title: Screening accuracy for late-life depression in primary care: a systematic review.

text: OBJECTIVE To determine the accuracy of depression screening instruments for older adults in primary care. STUDY DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO (search dates 1966 to January 2002), and the Cochrane database on depression, anxiety and neurosis. We also searched the second Guide to Clinical Preventive Services, the 1993 Agency for Health Care Policy and Research Clinical Practice Guideline on Depression, and recent systematic reviews. Hand-checking of bibliographies and extensive peer review were also used to identify potential articles. OUTCOMES MEASURED A predefined search strategy targeted only studies of adults aged 65 years or older in primary care or community settings, including long-term care. Articles were included in this review if they reported original data and tested depression screening instruments against a criterion standard, yielding sensitivity and specificity. RESULTS Eighteen articles met criteria and are included in this review, representing 9 different screening instruments. The most commonly evaluated were the Geriatric Depression Scale (30- and 15-item versions), the Center for Epidemiologic Studies Depression Scale, and the SelfCARE(D). Differences in the performance of these 3 instruments were minimal; sensitivities ranged from 74% to 100% and specificities ranged from 53% to 98%. CONCLUSIONS Accurate and feasible screening instruments are available for detecting late-life depression in primary care. More research is needed to determine the accuracy of depression screening instruments for demented individuals, and for those with subthreshold depressive disorders.


The role of CD4 and CD8 T cells in MHV-JHM-induced demyelination.


SARS: has it been a media fad or something to worry about?


title: Laparoscopic Spleen Surgery: Baia Mare County Emergency Hospital Experience, Romania.

text: BACKGROUND Spleen surgery is a surgery without anastomosis and without the modification of the body's physiological circuits; therefore, the difference in the size of the incision between the laparoscopic and the open approach determines the main advantages of the laparoscopic surgery: small amounts of painkillers, reduced postoperative complication rate, low duration of hospitalization and reduced intra- and postoperative blood transfusion requirements. METHODS Data from the medical records of 4 patients who underwent laparoscopic surgery were retrospectively analyzed. They underwent surgery for idiopathic thrombocytopenic purpura, splenic cyst and abscess. RESULTS Mean age of patients was 56 years old, postoperative hospital stay was 4 days in all cases, the surgery lasted 150 minutes on average and a single unit of blood was given after surgery. CONCLUSIONS Laparoscopic spleen surgery is achievable and safe in the initial experience of the Baia Mare County Emergency Hospital, Romania; it enables a rapid postoperative recovery of the patients and the preservation of the spleen in diseases only partially affecting the splenic parenchyma.


title: Severe acute respiratory syndrome (SARS) and coronavirus testing--United States, 2003.

text: CDC and the World Health Organization (WHO) are continuing to investigate the multicountry outbreak of severe acute respiratory syndrome (SARS). Infection with a novel coronavirus has been implicated as a possible cause of SARS. This report updates information on U.S. residents with SARS and summarizes the clinical histories of the five U.S. residents identified as of April 9, 2003, who have both suspected SARS and laboratory evidence of infection with a novel coronavirus.


title: 2'-C-Methyl branched pyrimidine ribonucleoside analogues: potent inhibitors of RNA virus replication.

text: RNA viruses are the agents of numerous widespread and often severe diseases. Their unique RNA-dependent RNA polymerase (RDRP) is essential for replication and, thus, constitutes a valid target for the development of selective chemotherapeutic agents. In this regard, we have investigated sugar-modified ribonucleoside analogues as potential inhibitors of the RDRP. Title compounds retain 'natural' pyrimidine bases, but possess a beta-methyl substituent at the 2'-position of the D- or L-ribose moiety. Evaluation against a broad range of RNA viruses, either single-stranded positive (ssRNA+), single-stranded negative (ssRNA-) or double-stranded (dsRNA), revealed potent activities for D-2'-C-methyl-cytidine and -uridine against ssRNA+, and dsRNA viruses. None of the L-enantiomers were active. Moreover, the 5'-triphosphates of the active D-enantiomers were found to inhibit the bovine virus diarrhoea virus polymerase. Thus, the 2'-methyl branching of natural pyrimidine ribonucleosides transforms physiological molecules into potent, broad-spectrum antiviral agents that merit further development.


title: A novel visual sputum suctioning system is useful for endotracheal suctioning in a dog model.

text: OBJECTIVE This study is to test the effectiveness of fiber-optic-guided endotracheal suction catheter (visual sputum suctioning system or VSSS) in dog models. METHODS Dog sputum models were established by administering dimethoate emulsifiable. Twenty-seven intubated dogs were equally randomized into three groups of conventional suctioning (CS) group, VSSS with no supplemental oxygen (VSSS) group and VSSS with 100% oxygen (VSSS/O2) group. The suctioning efficiency, vital signs and tracheal wall injury were assessed. RESULTS The VSSS/O2 (8.6 ± 0.7g) and VSSS groups (8.5 ± 0.9 g) collected significantly more sputum than the CS group (5.9 ± 0.8 g) (P < 0.05 for VSSS/O2 group versus CS group; P < 0.05 for VSSS group versus CS group). Immediately after suctioning, the arterial partial pressure of oxygen (PaO2 ) of VSSS/O2 group was significantly higher than that of the VSSS group or the CS group (both P < 0.05), and 5 min after suction the PaO2 , the mean arterial pressure (MAP) and heart rate (HR) in all groups returned to the baseline (p = 0.54, P = 0.67, P = 0.11, respectively). Moreover, in the VSSS/O2 and VSSS groups all the three variables were higher than the CS group at 5 min after suctioning (P < 0.01, P = 0.03; P = 0.02, P < 0.01; P = 0.02, P = 0.01 respectively). CONCLUSIONS Visual sputum suctioning system collected more sputum and caused less tracheal mucosa damage than conventional suctioning.


title: Risk factors for the presence of high-level shedders of Escherichia coli O157 on Scottish farms.

text: Escherichia coli O157 infections are the cause of sporadic or epidemic cases of often bloody diarrhea that can progress to hemolytic uremic syndrome (HUS), a systematic microvascular syndrome with predominantly renal and neurological complications. HUS is responsible for most deaths associated with E. coli O157 infection. From March 2002 to February 2004, approximately 13,000 fecal pat samples from 481 farms with finishing/store cattle throughout Scotland were examined for the presence of E. coli O157. A total of 441 fecal pats from 91 farms tested positive for E. coli O157. From the positive samples, a point estimate for high-level shedders was identified using mixture distribution analysis on counts of E. coli O157. Models were developed based on the confidence interval surrounding this point estimate (high-level shedder, greater than 10(3) or greater than 10(4) CFU g(-1) feces). The mean prevalence on high-level-shedding farms was higher than that on low-level-shedding farms. The presence of a high-level shedder on a farm was found to be associated with a high proportion of low-level shedding, consistent with the possibility of a higher level of transmission. Analysis of risk factors associated with the presence of a high-level shedder on a farm suggested the importance of the pathogen and individual host rather than the farm environment. The proportion of high-level shedders of phage 21/28 was higher than expected by chance. Management-related risk factors that were identified included the type of cattle (female breeding cattle) and cattle stress (movement and weaning), as opposed to environmental factors, such as water supply and feed.


title: [Dynamic changes of chest CT imaging in patients with corona virus disease-19 (COVID-19)].

text: OBJECTIVE To analyze the dynamic changes of chest CT images of patients with corona virus disease-19 (COVID-19). METHODS Fifty-two cases of COVID-19 were admitted in the First Affiliated Hospital of Zhejiang University School of Medicine. The consecutive chest CT scans were followed up for all patients with an average of 4 scans performed per patient during the hospitalization. The shortest interval between each scan was 2 days and the longest was 7 days. The shape, number and distribution of lung shadows, as well as the characteristics of the lesions on the CT images were reviewed. RESULTS The obvious shadows infiltrating the lungs were shown on CT images in 50 cases, for other 2 cases there was no abnormal changes in the lungs during the first CT examination. Ground-glass opacities (GGO) were found in 48 cases (92.3%), and 19 cases (36.5%) had patchy consolidation and sub-consolidation, which were accompanied with air bronchi sign in 17 cases (32.7%). Forty one cases (78.8%) showed a thickened leaflet interval, 4 cases (7.6%) had a small number of fibrous stripes. During hospitalization, GGO lesions in COVID-19 patients gradually became rare, the fibrous strip shadows increased and it became the most common imaging manifestation. The lesions rapidly progressed in 39 cases (75.0%) within 6-9 days after admission. On days 10-14 of admission, the lesions distinctly resolved in 40 cases (76.9%). CONCLUSIONS The chest CT images of patients with COVID-19 have certain characteristics with dynamic changes, which are of value for monitoring disease progress and clinical treatment.


title: [Acute bacterial exacerbation of chronic obstructive pulmonary disease and biofilm].

text: The lower respiratory tract of patients affected by COPD is constantly colonized by pathogenic microrganisms such as H. influenzae, M. catarrhalis and S. pneumoniae. Role of bacterial colonization of big and small airways in patients affected by COPD is still unclear but it is likely to play a role in directly or indirectly maintaining the vicious circle of infection/inflammation. Colonizer pathogens are capable to stimulate mucus production, to alter the ciliary function by inducing dyskinesia and stasis; in addition, they represent a strong stimulus for neutrophils to come in the airways, which release elastase that, in turn, inhibit the mucus-ciliary function. The same pathogens are responsible for epithelial damage and chronic inflammation, by releasing neutrophilic elastase, leading to the damage progression and obstruction. Recent studies have also shown that infection sustained by H. influenzae is not limited to bronchial mucosa, i.e. surface epithelial cells, but that the pathogen is capable to penetrate cells, so spreading the infection in sub-epithelial cellular layers. In addition, the ability to produce biofilm is another possible defence mechanism which allows them to grow and colonise. Such a mechanism could in part explain the lack of response to antimicrobials and contribute to stimulation of parenchymal inflammatory response, the cause of pathological-anatomic damage which occurs in COPD. The impossibility to eradicate chronic infection and bacterial exacerbations of COPD are likely the elements that promt and worsen obstruction, so determining the disease's progression.


title: The Class of COVID-19: Texas Medical Students Struggle with Uncertainty.

text: Texas medical students struggle to fight the pandemic in their own way while adjusting to a lot of uncertainty.


