients have survived to hospital discharge. Mortality was significantly associated with older age, lower body mass index, chronic renal disease, higher Sequential Organ Failure Assessment score, lower Pao(2)/Fio(2) ratio, higher d-dimer, higher C-reactive protein, and receipt of mechanical ventilation, vasopressors, renal replacement therapy, or vasodilator therapy. CONCLUSIONS: Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.


title: Integrating twisted wind profiles to Air Ventilation Assessment (AVA): The current status

text: Abstract Twisted wind flows generated by the complex terrain of Hong Kong induce two types of complication to Air Ventilation Assessment (AVA), first, imposing a false boundary condition on the wind tunnel tests done for AVA and, second, creating an ambiguity in determining the approaching wind direction in calculating the probability of occurrence of winds. The latter issue is partially solved using correction methods in post-analysis of AVA but the accuracy of these methods is not yet accessed. This study employs two twisted wind profiles to test an urban area in a boundary layer wind tunnel to investigate the influence of twisted wind flows on the outcomes of AVA and to estimate the accuracy of three common correction methods: No-Shift, Threshold, and Proportional methods. The results reveal significant differences in wind speeds at the pedestrian level for twisted and conventional wind flows at locations with low building densities. The discrepancies in wind speeds are minimum at the locations where the density of buildings is high. The indicators calculated by the No-Shift method frequently deviate from those of the twisted wind flows, while the Threshold and Proportional methods routinely over-predict the indicators of AVA.


title: Entrepreneurial uncertainty during the Covid-19 crisis: Mapping the temporal dynamics of entrepreneurial finance

text: Abstract This paper illustrates how chronic uncertainty caused by crisis events affects the availability of entrepreneurial sources of finance for start-ups and small and medium-sized enterprises (SMEs). To explore this line of argument, this paper examines Crunchbase real-time data examining entrepreneurial finance investments in China during unfolding Covid-19 crisis. The paper shows that these equity investments slumped dramatically in the immediate aftermath of the Covid-19 virus, resulting in a year on year decrease of 60% in the total volume of investment raised between quarter 1 in 2019 and quarter 1 in 2020. Importantly, the paper found early-stage seed investments falling the steepest, suggesting nascent start-ups are those most heavily affected by the crisis. While the global financial crisis heavily hit debt markets, the relational nature of equity investments may mean entrepreneurial finance is even more susceptible to major upheaval caused by the Covid-19 crisis. Overall, enterprise policy makers need to become better attuned at monitoring real-time data sources to mitigate chronic entrepreneurial uncertainty via strategic policy responses.


title: Spreading of sexually transmitted diseases in heterosexual populations

text: The spread of sexually transmitted diseases (e.g. Chlamydia, Syphilis, Gonorrhea, HIV) across populations is a major concern for scientists and health agencies. In this context, both data collection on sexual contact networks and the modeling of disease spreading, are intensively contributing to the search for effective immunization policies. Here, the spreading of sexually transmitted diseases on bipartite scale-free graphs, representing heterosexual contact networks, is considered. We analytically derive the expression for the epidemic threshold and its dependence with the system size in finite populations. We show that the epidemic outbreak in bipartite populations, with number of sexual partners distributed as in empirical observations from national sex surveys, takes place for larger spreading rates than for the case in which the bipartite nature of the network is not taken into account. Numerical simulations confirm the validity of the theoretical results. Our findings indicate that the restriction to crossed infections between the two classes of individuals (males and females) has to be taken into account in the design of efficient immunization strategies for sexually transmitted diseases.


title: The effect of diabetes on mortality of COVID-19: A protocol for systematic review and meta-analysis

text: BACKGROUND: Novel coronavirus pneumonia (COVID-19) is a very serious and urgent infectious disease. With the development of global economy and the improvement of living standard, the incidence of diabetes is increasing year by year. And it is more common in the elderly. COVID-19 is associated with much chronic disease, especially diabetes. At present, there is no systematic review and meta-analysis of mortality based on large scale of data between diabetes and COVID-19 all over the world. METHODS AND ANALYSIS: The databases of PubMed, the Cochrane Library, EMBASE, Wanfang Data, China National Knowledge Infrastructure database (CNKI) and VIP were searched by computer, and the researches related to diabetes mellitus and mortality of COVID-19 were collected. The searching time was from the establishment of the database to April 30 2020. The meta-analysis was carried out by Review Manager Version 5.3 and stata 14.0 software for Mac software after 2 researchers independently selected literature, extracted data and evaluated the bias risk. The main outcome was the mortality of COVID-19 which was included in meta-analysis and subgroup analysis. The bias of the study was evaluated independently by NOS scale, and published by funnel chart. The sensitivity was analyzed row by row. RESULTS: The results will be published at a peer-reviewed journal. Registration number: INPLASY202040158.


Human Leukocyte Transcriptional Response to SARS-CoV-2 Infection


title: Tocilizumab administration in a refractory case of COVID-19

text: Novel coronavirus (COVID-19) pneumonia as a pandemic disease leads to acute respiratory distress syndrome (ARDS), acute cardiac injury, multi organ failure, and shock. In the absence of specific treatment for COVID-19, there is an urgent need to find the alternative treatments to manage this pandemic. Pathophysiological studies have demonstrated the role of inflammatory mediators in COVID-19 pneumonia. It appears that imbalances between inflammatory and anti-inflammatory cytokines are the probable underlying mechanism. Since, there is no specific treatment for the inflammatory phase of COVID-19 pneumonia, consideration of treatments, such as tocilizumab, as salvage therapy is necessary. Here, we reported a challenging case of COVID-19 who was successfully treated with tocilizumab.


