title: [Effects of use of riboflavin and ultraviolet light for pathogen inactivation on quality of platelet concentrates].

text: BACKGROUND/AIM Pathogen inactivation in blood and blood products is one of the major means to achieve a zero risk blood supply and improve transfusion safety. 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 pathogens photoinactivation using riboflavin and UV rays on the biochemical and functional characteristics of platelet concentrates prepared from "buffy coat". METHODS The examination included 80 platelet concentrates prepared from "buffy coat", which was separated from whole blood donated by voluntary blood donors around 6 hours from the moment of collection. Concentrates were pooled, filtered and separated unton two groups: one consisted of 10 control units and the other of 10 examined units (pooled platelet concentrates). Examined units of the platelets 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 min. A total of 35 mL of saline solution was added to the control units. The samples for examining were taken from the control and examined units initially (K0, I0), after the addition of saline (K1) and riboflavin (I1), after illumination (I2), first day of storage (K3, I3) and the fifth day of storage (K4, I4). The following parameters were measured: platelet count and platelet yield, residual erythrocyte and leukocyte count, pH, pO2, pCO2 and bacterial contamination. RESULTS All the measured parameters showed a statistically significant decrease comparing to K0 and I0; all the results of the first day of platelet storage showed statistically significant decrease comparing to K1 and I1, and all the results of the fifth day of platelet storage (K4, I4) showed a statistically significant decrease comparing to K1 and K3 and to I1 and I3. There was no the mentioned difference in the measured parameters between K4 and I4 (the end of storage--the fifth day). All the platelet units were sterile till the seventh day, when the investigation ended. CONCLUSION Platelet concentrates inactivated by riboflavin and UV rays (Mirasol PRT sistem, Caridian BCT, USA) keep all the characteristics assessed by the Guide to the preparation, use and quality assurance of blood components (Council of Europe), during the whole storage period (five days). The obtained data were correlated with existing up to date literature and demonstrated that Mirasol treated platelets were safe and could be incorporated effectively in the routine blood bank and transfusion setting.


Faster... but fast enough? Responding to the epidemic of severe acute respiratory syndrome.


title: Full-length genome sequences of two SARS-like coronaviruses in horseshoe bats and genetic variation analysis.

text: Bats were recently identified as natural reservoirs of SARS-like coronavirus (SL-CoV) or SARS coronavirus-like virus. These viruses, together with SARS coronaviruses (SARS-CoV) isolated from human and palm civet, form a distinctive cluster within the group 2 coronaviruses of the genus Coronavirus, tentatively named group 2b (G2b). In this study, complete genome sequences of two additional group 2b coronaviruses (G2b-CoVs) were determined from horseshoe bat Rhinolophus ferrumequinum (G2b-CoV Rf1) and Rhinolophus macrotis (G2b-CoV Rm1). The bat G2b-CoV isolates have an identical genome organization and share an overall genome sequence identity of 88-92 % among themselves and between them and the human/civet isolates. The most variable regions are located in the genes encoding nsp3, ORF3a, spike protein and ORF8 when bat and human/civet G2b-CoV isolates are compared. Genetic analysis demonstrated that a diverse G2b-CoV population exists in the bat habitat and has evolved from a common ancestor of SARS-CoV.


title: Cryptic B-cell epitope identification through informational analysis of protein sequences.

text: A comparison of the location of B-cell epitopes and information structure (IS) of protein sequences was attempted. Analysis of 62 known B-cell epitopes located in five different proteins showed that they concentrated in IS sites with increased degree of information coordination. Based on the analysis of IS six peptides from two proteins were selected and produced in a recombinant form as yeast virus-like particles (VLPs). Immunization of mice with recombinant VLP-peptides has induced the production of IgG capable of recognizing full-length antigens. This result suggests that the analysis of IS of proteins can be useful in the selection of peptides possessing cryptic B-cell epitope activity.


title: Evaluation of in vitro biological activity of O-alkylated hydroxamic derivatives of some nonsteroidal anti-inflammatory drugs.

text: AIM Several published studies suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) are promising anticancer agents. This study examined the in vitro effect of O-alkylated NSAID hydroxamic acid derivatives 3a-i on cell survival for a panel of human tumour cell lines, their cytotoxicity on normal human fibroblasts and their antiviral activity. MATERIALS AND METHODS Established methods of cell viability testings, cell cycle analyses and Western blot assays were used. RESULTS O-Alkylated NSAID hydroxamic acid derivatives exerted poor antiviral activity butreduced the viability of the studied tumour cell lines in a concentration-dependent manner showing low cytotoxic effect on normal fibroblasts. Compounds 3a and 3i were shown to be potent inhibitors of the growth of MIA PaCa-2 cell line. They induced p53-independent S-phase arrest and triggered caspase 3-dependent apoptosis. CONCLUSION Two novel O-alkylated NSAID hydroxamic acid derivatives may be useful in the treatment of pancreatic cancer and should be further evaluated in vivo.


Risperidone-induced sialorrhea responsive to biperiden treatment.


title: Virus-neutralizing monoclonal antibody expressed in milk of transgenic mice provides full protection against virus-induced encephalitis.

text: Neutralizing antibodies represent a major host defense mechanism against viral infections. In mammals, passive immunity is provided by neutralizing antibodies passed to the offspring via the placenta or the milk as immunoglobulin G and secreted immunoglobulin A. With the long-term goal of producing virus-resistant livestock, we have generated mice carrying transgenes that encode the light and heavy chains of an antibody that is able to neutralize the neurotropic JHM strain of murine hepatitis virus (MHV-JHM). MHV-JHM causes acute encephalitis and acute and chronic demyelination in susceptible strains of mice and rats. Transgene expression was targeted to the lactating mammary gland by using the ovine beta-lactoglobulin promoter. Milk from these transgenic mice contained up to 0.7 mg of recombinant antibody/ml. In vitro analysis of milk derived from different transgenic lines revealed a linear correlation between antibody expression and virus-neutralizing activity, indicating that the recombinant antibody is the major determinant of MHV-JHM neutralization in murine milk. Offspring of transgenic and control mice were challenged with a lethal dose of MHV-JHM. Litters suckling nontransgenic dams succumbed to fatal encephalitis, whereas litters suckling transgenic dams were fully protected against challenge, irrespective of whether they were transgenic. This demonstrates that a single neutralizing antibody expressed in the milk of transgenic mice is sufficient to completely protect suckling offspring against MHV-JHM-induced encephalitis.


title: Effect of thromboxane synthetase inhibitor on feline infectious peritonitis in cats.

text: Two cats with abdominal effusion and anorexia were diagnosed as feline infectious peritonitis (FIP). We tried to evaluate the effect of thromboxane (Tx) synthetase inhibitor, ozagrel hydrochloride, on the progression of symptoms and clinicopathologic data characteristic to FIP. After administration of Tx synthetase inhibitor, improvement of appetite and activity, decreases of peritoneal effusion, reduction of leukocyte number to normal level, and improvement of hyper gamma-globulinemia were found in 2 cats with FIP. These findings suggest that the vasculitis in FIP can be successfully treated with Tx synthetase inhibitor which inhibits platelet aggregation.


Glycoprotein E1 of MHV-A59: structure of the O-linked carbohydrates and construction of full length recombinant cDNA clones.


Experimental pathological studies on mechanism of abortion caused by equine arteritis virus.


[Severe acute respiratory syndrome (SARS)].


Policies on SARS in UK boarding schools are confused.