title: Synthesis of coronavirus mRNAs: kinetics of inactivation of infectious bronchitis virus RNA synthesis by UV light.

text: Infection of cells with the avian coronavirus infectious bronchitis virus results in the synthesis of five major subgenomic RNAs. These RNAs and the viral genome form a 3' coterminal nested set. We found that the rates of inactivation of synthesis of the RNAs by UV light were different and increased with the length of the transcript. These results show that each RNA is transcribed from a unique promoter and that extensive processing of the primary transcripts probably does not occur.


title: [Emergency plan for inter-hospital transfer of newborns with SARS-CoV-2 infection].

text: Since December 2019, the outbreak of coronavirus disease (COVID-19) has become the most serious public health issue. As the special population with immature immune function, newborns with COVID-19 have been reported. Newborns with suspected or confirmed COVID-19 should be transferred to designated hospitals for isolation treatment. An emergency transfer response plan for newborns with COVID-19 has been worked out. This plan puts forward the indications for neonatal COVID-19 transfer, organization management, protection strategies for medical staff, work procedures, and disinfection methods for transfer equipment, in order to provide guidance and suggestions for the inter-hospital transfer of suspected or confirmed neonatal COVID-19.


title: [Organism distribution and drug resistance in 7 cases of severe acute respiratory syndrome death patients with secondary bacteria infection].

text: OBJECTIVE To study the organism distribution and drug resistance of seven cases of severe acute respiratory syndrome (SARS) death patients with secondary bacterial infection. METHODS Thirty strains of bacteria from seven cases of SARS patients with secondary bacterial infection were classified and drug resistance was analyzed. RESULTS Seven cases of SARS death patients were all infected secondly and 5 cases were polyinfection. Twenty-four (31.5 percent) of 76 examed samples were positive. There were 30 strains of bacteria isolated from seven cases of SARS death patients with secondary bacterial infection. There were 9 strains of Gram negative bacteria (GNB), 8 strains of Gram positive cocci (GPC), and 13 strains of Fungi. The sensitive rate of vancomycin to GPC was 100.0 percent. The sensitive rate of imipenem, piperacillin/tazobactan was 100.0 percent, 44.5 percent, respectively. The sensitive rate of fluconazole to fungi was 92.4 percent. CONCLUSION SARS patients are consitive to be infected secondary bacteria. Secondary bacteria infection is one of important reason of death.


title: [Immunoinformatic analysis for the epitopes on SARS virus surface protein].

text: SARS virus is a recently found coronavirus, which cause human atypical pneumonia through the binding of its spike protein to the receptor on human cells. By using the methods of immunoinformatics, we analyzed the virus surface protein and found that the epitopes, which can be recognized by human immune system, are strikingly changed or disappeared to compare with other common human coronavirus. This result may imply that the escape of SARS virus from human immune surveillance may be the causality plays a very of SARS virus infection. The immunoinformatics is a powerful fool for us to in screen the epitope specificial for SARS virus and identifying the candidate sites for peptide vaccine of SARS virus.


title: Perianal mucinous adenocarcinoma arising from a chronic fistula-in-ano.

text: Mucinous adenocarcinoma arising in a long-standing anorectal fistula is rare in clinical practice. Evidenced-based guidelines for treatment are lacking due to the rarity of this tumour. We present the clinical case of an advanced perianal mucinous adenocarcinoma associated with a longstanding perianal fistula, successfully treated by extended -abdomino-perineal resection, reconstructed by bilateral myocutaneous gluteus flaps, without any adjuvant therapy.


title: Fear of severe acute respiratory syndrome (SARS) among health care workers.

text: In this study, the authors examined fear related to severe acute respiratory syndrome (SARS) among 2 samples of hospital staff in Hong Kong. Sample 1 included health care workers (n=82) and was assessed during the peak of the SARS epidemic. Sample 2 included hospital staff who recovered from SARS (n=97). The results show that participants in both samples had equal, if not more, concern about infecting others (especially family members) than being self-infected. Sample 1 participants had stronger fear related to infection than Sample 2 participants, who seemed to be concerned more about other health problems and discrimination. Participants with lower self-efficacy tended to have higher fear related to SARS. Fear related to SARS was also correlated positively with posttraumatic stress symptoms among respondents of Sample 2 (recovered staff). Interventions based on these findings are described.


title: Hand-assisted laparoscopic surgery for liver tumors.

text: BACKGROUND The surgical treatment for liver tumors, whether metastatic or hepatic in origin, traditionally used the open approach through large incisions. In recent years the laparoscopic approach became popular but few centers use this method routinely. OBJECTIVES To assess the results of our initial experience with liver resection using the laparoscopic approach, in terms of patient safety and oncologic surgical outcome. METHODS Between August 2007 and April 2008 we performed 10 liver resections in 9 patients using the hand-assisted laparoscopic surgery technique. RESULTS The main indication for surgery was metastatic colorectal carcinoma in seven patients and hepatocellular carcinoma in two. The mean age was 67 +/- 11 years. The tumor was solitary in seven patients. Five patients had neoadjuvant chemotherapy. Altogether, 12 lesions with an average size of 17 +/- 9 mm were resected. The mean operative time was 180 +/- 52 minutes. Average postoperative stay was 6.5 +/- 3.5 days. There was no perioperative mortality. There was one conversion to open surgery due to bleeding from the left hepatic vein. No major perioperative complications were encountered. All resected margins were free of malignancy. CONCLUSIONS Liver resection using HALS is safe and feasible and should be considered in selected patients.


title: Identification of the membrane-active regions of the severe acute respiratory syndrome coronavirus spike membrane glycoprotein using a 16/18-mer peptide scan: implications for the viral fusion mechanism.

text: We have identified the membrane-active regions of the severe acute respiratory syndrome coronavirus (SARS CoV) spike glycoprotein by determining the effect on model membrane integrity of a 16/18-mer SARS CoV spike glycoprotein peptide library. By monitoring the effect of this peptide library on membrane leakage in model membranes, we have identified three regions on the SARS CoV spike glycoprotein with membrane-interacting capabilities: region 1, located immediately upstream of heptad repeat 1 (HR1) and suggested to be the fusion peptide; region 2, located between HR1 and HR2, which would be analogous to the loop domain of human immunodeficiency virus type 1; and region 3, which would correspond to the pretransmembrane region. The identification of these membrane-active regions, which are capable of modifying the biophysical properties of phospholipid membranes, supports their direct role in SARS CoV-mediated membrane fusion, as well as facilitating the future development of SARS CoV entry inhibitors.


title: Carotid Artery Stenting for Acute Ischemic Stroke Patients after Intravenous Recombinant Tissue Plasminogen Activator Treatment.

text: We herein report three ischemic stroke patients who underwent emergency carotid artery stenting after receiving intravenous tissue plasminogen activator (t-PA) treatment. All patients received antiplatelet medications immediately before stent placement for loading as well as dual antiplatelet therapy after stenting. Under high-dose and dual antiplatelet therapy, none of the three patients showed symptomatic intracranial hemorrhaging. However, one case showed reocclusion of the placed stent after acute thrombosis. As a result, new treatment strategies for the use of antiplatelet agents during emergency stent placement must be developed, particularly for patients who have received intravenous t-PA therapy.


title: Cerebral oximetry in cardiac and major vascular surgery.

text: We describe the development and current applications of cerebral oximetry (based on near-infrared reflectance spectroscopy) that can be used during cardiac and major vascular surgery to determined brain tissue oxygen saturation. There are presently three cerebral oximetry devices with FDA approval in the United States to measure and monitor cerebral tissue oxygen saturation. 1. INVOS (Somanetics Corporation, Troy, MI - recently COVIDIEN, Boulder, CO); FORE-SIGHT (CAS Medical Systems, Inc. Branford, CT); EQUANOX (Nonin Medical Inc.Minnesota, MN). All devices are portable, non-invasive and easy to use in operating room and intensive care unit. The data provided in these communication may provided information for improvement of perioperative neuromonitoring techniques, and may be crucial in the design of future clinical trials.


title: Modifications to facilitate extraperitoneal robot-assisted radical prostatectomy post kidney transplant.

text: INTRODUCTION Renal transplantation is the treatment of choice for patients with end-stage renal failure. With advances in immunosuppression, the short-term and long-term outcome has improved significantly. Subsequently, urologists are encountering more transplant recipients with genitourinary malignancies, and therefore urologists are becoming increasingly compelled to offer curative treatment options. MATERIALS AND METHODS We present modifications to facilitate E-RARP in these patients that include modified trocar arrangement, delayed bladder neck transection, utilizing the robotic Hem-o-lok applier, and posterior reconstruction of the anastomosis using a barbed V-loc suture. A 68-year-old male with a history of polycystic kidney disease, end-stage renal failure, and an allograft renal transplantation in the right iliac fossa, presented with T1c, Gleason 3+4 prostate cancer. He had a preoperative PSA of 6.93ng/mL, ASA score of 3, and a BMI of 26kg/m2. Follow-up for metastasis (MRI and bone scan) was negative. E-RARP was performed via the extraperitoneal approach using a 5-port 2-arm approach at an insufflation pressure of 10 mm Hg. RESULTS The radical prostatectomy was successfully performed. Ureterovesical anastomosis was completed, and total console time was 130 minutes, with an estimated blood loss of 125mL. Final pathology was T2bNx, Gleason 3+4 with negative surgical margins. The patient was discharged with no change in serum creatinine or GFR. The catheter was removed on POD 10 with no intraoperative or immediate postoperative complications. CONCLUSION E-RARP in the carefully selected renal allograft recipient is feasible and accomplished safely with technical modifications to avoid injuring the renal allograft, transplanted ureter, and ureteroneocystostomy.


title: Development of NGR peptide-based agents for tumor imaging.

text: Molecular imaging allows direct visualization of targets and characterization of cellular pathways, as long as a high signal/background ratio can be achieved, which requires a sufficient amount of probes to accumulate in the imaging region. The Asn-Gly-Arg (NGR) tripeptide selected by phage display can specifically target tumor vasculature. Recognizing the aminopeptidase N (APN or CD13) receptor on the membrane of tumor cells, the peptide can be further internalized into cytoplasma by the endosomal pathway. Hence NGR can serve as an ideal candidate for tumor imaging, once it is conjugated with fluorescent or radiolabeled imaging probes. Herein, we highlight some recent developments of NGR peptide based imaging of tumors. Although still in the preliminary stage, some NGR probes have shown potential as promising agents in future clinical applications.


