title: Identification of the murine coronavirus p28 cleavage site.

text: Mouse hepatitis virus strain A59 encodes a papain-like cysteine proteinase (PLP-1) that, during translation of ORF1a, cleaves p28 from the amino terminus of the growing polypeptide chain. In order to determine the amino acid sequences surrounding the p28 cleavage site, the first 4.6 kb of murine hepatitis virus strain A59 ORF1a was expressed in a cell-free transcription-translation system. Amino-terminal radiosequencing of the resulting downstream cleavage product demonstrated that cleavage occurs between Gly-247 and Val-248. Site-directed mutagenesis of amino acids surrounding the p28 cleavage site revealed that substitutions of Arg-246 (P2) and Gly-247 (P1) nearly eliminated cleavage of p28. Single-amino-acid substitutions of other residues between P7 and P2' were generally permissive for cleavage, although a few changes did greatly reduce proteolysis. The relationship between the p28 cleavage site and other viral and cellular papain proteinase cleavage sites is discussed.


title: [Study on etiology and pathology of severe acute respiratory syndrome].

text: OBJECTIVE To investigate the clinicopathologic characteristics of severe acute respiratory syndrome (SARS). METHODS Three autopsy cases were studied retrospectively. Routine HE stain was used to study all the cases. Part of the lung tissue specimens were studied further with Macchiavello's stain, viral inclusion body stain, reticulin and PAS stains, immunohistochemistry, thin sections with staining, light microscopy and transmission electronic microscope investigation. RESULTS The earliest symptom of all 3 cases was hyperpyrexia and followed by progressive dyspnea and appearance of lung field shadows in X rays findings. Pulmonary lesions included: bilateral and extensive consolidation, localized hemorrhage and necrosis, desquamative alveolitis and bronchitis, alveolar proliferation and desquamation, accumulation of protein exudates, mononuclear cells, lymphocytes, and plasma cells as well as hyaline membrane formation in alveoli and viral inclusion bodies were seen in the alveolus epithelial cells. The exudated organization tended to become glomeruloid organizing pneumonitis in a few avaoli. Lesions of the immune organs included: large patchy necrosis in the spleens and localized necrosis in the lymph nodes were seen. Bone marrow became restrained. There were lesions of systemic small vasculitis including edema of the perivascular tissue and vascular wall of the small veins with localized fibrinoid necrosis distributing in the heart, lungs, kidneys, adrenal glands and the striated muscles accompanying with mononuclear cells and lymphocytes infiltration. Thrombosis was seen in part of the small veins. In addition, there were also the systemic poisonous changes including: degeneration and necrosis of the parenchyma cells in lungs, liver, kidneys, heart and adrenals. Electronic microscopy demonstrated clusters of virus particles seen in the lung tissue. CONCLUSION SARS is a systemic disease. Lungs, immune system and systemic small vessels are the main target organs attacked by the virus. Extensive consolidation of lungs, formation of hyaline membrane to a large extent, respiratory distress and decrease of immune function are the main causes of death.


title: [Rationales for using JAK 1/2 inhibitors in severely afflicted patients with COVID-19 pneumonia].

text: Severely afflicted patients with the COVID-19 may become in need of mechanical ventilation. The cause of acute respiratory failure is a massive hyperinflammation in the lungs, and treatment with glucocorticoids is not recommended by the WHO. A rare haematological disease, the virus-associated haemophagocytic lymphohistiocytosis syndrome (HLS), is associated with high mortality and a similar hyperinflammation syndrome. Janus kinase (JAK) 1/2 inhibitor treatment is highly efficacious in HLS. In this review, we discuss the rationales and perspectives for using JAK1/2 inhibitors in severely afflicted patients with COVID-19 pneumonia.


What we have learnt from SARS epidemics in China.


title: A General Framework to Test and Evaluate Filtering Facepiece Respirators Considered for Crisis Capacity Use as a Strategy to Optimize Supply.

text: During a public health emergency, respirator shortages can have a profound impact on the national response, such as for the current coronavirus disease 2019 (COVID-19) pandemic. Due to a severe shortage of respirators (particularly filtering facepiece respirators [FFRs]), there may be contexts in which understanding the performance of FFRs that are approved for use as part of a crisis capacity strategy is desired. This includes FFRs that are not covered under the National Institute for Occupational Safety and Health (NIOSH) Respirator Approval Program because they have been stored past their designated shelf life, have been decontaminated, or are approved by international certification bodies other than NIOSH. The purpose of this document is to provide a general framework to assess the performance of FFRs that are only being used as a crisis capacity strategy. The intended audience are those who are responsible for managing large amounts of FFRs. This framework includes a four-step process consisting of: 1) defining the population of FFRs to be sampled; 2) providing sampling strategy options; 3) inspecting and testing the sampled units; and 4) evaluating the results. In addition to the four-step process, we provide an example of how NIOSH recently evaluated the quality of FFRs sampled from ten U.S. stockpiles.


title: Therapies for coronaviruses. Part I of II -- viral entry inhibitors.

text: BACKGROUND Severe acute respiratory syndrome (SARS) coronavirus emerged fleetingly in the winter of 2002 and again in the winter of 2003, resulting in the infection of ~8,000 people and the death of ~800. The identification of the putative natural reservoir suggests that a re-emergence is possible. The functions of many coronaviral proteins have now been elucidated, resulting in many novel approaches to therapy. OBJECTIVE To review anticoronaviral therapies based on inhibition of viral entry into the host cell and to cast light on promising approaches and future developments. METHOD The published literature, in particular patent publications, is searched for relevant documents. The information is organized and critiqued. RESULTS/CONCLUSION The approaches to combating coronaviral infections are built on the foundation of antivirals against other viruses and the fundamental insights gained by dissection of the coronaviral lifecycle. These approaches include the prevention of viral entry, reviewed here, and interference with the intracellular lifecycle of the virus in the infected cell, reviewed next. Of the viral-entry inhibitors, monoclonal antibodies have demonstrated efficacy, clinical application in other viral infections, and the potential to impact a future epidemic. Moreover, combinations of monoclonal antibodies have been shown to have a broader spectrum of antiviral activity.


title: Development of clinical signs and occurrence of feline corona virus antigen in naturally infected barrier reared cats and their offspring.

text: The onset and pattern of the clinical signs of feline corona virus (FCoV) infection in cats were studied in a setting behind an isolation barrier. Two FCoV-seropositive cats were the source of the infection, and 3 barrier reared cats - initially FCoV-seronegative - were the recipients. The first clinical sign in the recipients appeared 11 days after contact with the source of infection. After 2 years 1 male and 1 female of the recipients started to breed. Their offspring developed clinical signs of disease at an age of 4-5 weeks. A pattern of recurring upper respiratory tract signs and conjunctivitis at intervals of about 4 months was observed in both the recipients and their offspring, while CNS dependent signs and wasting remained or got worse, once developed. Once demonstrated, FCoV antigen persisted in membrana nictitans throughout the investigation, and was found in all cats but 4 (90%). The offspring died during 2 periods, around the first week of life (9/37), and at 3-5 months of age (5/25). For comparison 3 offspring were euthanized at an age of 1 day and 16 offspring at an age of 3-6 months. FCoV antigen was demonstrated in all organs investigated (100%) from offspring dying during the first period, and in 97% from those dying during the second period. For the offspring euthanized during the same 2 periods the corresponding findings were 95% and 85%. Offspring euthanized between 9 and 17 months (4 kittens) had antigen in 67% of all investigated organs. The incidence of FCoV antigen in almost every organ in the investigated newborn kittens suggests an intrauterine infection. The demonstration of FCoV antigen in all euthanised cats, suggests a persistent infection. Virus was cultivated from membrana nictitans, that was FCoV antigen positive in the M3 test.


China joins global effort over pneumonia virus.


title: Avian influenza--a pandemic waiting to happen?

text: Cross-species transmission of a highly pathogenic subtype of influenza A virus directly from birds to humans has raised many concerns. The radical methods of immune evasion and the possibility of human-to-human transmission as a result of gene reassortment between the human and avian viral subtypes pose an imminent threat of a global pandemic. The growing reservoir of circulating influenza among the bird population and the perpetuating human demographic factors promote the emergence of a novel viral strain. This article discusses current methods of identifying and treating the illness in individuals, and outlines principles of public health measures for preventing and containing an influenza pandemic.


title: RNA interference for viral infections.

text: The treatment of viral infections has relied on pre-emptive vaccination or use of a limited range of anti-viral drugs. However, the majority of viruses have no available drugs and treatment is merely supportive. RNA interference (RNAi) offers the ability to directly and rapidly treat virus infections via the targeting of viral genes. Indeed, clinical trials have already been undertaken with promising results. Here we review the current state of the RNAi field for the treatment of viral infections such as HIV, human papillomavirus and HCV. We also review novel strategies including the concept of targeting self-genes to limit viral infection and activating the immune system for improved outcomes. Finally we examine innovative approaches being pursued at the Australian Infectious Diseases Research Centre including the use of high-throughput siRNA screens to identify new antiviral targets.


title: Toward the definition of acute disseminated encephalitis of childhood.

text: PURPOSE OF REVIEW Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder most common in childhood and adolescence and thought to have an immune pathogenesis. Some children with ADEM develop additional temporally remote episodes of demyelination with localizations that differ from those of the initial episode and multiple sclerosis is diagnosed. Others have only a single episode. Still others have recurrent episodes in temporal proximity to or with the same localizations as the initial presentation. This review is aimed at delineating what will be required to arrive at a definition of ADEM so as to distinguish it from childhood multiple sclerosis on first presentation. RECENT FINDINGS All studies to date aimed at differential characterization of ADEM and childhood multiple sclerosis have been retrospective case reviews. Each has examined a different array of historical, physical examination, laboratory, and radiologic characteristics of a differently defined patient population. SUMMARY Defining ADEM and distinguishing it from multiple sclerosis early in the course of the latter disease depends critically on standardization of prospective, multicenter study design, execution, and data analysis. This has become of paramount importance, as preventive therapies have evolved for recurrent attacks of multiple sclerosis.