COVID-19: Important Issues for Pediatricians.


title: Amino acid mutations in the replicase protein nsP3 of Semliki Forest virus cumulatively affect neurovirulence.

text: It has been shown previously that an avirulent Semliki Forest virus (SFV) clone, rA774, engineered to carry the nsP3 gene of the virulent clone SFV4 becomes highly neurovirulent and is lethal for adult BALB/c mice. rA774, like several other alphaviruses, has an opal termination codon close to the 5' end of nsP3 (aa 469), while SFV4 has an arginine residue at this position. Mutation of the opal codon to an arginine residue increases the virulence of rA774 but does not reconstruct the severe neurovirulence of SFV4. Additionally, nsP3 amino acid sequences differ between these two strains by eight amino acids and by a deletion of seven amino acids in the C-terminal third of rA774 nsP3. This study shows that neurovirulence can be reconstituted gradually by exchanging individual amino acids and is fully retained when combinations of two nsP3 mutations, V(11)-->I and L(201)-->F, V(11)-->I and D(249)-->N, A(48)-->E and G(70)-->A or T(435)-->A and F(442)-->L, are introduced into an rA774 derivative carrying R(469). The critical role of the arginine codon for neurovirulence was confirmed further by the acquisition of a fully lethal phenotype following the introduction of R(469) into a moderately virulent rA774 recombinant carrying the SFV4 nsP1 and nsP2 genes. In conclusion, virulence determinants in SFV are distributed over a wide region of the nonstructural genes.


title: CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report.

text: The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It is an important cause of buttock pain that may often be accompanied by sciatica. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The diagnosis relies on the clinical presentation and the electromyelography (EMG) findings. Other causes of symptoms should be excluded by careful examination and detailed neuroradiological studies of the lumbosacral spine, sacro-iliac and hip joints. A case of this syndrome seen in a 36-year-old man who recovered by CT-guided corticosteroid injection is reported.


Occurrence of antibodies to human coronavirus OC43 in Finland.


title: A new lignan glycoside and phenylethanoid glycosides from Strobilanthes cusia BREMEK.

text: The root of Strobilanthes cusia BREMEK. (Acanthaceae), popularly known as Da-Ching-Yeh, has been commonly used in traditional Chinese medicine. It is used to treat influenza, epidemic cerebrospinal meningitis, encephalitis B, viral pneumonia, mumps, and severe acute respiratory syndrome (SARS). In this study, we found a new lignan glycoside (6) and two new phenylethanoid glycosides (7, 8) together with five known compounds as chemical constituents of Strobilanthes cusia root. Some samples were examined for anti-herpes simplex virus type-1 (HSV-1) activity. Among the tested samples, lupeol showed anti-HSV-1 activity (EC(50): 11.7 microM) and showed 100% inhibition of virus plaque formation at 58.7 microM.


Facing the severe acute respiratory syndrome epidemic. Hope for the best and prepare for the worst.


title: Immunofluorescent studies on localization of secretory immunoglobulins in the intestines of turkeys recovered from turkey coronaviral enteritis.

text: The present study concerns the production of specific secretory antibodies in turkeys orally inoculated with turkey coronavirus (TCV). Tissue localization of secretory antibodies in the intestines of recovered birds 4 and 5 months later was demonstrated by immunofluorescence technique. Intestinal sections were stained by sandwich method, using concentrated TCV antigen and anti-TCV conjugate. It was suggested that local synthesis of antibody might be responsible for life-long immunity seen in these birds after recovery from infection.


title: 9-O-acetylated sialic acid, a receptor determinant for influenza C virus and coronaviruses.

text: Influenza C virus and a group of coronaviruses, a typical representative of which is bovine coronavirus, use the same strategy for binding to cells. Surface components containing 9-O-acetylated sialic acid are recognized as cellular receptors by these viruses. In addition to the receptor determinant both virus groups have a receptor-destroying enzyme in common, which has been identified as a sialate 9-O-acetylesterase. Differences are, however, found in the distribution of these activities on the viral surface proteins. The influenza C glycoprotein HEF is a multifunctional protein, which is responsible for receptor-binding, receptor-inactivation and fusion. In the case of coronaviruses these activities are functions of two different glycoproteins, S and HE.


Enteric coronavirus TGEV: mapping of four major antigenic determinants in the amino half of peplomer protein E 2.


title: Rabbit sucrase-isomaltase contains a functional intestinal receptor for Clostridium difficile toxin A.

text: The intestinal effects of Clostridium difficile toxin A are inidated by toxin binding to luminal enterocyte receptors. We reported previously that the rabbit ileal brush border (BB) receptor is a glycoprotein with an alpha-d-galactose containing trisaccharide in the toxin-binding domain (1991. J. Clin. Invest. 88:119-125). In this study we characterized the rabbit ileal BB receptor for this toxin. Purified toxin receptor peptides of 19 and 24 amino acids showed 100% homology with rabbit sucrase-isomaltase (SI). Guinea pig receptor antiserum reacted in Western blots with rabbit SI and with the purified toxin receptor. Antireceptor IgG blocked in vitro binding of toxin A to rabbit ileal villus cell BB. Furthermore, anti-SI IgG inhibited toxin A-induced secretion (by 78.1%, P < 0.01), intestinal permeability (by 80.8%, P < 0.01), and histologic injury (P < 0.01) in rabbit ileal loops in vivo. Chinese hamster ovary cells transfected with SI cDNA showed increased intracellular calcium increase in response to native toxin (holotoxin) or to a recombinant 873-amino acid peptide representing the receptor binding domain of toxin A. These data suggest that toxin A binds specifically to carbohydrate domains on rabbit ileal SI, and that such binding is relevant to signal transduction mechanisms that mediate in vitro and in vivo toxicity.


title: Porcine respiratory coronavirus-mediated interference against influenza virus replication in the respiratory tract of feeder pigs.

text: Effect of prior porcine respiratory coronavirus (PRCV) infection on replication of H1N1-influenza virus in the respiratory tract of swine was studied. In an initial experiment, 3 groups of 5 feeder pigs were studied. Pigs of 2 groups were inoculated sequentially with PRCV, followed by H1N1-influenza virus at 2- and 3-day intervals. Pigs of the other group were inoculated with H1N1-influenza virus only. Pigs were monitored clinically and examined for nasal excretion of influenza virus. In the singly influenza virus-inoculated group, 83% of nasal swab specimens were influenza virus-positive over a period of 6 days after inoculation. In the dually virus-inoculated groups, only 27% (2-day interval) and 53% (3-day interval) of nasal swab specimens were virus-positive over the same postinoculation period. However, clinical signs of infection in these dually inoculated pigs were more severe than those in the singly influenza virus-inoculated pigs. There were no significant differences in antibody responses against influenza virus among the 3 groups of pigs. In a second experiment, 2 groups of pigs were studied. One group of pigs was inoculated sequentially with PRCV, followed by H1N1-influenza virus 2 days later; the other group was inoculated with H1N1-influenza virus only. Pigs of both groups were serially euthanatized on postinoculation days (PID) 1, 2, 3, and 4 (after influenza virus). At necropsy, influenza virus titer and immunofluorescence in lung tissue were determined and gross lung lesions were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)


title: Robust sequence selection method used to develop the FluChip diagnostic microarray for influenza virus.

text: DNA microarrays have proven to be powerful tools for gene expression analyses and are becoming increasingly attractive for diagnostic applications, e.g., for virus identification and subtyping. The selection of appropriate sequences for use on a microarray poses a challenge, particularly for highly mutable organisms such as influenza viruses, human immunodeficiency viruses, and hepatitis C viruses. The goal of this work was to develop an efficient method for mining large databases in order to identify regions of conservation in the influenza virus genome. From these regions of conservation, capture and label sequences capable of discriminating between different viral types and subtypes were selected. The salient features of the method were the use of phylogenetic trees for data reduction and the selection of a relatively small number of capture and label sequences capable of identifying a broad spectrum of influenza viruses. A detailed experimental evaluation of the selected sequences is described in a companion paper. The software is freely available under the General Public License at http://www.colorado.edu/chemistry/RGHP/software/.