title: Detection of infectious salmon anaemia virus by real-time nucleic acid sequence based amplification.

text: We have developed a real-time nucleic acid sequence based amplification (NASBA) procedure for detection of infectious salmon anaemia virus (ISAV). Primers were designed to target a 124 nucleotide region of ISAV genome segment 8. Amplification products were detected in real-time with a molecular beacon (carboxyfluorescin [FAM]-labelled and methyl-red quenched) that recognised an internal region of the target amplicon. Amplification and detection were performed at 41 degrees C for 90 min in a Corbett Research Rotorgene. The real-time NASBA assay was compared to a conventional RT-PCR for ISAV detection. From a panel of 45 clinical samples, both assays detected ISAV in the same 19 samples. Based on the detection of a synthetic RNA target, the real-time NASBA procedure was approximately 100x more sensitive than conventional RT-PCR. These results suggest that real-time NASBA may represent a useful diagnostic procedure for ISAV.


title: Transgenic farm animals: present and future.

text: Until recently, pronuclear microinjection of deoxyribonucleic acid (DNA) was the standard method for producing transgenic animals. This technique is now being replaced by more efficient protocols based on somatic nucleartransferthat also permit targeted genetic modifications. Lentiviral vectors and small interfering ribonucleic acid technology are also becoming important tools for transgenesis. Transgenic farm animals are important in human medicine as sources of biologically active proteins, as donors in xenotransplantation, and for research in cell and gene therapy. Typical agricultural applications include improved carcass composition, lactational performance and wool production, as well as enhanced disease resistance and reduced environmental impact. Product safety can be ensured by standardisation of procedures and monitored by polymerase chain reaction and array technology. As sequence information and genomic maps of farm animals are refined, it becomes increasingly practical to remove or modify individual genes. This approach to animal breeding will be instrumental in meeting global challenges in agricultural production in the future.


The Biology of Pulmonary Coronavirus Infection Underscores Host-Directed Therapies as an Option.


title: Coronavirus infection and demyelination. Development of inflammatory lesions in Lewis rats.

text: Coronavirus infections of rodents can cause diseases of the central nervous system characterised by inflammatory demyelination. The lesions mimick in many aspects the pathology of multiple sclerosis in humans and of other neurological diseases. As an animal model for demyelination, we studied the MHV-JHM induced encephalomyelitis of Lewis rats. The pathomorphological analysis revealed patterns of lesions which developed in stages. Infected oligodendrocytes were first destroyed by necrosis. Later stages were characterized by demyelinated plaques. In the center of plaques, no virus antigen was found and oligodendrocytes were mainly destroyed by apoptosis. At the edge of plaques, virus antigen was expressed in parallel to infiltrations consisting of lymphocytes and macrophages. The prevailing mechanisms leading to demyelination may change individually and during defined stages of the disease. The transcriptional expression of chemoattractants and other mediators of inflammation was studied by semiquantitative RT-PCR. Virus induced inflammatory demyelination was accompanied by high expression of a relatively novel cytokine, the endothelial monocyte activating polypeptide II (EMAP II). By immunocytochemistry, EMAP II was detected in parenchymal microglia located both within the lesions and in unaffected areas. Furthermore, the level of transcriptional expression of the regulatory calcium binding S100 proteins MRP8, MRP14 and CP10 was associated with inflammatory demyelination and expression of IFN gamma, IL-2, TNF alpha, and iNOS.


title: Development of a multiplex reverse transcription-polymerase chain reaction diagnostic test specific for turkey astrovirus and coronavirus.

text: A multiplex reverse transcription-polymerase chain reaction (RT-PCR) assay was developed for the simultaneous detection of two enteric viruses of poultry: turkey enteric coronavirus (TCV) and turkey astrovirus (TAstV). PCR primers were designed to conserved regions within the nucleocapsid gene of TCV and to the polymerase gene of TAstV-2. The primer pairs were successfully used in a multiplex RT-PCR to detect nucleic acid of TAstV-2 and TCV. The test was optimized for use with intestines/feces from naturally infected turkeys. The primers were specific and did not amplify other common RNA or DNA avian viruses. The detection limit was determined to be 10 ng of RNA used as starting template. The use of this specific test allows the rapid and early diagnosis of two financially costly viruses affecting the commercial turkey industry.


title: A case-control study of the role of cold symptoms and other historical triggering factors in asthma exacerbations.

text: BACKGROUND Asthma exacerbations can be provoked by many triggers such as allergens, respiratory irritants and viral infections. The relative importance of these has not been prospectively documented in a case-control study. OBJECTIVE To assess the relative importance of colds and other nonclimatic historical triggers of asthma exacerbations. METHODS One hundred and nineteen adults and children with asthma in two Canadian cities participated in a one-year study of the role of exacerbating factors in asthma. Among these, 36 pairs (21 adult, 15 children) completed the case-control study. Patients were considered cases if they developed an acute asthma exacerbation and notified the centre within 24 h to allow the completion of a questionnaire and viral studies (cultures of nasopharyngeal swabs and serology). Control people with asthma were matched for sex, age and area of residence, had no exacerbation during the preceding four weeks and participated within 48 h of the case patients. RESULTS Case patients versus control patients had a mean age of 22 years versus 20 years, 50% versus 55% were male, and 92% versus 86% had at least one positive aeroallergen skin test. Cases were more likely to have taken regular inhaled steroids (63% versus 33%, P<0.002). Cases were more likely to report the following within the previous week: fever (P<0.001), sore throat (P<0.001), increase in nasal symptoms (P<0.01), increased dust exposure (P<0. 05), exposure to others with a cold (P<0.001) and, over the previous year, increased passive smoke exposure (P<0.05). Viral cultures and paired serology were negative. CONCLUSIONS Symptomatic colds were the most common trigger of asthma exacerbations in the winter and spring, while a transient increase in dust exposure was also identified as a significant trigger. The association with chronic, passive smoke exposure and the use of inhaled costicosteroid medications likely reflected less stable pre-study asthma in those with exacerbations.


COVID-19, a graphic account.


title: Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong.

text: BACKGROUND Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout the world, including Hong Kong. AIM To compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB65 scale adopted by the British Thoracic Society and the simpler CRB65. METHODS A prospective observational study of 1016 consecutive inpatients with CAP (583 men, mean (SD) age 72 (17) years) was performed in a university hospital in the New Territories of Hong Kong in 2004. The patients were classified into three risk groups (low, intermediate and high) according to each rule. The ability of the three rules to predict 30 day mortality was compared. RESULTS The overall mortality and intensive care unit (ICU) admission rates were 8.6% and 4.0%, respectively. PSI, CURB65 and CRB65 performed similarly, and the areas under the receiver operating characteristic (ROC) curve were 0.736 (95% CI 0.687 to 0.736), 0.733 (95% CI 0.679 to 0.787) and 0.694 (95% CI 0.634 to 0.753), respectively. All three rules had high negative predictive values but relatively low positive predictive values at all cut-off points. Larger proportions of patients were identified as low risk by PSI (47.2%) and CURB65 (43.3%) than by CRB65 (12.6%). CONCLUSION All three predictive rules have a similar performance in predicting the severity of CAP, but CURB65 is more suitable than the other two for use in the emergency department because of its simplicity of application and ability to identify low-risk patients.


title: Surveillance of communicable diseases for decisionmaking in Egypt: 2006-2013.

text: The Egyptian Ministry of Health and Population surveillance system provides data about notifiable communicable diseases. This study aimed to provide information for decision-making to reduce the burden of communicable diseases in Egypt by analysis of the surveillance data for 2006-2013 to identify trends in the incidence of the diseases by governorate, season, age and sex. Composite risk-index scores were estimated to rank the 27 Egyptian governorates into 3 groups: high, medium and low risk. The 15 diseases with the highest incidence were food and waterborne diseases (5 diseases), vaccine-preventable diseases (7 diseases) and others, e.g. hepatitis C infection. Bloody diarrhoea and typhoid had the high incidence for 2006-2013. There were 11 high-risk governorates; Ismailia had the highest risk-index score. The findings suggest the need for specific interventions related to environmental sanitation and improving the childhood immunization programme, particularly in the high-risk governorates.


Living with Viruses.


title: Feasibility of Extracted-Overlay Fusion Imaging for Intraoperative Treatment Evaluation of Radiofrequency Ablation for Hepatocellular Carcinoma.

text: BACKGROUND AND AIMS Extracted-overlay fusion imaging is a novel computed tomography/magnetic resonance-ultrasonography (CT/MR-US) imaging technique in which a target tumor with a virtual ablative margin is extracted from CT/MR volume data and synchronously overlaid on US images. We investigated the applicability of the technique to intraoperative evaluation of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). METHODS This retrospective study analyzed 85 HCCs treated with RFA using extracted-overlay fusion imaging for guidance and evaluation. To perform RFA, an electrode was inserted targeting the tumor and a virtual 5-mm ablative margin overlaid on the US image. Following ablation, contrast-enhanced US (CEUS) was performed to assess the ablative margin, and the minimal ablative margins were categorized into three groups: (I) margin <0 mm (protrusion), (II) margin 0 to <5 mm, and (III) margin ≥5 mm. Margin assessment was based on the positional relationship between the overlaid tumor plus margin and the perfusion defect of the ablation zone. Tumors in group I underwent repeat ablation until they were in groups II or III. The final classifications were compared with those obtained by retrospectively created fusion images of pre- and post-RFA CT or MR imaging (CT-CT/MR-MR fusion imaging). RESULTS Treatment evaluation was impossible using CEUS in six HCCs because the tumors were located far below the body surface. Of the remaining 79 HCCs, the categorizations of minimal ablative margins between CEUS extracted-overlay fusion imaging and CT-CT/MR-MR fusion imaging were in agreement for 72 tumors (91.1%) (Cohen's quadratic-weighted kappa coefficient 0.66, good agreement, p<0.01). CONCLUSIONS Extracted-overlay fusion imaging combined with CEUS is feasible for the evaluation of RFA and enables intraoperative treatment evaluation without the need to perform contrast-enhanced CT.


title: Expression of the surface glycoprotein E2 of Bovine viral diarrhea virus by recombinant vesicular stomatitis virus.

