title: Severe acute respiratory syndrome epidemic in Taiwan, 2003.

text: In Taiwan, since the first case of severe acute respiratory syndrome (SARS) was identified on February 25, 2003, a total of 3032 cases of suspected or probable SARS were reported prior to July 5, 2003. Among these cases, 664 cases were classified as probable SARS based on the clinical case definitions and 346 had a positive result for the SARS-associated coronavirus (SARS-CoV). The epidemic in Taiwan could be divided into 2 distinct stages. In stage I (late-February to mid-April) patients had traceable contact with infected patients or travel histories to known affected areas of SARS. By contrast, patients in stage II (mid-April to June) acquired infection via intra-hospital or inter-hospital transmission. The mortality rate directly attributable to SARS during the 2 stages of the outbreak in Taiwan was 11% (37 patients). Phylogenetic analysis of sequences of SARS-CoV strains in Taiwan and other countries showed that Taiwanese strains were closely related to those isolated from patients in Hong Kong and Guangdong. The nonspecific initial symptoms and signs of the illness, the absence of reliable diagnostic tests, as well as the initial lack of strict infection control measures in hospitals and effective national control policies contributed to the island-wide spread of the SARS epidemic in Taiwan. Development of an effective strategy to prepare for future outbreaks will require the implementation of an active coordinated clinical reporting system, international collaboration to identify cases in the early stage, development of laboratory tools for early diagnosis, a robust system of prepared isolation, and adequate quarantine facilities.


title: Update on pediatric vasculitis.

text: PURPOSE OF REVIEW The purpose of this review is to provide an overview of the recent research and progress made in the field of pediatric vasculitis. RECENT FINDINGS Over the past year, researchers have described several polymorphisms in Henoch-Schonlein purpura and Kawasaki Disease as well as the association between various vasculitides and infections. International and multidisciplinary efforts in Kawasaki Disease have resulted in recommendations for its diagnosis, treatment, and long-term management to improve patient care and further increase global collaboration. Researchers are investigating the role of inflammation and its role in endothelial health and atherosclerosis. Treatment regimens continue to improve, with the use of different immunosuppressive medications; however, we continue to have incomplete treatment successes. SUMMARY Vasculitides are rare conditions with significant morbidity and mortality whose prognosis has improved with newer diagnostic modalities and treatments; however, we continue to have insufficient knowledge of vasculitides and lack unambiguous diagnostic criteria. As technology continues to progress it is clear that a single cause of these diseases may be an oversimplification: the genetic makeup of individuals, as well as various environmental exposures, are of vital importance in the pathophysiology and evolution of disease processes, as well as response to therapy. Efforts should continue to improve international multicenter collaboration and interdisciplinary efforts to help solve this ever-growing puzzle.


title: On the spread of the novel influenza A (H1N1) virus in Mexico.

text: A novel influenza A H1N1 virus of swine origin is responsible for the influenza epidemic affecting Mexico, the United States of America (USA), and 39 other countries. While the origin of this emerging pathogen remains uncertain, an increase in the reported incidence of respiratory diseases was noted during March 2009 at the town of La Gloria, in the southeastern state of Veracruz, Mexico. So far, this is the first community in which a case of novel influenza A H1N1 virus has been identified. Further cases were rapidly detected in other areas of Mexico and elsewhere. Initially, the atypical respiratory disease outbreak caused great uncertainty posing a challenge to the Mexican health system. Control measures such as social distancing, timely medical care, and personal hygiene have so far proven effective in containing the outbreak, resulting in a decline of the number of new cases. To the best of our knowledge, it appears that the virus might not be as virulent or contagious as previously thought. Here we provide a description of the influenza epidemic spread in Mexico. As the virus disseminates worldwide, there is concern about the possibility of a new reassortment resulting in a more pathogenic strain that will pose a threat for every country. The influenza epidemic provided lessons that underscore the importance of epidemiologic surveillance and preparedness. Further investigation to address questions about this new virus and conditions for its spread is warranted.


title: Good governance in 'one health' approaches.

text: The authors discuss 'One Health' approaches for controlling newly recognised and re-emerging diseases of animal origin and contributions towards pandemic preparedness based on enhanced collaboration between Veterinary Services, Human Health Services and Environmental Services. Improved veterinary governance and cooperation with public health managers, social scientists, ecologists and many other stakeholders are important for reducing the risks of potential zoonoses--including foodborne diseases--at their source. Two case studies are presented to illustrate how One Health approaches can make a difference--Hendra disease incidents in Australia and rabies management on the African continent. This article also includes an overview of collaboration at the international level between the Food and Agriculture Organization of the United Natiorfs, the World Organisation for Animal Health, and the World Health Organization. Environmental determinants for disease emergence, anthropogenic climate change and human encroachment on shrinking wildlife habitats are considered, using highly pathogenic avian influenza A (H5N1) and Nipah virus as examples. Finally, the authors discuss the effects of livestock production on environmental change--in the light of global population growth and increasing demand for livestock and aquaculture products--with the need for future policy decisions to be based on a multidisciplinary One Health approach.


title: Computational fluid dynamics for turbomachinery internal air systems.

text: Considerable progress in development and application of computational fluid dynamics (CFD) for aeroengine internal flow systems has been made in recent years. CFD is regularly used in industry for assessment of air systems, and the performance of CFD for basic axisymmetric rotor/rotor and stator/rotor disc cavities with radial throughflow is largely understood and documented. Incorporation of three-dimensional geometrical features and calculation of unsteady flows are becoming commonplace. Automation of CFD, coupling with thermal models of the solid components, and extension of CFD models to include both air system and main gas path flows are current areas of development. CFD is also being used as a research tool to investigate a number of flow phenomena that are not yet fully understood. These include buoyancy-affected flows in rotating cavities, rim seal flows and mixed air/oil flows. Large eddy simulation has shown considerable promise for the buoyancy-driven flows and its use for air system flows is expected to expand in the future.


title: Coronavirus multiplication strategy. I. Identification and characterization of virus-specified RNA.

text: We examined the synthesis of intracellular RNA in primary chicken embryo kidney cells infected with the avian coronavirus infectious bronchitis virus. Infected cells were labeled with (32)P(i) in the presence of actinomycin D for the duration of the viral multiplication cycle, and nucleic acids were extracted, denatured, and analyzed on agarose slab gels. Six major RNA species were found. None of these RNAs was found in extracts of mock-infected cells. All six of the virus-specified RNAs (designated species A through F) were single stranded, and RNA species F had the same electrophoretic mobility as purified viral genome RNA. The molecular weights of the five subgenomic RNAs were estimated to be 0.8 x 10(6), 0.9 x 10(6), 1.3 x 10(6), 1.5 x 10(6), and 2.6 x 10(6) for species A through E, respectively. All of the RNAs were polyadenylated and are therefore likely to be viral mRNA's. The RNAs were synthesized in approximately constant proportions throughout the viral multiplication cycle. Intracellular RNA species A, B, C, D, and F and the purified viral genome were analyzed by RNase T(1) fingerprinting. The results confirmed the identification of RNA species F as the intracellular genome and the derivation of the four smaller RNAs from the genome. Fingerprinting also showed that the intracellular RNAs constitute a nested set such that the nucleotide sequence of each RNA is contained within all larger RNAs and each larger RNA contains an additional sequence congruent with its greater size. Finally, the possible modes of transcription and translation of the infectious bronchitis virus RNAs are discussed.


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title: Mechanisms and experimental models of chronic obstructive pulmonary disease exacerbations.

text: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity, mortality, and rising health care costs. In addition, they are associated with an accelerated loss of lung function and thus have a direct effect on disease progression. There are few studies examining the cellular and molecular mechanisms of COPD exacerbations. Exacerbations are linked to increased airway inflammation and oxidative stress, but many questions remain unanswered regarding the key inflammatory cells and mediators. Current therapies for COPD exacerbations are of limited effectiveness, and a better understanding of the inflammatory events at exacerbation is required to devise new therapeutic agents. The development of experimental models of exacerbation-for example, the use of experimental rhinovirus infection in humans with COPD-would greatly facilitate studies of exacerbations.


title: Airborne inflammatory factors: "from the nose to the brain".

text: The intranasal pathway is a direct route of communication between the environment and the brain. This pathway is currently used for the delivery of several experimental therapeutic peptides and vaccines because it bypasses the blood brain barrier. It is also a route of entrance to the brain for several viruses and toxic substances. Airborne infectious, allergic and pollution agents are among the most common inflammatory factors which may affect brain function via the brain-nose interface. The inflammatory processes triggered in the upper respiratory tract by these agents are positioned to influence the immune response of the brain and therefore, influence its function and alter behavior. Several clinical and epidemiological studies find an association between inflammatory factors affecting the intranasal pathway and neurological disorders such as multiple sclerosis, Alzheimer and Parkinson diseases as well as mental disorders including anxiety and mood disorders. However the mechanisms of interaction between the immune response in the nasal epithelium and the brain are poorly understood. This article discusses current evidence about these mechanisms and associations with neurological and mental diseases.


title: Microarray technology as a universal tool for high-throughput analysis of biological systems.

text: Over the last years microarray technology has become one of the principal platform technologies for the high-throughput analysis of biological systems. Starting with the construction of first DNA microarrays in the 1990s, microarray technology has flourished in the last years and many different new formats have been developed. Peptide and protein microarrays are now applied for the elucidation of interaction partners, modification sites and enzyme substrates. Antibody microarrays are envisaged to be of high importance for the high-throughput determination of protein abundances in translational profiling approaches. First cell microarrays have been constructed to transform microarray technology from an in vitro technology to an in vivo functional analysis tool. All of these approaches share a common prerequisite: the solid support on which they are generated. The demands on this solid support are thereby as manifold as the applications themselves. This review is aimed to display the recent developments in surface chemistry and derivatization, and to summarize the latest developments in the different application areas of microarray technology.