Safety of convalescent sera for the treatment of viral severe acute respiratory syndrome: an experimental model in rhesus macaque.


title: Coronavirus JHM: characterization of intracellular viral RNA.

text: After infection of Sac(-) cells with the murine coronavirus JHM the synthesis of seven major and two minor RNA species was induced. These RNAs were polyadenylated and single-stranded. Their mol. wt. were estimated by electrophoresis in agarose gels containing methylmercury hydroxide. The values for the major species were 6.67 x 10(6) for RNA of genome size (RNA 1), 3.42 x 10(6) for RNA 2, 2.76 x 10(6) for RNA 3, 1.35 x 10(6) for RNA 4, 1.19 x 10(6) for RNA 5, 0.93 x 10(6) for RNA 6 and 0.62 x 10(6) for RNA 7. The minor species have a size of 4.7 x 10(6) (RNA a) and 1.5 x 10(6) (RNA b). The same number of species were found by electrophoresis after denaturation with glyoxal-dimethyl sulphoxide. No gross difference in number of RNAs and the amount of each species was found between total cytoplasmic RNA, polyadenylated cytoplasmic RNA and RNA extracted from pelleted polysomes.


title: Self-gripping Parietene and Parietex Progrip mesh laparoscopic hernia repair: have we found the ideal implant?

text: INTRODUCTION The goal of modern laparoscopic hernia repair is to achieve a high standard of patient safety with a low threshold of hernia recurrence and chronic inguinal pain. In the absence of fixating devices and the use of the self-gripping Parietene and Parietex ProGrip mesh (Covidien AG, Zurich, Switzerland) was evaluated in this prospective clinical study. The incidence of chronic pain, postoperative complications, patient satisfaction, and hernia recurrence at follow-up after 12 and 24 months was recorded. METHODS Data were collected retrospectively from patient files and were analyzed for 405 male and female patients with 483 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal (TAPP) approach using Parietex ProGrip meshes performed in the same clinical center in Germany. Pre-, peri-, and postoperative data were collected and a follow-up after 12 and 24 months was performed prospectively. Complications, pain scored on a 0 to 10 NRS scale, patient satisfaction, and hernia recurrence were assessed. RESULTS The only complications were minor and were postoperative: hematoma/seroma (nine cases), secondary hemorrhage through the trocar's site (eight cases), hematuria, emphysema in the inguinal regions (both sides), and swelling above the genital organs (one case for each). Two patients had to be reoperated due to a hematoma in inguinal canal. At mean follow-up at 22.8 months, there were only eight reports of hernia recurrence: 1.9% of the hernias. Most patients (94.9%) were satisfied or very satisfied with their hernia repair with only 1.2% reporting severe pain (NRS score 7 to 10) and 3.6% reported mild pain. CONCLUSION This study demonstrates that, in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietene and Parietex ProGrip self-gripping meshes is rapid, efficient, and safe with low pain and low hernia recurrence rate. Since no fixating device or glue is necessary for the procedure, additional cost-effectiveness is achieved.


Super-spreading events of SARS in a hospital setting: who, when, and why?


title: Health and foreign policy: influences of migration and population mobility.

text: International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions. Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented. Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic. The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome). Migration and population mobility play a role in each of these public health challenges. The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration. As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries. However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking. As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level.


In vitro study of esomeprazole sachet suspension administered via enteral feeding tubes.


title: Epidemiology of coronavirus respiratory infections.

text: Human coronaviruses were found by enzyme linked immunosorbent assay in upper respiratory tract secretions taken during 30% of 108 acute respiratory infections experienced by 30 children under age 6 years with recurrent respiratory infections (index group), and during 29% of 51 acute infections experienced by their siblings. Lower respiratory tract infection--predominantly wheezy bronchitis--occurred in 30% of the index children's coronavirus positive infections but in none of their siblings' infections. Reinfections were common. Two peaks of infection were seen each year in the late autumn/early winter and in the early summer.


title: Viral evolution and the emergence of SARS coronavirus.

text: The recent appearance of severe acute respiratory syndrome coronavirus (SARS-CoV) highlights the continual threat to human health posed by emerging viruses. However, the central processes in the evolution of emerging viruses are unclear, particularly the selection pressures faced by viruses in new host species. We outline some of the key evolutionary genetic aspects of viral emergence. We emphasize that, although the high mutation rates of RNA viruses provide them with great adaptability and explain why they are the main cause of emerging diseases, their limited genome size means that they are also subject to major evolutionary constraints. Understanding the mechanistic basis of these constraints, particularly the roles played by epistasis and pleiotropy, is likely to be central in explaining why some RNA viruses are more able than others to cross species boundaries. Viral genetic factors have also been implicated in the emergence of SARS-CoV, with the suggestion that this virus is a recombinant between mammalian and avian coronaviruses. We show, however, that the phylogenetic patterns cited as evidence for recombination are more probably caused by a variation in substitution rate among lineages and that recombination is unlikely to explain the appearance of SARS in humans.


Laparoscopic cholecystectomy using standard instruments through a single umbilical incision: feasibility in Jamaica.


title: Multicentric T-cell lymphoma associated with feline leukemia virus infection in a captive namibian cheetah (Acinonyx jubatus).

text: This case report describes a multicentric lymphoma in a 4 yr old female wildborn captive cheetah (Acinonyx jubatus) in Namibia after being housed in an enclosure adjacent to a feline leukemia virus (FeLV) infected cheetah that had previously been in contact with domestic cats. The year prior to the onset of clinical signs, the wild-born cheetah was FeLV antigen negative. The cheetah subsequently developed lymphoma, was found to be infected with FeLV, and then rapidly deteriorated and died. At necropsy, the liver, spleen, lymph nodes, and multiple other organs were extensively infiltrated with neoplastic T-lymphocytes. Feline leukemia virus DNA was identified in neoplastic lymphocytes from multiple organs by polymerase chain reaction and Southern blot analysis. Although the outcome of infection in this cheetah resembles that of FeLV infections in domestic cats, the transmission across an enclosure fence was unusual and may indicate a heightened susceptibility to infection in cheetahs. Caution should be exercised in holding and translocating cheetahs where contact could be made with FeLV-infected domestic, feral, or wild felids.


title: The Human Proteome Organization Plasma Proteome Project pilot phase: reference specimens, technology platform comparisons, and standardized data submissions and analyses.

text: A comprehensive, systematic characterization of cirolating proteins in health and disease will greatly facilitate development of biomarkers for prevention, diagnosis, and therapy of cancers and other diseases. The Human Proteome Organization Plasma Proteome Project pilot phase aims to (1) compare the advantages and limitations of many technology platforms; (2) contrast reference specimens of human plasma (ethylenediaminetetra acetic acid, heparin, citrate-anticoagulated) and serum, in terms of numbers of proteins identified and any interferences with various technology platforms; and (3) create a global knowledge base/data repository.