text: This study analysed the transport behaviour of the glycoprotein E2 of Bovine viral diarrhea virus (BVDV) expressed from recombinant vesicular stomatitis virus (rVSV). E2 protein was found to be retained at an intracellular compartment. A chimeric protein containing the membrane anchor and cytoplasmic tail of the VSV G protein, E2-G(MT), was transported to the cell surface. Only the latter protein was incorporated into rVSV particles in significant amounts. A soluble form of E2 lacking the membrane anchor, E2(MTdel), appeared to be affected in conformational stability. In contrast to both membrane-anchored forms of E2, expression of the soluble form was detectable only by immunofluorescence microscopy but not by Western blotting. These results are in agreement with reports of intracellular retention of the E2 protein due to a retention signal in the membrane anchor. However, in another analysis of E2 expressed from rVSV, E2 protein was reported to be transported to the cell surface and incorporated into VSV particles [Grigera, P. R., Marzocca, M. P., Capozzo, A. V. E., Buonocore, L., Donis, R. O. & Rose, J. K. (2000). Virus Res 69, 3-15]. Reasons for these contradictory results are discussed.


title: Effect of vaccinations with recombinant fusion proteins on Ancylostoma caninum habitat selection in the canine intestine.

text: Laboratory dogs were vaccinated subcutaneously with 3 different recombinant fusion proteins, each precipitated with alum or calcium phosphate. The vaccinated dogs were then challenged orally with 400 third-stage infective larvae (L3) of the canine hookworm, Ancylostoma caninum. The 3 A. caninum antigens selected were Ac-TMP, an adult-specific secreted tissue inhibitor of metalloproteases; Ac-AP, an adult-specific secreted factor Xa serine protease inhibitor anticoagulant; and Ac-ARR-1, a cathepsin D-like aspartic protease. Each of the 3 groups comprised 6 male beagles (8 +/- 1 wk of age). A fourth group comprised control dogs injected with alum. All of the dogs vaccinated with Ac-TMP or Ac-APR-1 exhibited a vigorous antigen-specific antibody response, whereas only a single dog vaccinated with Ac-AP developed an antibody response. Dogs with circulating antibody responses exhibited 4.5-18% reduction in the numbers of adult hookworms recovered from the small intestines at necropsy, relative to alum-injected dogs. In contrast, there was a concomitant increase in the number of adult hookworms recovered from the colon. The increase in colonic hookworms was as high as 500%, relative to alum-injected dogs. Female adult hookworms were more likely to migrate into the colon than were males. Anti-enzyme and anti-enzyme inhibitor antibodies correlated with an alteration in adult hookworm habitat selection in the canine gastroinntestinal tract.


title: [Clinical analysis of suspected COVID-19 patients with anxiety and depression].

text: OBJECTIVE To explore the risk factors of anxiety and depression in patients with suspected coronavirus disease 2019 (COVID-19) so as to achieve early intervention and better clinical prognosis. METHODS Seventy-six patients with suspected COVID-19 in fever isolation wards of Second Hospital of Lanzhou University were enrolled From January 31, 2020 to February 22, 2020. Their clinical baseline data were collected. The anxiety of patients was assessed by Hamilton Anxiety Scale, and the depression of patients was assessed by Hamilton Depression Scale. Multivariate Logistic regression analysis was performed to explore the risk factors of anxiety and depression in these patients. RESULTS Female patients are more likely to have anxiety (OR=3.206, 95%CI: 1.073-9.583, P<0.05) and depression (OR=9.111, 95%CI: 2.143-38.729, P<0.01) than male patients; patients with known contact history of epidemic area and personnel in epidemic area are more likely to have depression (OR=3.267, 95%CI: 1.082-9.597, P<0.05). CONCLUSIONS During the isolation treatment of suspected COVID-19 patients, early psychological intervention should be carried out for the female patients with known contact history of epidemic area and personnel in epidemic area, and drug treatment should be given in advance if necessary.


title: Cerebral "hyperoxygenation" with inhalational induction of anesthesia in children: a retrospective comparison between vasoparalytic sevoflurane vs. vasoneutral fentanyl.

text: BACKGROUND The higher levels of oxygen in cerebrum may contribute to neuro-apoptosis, analogous to direct tissue injury induced by toxic levels of oxygen. Earlier report highlighted the possibility of cerebral "hyperoxygenation" secondary to inhalational induction of anesthesia with sevoflurane in small number of children. OBJECTIVE The aim of this retrospective review was whether similar cerebral "hyperoxygenation" trends can be seen in larger and retrospective patients' database. METHODS Data of patients who had undergone cardiac surgeries at Children's Hospital during the two-year period (2010-2011) was retrieved during this retrospective review: (a) stored computer data from INVOS Cerebral/Somatic Oximeter for oximetry numbers and total duration of oximetry monitoring, (b) paper chart perfusion records of the cardiac surgeries for age and sex of the patient, urgency of the surgery, type of induction (inhalational or intravenous), and total duration of cardiopulmonary bypass, (c) general medical records for inpatient setting vs. outpatient setting of the patient, and (d) anesthesia medical records for name of the medications used during induction of anesthesia to segregate the patients who had fentanyl as a lone induction agent and sevoflurane as a lone induction agent, for final statistical calculations and analysis. For the two-year period (2010-2011), data of 358 patients who had cardiac surgeries at Children's Hospital were reviewed. However, after deletions of various patients' data due to various reasons, only 69 patients (0-4 years of age) who had sevoflurane induction were analyzed for final statistical comparisons to 14 patients (0-4 years of age) who had fentanyl induction. RESULTS Cerebral and renal "hyperoxygenation" occurred during the first 127 minutes with sevoflurane as compared to fentanyl though the percentage changes from pre-induction values in oximetry during this time did not reach level of significance. However, only cerebral "hyperoxygenation" persisted in the last 127 minutes when patients had been induced with sevoflurane as compared to fentanyl. CONCLUSION Cerebral "hyperoxygenation" occurs with inhalational induction of anesthesia with vasoparalytic sevoflurane in children 0 to 4 years of age when compared to anesthesia induction with vasoneutral fentanyl.


title: Spatiotemporal distributions of reported cases of the avian influenza H5N1 (bird flu) in Southern China in early 2004.

text: This study investigates spatiotemporal distributions of reported cases of the avian influenza H5N1 (bird flu) in Southern China in early 2004. Forty-nine cases of the avian influenza H5N1 covering a 6-week period (January 19, 2004, through March 9, 2004) were compiled from the Chinese Ministry of Agriculture and the World Health Organization. Geographic information systems (GIS) techniques combined with statistical techniques were used to analyze the spatiotemporal variation of reported cases of avian influenza. Using Oden's direction method, we also explored the spatiotemporal interaction of individual-level avian influenza cases during the study duration. The peak period (temporal clustering) for the epidemiological avian influenza outbreak occurred between the third and fourth weeks. Although we observed a major northeast-southwest distribution of the avian influenza H5N1 cases, there was no significant spatiotemporal association in average "direction of advance" of these cases. The directional finding is very consistent with the major migratory bird routes in East Asia, but owing to weak surveillance and reporting systems in the region, the study findings warrant further evaluation.


title: Trauma care and referral patterns in Rwanda: implications for trauma system development.

text: BACKGROUND Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. METHODS We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ² and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. RESULTS Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). CONCLUSION To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.


title: An epidemiological survey of hemoplasma infection in Iriomote cats (Prionailurus bengalensis iriomotensis).

text: An epidemiological survey of Iriomote cats (Prionailurus bengalensis iriomotensis) was conducted to understand the prevalence and molecular characteristics of hemotropic mycoplasma (hemoplasma). A series of ecological surveys of Iriomote cats were performed between November 2003 and September 2010. During this period, 31 Iriomote cats were captured or found, and 39 blood samples were collected. Polymerase chain reaction screening for hemoplasmas and BLAST searches revealed that 4 of the 31 cats were positive for hemoplasma infection (n=3, Mycoplasma haemofelis [Mhf]; n=1, 'Candidatus M. turicensis' [CMt]). The 4 infected cats were captured or found in the northern area of the island of Iriomote. Phylogenetic analyses revealed close relationships between Mhf and CMt isolated from Iriomote cats compared with those from domestic cats and other wild felids. In our study, we identified two species of hemoplasma in Iriomote cats. The number and location of the hemoplasma-positive cats appeared to be limited; however, continuous surveillance of hemoplasma infection in Iriomote cats is necessary.


title: Endovenous radiofrequency ablation for the treatment of varicose veins.

text: Varicose veins are a common condition that can be treated surgically. Available operative modalities include saphenous venous ligation and stripping, phlebectomy, endovenous laser therapy and radiofrequency ablation. Radiofrequency ablation is the newest of these technologies, and to our knowledge our group was the first to use it in Canada. Our experience suggests that it is a safe and effective treatment for varicose veins, with high levels of patient satisfaction reported at short-term follow-up. More studies are needed to assess long-term effectiveness and compare the various available treatment options for varicose veins.


title: Detection of bovine coronavirus by enzyme-linked immunosorbent assay using monoclonal antibodies.

text: A sensitive and highly specific enzyme-linked immunosorbent assay (ELISA) system for detection of bovine coronavirus was developed using monoclonal antibodies, which showed both neutralization and hemagglutination inhibition activities. A monoclonal antibody was coated onto microplates for capturing antigen and a mixture of two monoclonal antibodies served as detecting antibodies. Using this assay, 40 of 202 fecal specimens from 29 herds were shown to be positive for viral antigen. From 10 ELISA positive specimens from 5 herds, the virus was isolated after several passages on human rectal adenocarcinoma (HRT-18) cell culture.


title: Counterimmunoelectroosmophoresis for detection of neonatal calf diarrhea coronavirus: methodology and comparison with electron microscopy.

text: A counterimmunoelectroosmophoresis (CIE) technique is described for the detection of calf diarrhea coronavirus antigens in intestinal contents. The antibody reagent was prepared in rabbits against the Nebraska calf diarrhea coronavirus adapted to Vero cells and purified by density gradient centrifugation. The method was applied to intestinal contents of diarrheic and normal calves and compared with electron microscopy (EM). Calf coronavirus antigens were detected in intestinal contents of 44% (21/48) of the diarrheic calves and 24% (4/17) of the normal calves. Two precipitin lines could be observed in the majority of the positive samples. When compared with EM, CIE detected more positive animals. In only two cases (2/20) CIE was negative despite the visualization of coronavirus particles by EM.