title: [Surgical aspects of endoscopic treatment of sagittal craniosynostosis (scaphocephaly) in children].

text: The article is devoted to the surgical treatment of sagittal craniosynostosis in children. Among non-syndromic monosynostosis sagittal craniosynostosis (scaphocephaly) is the most common. Treatment of children with craniosynostosis should begin as soon as possible. Endoscopic method refers to minimally invasive technique in surgical correction of craniosynostosis. This article presents a features of surgical treatment at all stages of the endoscopic cranioplasty. Presented data is based on the experience of treatment of 20 children with primary sagittal craniosynostosis. Treatment was performed using endoscopic techniques, special tools designed specifically for the endoscopic cranioplasty.


title: Validation of a questionnaire about the perception of occupational biohazard in Spanish companies.

text: OBJECTIVES The aim of this work was to develop, validate and test a new questionnaire to assess the biological risk in workers with intentional or unintentional exposure to biological agents. METHODS A questionnaire including 34 questions was developed to study the perception of workers against occupational biohazard. Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated for the analysis of content validity. A pilot study was carried out with 60 workers from 17 companies performing analysis of Cronbach's α to assess the internal consistency or reliability. RESULTS A total of 518 workers from 51 Spanish companies in which there is exposure to biological agents participated in the study yielding a response rate of 90%. The final questionnaire obtained a Cronbach's α > 0.759 with a stable test-retest result. The questionnaire validation demonstrates that it could be used to evaluate the biological risks and help the prevention of occupational accidents and diseases. DISCUSSION This study has validated the need to evaluate worker's perception against occupational risks, as well as the application of prevention methods and protective equipment. It is a first step towards developing an occupational biohazards assessment method including all the requirements set by the European Health and Safety Strategy 2013-2020.


title: [Human bocavirus: studies in the literature and in Chile].

text: The human bocavirus (HBoV), virus of the Parvoviridae family, discovered by molecular methods in 2005, has been reported in respiratory samples, stool, urine and blood, both in children and adults. Prevalence rates range from 0.8% in fecal samples of individuals with acute diarrhea, up to 19% in respiratory samples and blood. HBoV has been detected in up to 43% of nasopharyngeal samples in asymptomatic children. In Chile, HBoV was detected in 24.2% of nasopharyngeal swabs in children under 5 years of age with respiratory symptoms of which 74% had coinfection with other viruses. In asymptomatic children under 5 years of age, 37.5% of NP samples were positive for HBoV. We discuss the role of HBoV as a causal agent of respiratory and/or enteric disease in light of the high rates of coinfection and asymptomatic infections.


title: The use of alveolar epithelial type I cell-selective markers to investigate lung injury and repair.

text: Alveolar epithelial type I cells cover most of the internal surface area of the lungs. Ultrastructural studies demonstrate that alveolar epithelial type I cell damage is frequently observed in acute and chronic lung diseases. This article discusses the use of cell-selective proteins as markers for the investigation of injury and repair of the alveolar epithelium. The utility of proteins specific to alveolar epithelial type I cells as diagnostic markers of alveolar epithelial injury in acute lung injury is considered, and expression of proteins selective for alveolar epithelial type I cells in lungs following injury and in fibrosis are discussed.


From smallpox to polio and beyond: disease surveillance in India.


title: Post-earthquake injuries treated at a field hospital --- Haiti, 2010.

text: On January 12, 2010, a 7.0-magnitude earthquake struck Haiti, resulting in an estimated 222,570 deaths and 300,000 persons with injuries. The University of Miami Global Institute/Project Medishare (UMGI/PM) established the first field hospital in Port-au-Prince, Haiti, after the earthquake. To characterize injuries and surgical procedures performed by UMGI/PM and assess specialized medical, surgical, and rehabilitation needs, UMGI/PM and CDC conducted a retrospective medical record review of all available inpatient records for the period January 13-May 28, 2010. This report describes the results of that review, which indicated that, during the study period (when a total of 1,369 admissions occurred), injury-related diagnoses were recorded for 581 (42%) admitted patients, of whom 346 (60%) required a surgical procedure. The most common injury diagnoses were fractures/dislocations, wound infections, and head, face, and brain injuries. The most common injury-related surgical procedures were wound debridement/skin grafting, treatment for orthopedic trauma, and surgical amputation. Among patient records with documented injury-related mechanisms, 162 (28%) indicated earthquake-related injuries. Earthquake preparedness planning for densely populated areas in resource-limited settings such as Haiti should account for injury-related medical, surgical, and rehabilitation needs that must be met immediately after the event and during the recovery phase, when altered physical and social environments can contribute to a continued elevated need for inpatient management of injuries.


Using lessons from the past to plan for pandemic flu.


title: Regulation of hepatitis B virus replication by the phosphatidylinositol 3-kinase-akt signal transduction pathway.

text: The phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) signaling pathway is one of the major oncogenic pathways and is activated in many types of human cancers, including hepatocellular carcinoma. It can also be activated by the hepatitis C virus (HCV) nonstructural 5A (NS5A) protein. In the present study, we set out to determine the regulatory effects of this pathway on the replication of hepatitis B virus (HBV). Our results demonstrate that the expression of a constitutively active Akt1 profoundly inhibited HBV RNA transcription and consequently reduced HBV DNA replication in HepG2 cells. This suppression of HBV gene transcription was apparently mediated by the activation of mTOR, as it was abolished by the mTOR inhibitor rapamycin. Moreover, treatment of HBV-expressing HepG2.2.15 cells with inhibitors of PI3K, Akt, and mTOR increased the transcription of 3.5-kb and 2.4-kb viral RNA as well as the replication of HBV DNA. This observation implies that the basal level activation of this pathway in HepG2 cells regulated HBV replication. Consistent with previous reports showing that the HCV NS5A protein could bind to the p85 subunit of PI3K and activate the PI3K-Akt signal transduction pathway, our results showed that expression of this protein could inhibit HBV RNA transcription and reduce HBV DNA replication in HepG2 cells. Taken together, our results suggest that the activation of the PI3K-Akt pathway during liver oncogenesis may be at least partially responsible for the elimination of HBV replication from tumor cells and may also provide an explanation for the observed suppression of HBV replication by HCV coinfection.


title: Clinical impact and diagnosis of human metapneumovirus infection.

text: BACKGROUND Acute respiratory infections are the most common illnesses experienced by people of all ages worldwide. A portion of hitherto unexplained viral respiratory tract illnesses (RTIs) can now be attributed to the human metapneumovirus (hMPV), which was discovered in 2001. Several surveys on the burden of disease of hMPV infection have been conducted in various study groups and with different diagnostic assays. To estimate the impact of hMPV infection in a hospital setting and in the community at large, we reviewed these surveys to establish the burden of disease of hMPV infection. METHODS Published data and our own additional unpublished data on the clinical impact of hMPV infection were reviewed. RESULTS AND CONCLUSION Worldwide, hMPV infections account for at least 5 to 7% of the RTI in hospitalized children, but immunocompromised and elderly individuals are also at risk. In the general community hMPV infections account for at least 3% of patients who visit a general practitioner for RTI. The seasonality of hMPV infections resembles that for respiratory syncytial virus and influenza virus infections, with recurrent epidemics during the winter months. Clinical symptoms and laboratory findings associated with hMPV infection exhibit a spectrum virtually indistinguishable from those associated with respiratory syncytial virus disease. The development of diagnostic assays must take into account the existence of two hMPV serotypes.


Cell death in planktonic, photosynthetic microorganisms.


title: Gastrointestinal parasites of cougars (Felis concolor) in Washington and the first report of Ollulanus tricuspis in a sylvatic felid from North America.

text: Gastrointestinal helminths including two species of cestodes (Taenia omissa and T. ovis krabbei) and three species of nematodes (Toxocara cati, Cylicospirura subequalis and Ollulanus tricuspis) are reported from two free-ranging cougars (Felis concolor) in Washington (USA). Ollulanus tricuspis is reported for the first time from cougars and represents the first occurrence of this parasite in a sylvatic felid from North America.


title: Assessing the genetic component of the susceptibility of mice to viral infections.

text: Laboratory mice often exhibit wide differences in susceptibility when infected experimentally with viruses. Based on such observations, experiments have been designed to investigate the determinism of these differences at the molecular level, and a few genes that play a major role in the innate mechanisms of defence of the species toward viral aggressions have been characterised. For example, the extraordinary resistance of SJL mice to experimental infections with hepatitis virus strain A59 is the consequence of a structural alteration of a cell adhesion molecule which normally binds to the spikes of the virus, allowing its entry into the cells. If the virus cannot bind to the molecule, or if the molecule is absent, epithelial cells of the intestine and liver are not infected and mice are resistant. In the same way, most--not to say all--laboratory strains of mice are susceptible to infections with orthomyxoviruses or flaviviruses because essential molecules, the synthesis of which is normally triggered by interferon, are defective in these mice. Wild mice, by contrast --probably because they are constantly exposed to natural infections--are resistant. Finally, some mouse strains resist experimental infections by the mouse cytomegalovirus 1 (MCMV-1) because, once infected, these mice synthesise a molecule at the surface of infected cells which allows immediate recognition and killing by natural killer (NK) cells. With the exuberant development of mouse genetics and the constant generation of new mutant alleles, it is likely that many more genes with an impact on the phenotype of resistance or susceptibility will be identified in the forthcoming years. These genes are probably numerous, however, and many of them presumably interact with each other and/or have additive effects. This might slow down progress in our understanding of the innate mechanism of defence.


title: Suspensory ligament rupture technique during ovariohysterectomy in small animals.

text: During ovariohysterectomy, suspensory ligament (SL) rupture permits retraction of the ovary and distal ovarian pedicle through a limited ventral midline incision. This allows the surgeon to confirm that the pedicle is securely double ligated and includes no ovarian remnant. For less experienced surgeons, SL rupture is often difficult and daunting because the ligament is buried within the abdominal viscera and must be identified blindly by palpation. Furthermore, in dogs, the ligament must be digitally disrupted, which may cause hemorrhage and serious injury to surrounding structures such as the ovarian pedicle. This article describes step-by-step techniques to disrupt the SL in dogs and cats. We have found that these techniques can be taught easily and successfully to novice surgeons.