title: [Democracy and Covid-19 mortality in Europe.]

text: OBJECTIVE In Europe there is a great variability in mortality by Covid-19 among different countries. While some countries, such as Greece, Belarus or Ukraine, have a mortality rate of less than 5 cases/100,000 inhabitants, other countries such as Belgium, Spain or the United Kingdom have a mortality rate of well over 50 cases/100,000 inhabitants. It is generally considered that the reason for this variability is multifactorial (including political reasons), but there are few studies that associate factors related to this variability. The objective of this work was to analyse political risk factors/markers that could explain the variability in mortality due to Covid-19 among different European countries. METHODS This is a retrospective, multinational, ecological study based on the exploitation of the database provided by the European Centre for Disease Prevention and Control which collects daily information worldwide on new cases and deaths. The accumulated mortality of Covid-19 in European countries (with more than 100 deaths on 01/05/2020) was calculated up to 29/05/2020. Political variables were compiled from different sources in the countries included in the study. The variables analysed were: the democracy index and the different factors included in it, the country's political system and the country's corruption index. On the other hand, specific political measures implemented in the different countries were collected, such as the number of days elapsed from the notification of the first infected person to 100 infected persons, to lockdown, to the closure of schools or the cancelation of meetings. The number of people infected up to the date of lockdown was also registered. For the statistical analysis of the association between the dependent variable (mortality) and the factors studied, correlation index were calculated, and the association was studied through univariate and multivariate linear regression models. RESULTS At May 1 2020, 27 European countries had at least 100 deaths. The mean mortality was 19.83 cases/100,000 inhabitants (SD 22.4) and a median of 7.95. Mortality varied from a minimum of 1.49 cases/100,000 population in Ukraine to 82.19 cases/100,000 population in Belgium. About factors analyzed both the democracy index (as well as the factors included in it), the political system (full democracy vs. no) and the corruption index were statistically associated with mortality. Also, the time until the implementation of the political measures was associated with mortality. CONCLUSIONS In Europe, there is a west to east (from highest to lowest) gradient in the mortality of Covid-19. Some of the observed mortality variability can be explained by political factors.


Clostridium perfringens type D epsilon intoxication in one-day-old calves.


Health assembly adopts new regulations for tackling emergencies.


title: Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP).

text: In 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed and recommended for use in adults and adolescents in the United States: ADACEL (sanofi pasteur, Swiftwater, Pennsylvania), which is licensed for use in persons aged 11--64 years, and BOOSTRIX (GlaxoSmithKline Biologicals, Rixensart, Belgium), which is licensed for use in persons aged 10-18 years. Both Tdap vaccines are licensed for single-dose use to add protection against pertussis and to replace the next dose of tetanus and diphtheria toxoids vaccine (Td). Available evidence does not address the safety of Tdap for pregnant women, their fetuses, or pregnancy outcomes sufficiently. Available data also do not indicate whether Tdap-induced transplacental maternal antibodies provide early protection against pertussis to infants or interfere with an infant's immune responses to routinely administered pediatric vaccines. Until additional information is available, CDC's Advisory Committee on Immunization Practices recommends that pregnant women who were not vaccinated previously with Tdap: 1) receive Tdap in the immediate postpartum period before discharge from hospital or birthing center, 2) may receive Tdap at an interval as short as 2 years since the most recent Td vaccine, 3) receive Td during pregnancy for tetanus and diphtheria protection when indicated, or 4) defer the Td vaccine indicated during pregnancy to substitute Tdap vaccine in the immediate postpartum period if the woman is likely to have sufficient protection against tetanus and diphtheria. Although pregnancy is not a contraindication for receiving Tdap vaccine, health-care providers should weigh the theoretical risks and benefits before choosing to administer Tdap vaccine to a pregnant woman. This report 1) describes the clinical features of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants, 2) reviews available evidence of pertussis vaccination during pregnancy as a strategy to prevent infant pertussis, 3) summarizes Tdap vaccination policy in the United States, and 4) presents recommendations for use of Td and Tdap vaccines among pregnant and postpartum women.


title: Patient-Reported Outcomes and Quality of Life with Sunitinib Versus Placebo for Pancreatic Neuroendocrine Tumors: Results From an International Phase III Trial.

text: OBJECTIVE The objective of this analysis was to compare patient-reported outcomes and health-related quality of life (HRQoL) in a pivotal phase III trial of sunitinib versus placebo in patients with progressive, well-differentiated pancreatic neuroendocrine tumors (NCT00428597). PATIENTS AND METHODS Patients received sunitinib 37.5 mg (n = 86) or placebo (n = 85) on a continuous daily-dosing schedule until disease progression, unacceptable adverse events (AEs), or death. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at baseline, Day 1 of every 4-week cycle, and end of treatment or withdrawal. Changes ≥10 points on each scale or item were deemed clinically meaningful. RESULTS Sunitinib had anti-tumor effects and improved progression-free survival (PFS) compared with placebo. The study was terminated early for this reason and because of more serious AEs and deaths with placebo. Baseline HRQoL scores were well balanced between study arms, and were generally maintained over time in both groups. In the first 10 cycles, there were no significant differences between groups in global HRQoL, cognitive, emotional, physical, role, and social functioning domains, or symptom scales, except for worsening diarrhea with sunitinib (p < 0.0001 vs. placebo). Insomnia also worsened with sunitinib (p = 0.0372 vs. placebo), but the difference was not clinically meaningful. CONCLUSION With the exception of diarrhea (a recognized side effect), sunitinib had no impact on global HRQoL, functional domains, or symptom scales during the progression-free period. Hence, in patients with pancreatic neuroendocrine tumors, sunitinib provided a benefit in PFS without adversely affecting HRQoL.


title: Primary structure of the S peplomer gene of bovine coronavirus and surface expression in insect cells.

text: The nucleotide sequence of the S peplomer gene of bovine coronavirus (BCV) has been determined. A single open reading frame of 4089 nucleotides encodes a polypeptide of 150K with 20 potential sites for addition of N-linked oligosaccharides. Expression of the cloned BCV S gene by a recombinant of Autographa californica nuclear polyhedrosis virus resulted in production of a 180K glycosylated polypeptide which was transported to the surface of the cell. Comparison of the BCV S gene with the analogous genes of murine hepatitis viruses shows that the BCV S polypeptide contains a unique domain of 138 amino acids not present in murine hepatitis virus strain JHM, but which has a partially homologous counterpart in strain A59. This domain accounts for most of the differences in size of the S gene products of these coronaviruses.


title: Public health ethics: the voices of practitioners.

text: Public health ethics is emerging as a new field of inquiry, distinct not only from public health law, but also from traditional medical ethics and research ethics. Public health professional and scholarly attention is focusing on ways that ethical analysis and a new public health code of ethics can be a resource for health professionals working in the field. This article provides a preliminary exploration of the ethical issues faced by public health professionals in day-to-day practice and of the type of ethics education and support they believe may be helpful.


title: Acquired immunity of A/J mice to mouse hepatitis virus 3 infection: dependence on interferon-gamma synthesis and macrophage sensitivity to interferon-gamma.

text: Coronavirus-free A/J mice (A/J-), in contrast to those naturally infected with coronavirus (A/J+), were shown to be susceptible to experimental infection with our strain of mouse hepatitis virus 3 (MHV3). A/J- mice experimentally hyperimmunized with inactivated MHV3 (A/Ji) became resistant to challenge with this virus. BALB/c mice free of (BALB/c-) or naturally infected with (BALB/c+) coronavirus, or hyperimmunized with inactivated MHV3 (BALB/ci), were always fully susceptible. All susceptible mice developed an acute hepatitis with a high virus titre in the tissues. Resistance mice developed a mild disease in which the low virus titres detected in the tissues were cleared. After infection, interferon (IFN)-gamma synthesis in A/J- mice was lower than that in A/J+ and A/J mice; IFN-gamma synthesis was very high in BALB/c+ and BALB/ci mice, but low in BALB/c- mice. Studies of the anti-MHV3 effect induced in macrophages in vitro showed that only IFN-gamma-activated A/J mouse macrophages were able to restrict partially the growth of MHV3, regardless of whether the animals had been immunized. The effect occurred only when the cells were activated with IFN-gamma before virus infection. The results indicate that the resistance of A/J mice to our strain of MHV3 is not natural but is acquired after immunization, and that the mechanism involved is dependent on T cell activity, IFN-gamma production and the sensitivity of macrophages to IFN-gamma.


title: Development of recombinant nucleoprotein-based diagnostic systems for Lassa fever.

text: Diagnostic systems for Lassa fever (LF), a viral hemorrhagic fever caused by Lassa virus (LASV), such as enzyme immunoassays for the detection of LASV antibodies and LASV antigens, were developed using the recombinant nucleoprotein (rNP) of LASV (LASV-rNP). The LASV-rNP was expressed in a recombinant baculovirus system. LASV-rNP was used as an antigen in the detection of LASV-antibodies and as an immunogen for the production of monoclonal antibodies. The LASV-rNP was also expressed in HeLa cells by transfection with the expression vector encoding cDNA of the LASV-NP gene. An immunoglobulin G enzyme-linked immunosorbent assay (ELISA) using LASV-rNP and an indirect immunofluorescence assay using LASV-rNP-expressing HeLa cells were confirmed to have high sensitivity and specificity in the detection of LASV-antibodies. A novel monoclonal antibody to LASV-rNP, monoclonal antibody 4A5, was established. A sandwich antigen capture (Ag-capture) ELISA using the monoclonal antibody and an anti-LASV-rNP rabbit serum as capture and detection antibodies, respectively, was then developed. Authentic LASV nucleoprotein in serum samples collected from hamsters experimentally infected with LASV was detected by the Ag-capture ELISA. The Ag-capture ELISA specifically detected LASV-rNP but not the rNPs of lymphocytic choriomeningitis virus or Junin virus. The sensitivity of the Ag-capture ELISA in detecting LASV antigens was comparable to that of reverse transcription-PCR in detecting LASV RNA. These LASV rNP-based diagnostics were confirmed to be useful in the diagnosis of LF even in institutes without a high containment laboratory, since the antigens can be prepared without manipulation of the infectious viruses.