title: Persistence of rhinovirus RNA and IP‐10 gene expression after acute asthma

text: Background and objective: Viral nucleic acid may be detected for up to 6 months after an acute asthma deterioration, but the pattern and consequences of viral persistence after acute asthma are incompletely understood. This study investigates the frequency of viral persistence after acute asthma, assesses viral infectivity and determines the host inflammatory responses to viral persistence. Methods: Adults and children presenting to hospital with acute asthma and a confirmed respiratory virus infection were studied acutely and at recovery 4–6 weeks later by clinical evaluation and induced sputum for viral and inflammatory mediator detection. Results: Viral RNA was detected during both acute asthma and recovery visits in 17 subjects (viral persistence), whereas in 22 subjects viral RNA had cleared by recovery (viral clearance). The following viruses were detected at recovery: human rhinovirus: 16; respiratory syncytial virus: 2; influenza: 2. In subjects with viral persistence, eight isolates were different to the virus detected at Visit 1. Forty‐four per cent of the human rhinovirus isolates were infective at recovery. Asthma and infection severity were similar in the viral clearance and viral persistence groups. Viral persistence was associated with elevated IL‐10 mRNA and inducible protein‐10 gene expression. Conclusions: Respiratory viral detection after acute asthma is common, and most often persistence is with non‐infective human rhinovirus. There is a host inflammatory response with an altered cytokine environment, and the viral RNA can be source of persistent infection. These effects may have longer‐term consequences in asthma.


Quality of life of cancer patients during coronavirus disease (COVID‐19) pandemic


We know liver biochemistries are elevated in COVID-19, but should we be concerned?


title: Disability, Urban Health Equity, and the Coronavirus Pandemic: Promoting Cities for All

text: Persons with disabilities (PWDs) living in cities during the COVID-19 pandemic response may be four times more likely to be injured or die than non-disabled persons, not because of their “vulnerable” position but because urban health policy, planning and practice has not considered their needs. In this article, the adverse health impacts on PWDs during the COVID-19 pandemic reveals the “everyday emergencies” in cities for PWDs and that these can be avoided through more inclusive community planning, a whole-of-government commitment to equal access, and implementation of universal design strategies. Importantly, COVID-19 can place PWDs at a higher risk of infection since some may already have compromised immune and respiratory systems and policy responses, such as social distancing, can lead to life-threatening disruptions in care for those that rely on home heath or personal assistants. Living in cities may already present health-damaging challenges for PWDs, such as through lack of access to services and employment, physical barriers on streets and transportation, and smart-city technologies that are not made universally accessible. We suggest that the current pandemic be viewed as an opportunity for significant urban health reforms on the scale of the sanitary and governance reforms that followed ninetieth century urban epidemics. This perspective offers insights for ensuring the twenty-first century response to COVID-19 focuses on promoting more inclusive and healthy cities for all.


title: Identification of a minimal peptide derived from heptad repeat (HR) 2 of spike protein of SARS-CoV and combination of HR1-derived peptides as fusion inhibitors

text: Abstract The heptad repeats (HR1 and HR2) of the spike protein of SARS-CoV are highly conserved regions forming a critical 6-helix bundle during the fusion step of virus entry and are attractive targets of entry inhibitors. In this study, we report that a minimal HR2 peptide, P6 of 23-mer, can block the fusion of SARS-CoV with an IC50 of 1.04±0.22μM. This finding supports the structural prediction of the deep groove of HR1 trimer as a target for fusion inhibitors, and suggests P6 as a potential lead peptide for future drug development. Moreover, combination of an HR-1 peptide, N46, and its mutated version, N46eg, shows synergistic inhibition with an IC50 of 1.39±0.05μM and combination index of 0.75±0.15, suggesting a common strategy to achieve promising inhibition by HR1 peptide for other class I envelope viruses.


title: Monoclonal antibodies identify multiple epitopes on maize leaf nitrate reductase

text: Abstract Nine hybridoma cell lines secreting antibodies against the maize leaf nitrate reductase have been distinguished by reciprocal competition for binding to the antigenic site. Inhibition of enzymatic activities, and western blots of native enzyme and denatured subunits revealed different behaviors of individual antibodies towards the antigen. Two classes of monoclonal antibodies are inhibitory of NADH and methyl viologen nitrate reductase activities, but only one affects also NADH cytochrome c reductase activity. The associated epitopes are sensitive to antigen conformation. Among the 4 other classes, one is specific for the native conformation of the molecule, another binds more strongly to the denatured antigen, and two recognize equally well the two forms.


title: Development of a safe neutralization assay for SARS-CoV and characterization of S-glycoprotein

text: Abstract The etiological agent of severe acute respiratory syndrome (SARS) has been identified as a novel coronavirus SARS-CoV. Similar to other coronaviruses, spike (S)-glycoprotein of the virus interacts with a cellular receptor and mediates membrane fusion to allow viral entry into susceptible target cells. Accordingly, S-protein plays an important role in virus infection cycle and is the primary target of neutralizing antibodies. To begin to understand its biochemical and immunological properties, we expressed both full-length and ectodomain of the protein in various primate cells. Our results show that the protein has an electrophoretic mobility of about 160–170 kDa. The protein is glycosylated with high mannose and/or hybrid oligosaccharides, which account for approximately 30 kDa of the apparent protein mass. The detection of S-protein by immunoassays was difficult using human convalescent sera, suggesting that the protein may not elicit strong humoral immune response in virus-infected patients. We were able to pseudotype murine leukemia virus particles with S-protein and produce SARS pseudoviruses. Pseudoviruses infected Vero E6 cells in a pH-independent manner and the infection could be specifically inhibited by convalescent sera. Consistent with low levels of antibodies against S-protein, neutralizing activity was weak with 50% neutralization titers ranging between 1:15 to 1:25. To facilitate quantifying pseudovirus-infected cells, which are stained blue with X-Gal, we devised an automated procedure using an ELISPOT analyzer. The high-throughput capacity of this procedure and the safety of using SARS pseudoviruses should make possible large-scale analyses of neutralizing antibody responses against SARS-CoV.