Global changes related to travelers' health.


title: A functional -1 ribosomal frameshift signal in the human paraneoplastic Ma3 gene.

text: A bioinformatics approach to finding new cases of -1 frameshifting in the expression of human genes revealed a classical retrovirus-like heptanucleotide shift site followed by a potential structural stimulator in the paraneoplastic antigen Ma3 and Ma5 genes. Analysis of the sequence 3' of the shift site demonstrated that an RNA pseudoknot in Ma3 is important for promoting efficient -1 frame-shifting. Ma3 is a member of a family of six genes in humans whose protein products contain homology to retroviral Gag proteins. The -1 frameshift site and pseudoknot structure are conserved in other mammals, but there are some sequence differences. Although the functions of the Ma genes are unknown, the serious neurological effects of ectopic expression in tumor cells indicate their importance in the brain.


title: Modelling potential responses to severe acute respiratory syndrome in Japan: the role of initial attack size, precaution, and quarantine.

text: BACKGROUND There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. With the use of detailed epidemiological data from other countries, this article describes the possible reason for the SARS epidemic not appearing in Japan, and simulates the impact of different control strategies that can break the transmission cycle of SARS associated coronavirus. METHOD Mathematical modelling is used for predicting the epidemiological outcome and simultaneously for evaluating the effect of interventions on SARS. The study estimates the initial attack size that would result in failed invasion. Three different interventions have been incorporated into the public health response policies; precautionary public health measures, isolation of infected people, and quarantine of exposed humans. RESULTS The maximum number of humans newly infected could be roughly estimated on the basis of the initial attack size, using simple formulas. It is seen that the introduction of only a few cases into certain communities would not lead easily to an epidemic. The possible trajectories of SARS epidemic depend on the levels of public health interventions as quarantine and precautionary public health measures greatly affected the transmissibility of the disease. It is shown that there exist threshold levels of interventions at which the SARS epidemic settles down. CONCLUSION Initial attack size is one of the determinants of whether SARS can successfully invade the community or not. Two of the most effective policy procedures to prevent new infections would be to apply stringent precautionary measures and to impose quicker and more effective quarantine of the exposed populace.


title: Battery performance of 4 intensive care ventilator models.

text: BACKGROUND Hospital electrical power failure represents an important challenge in the intensive care unit. Despite the presence of backup generators, total electrical power failure may still occur. Life-support equipment should have a reliable internal battery to ensure patient safety. We tested the duration of operation of the internal battery of 4 intensive care ventilators. METHODS In our laboratory we evaluated one each of 4 ventilator models available in our facility (Evita XL, Puritan Bennett 840, Avea, and Servo 300), with volume-control and pressure-control ventilation, and with positive end-expiratory pressure (PEEP) of zero and 20 cm H(2)O. We then randomly selected and tested 6 Evita XL and 4 Servo 300 ventilators from our inventory to determine the variability of internal battery duration among ventilators of the same model. The ventilator settings were identical to the previous tests, other than fraction of inspired oxygen, which was set at 0.6, and PEEP was 5 cm H(2)O. RESULTS The battery-duration range of the tested ventilators was 20.5-170.5 min, and the mean +/- SD battery duration was 80.4 +/- 49.3 min. Changes in breath type and PEEP did not significantly impact battery duration. Among the ventilators of the same model, the battery-duration range was 5-69 min and the mean +/- SD battery duration was 28.9 +/- 21.4 min. Use of a compressor significantly shortened battery duration. There was no correlation between battery duration and battery age (r = -0.263). CONCLUSIONS The duration of ventilator operation on internal battery ranged widely among the tested devices. Clinicians need to be aware of these differences in the event of power failure.


title: Triple decoding of hepatitis C virus RNA by programmed translational frameshifting.

text: Ribosomes can be programmed to shift from one reading frame to another during translation. Hepatitis C virus (HCV) uses such a mechanism to produce F protein from the -2/+1 reading frame. We now report that the HCV frameshift signal can mediate the synthesis of the core protein of the zero frame, the F protein of the -2/+1 frame, and a 1.5-kDa protein of the -1/+2 frame. This triple decoding function does not require sequences flanking the frameshift signal and is apparently independent of membranes and the synthesis of the HCV polyprotein. Two consensus -1 frameshift sequences in the HCV type 1 frameshift signal facilitate ribosomal frameshifts into both overlapping reading frames. A sequence which is located immediately downstream of the frameshift signal and has the potential to form a double stem-loop structure can significantly enhance translational frameshifting in the presence of the peptidyl-transferase inhibitor puromycin. Based on these results, a model is proposed to explain the triple decoding activities of the HCV ribosomal frameshift signal.


title: Structural analysis of virion proteins of the avian coronavirus infectious bronchitis virus.

text: We have found six major polypeptides in virions of the avian coronavirus infectious bronchitis virus grown in tissue culture: four glycoproteins, GP84, GP36, GP31, and GP28, and two non-glycosylated proteins, P51 and P23. In addition, we detected three minor species: two glycoproteins, GP90 and GP59, and one non-glycosylated protein, P14. Two-dimensional tryptic peptide mapping showed that GP36, GP31, GP28, and P23 comprise a group of closely related proteins which we have designated the "P23 family," but that the other proteins are distinct. Analysis by partial proteolytic digestion of P23 family, but that the other proteins are distinct. Analysis by partial proteolytic digestion of the P23 family labeled biosynthetically with [35S] methionine, and P23, labeled with [35S] formyl-methionine by in vitro translation of RNA from infected cells, revealed that the proteins of the P23 family differ in their amino-terminal domains. Similar analysis of GP31 and Gp36 labeled with [3H] mannose showed that the partial proteolytic fragments unique to these proteins were glycosylated. This suggests that differences in glycosylation in the amino-terminal domains contributes to the marked polymorphism os the P23 family. The results are discussed with respect to possible models for synthesis of the virion proteins.


title: [A case of bronchiolitis obliterans secondary to human metapneumovirus bronchiolitis].

text: Human metapneumovirus (hMPV), formerly classified in Paramyxoviridae family is now moved into Pneumoviridae, which was described as a novel family. It causes upper and lower respiratory tract infections (LRTIs) usually in children younger than five years old. The recent epidemiological studies indicated that hMPV is the second most frequently detected virus in LRTIs of young children, following the respiratory syncytial virus (RSV). Bronchiolitis obliterans (BO) is a chronic obstructive lung disease characterized by fibrosis of the distal respiratory airways. It is usually a result of an inflammatory process triggered by a LRTI related to adenovirus, RSV, Mycoplasma pneumoniae, measles virus, Legionella pneumophila, influenza virus or Bordetella pertussis as a causative agent. In this report, a case of hMPV bronchiolitis complicated with BO has been reported to point out the complications and severity of the clinical progress belongs to this virus. A three-month-old female patient has admitted to our pediatric intensive care unit with the diagnosis of acute bronchiolitis and respiratory failure. She was born at term, weighing 2950 gram and had been hospitalized in newborn intensive care unit for 11 days with the diagnosis of transient tachypnea of the newborn and neonatal sepsis. On auscultation, there were bilateral crepitant rales, wheezing and prolonged expirium. Her oxygen saturation was 97-98% while respiratory support was given with a non-rebreathing reservoir mask. Complete blood count, procalcitonin and C-reactive protein levels were in normal ranges. The chest radiography yielded right middle lobe atalectasia, left paracardiac infiltration and bilateral air trapping. A nasopharyngeal swab sample was analyzed by a commercial multiplex real-time reverse transcriptase-polymerase chain reaction (Thermo Fisher Scientific®, USA) developed for the detection of 15 respiratory viruses. Her sample yielded positive result for only hMPV. On the 4th day of hospitalization, the patient was intubated because of respiratory failure and carbon dioxide retention. She was extubated on the 19th day but could not tolerate. In the thorax computed tomography (CT), bilateral hyperinflation, patchy infiltration, mosaic perfusion and atelectasis especially bilateral posterior areas were detected. Bronchoscopy was normal except mild bronchomalacia in right middle lobe bronchus. The patient was diagnosed as BO secondary to hMPV bronchiolitis, according to the clinical, virological, bronchoscopic and thorax CT results. On the 76th day of admission, she was discharged with respiratory support with home ventilation via a tracheostomy cannula and medical treatments of oral metilprednisolone, nebulized salbutamol and budesonide. In conclusion, hMPV should not be undervalued especially in infants with severe LRTI that can be complicated with BO.


title: Detention for tuberculosis: public health and the law.

text: Non-compliance with treatment of pulmonary tuberculosis (TB) by an individual can put the community at risk of transmission of TB. Public health (detention) orders can be issued to detain non-compliant individuals, but this is a last resort and rarely used. Two recent cases in New South Wales illustrate the process of issuing a public health order in NSW, and some of the issues that may arise. The NSW law can also be applied to patients with severe acute respiratory syndrome (SARS) or HIV/AIDS. The other states and territories have similar laws, which often apply to a broader range of diseases and have fewer limits on issuing and extending orders.


title: Apoptosis induced by the SARS-associated coronavirus in Vero cells is replication-dependent and involves caspase.

text: The pathogenesis of the severe acute respiratory syndrome (SARS), a newly emerging life-threatening disease in humans, remains unknown. It is believed that the modulation of apoptosis is relevant to diseases that are caused by various viruses. To examine potential apoptotic mechanisms related to SARS, we investigated features of apoptosis induced by the SARS-associated coronavirus (SARS-CoV) in host cells. The results indicated that the SARS-CoV-induced apoptosis in Vero cells in a virus replication-dependent manner. Additionally, the downregulation of Bcl-2, the activation of casapse 3, as well as the upregulation of Bax were detected, suggesting the involvement of the caspase family and the activation of the mitochondrial signaling pathway. Although there is a positive correlation between apoptosis and virus replication, the latter is not significantly blocked by treatment with the caspase inhibitor z-DEVD-FMK. These preliminary data provide important information on both the pathogenesis and potential antiviral targets of SARS-CoV.