Virus-encoded proteinases of the Togaviridae.


title: Pulmonary changes in rats following administration of 3-methylindole in cremophore EL.

text: 3-methylindole (3-MI) dissolved in the lipophilic carrier Cremophore EL was administered intraperitoneally to male, twelve-week-old Sprague-Dawley rats. Gross and histopathologic changes in the lungs were studied using light microscopy at three time-periods following administration: 16, 24, and 46 hours. Both 3-MI and Cremophore caused changes in bronchiolar epithelium at 16 hours. By 46 hours, Cremophore-injected rats showed no effects of the carrier; whereas, 3-MI rats showed severe lung changes characterized by airway epithelial and pulmonary vascular endothelial necrosis and sloughing, cellular infiltration by lymphocytes and macrophages, perivascular edema, alveolar edema, and lymph stasis. Grossly, the controls showed no effect of the carrier and none died during the studies. In contrast, 3-MI injected rats quickly became lethargic and displayed tachypnea, anorexia, and progressive respiratory distress. Two of five 3-MI rats in the final group died just prior to 46 hours. All of this group had grossly congested lungs and marked pleural effusion. The lesions and time course showed similarities to those observed in ruminants and mice. We conclude that 3-MI in Cremophore causes an acute progressive pneumonitis in rats and suggest that the rats may be a suitable model for 3-MI-induced and similar toxic lung diseases in domestic animals and people.


Premenstrual complaints before and after 40 years of age.


title: Kawasaki disease: an update.

text: Kawasaki disease is the leading cause of acquired heart disease in children in many parts of the world. It is an acute systemic vasculitis of unknown etiology predominantly affecting children under 5 years of age. It is diagnosed clinically by the presence of a constellation of manifestations and exclusion of other diseases with similar findings. Children develop a spectrum of cardiovascular manifestations including coronary artery involvement in 30-35% of untreated cases with myocardial infarction and death in < or = 2% of them. Acute stage treatment is by administration of intravenous immunoglobulin and aspirin. Those with coronary artery involvement need long-term cardiac risk stratification and management because many of them will become the part of a growing pool of adults with ischemic heart disease.


title: Inhibitory effects of anti-SARS traditional Chinese medicines on the UV irradiation of lambda-lysogen.

text: By using lambda-lysogen as a model, the inhibitory effects of anti-severe acute respiratory syndrome (SARS) traditional Chinese medicines (TCMs) prescription I on the UV irradiation were investigated in this present study. It was found that the prescription I possessed obvious inhibitory effects on the UV induction of lambda-lysogen, the inhibitory rate reaching 83.87%. Among five medicinal herbs prescribed in that formula, Herba Patriniae, Radix Astragali and Radix Glycyrrhizae played important roles. When these three herbs were eliminated from the recipe separately, the inhibitory effects were prominently decreased. If only one of these five medicinal herbs was added into the medium of lambda-lysogen, the inhibitory rates ranged from 27.0% approximately 45.0%. By electron spin resonance (ESR) detection, we found that the prescription I, Herba Patriniae and other main herbs in that recipe, could quench effectively the free radicals generated in the process of lambda-lysogenic cells by UV. These results provide a novel idea for further studying the pharmacology of TCM and exploring the mechanism of SARS virus infection.


Encountering COVID in a Cancer Ward: Lessons in Infection Prevention.


title: Late viral RNA export, rather than p53 inactivation, determines ONYX-015 tumor selectivity.

text: ONYX-015 is an adenovirus that lacks the E1B-55K gene product for p53 degradation. Thus, ONYX-015 was conceived as an oncolytic virus that would selectively replicate in p53-defective tumor cells. Here we show that loss of E1B-55K leads to the induction, but not the activation, of p53 in ONYX-015-infected primary cells. We use a novel adenovirus mutant, ONYX-053, to demonstrate that loss of E1B-55K-mediated late viral RNA export, rather than p53 degradation, restricts ONYX-015 replication in primary cells. In contrast, we show that tumor cells that support ONYX-015 replication provide the RNA export function of E1B-55K. These data reveal that tumor cells have altered mechanisms for RNA export and resolve the controversial role of p53 in governing ONYX-015 oncolytic selectivity.


title: Cryptosporidiosis outbreaks associated with recreational water use--five states, 2006.

text: Cryptosporidiosis is a gastrointestinal illness caused by parasitic protozoa of the genus Cryptosporidium and can produce watery diarrhea lasting 1-3 weeks; one or two cases per 100,000 population are reported annually in the United States. Fecal-oral transmission of Cryptosporidium oocysts occurs through ingestion of contaminated drinking or recreational water, consumption of contaminated food, and contact with infected persons or animals (e.g., cattle or sheep). Unlike bacterial pathogens, Cryptosporidium oocysts are resistant to chlorine disinfection and can survive for days in treated recreational water venues (e.g., public and residential swimming pools and community and commercial water parks) despite adherence to recommended residual chlorine levels (1-3 ppm). For 2006, a total of 18 cryptosporidiosis outbreaks have been reported (as of July 24, 2007) to CDC's U.S. Waterborne Disease and Outbreak Surveillance System, compared with five outbreaks reported for 2003 and seven for 2004; data for 2005 and 2006 are not yet final. This report describes five laboratory-confirmed cryptosporidiosis outbreaks in 2006 that involved public recreational water use. The popularity of recreational water venues, the number and geographic distribution of recent cryptosporidiosis outbreaks, and the resistance of Cryptosporidium to chlorination suggest that treatment strategies for recreational water facilities need to be improved.


title: The re-expression of the homeodomain transcription factor Gtx during remyelination of experimentally induced demyelinating lesions in young and old rat brain.

text: Since myelination and remyelination both involve investing an axon with a myelin sheath, a plausible hypothesis is that the two processes involve the expression of similar transcription factors. In this study we have addressed this hypothesis by comparing the expression of messenger RNA of Gtx, a homeodomain transcription factor expressed within oligodendrocytes during myelination, with the expression of messenger RNAs of the major myelin proteins, myelin basic protein and proteolipid protein during remyelination of experimentally induced demyelination in the adult rat brain. We have found a close temporal and spatial association between the expression patterns of the three messenger RNA species during remyelination. By comparing the expression patterns in rapidly remyelinating lesions in young adult rats with slowly remyelinating lesions in old adult rats, we have shown that Gtx messenger RNA expression follows the reappearance of myelin basic protein and proteolipid protein messenger RNAs regardless of the rate of remyelination. This observation demonstrates a clear association between the expression of Gtx messenger RNA and myelin repair. We have also shown that there is a decrease in constitutive levels of expression of myelin basic protein, proteolipid protein and Gtx messenger RNA in old adults compared with young adults. Taken together, our results indicate that Gtx, which has multiple binding sites in the promoter regions of both myelin basic protein and proteolipid protein genes, may have a similar role in the regulation of myelin protein gene expression during remyelination as has been proposed in myelination.


title: Prevalence of respiratory viruses in wheezing children not older than 24 months of age.