title: The Dipeptidyl Peptidase Family, Prolyl Oligopeptidase, and Prolyl Carboxypeptidase in the Immune System and Inflammatory Disease, Including Atherosclerosis

text: Research from over the past 20 years has implicated dipeptidyl peptidase (DPP) IV and its family members in many processes and different pathologies of the immune system. Most research has been focused on either DPPIV or just a few of its family members. It is, however, essential to consider the entire DPP family when discussing any one of its members. There is a substantial overlap between family members in their substrate specificity, inhibitors, and functions. In this review, we provide a comprehensive discussion on the role of prolyl-specific peptidases DPPIV, FAP, DPP8, DPP9, dipeptidyl peptidase II, prolyl carboxypeptidase, and prolyl oligopeptidase in the immune system and its diseases. We highlight possible therapeutic targets for the prevention and treatment of atherosclerosis, a condition that lies at the frontier between inflammation and cardiovascular disease.


title: Interventions for treatment of COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING Project)

text: BACKGROUND: COVID-19 is a rapidly spreading virus infection that has quickly caused extensive burden to individual, families, countries, and the globe. No intervention has yet been proven effective for the treatment of COVID-19. Some randomized clinical trials assessing the effects of different drugs have been published, and more are currently underway. There is an urgent need for a living, dynamic systematic review that continuously evaluates the beneficial and harmful effects of all available interventions for COVID-19. METHODS/DESIGN: We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and perform risk of bias assessment. We will include randomized clinical trials comparing any intervention for the treatment of COVID-19 (e.g., pharmacological interventions, fluid therapy, invasive or noninvasive ventilation, or similar interventions) with any comparator (e.g., an “active” comparator, standard care, placebo, no intervention, or “active placebo”) for participants in all age groups with a diagnosis of COVID-19. Primary outcomes will be all-cause mortality and serious adverse events. Secondary outcomes will be admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, Trial Sequential Analyses, network meta-analysis, and individual patient data meta-analyses. Risk of bias will be assessed with domains, an eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DISCUSSION: COVID-19 has become a pandemic with substantial mortality. A living systematic review evaluating the beneficial and harmful effects of pharmacological and other interventions is urgently needed. This review will continuously inform best practice in treatment and clinical research of this highly prevalent disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178787


title: A shifty stop for a hairy tail

text: The tail apparatus of the bacteriophage SPP1 is an extraordinary ~1600-Å-long molecular machine. The tail mediates attachment of the virus to the host surface receptor, as well-as ejection of the viral genome into the host. The distal tip of the tail binds the extracellular ectodomain of the Bacillus subtilis receptor YueB, while the tail tube provides a conduit to funnel the viral genome into the host. This process, which culminates with the ejection of the ~44 kb of viral DNA across the thick, cell envelope of the Gram-positive bacterial cell, takes place in a time scale of seconds to minutes and represents a remarkable example of biotransformation. In this issue of Molecular Microbiology, Auzat et al. provide compelling evidence that the two major structural proteins of the SPP1 tail, gp17.1 (~19.1 kDa) and gp17.1* (~28 kDa), share a common N-terminal sequence, and that gp17.1* is generated by a translational frameshift in the gene 17.1. The extra domain fused to gp17.1* is synthesized by a +1 programmed translational frame-shift at the end of gene 17.1, which leads to the synthesis of approximately one gp17.1* for every three equivalents of gp17.1. This finding extends our current knowledge of translational frameshifts and provides a framework to understand how Siphoviridae phages like SPP1 have developed long-tail machines using only two major structural proteins.


CS16.2 Improving survival in patients with decompensated cirrhosis


title: Using the internet search data to investigate symptom characteristics of COVID-19: a big data study

text: OBJECTIVE: Analyzing the symptom characteristics of Coronavirus Disease 2019(COVID-19) to improve control and prevention. METHODS: Using the Baidu Index Platform (http://index.baidu.com) and the website of Chinese Center for Disease Control and Prevention as data resources to obtain the search volume (SV) of keywords for symptoms associated with COVID-19 from January 1 to February 20 in each year from 2017 to 2020 and the epidemic data in Hubei province and the other top 9 impacted provinces in China. Data of 2020 were compared with those of the previous three years. Data of Hubei province were compared with those of the other 9 provinces. The differences and characteristics of the SV of COVID-19-related symptoms, and the correlations between the SV of COVID-19 and the number of newly confirmed/suspected cases were analyzed. The lag effects were discussed. RESULTS: Comparing the SV from January 1, 2020 to February 20, 2020 with those for the same period of the previous three years, Hubei's SV for cough, fever, diarrhea, chest tightness, dyspnea, and other symptoms were significantly increased. The total SV of lower respiratory symptoms was significantly higher than that of upper respiratory symptoms (P<0.001). The SV of COVID-19 in Hubei province was significantly correlated with the number of newly confirmed/suspected cases (r(confirmed) = 0.723, r(suspected) = 0.863, both P< 0.001). The results of the distributed lag model suggested that the patients who searched relevant symptoms on the Internet may begin to see doctors in 2-3 days later and be confirmed in 3-4 days later. CONCLUSION: The total SV of lower respiratory symptoms was higher than that of upper respiratory symptoms, and the SV of diarrhea also increased significantly. It warned us to pay attention to not only the symptoms of the lower respiratory tract but also the gastrointestinal symptoms, especially diarrhea in patients with COVID-19. Internet search behavior had a positive correlation with the number of newly confirmed/suspected cases, suggesting that big data has an important role in the early warning of infectious diseases.