[SAFE SURGICAL PRACTICE IN THE ERA OF COVID-19].


Severe Acute Respiratory Syndrome (SARS) in China and status of scientific and clinical knowledge, 14 April 2003.


title: A historical overview of Balkan Endemic Nephropathy (BEN) in relation to published hypotheses.

text: Balkan Endemic Nephropathy occurs with a high rate of prevalence in Serbia, Bulgaria, Romania, Bosnia and Herzegovina, and Croatia. The first cases described in Bulgaria, Serbia and Romania date to the late 1950s and early 1960s. BEN has been characterized to date as a chronic, slowly progressive familial tubular interstitial renal disease of unknown aetiology. The disease is characterized by its endemic nature, long incubation period, the familial clustering of the disease, and a exceptionally high incidence of upper urothelial tumour associated with BEN. To date several hypotheses have presented some findings that could be relevant to the etiology of BEN, but only one of them, chronic poisoning with Aristolochic acids, has provided convincing evidence related to BEN etiology and its clinical characteristics.


Dengue haemorrhagic fever: early recognition, diagnosis and hospital management--an audiovisual guide for health-care workers responding to outbreaks.


title: Molecular mimicry between Fc receptor and S peplomer protein of mouse hepatitis virus, bovine corona virus, and transmissible gastroenteritis virus.

text: We have previously demonstrated molecular mimicry between the S peplomer protein of mouse hepatitis virus (MHV) and Fc gamma R (Fc gamma R). A monoclonal antibody (MAb) to mouse Fc gamma R (2.4G2 anti-Fc gamma R MAb), purified rabbit immunoglobulin, but not their F(ab')2 fragments, as well as mouse and rat IgG, immunoprecipitated (1) recombinant S peplomer protein expressed by a vaccinia virus recombinant in human, rabbit, and mouse cells, and (2) natural S peplomer protein from cells infected with several strains of MHV and MHV escaped mutants. We report here results of studies documenting molecular mimicry between Fc gamma R and S peplomer protein of viruses representing three distinct antigenic subgroups of the Coronaviridae. We have shown a molecular mimicry between the S peplomer protein of bovine corona virus (BCV) and Fc gamma R. The 2.4G2 anti-Fc gamma R MAb, rabbit IgG, but not its F(ab')2 fragments, as well as homologous bovine serum, free of anti-BCV antibodies, immunoprecipitated S peplomer protein of BCV (Mebus strain). In contrast, we did not find molecular mimicry between S peplomer protein of human corona virus (HCV-OC43) and Fc gamma R. Although the OC43 virus belongs to the same antigenic group as MHV and BCV, MAb specific for human Fc gamma RI or Fc gamma RII and purified human IgG1, IgG2, and IgG3 myeloma proteins did not immunoprecipitate the S peplomer protein from HCV-OC43-infected RD cells. In addition, we did demonstrate molecular mimicry between the S peplomer protein of porcine transmissible gastroenteritis virus (TGEV) and Fc gamma R. TGEV belongs to the second antigenic subgroup of coronaviridae.(ABSTRACT TRUNCATED AT 250 WORDS)


title: Outcome of patients receiving high dose vasopressor therapy: a retrospective cohort study.

text: The aim of this study was to determine the hospital survival of patients receiving high doses of catecholamines. A retrospective observational study was conducted in a 22-bed multidisciplinary adult intensive care unit of a tertiary referral university hospital. All patients (n = 64) receiving > 100 microg/min of adrenaline or noradrenaline or adrenaline and noradrenaline combined over a one-year period were studied to determine survival to intensive care unit and hospital discharge. Four patients survived to intensive care unit discharge and hospital discharge (6.25%, 95% CI 0.3 to 12.2%). Survival was 3.3% (95% CI 0 to 7.9%) in the subgroup of 60 patients who received > 100 microg/min noradrenaline and 3.6% (95% CI 0 to 8.6%) in the 55 patients who received > 2 microg/kg/min noradrenaline. None of the 32 patients who received > 200 microg/min noradrenaline survived. We conclude that the survival of patients requiring high doses of catecholamines is poor but the use of such doses is probably not futile. It remains for individual clinicians, patients and their surrogates to decide whether use of high doses of vasopressor is appropriate, given the low probability of survival.


title: Reverse transcription-PCR assays for detection of bovine enteric caliciviruses (BEC) and analysis of the genetic relationships among BEC and human caliciviruses.

text: Two genetically distinct bovine enteric caliciviruses (BECs) have been identified: the norovirus (NLV) Jena and Newbury Agent-2 (NA-2) BECs, which are genetically related to human noroviruses, and the Nebraska (NB) BECs, which is related to sapoviruses and lagoviruses but may also represent a new calicivirus genus. The prevalence of these two BEC genotypes in cattle is unknown. Although reverse transcription-PCR (RT-PCR) primers for human NLV recognize NLV-BECs, the genetic relationships between NLV from humans and the NLV-BECs commonly circulating in cattle is undefined. In the present study, veal calf fecal samples were assayed for enteric caliciviruses by using six RT-PCR primer sets designed for the detection of human NLVs or BECs. Caliciviruses genetically related to the NLV-BEC Jena and NA-2 strains or to the recently characterized NB BEC strain were identified in three of four and four of four sampled veal herds, respectively. Extended 3'-terminal genome sequences of two NLV-BECs, designated CV95-OH and CV186-OH, encoding the RNA-dependent RNA polymerase (RdRp; open reading frame 1 [ORF-1]), VP1 (ORF-2), and VP2 (ORF-3) genes were determined. Phylogenetic and sequence identity analyses of each genome region demonstrated these viruses to be most closely related to the NLV-BEC Jena and NA-2 strains. In initial testing, the human P289-P290 (P289/290) primer set was found to be the most sensitive for calicivirus detection. However, its failure to identify all positive fecal pools (as determined by other assays) led us to design two new primer sets, CBECU-F/R and NBU-F/R, for the sensitive and specific detection of NLV-BEC (NLV-BEC Jena and NA-2) and BEC-NB-like viruses, respectively. The RT-PCR assays with the new primers were compared against other primer sets, including P289/290. Composite results of the tests completed by using the new assays identified 72% (54 of 75) of veal calf fecal samples as positive, with 21 of 21 sequenced reaction products specific for the target RdRp gene. The same design strategy used for the new BEC assays may also be applicable to the design of similar assays for the detection of human caliciviruses (HuCVs). Our data support the genetic relationship between NLV-BECs and NLV-HuCVs but with the NLV-BECs comprising two clusters within a third NLV genogroup.


title: Evaluation of ELISA and electron microscopy for the detection of coronavirus and rotavirus in bovine faeces.

text: Enzyme-linked immunosorbent assay (ELISA) was compared with electron microscopy in the examination of faeces from experimental calves and showed 100 per cent agreement in the detection of 19 bovine coronavirus and 15 bovine rotavirus electron microscope positive samples. In a limited field survey of calf diarrhoea 75 selected faeces were examined independently by ELISA and electron microscopy and the agreement between the two tests was 95 per cent for coronavirus and 84 per cent for rotavirus. A further comparison was made with 74 samples submitted for routine diagnosis and this yielded agreements of 82 per cent (coronavirus) and 89 per cent (rotavirus). Factors contributing to discrepant results were examined and the relative advantages and disadvantages of the two tests for routine detection of these enteric viruses are discussed.


title: Delayed cerebrospinal fluid leak after watertight dural closure with a polyethylene glycol hydrogel dural sealant in posterior fossa surgery: case report.

text: A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fluid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fibrin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefied and almost absorbed. A fistula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.


title: Virus-ligand interactions of OC43 coronavirus with cell membranes.

text: The binding of human coronavirus OC43 to human rhabdomyosarcoma cells which are highly susceptible to infection was studied by a solid phase virus binding assay and a receptor blockade assay. It was observed that whole virions and S(spike) bound to a 90 kD glycoprotein of RD cells even after treatment of the substrate with neuraminidase or 0.1 M NaOH. A second receptor of 45 kD also bound virus and was identified as HLA class I antigen. Antibody to both receptors reduced the virus yield in a receptor blockade assay. Sera from four patients with multiple sclerosis contained receptor blocking activity which correlated with antibodies to HLA. No receptor blocking antibodies to the 90 kD RD cell protein were found in human sera.


title: [Study on the response of specific antibodies against SARS-CoV in patients infected with SARS].

text: OBJECTIVE To study the response of specific antibodies against severe acute respiratory syndrome (SARS)-CoV in patients infected with SARS. METHODS IgM-capture, indirect and antigen-sandwiched enzyme linked immunosorbent assay (ELISA) were used to detect the SARS-CoV specific IgM, IgG and total antibodies in sera of clinical SARS patients or non-SARS individuals. RESULTS The positive rates of IgM, IgG and total antibodies to SARS-CoV in 146 sera of SARS patients collected in different phases of the disease were 61.64%, 53.43% and 69.86%, respectively. The earliest detectable days after onset of the disease for IgM and IgG to SRAS-CoV were 7 and 12 days, respectively. The specific IgM disappeared as early as 42 days after the onset of SARS. Of 70 sera from hepatitis A patients, 2 showed false positive results, while 127 sera from other patients were all negative, detected by the 3 methods. Serum from one medical worker who had been close contact to SARS patients was positive for anti-SARS-CoV IgG and total antibodies. These 3 methods used for detection were all not influenced by rheumatoid factor (RF). CONCLUSION All of the three methods were specific and sensitive for the detection of specific antibodies to SARS-CoV, and useful for epidemiological research and clinical diagnosis, but not for early diagnosis of SARS.