Neonatal calf diarrhea.


title: Eradicating infectious disease using weakly transmissible vaccines.

text: Viral vaccines have had remarkable positive impacts on human health as well as the health of domestic animal populations. Despite impressive vaccine successes, however, many infectious diseases cannot yet be efficiently controlled or eradicated through vaccination, often because it is impossible to vaccinate a sufficient proportion of the population. Recent advances in molecular biology suggest that the centuries-old method of individual-based vaccine delivery may be on the cusp of a major revolution. Specifically, genetic engineering brings to life the possibility of a live, transmissible vaccine. Unfortunately, releasing a highly transmissible vaccine poses substantial evolutionary risks, including reversion to high virulence as has been documented for the oral polio vaccine. An alternative, and far safer approach, is to rely on genetically engineered and weakly transmissible vaccines that have reduced scope for evolutionary reversion. Here, we use mathematical models to evaluate the potential efficacy of such weakly transmissible vaccines. Our results demonstrate that vaccines with even a modest ability to transmit can significantly lower the incidence of infectious disease and facilitate eradication efforts. Consequently, weakly transmissible vaccines could provide an important tool for controlling infectious disease in wild and domestic animal populations and for reducing the risks of emerging infectious disease in humans.


title: Use of molecular assays for the diagnosis of influenza.

text: Respiratory infections are the third highest cause of death worldwide and influenza has the highest mortality rate among lower respiratory tract infections (LRTIs). Diagnosis of LRTIs relies mostly on clinical symptoms and is not fully satisfactory. Influenza laboratory diagnosis improves the efficiency of prophylaxis or treatment of influenza by antiviral molecules and has a strong impact on the cost-effectiveness of curative treatment. Inappropriate treatment of patients may result in spreading of resistant strains. Molecular diagnostics play a central role in the surveillance and response of pandemic influenza due to highly pathogenic strains. Real-time assays can be used for diagnosis or surveillance purposes in humans and animals, and microarrays can be used to identify and monitor the spread of dangerous variants. Molecular assays are also useful to identify and distinguish influenza, other respiratory viruses and bacteria, although their cost-effectiveness must be proven on a large scale. As new antiviral options will be available to clinicians, a better treatment choice will benefit the patient and community. Recent progress in molecular techniques will be reviewed. Examples of real-time assays for the detection of influenza viruses, including the highly pathogenic influenza A strains H5N1 and H7N7, will be discussed. Promising new techniques that allow detailed genotyping of viruses or multiplex detection of several respiratory pathogens from a unique specimen will also be discussed. These techniques will, in the near future, significantly improve the quality of diagnosis and surveillance of respiratory pathogens.


title: Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand.

text: BACKGROUND On March 11, 2003, a World Health Organization (WHO) physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of severe acute respiratory syndrome (SARS) in Vietnam and developing a fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel coronavirus, by culture, reverse transcription-polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective measures remained unknown. The authors instituted airborne, droplet and contact precautions from the time of admission, and reviewed the efficacy of these measures. MATERIAL AND METHOD A specific unit was set up to care for the physician, beginning by roping off an isolated room and using a window fan to create negative pressure, and later by constructing a glass-walled antechamber, designated changing and decontamination areas, and adding high-efficiency particulate air (HEPA) filters. The use of personal protective equipment (PPE) was consistently enforced by nurse managers for all the staff and visitors, including a minimum of N95 respirators, goggles or face shields, double gowns, double gloves, full head and shoe covering, and full Powered Air Purifying Respirator (PAPR) for intubation. To assess the adherence to PPE and the possibility of transmission to exposed staff a structured questionnaire was administered and serum samples tested for SARS coronavirus by enzyme-linked immunosorbent assay (ELISA). Exposure was defined as presence on the SARS ward or contact with laboratory specimens, and close contact was presence in the patient's room. RESULTS The WHO physician died from respiratory failure on day 19. 112 of 129 exposed staff completed questionnaires, and the 70 who entered the patient's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent handwashing after exposure, 95% consistently used a fit-tested N95 or greater respirator, and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS. Serum samples from 35 close contacts obtained after day 28 had a negative result for SARS coronavirus antibody. CONCLUSIONS Hospitalization of one of the earliest SARS patients with documented coronavirus shedding provided multiple opportunities for spread to the hospital staff, but strict enforcement of conservative infection control recommendations throughout the hospitalization was associated with no transmission.


title: [Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome].

text: OBJECTIVE To explore and analyze the clinical manifestation, diagnosis, management and maternal-perinatal prognosis of severe acute respiratory syndrome (SARS)-complicated pregnancy in second and third trimesters. METHODS Clinical data of 5 inpatients with SARS-complicated pregnancy in second and third trimesters from 4(th) February to 17(th) March 2003 were analyzed retrospectively. RESULTS Five patients were all primigravida (including 2 twins). Two were infected in second trimester while the other 3 in third trimester with 2 hospital-acquired infections and 3 community-acquired infections. All patients had fever (5/5), 3 chills or rigor, 4 cough; 2 with decreased lymphocyte, 2 decreased platelet, 3 elevated alanine aminotransferase (ALT), 4 hypoalbuminemia, 5 abnormal chest radiographs. All 5 patients were cured with 1 requiring intensive care. 5 neonates including 1 twins have been followed up without evidence of SARS infections up to now. In a twin-pregnancy 1 fetus was lost while the pregnant's situation is stable. CONCLUSIONS Common diagnostic criteria were Suitable for SARS-complicated pregnancy in second and third trimesters, but attention should be paid to the interaction between SARS and special pathological changes during pregnancy. Patients should be isolated and monitored intensively with timely cesarean section in severe cases, which could significantly decrease the maternal-perinatal mortality. The use of corticosteroids and psychological supports need further study.


docid: npqooqli

title: Human coronavirus NL-63 infections in children: a 1-year study.

text: Human coronavirus NL63 (HCoV-NL63), a newly discovered coronavirus, has been associated with acute respiratory tract infections (ARI). Important questions pertaining to the contribution of HCoV-NL63 to ARI and its impact on public health remain. We reviewed HCoV-NL63 in specimens collected from 13 November 2002 to 31 December 2003 from the Stollery Children's Hospital on patients of <17 years of age to assess the role of this virus in ARI in children. Twenty-six of 1,240 specimens (2.1%) from seven outpatients and 19 inpatients aged 7 days to 9.5 years tested positive for HCoV-NL63 by reverse transcription-PCR. The majority of outpatients (86%) had upper respiratory tract infections, while the majority of inpatients (58%) had bronchiolitis. Peak HCoV-NL63 activity occurred in March. These results provide further evidence of the importance of HCoV-NL63 in ARI in children.


title: Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.

text: OBJECTIVE To describe the outbreak of severe acute respiratory syndrome in Hong Kong. DESIGN Descriptive case series. SETTING Hong Kong, Special Administrative Region, China RESULTS The outbreak started with a visitor from southern China on 21 February. At the hospitals where the first cases were treated the disease spread quickly among healthcare workers, and then out into the community as family members became infected. By 1 April, 685 cases had been reported with 16 deaths. Symptoms include high fever and one or more respiratory symptoms (including cough, shortness of breath, and difficulty breathing). Changes in lung tissue suggest that part of the lung damage is due to cytokines induced by the microbial agent, which has led to empirical treatment with corticosteroids, broad spectrum antiviral agent, and antibacterial cover. There is strong evidence that a novel coronavirus is the pathogen. Precautions for droplet infection should be instituted, including the wearing of masks and rigorous disinfection and hygiene procedures. On 27 March the Department of Health announced drastic measures, including vigorous contact tracing and examination, quarantine of contacts in their homes, and closure of all schools and universities. CONCLUSION The rapidity of the spread of the disease and the morbidity indicate that the agent responsible is highly infectious and virulent. Strict infection control measures for droplet and contact transmission by healthcare workers, a vigilant healthcare profession, and public education are essential for disease prevention.


title: Immunoassay of infectious agents.

text: Immunoassays have evolved for a broad range of applications since the pioneering work of Yalow and Berson who developed the first competitive radioimmunoassay (RIA) for human insulin in 1959. Immunoassay detection of specific antigens and host-produced antibodies directed against such antigens consitutes one of the most widely used and successful methods for diagnosing infectious diseases (IDs). The number and variety of new assay systems that are continually being developed reflect the increasing demand for immunoassays possessing greater sensitivity, speed, and ease of use. This trend has been driven, in part, by the need for improved immunodiagnostic systems to perform rapid testing and counter emerging IDs and biothreat (BT) agents. Another factor driving this trend is the need to integrate immunoassays with more sensitive nucleic acid-based methods for a comprehensive approach. Here we examine the development of immunoassays, some of the key formats used for the detection and identification of BT/ID agents, and the application of these technologies under different scenarios.


title: Diagnosis and Management of Periprosthetic Shoulder Infections.

text: ➤ The unique bacterial flora of the shoulder present diagnostic and treatment challenges that are distinct from those seen with failed hip and knee arthroplasties.➤ The presentation, diagnosis, and management of suppurative periprosthetic joint infections of the shoulder are similar to those of the hip and the knee.➤ Failed arthroplasties with positive cultures (FAPCs) are poorly performing shoulder reconstructions associated with low-virulence microorganisms that do not evoke a suppurative inflammatory response. Propionibacterium acnes is the predominant bacterium isolated from these cases.➤ With improved surgeon awareness and the addition of longer tissue-culture incubation times, detection of FAPCs has become more common. However, management is hampered by the lack of reliable, timely tests that can determine the presence of less virulent organisms in the preoperative or intraoperative settings.➤ The implications of positive culture results in FAPCs are unclear. Key test characteristics such as the false-positive rate and the prevalence of positive cultures in well-performing shoulders are unknown as there is no useful confirmatory test to validate the culture data and no reliable way to detect the presence of less virulent microorganisms without reoperation.➤ Soft-tissue and osseous deficits are frequently encountered when revising previously infected shoulders. The rate of complications in these scenarios is high, and the outcomes are the least favorable compared with revisions for any other indication.➤ The development of a consensus definition of a periprosthetic shoulder infection is critical to future investigations of these devastating complications.