Financials


title: Cytokine Activation Patterns and Biomarkers Are Influenced by Microorganisms in Community-Acquired Pneumonia

text: Background The inflammatory response in community-acquired pneumonia (CAP) depends on the host and on the challenge of the causal microorganism. Here, we analyze the patterns of inflammatory cytokines, procalcitonin (PCT), and C-reactive protein (CRP) in order to determine their diagnostic value. Methods This was a prospective study of 658 patients admitted with CAP. PCT and CRP were analyzed by immunoluminometric and immunoturbidimetric assays. Cytokines (tumor necrosis factor-α [TNF-α], IL-1β, IL-6, IL-8, and IL-10) were measured using enzyme immunoassay. Results The lowest medians of CRP, PCT, TNF-α, and IL-6 were found in CAP of unknown cause, and the highest were found in patients with positive blood cultures. Different cytokine profiles and biomarkers were found depending on cause: atypical bacteria (lower PCT and IL-6), viruses (lower PCT and higher IL-10), Enterobacteriaceae (higher IL-8), Streptococcus pneumoniae (high PCT), and Legionella pneumophila (higher CRP and TNF-α). PCT ≥ 0.36 mg/dL to predict positive blood cultures showed sensitivity of 85%, specificity of 42%, and negative predictive value (NPV) of 98%, whereas a cutoff of ≤ 0.5 mg/dL to predict viruses or atypicals vs bacteria showed sensitivity of 89%/81%, specificity of 68%/68%, positive predictive value of 12%/22%, and NPV of 99%/97%. In a multivariate Euclidean distance model, the lowest inflammatory expression was found in unknown cause and the highest was found in L pneumophila, S pneumoniae, and Enterobacteriaceae. Atypical bacteria exhibit an inflammatory pattern closer to that of viruses. Conclusions Different inflammatory patterns elicited by different microorganisms may provide a useful tool for diagnosis. Recognizing these patterns provides additional information that may facilitate a broader understanding of host inflammatory response to microorganisms.


Chest computed tomography in recovered and discharged COVID-19 patients


docid: reqluupv

title: Autophagy Genes Enhance Murine Gammaherpesvirus 68 Reactivation From Latency by Preventing Virus-induced Systemic Inflammation

text: Host genes that regulate systemic inflammation upon chronic viral infection are incompletely understood. Murine γ-herpesvirus 68 (MHV68) infection is characterized by latency in macrophages, and reactivation is inhibited by Interferon-γ (IFN-γ). Using a Lysozyme-M-cre (LysMcre) expression system, we show that deletion of autophagy-related (Atg) genes Fip200, beclin 1, Atg14, Atg16L1, Atg7, Atg3, and Atg5, in the myeloid compartment, inhibited MHV68 reactivation in macrophages. Atg5-deficiency did not alter reactivation from B cells, and effects on reactivation from macrophages were not explained by alterations in productive viral replication or the establishment of latency. Rather, chronic MHV68 infection triggered increased systemic inflammation, increased T cell production of IFN-γ and an IFN-γ-induced transcriptional signature in macrophages from Atg gene-deficient mice. The Atg5-related reactivation defect was partially reversed by neutralization of IFN-γ. Thus Atg genes in myeloid cells dampen virus-induced systemic inflammation, creating an environment that fosters efficient MHV68 reactivation from latency.


title: RNAVLab: A virtual laboratory for studying RNA secondary structures based on grid computing technology

text: As ribonucleic acid (RNA) molecules play important roles in many biological processes including gene expression and regulation, their secondary structures have been the focus of many recent studies. Despite the computing power of supercomputers, computationally predicting secondary structures with thermodynamic methods is still not feasible when the RNA molecules have long nucleotide sequences and include complex motifs such as pseudoknots. This paper presents RNAVLab (RNA Virtual Laboratory), a virtual laboratory for studying RNA secondary structures including pseudoknots that allows scientists to address this challenge. Two important case studies show the versatility and functionalities of RNAVLab. The first study quantifies its capability to rebuild longer secondary structures from motifs found in systematically sampled nucleotide segments. The extensive sampling and predictions are made feasible in a short turnaround time because of the grid technology used. The second study shows how RNAVLab allows scientists to study the viral RNA genome replication mechanisms used by members of the virus family Nodaviridae.


Viruses and diarrhoea


title: Metabolic and inflammatory functions of short chain fatty acid receptors

text: FFA2 and FFA3 are receptors for short chain fatty acids which are produced in prodigious amounts by fermentation of poorly digested carbohydrates by gut bacteria. Understanding the roles of these receptors in regulating enteroendocrine, metabolic and immune functions has developed with the production and use of novel pharmacological tools and animal models. A complex (patho)physiological scenario is now emerging in which strategic expression of FFA2 and FFA3 in key cell types and selective modulation of their signaling might regulate body weight management, energy homeostasis and inflammatory disorders.


title: Consideration of Severe Coronavirus Disease 2019 As Viral Sepsis and Potential Use of Immune Checkpoint Inhibitors

text: Taking into consideration the multisystemic clinical and autopsy findings in “severe” coronavirus disease 2019 patients, viral sepsis would be a more accurate term to describe the whole clinical picture. The most significant pathophysiological components of this picture are intense cytokine release, prolonged inflammation, immunosuppression with T cell exhaustion, and the development of organ dysfunctions. Currently, the optimal treatment for severe coronavirus disease 2019 is uncertain. Supportive treatment and immunomodulators have a critical place in the treatment of severe patients until effective antivirals are developed. Interleukin-6 antagonists, one of the immunomodulating agents, appears to be effective in the treatment of cytokine storm, but some patients continue to have severe lymphopenia and immunosuppression. We believe it can be useful as immunomodulator therapy in critical coronavirus disease 2019 patients because of the benefits of immune checkpoint inhibitors in cancer and sepsis patients.


title: Virus/Allergen Interactions and Exacerbations of Asthma

text: Clinical research findings indicate that there are synergistic interactions between allergy and viral infection that cause increased severity of asthma exacerbations. This article summarizes the current literature linking these 2 risk factors for asthma exacerbation, and reviews experimental data suggesting potential mechanisms for interactions between viral infection and allergy that cause asthma exacerbations. In addition, the authors discuss clinical evidence that treatment of allergic inflammation could help to reduce the frequency and severity of virus-induced exacerbations of asthma.


title: Cytosolic Innate Immune Sensing and Signaling upon Infection

text: Cytosolic sensing of pathogens is essential to a productive immune response. Recent reports have emphasized the importance of signaling platforms emanating from organelles and cytosolic sensors, particularly during the response to intracellular pathogens. Here, we highlight recent discoveries identifying the key mediators of nucleic acid and cyclic nucleotide sensing and discuss their importance in host defense. This review will also cover strategies evolved by pathogens to manipulate these pathways.