text: INTRODUCTION Wheezing in children not older than 24 months of age is a frequent event, and viruses are usually the causative agents. The aim of the study was to estimate the prevalence of respiratory viruses in wheezing children who were not older than 24 months of age and who had no history of asthma. METHODS Fifty-five Mexican children were included in an analytical cross-sectional study. Nasal secretions were obtained by using sterile rayon-tipped applicators to identify the virus by polymerase chain reaction or reverse transcription-polymerase chain reaction: adenovirus, bocavirus, human rhinovirus, influenza virus type A, human metapneumovirus, parainfluenza, rhinovirus, and respiratory syncytial virus. The prevalence of viral etiology was estimated by dividing the frequency of the identified virus by the number of participants. Ninety-five percent confidence intervals for proportions were calculated. RESULTS Most of the patients were male (35/55, 63.6%). The average time of evolution of wheezing episode was 3 days. The third part of enrolled population were receiving antibiotics. Respiratory viruses were detected in 33 (60%; 95% CI: 46.8-71.9%) out of 55 cases, and viral coinfection was detected in five cases (9.1%; 95% CI: 3.5-19.9%). Human metapneumovirus was the most frequently identified virus (23.6%), followed by bocavirus (14.5%), respiratory syncytial virus and rhinovirus (12.7% each), and to a lesser extent influenza virus type A and parainfluenza. Rhinovirus was the predominant virus in outpatient children (28.6%). In the inpatient emergency room and inhalotherapy room, human metapneumovirus predominated (41.2 and 16.1%, respectively). CONCLUSION bocavirus and human metapneumovirus were the most frequently identified viruses in Mexican children who were < 2 years of age, suffered from wheezing, and had no history of asthma.


title: Identification of polypeptides encoded in open reading frame 1b of the putative polymerase gene of the murine coronavirus mouse hepatitis virus A59.

text: The polypeptides encoded in open reading frame (ORF) 1b of the mouse hepatitis virus A59 putative polymerase gene of RNA 1 were identified in the products of in vitro translation of genome RNA. Two antisera directed against fusion proteins containing sequences encoded in portions of the 3'-terminal 2.0 kb of ORF 1b were used to immunoprecipitate p90, p74, p53, p44, and p32 polypeptides. These polypeptides were clearly different in electrophoretic mobility, antiserum reactivity, and partial protease digestion pattern from viral structural proteins and from polypeptides encoded in the 5' end of ORF 1a, previously identified by in vitro translation. The largest of these polypeptides had partial protease digestion patterns similar to those of polypeptides generated by in vitro translation of a synthetic mRNA derived from the 3' end of ORF 1b. The polypeptides encoded in ORF 1b accumulated more slowly during in vitro translation than polypeptides encoded in ORF 1a. This is consistent with the hypothesis that translation of gene A initiates at the 5' end of ORF 1a and that translation of ORF 1b occurs following a frameshift at the ORF 1a-ORF 1b junction. The use of in vitro translation of genome RNA and immunoprecipitation with antisera directed against various regions of the polypeptides encoded in gene A should make it possible to study synthesis and processing of the putative coronavirus polymerase.


title: A pilot study of short-term high-pressure support ventilation in persistent sudden-onset rapid breathing.

text: Sudden-onset rapid breathing commonly occurs in previously calm, invasively-ventilated patients. In most cases it can be resolved easily by traditional management techniques, but other cases can be very challenging. We enrolled 40 patients who failed traditional interventions and performed short-term high-pressure support ventilation (HPSV). Thirty-three (83%) patients were responsive to HPSV. In the responders, ten minute HPSV reduced mean airway pressure (P=0.030), minute ventilation (P <0.001), respiratory rate (P <0.001) and heart rate (P <0.001) compared to before HPSV therapy. It also stabilised tidal volume (P <0.001) and improved oxygenation (P=0.007). After 58 minutes, HPSV relieved tachypnoea. However, compared with the responders, the non-responders (7/40, 17%) were younger (77.0 versus 59.7 years, P=0.002), and had higher Glasgow Coma Scale score (9.0 versus 14.0, P <0.001), pressure support (P=0.029), peak pressure (P=0.048) and heart rate (P=0.004) before sudden-onset rapid breathing. The non-responders also had higher peak pressure (P=0.046), minute ventilation (P=0.024), respiratory rate (P=0.027) and heart rate (P <0.001) when the rapid breathing happened. At or before sudden-onset rapid breathing, peak pressure, minute ventilation and heart rate had a high accuracy to predict the non-responsive patients (each with area under the curve of ≥0.7). The age and Glasgow Coma Scale also had high predicted ability (both with areas under the curve of ≥0.8). In conclusion, short-term HPSV relieved persistent sudden-onset rapid breathing. However, it was not effective in the relatively young and conscious patients with relatively high support pressure, peak pressure, minute ventilation and heart rate.


title: Building new hospitals: a UK infection control perspective.

text: Infection control input is vital throughout the planning, design and building stages of a new hospital project, and must continue through the commissioning (and decommissioning) process, evaluation and putting the facility into full clinical service. Many hospitals continue to experience problems months or years after occupying the new premises; some of these could have been avoided by infection control involvement earlier in the project. The importance of infection control must be recognized by the chief executive of the hospital trust and project teams overseeing the development. Clinical user groups and contractors must also be made aware of infection control issues. It is vital that good working relationships are built up between the infection control team (ICT) and all these parties. ICTs need the authority to influence the process. This may require their specific recognition by the Private Finance Initiative National Unit, the Department of Health or other relevant authorities. ICTs need training in how to read design plans, how to write effective specifications, and in other areas with which they may be unfamiliar. The importance of documentation and record keeping is paramount. External or independent validation of processes should be available, particularly in commissioning processes. Building design in relation to infection control needs stricter national regulations, allowing ICTs to focus on more local usage issues. Further research is needed to provide evidence regarding the relationship between building design and the prevalence of infection.


title: [Detection of SARS-coronavirus in both human and animals by RT-PCR].

text: OBJECTIVE To find the most suitable RT-PCR detection method for SARS-Coronavirus (SARS-CoV) detection in both human and animals, and to study the source of SARS virus by investigating the condition of virus carried by wild, domestic animals and animals sold in market. METHODS 350 throat washes of confirmed, suspected and observed SARS cases were tested by TaqMan and molecular beacon fluorescence RT-PCR methods. 386 animals with 442 nasal-throat swabs, fecal swabs of animals and cell cultured were detected by TaqMan method and conventional RT-PCR method. RESULTS 10 positive were detected from 41 SARS clinical confirmed cases (24.39%). The results of TaqMan and molecular beacon are basically coincident with the coincident rate of 88.89%. 18 cell cultures with CPE were detected and find 16 positive, among which, 14 were civet cats (87.5%). The detecting results of animal samples from Dongmen Market (Shenzhen) and other markets and farms in peripheral areas show that: the total positive rate of 4 kinds of wild animal (civet cat, raccoon dog, hog-badge and Chinese ferret-badge) is 39.02% , which has an significant difference (P < 0.01) compared with the positive rate of other animals as 0. The positive rate of PCR for nasal and fecal swabs from 109 major wild animals is 44.04%, but the positive rate of 145 wild live-animals is 0. CONCLUSION TaqMan and molecular beacon PCR methods both can be used in SARS detection.The results could support the hypothesis that animals (especially civet cat) could carry SARS virus.


title: Safety of energy based devices for hemostasis in thyroid surgery.

text: Energy based devices (EBD) have been developed, implemented and increasingly applied in thyroid surgery because they can provide a combined dissection and haemostatic effect. In particular, advantages of EBD have been described in terms of efficacious haemostasis, reduction of procedure-associated time, reduced incision length, less operative blood loss and transfusion need, decreased postoperative drain, pain and hospital stay. In addition, EBD are essential for endoscopic procedures. On the contrary, a potential drawback is the increased health care costs. This paper reviews relevant medical literature published on the safety of new devices for achieving hemostasis and dissection around the recurrent laryngeal nerve (RLN).