title: Relational Modeling for Robust and Efficient Pulmonary Lobe Segmentation in CT Scans.

text: Pulmonary lobe segmentation in computed tomography scans is essential for regional assessment of pulmonary diseases. Recent works based on convolution neural networks have achieved good performance for this task. However, they are still limited in capturing structured relationships due to the nature of convolution. The shape of the pulmonary lobes affect each other and their borders relate to the appearance of other structures, such as vessels, airways, and the pleural wall. We argue that such structural relationships play a critical role in the accurate delineation of pulmonary lobes when the lungs are affected by diseases such as COVID-19 or COPD. In this paper, we propose a relational approach (RTSU-Net) that leverages structured relationships by introducing a novel non-local neural network module. The proposed module learns both visual and geometric relationships among all convolution features to produce self-attention weights. With a limited amount of training data available from COVID-19 subjects, we initially train and validate RTSU-Net on a cohort of 5000 subjects from the COPDGene study (4000 for training and 1000 for evaluation). Using models pre-trained on COPDGene, we apply transfer learning to retrain and evaluate RTSU-Net on 470 COVID-19 suspects (370 for retraining and 100 for evaluation). Experimental results show that RTSU-Net outperforms three baselines and performs robustly on cases with severe lung infection due to COVID-19.


title: Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest.

text: Increased stability has been reported with both autografts and allografts for anterior cruciate ligament (ACL) reconstruction. However, meta-analysis has shown significantly lower overall knee stability rates and more than double the abnormal stability rate with allografts. Some issues surrounding allograft sterilization (ie, risk of disease transmission) are unresolved, and cost is also a concern. Single-bundle ACL reconstruction can produce high stability rates when tunnels are properly placed, but there is evidence that double-bundle repair may offer greater rotatory stability. Cortical fixation has been associated with increased stability owing to the high stiffness of cortical bone. Anterior and posterior approaches are both recommended. The controversy related to single-bundle versus double-bundle ACL reconstruction remains unresolved.


FDA places "black box" warning on antidiabetes drugs.


title: Human coronavirus OC43 causes influenza-like illness in residents and staff of aged-care facilities in Melbourne, Australia.

text: Three outbreaks of respiratory illness associated with human coronavirus HCoV-OC43 infection occurred in geographically unrelated aged-care facilities in Melbourne, Australia during August and September 2002. On clinical and epidemiological grounds the outbreaks were first thought to be caused by influenza virus. HCoV-OC43 was detected by RT-PCR in 16 out of 27 (59%) specimens and was the only virus detected at the time of sampling. Common clinical manifestations were cough (74%), rhinorrhoea (59%) and sore throat (53%). Attack rates and symptoms were similar in residents and staff across the facilities. HCoV-OC43 was also detected in surveillance and diagnostic respiratory samples in the same months. These outbreaks establish this virus as a cause of morbidity in aged-care facilities and add to increasing evidence of the significance of coronavirus infections.


Health communications and community mobilization during an Ebola response: partnerships with community and faith-based organizations.


docid: zbblwhiw

title: A comparison of revisional and primary bariatric surgery.

text: BACKGROUND Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. METHODS We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. RESULTS We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p < 0.001); their BMI at 12-month follow-up was similar to that of primary clinic patients (34.5 ± 7.0, p = 0.7). Complications were significantly more frequent in revision patients than primary patients (41% v. 15%, p < 0.001). CONCLUSION A bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system.


Vacuolar encephalomyelopathy in mice induced by intracerebral inoculation with a coronavirus JHM-CC strain.


Maintaining a Medical Oncology Service during the Covid-19 Pandemic.


title: The Role of Synovial Cytokines in the Diagnosis of Periprosthetic Joint Infections: Current Concepts.

text: Periprosthetic joint infection (PJI) is a serious and potentially devastating complication of total joint arthroplasty. Accurate diagnosis of PJI is of utmost importance, but differentiating septic from aseptic failed total joint arthroplasty is extremely challenging, and improper management can lead to significant morbidity. The gold standard for PJI diagnosis is based on standardized laboratory and clinical criteria but relies on preoperative and intraoperative findings, which can be unreliable. Given these limitations, research has focused on new methods for diagnosing PJI. Synovial fluid inflammatory cytokines have been found to accurately diagnose PJI. In this article, we review the synovial fluid cytokines that are being used as aids in PJI diagnosis.


title: Barriers to public health management of a pertussis outbreak in Arkansas.

text: BACKGROUND During the 2001-2002 respiratory season, Arkansas experienced one of its worst pertussis outbreaks. This crisis occurred shortly after the September 11, 2001, terrorist attacks. OBJECTIVE To determine whether vulnerabilities in the public health infrastructure existed in the context of emerging infectious diseases or possible bioterrorist attacks. DESIGN Key personnel involved in the Arkansas pertussis outbreak were interviewed, and health department epidemiologic data were reviewed. SETTING Observations were made for the statewide private-public management of the epidemic. PARTICIPANTS Physicians, infectious disease specialists, epidemiologists, field nurses, health department staff, laboratory staff, and administrators. MAIN OUTCOME MEASURES Diagnosis capability; vaccine, prophylaxis, and treatment programs; and effectiveness of global outbreak management. RESULTS Diagnosis of pertussis was a major barrier to management of the outbreak. The nonspecific clinical diagnosis, unreliability of testing methods, excessive number of samples, unavailability of reagents, and inadequate transport system, laboratory personnel, and equipment all impeded effective diagnosis. Vaccine shortage was not believed to contribute to the extent of the outbreak. Prophylaxis was problematic because of feared adverse effects of drugs and uncertainty about the efficacy of new drugs, but compliance was found to be good. From a public health perspective, isolation procedures, school absence policies, and health department referrals to private physicians all contributed to confusion. Problems with communications, staffing, and public cooperation were identified. Despite these barriers, the epidemic was well tolerated, with no known mortality and limited morbidity. CONCLUSIONS Despite many identified barriers to effective public health management, Arkansas tolerated its worst epidemic of pertussis in many years. However, were the state to experience an outbreak of a more pathogenic agent, introduced either naturally or of bioterrorist origin, these vulnerabilities could become critical. Natural outbreaks serve as excellent experiences on which to recognize and correct barriers to public health management.


title: Use of a novel adjunctive kissing-balloon technique with the Trellis device to successfully prevent embolization across juxtaposed kissing aortoiliac stents.

text: The Trellis thrombectomy system (Covidien) has been used successfully to perform isolated pharmacomechanical thrombectomy of both venous and arterial thrombi. The device is designed to provide localized treatment while preventing both systemic spread of the thrombolytic agent and also distal embolization. However, when this device is utilized to remove thrombi at bifurcation lesions, embolization into the contralateral vessel can potentially occur. We describe a novel and simple technique of adjunctive kissing balloon inflation while using the Trellis device for the management of an aortoiliac occlusion that occurred in one of two juxtaposed stents previously placed in the distal aorta into the bilateral iliac arteries. This technique prevented distal embolization into the contralateral iliac artery.


Selective tropism of MHV3 for CNS cells and consequences of MHV3 infection on CNS cells activities.


Reproductive toxicology. Acetaminophen.


title: The relationship between the feline coronavirus antibody titre and the age, breed, gender and health status of Australian cats.

text: OBJECTIVES To investigate the relationship between Feline Coronavirus (FCoV) antibody titres and age, breed, gender and health status of Australian cats DESIGN Retrospective study PROCEDURE Results from two serological tests that measure FCoV antibody levels, the Coronase test and the 7B Feline Infectious Peritonitis (FIP) test, were recorded over a 2-year period, with patient signalment, history, presenting complaint and the reason for ordering the test (as available). Results from each antibody test were related to four explanatory variables (breed, age, gender and health status at the time of blood collection) using univariate ordinal logistic regression analyses, Mann Whitney U tests, one-sample sign tests or Kruskal-Wallis analyses, as appropriate. RESULTS Results from 637 Coronase and 191 7B FIP antibody tests were recorded. There were significant differences in median Coronase antibody titres between breeds of cats (P < 0.0005). Specifically, the median Coronase antibody titres of Siamese, Persians, Domestic Shorthairs and Bengal cats (100) were significantly lower than that of British Shorthairs, Cornish Rex and Burmese cats (400, P < 0.0005). There was no statistical relationship between the Coronase or 7B FIP antibody titres and age, gender or overall health status, even when considering only those cats in which clinical signs suggestive of FIP were present. CONCLUSION This study reinforces the complexity of interpreting serological tests for FCoV in both healthy cats and patients with signs compatible with FIR Unique to this study is the detection of a significant relationship between breed and median FCoV antibody titre. This supports the theory that breed related differences exist in response to FCoV infection. The distribution of median Coronase antibody titres by breed was very similar to the pattern of breed predisposition to FIP recently reported in Sydney.


title: Ventilator management of adult patients in the emergency department.

text: There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. An update on managing COVID-19-associated acute respiratory distress syndrome is also included.


title: Carbohydrate-binding agents: a potential future cornerstone for the chemotherapy of enveloped viruses?