title: Animal and human influenzas.

text: Influenza type A viruses affect humans and other animals and cause significant morbidity, mortality and economic impact. Influenza A viruses are well adapted to cross species barriers and evade host immunity. Viruses that cause no clinical signs in wild aquatic birds may adapt in domestic poultry to become highly pathogenic avian influenza viruses which decimate poultry flocks. Viruses that cause asymptomatic infection in poultry (e.g. the recently emerged A/H7N9 virus) may cause severe zoonotic disease and pose a major pandemic threat. Pandemic influenza arises at unpredictable intervals from animal viruses and, in its global spread, outpaces current technologies for making vaccines against such novel viruses. Confronting the threat of influenza in humans and other animals is an excellent example of a task that requires a One Health approach. Changes in travel, trade in livestock and pets, changes in animal husbandry practices, wet markets and complex marketing chains all contribute to an increased risk of the emergence of novel influenza viruses with the ability to cross species barriers, leading to epizootics or pandemics. Coordinated surveillance at the animal- human interface for pandemic preparedness, risk assessment, risk reduction and prevention at source requires coordinated action among practitioners in human and animal health and the environmental sciences. Implementation of One Health in the field can be challenging because of divergent short-term objectives. Successful implementation requires effort, mutual trust, respect and understanding to ensure that long-term goals are achieved without adverse impacts on agricultural production and food security.


title: Terrorism in France.

text: France has experienced two waves of major terrorist bombings since 1980. In the first wave (1985-1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995-1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d'Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance. Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.


title: A case of fever of unknown origin: co-existence of Kikuchi-Fujimoto disease and acute disseminated encephalomyelitis (ADEM).

text: It is believed that viral infections and the hyperimmune reaction due to these infections are involved in the etiology of Kikuchi-Fujimoto Disease (KFD), a rare cause of fever of unknown origin. Axillary lymphadenopathy and neurologic involvement are rare in KFD. We present a patient diagnosed with KFD histopathologically during an investigation of the origin of fever and axillary lymphadenopathy. Subsequently, incidental sinus aspergilloma was diagnosed radiologically in the patient and acute disseminated encephalitis developed during follow-up. This report aims to draw attention to the co-existence of KFD and Acute Disseminated Encephalomyelitis, two diseases of which the origins are not clear.


title: Impact of the 2009 influenza A(H1N1) pandemic on public health workers in the Netherlands.

text: A cross-sectional study was undertaken to analyse the impact of the 2009 influenza A(H1N1) pandemic on frontline public health workers in the Netherlands and to consider its implications for future pandemics. A structured, self-administered questionnaire was made available online (26 March to 26 May 2010) for frontline public health workers employed by the communicable disease departments of the public health services in the Netherlands (n=302). A total of 166 questionnaires (55%) were completed. The majority of respondents reported an increased workload, perceived as too busy (117 respondents, 70.5%) or extreme (13 respondents, 7.8%). Most respondents were not anxious about becoming infected (only seven were regularly concerned). The overall compliance with the control measures was good. The case definition was strictly applied by 110 of the 166 respondents (66%); 56 of 141 (39.7%) consistently consulted the Preparedness and Response Unit within a centralised assessment system, while 68 of 141 (48.2%) consulted the unit only at the beginning of the pandemic. Of 145 respondents with available data, 128 (88.3%) always used personal protective equipment. Reported adherence to the advice to discuss the various isolation measures with patients and their contacts was between 71% and 98.7%. Our study shows that the surveyed frontline public health workers considered the workload to be high during the first 3.5 months of the pandemic and their level of anxiety about becoming infected was reported to be low. During the pandemic, these workers were able to accommodate what they considered to be an excessive workload, even though initially their assignments were unfamiliar to them.


Oxymorphone Extended-Release Tablets (Opana ER) For the Management of Chronic Pain: A Practical Review for Pharmacists.


title: Application of knowledge management and the intelligence continuum for medical emergencies and disaster scenarios.

text: The world has recently witnessed several large scale natural disasters. These include the Asian tsunami which devastated many of the countries around the rim of the Indian Ocean in December 2004, extensive flooding in many parts of Europe in August 2005, hurricane katrina (September 2005), the outbreak of severe acute respiratory syndrome (SARS) in many regions of Asia and Canada in 2003 and the Pakistan earthquake (towards the end of 2005). Such emergency and disaster situations (E&DS) serve to underscore the utter chaos that ensues in the aftermath of such events, the many casualties and lives lost not to mention the devastation and destruction that is left behind. One recurring theme that is apparent in all these situations is that, irrespective of the warnings of imminent threats, countries have not been prepared and ready to exhibit effective and efficient crisis management. This paper examines the application of the tools, techniques and processes of the knowledge economy to develop a prescriptive model that will support superior decision making in E&DS, thereby enabling effective and efficient crisis management.


title: Antiviral therapy in management of COVID-19: a systematic review on current evidence.

text: Background The purpose of the current systematic review is to evaluate the efficacy of antiviral therapies in treatment of COVID-19. In addition, clinical trials on the efficacy of antiviral therapies in the management of Severe Acute Respiratory Syndrome coronavirus (SARS-Cov) or Middle East Respiratory Syndrome coronavirus (MERS-CoV) have also been reviewed, in order to identify potential treatment options for COVID-19. Method An extensive search was performed in Medline, Embase, Scopus, Web of Science and CENTRAL databases until the end of March 15, 2020. Two independent researchers performed the screening, and finally the related studies were included. Results Only one clinical trial on the efficacy of antiviral therapy in management of COVID-19 was found. The results depicted that adding Lopinavir-Ritonavir to the standard treatment regimen of patients with severe COVID-19 has no benefits. Moreover, 21 case-series and case-report studies reported the prescription of antiviral agents in COVID-19, none of which can be used to determine the efficacy of antiviral therapies in confronting COVID-19. In addition, no clinical trials were found to be performed on the efficacy of antiviral agents in the management of SARS-CoV and MERS-CoV. Conclusion The current evidence impede researchers from proposing an appropriate antiviral therapy against COVID-19, making the current situation a serious concern for international organizations such as World Health Organization (WHO). In the time of the current pandemic and future epidemics, organizations such as WHO should pursue more proactive actions and plan well-designed clinical trials so that their results can be used in managing future epidemics.


title: Modified Blumgart Suturing Technique for Remnant Closure After Distal Pancreatectomy: a Propensity Score-Matched Analysis.

text: Despite recent advances in surgical techniques including staple closure and ultrasonic devices, the reported incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. Therefore, we devised a new strategy in which the pancreatic stump is enveloped with the elevated jejunum (EJ) by a modified Blumgart anastomotic technique. Eighty-one patients who underwent open DP with splenectomy from January 2008 to December 2014 were enrolled. Comparisons were made between 42 patients who underwent placement of an EJ patch using the modified Blumgart method after scalpel transection and 39 patients who underwent scalpel transection alone, using unmatched and propensity score-matched analysis. After 25 patients from each group were selected by propensity score matching, the EJ patch technique was significantly associated with a lower incidence of clinically relevant POPF (P = 0.036). Multivariate analysis showed that the EJ patch was an independent predictor of a lower incidence of POPF (odds ratio, 0.16; 95 % confidence interval, 0.01–0.48; P = 0.017) as was the estimated remnant pancreatic volume. Addition of the EJ patch improves postoperative outcomes in patients who undergo open DP with splenectomy by scalpel transection and hand-sewn closure of the pancreatic remnant.


title: Imported Infections in Rural Mid-West United States - A Report from a Tertiary Care Center.

text: Background There is lack of specific data on imported infections in the mid-west United States (U.S.). Methods Retrospective data on demographic and geographic data of imported infections seen by the infectious diseases clinics and consultation service from 2001-2018 was collected. Results Of the 64 infections, tuberculosis(TB) was most common [20(31.3%); pulmonary(11,55%), lymphadenopathy(8,40%), gastrointestinal(4,20%), disseminated(2,10%), and 1(5%) each of genitourinary and vertebral spine infection, 4 Human immune-deficiency virus infection and 1 echinococcosis)] followed by malaria(11,17.2%). Other infections: Cysticercosis [7,10.9%], giardiasis (4,6.3%), 3 each (4.7%) Human T-lymphotrophic Virus infection and schistosomiasis, 2 each (3.1%) leprosy, strongyloidiasis, and typhoid fever, one each (1.6%) of ascariasis, brucellosis, Chagas disease, Chikungunya virus, hepatitis A virus, echinococcosis, Japanese encephalitis virus, loiasis, paratyphoid fever, Q fever, and unspecified parasitosis. Geographic origins: Africa(26,40.6%), Asia(16,25%), Central America(11,17.2%), Europe(2,3.1%), Oceania(2,3.1%), South America(2,3.1%), and Unknown(5). More cases were seen after 2015. Conclusions With increasing tourism, it is important to educate rural mid-west healthcare professionals on travel medicine. The current COVID-19 pandemic illustrates the importance of this type of education and data accumulation now and in the future.


title: Use of anti-coronavirus antibody testing of cerebrospinal fluid for diagnosis of feline infectious peritonitis involving the central nervous system in cats.

text: OBJECTIVE To assess the use of measuring anti-coronavirus IgG in CSF for the diagnosis of feline infectious peritonitis (FIP) involving the CNS in cats. DESIGN Prospective study. SAMPLE POPULATION CSF and serum samples from 67 cats. PROCEDURES CSF and serum samples were allocated into 4 groups: cats with FIP involving the CNS (n = 10), cats with FIP not involving the CNS (13), cats with CNS disorders caused by diseases other than FIP (29), and cats with diseases other than FIP and not involving the CNS (15). Cerebrospinal fluid was evaluated for concentrations of erythrocytes, leukocytes, and total protein. Anti-coronavirus IgG was measured in CSF and serum by indirect immunofluorescence assay. RESULTS CSF IgG (range of titers, 1:32 to 1:4,096) was detected in 12 cats, including 6 cats with neurologic manifestation of FIP, 4 cats with FIP not involving the CNS, and 2 cats with brain tumors. Cerebrospinal fluid IgG was detected only in cats with correspondingly high serum IgG titers (range, 1:4,096 to 1:16,384) and was positively correlated with serum IgG titers (r = 0.652; P < 0.01), but not with any other CSF parameter. Blood contamination of CSF resulted in < or = 333 erythrocytes/microL in cats with CSF IgG. CONCLUSIONS AND CLINICAL RELEVANCE The correlation between serum and CSF IgG and the fact that CSF IgG was detected only in strongly seropositive cats suggested that CSF anti-coronavirus IgG was derived from blood. Measurement of anti-coronavirus IgG in CSF was of equivocal clinical use.