title: Ocular tropisms of murine coronavirus (strain JHM) after inoculation by various routes.

text: The coronavirus mouse hepatitis virus (MHV, strain JHM) infects tissues in the anterior and posterior segments when injected intravitreally into adult mouse eyes. Infection causes progressive damage to the photoreceptors and retinal pigment epithelium (RPE), resulting in a disease the authors have termed JHM retinopathy. To determine whether this virus is retinotropic independent of route of inoculation, the authors injected mice with virus by several different routes: into the anterior chamber (AC), onto the cornea, intranasally, or intracerebrally. Inoculation into the AC produced effects similar to those after intravitreal inoculation, although slightly slower in onset. Viral antigen was detected in the anterior portion of the iris on day 3, and by day 6, was also located primarily in the inner nuclear layer, photoreceptors, Müller cells, and RPE. However, by day 10, viral antigens were only detected in a few cells in the ganglion cell layer. Infectious virus was isolated from neural retinas on days 3 and 6, but not on day 10. In contrast, infectious virus could not be isolated from contralateral eyes. After 14 weeks, specific regions of some retinas were atrophied, with most of the retinal layers involved. Inoculation by other routes also resulted in virus-induced disease. Scarification of the cornea with virus, but not application of virus droplets alone, caused pathologic changes in the corneal epithelium and stroma and subtle effects on the ganglion cell and inner plexiform layers. Intracerebral inoculation of virus affected mainly the RPE. Pathologic effects and viral antigens were not detected in eyes from four mice inoculated intranasally. These results show that a murine coronavirus is retinotropic when introduced by several direct routes and one indirect route. Moreover, these studies show that long-lasting retinal disorders ranging in intensity from mild to severe can occur after coronavirus infection.


title: Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade – A possible mechanism of appearance.

text: Introduction Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries. Case Outline We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. Conclusion We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage.


title: A translation-attenuating intraleader open reading frame is selected on coronavirus mRNAs during persistent infection.

text: Short open reading frames within the 5' leader of some eukaryotic mRNAs are known to regulate the rate of translation initiation on the downstream open reading frame. By employing the polymerase chain reaction, we learned that the 5'-terminal 5 nt on the common leader sequence of bovine coronavirus subgenomic mRNAs were heterogeneous and hypervariable throughout early infection in cell culture and that as a persistent infection became established, termini giving rise to a common 33-nt intraleader open reading frame were selected. Since the common leader is derived from the genomic 5' end during transcription, a common focus of origin for the heterogeneity is expected. The intraleader open reading frame was shown by in vitro translation studies to attenuate translation of downstream open reading frames in a cloned bovine coronavirus mRNA molecule. Selection of an intraleader open reading frame resulting in a general attenuation of mRNA translation and a consequent attenuation of virus replication may, therefore, be a mechanism by which coronaviruses and possibly other RNA viruses with a similar transcriptional strategy maintain a persistent infection.


title: Physiologic and performance effects of sago supplementation before and during cycling in a warm-humid environment.

text: The present study determined whether 0.8g/kg bodyweight sago ingested before (Pre-Sago) or during (Dur-Sago) exercise under warm-humid conditions (30 ± 2°C, 78 ± 3 % RH; 20 km·h-1 frontal airflow) conferred a performance and/or physiological benefit compared to a control (Control) condition. Eight trained, male cyclists/triathletes (45 ± 4 y, VO2peak: 65 ± 10 ml·kg-1·min-1, peak aerobic power: 397 ± 71 W) completed 3 15-min time-trials (∼75% VO2peak) pre-loaded with 45 min of steady-state (∼55% VO2peak) cycling following > 24 h standardization of training and diet. Measures of work completed, rectal and mean skin temperatures, heart rate, expiratory gases and venous blood samples were taken. Compared to Control, Pre-Sago resulted in a smaller rise in rectal temperature (0.3 ± 0.5°C) while heart rate increased to a greater extent (6 ± 13 beats·min-1) during exercise (both P < 0.05), however, compared to Control time-trial performance remained unaffected (Pre-Sago: -0.5 ± 4.0%, P > 0.05). During exercise, plasma glucose concentrations were maintained higher for Dur-Sago than Control (P < 0.05), however substrate oxidation rates remained similar (P > 0.05). Dur-Sago also resulted in a higher plasma sodium concentration (2 ± 2 mmol·l1) and lower whole-body sweat loss (544 ± 636 g) and, therefore, reduced plasma volume contraction (all P < 0.05). Heart rate increased to a greater extent (5 ± 13 beats·min-1) during Dur-Sago, yet compared to Control time-trial performance remained unaffected (+0.9 ± 2.3%, P > 0.05). Uniquely, these results indicate that during exercise heat stress feeding sago can result in some 'beneficial' physiological responses, however these do not translate to changes in exercise performance when performed in a post-prandial state.


title: Tissue tropism of three cloacal isolates and Massachusetts strain of infectious bronchitis virus.

text: Three virus isolates (ECV-1, -2, and -3) recovered from cloacae of chickens in flocks that experienced drops in egg production were identified as infectious bronchitis virus (IBV), based on characteristic embryo lesions, chloroform sensitivity, coronavirus morphology, and serology. Because these isolates were recovered from the cloacae of the hens, their tissue tropism was compared with the prototype strain of IBV, Massachusetts-41 (M-41), in experimentally inoculated chickens. During the 39-day period postinoculation (PI), virus isolation was attempted from digestive and respiratory tracts, kidney, and cloacal swabs. ECV-1, ECV-2, and M-41 were more frequently recovered from the cecal tonsils than from other tissues. ECV-1, ECV-3, and M-41 were also recovered from kidney for up to 39 days PI. ECV-2 and ECV-3 had a limited distribution in respiratory tissues, being isolated only sporadically from trachea, bronchus, and lung. Surprisingly, ECV-2 was isolated from esophagus at 2, 16, 30, and 39 days PI; otherwise, its distribution in other tissues was sporadic. Results confirmed that IBV, including M-41, can infect a variety of tissues and that some isolates may be recovered frequently from digestive tract tissues, particularly from the cecal tonsils.


title: CEACAM1 in cervical cancer and precursor lesions: association with human papillomavirus infection.

text: Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is an adhesion molecule expressed in a wide variety of tissues including epithelial cells, leukocytes, and tumors that may establish both homotypic and heterotypic interactions. The aim of this work was to study the protein expression pattern of CEACAM1 in cervical cancer and precursor lesions in the context of human papillomavirus (HPV) infection. We used immunohistochemistry to analyze CEACAM1 expression in formalin-fixed, paraffin-embedded cervical tissues from 15 healthy women, 15 patients with low-grade squamous intraepithelial lesions (SIL), 15 patients with high-grade SIL, and 15 patients with squamous carcinomas. HPV types were identified by PCR. CEACAM1 was either undetectable (13/15) or low (2/15) in normal cervical tissues. By contrast, CEACAM1 expression was increased in high-grade SIL (10 samples staining intermediate/high and 4 samples staining low) as compared with low-grade SIL with undetectable (n=3) or low (n=12) expression. CEACAM1 expression was undetectable or low in cervical carcinoma. Our results suggest that CEACAM1 may be an interesting progression marker in SIL and cervical cancer, in particular due to reported immunoregulatory properties.