End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV


title: Feline Infectious Peritonitis Virus

text: SUMMARY: From ascitic fluids and liver homogenates of natural and experimentally induced cases of feline infectious peritonitis (FIP) virus particles have been purified by ammonium sulphate precipitation and sucrose gradient centrifugation; they appear as coronavirus‐like on the basis of their morphology (round, non‐rigid, about 100 nm. in diameter, surface projections), sedimentation behaviour (about 400 S) and buoyant density in sucrose (between 1.17 and 1.18 g./ml.). Using gradient‐purified virus material the disease could be reproduced in experimental kittens and the virus recovered from them whereas it was absent from surviving animals. Based on these results it is proposed to classifiy FIP virus as a new member of the Coronaviridae family. ZUSAMMENFASSUNG: Virus der infektiösen felinen Peritonitis I. Reinigung und Elektronenmikroskopie Aus Ascitesflüssigkeiten und Leberhomogenaten von natürlichen und experimentell induzierten Fällen von Feliner Infektiöser Peritonitis wurden mittels Ammoniumsulfatpräzipitation und Rohrzucker‐Dichtegradientenzentrifugierung Viruspartikeln gereinigt. Sie ähneln Coronaviren hinsichtlich ihrer Morphologie (sphärisch, verformbar, etwa 100 nm Durchmesser, Oberflächenprojektionen), ihres Sedimentierungsverhaltens (etwa 400 S) und ihrer Schwebedichte in Rohrzucker (zwischen 1,17 und 1,18 g/ml). Mit gereinigtem Material aus Gradienten konnte die Erkrankung in Versuchskatzen reproduziert und das Virus in diesen wiederum demonstriert werden, während es in den überlebenden Tieren nicht nachweisbar war. Auf Grund dieser Ergebnisse wird vorgeschlagen, das FIP‐Virus als ein neues Mitglied der Familie Coronaviridae zu klassifizieren. RÉSUMÉ: Virus de la péritonite infectieuse du chat I. Purification et microscopie électronique Des liquides ascitiques et des homogénats de foie de cas péritonites infectueuses félines, enduits de façon naturelle et expérimentale, on a purifié des particules de virus au moyen de précipitation sulfat d'ammonium et de centrifugation en gradients de sucrose; ils resemblent les coronavirus vue leur morphologie (sphérique, non rigide, environ 100 nm de diamètre, projections de surface), leur coefficient de sédimentation (environ 400 S) et leur densité de flottaison en sucrose (entre 1,17 et 1,18 g/ml). Utilisant du matériel viral purifié par gradients de densité, on a reproduit la maladie chez les chats expérimentaux et démontré le même virus dans ces animaux, tandis qu'il était absent chez les animaux survivants. Vue les résultats mentionnés ci‐des‐sus il est proposé de classifier le virus FIP parmi la famille des Coronaviridae. RESUMEN: Virus de la peritonitis infecciosa del gato I. Purificación y microscopía electrónica De los líquidos ascíticos y homogenados de hígado de casos naturales e inducidos por vía experimental de peritonitis felina infecciosa, se purificaron partículas virales mediante precipitación con sulfato amónico y centrifugación con gradientes de sucrosa. Las mismas se asemejan a los virus Corona en cuanto a su morfología (esféricas, deformables, de un diámetro de unos 100 nm, con proyecciones en la superficie), su coeficiente de sedimentación (alrededor de 400 S) y su densidad de flotación en sucrosa (entre 1,17 y 1,18 g/ml). Partiendo de un material purificado en los gradientes, se logró reproducir la enfermedad en gators de experimentación, recuperándose el virus en estos animales, mientras que no se pudo evidenciar en aquellos que sobrevivieron. A la vista de los resultados mencionados, se propone clasificar el virus de la peritonitis felina infecciosa (FIP) como un miembro nuevo de la familia de los Coronaviridae.


title: Extreme thrombocytosis in a young cat

text: A 7-month-old unvaccinated domestic shorthair cat was presented with a history of inappetence and hypersalivation. Clinical examination revealed fever, gingivitis and oral ulceration. An initial blood sample revealed a severe leukopenia and neutropenia and a feline panleukopenia virus (FPV) titre of 1:640; a second titre 10 days later was 1:2,560. A feline calicivirus (FCV) titre was 1:320 and the initial clinical signs and laboratory findings were attributed to a coinfection with FPV and FCV. The cat was treated with interferon omega. A blood sample taken 10 days later revealed a severe thrombocytosis of 3,448 × 10(9)/L (reference range 200–500 × 10(9)/L) confirmed by blood smear examination. The platelet count on day 35 was 4,990 × 10(9)/L. No bone marrow examination was carried out. Two differential diagnoses for an extreme thrombocytosis are a reactive thrombocytosis or essential thrombocythemia (ET). ET is a hemic neoplasia that causes a severe and persistent thrombocytosis, and is a diagnosis of exclusion. Reactive thrombocytosis is generally mild to moderate and of shorter duration than described here, but an excessive response could have been caused by infection. The influence of additional factors such as an initial thrombocytopenia, age and interferon treatment are not clear but can be speculated on. Although the exact pathophysiology in this case remains unclear, such high, persistent thrombocyte numbers have not been reported in cats in the absence of a neoplastic process.