title: Aetiology of viral gastroenteritis: a review.

text: Over the past seven to eight years, several virus groups have been shown to be associated with gastroenteritis. They are adenoviruses, astroviruses, caliciviruses, coronaviruses. Norwalk-like viruses and rotaviruses. In infants and young children, rotaviruses are the single most important aetiological agents of acute gastroenteritis in terms of numbers of cases and also of patients requiring admission to hospital. In older children and adults, the aetiology is less clear, but the present state of our knowledge indicates that Norwalk-like viruses are one of the major causes. Most of these gastroenteritis-producing viruses cannot be propagated satisfactorily in laboratory cell-culture systems, and electron microscopy is the chief method of detection. Immune electron microscopy is used to demonstrate specific antibody increases during infection and to show antigenic differences between morphologically similar viruses. These techniques are relatively insensitive, and the development of a cell-culture system for the propagation of these "gastroenteritis viruses" would greatly facilitate epidemiological studies and vaccine development.


title: Characterization and translation of transmissible gastroenteritis virus mRNAs.

text: Three protein species were identified in purified transmissible gastroenteritis virus particles (strain Purdue). They are thought to represent constituents of the peplomer (E2; molecular weights of 280,000 and 240,000), the envelope (E1; molecular weights of 28,000, 31,500, and 33,000), and the nucleocapsid (N; molecular weight of 48,000). In infected cells, proteins with molecular weights of 195,000 (E2), 48,000 (N), and 28,000 (E1) were detected. Tunicamycin, an inhibitor of N glycosylation, prevented the appearance of polypeptides with molecular weights of 195,000 and 28,000 in infected cells; instead, proteins with molecular weights of 160,000 and 25,000 were observed. One minor and five major mRNA species were detected in porcine cells after infection. Their size was determined to be 23.6 kilobases (kb) (RNA1), 8.4 kb (RNA3), 3.8 kb (RNA4), 3.0 kb (RNA5), 2.6 kb (RNA6), and 1.9 kb (RNA7). The RNAs were translated in vitro. RNA7 was shown to code for the N protein. Although complete separation of RNA6 could not be achieved, it was shown to encode an unglycosylated (molecular weight of 25,000) precursor of E1 (molecular weight of 28,000). RNA4 was translated into a nonstructural protein with a molecular weight of 24,000. Translation of RNA3 resulted in proteins with molecular weights of 250,000 and 130,000 and smaller molecules which could be precipitated with a monoclonal antibody directed against E2.


title: Characterization of an equine arteritis virus replicase mutant defective in subgenomic mRNA synthesis.

text: Equine arteritis virus (EAV) is a positive-stranded RNA virus that synthesizes a 5'- and 3'-coterminal nested set of six subgenomic mRNAs. These mRNAs all contain a common leader sequence which is derived from the 5' end of the genome. Subgenomic mRNA transcription and genome replication are directed by the viral replicase, which is expressed in the form of two polyproteins and subsequently processed into smaller nonstructural proteins (nsps). During the recent construction of an EAV infectious cDNA clone (pEAV030 [L. C. van Dinten, J. A. den Boon, A. L. M. Wassenaar, W. J. M. Spaan, and E. J. Snijder, Proc. Natl. Acad. Sci. USA 94:991-996, 1997]), a mutant cDNA clone (pEAV030F) which carries a single replicase point mutation was obtained. This substitution (Ser-2429-->Pro) is located in the nsp10 subunit and renders the EAV030F virus deficient in subgenomic mRNA synthesis. To obtain more insight into the role of nsp10 in transcription and the nature of the transcriptional defect, we have now analyzed the EAV030F mutant in considerable detail. The Ser-2429-->Pro mutation does not affect the proteolytic processing of the replicase but apparently affects the function of nsp10 in transcription. Furthermore, our study showed that EAV030F still produces subgenomic positive and negative strands, albeit at a very low level. Both subgenomic positive-strand synthesis and negative-strand synthesis are equally affected by the Ser-2429-->Pro mutation, suggesting that nsp10 plays an important role in an early step of EAV mRNA transcription.


An intraleader open reading frame is selected from a hypervariable 5' terminus during persistent infection by the bovine coronavirus.


title: Coronative antibody tires in sera of healthy adults and experimentally infected volunteers.

text: Six coronaviruses isolated in the U.S.A. have been inoculated into volunteers and all produced colds. Between 10 and 20% of infected volunteers developed heterologous antibody responses after these and other experimental infections with coronaviruses. The haemagglutination-inhibition test with the OC43 virus strain was found to detect antibody rises after infection with a variety of strains.Studies on normal adult sera taken between 1965 and 1970 revealed a high frequency of neutralizing antibody to one strain (229 E) and a frequency of HI antibody to strain OC43 which fluctuated from year to year. Complement-fixing antibodies to these two viruses were also found, revealing an apparent increase in the activity of coronaviruses in the general population of the U.K., during the winter of 1968-9.


title: Chemical threats.

text: The use of chemical agents as military weapons has been recognized for many centuries but reached the most feared and publicized level during World War I. Considerable political effort has been exercised in the twentieth century to restrict military strategies with chemicals. However, considerable concern currently exists that chemical weapons may be used as agents in civilian terrorism. The distribution of acetaminophen tablets contaminated with potassium cyanide and the release of sarin in the Tokyo sub-way system show that larger-scale deployment of chemical agents can be a reality. This reality makes it necessary for civilian disaster-planning strategies to incorporate an understanding of chemical agents, their effects, and the necessary treatment.


title: The greater than twofold cost of integration for retroviruses.

text: Sexual reproduction, typically conceived of as a puzzling feature of eukaryotes, has posed an extraordinary evolutionary challenge in terms of the twofold replicative advantage of asexual over sexual organisms. Here we show mathematically that a greater than twofold cost is paid by retroviruses such as HIV during reverse transcription. For a retrovirus, replication is achieved through RNA reverse transcription and the effectively linear growth processes of DNA transcription during gene expression. Retroviruses are unique among viruses in that they show an alternation of generations between a diploid free living phase and a haploid integrated phase. Retroviruses engage in extensive recombination during the synthesis of the haploid DNA provirus. Whereas reverse transcription generates large amounts of sequence variation, DNA transcription is a high-fidelity process. Retroviruses come under strong selection pressures from immune systems to generate escape mutants, and reverse transcription into the haploid DNA phase serves to generate diversity followed by a phase of transcriptional clonal expansion during the restoration of diploidy from a stable, long lived, DNA encoded provirus.


title: Clinical relapses and disease activity on magnetic resonance imaging associated with viral upper respiratory tract infections in multiple sclerosis.

text: BACKGROUND Although the risk of clinical attacks of multiple sclerosis seems to be significantly increased with viral upper respiratory tract infections (URTI), serological evidence for the reported association remains controversial. In addition, although MRI is six to 10 times more sensitive than clinical exacerbations in indexing disease activity, any possible association between URTI and MRI activity has yet to be investigated. OBJECTIVES To examine the relation between URTI and disease activity, in multiple sclerosis patients participating in a placebo controlled trial of interferon beta-1a, as indexed both by clinical exacerbation rate and by the number and volume of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) enhancing lesions on MRI. "At risk" periods were defined around symptomatic URTI, with or without serological confirmation. RESULTS The relative risk of clinical relapse for serologically unconfirmed symptomatic URTI was 2.1 (p=0.004). Raised antiviral antibody titres conferred a relative risk of multiple sclerosis exacerbations that was 3.4 times higher than the "not at risk" periods (annual attack rates of 5.7 v 1.6, respectively, p=0.006). There was no definite relation between the number or the volume of active lesions on MRI and either symptomatic or serologically defined at risk periods. CONCLUSIONS These results confirm the previously reported association between viral infections and multiple sclerosis exacerbations and indicate that the relative risk may be even higher when viral infection is serologically confirmed. However, the results, perhaps because of the confounding effects of interferon beta-1a, do not provide convincing evidence of increased blood-brain barrier breakdown or inflammation during periods of virally induced immune stimulation.


Highs and lows.


title: Further validation of antibody-capture and antigen-capture enzyme-linked immunosorbent assays for determining exposure of cattle to bovine coronavirus.

text: OBJECTIVE To further validate an antibody-capture ELISA for measuring bovine coronavirus (BCV) exposure (antibody seroresponse) in cattle and to explain the apparent loss of sensitivity of a BCV antigen-capture ELISA when testing feces from adult versus neonatal cattle. ANIMALS 98 adult cows from herds with and without winter dysentery; 10 gnotobiotic or colostrum-deprived calves. PROCEDURES Results of an antibody-capture ELISA for BCV and a plaque reduction virus neutralization assay performed on paired serum samples from 24 cattle were compared with each other and with results of immunoelectron microscopy (IEM) of feces for BCV. For samples from 98 cattle, results of antibody-capture ELISA were compared with results of IEM. Calves were inoculated with feces ELISA-positive or IEM-positive for BCV and monitored for BCV infection. An ELISA was developed to detect BCV antigen-antibody complexes in feces and results were compared with results of an antigen-capture ELISA and IEM. RESULTS Antibody-capture ELISA results correlated with neutralization assay results, but agreed more closely with results of IEM. Calves became infected with BCV following inoculation with either ELISA-positive or ELISA-negative but IEM-positive feces. Results of the antigen-antibody ELISA correlated with results of IEM and the antigen-capture ELISA. CLINICAL IMPLICATIONS In adult cattle, testing of paired serum samples by use of an antibody-capture ELISA may be a better indicator of recent BCV exposure than results of virus neutralization tests. Antigen-antibody binding in feces may interfere with results of antigen-capture ELISA for BCV.


title: Real-time syndrome surveillance in Ontario, Canada: the potential use of emergency departments and Telehealth.