title: The predicted primary structure of the peplomer protein E2 of the porcine coronavirus transmissible gastroenteritis virus.

text: The complete nucleotide sequence of cloned cDNAs containing the E2 glycoprotein-encoding region of the genome of transmissible gastroenteritis virus (TGEV) has been determined. A single large translatable frame of 4.3 kb starting at 8.2 kb from the 3' end of the genome was identified. Its deduced amino acid sequence contains the characteristic features of a coronavirus peplomer protein: the precursor polypeptide of TGEV E2 is 1447 residues long (i.e. 285 longer than the avian infectious bronchitis coronavirus spike protein); partial N-terminal sequencing demonstrated that a putative secretory signal sequence of 16 amino acids is absent in the virion-associated protein; the predicted mol. wt. of the apoprotein is 158K; most of the 32 potential N-glycosylation sites available in the sequence are presumed to be functional to account for the difference between this and the experimentally determined value (200K to 220K); a typical hydrophobic sequence near the C terminus is likely to be responsible for anchoring the peplomer to the virion envelope.


title: Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

text: The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.


title: Available Interventions for Prevention of Cotton Dust-Associated Lung Diseases Among Textile Workers.

text: The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is a dearth of literature regarding field-based assessment of interventions for control of cotton dust associated respiratory diseases and the available studies primarily focus on pre-processing of cotton. This review highlights the uncertainties that remain; and recommends several areas for future research on respiratory health of textile workers.


title: Challenges of virtual talking therapies for substance misuse in New Zealand during the COVID-19 pandemic: an opinion piece.

text: The COVID-19 pandemic requires us to rethink how virtual approaches might work for people who use alcohol and other drugs. Are virtual clinics only suitable for clients with whom clinicians have already formed a therapeutic relationship? How well would virtual clinics work for new clients presenting to services, for clients in acute distress, and for those with complex problems? Addressing the sustained change required to maintain substance-free lives or a safe substance-use life requires robust psychotherapeutic approaches, which have traditionally been delivered through physical contact, whether they are one-to-one or group-based interventions. The challenge during this time of the COVID-19 pandemic is to deliver effective talking therapies while avoiding physical contact. How then should services continue to offer counselling and support in such an environment? How can we learn from the COVID-19 situation to deliver treatment to individuals who may have difficulties attending traditional clinic-based care, such as those in more rural areas with transport difficulties? This article focuses on identifying practical issues and providing some solutions.


title: A multi-data source surveillance system to detect a bioterrorism attack during the G8 Summit in Scotland.

text: In 18 weeks, Health Protection Scotland (HPS) deployed a syndromic surveillance system to early-detect natural or intentional disease outbreaks during the G8 Summit 2005 at Gleneagles, Scotland. The system integrated clinical and non-clinical datasets. Clinical datasets included Accident & Emergency (A&E) syndromes, and General Practice (GPs) codes grouped into syndromes. Non-clinical data included telephone calls to a nurse helpline, laboratory test orders, and hotel staff absenteeism. A cumulative sum-based detection algorithm and a log-linear regression model identified signals in the data. The system had a fax-based track for real-time identification of unusual presentations. Ninety-five signals were triggered by the detection algorithms and four forms were faxed to HPS. Thirteen signals were investigated. The system successfully complemented a traditional surveillance system in identifying a small cluster of gastroenteritis among the police force and triggered interventions to prevent further cases.


Why Australia needs a Medical Research Future Fund.


title: Viral cross contamination of rats maintained in a fabric-walled mass air flow system.

text: Rates for microbial cross transmission were measured in sentinel rats housed for 60 days in a fabric-walled mass air flow system. Naturally infected rats housed in the enclosure were the source of the infectious material. The cross transmission rates for rat coronaviruses, Kilham's rat virus, pneumonia virus of mice, Sendai virus, and Toolan's H-1 virus, were measured by positive seroconversion. The mass air flow system did not prevent, over a 60-day period, the transmission of the rat coronaviruses or Sendai virus between rats housed on separate racks maintained 81 cm apart. At 15 days, all sentinel rats had acquired two or more additional bacterial organisms, indicating rapid cage to cage cross transmission. It was concluded that rats from different sources with different microbial profiles should not be housed in this room at the same time.


title: Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome.

text: OBJECTIVE To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. METHODS Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. RESULTS A significant decrease was observed in all SARS patients in their peripheral CD4(+) and CD8(+) T lymphocyte absolute counts [256 (104) x 10(6)/L and 256 (117) x 10(6)/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8(+) T lymphocyte counts in comparison with normal controls. CONCLUSIONS Decrease of both CD4(+) and CD8(+) T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.


title: The future of topical analgesics.

text: Topically applied analgesic therapies have been used throughout history to treat a variety of patient conditions that present with pain. Before modem pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug-delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain.


title: Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage.

text: BACKGROUND Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea. OBJECTIVE To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD). METHODS Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the procedure using midazolam and propofol. Aside from standard monitoring, additional capnographic monitoring was used and analyzed by an independent observer. RESULTS The mean (± SD) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinically detected apnea (207.5 ± 348.8 s versus 8.2 ± 17.9 s; P=0.015). The overall number of detected episodes of apnea was also significantly different (113 versus seven; P=0.012). There were 15 events of oxygen desaturation (decrease in oxygen saturation [SaO2] ≥ 5%), which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation. There were three events of hypoxemia (SaO2 <90%) that were predicted in three of three cases by capnography and in one of three cases by clinical observation. CONCLUSION Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD.


title: Analysis of human coronavirus 229E spike and nucleoprotein genes demonstrates genetic drift between chronologically distinct strains.

text: Historically, coronaviruses have been recognized as a cause of minor respiratory infections in humans. However, the recent identification of three novel human coronaviruses, one causing severe acute respiratory syndrome (SARS), has prompted further examination of these viruses. Previous studies of geographically and chronologically distinct Human coronavirus 229E (HCoV-229E) isolates have found only limited variation within S gene nucleotide sequences. In contrast, analysis of the S genes of contemporary Human coronavirus OC43 variants identified in Belgium revealed two distinct viruses circulating during 2003 and 2004. Here, the S and N gene sequences of 25 HCoV-229E variants identified in Victoria, Australia, between 1979 and 2004 in patients with symptomatic infections were determined. Phylogenetic analysis showed clustering of the isolates into four groups, with evidence of increasing divergence with time. Evidence of positive selection in the S gene was also established.


title: Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic.

text: CONTEXT A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure. OBJECTIVES To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density. DESIGN AND SETTING Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine. MAIN OUTCOME MEASURES Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period. RESULTS There were 115,340 excess pneumonia and influenza deaths (EDR, 500/100,000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r = -0.74, P < .001), lower peak mortality rates (Spearman r = 0.31, P = .02), and lower total mortality (Spearman r = 0.37, P = .008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = -0.39, P = .005). CONCLUSIONS These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.


title: Accuracy of the oxygen cylinder duration calculator of the LTV-1000 portable ventilator.