title: Replication of murine hepatitis virus is regulated by papain-like proteinase 1 processing of nonstructural proteins 1, 2, and 3.

text: Coronaviruses are positive-strand RNA viruses that translate their genome RNA into polyproteins that are co- and posttranslationally processed into intermediate and mature replicase nonstructural proteins (nsps). In murine hepatitis virus (MHV), nsps 1, 2, and 3 are processed by two papain-like proteinase activities within nsp3 (PLP1 and PLP2) to yield nsp1, an nsp2-3 intermediate, and mature nsp2 and nsp3. To determine the role in replication of processing between nsp2 and nsp3 at cleavage site 2 (CS2) and PLP1 proteinase activity, mutations were engineered into the MHV genome at CS2, at CS1 and CS2, and at the PLP1 catalytic site, alone and in combination. Mutant viruses with abolished cleavage at CS2 were delayed in growth and RNA synthesis but grew to wild-type titers of >10(7) PFU/ml. Mutant viruses with deletion of both CS1 and CS2 exhibited both a delay in growth and a decrease in peak viral titer to approximately 10(4) PFU/ml. Inactivation of PLP1 catalytic residues resulted in a mutant virus that did not process at either CS1 or CS2 and was severely debilitated in growth, achieving only 10(2) PFU/ml. However, when both CS1 and CS2 were deleted in the presence of inactivated PLP1, the growth of the resulting mutant virus was partially compensated, comparable to that of the CS1 and CS2 deletion mutant. These results demonstrate that interactions of PLP1 with CS1 and CS2 are critical for protein processing and suggest that the interactions play specific roles in regulation of the functions of nsp1, 2, and 3 in viral RNA synthesis.


title: Application of acute stroke imaging: selecting patients for revascularization therapy.

text: Due to the dynamic and versatile characteristics of ischemic penumbra, selecting the right acute ischemic stroke (AIS) patients for revascularization therapy (RT) based on initial available imaging can be challenging. The main patient selection criterion for RT is the size of the mismatch between the potentially salvageable tissue (penumbra) and the irreversibly damaged tissue (core). The goal of revascularization RT is to "freeze" the core and prevent it from extending to the penumbral tissue. Penumbral imaging selection of AIS patients for RT, using magnetic resonance or CT-based studies, may provide more clinical benefit to the appropriate patients, although direct evidence is pending. Not all penumbra-core mismatches beyond 3 hours are equal and need treatment, and defining which mismatches to target for RT is the current goal of ongoing clinical trials. In addition to "penumbral"-based imaging, large vessel occlusion and clot length estimation based on CT angiography and noncontrasted ultrathin CT scan has been used to identify patients who are refractory to systemic thrombolysis and may be eligible for endovascular therapy. The application of various imaging modalities in selecting and triaging AIS patients for RT is discussed in this review. Larger prospective randomized trials are needed to better understand the role of various imaging modalities in selecting AIS patients for RT and to understand its influence on clinical outcome.


title: Laminated cisternae of the rough endoplasmic reticulum induced by coronavirus MHV-A59 infection.

text: The infection of murine fibroblasts of the sac- line with a coronavirus, mouse hepatitis virus strain A59 (MHV-A59), results in a novel modification to some cisternae of the rough endoplasmic reticulum (RER). From 8 hours post infection (h.p.i.) we see in thin sections pairs of cisternae closely, stably and uniformly aligned. Serial sectioning shows that the regions of pairing or lamination extend for many thousands of nm in two dimensions, with the spacing between the juxtaposed membranes remaining very uniform at about 18 nm. These structures appear coincident with the onset of accumulation of the viral glycoprotein E1 in the RER membrane but 2 hours after the viral glycoprotein E2 can first be detected there. Ribosomes are excluded from the paired cisternal surfaces, while budding of progeny virions has never been seen at the cisternal membranes facing the cytosol, although ribosomes bind there. The lumina of paired cixternae are usually devoid of virions which, however, accumulate in areas where the paired cisternae diverge. Electron immunocytochemistry shows that both E1 and E2 glycoproteins are abundant in the paired cisternae. Following labelling for the E1 glycoprotein we see a periodic fine structure, rows of "beads" with a centre to centre spacing of about 7.5 nm, in the region between the paired membranes. In oblique sections of this region in cells fixed as if for the immunoperoxidase labelling, but omitting all its steps we see parallel rows of "beads" separated by about 7 nm. We suggest that the membrane spanning viral glycoprotein E1 together with viral nucleocapsids may be involved in laminating cisternae of the RER.


title: [Pathogen inactivation in fresh frozen plasma using riboflavin and ultraviolet light: effects on plasma proteins and coagulation factor VII].

text: BACKGROUND/AIM Riboflavin (vitamin B2) activated by ultraviolet (UV) light, produces active oxygen which damages cell membrane and prevents replication of the carrier of diseases (viruses, bacteria, protozoa) in all blood products. The aim of this study was to establish the influence of the process of photo inactivation in pathogens using riboflavin and UV rays on the concentration of coagulation factor VIII:C (FVIII:C) and proteins in plasma that were treated before freezing. METHODS The examination included 20 units of plasma, separated from whole blood donated by voluntary blood donors around 6 hours from the moment of collection. The units were pooled and separated in to two groups: one consisted of 10 control units and the other of 10 experimental units. Experimental units of the plasma were treated by riboflavin (35 mL) and UV rays (6.24 J/mL, 265-370 nm) on Mirasol aparature (Caridian BCT Biotechnologies, USA) in approximate duration of 6 minutes. Furthermore, 35 mL of saline solution was added to the control plasma. One sample for examining was taken from the control plasma (KG) and two residual were taken from experimental plasma after the addition of riboflavin either before (EG1) or post illumination (EG2). Results. Comparing the mean values of FVIII:C (%) we noticed statistically significantly higher level in the EG1 group than in the EG2 group (65.00 +/- 4.52 vs. 63.20 +/- 4.73; t = 4.323, p = 0.002), while between the KG and experimental groups (EG1 and EG2) there was no statistically significant difference in the concentration of FVIII:C. There was a statistically significant decrease of albumin concentration (g/L) in the EG2 group comparing to the KG (33.35 +/- 0.94 vs. 31.94 +/- 0.84; t = 3.534, p = 0.002), but there was no mentioned difference in albumin concentration between the KG and the EG1, so as between the EG1 and the EG2. CONCLUSION Plasma inactivated by riboflavin and UV rays (Mirasol PRT system, Caridian BCT, U.S.A.) keeps all the characteristics of conventional plasma, so it could be used for the treatment of pathological conditions that demand transfusion of fresh frozen plasma, or in patients with thrombotic thrombocytopenic purpure when we use therapeutic exchange of plasma.


title: Modelling SARS data using threshold geometric process.

text: During the outbreak of an epidemic disease, for example, the severe acute respiratory syndrome (SARS), the number of daily infected cases often exhibit multiple trends: monotone increasing during the growing stage, stationary during the stabilized stage and then decreasing during the declining stage. Lam first proposed modelling a monotone trend by a geometric process (GP) [X(i), i=1,2,...] directly such that [a(i-1)X(i), i=1,2,...] forms a renewal process for some ratio a>0 which measures the direction and strength of the trend. Parameters can be conveniently estimated using the LSE methods. Previous GP models limit to data with only a single trend. For data with multiple trends, we propose a moving window technique to locate the turning point(s). The threshold GP model is fitted to the SARS data from four regions in 2003.


[Intestinal disorders].


title: Necrotizing enterotyphlocolitis in dogs treated with a potent antimuscarinic.

text: To assess the safety of a potent muscarinic receptor antagonist (antimuscarinic) for human clinical testing, repeat-dose oral toxicity studies were conducted in the Beagle dog. Treatment resulted in unexpected gastrointestinal system effects that were likely mediated by the exaggerated pharmacologic effects of the antimuscarinic on intestinal motility. Dogs developed profound anorexia followed by severe bloody diarrhea, and at necropsy, the intestinal tract was distended, filled with red-tinged fluid, and the mucosa was reddened. Histologically, intestinal lesions consisted of severe epithelial necrosis and mucosal atrophy localized predominantly to the ileum and large intestine. Feces from dogs with diarrhea were culture-positive for Clostridium perfringens (CP), suggesting that CP might be the etiologic agent; however, the intestinal lesions were not consistent with histologic findings reported in dogs with hemorrhagic canine enteritis.


title: Sequence analysis of the turkey enteric coronavirus nucleocapsid and membrane protein genes: a close genomic relationship with bovine coronavirus.

text: The 3' end of the turkey coronavirus (TCV) genome and the gene encoding the nucleocapsid protein (N) were cloned and sequenced. The gene encoding the membrane protein (M) was obtained by cloning a polymerase chain reaction (PCR)-amplified fragment obtained using bovine coronavirus (BCV)-specific primers. Furthermore, five TCV DNA fragments, obtained by PCR on RNA from clinical specimens and corresponding to either the N terminus of the M protein or the complete M protein were also cloned and sequenced. The sequence revealed a 3' non-coding region of 291 bases, an open reading frame (ORF) encoding the N protein with a predicted size of 448 amino acids, or an Mr of 49K, and an ORF encoding the M protein with a predicted size of 230 amino acids and an Mr of 26K. A third ORF, encoding a hypothetical protein of 207 amino acids with an Mr of 23K was found within the N gene sequence. The amino acid sequences of both the N and M proteins were more than 99% similar to those published for BCV. Extensive similarity was also observed between the amino acid sequences of the TCV N protein and those of murine hepatitis virus (MHV) (70%) and human respiratory coronavirus strain OC43 (HCV-OC43) (98%) and between the amino acid sequences of the predicted M proteins of TCV and MHV (86%). Such striking identity suggests that BCV, TCV and HCV-OC43 must have diverged from each other only recently. A potential N-glycosylation site was found at the N terminus of the TCV M protein and is situated at the same location in BCV, MHV and transmissible gastroenteritis virus.


title: Cognitive rehabilitation for attention deficits following stroke.