text: Carbohydrate-binding agents (CBAs) inhibit HIV-1 and it is proposed that therapy with such agents may have important implications for the future of anti-HIV therapy. Examples of CBAs include the procaryotic cyanovirin-N (CV-N), plant lectins such as HHA, GNA, NPA, CA and UDA, the monoclonal antibody 2G12 directed against a glycan-containing epitope on HIV envelope gp120, and the mannose-specific non-peptidic antibiotic Pradimicin A, which inhibits the entry of HIV-1 into its target cells. CBAs prevent not only virus infection of susceptible cells, but also inhibit syncytia formation between persistently HIV-infected cells and uninfected lymphocytes. In addition, CBAs may also prevent DC-SIGN-mediated transmission of HIV to T-lymphocytes. Therefore, CBAs qualify as potential microbicide drugs. Long-term exposure of HIV to CBAs in cell culture results in the progressive deletion of N-glycans of HIV gpl20 in an attempt of the virus to escape drug pressure. In this respect, the CBAs are endowed with a high genetic barrier. Multiple mutations at N-glycosylation sites are required before pronounced phenotypic drug resistance development becomes evident. CBA treatment of HIV may consist of a novel chemotherapeutic concept with a dual mechanism of antiviral action: a direct antiviral activity by preventing HIV entry and transmission to its target cells, and an indirect antiviral activity by forcing HIV to delete glycans in its gpl20 envelope. The latter phenomenon will result in creating 'holes' in the protective glycan shield of the HIV envelope, whereby the immune system may become triggered to produce neutralizing antibodies against previously hidden immunogenic epitopes of gp120. If this concept can be proven in in vivo, low-molecular-weight non-peptidic CBAs such as Pradimycin A may become the cornerstone for the efficient treatment of infections of those viruses that require a glycosylated envelope (that is, HIV, but also hepatitis C virus) for entry into its target cells. In addition, influenza virus and coronavirus infections may also qualify to be treated by CBAs.


title: Evaluation of two Toxoplasma gondii serologic tests used in a serosurvey of domestic cats in California.

text: We evaluated the sensitivity (Se) and specificity (Sp) of an IgG enzyme-linked immunosorbent assay (ELISA) and IgG indirect fluorescent antibody test (IFAT) for detection of Toxoplasma gondii-specific antibodies in sera from 2 cat populations using a Bayesian approach. Accounting for test covariance, the Se and Sp of the IgG ELISA were estimated to be 92.6% and 96.5%, and those of the IgG IFAT were 81.0% and 93.8%, respectively. Both tests performed poorly in cats experimentally coinfected with feline immunodeficiency virus and T. gondii. Excluding this group, Se and Sp of the ELISA were virtually unchanged (92.3% and 96.4%, respectively), whereas the IFAT Se improved to 94.2% and Sp remained stable at 93.7%. These tests and an IgM ELISA were applied to 123 cat sera from the Morro Bay area, California, where high morbidity and mortality attributable to toxoplasmosis have been detected in southern sea otters. Age-adjusted IgG seroprevalence in this population was estimated to be 29.6%, and it did not differ between owned and unowned cats. Accounting for Se, Sp, and test covariances, age-adjusted seroprevalence was 45.0%. The odds for T. gondii seropositivity were 12.3-fold higher for cats aged >12 mo compared with cats aged <6 mo.


Antigenic relationships among the coronaviruses of man and between human and animal coronaviruses.


title: Use of a Respiratory Volume Monitor to Assess Respiratory Competence in Cardiac Surgery Patients After Extubation.

text: BACKGROUND Patients who have undergone cardiac surgery are generally mechanically ventilated postoperatively. Early postoperative extubation is currently recommended in anesthesia guidelines. No current technology can accurately, non-invasively, measure respiratory competence after extubation. Pulse oximetry has been helpful, but this is a late indicator of respiratory compromise. A novel, non-invasive, respiratory volume monitor (RVM) has been shown to deliver accurate continuous, real-time minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) measurements and provide an objective measure of respiratory competence. The RVM will accurately reflect MV, TV and RR in cardiac surgery patients before and after extubation. METHODS RVM traces were recorded from patients before and after cardiac surgery. Continuous monitoring began on admission to the unit and was ended at 24 h after extubation. RVM-based MV, TV and RR were calculated from 30-s segments. MV, TV and RR were also continuously recorded from the ventilator prior to extubation. The RVM was calibrated to each patient using the readings from the ventilator. RESULTS During mechanical ventilation, the RVM measured TVs strongly correlated with the ventilator TVs (r = 0.97). Following extubation, the patient's breathing became more erratic and TVs and MVs decreased. Within 1 h, all patients studied showed a marked recovery of MV and TV. CONCLUSIONS RVM-based MV, TV and RR correlated well with similar data collected from ventilators. After extubation, RVM shows promise as a means to monitor respiratory competence of non-intubated patients, and has implications for use in other settings and improving patient safety.


title: Assessing recovery and establishing prognosis following total knee arthroplasty.

text: BACKGROUND AND PURPOSE Information about expected rate of change after arthroplasty is critical for making prognostic decisions related to rehabilitation. The goals of this study were: (1) to describe the pattern of change in lower-extremity functional status of patients over a 1-year period after total knee arthroplasty (TKA) and (2) to describe the effect of preoperative functional status on change over time. SUBJECTS Eighty-four patients (44 female, 40 male) with osteoarthritis, mean age of 66 years (SD=9), participated. METHODS Repeated measurements for the Lower Extremity Functional Scale (LEFS) and the Six-Minute Walk Test (6MWT) were taken over a 1-year period. Data were plotted to examine the pattern of change over time. Different models of recovery were explored using nonlinear mixed-effects modeling that accounted for preoperative status and gender. RESULTS Growth curves were generated that depict the rate and amount of change in LEFS scores and 6MWT distances up to 1 year following TKA. The curves account for preoperative status and gender differences across participants. DISCUSSION AND CONCLUSION The greatest improvement occurred in the first 12 weeks after TKA. Slower improvement continued to occur from 12 weeks to 26 weeks after TKA, and little improvement occurred beyond 26 weeks after TKA. The findings can be used by physical therapists to make prognostic judgments related to the expected rate of improvement following TKA and the total amount of improvement that may be expected.


title: Mouse hepatitis coronavirus A59 nucleocapsid protein is a type I interferon antagonist.

text: The recent emergence of several new coronaviruses, including the etiological cause of severe acute respiratory syndrome, has significantly increased the importance of understanding virus-host cell interactions of this virus family. We used mouse hepatitis virus (MHV) A59 as a model to gain insight into how coronaviruses affect the type I alpha/beta interferon (IFN) system. We demonstrate that MHV is resistant to type I IFN. Protein kinase R (PKR) and the alpha subunit of eukaryotic translation initiation factor are not phosphorylated in infected cells. The RNase L activity associated with 2',5'-oligoadenylate synthetase is not activated or is blocked, since cellular RNA is not degraded. These results are consistent with lack of protein translation shutoff early following infection. We used a well-established recombinant vaccinia virus (VV)-based expression system that lacks the viral IFN antagonist E3L to screen viral genes for their ability to rescue the IFN sensitivity of the mutant. The nucleocapsid (N) gene rescued VVDeltaE3L from IFN sensitivity. N gene expression prevents cellular RNA degradation and partially rescues the dramatic translation shutoff characteristic of the VVDeltaE3L virus. However, it does not prevent PKR phosphorylation. The results indicate that the MHV N protein is a type I IFN antagonist that likely plays a role in circumventing the innate immune response.


title: Bottom-up control of consumers leads to top-down indirect facilitation of invasive annual herbs in semiarid Chile.

text: The abundance of exotic plants is thought to be limited by competition with resident species (including plants and generalist herbivores). In contrast, observations in semiarid Chile suggest that a native generalist rodent, the degu (Octodon degus), may be facilitating the expansion of exotic annual plants. We tested this hypothesis with a 20-year data set from a World Biosphere Reserve in mediterranean Chile. In this semiarid environment, rainfall varies annually and dramatically influences cover by both native and exotic annual plants; degu population density affects the composition and cover of exotic and native annual plants. In low-rainfall years, cover of both native and exotic herbs is extremely low. Higher levels of precipitation result in proportional increases in cover of all annual plants (exotic and native species), leading in turn to increases in degu population densities, at which point they impact native herbs in proportion to their greater cover, indirectly favoring the expansion of exotic plants. We propose that bottom-up control of consumers at our site results in top-down indirect facilitation of invasive annual herbs, and that this pattern may be general to other semiarid ecosystems.


title: Is there an alternative?

text: EARLIER THIS year, scientists claimed a partial victory in the fight against severe acute respiratory syndrome (SARS). To date, there have been more than 8,000 cases of SARS worldwide and more than 750 deaths. So when Dutch scientists working for the World Health Organization announced that they had identified the virus that causes SARS, there was general rejoicing. David Heymann, the WHO executive director responsible for communicable diseases, said he was '99 per cent sure' that SARS was caused by a mutant form of coronavirus, the virus that causes the common cold.


title: Fever attribution in the SARS outbreak.

text: Fever as a somatised symptom is not commonly described. We report a patient who complained of recurrent unexplained "fevers" during the severe acute respiratory syndrome (SARS) outbreak in Singapore. The presentation, while likely to be peculiar to the outbreak, posed challenges and difficulties to the primary care doctors. Investigations did little to allay her anxiety. Instead, appreciating the psychosocial backdrop and how the SARS outbreak affects patient and doctor may be useful.


docid: bqyoveoa

title: Molecular epidemiology of SARS--from Amoy Gardens to Taiwan.


title: Accuracy of screening for inhalational anthrax after a bioterrorist attack.