title: Hydroxychloroquine effects on psoriasis: a systematic review and a cautionary note for COVID-19 treatment

text: Abstract: Background While evidence suggests that hydroxychloroquine (HCQ) may decrease the viral load in patients with a COVID-19 infection, a number of case reports indicate adverse dermatologic effects of this potential treatment. Objective To conduct a systematic review of previously reported cases of psoriasis onset, exacerbation, or relapse after HCQ treatment. Methods A comprehensive EMBASE and MEDLINE search of original studies examining adverse effects of HCQ treatment related to psoriasis was conducted. Participant demographics, and details of HCQ administration and psoriasis diagnosis were extracted from 15 articles representing 18 patients. Results Females accounted for a significantly larger number of psoriatic cases compared to males and unreported sex (n=14, 77.8% vs. n=2, 11.1% vs n=2, 11.1% respectively). Additionally, 50% (n=9) of the cases did not have a history of psoriasis prior to taking HCQ. Of the 18 patients, 50.0% (n=9) experienced de novo psoriasis, 27.8% (n=5) experienced exacerbation of psoriatic symptoms and 22.2% (n=4) had a relapse of psoriasis after HCQ administration. Conclusions HCQ treatment may result in induction, exacerbation, or relapse of psoriasis. Monitoring for adverse effects of HCQ treatment is necessary, and clinical trials are essential in characterizing the safety profile of HCQ use in patients with a COVID-19 infection.


¿Qué papel desempeña la Fisioterapia en la pandemia mundial por COVID-19?


title: The dark cloud with a silver lining: Assessing the impact of the SARS COVID-19 pandemic on the global environment

text: Abstract The Severe Acute Respiratory Syndrome-Coronavirus Disease 2019 (COVID-19) pandemic caused by a novel coronavirus known as SARS-CoV-2 has caused tremendous suffering and huge economic losses. We hypothesized that extreme measures of partial-to-total shutdown might have influenced the quality of the global environment because of decreased emissions of atmospheric pollutants. We tested this hypothesis using satellite imagery, climatic datasets (temperature, and absolute humidity), and COVID-19 cases available in the public domain. While the majority of the cases were recorded from Western countries, where mortality rates were strongly positively correlated with age, the number of cases in tropical regions was relatively lower than European and North American regions, possibly attributed to faster human-to-human transmission. There was a substantial reduction in the level of nitrogen dioxide (NO2: 0.00002 mol m−2), a low reduction in CO (<0.03 mol m−2), and a low-to-moderate reduction in Aerosol Optical Depth (AOD: ~0.1–0.2) in the major hotspots of COVID-19 outbreak during February–March 2020, which may be attributed to the mass lockdowns. Our study projects an increasing coverage of high COVID-19 hazard at absolute humidity levels ranging from 4 to 9 g m−3 across a large part of the globe during April–July 2020 due to a high prospective meteorological suitability for COVID-19 spread. Our findings suggest that there is ample scope for restoring the global environment from the ill-effects of anthropogenic activities through temporary shutdown measures.


title: Viruses causing severe acute respiratory infections (SARI) in children ≤5 years of age at a tertiary care hospital in Rajasthan, India

text: BACKGROUND & OBJECTIVES: Severe acute respiratory infection (SARI) is one of the leading causes of death among children worldwide. As different respiratory viruses exhibit similar symptoms, simultaneous detection of these viruses in a single reaction mixture can save time and cost. The present study was done in a tertiary care children's hospital for rapid identification of viruses causing SARI among children less than or equal to five years of age using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR) kit. METHODS: A total of 155 throat swabs were collected from equal number of children suspected to have SARI and processed for extraction of nucleic acids using automated extraction system. Multiplex real-time RT-PCR was done to identify the viruses in the samples. RESULTS: The overall positivity for viruses in the study was found to be 72.9 per cent with a co-infection rate of 19.5 per cent. Human metapneumovirus (HMPV) was the predominant virus detected in 25.7 per cent children followed by influenza A (H1N1)pdm09, human rhinovirus (HRV) and human adenovirus (HAdV) in 19.9, 11.0 and 8.8 per cent children, respectively. The HMPV was at its peak in February 2013, HAdV showed two peaks in March-April, 2012 and November 2012-March 2013 while HRV was detected throughout the year. INTERPRETATION & CONCLUSIONS: Multiplex real-time PCR helped in rapid identification of viruses. Seventeen viruses were detected in SARI cases with overall positivity of 72.9 per cent. HMPV was the most predominant virus. However, for better clinico-virological correlation, studies are required with complete work up of all the aetiological agents, clinical profile of patients and treatment outcome.


title: Asymptomatic COVID‐19 infection in late pregnancy indicated no vertical transmission

text: This study is to investigate the clinical characteristics of late pregnancy with asymptomatic 2019 novel coronavirus disease (COVID‐19) infection, evaluate the outcome of maternal and fetal prognosis, and identify the evidence of intrauterine vertical transmission. A 22‐years‐old pregnant woman with asymptomatic COVID‐19 infection who was admitted to our hospital on 11 February 2020 was enrolled in this study. Clinical data including laboratory test results and chest computed tomography (CT) scanning were collected and reviewed. Diagnosis of late pregnancy with asymptomatic COVID‐19 infection was made. Lumbar anesthesia for cesarean section was performed and a female baby was delivered uneventfully, with the Apgar score of 9 to 10 points. Three times of COVID‐19 nucleic acid test for the baby was negative after delivery. The puerpera returned to normal after the operation and two times of throat swab COVID‐19 nucleic acid test were all negative after antiviral therapy. We reported an asymptomatic COVID‐19 pregnant woman with detailed clinical information and our result indicated that for late pregnant women with asymptomatic COVID‐19 infection, there might be no intrauterine infection caused by vertical transmission.