text: BACKGROUND Attention problems occur following stroke and are treated using computerised activities or paper and pencil tasks. OBJECTIVES To determine the effects of cognitive rehabilitation for attention deficits following stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register, Medline, EMBASE, CINHAL and CLIN PSYCH databases and reference lists from relevant articles. Date of most recent searches: December 1998 SELECTION CRITERIA Controlled trials of attention training in stroke. Studies with mixed aetiology groups were excluded unless they included more than 75% of stroke patients or separate data were available for the stroke patients. DATA COLLECTION AND ANALYSIS Two reviewers extracted trial data and assessed trial quality. Reviewers contacted investigators for further details of trials. MAIN RESULTS Two trials were identified with 56 participants. The two trials showed a benefit of training on measures of alertness and sustained attention. Only one trial included a measure of functional independence and this showed no significant effect of training. REVIEWER'S CONCLUSIONS There is some indication that training improves alertness and sustained attention but no evidence to support or refute the use of cognitive rehabilitation for attention deficits to improve functional independence following stroke.


title: Coronavirus-associated pneumonia in previously healthy children.

text: The extent to which coronaviruses are associated with lower respiratory tract disease in previously healthy children without underlying medical conditions is unknown. We investigated instances of radiographically confirmed lower respiratory tract disease among symptomatic children with coronavirus infection. Here, we document the clinical courses of 2 previously healthy children with coronavirus-associated pneumonia.


title: [Epidemiological study of the transmission chain of a severe acute respiratory syndrome outbreak].

text: OBJECTIVE To investigate the process of SARS transmission and to evaluate infectivity of SARS patients in different periods of disease development. METHODS A case of SARS outbreak beginning from a male, 74-year-old patient in Beijing. Two hundred and seventy five primary, secondary and tertiary contacts, including family members relatives, colleagues, and others exposed to him, were traced by field investigation and telephone interview using a standardized questionnaire. The transmission process and infectivity of disease were analyzed with transmission chain diagram and contact history diagram. RESULTS Among the 275 contacts of the index case, 41 fell ill of SARS with an attack rate of 14.9% and 5 deaths with a fatality rate of 12.2%. The transmission chain of this outbreak could be clearly delineated, and all the 41 cases had close contacts with their infectors, SARS cases of the previous generation within the symptomatic period thereof. All of the 114 contacts that contacted their infectors, SARS cases of the previous generation during the incubation period thereof remained healthy. The incubation period of 27 cases that had contacted their infectors only once was 1 - 10 days with a median of 3 days. The highest risk of being infected was caring the patients unprotectedly, followed by living together with patient, visiting patient, and handling patient without protection. CONCLUSION All the secondary cases have the history of close contact with their symptomatic infectors of previous generation. It cannot be proved at all that SARS is infective during the incubation period. The infectivity of SARS is related to the degree of closeness of contact with the patient.


title: Evaluation of a novel permanent capped helical coil fastener in a porcine model of laparoscopic ventral hernia repair.

text: BACKGROUND Existing permanent helical coil fasteners, although commonly employed for mesh fixation during laparoscopic hernia repair, are associated with peritoneal tissue attachment formation and resultant visceral complications. We evaluated attachment formation, fastener engagement, and mesh/tissue integration associated with laparoscopic fixation using a novel permanent capped helical coil fastener (HC-Capped) compared to permanent non-capped helical coil fasteners (HC-Non-Capped) in a porcine model. METHODS Twelve female pigs underwent bilateral laparoscopic intraperitoneal fixation of Composix™ L/P Mesh (10 × 15 cm oval) with HC-Capped or HC-Non-Capped fasteners. Thirty-two fasteners were used to secure each mesh utilizing a "double-crown" technique. Laparoscopy at 30 days was used to evaluate the presence and area coverage of attachments (Diamond Score) and percentage of engaged fasteners. At 90 days, following necropsy, each mesh was evaluated for the presence, percentage, and tenacity (Butler Score) of attachments and fastener engagement. Samples were biomechanically evaluated to assess tissue integration via T-peel testing. RESULTS HC-Capped fasteners demonstrated a significantly lower attachment area score compared to the HC-Non-Capped group at 30 days (0.92 ± 0.26 vs. 2.50 ± 0.29/3.00, p = 0.002) and 90 days (0.60 ± 0.22 vs. 2.08 ± 0.29/3.00, p = 0.004). At 90 days, the HC-Capped group evidenced significantly lower attachment tenacity score (1.00 ± 0.37 vs. 2.75 ± 0.33/4.00, p = 0.013). Furthermore, at 30 and 90 days, a significantly greater percentage of HC-Capped fasteners remained properly engaged (30 days: 99.7 % vs. 86.5 %, p < 0.001 and 90 days: 99.4 % vs. 74.5 %, p = 0.001). T-peel biomechanical testing demonstrated significantly greater mesh/tissue integration for HC-Capped group (2.16 ± 0.24 vs. 1.16 ± 0.29 N/cm, p = 0.038). CONCLUSIONS In a porcine model, HC-Capped fasteners demonstrated significantly less attachment coverage and tenacity in the early postoperative period. Furthermore, the HC-Capped cohort evidenced significantly greater percentage of properly engaged fasteners and greater mesh/tissue integration. Data suggest that shielding exposed fastener points on the visceral mesh surface with polymer caps may reduce attachment formation and aid in mesh fixation and integration.


title: Interaction of immune and central nervous systems: contribution of anti-viral Thy-1+ cells to demyelination induced by coronavirus JHM.

text: The murine coronavirus JHM (JHMV or MHV-4) has been intensively studied as an experimental model of viral-induced demyelination; nonetheless, the degree to which demyelination results from direct viral cytolysis of oligodendroglia or immunological mechanisms remains controversial. To examine the contribution of immunity to the pathogenesis of JHMV in the central nervous system (CNS), mice were exposed to immunosuppressive doses of x-irradiation 3 days post infection and observed for clinical and pathological evidence of acute and subacute demyelination. Irradiated mice were found to have a nearly thousand-fold increase in central nervous system virus titer, as well as the presence of both abundant virus and viral antigen in white matter cells with the morphological characteristics of oligodendrocytes. Nonetheless, infected, irradiated mice had little or no evidence of demyelination or destruction of CNS cells. Adoptive transfers of spleen cells from syngeneic JHMV-immunized donors into irradiated JHMV-infected mice were carried out in order to determine the effect of immune reconstitution on pathogenesis. Splenocytes from JHMV-immune donors, but not naive donors or donors immunized with irrelevant antigen, completely restored demyelination in irradiated, JHMV-infected recipients. Depletion of Thy-1+ cells by treatment with monoclonal antibody and complement abolished the ability to transfer demyelination. We conclude that: 1) JHMV infection of the CNS does not result in acute or subacute demyelination in the absence of an intact immune response, and 2) viral-specific Thy-1+ cells are an essential element in the induction of demyelinating CNS lesions that result from JHMV infection.


title: Knowledge of risk and self-protection practices and the degree of influenza hazard from live poultry sales.

text: 1. Perceptions of risk from buying live chickens were moderate, but sickness anxieties did not predict buying or touching habits. 2. Buying was strongly predicted by the erroneous belief that cooking is the best means of protection from avian influenza. Health education groups seeking to increase preventive practices to control possible avian influenza outbreaks need to learn from this.


title: Clinical impact of community-acquired respiratory viruses on bronchiolitis obliterans after lung transplant.

text: Community-acquired viral respiratory tract infections (RTI) in lung transplant recipients may have a high rate of progression to pneumonia and can be a trigger for immunologically mediated detrimental effects on lung function. A cohort of 100 patients was enrolled from 2001 to 2003 in which 50 patients had clinically diagnosed viral RTI and 50 were asymptomatic. All patients had nasopharyngeal and throat swabs taken for respiratory virus antigen detection, culture and RT-PCR. All patients had pulmonary function tests at regular intervals for 12 months. Rates of rejection, decline in forced expiratory volume (L) in 1 s (FEV-1) and bacterial and fungal superinfection were compared at the 3-month primary endpoint. In the 50 patients with RTI, a microbial etiology was identified in 33 of 50 (66%) and included rhinovirus (9), coronavirus (8), RSV (6), influenza A (5), parainfluenza (4) and human metapneumovirus (1). During the 3-month primary endpoint, 8 of 50 (16%) RTI patients had acute rejection versus 0 of 50 non-RTI patients (p=0.006). The number of patients experiencing a 20% or more decline in FEV-1 by 3 months was 9 of 50 (18%) RTI versus 0 of 50 non-RTI (0%) (p=0.003). In six of these nine patients, the decline in FEV-1 was sustained over a 1-year period consistent with bronchiolitis obliterans syndrome (BOS). Community-acquired respiratory viruses may be associated with the development of acute rejection and BOS.


title: Clinician/patient connections in ethnoculturally nonconcordant encounters with political-asylum seekers: a comparison of physicians and nurses.

text: The article compares the ability of nurses and physicians to connect with patients in ethnoculturally nonconcordant clinical encounters with 41 randomly selected political-asylum seekers (PAS) residing at five Finnish reception centers in summer 2002. Doctors and nurses were equally unlikely to draw congruent assessments of the patient's past and present health condition, mixed use of biomedical/ethnocultural practices, adherence with medication and eat/drink instructions, (dis)satisfaction, and future confidence in recommended biomedical and ethnocultural approaches. Nurses were considerably more likely to hold views that were congruent with the patient's reported health care effectiveness in Finland. The findings suggest that doctors should request and place special weight on the insights of the principal attending nurse when assessing the potential contributions of personal, family, and host-society health care assets and inhibitors to a migrant patient's overall health plan. The results also suggest that culturally sensitive health care training offers specific advantages to nurses who attend to PAS.


title: Characterization of human T cell clones specific for coronavirus 229E.