text: BACKGROUND Bioterrorism using anthrax claimed five lives in the United States in 2001 and remains a potential public health threat. In the aftermath of a large-scale anthrax attack, mass screening to identify early inhalational anthrax may improve both the management of individual cases and the efficiency of health resource utilization. PURPOSE To develop the evidence base for outpatient anthrax screening protocols by quantifying differences in clinical presentation between inhalational anthrax and common viral respiratory tract infections. DESIGN Review, compilation, and data extraction from English-language case reports of inhalational anthrax and epidemiologic studies of influenza and other viral respiratory infections. DATA SOURCES 13 reports of 28 cases of inhalational anthrax from 1920 to 2001 and 5 studies reporting on the clinical features of 2762 cases of influenza and 1932 cases of noninfluenza viral respiratory disease. DATA SYNTHESIS Characterization of presenting clinical symptoms in anthrax and viral disease and calculation of likelihood ratios for the presence of selected clinical features. RESULTS Fever and cough do not reliably discriminate between inhalational anthrax and viral respiratory tract infection. Features suggestive of anthrax include the presence of nonheadache neurologic symptoms (positive likelihood ratio cannot be calculated), dyspnea (positive likelihood ratio, 5.3 [95% CI, 3.7 to 7.4]), nausea or vomiting (positive likelihood ratio, 5.1 [CI, 3.0 to 8.5]), and finding of any abnormality on lung auscultation (positive likelihood ratio, 8.1 [CI, 5.3 to 12.5]). In contrast, rhinorrhea (positive likelihood ratio, 0.2 [CI, 0.1 to 0.4]) and sore throat (positive likelihood ratio, 0.2 [CI, 0.1 to 0.5]) are more suggestive of viral respiratory tract infection. CONCLUSION Inhalational anthrax has characteristic clinical features that are distinct from those seen in common viral respiratory tract infections. Screening protocols based on these features may improve rapid identification of patients with presumptive inhalational anthrax in the setting of a large-scale anthrax attack.


title: Use of Equine Derived Pericardium as a Biological Cover To Promote Closure of a Complicated Wound With Associated Scleroderma and Raynaud's Disease .

text: A 39-year-old man with previously undiagnosed scleroderma was admitted to the UCSD Medical Center with bilateral, limb-threatening necrotic lower extremity ulcers extending to underlying fascia and muscle. Rather than amputate the extremities, the patient requested alternative treatment and underwent extensive tissue debridement followed by placement of an equine pericardium xenograft. Subsequent to treatment, the patient underwent weekly examinations and dressing changes without additional treatment. The patient was ambulating without assistance and with complete closure of all wounds in 10 weeks. The patient remained without wound recurrence at a recent 6-month follow-up visit .


title: Comparison of serologic assays for measurement of antibody response to coronavirus in cats.

text: Serologic virus neutralization tests, indirect immunofluorescence tests, and ELISA, using tissue culture-adapted feline infectious peritonitis virus (FIPV) or feline enteric coronavirus (FECV) were compared for their ability to distinguish specific virus exposure in cats. Sera of specific-pathogen-free cats inoculated with virulent or modified FIPV or FECV were used to compare the sensitivity and specificity of the homologous assays to a heterologous assay that measures antibody reactivity with transmissible gastroenteritis virus of swine. The geometric means of the serologic titers in FIPV and FECV assays were higher for FIPV- or FECV-infected specific-pathogen-free cats than the geometric means of the transmissible gastroenteritis virus assays for most groups. None of the assays was specific enough to discern the virus to which a cat had been exposed. However, the FIPV virus neutralization test appeared to be more sensitive for detection of an early response to FIPV infection than did the FIPV immunofluorescence test or FIPV-ELISA.


title: Microbiological monitoring of laboratory mice and biocontainment in individually ventilated cages: a field study.

text: Over recent years, the use of individually ventilated cage (IVC) rack systems in laboratory rodent facilities has increased. Since every cage in an IVC rack may be assumed to be a separate microbiological unit, comprehensive microbiological monitoring of animals kept in IVCs has become a challenging task, which may be addressed by the appropriate use of sentinel mice. Traditionally, these sentinels have been exposed to soiled bedding but more recently, the concept of exposure to exhaust air has been considered. The work reported here was aimed firstly at testing the efficiency of a sentinel-based microbiological monitoring programme under field conditions in a quarantine unit and in a multi-user unit with frequent imports of mouse colonies from various sources. Secondly, it was aimed at determining biocontainment of naturally infected mice kept in an IVC rack, which included breeding of the mice. Sentinels were exposed both to soiled bedding and to exhaust air. The mice which were used in the study carried prevalent infectious agents encountered in research animal facilities including mouse hepatitis virus (MHV), mouse parvovirus (MPV), intestinal flagellates and pinworms. Our data indicate that the sentinel-based health monitoring programme allowed rapid detection of MHV, intestinal flagellates and pinworms investigated by a combination of soiled bedding and exhaust air exposure. MHV was also detected by exposure to exhaust air only. The IVC rack used in this study provided biocontainment when infected mice were kept together with non-infected mice in separate cages in the same IVC rack.


The multiple aetiology of viral hepatitis.


The flu and you.


Replication of murine coronaviruses in somatic cell hybrids formed between a mouse fibroblast cell line and either a rat Schwannoma line or a rat glioma line.


title: False-positive results in a recombinant severe acute respiratory syndrome-associated coronavirus (SARS-CoV) nucleocapsid-based western blot assay were rectified by the use of two subunits (S1 and S2) of spike for detection of antibody to SARS-CoV.

text: To evaluate the reactivity of the recombinant proteins expressed in Escherichia coli strain BL21(DE3), a Western blot assay was performed by using a panel of 78 serum samples obtained, respectively, from convalescent-phase patients infected with severe acute respiratory syndrome-associated coronavirus (SARS-CoV) (30 samples) and from healthy donors (48 samples). As antigen for detection of SARS-CoV, the nucleocapsid protein (N) showed high sensitivity and strong reactivity with all samples from SARS-CoV patients and cross-reacted with all serum samples from healthy subjects, with either those obtained from China (10 samples) or those obtained from France (38 serum samples), giving then a significant rate of false positives. Specifically, our data indicated that the two subunits, S1 (residues 14 to 760) and S2 (residues 761 to 1190), resulted from the divided spike reacted with all samples from SARS-CoV patients and without any cross-reactivity with any of the healthy serum samples. Consequently, these data revealed the nonspecific nature of N protein in serodiagnosis of SARS-CoV compared with the S1 and S2, where the specificity is of 100%. Moreover, the reported results indicated that the use of one single protein as a detection antigen of SARS-CoV infection may lead to false-positive diagnosis. These may be rectified by using more than one protein for the serodiagnosis of SARS-CoV.


title: Genetic basis for species vulnerability in the cheetah.

text: A population genetic survey of over 200 structural loci previously revealed that the South African cheetah (Acinonyx jubatus jubatus) has an extreme paucity of genetic variability, probably as a consequence of a severe population bottleneck in its recent past. The genetic monomorphism of the species is here extended to the major histocompatibility complex, since 14 reciprocal skin grafts between unrelated cheetahs were accepted. The apparent consequences of such genetic uniformity to the species include (i) great difficulty in captive breeding, (ii) a high degree of juvenile mortality in captivity and in the wild, and (iii) a high frequency of spermatozoal abnormalities in ejaculates. The species vulnerability of the cheetah was demonstrated by an epizootic of coronavirus-associated feline infectious peritonitis in an Oregon breeding colony in 1983. Exposure and spread of the coronavirus, which has a very low morbidity in domestic cats (approximately 1 percent), has decimated a heretofore productive and healthy captive population. The extreme genetic monomorphism, especially at the major histocompatibility complex, and the apparent hypersensitivity of the cheetah to a viral pathogen may be related, and provide a biological basis for understanding the adaptive significance of abundant genetic variation in outbred mammalian species.


docid: yahrorbr

title: Detection of Japanese encephalitis virus antibodies in bats in Southern China.

text: In this study, 336 bats of eight species were collected during 2004-2007 in six provinces of Southern China. Antibodies against Japanese encephalitis virus (JEV) were detected by ELISA in 43 of 336 (12.8%) serum samples. Among those ELISA-positive samples, 11 serum samples had neutralizing antibodies against JEV. No JEV was detected in brain and liver samples using specific real-time reverse transcriptase-polymerase chain reaction. This is the first report of JEV neutralizing antibodies in bats in China, which reinforces that bats can be involved in the life cycle of this virus.


title: [Acute viral respiratory diseases as a cause of work disability in miners during an inter-epidemic period].

text: During the interepidemic period between October 1 and November 20 1987 96 miners from a coal mine were examined who suffered from diseases of the upper airways which caused their work incapacity. In paired sera the rise of antibodies against M. pneumoniae and respiratory viruses were examined (adeno, influenza virus A and B, Coxsackie A21, corona 229E and OC43, parainfluenza type 1, 2 and 3, rhino type 13 and 44, RS). A viral aetiology was confirmed in 31 patients (32.3%). An evident rise of antibodies against the following viruses was found: adenoviruses 3X, Coxsackie A21 5X, coronaviruses 229E 1X and OC43 2X, parainfluenza virus type 1 1X and type 2 5X, rhinovirus type 13 11X and type 44 4X, RS virus 1X. As to the period of work incapacity and clinical manifestations, there was no difference between the diseases caused by different agents. The results of the investigation indicate that also viruses which are not used in common diagnostic practice may frequently evoke diseases which cause work incapacity.


docid: dgmmdlfa

title: Medical multimedia retrieval 2.0.

text: OBJECTIVES The objective of this article is to provide an overview of current trends in medical multimedia retrieval. This state of the art is then compared with trends and techniques in the Web 2.0 field that addresses several of the problems of current multimedia retrieval and may help in solving them. METHODS The article uses a review of the current literature on medical imaging and medical multimedia retrieval from the Pubmed and Google scholar literature search engines. Other sources include popular Web 2.0 web pages and articles on Web 2.0 describing the main concepts of these technologies in the medical domain. RESULTS Web 2.0 has significantly changed the way we interact with the Internet and has created an important added-value by promoting activities of users and interactions between users. In the medical field, there are many examples of adoption of these methods and multimedia retrieval can play an important role in this field by supplying the right data at the right time. CONCLUSIONS Medical multimedia retrieval still has a long way to go to become an everyday tool in the medical field and in clinical practice. Still, when reusing and linking much of the electronic patient record's data, image retrieval can be a technology to help extract important knowledge and navigate through the large amounts of data. Key challenges for more widespread adoption of these technologies involve legal rules for secondary use of medical data because currently only very few image data sets with ground truth have been made available.