text: OBJECTIVE The purpose of this paper is to review new bioterrorist and emerging infectious threats to public health in Ontario, Canada, and to propose a means of integrating a telephone-based health information service and emergency department triage with a first-line real-time, 24-h a day syndrome surveillance system. This automated system could be beneficial in detecting a bioterrorist threat as well as in detecting and monitoring disease outbreaks such as influenza, Norwalk, West Nile virus, Escherichia coli 0157 or severe acute respiratory syndrome. METHOD The Medline PubMed database was searched for articles relating to bioterrorism and syndromic surveillance from 1997 onwards. The websites of the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Public Safety and Security, Centers for Disease Control and Canadian Population and Public Health Branch of Health Canada were searched for articles relating to bioterrorism and syndromic surveillance. Interviews were conducted with key informants from Telehealth staff, the public health services of Ontario and the Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS Real-time syndrome surveillance is a new means of detecting disease outbreaks or possibly acts of bioterrorism at the first contact with the healthcare system. It has been used successfully to detect influenza outbreaks at an early stage. The system that is proposed would be a province-wide integrated early warning system for both bioterrorist events and emerging infections. It would use clusters of symptoms tied to temporal, demographic and spatial data to increase sensitivity and specificity. CONCLUSION Real-time syndrome surveillance is an evolving science. Emergency departments and Telehealth in Ontario lend themselves as first contacts to the healthcare system as excellent opportunities to perform syndrome surveillance. They offer the opportunity properly to identify at-risk patients for emerging infections by including contact and travel data into the symptom complex. This could identify at-risk patients early and lead to appropriate public health measures. The benefit of using Telehealth in Ontario is the provincial accessibility of Telehealth and the extensive data collected on one computerized system. Emergency departments should also have a uniform computerized triage data collection system to facilitate surveillance.


title: Recurrent wheezy bronchitis and viral respiratory infections.

text: Fifty four patients aged from 1 to 6 years who had had recurrent attacks of wheezy bronchitis were prospectively followed up for three months to find out if there was an association between different viral respiratory infections and episodes of wheezing. Of the 115 episodes of upper or lower respiratory tract symptoms, virus or Mycoplasma pneumoniae infection were diagnosed in 52 (45%). Thirty four of rhinoviruses. The patients had an average of 2.1 episodes of respiratory tract symptoms the total mean (SD) duration of which was 30 (2) days of the 92 days that followed. Wheezing occurred during 76 (66%) of the 115 episodes and during a third of these the patient was admitted to hospital because of severe dyspnoea. Wheezing started a mean (SD) of 43 (7) hours after the first symptoms of respiratory infection and persisted for 3.8 (4.2) days in patients in whom virus infection was diagnosed. The incidence of wheezing was not associated with IgE mediated atopy, with positive virological tests, or with fever during virus infection, but was associated with parental smoking and more than one sibling.


title: Infectious mechanisms of enteropathogenic bovine coronaviruses.

text: The primary disease mechanism in infections of calves with enteropathogenic bovine coronaviruses (BCV) involves cytocidal interaction with differentiated enterocytes. Cytopathic expression of BCV infection of cultured cells depends on the viral strain and the cell type. BCV-induced cell fusion occurred under neutral or alkaline but not acidic conditions. Lysosomotropic bases did not significantly reduce virus yield, suggesting that productive BCV infection was not mediated by endocytosis but rather by direct fusion of the viral envelope with the plasma membrane. Trypsin cleavage of the 185 kDa S glycoprotein into 100 and 110 kDa subunits was required for cell fusion and productive infection of cultured BFS cells with the cell-adapted, avirulent strain BCV-L9. This strain has a wide host cell range in vitro while several wild-type, virulent strains were restricted to HRT-18 cells. Antigenic and genomic comparisons of the avirulent and virulent strains revealed corresponding differences. Some monoclonal antibodies against S reacted with both virulent and avirulent strains, while others reacted only with the avirulent strain BCV-L9. Nucleotide sequences of the S genes indicated that amino acid substitutions in cleavage sites, antigenic regions, and putative fusion domains occurred and differentiated BCV strains.


title: Severe acute respiratory syndrome in a doctor working at the Prince of Wales Hospital.

text: Severe acute respiratory syndrome is a new disease that is highly contagious and is spreading in the local community and worldwide. This report is of a hospital medical officer with severe acute respiratory syndrome. He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. Blood tests showed lymphopenia, mild thrombocytopenia, and prolonged activated partial thromboplastin time with normal d-dimer level. His chest condition gradually responded to ribavirin and corticosteroids, and serial chest X-ray showed resolving pulmonary infiltrates. The importance of early diagnosis lies in the potential for early treatment, leading to better response.


title: An immunocytochemical search for infectious agents in Crohn's disease.

text: Microorganisms have long been suspected of causing Crohn's disease (CD); however, an etiologic agent has yet to be identified. Few studies have employed immunocytochemistry (ICC) to examine tissue from patients with CD for microbial antigens. We investigated 36 formalin-fixed tissues from 16 patients with CD with ICC. No evidence of adenovirus, Borrelia, Brucella, BVDV, Campylobacter, Campylobacter-like organisms, Chlamydia, coronavirus, CMV, EBV, Legionella, mycobacteria, Pseudomonas, rotavirus, Salmonella, Shigella, staphylococci, Toxoplasma gondii, Treponema, or Yersinia was found. ICC identified E. coli and streptococcal antigens in 11 (69%) and 10 (63%) of the 16 cases studied, respectively. Escherichia coli immunoreactivity was located in ulcers, within the lamina propria, and along fissures. Streptococcal immunolabeling occurred within mucosal epithelial cells, in the lamina propria, in ulcers, along fissures, in granulomatous inflammation including multinucleate giant cells, and in lymph nodes. These results suggest that some of the granulomas in CD may result from immunologic processing of bacterial antigens following their penetration through a compromised mucosa. E. coli and streptococcal antigens may contribute to the pathogenesis of CD.


title: Use of radiofrequency ablation in the treatment of hepatocellular carcinoma: Experience of ablation protocols.

text: Hepatocellular carcinoma (HCC) is one of the most common cancer types worldwide. Percutaneous radiofrequency ablation (RFA) for HCC was introduced in Japan in 1999. It has been established as a major local treatment method worldwide including in Japan. On comparing outcomes between resection and RFA, they were comparable when cases were limited to those with 3 or fewer tumors of size 3 cm or smaller in many reports, based on which RFA has become the main treatment for small HCCs. RFA was introduced into our system at Toho University Medical Center Omori Hospital in 1999, and we treat nearly 200 HCC cases annually with RFA. Although individual medical facilities use their own methods of RFA, we would like to share our experience of RFA treatment protocols.


title: Sequence and expression of the ns2 protein gene of human coronavirus OC43.

text: The complete nucleotide sequence of the ns2 gene of human coronavirus OC43 (HCV-OC43) was determined. Sequence analysis revealed an open reading frame that could encode a protein of 278 amino acids, with an estimated molecular mass of 32.2 kDa. Six potential phosphorylation sites are present but no sites of N-glycosylation were found. The amino acid sequence of the HCV-OC43 ns2 protein shows 92% identity with that of the Mebus strain of bovine coronavirus (BCV). However, a stretch of nine consecutive amino acids near the C terminus is completely different, causing it to be very hydrophilic, which contrasts with the hydrophobic nature of this region in BCV. As shown by immunofluorescence with a monospecific antiserum, the ns2 protein was expressed in the cytoplasm of HCV-OC43-infected HRT-18 cells.


title: Human coronaviruses: what do they cause?

text: SARS-CoV, human coronavirus NL63 (HCoV-NL63) and HCoV-HKU1 were first described in 2003, 2004 and 2005 respectively. Nevertheless, discovery of three new human coronaviruses does not necessary represent a sudden increase in emerging infections by new coronaviruses. Only SARS-CoV has recently been introduced to the human population; the other two have been circulating in humans for a long time. HCoV-HKU1 and HCoV-NL63 are respiratory coronaviruses, are frequently found during lower and upper respiratory tract infections, have spread worldwide, and prefer the winter season. These characteristics do not differ greatly from the symptoms described for the 'old' viruses HCoV-229E and HCoV-OC43. This report presents an overview of the current knowledge of the four human coronavirus that are now circulating in the human population.


title: Health department use of social media to identify foodborne illness - Chicago, Illinois, 2013-2014.

text: An estimated 55 million to 105 million persons in the United States experience acute gastroenteritis caused by foodborne illness each year, resulting in costs of $2-$4 billion annually. Many persons do not seek treatment, resulting in underreporting of the actual number of cases and cost of the illnesses. To prevent foodborne illness, local health departments nationwide license and inspect restaurants and track and respond to foodborne illness complaints. New technology might allow health departments to engage with the public to improve foodborne illness surveillance. For example, the New York City Department of Health and Mental Hygiene examined restaurant reviews from an online review website to identify foodborne illness complaints. On March 23, 2013, the Chicago Department of Public Health (CDPH) and its civic partners launched FoodBorne Chicago, a website (https://www.foodbornechicago.org) aimed at improving food safety in Chicago by identifying and responding to complaints on Twitter about possible foodborne illnesses. In 10 months, project staff members responded to 270 Twitter messages (tweets) and provided links to the FoodBorne Chicago complaint form. A total of 193 complaints of possible foodborne illness were submitted through FoodBorne Chicago, and 133 restaurants in the city were inspected. Inspection reports indicated 21 (15.8%) restaurants failed inspection, and 33 (24.8%) passed with conditions indicating critical or serious violations. Eight tweets and 19 complaint forms to FoodBorne Chicago described seeking medical treatment. Collaboration between public health professionals and the public via social media might improve foodborne illness surveillance and response. CDPH is working to disseminate FoodBorne Chicago via freely available open source software.


title: Synthesis and evaluation of keto-glutamine analogues as potent inhibitors of severe acute respiratory syndrome 3CLpro.

text: The 3C-like proteinase (3CL(pro)) of severe acute respiratory syndrome (SARS) coronavirus is a key target for structure-based drug design against this viral infection. The enzyme recognizes peptide substrates with a glutamine residue at the P1 site. A series of keto-glutamine analogues with a phthalhydrazido group at the alpha-position were synthesized and tested as reversible inhibitiors against SARS 3CL(pro). Attachment of tripeptide (Ac-Val-Thr-Leu) to these glutamine-based "warheads" generated significantly better inhibitors (4a-c, 8a-d) with IC(50) values ranging from 0.60 to 70 microM.


title: Curcumin suppression of cytokine release and cytokine storm. A potential therapy for patients with Ebola and other severe viral infections.