text: Coronaviruses (CV) are pleomorphic enveloped RNA viruses that are ubiquitous in nature, causing a variety of diseases in both man and domestic animals. In man, CV are generally associated with upper respiratory tract infections. The two prototype strains that are the best studied human CV isolates and which are thought to be responsible for most of the respiratory infections caused by CV are called 229E and OC43. Humoral responses consisting of neutralizing antibodies to CV are present in most individuals by six years of age. Although the cellular immune response to CV in man has not been characterized at all, it is known that the spike (S) and nucleocapsid (N) proteins elicit the major cell mediated immune responses in the mouse. This report describes the production and characterization of eleven independently isolated T cell clones that are specific for the human CV(HCV) 229E. The T cell clones are CD4+ and presumably recognize a processed viral peptide presented by class II molecules on the surface of antigen presenting cells. Of six 229E-specific T cell clones tested against purified viral proteins, three recognize the 180 kD spike glycoprotein while the other three recognize the 55 kD nucleocapsid phosphoprotein. Analysis of the human T cell mediated response to HCV will provide information regarding which viral proteins elicit the immunodominant response, what the fine specificity of these T cell clones are (immuno-dominant peptides), and what the T cell receptor (TCR) and cytokine usage is of these virus specific clones.


title: Protecting healthcare workers from pandemic influenza: N95 or surgical masks?

text: OBJECTIVE The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infections and N95 masks to protect against aerosol-spread infections. A literature review was undertaken for evidence of superior protective value of N95 masks or surgical masks for healthcare workers against influenza and extraneous factors influencing conferred protection. METHODS Four scientific search engines using 12 search sequences identified 21 mask studies in healthcare settings for the prevention of transmission of respiratory syncytial virus, Bordetella pertussis, and severe acute respiratory syndrome. Each was critically assessed in accordance with Australian National Health Medical Research Council guidelines. An additional 25 laboratory-based publications were also reviewed. RESULTS All studies reviewed used medium or lower level evidence study design. In the majority of studies, important confounders included the unrecognized impact of concurrent bundling of other infection control measures, mask compliance, contamination from improper doffing of masks, and ocular inoculation. Only three studies directly compared the protective value of surgical masks with N95 masks. The majority of laboratory studies identified both mask types as having a range of filtration efficiency, yet N95 masks afford superior protection against particles of a similar size to influenza. CONCLUSIONS World Health Organization guidelines recommend surgical masks for all patient care with the exception of N95 masks for aerosol generating procedures. Because of the paucity of high-quality studies in the healthcare setting, the advocacy of mask types is not entirely evidence-based. Evidence from laboratory studies of potential airborne spread of influenza from shedding patients indicate that guidelines related to the current 1-meter respiratory zone may need to be extended to a larger respiratory zone and include protection from ocular inoculation.


title: Adult autoimmune enteropathy treated successfully with tacrolimus.

text: BACKGROUND Autoimmune enteropathy is a life-threatening, chronic disease of the small bowel mucosa, which generally responds well to steroids. Treatment requires long-term immunosuppression, and steroid-sparing treatment strategies are desirable. Azathioprine and cyclosporine A have limitations, however alternatives have not been described in adults. CASE REPORT We present the case of a 54-year-old male patient with autoimmune enteropathy who responded initially to a standard treatment with steroids, but was dependent on 30 mg prednisolone. Medical treatment was changed to tacrolimus after renal function deteriorated under treatment with cyclosporine A. Under this regimen, small bowel histology normalized and the clinical condition is stable after 2 years of introduction of tacrolimus. CONCLUSION This constitutes the first report of effective treatment of adult autoimmune enteropathy with tacrolimus, a substance with a similar mode of action to cyclosporine, but with fewer side effects and improved bioavailability.


title: Clinical importance of significant asimptomatic bacteriuria in newborns and infants during early postnatal period.

text: The aim of the study was to detect newborns at risk for developing renal impairment, and to point out the importance of significant asimptomatic bacteriuria in perinatal period and early infancy. Severe urinary tract anomalies are very often accompanied only by asimptomatic bacteriuria in perinatal period. Three urinalysis ware done after delivery. 212 newborns with significant asimptomatic bacteriuria underwent ultrasound examination, and were followed up to three months. Those with normal findings and with passing bacteriuria in the first 2 months were excluded. Group of 52 newborns underwent radioisotope examination. Frequency of urinary tract anomalies in newborns was 34.6%. Increased risk for renal impairment had children with urinary tract anomalies in close family, urinary tract infection or bacteriuria, EPH gestosis and prepartal symptoms of febrile infection in mother, children with IUGR, strangulated umbilical cord, prolonged jaundice and attacks of peripheral cyanosis in perinatal period.


title: [Possibilities for ultrasonic diagnosis of pleura pathology in patients with pleural exudate].

text: The authors have analyzed results of thoracovideoscopy in 45 patients with the syndrome of pleural exudate, 17 of them had undergone the ultrasonic examination of the pleural cavity before thoracoscopy. The examination has revealed high sensibility of the ultrasonic method in the diagnosis of fragmentations of pleural exudate and pathology of the pleural leaves. The endoscopic and echographic classification of the pleural exudate is given depending on the fragmentation degree. The authors consider that echography of the pleural cavity as a noninvasive and highly informative method should be included in the first rank in making an algorithm of clinico-diagnostic measures for patients with exudative pleuritis.


The SARS outbreak and community paediatrics.


title: Diseases of the European wildcat (Felis silvestris Schreber, 1777) in Great Britain.

text: The author describes an examination conducted in collaboration with the Nature Conservancy Council of Great Britain into the status with regard to disease, conservation and genetics of the European wildcat (Felis silvestris). Feline leukaemia virus (FeLV) infection was detected by positive enzyme-linked immunosorbent assay in blood from 2 of 23 wildcats and was tested and confirmed by FeLV isolation in one of the two cats. This is the first time the virus has been clearly demonstrated in a free-living felid, other than the domestic cat. Toxoplasmosis was detected in all cats tested, but neither feline coronavirus nor feline immunodeficiency virus was detected in any sample. The genetic analysis indicated that only 8 of 42 wildcats tested were genetically distinct. These were mainly located in the western highlands of Scotland where "relict" populations may have survived. Interbreeding with domestic cats and persecution by trapping and hunting represent major threats to the survival of the European wildcat.


title: Prior immunization with severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV) nucleocapsid protein causes severe pneumonia in mice infected with SARS-CoV.

text: The details of the mechanism by which severe acute respiratory syndrome-associated coronavirus (SARS-CoV) causes severe pneumonia are unclear. We investigated the immune responses and pathologies of SARS-CoV-infected BALB/c mice that were immunized intradermally with recombinant vaccinia virus (VV) that expressed either the SARS-CoV spike (S) protein (LC16m8rVV-S) or simultaneously all the structural proteins, including the nucleocapsid (N), membrane (M), envelope (E), and S proteins (LC16m8rVV-NMES) 7-8 wk before intranasal SARS-CoV infection. The LC16m8rVV-NMES-immunized group exhibited as severe pneumonia as the control groups, although LC16m8rVV-NMES significantly decreased the pulmonary SARS-CoV titer to the same extent as LC16m8rVV-S. To identify the cause of the exacerbated pneumonia, BALB/c mice were immunized with recombinant VV that expressed the individual structural proteins of SARS-CoV (LC16mOrVV-N, -M, -E, -S) with or without LC16mOrVV-S (i.e., LC16mOrVV-N, LC16mOrVV-M, LC16mOrVV-E, or LC16mOrVV-S alone or LC16mOrVV-N + LC16mOrVV-S, LC16mOrVV-M + LC16mOrVV-S, or LC16mOrVV-E + LC16mOrVV-S), and infected with SARS-CoV more than 4 wk later. Both LC16mOrVV-N-immunized mice and LC16mOrVV-N + LC16mOrVV-S-immunized mice exhibited severe pneumonia. Furthermore, LC16mOrVV-N-immunized mice upon infection exhibited significant up-regulation of both Th1 (IFN-gamma, IL-2) and Th2 (IL-4, IL-5) cytokines and down-regulation of anti-inflammatory cytokines (IL-10, TGF-beta), resulting in robust infiltration of neutrophils, eosinophils, and lymphocytes into the lung, as well as thickening of the alveolar epithelium. These results suggest that an excessive host immune response against the nucleocapsid protein of SARS-CoV is involved in severe pneumonia caused by SARS-CoV infection. These findings increase our understanding of the pathogenesis of SARS.


title: Bioterrorism in the United States: a balanced assessment of risk and response.

text: There are many definitions of terrorism and numerous examples of the use of explosives and small arms, especially against civilians and with the objective of instilling fear. Although chemical and biological agents have only rarely been used by terrorists, there has recently been much concern about the threat of bioterrorism and the role of future health personnel in counteracting it. Rational setting of priorities requires the balance of risks against benefits in prevention and preparedness. Adverse effects of preparedness include inappropriate warnings, diversion of resources from other public health measures, both in the United States and overseas and constraints on civil rights. It is argued that the US should counteract the threat of bioterrorism by dealing with its root causes and by strengthening civil rights, international arms control and international law rather than by a self-defeating 'war on terrorism'.