title: Becoming “Teletherapeutic”: Harnessing Accelerated Experiential Dynamic Psychotherapy (AEDP) for Challenges of the Covid-19 Era

text: The covid-19 pandemic raises substantial challenges for the practice of psychotherapy. The rapid changes in the personal experiences of both clients and therapists, and the required adaptations in the therapeutic setting, affect the therapeutic relationship and its process. We examine common challenges observed through supervision of therapists and peer group discussions, viewing them in light of reports of previous collective traumatic events. Consequently, we introduce major premises and techniques borrowed from Accelerated Experiential Dynamic Psychotherapy as they may apply to teletherapy. These interventions aim to maintain and strengthen the intimacy and safety of the therapeutic attachment relationship, essential for processing actual experiences of emotions and creating affective changes. We explicate the rationale and the clinical application of these relational and experiential interventions, and organize them through a comprehensive model. The model visually illustrates the matching of therapeutic interventions to the handling of the psychological upheavals triggered by the changes imposed by the pandemic, particularly the move to teletherapy. In addition to theoretical and practical suggestions, which could be adapted to various models of therapy, we present a brief clinical case demonstrating the application of the suggested therapeutic thinking and interventions.


title: Seasonal Influenza Forecasting in Real Time Using the Incidence Decay With Exponential Adjustment Model

text: BACKGROUND: Seasonal influenza epidemics occur frequently. Rapid characterization of seasonal dynamics and forecasting of epidemic peaks and final sizes could help support real-time decision-making related to vaccination and other control measures. Real-time forecasting remains challenging. METHODS: We used the previously described “incidence decay with exponential adjustment” (IDEA) model, a 2-parameter phenomenological model, to evaluate the characteristics of the 2015–2016 influenza season in 4 Canadian jurisdictions: the Provinces of Alberta, Nova Scotia and Ontario, and the City of Ottawa. Model fits were updated weekly with receipt of incident virologically confirmed case counts. Best-fit models were used to project seasonal influenza peaks and epidemic final sizes. RESULTS: The 2015–2016 influenza season was mild and late-peaking. Parameter estimates generated through fitting were consistent in the 2 largest jurisdictions (Ontario and Alberta) and with pooled data including Nova Scotia counts (R(0) approximately 1.4 for all fits). Lower R(0) estimates were generated in Nova Scotia and Ottawa. Final size projections that made use of complete time series were accurate to within 6% of true final sizes, but final size was using pre-peak data. Projections of epidemic peaks stabilized before the true epidemic peak, but these were persistently early (~2 weeks) relative to the true peak. CONCLUSIONS: A simple, 2-parameter influenza model provided reasonably accurate real-time projections of influenza seasonal dynamics in an atypically late, mild influenza season. Challenges are similar to those seen with more complex forecasting methodologies. Future work includes identification of seasonal characteristics associated with variability in model performance.


title: Human β-defensin 2 plays a regulatory role in innate antiviral immunity and is capable of potentiating the induction of antigen-specific immunity

text: BACKGROUND: Antimicrobial peptides (AMPs) are primarily known for their innate immune defense against invading microorganisms, including viruses. In addition, recent research has suggested their modulatory activity in immune induction. Given that most subunit vaccines require an adjuvant to achieve effective immune induction through the activation of innate immunity, AMPs are plausible candidate molecules for stimulating not only innate immune but also adaptive immune responses. RESULTS: In this study, we investigated the ability of human β-defensin (HBD) 2 to promote antiviral immunity in vitro and in vivo using a receptor-binding domain (RBD) of Middle East respiratory syndrome-coronavirus (MERS-CoV) spike protein (S RBD) as a model antigen (Ag). When HBD 2-conjugated S RBD was used to treat THP-1 human monocytic cells, the expression levels of antiviral (IFN-β, IFN-γ, MxA, PKR, and RNaseL) and primary immune-inducing (NOD2, TNF-α, IL-1β, and IL-6) molecules were enhanced compared to those expressed after treatment with S RBD only. The expression of chemokines capable of recruiting leukocytes, including monocytes/macrophages, natural killer cells, granulocytes, T cells, and dendritic cells, was also increased following HBD 2-conjugated S RBD treatment. More important, immunization of mice with HBD 2-conjugated S RBD enhanced the immunogenicity of the S RBD and elicited a higher S RBD-specific neutralizing antibody response than S RBD alone. CONCLUSIONS: We conclude that HBD 2 activates the primary antiviral innate immune response and may also mediate the induction of an effective adaptive immune response against a conjugated Ag.


title: Martini‐Klinik experience on prostate cancer surgery during the early phase of COVID‐19

text: In order to restrain an uncontrolled spread of the 2019 Coronavirus‐Disease (COVID‐19) and to provide sufficient intensive‐care unit (ICU) capacity, medical specializations needed to develop new routines and risk‐strategy protocols. Those restrictions have also impacted the urologic community. Several medical organisations developed specific information‐hubs, blogs and resource centers on how to tackle the COVID‐19 situation (1–3). Although the German Society of Urology (“DGU”) has published a recommendation to evaluate the need for a timely therapy in prostate cancer (PCa) patients according to D’Amico risk groups on the 2(nd) of April 2020, up to now no compulsory directives exist regarding omitting radical prostatectomy (RP) during the COVID‐19 pandemic.