text: BACKGROUND The terminal stage of Ebola and other viral diseases is often the onset of a cytokine storm, the massive overproduction of cytokines by the body's immune system. MATERIALS AND METHODS The actions of curcumin in suppressing cytokine release and cytokine storm are discussed. RESULTS Curcumin blocks cytokine release, most importantly the key pro-inflammatory cytokines, interleukin-1, interleukin-6 and tumor necrosis factor-α. The suppression of cytokine release by curcumin correlates with clinical improvement in experimental models of disease conditions where a cytokine storm plays a significant role in mortality. CONCLUSION The use of curcumin should be investigated in patients with Ebola and cytokine storm. Intravenous formulations may allow achievement of therapeutic blood levels of curcumin.


title: [Retrospective analysis on clinical features of 35 patients with severe acute respiratory syndrome].

text: OBJECTIVE To analyze the clinical features of severe acute respiratory syndrome (SARS). METHODS The clinical features of 35 patients with SARS in the past five months were retrospectively studied, and compared with 35 patients with community-acquired pneumonia. Consecutive blood samples from 13 patients with SARS and 10 healthy volunteers were collected. The CD+4 and CD+8 in T cell in peripheral blood were detected by flow cytometry. RESULTS The most common symptoms included fever (in 100.0 percent of the patients), cough (74.3 percent), headache (45.7 percent), myalgia (45.7 percent) and lymphopenia (20/33). Serial chest radiographs showed progressive multi-infiltration in the lung fields. The CD+4 and CD+8 in T cell in 13 patients with SARS significantly decreased [CD+4: (16.10+/-4.31) percent vs. (38.30+/-8.52) percent, t=8.174,P<0.01; CD+8: (19.90+/-5.40) percent vs. (28.38+/-4.33) percent, t=4.055, P<0.01]. The time of bringing down the fever and the time of absorption of pathological changes in SARS patients were prolonged than those of the pneumonia patients [the time of bringing down the fever (13.92+/-8.35) days vs. (3.86+/-1.42)days, t=16.490,P=0.000;the time of absorption of pathological changes: (11.97+/-4.41) days vs. (9.21+/-4.42) days, t=3.082,P=0.003]. CONCLUSION SARS is a serious respiratory illness, the most common symptoms are fever, cough, headache and myalgia, other common findings are lymphopenia, the CD+4 and CD+8 in T cell in peripheral blood decrease and multi-infiltrate through out the lung fields.


[Ethical decision-making framework for the allocation of scarce mechanical ventilators during the COVID-19 crisis].


title: Effects of different tidal volumes for one-lung ventilation on oxygenation with open chest condition and surgical manipulation: a randomised cross-over trial.

text: BACKGROUND The ideal tidal volume (TV) during one-lung ventilation (OLV) remains controversial. High TVs may increase the incidence of postoperative lung injury after thoracic surgery. There is nonetheless little evidence that the use of low TV during OLV will fail to provide adequate arterial oxygenation. We evaluated the influence of low (5 mL/kg-1) and high (10 mL/kg-1) TV on arterial oxygenation during one-lung ventilation in clinical conditions. METHODS A hundred patients scheduled for lung surgery were studied. Patients were randomly assigned to either 30 minutes of one-lung ventilation with a TV of 10 mL/kg-1 at a rate of 10 breaths/minute (Group 10, N.=50) or a TV of 5 mL/kg-1 with 5 cmH2O PEEP at a rate of 20 breaths/minute (Group 5, N.=50). According to the rules of crossover design during the subsequent 30 minutes, each patient received the alternative management. Arterial blood partial pressures, hemodynamic responses, and ventilatory parameters were recorded. Results are presented as means ± SDs; P<0.05 was considered statistically significant. RESULTS PaO2 was unaffected by TV (10 mL/kg-1: 218±106 versus 5 mL/kg-1: 211±119 mmHg, P=0.29). Calculated intrapulmonary shunt fraction was also similar with each TV during OLV (5 mL/kg-1: 25±9% versus 10 mL/kg-1: 24±8%, p=0.14). In contrast, low TV significantly increased PaCO2 (10 mL/kg-1: 39±6 versus 5 mL/kg-1: 44±8 mmHg, P<0.001). There were significant differences both in peak (10 mL/kg-1: 27±6 versus 5 mL/kg-1: 21±5 cmH2O, P<0.001) and plateau airway pressure values (10 mL/kg-1: 22±6 versus 5 mL/kg-1: 18±5 cmH2O, P<0.001) during OLV. CONCLUSION Low TV (5 mL/kg-1) accompanied by 5 cmH2O PEEP provides comparable arterial oxygenation and intrapulmonary shunt fraction during one-lung ventilation as higher TV (10 mL/kg-1) without PEEP.


title: COVID-19 infection and mental disorders: a call for action to enhance protection and break down barriers.

text: No abstract available.


title: Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis From the First-in-Human Proof-of-Concept Study.

text: OBJECTIVE To assess procedural safety and glycemic indices at 6 months in a first-in-human study of duodenal mucosal resurfacing (DMR), a novel, minimally invasive, upper endoscopic procedure involving hydrothermal ablation of the duodenal mucosa, in patients with type 2 diabetes and HbA1c ≥7.5% (58 mmol/mol) on one or more oral antidiabetic agents. RESEARCH DESIGN AND METHODS Using novel balloon catheters, DMR was conducted on varying lengths of duodenum in anesthetized patients at a single medical center. RESULTS A total of 39 patients with type 2 diabetes (screening HbA1c 9.5% [80 mmol/mol]; BMI 31 kg/m2) were treated and included in the interim efficacy analysis: 28 had a long duodenal segment ablated (LS; ∼9.3 cm treated) and 11 had a short segment ablated (SS; ∼3.4 cm treated). Overall, DMR was well tolerated with minimal gastrointestinal symptoms postprocedure. Three patients experienced duodenal stenosis treated successfully by balloon dilation. HbA1c was reduced by 1.2% at 6 months in the full cohort (P < 0.001). More potent glycemic effects were observed among the LS cohort, who experienced a 2.5% reduction in mean HbA1c at 3 months postprocedure vs. 1.2% in the SS group (P < 0.05) and a 1.4% reduction at 6 months vs. 0.7% in the SS group (P = 0.3). This occurred despite net medication reductions in the LS cohort between 0 and 6 months. Among LS patients with a screening HbA1c of 7.5-10% (58-86 mmol/mol) and on stable antidiabetic medications postprocedure, HbA1c was reduced by 1.8% at 6 months (P < 0.01). CONCLUSIONS Single-procedure DMR elicits a clinically significant improvement in hyperglycemia in patients with type 2 diabetes in the short-term, with acceptable safety and tolerability. Long-term safety, efficacy, and durability and possible mechanisms of action require further investigation.


title: The telemedicine and teleconsultation system application in clinical medicine.

text: Telemedicine and teleconsultation are the application and development of the telecommunication networks. Health experts can solve problems by using the electronic and communication technologies without distance limitation. In this study, we try to develop the telemedicine and teleconsultation system between local site and consulting expert site. Two applications of this system in clinical medicine are discussed. The system at each site has a workstation including a cable modem or ADSL connection, a monitor, a web camera, speakers, a microphone for communication, and NetMeeting application software. The first application in this study is to develop a school-based intervention program by using this system for high-risk school-age children in one of the earthquake-struck areas. The preliminary result of this study is that the telemedicine and teleconsultation system is more effective than traditional consultation and supervision. Moreover, we can apply this system in training local volunteers, educators, and welfare workers. Meanwhile, we can save lots of cost and time since we don't need to travel between the local site and the expert site. In the end of this study, the second application of this system in SARS case treatment was also discussed.


title: Emergence of Avian Infectious Bronchitis Virus and its variants need better diagnosis, prevention and control strategies: a global perspective.

text: Growth in poultry sector is being challenged due to increased incidence and re-emergence of diseases caused due to evolution of several viral pathogens and use of live vaccines. Piles of economic losses are encountered due to these diseases. Avian Infectious Bronchitis (IB), caused by Corona virus, is OIE-listed disease and characterized by respiratory, renal and urogenital involvements, causing high mortality. Economic losses are encountered due to loss of productive performance of both egg and meat-type chickens. Variant viruses evolve due to spontaneous mutations and recombinations, causing disease in vaccinated flocks of all ages. Serotyping and genotyping are the common methods of classification of IBV strains. The virus has 4 clusters, grouped into 7 serotypes and the most important strains are Massachusetts, Connecticut, Arkansas, Gray, Holte and Florida along with numerous others, distributed round the globe. Several conventional and molecular diagnostic methods have been described for the diagnosis of IB in chickens. 'All-in/all-out' operations of rearing along with good biosafety measures forms the basis of prevention, whereas vaccination forms the backbone of IB control programme. Both live and inactivated (oil emulsified) conventional vaccines are available. The new generation vaccines (recombinant and vector-based) developed against locally prevailing IBV strains may be more helpful and avoid the reversion of virulence in live vaccine viruses. The present review deals with all these perspectives of this important emerging poultry pathogen.


title: Cell cycle perturbations induced by infection with the coronavirus infectious bronchitis virus and their effect on virus replication.

text: In eukaryotic cells, cell growth and division occur in a stepwise, orderly fashion described by a process known as the cell cycle. The relationship between positive-strand RNA viruses and the cell cycle and the concomitant effects on virus replication are not clearly understood. We have shown that infection of asynchronously replicating and synchronized replicating cells with the avian coronavirus infectious bronchitis virus (IBV), a positive-strand RNA virus, resulted in the accumulation of infected cells in the G2/M phase of the cell cycle. Analysis of various cell cycle-regulatory proteins and cellular morphology indicated that there was a down-regulation of cyclins D1 and D2 (G1 regulatory cyclins) and that a proportion of virus-infected cells underwent aberrant cytokinesis, in which the cells underwent nuclear, but not cytoplasmic, division. We assessed the impact of the perturbations on the cell cycle for virus-infected cells and found that IBV-infected G2/M-phase-synchronized cells exhibited increased viral protein production when released from the block when compared to cells synchronized in the G0 phase or asynchronously replicating cells. Our data suggested that IBV induces a G2/M phase arrest in infected cells to promote favorable conditions for viral replication.


Activation-dependent induction of T cell alanyl aminopeptidase and its possible involvement in T cell growth.