Successful treatment of Tourette's disorder with amisulpride.


title: Severe acute respiratory syndrome coronavirus (SARS-CoV) infection inhibition using spike protein heptad repeat-derived peptides.

text: The coronavirus SARS-CoV is the primary cause of the life-threatening severe acute respiratory syndrome (SARS). With the aim of developing therapeutic agents, we have tested peptides derived from the membrane-proximal (HR2) and membrane-distal (HR1) heptad repeat region of the spike protein as inhibitors of SARS-CoV infection of Vero cells. It appeared that HR2 peptides, but not HR1 peptides, were inhibitory. Their efficacy was, however, significantly lower than that of corresponding HR2 peptides of the murine coronavirus mouse hepatitis virus (MHV) in inhibiting MHV infection. Biochemical and electron microscopical analyses showed that, when mixed, SARS-CoV HR1 and HR2 peptides assemble into a six-helix bundle consisting of HR1 as a central triple-stranded coiled coil in association with three HR2 alpha-helices oriented in an antiparallel manner. The stability of this complex, as measured by its resistance to heat dissociation, appeared to be much lower than that of the corresponding MHV complex, which may explain the different inhibitory potencies of the HR2 peptides. Analogous to other class I viral fusion proteins, the six-helix complex supposedly represents a postfusion conformation that is formed after insertion of the fusion peptide, proposed here for coronaviruses to be located immediately upstream of HR1, into the target membrane. The resulting close apposition of fusion peptide and spike transmembrane domain facilitates membrane fusion. The inhibitory potency of the SARS-CoV HR2-peptides provides an attractive basis for the development of a therapeutic drug for SARS.


title: Mechanism of the maturation process of SARS-CoV 3CL protease.

text: Severe acute respiratory syndrome (SARS) is an emerging infectious disease caused by a novel human coronavirus. Viral maturation requires a main protease (3CL(pro)) to cleave the virus-encoded polyproteins. We report here that the 3CL(pro) containing additional N- and/or C-terminal segments of the polyprotein sequences undergoes autoprocessing and yields the mature protease in vitro. The dimeric three-dimensional structure of the C145A mutant protease shows that the active site of one protomer binds with the C-terminal six amino acids of the protomer from another asymmetric unit, mimicking the product-bound form and suggesting a possible mechanism for maturation. The P1 pocket of the active site binds the Gln side chain specifically, and the P2 and P4 sites are clustered together to accommodate large hydrophobic side chains. The tagged C145A mutant protein served as a substrate for the wild-type protease, and the N terminus was first digested (55-fold faster) at the Gln(-1)-Ser1 site followed by the C-terminal cleavage at the Gln306-Gly307 site. Analytical ultracentrifuge of the quaternary structures of the tagged and mature proteases reveals the remarkably tighter dimer formation for the mature enzyme (K(d) = 0.35 nm) than for the mutant (C145A) containing 10 extra N-terminal (K(d) = 17.2 nM) or C-terminal amino acids (K(d) = 5.6 nM). The data indicate that immature 3CL(pro) can form dimer enabling it to undergo autoprocessing to yield the mature enzyme, which further serves as a seed for facilitated maturation. Taken together, this study provides insights into the maturation process of the SARS 3CL(pro) from the polyprotein and design of new structure-based inhibitors.


Health and economic benefits of an accelerated program of research to combat global infectious diseases.


title: Sequence analysis of the gene encoding the fusion glycoprotein of pneumonia virus of mice suggests possible conserved secondary structure elements in paramyxovirus fusion glycoproteins.

text: The gene encoding the fusion (F) glycoprotein of pneumonia virus of mice consists of 1657 bases and contains an open reading frame encoding 537 amino acids which is more similar to the F proteins of pneumoviruses than to those of other paramyxoviruses. Computer-assisted sequence analyses can be combined with data on the antigenicity of various F proteins to suggest a possible arrangement of secondary structure elements common to all pneumovirus and paramyxovirus F proteins.


title: [Ethical guides, criteria for admission in intensive care, palliative care. Multi-society recommendations for allocation of resources during the COVID-19 pandemic].

text: Guidelines on resource allocation, ethics, triage processes with admission and discharge criteria from critical care and palliative care units during the pandemia are here presented. The interdisciplinary and multi-society panel that prepared these guidelines represented by bioethicists and specialists linked to the end of life: clinicians, geriatricians, emergentologists, intensivists, and experts in palliative care and cardiopulmonary resuscitation. The available information indicates that approximately 80% of people with COVID-19 will develop mild symptoms and will not require hospital care, while 15% will require intermediate or general room care, and the remaining 5% will require assistance in intensive care units. The need to think about justice and establish ethical criteria for allocation patients arise in conditions of exceeding available resources, such as outbreaks of diseases and pandemics, with transparency being the main criterion for allocation. These guides recommend general criteria for the allocation of resources relies on bioethical considerations, rooted in Human Rights and based on the value of the dignity of the human person and substantial principles such as solidarity, justice and equity. The guides are recommendations of general scope and their usefulness is to accompany and sustain the technical and scientific decisions made by the different specialists in the care of critically ill patients, but given the dynamic nature of the pandemic, a process of permanent revision and adaptation of recommendations must be ensured.


Severe acute respiratory syndrome coronavirus sequence characteristics and evolutionary rate estimate from maximum likelihood analysis.


Quarantine: voluntary or not?


title: Role of virus receptor-bearing endothelial cells of the blood-brain barrier in preventing the spread of mouse hepatitis virus-A59 into the central nervous system.

text: BALB/c mice develop a neurologic demyelinating disease after inoculation of mouse hepatitis virus (MHV), strain A59, by the intracranial, but not by the intraperitoneal route. To determine the mechanisms that prevent virus spreading through the blood-brain barrier, we analyzed expression of MHVR, a glycoprotein that serves as receptor for mouse hepatitis virus on endothelial cells of cerebral blood vessels. Our results indicated that MHVR was strongly expressed on the endoluminal pole of these cells. In addition, a direct virus binding assay showed that mouse hepatitis virus was able to bind endothelial cells via this receptor. Despite this expression of a functional viral receptor, in normal mice infected with mouse hepatitis virus by the contra-peritoneal route, no in vivo viral replication could be detected in endothelial cells from the brain, contrasting with the equivalent cells from the liver. However, shortly after i.v. administration of sodium dodecylsulfate detergent to the mice, virus infection of some cerebral endothelial cells was detected in a few mice. As a consequence of detergent treatment, virus infection was able to cross the blood-brain barrier. These results suggest that the protective role of the blood-brain barrier against spreading of mouse hepatitis virus A59 into the central nervous system is determined by a specific restriction of viral entry into the endothelial cells of cerebral origin.


title: Development of effective therapies against West Nile virus infection.

text: Since its entry into North America in 1999, West Nile virus has spread throughout the USA and Canada, and now annually causes a clinical spectrum of human disease ranging from a self-limiting acute febrile illness to potentially lethal encephalitis. Although no therapy is currently approved for use in humans, several strategies are being pursued to develop effective prophylaxis and treatments. This review describes the epidemiology, clinical presentation and pathogenesis of West Nile virus infection, and highlights recent progress towards an effective therapy.


title: Transanal Endoscopic Surgery Using Different Single-Port Devices.

text: Currently, there is a new transanal approach to be used for the excision of selected low-risk rectal cancers and broad-based polyps, the transanal endoscopic surgery using a single-port device. We transferred the single port access surgery (SPA) well-established from laparoscopic surgery as an improvement of the transanal endoscopic microsurgery (TEM). The aim of this article is to give an overview about the technical options and our experiences with different devices. Thirteen patients with selected low-risk rectal cancers or broad-based polyps with dysplasia underwent the SPA modified TEM using the SILS Port (Covidien Norwalk, CT), the TriPort (Olympus KeyMed, Southend, UK) or TriPort+ (Olympus KeyMed, Southend, UK), and laparoscopic instruments. The transanal single port procedure was in all cases completely successful without major complications. The transanal placement of SILS Port (Covidien) and TriPort/TriPort+ (Olympus) was easy to perform; a prior dilatation of the anal sphincter was not necessary. With an excellent view, accurate dissection was possible, all of them are appropriate for transanal single-port device. The postoperative follow-up showed an unremarkable examination. The transanal single port surgery with its benefits is a modified way to replace the TEM procedure. Our first experiences showed comfortable feasibility, less postoperative discomfort, and a reduced risk of damage to the anal sphincter.


United Kingdom has its first confirmed case of SARS.


title: Feasibility of radiofrequency ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses: A retrospective cohort study.

text: This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs).From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients' blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established.RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics.Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention.


title: [To develop a model on severe acute respiratory syndrome epidemics to quantitatively evaluate the effectiveness of intervention measures].

text: OBJECTIVE To build an epidemic model of severe acute respiratory syndrome (SARS) to be used to quantitatively evaluate the effectiveness of intervention measures. METHODS Following the nature of SARS epidemics, an epidemic model of SARS based on SEIR model of infectious disease was built, in which case management group was set up and some parameters related to control measures were included. As an example, data gathered from Beijing was fitted to illustrate its application to quantitatively evaluate the intervention measures. RESULTS In the newly developed model of epidemics, parameters related to control measures could easily be modified. When scenario assumption was used, a model on SARS outbreak under various circumstances of intervention measures could be set. Thus, quantitative evaluation of intervention measures could perfectly be caried out. Pilot study revealed that the fitness existed in modeling the outbreak of SARS in Beijing and the intervention measures implemented around April 20, 2003, had major contribution to the control of SARS. CONCLUSION The model of SARS epidemics seemed to be stable and reliable to be used to evaluate the effectiveness of intervention measures implemented during the SARS outbreak in a quantitative way.


title: Close relationship between SARS-coronavirus and group 2 coronavirus.

text: The sudden appearance and potential lethality of severe acute respiratory syndrome (SARS)-associated coronavirus (SARS-CoV) in humans has resulted in a focusing of new attention on the determination of both its origins and evolution. The relationship existing between SARS-CoV and other groups of coronaviruses was determined via analyses of phylogenetic trees and comparative genomic analyses of the coronavirus genes: polymerase (Orf1ab), spike (S), envelope (E), membrane (M) and nucleocapsid (N). Although the coronaviruses are traditionally classed into 3 groups, with SARS-CoV forming a 4th group, the phylogenetic position and origins of SARS-CoV remain a matter of some controversy. Thus, we conducted extensive phylogenetic analyses of the genes common to all coronavirus groups, using the Neighbor-joining, Maximum-likelihood, and Bayesian methods. Our data evidenced largely identical topology for all of the obtained phylogenetic trees, thus supporting the hypothesis that the relationship existing between SARS-CoV and group 2 coronavirus is a monophyletic one. Additional comparative genomic studies, including sequence similarity and protein secondary structure analyses, suggested that SARS-CoV may bear a closer relationship with group 2 than with the other coronavirus groups. Although our data strongly suggest that group 2 coronaviruses are most closely related with SARS-CoV, further and more detailed analyses may provide us with an increased amount of information regarding the origins and evolution of the coronaviruses, most notably SARS-CoV.


Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment.


title: Switching species tropism: an effective way to manipulate the feline coronavirus genome.

text: Feline infectious peritonitis virus (FIPV), a coronavirus, is the causative agent of an invariably lethal infection in cats. Like other coronaviruses, FIPV contains an extremely large positive-strand RNA genome of ca. 30 kb. We describe here the development and use of a reverse genetics strategy for FIPV based on targeted RNA recombination that is analogous to what has been described for the mouse hepatitis virus (MHV) (L. Kuo et al., J. Virol. 74:1393-1406, 2000). In this two-step process, we first constructed by targeted recombination a mutant of FIPV, designated mFIPV, in which the ectodomain of the spike glycoprotein was replaced by that of MHV. This switch allowed for the selection of the recombinant virus in murine cells: mFIPV grows to high titers in these cells but has lost the ability to grow in feline cells. In a second, reverse process, mFIPV was used as the recipient, and the reintroduction of the FIPV spike now allowed for selection of candidate recombinants by their regained ability to grow in feline cells. In this fashion, we reconstructed a wild-type recombinant virus (r-wtFIPV) and generated a directed mutant FIPV in which the initiation codon of the nonstructural gene 7b had been disrupted (FIPV Delta 7b). The r-wtFIPV was indistinguishable from its parental virus FIPV 79-1146 not only for its growth characteristics in tissue culture but also in cats, exhibiting a highly lethal phenotype. FIPV Delta 7b had lost the expression of its 7b gene but grew unimpaired in cell culture, confirming that the 7b glycoprotein is not required in vitro. We establish the second targeted RNA recombination system for coronaviruses and provide a powerful tool for the genetic engineering of the FIPV genome.


title: [Perceived stress in general public during prevalence of severe acute respiratory syndrome and its impact on health behavior].

text: OBJECTIVE To find out the perceived stress in general public during prevalence of severe acute respiratory syndrome (SARS) and its impact on health behavior. METHODS A retrospective survey was conducted in Guangzhou, Hangzhou, and Taiyuan according to the epidemic situations of SARS, and 2532 subjects were randomly selected from constructive industry, school, and commercial business and residents in urban and rural areas. The perceive stress was measured by Chinese perceived stress scale (CPSS), and health related behavior during SARS was tested by uniform and self-made questionnaire. EpiData 2.0 was used for data management and CPSS value was calculated according to answer to 14 questions contained in the scale. Health risk stress among different population group and health related behavior among low, medium and high stress state were analyzed by SPSS 11.5. RESULTS 2424 subjects were involved in the survey. The CPSS value was measured from 0 - 49 (22.7 +/- 6.8), M = 24.0. 39.3% (953/2379) subjects were under the health risk stress. The health related behaviors such as washing hands, opening the window for air, keeping away from others when cough and sneeze, doing exercises etc were reduced with the stress increased. Logistic regression indicated that compared with the persons with the thoughts of nothing serious of SARS, without any dread of SARS, and knowing nothing about prevention of SARS, the perceived stress was significantly related with perceiving of the thread to certain extent (beta = 0.41, Wald chi(2) = 4.84, P = 0.03), worrying little about the epidemic (beta = 0.50, Wald chi(2) = 6.69, P = 0.01), worrying about it to certain extent (beta = 1.39, Wald chi(2) = 48.59, P = 0.00) and scared so much (beta = 1.77, Wald chi(2) = 53.59, P = 0.00), and knowing little about the prevention (beta = 0.74, Wald chi(2) = 4.48, P = 0.03), knowing something about prevention (beta = -0.98, Wald chi(2) = 8.29, P = 0.00) and knowing the prevention very well (beta = -1.18, Wald chi(2) = 10.66, P = 0.00). CONCLUSION The adoption of health related behaviors declined with increase of perceived stress. Opening connection to authority and government, enhancing the awareness of outburst affairs among general public and providing positive social support may be effective ways to reduce the population perceived stress.


title: Robotic Inguinal Hernia Repair: Technique and Early Experience.

text: Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45-67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.


title: The quest for a true One Health perspective of brucellosis.

text: One Health is an interdisciplinary collaboration that aims at mitigating risks to human health arising from microorganisms present in non-human animal species, which have the potential to be transmitted and cause disease in humans. Different degrees of scientific collaboration and sectoral integration are needed for different types of zoonotic diseases, depending on the health and associated economic gains that can be expected from a One Health approach. Indeed, mitigating zoonotic risks related to emerging diseases with pandemic potential is different from mitigating risks related to endemic zoonotic diseases like brucellosis. Likewise, management of brucellosis at the wildlife-livestock interface in wildlife conservation areas is in essence different from mitigating transmission of a given Brucella species within its preferential host species, which in turn is different from mitigating the spillover of a given Brucella species to non-preferential host species, humans included. Brucellosis economic models often oversimplify and/or wrongly assess transmission between reservoir hosts and spillover hosts. Moreover,they may not properly value non-market outcomes, such as avoidance of human disease, consumer confidence and conservation biology issues. As a result, uncertainty is such that the economic predictions of these models can be questionable. Therefore, understanding the infection biology of Brucella species is a prerequisite. This paper reviews and highlights important features of the infection biology of Brucella species and the changing epidemiology of brucellosis that need to be integrated into a true One Health perspective of brucellosis.


title: Medical Education Amid the COVID-19 Pandemic.

text: The coronavirus pandemic has shaken the mankind to its core. Social distancing is the most important preventive strategy for the spread of this contagion, short of a vaccine. Implementation of the same has forced many countries in to a complete lock-down. Closure of schools and universities has made education uncertain at all levels. Medical education is no exception. In this pandemic, the need for uninterrupted generation of future doctors is felt more than ever in our living memory. Continuity of medical education is thus imperative. While "Live" patient contact is an irreplaceable tenet of clinical teaching, these extraordinary times demand exceptional measures. Pedagogical innovations involving technology and simulation based teaching (Online lectures, video vase vignettes, virtual simulators, webcasting, online chat-rooms) need to be brought to the forefront. Since the medical educators have been pushed inevitably to rely on technology-based learning, they should not only embrace it but also develop and evaluate its sustainability and application in preclinical and clinical setting. Meanwhile, the students, whose medical educations are stuck in this pandemic time, should realize that there is no bigger teacher than a first-hand experience, and they are eyewitnesses to the making of history.


title: Limitations of forehead infrared body temperature detection for fever screening for severe acute respiratory syndrome.

text: We investigated alternative measurement methodology for infrared body thermometry to increase accuracy for outdoor fever screening during the 2003 SARS epidemic. Our results indicate that the auditory meatus temperature is a superior alternative compared with the forehead body surface temperature due to its close approximation to the tympanic temperature.


title: High frequency of mutations that expand the host range of an RNA virus.

text: The ability of a virus population to colonize a novel host is predicted to depend on the equilibrium frequency of potential colonists (i.e., genotypes capable of infecting the novel host) in the source population. In this study, we investigated the determinants of the equilibrium frequency of potential colonists in the RNA bacteriophage 6. We isolated 40 spontaneous mutants capable of infecting a novel Pseudomonas syringae host and sequenced their host attachment genes to identify the responsible mutations. We observed 16 different mutations in the host attachment gene and used a new statistical approach to estimate that 39 additional mutations were missed by our screen. Phenotypic and fitness assays confirmed that the proximate mechanism underlying host range expansion was an increase in the ability to attach to the novel host and that acquisition of this ability most often imposed a cost for growth rate on two standard hosts. Considered in a population genetic framework, our data suggest that host range mutations should exist in phage populations at an equilibrium frequency (3 x 10(-4)) that exceeds the phage mutation rate by more than two orders of magnitude. Thus, colonization of novel hosts is unlikely to be limited by an inability to produce appropriate mutations.


title: Use of the COOH portion of the nucleocapsid protein in an antigen-capturing enzyme-linked immunosorbent assay for specific and sensitive detection of severe acute respiratory syndrome coronavirus.

text: Antibody detection with a recombinant COOH portion of the severe acute respiratory syndrome (SARS) coronavirus nucleocapsid (N) protein, N13 (amino acids 221 to 422), was demonstrated to be more specific and sensitive than that with the full-length N protein, and an N13-based antigen-capturing enzyme-linked immunosorbent assay providing a convenient and specific test for serodiagnosis and epidemiological study of SARS was developed.


title: Case-Based Surveillance of Pandemic (H1N1) 2009 in Maebashi City, Japan.

text: After national case-based surveillance for pandemic influenza A (H1N1) ceased on July 23, 2009, a daily case-based surveillance system was implemented in Maebashi City, Japan. All medical facilities in the city reported all patients who had positive rapid antigen tests for influenza A. When the epidemic exploded in late October, case-based surveillance for influenza-like illness (ILI) was implemented from November 3, 2009 until the end of the epidemic. A total of 7,781 influenza cases were reported between July 25 and November 2, 2009, with a cumulative incidence rate of 22.5 per 1,000 population. Nearly 70% of the patients were under 15 years old. Between November 3, 2009 and the end of March 2010, a total of 16,394 ILI cases were reported, with a cumulative incidence rate of 47.4 per 1,000 population. Of the ILI cases reported, 63% were in patients younger than 15 years old. Only one death with laboratory confirmation of the H1N1 2009 virus was reported during the epidemic. The age-specific reproduction number among children under 15 years of age was almost 1.40, whereas between children and adults (15 years of age and above) it was considerably less than 1.0. The reproduction number derived from the next-generation matrix using data from September 30 to October 14 was estimated to be 1.48 (95% confidence interval, 1.41-1.56). Among individuals under 15 years of age, the infection rate calculated using the final size equation under the assumption of no mitigation measures was nearly twice the rate reported during the epidemic. These findings indicate that the majority of the transmission of influenza A (H1N1) 2009 in the city occurred among children.