title: Mucosal exudation of fibrinogen in coronavirus-induced common colds.

text: We studied the mucosal exudation of plasma in relation to pathophysiological events during an induced common cold. Coronavirus 229E was inoculated nasally in 20 healthy volunteers under controlled conditions. Ten volunteers developed the common cold, determined by symptom scores and serology. The bulk plasma exudate was monitored, using fibrinogen (MW 340 kD) in nasal lavage fluids as an endogenous marker. Following inoculation, anterior rhinoscopy and objective registrations of nasal mucosal temperature, nasal discharge weight, and nasal blockage index by peak expiratory air flow, were followed twice daily for 6 days. Mucosal plasma exudation, as assessed by fibrinogen in lavage fluids, increased hundredfold after virus inoculation, concomitantly with the subjective symptoms and objective physiological changes. We propose that this exudation reflects the degree of subepithelial inflammation, and suggests that plasma bulk exudate, including all potent plasma protein systems may be involved in the resolution of acute viral rhinitis--common cold.


title: The changing world of biocontainment and biosecurity.

text: Since the 1980s, a number of key events have significantly altered our ideas on biosecurity and the role of biocontainment laboratories, such as the bovine spongiform encephalopathy (BSE) and severe acute respiratory syndrome (SARS) outbreaks and the anthrax episode of 2001 in the USA. This has resulted in the development of plans to build "high containment" facilities around the world and an array of new regulations at both national and international levels regarding the management of pathogens, the operation of high containment facilities, the use of genetically modified material, and the transportation of such agents and personnel security issues. Considering the cost, however, it is debatable whether every country needs to build its own high containment facility. The Australian Animal Health Laboratory (AAHL) provides an example of what might be considered best practice in biocontainment while considering regulations, cost and need.


title: The effect of L3T4 T cell depletion on the pathogenesis of Theiler's murine encephalomyelitis virus infection in CBA mice.

text: Theiler's murine encephalomyelitis virus (TMEV) gives rise to a biphasic disease of the central nervous system (CNS) following intracranial inoculation of susceptible strains of mice. The early phase, during the first month, resembles poliomyelitis and in the late phase the mice suffer from inflammatory demyelination reminiscent of multiple sclerosis. In order to investigate the role of helper T cells in the acute and chronic phases of the disease we depleted mice of their L3T4 T cells in vivo with rat monoclonal antibodies, prior to infection and prior to the onset of clinical signs of demyelination. Mice depleted of their helper cells failed to produce antibodies to TMEV and consequently were unable to clear virus from the CNS and died within the first month of infection. Depletion of T cells before the demyelinating phase of the disease resulted in a marked decrease in the incidence of disease from 77% of the immunocompetent animals with clinical signs of paralysis to 36%. Immunocompetent TMEV-infected mice also developed antibodies against myelin suggesting that autoimmune mechanisms may play a role in TMEV-induced demyelination.


title: Stress and psychological distress among SARS survivors 1 year after the outbreak.

text: OBJECTIVE Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak. METHOD During the SARS outbreak in 2003, we used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors treated in 2 major hospitals (non-health care workers, n = 49; health care workers, n = 30). We invited SARS survivors from the same hospitals (non-health care workers, n = 63; health care workers, n = 33) to complete the PSS-10 again in 2004. At that time, they were also asked to complete the General Health Questionnaire (GHQ-12) and measures of depression, anxiety, and posttraumatic symptoms. PSS-10 scores were also obtained from matched community control subjects during the outbreak (n = 145) and again in 2004 (n = 112). RESULTS SARS survivors had higher stress levels during the outbreak, compared with control subjects (PSS-10 scores = 19.8 and 17.9, respectively; P < 0.01), and this persisted 1 year later (PSS-10 scores = 19.9 and 17.3, respectively; P < 0.01) without signs of decrease. In 2004, SARS survivors also showed worrying levels of depression, anxiety, and posttraumatic symptoms. An alarming proportion (64%) scored above the GHQ-12 cut-off that suggests psychiatric morbidity. During the outbreak, health care worker SARS survivors had stress levels similar to those of non-health care workers, but health care workers showed significantly higher stress levels in 2004 (PSS-10 score = 22.8, compared with PSS-10 score = 18.4; P < 0.05) and had higher depression, anxiety, posttraumatic symptoms, and GHQ-12 scores. CONCLUSIONS One year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.


title: Contribution of antibody-secreting cells induced in mucosal lymphoid tissues of pigs inoculated with respiratory or enteric strains of coronavirus to immunity against enteric coronavirus challenge.

text: Two antigenically related porcine coronaviruses, transmissible gastroenteritis virus (TGEV) which infects primarily the intestinal tract and causes severe diarrhea, and porcine respiratory coronavirus (PRCV) which infects the respiratory tract and causes subclinical or mild respiratory infections, presented a unique opportunity to study the interrelationship of gut-(GALT) and bronchus-associated lymphoid tissues (BALT) and their contribution to protective immunity against TGEV infection. Pigs were inoculated oral-nasally with TGEV or with PRCV at eleven days of age and challenged 24 days later with TGEV. All pigs initially given TGEV developed diarrhea and were completely protected against disease upon challenge. In contrast, pigs given PRCV had no clinical disease and shed virus in nasal secretions only; after challenge, 5 of 12 pigs developed diarrhea. Virus-specific IgG and IgA Ab-secreting cells (ASC) were enumerated by ELISPOT in the mesenteric and bronchial lymph nodes, spleens, and gut lamina propria at challenge and various post challenge days. Before challenge, in pigs exposed to TGEV, IgA-ASC in the duodenum and jejunum constituted the major ASC response. Conversely, PRCV-exposed pigs had mainly IgG-ASC in bronchial lymph nodes, with low ASC responses in the gut. After challenge, numbers of IgG-ASC increased rapidly in the gut lamina propria and mesenteric lymph nodes of only PRCV-primed pigs. Our results suggest that virus-specific IgG-ASC precursors derived in BALT of PRCV-primed pigs may migrate to the gut in response to TGEV challenge and contribute to the partial protection observed. The presence of IgA-ASC in the gut lamina propria of TGEV-primed pigs at the time of challenge correlated with complete protection against TGEV challenge. Thus a dichotomy exists in the BALT and GALT ASC responses; immunization via BALT induced a systemic type of response (IgG-ASC) and provided imperfect protection against an enteric pathogen, whereas immunization via GALT induced IgA-ASC and provided complete protection.


title: Alterations in endothelin receptors following hemorrhage and resuscitation by centhaquin.

text: Endothelin-1 (ET-1) acts on ET(A) and ET(B) receptors and has been implicated in hemorrhagic shock (shock). We determined effect of shock and resuscitation by hypertonic saline (saline) or centhaquin on ET(A) and ET(B) receptor expression. Rats were anesthetized, a pressure catheter was placed in the left femoral artery; blood was withdrawn from the right femoral artery to bring mean arterial pressure (MAP) to 35 mm Hg for 30 min, resuscitation was performed and 90 min later sacrificed to collect samples for biochemical estimations. Resuscitation with centhaquin decreased blood lactate and increased MAP. Protein levels of ET(A) or ET(B) receptor were unaltered in the brain, heart, lung and liver following shock or resuscitation. In the abdominal aorta, shock produced an increase (140 %) in ET(A) expression which was attenuated by saline and centhaquin; ET(B) expression was unaltered following shock but was increased (79 %) by centhaquin. In renal medulla, ET(A) expression was unaltered following shock, but was decreased (-61 %) by centhaquin; shock produced a decrease (-34 %) in ET(B) expression which was completely attenuated by centhaquin and not saline. Shock induced changes in ET(A) and ET(B) receptors in the aorta and renal medulla are reversed by centhaquin and may be contributing to its efficacy.


title: Competencies needed by graduate respiratory therapists in 2015 and beyond.

text: The American Association for Respiratory Care has established a task force to identify potential new roles and responsibilities of respiratory therapists (RTs) in 2015 and beyond. The first task force conference confirmed that the healthcare system in the United States is on the verge of dramatic change, driven by the need to decrease costs and improve quality. Use of evidence-based protocols that follow a nationally accepted standard of practice, and application of biomedical innovation continue to be important competency areas for RTs. The goal of the second task force conference was to identify specific competencies needed to assure safe and effective execution of RT roles and responsibilities in the future. The education needed by the workforce to assume the new responsibilities emerging as the healthcare system changes starts with a close look at the competencies that will be needed by graduate RTs upon entry into practice. Future specialty practice areas for experienced RTs are identified without defining specific competencies. We present the findings of the task force on the competencies needed by graduate RTs upon entry into practice in 2015.


title: Fibrino-necrotic typhlitis caused by Escherichia fergusonii in ostriches (Struthio camelus).

text: Two adult ostriches developed anorexia, prostration, and severe hemorrhagic diarrhea, dying 24 hr after the onset of clinical signs. On postmortem examination, the cecal mucosa showed locally extensive areas of hemorrhages and fibrino-necrotic typhlitis with a white-yellowish material covering the mucosal surface. Multiple serosal petequial hemorrhages and fibrinous peritonitis were present. Histologic examination revealed an intense mononuclear infiltration in the lamina propria and submucosa of the cecum and extensive superficial necrosis associated with fibrin and serocellular deposits. Several gram-negative bacterial colonies were observed within the necrotic areas. Samples from intestinal lesions were collected, and pure growth of Escherichia fergusonii was obtained. Escherichia fergusonii is a member of Enterobacteriaceae, closely related to Escherichia coli and Shigella sp., established as a new species of the genus Escherichia in 1985. In veterinary medicine, E. fergusonii has been reported in calves and sheep from dinical cases suggestive of salmonellosis. To our knowledge, this report represents the first description of E. fergusonii associated with enteritis in ostrich.