Covid-19: Decisions to offer interventions with limited availability should be decided based on chance of recovery.


docid: lzaxzuwe

title: Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019

text: AIMS: To investigate the characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 (COVID-19). METHODS AND RESULTS: We enrolled 671 eligible hospitalized patients with severe COVID-19 from 1 January to 23 February 2020, with a median age of 63 years. Clinical, laboratory, and treatment data were collected and compared between patients who died and survivors. Risk factors of death and myocardial injury were analysed using multivariable regression models. A total of 62 patients (9.2%) died, who more often had myocardial injury (75.8% vs. 9.7%; P < 0.001) than survivors. The area under the receiver operating characteristic curve of initial cardiac troponin I (cTnI) for predicting in-hospital mortality was 0.92 [95% confidence interval (CI), 0.87–0.96; sensitivity, 0.86; specificity, 0.86; P < 0.001]. The single cut-off point and high level of cTnI predicted risk of in-hospital death, hazard ratio (HR) was 4.56 (95% CI, 1.28–16.28; P = 0.019) and 1.25 (95% CI, 1.07–1.46; P = 0.004), respectively. In multivariable logistic regression, senior age, comorbidities (e.g. hypertension, coronary heart disease, chronic renal failure, and chronic obstructive pulmonary disease), and high level of C-reactive protein were predictors of myocardial injury. CONCLUSION: The risk of in-hospital death among patients with severe COVID-19 can be predicted by markers of myocardial injury, and was significantly associated with senior age, inflammatory response, and cardiovascular comorbidities.


title: Anemia and transfusion therapy: an update

text: Abstract Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient.


title: Alcohol store closure in Pennsylvania: Withdrawals in future?

text: Last week, the Pennsylvania Liquor Control Board, which runs all liquor stores in the state (and employs all the workers), announced that the stores would be closed 24/7 to mitigate against the spread of COVID‐19. The announcement came on March 16, with stores to close at 9:00 p.m. the next day (St. Patrick's Day, a notorious drinking day).


title: The glycosylation status of the murine hepatitis coronavirus M protein affects the interferogenic capacity of the virus in vitro and its ability to replicate in the liver but not the brain

text: Abstract The coronavirus M protein, the most abundant coronaviral envelope component, is invariably glycosylated, which provides the virion with a diffuse, hydrophilic cover on its outer surface. Remarkably, while the group 1 and group 3 coronaviruses all have M proteins with N-linked sugars, the M proteins of the group 2 coronaviruses [e.g., mouse hepatitis virus (MHV)] are O-glycosylated. The conservation of the N- and O-glycosylation motifs suggests that each of these types of carbohydrate modifications is beneficial to their respective virus. Since glycosylation of the M protein is not required for virus assembly, the oligosaccharides are likely to be involved in the virus–host interaction. In order to investigate the role of the M protein glycosylation in the host, two genetically modified MHVs were generated by using targeted RNA recombination. The recombinant viruses carried M proteins that were either N-glycosylated or not glycosylated at all, and these were compared with the parental, O-glycosylated, virus. The M protein glycosylation state did not influence the tissue culture growth characteristics of the recombinant viruses. However, it affected their interferogenic capacity as measured using fixed, virus-infected cells. Viruses containing M proteins with N-linked sugars induced type I interferons to higher levels than viruses carrying M proteins with O-linked sugars. MHV with unglycosylated M proteins appeared to be a poor interferon inducer. In mice, the recombinant viruses differed in their ability to replicate in the liver, but not in the brain, whereas their in vivo interferogenic capacity did not appear to be affected by their glycosylation status. Strikingly, their abilities to replicate in the liver correlated with their in vitro interferogenic capacity. This apparent correlation might be explained by the functioning of lectins, such as the mannose receptor, which are abundantly expressed in the liver but also play a role in the induction of interferon-α by dendritic cells.


docid: kheqbtqo

title: Network theory may explain the vulnerability of medieval human settlements to the Black Death pandemic

text: Epidemics can spread across large regions becoming pandemics by flowing along transportation and social networks. Two network attributes, transitivity (when a node is connected to two other nodes that are also directly connected between them) and centrality (the number and intensity of connections with the other nodes in the network), are widely associated with the dynamics of transmission of pathogens. Here we investigate how network centrality and transitivity influence vulnerability to diseases of human populations by examining one of the most devastating pandemic in human history, the fourteenth century plague pandemic called Black Death. We found that, after controlling for the city spatial location and the disease arrival time, cities with higher values of both centrality and transitivity were more severely affected by the plague. A simulation study indicates that this association was due to central cities with high transitivity undergo more exogenous re-infections. Our study provides an easy method to identify hotspots in epidemic networks. Focusing our effort in those vulnerable nodes may save time and resources by improving our ability of controlling deadly epidemics.


title: Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management

text: More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by β-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify β-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of β-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin–potassium (penicillin V potassium), also phenoxymethlpenicillin–benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more reliable eradication of β-hemolytic streptococci is desirable. In cases of allergy or incompatibility of penicillin, cephalosporins or macrolides (e.g. Erythromycin-estolate) are valuable alternatives.


title: Application and Prospect of a Mobile Hospital in Disaster Response

text: Disasters such as an earthquake, a flood, and an epidemic usually lead to large numbers of casualties accompanied by disruption of the functioning of local medical institutions. A rapid response of medical assistance and support is required. Mobile hospitals have been deployed by national and international organizations at disaster situations in the past decades, which play an important role in saving casualties and alleviating the shortage of medical resources. In this paper, we briefly introduce the types and characteristics of mobile hospitals used by medical teams in disaster rescue, including the aspects of structural form, organizational form, and mobile transportation. We also review the practices of mobile hospitals in disaster response and summarize the problems and needs of mobile hospitals in disaster rescue. Finally, we propose the development direction of mobile hospitals, especially on the development of intelligence, rapid deployment capabilities, and modularization, which provide suggestions for further research and development of mobile hospitals in the future.


title: Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study

text: BACKGROUND: Despite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD. METHODS: We conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients. RESULTS: During the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care. CONCLUSIONS: Overall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.