text: BACKGROUND Resource planning is essential for successful transport of the mechanically ventilated patient. Mechanically ventilated patients require adequate oxygen supplies to ensure transport is completed without incident. The LTV-1000 portable ventilator utilizes a program to calculate oxygen cylinder duration, based on cylinder size, fraction of inspired oxygen (F(IO(2))), and current minute ventilation. We evaluated the accuracy of the cylinder-duration algorithm in a laboratory setting. METHODS The LTV-1000 was attached to a test lung. Lung compliance was set at 0.04 L/cm H(2)O, and airway resistance was 5.0 cm H(2)O/L/s. We tested 7 different combinations of ventilator settings a minimum of 2 times each. With each setting, minute ventilation was kept at 10 L/min. Breath type, positive end-expiratory pressure, and F(IO(2)) were varied to evaluate the accuracy of the algorithm across a range of clinical scenarios. The cylinder-duration calculation from the ventilator program and manual calculation was determined at each setting and compared to the actual cylinder duration. RESULTS The ventilator algorithm and the manual calculation underestimated the actual cylinder duration by 12 +/- 3% with each test. The range of differences between calculated and actual cylinder duration was 2-26 min across the 7 conditions. CONCLUSION Actual cylinder duration averaged 12% longer than the cylinder duration estimated by the algorithm of the LTV-1000. One explanation is that the E cylinders may contain more liters of oxygen than indicated by the sticker on the side of the tank. Additionally, the bias flow during expiration is affected by inspiratory-expiratory ratio and respiratory rate. Clinicians should be aware of these differences when planning for patient transport.


title: Management of uterine fibroids: an update of the evidence.

text: OBJECTIVES The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically updated evidence on the management of uterine fibroids, specifically incidence and prevalence of fibroids, treatment outcomes, comparisons of treatment, modifiers of outcomes, and costs. DATA SOURCES We searched MEDLINE(R), Cochrane Collaboration resources, and Embase. REVIEW METHODS We included studies published in English from February 2000 through August 2006. We excluded studies with low sample size (based on study design, cases series < 100 and cohorts < 40) or lack of relevance to uterine fibroids. Of 107 included studies, 3 were good quality, 56 fair, and 48 poor. RESULTS The cumulative incidence by age 50 is 70 percent to 80 percent; black women are more likely to get fibroids at younger ages. Appearance of new fibroids and growth of existing fibroids after treatment are poorly studied. Trials of preoperative medical management indicate that treatment reduces fibroid volume but do not provide sufficient evidence of improvement in important operative outcomes. When women are treated for reasons other than symptom relief, such as when pregnancy is desired, weak evidence supports treating submucous fibroids via hysteroscopy. No well-conducted trials in U.S. populations directly compared treatment options, including the option of expectant management, or followed women to determine whether the intervention met their treatment objectives. Common procedures such as hysterectomy and myomectomy, including choice among types of myomectomy, still cannot be meaningfully compared. Studies comparing uterine artery embolization (UAE) with other procedures reported procedure time and length of stay favoring UAE, but inconsistency of the direction of effect for complications and absence of key information on longer-term outcomes suggest that this evidence base is inadequate to comment on the relative risks and benefits of UAE versus hysterectomy or myomectomy. Costs of fibroid treatment, despite shorter average lengths of stay, are rising. CONCLUSIONS The dearth of high-quality evidence supporting the effectiveness of most interventions for uterine fibroids is remarkable, given how common this problem is. The current state of the literature does not permit definitive conclusions about benefit, harm, or relative costs to help guide women's choices. Significant research gaps include well-conducted trials in U.S. populations that directly compare interventions on short- and, especially, long-term outcomes, studies on therapeutics for medical management, and information on treatment decisions for women who desire a pregnancy.


Novel coronavirus infection: time to stay ahead of the curve.


title: Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma.

text: PURPOSE The aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts. MATERIALS AND METHODS The study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1-40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model. RESULTS Age was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155). CONCLUSION Similar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.


title: Preperitoneal balloon tamponade for lethal closed retroperitoneal pelvic hemorrhage in a swine model: A comparable and minimally invasive alternative to open pre-peritoneal pelvic packing.

text: BACKGROUND The management of massive pelvic fracture-associated hemorrhage is extremely challenging, particularly in the unstable patient. We sought to characterize and compare the efficacy of a minimally invasive preperitoneal balloon technique (MIB) to standard open packing. METHODS Twenty-six swine were randomized to control (C), open preperitoneal packing technique (OP), and MIB groups. A closed extraperitoneal iliac vascular injury followed by intervention + resuscitation over a 120-minute OP and MIB efficacy was assessed by procedure time, hemodynamics, extraperitoneal tamponade pressures (ETPs), blood loss, and survival. Angiography was performed in select animals, and ETPs were also measured in humans undergoing MIB placement for an elective procedure. RESULTS Baseline parameters (mean arterial pressure [MAP] 29, 38, and 38 mm Hg; cardiac index [CI] 3.5, 3.8, and 4.2; and EPTs 5, 4, and 5 mm Hg) were similar among C, OP, and MIB groups, respectively (all p's > 0.05). The OP and MIB groups had markedly improved MAP and CI versus C. MIB generated significantly higher ETP (28 vs 17 mm Hg), was faster to deploy (164 vs 497 seconds), and had lower total blood loss versus OP (0.7 vs 1.2 L, all p's < 0.05). OP and MIB had equivalent survival times that were significantly improved versus C (91 and 116 vs 43 minutes, p < 0.05). Survival to 2 hours was 80% with OP versus 100% in the MIB group. Angiography showed no active extravasation in both study groups, but controlled partial deflation of the MIB allowed easy visualization of extravasation. Minimally invasive preperitoneal balloon inflation in five human subjects demonstrated a significant increase in mean ETP from 2.4 to 31 mm Hg (p < 0.01). CONCLUSION Minimally invasive preperitoneal balloon tamponade was as effective as OP in improving hemodynamics and prolonging survival times, and performed superiorly to OP in time to placement, blood loss, and generation of tamponade pressures. The MIB allows for controlled deflation and reinflation to facilitate angiographic interventions, and may represent a promising new bedside intervention in this patient population.


title: Canine-coronavirus (CCV) characterization in Spain. Epidemiological aspects.

text: In this paper the characterization of a canine-coronavirus (CCV) strain isolated in Spain is reported. The CCV cellular-infection cycle on A-72 cells was studied using electron-microscopy techniques. The isolate was found to have similar electrophoretic profile and antigenic properties to an American reference strain. Sera samples were obtained from several canine populations and tested for viral antibodies using two immunoenzymatic methods. Sera specificity was confirmed using immunoblot analysis. The agreement between both ELISA tests produced adequate results (kappa value = 0.64).


title: Adenosine A2a and A2b receptors in cultured fetal chick heart cells. High- and low-affinity coupling to stimulation of myocyte contractility and cAMP accumulation.

text: Adenosine exerts pronounced biological effects in the heart cell. The role of multiple adenosine receptor subtypes in regulating the heart cell function is not known. Ventricular cells cultured from chick embryos 14 days in ovo were used to study a novel feature of heart cell regulation by the stimulatory adenosine receptors. The inhibitory adenosine A1 receptor pathway was first inactivated by pertussis toxin treatment of the cultures, and the effects of adenosine agonists and antagonists on the heart cell contractile amplitude, measured via an opticovideo motion detection system, and on the modulation of cAMP level were determined. Adenosine and N-ethyladenosine-5'-uronic acid (NECA), capable of activating both the adenosine A2a and A2b receptors, caused a greater increase in the contractile amplitude than did the A2a-selective agonist 2-[4-(2-carboxythyl)phenylethylamino]-5'-N-ethylcarboxamidoa denosine (CGS21680). NECA caused a biphasic increase in cAMP, which became monophasic in the presence of the A2a receptor-selective antagonist 8-(3-chlorostyryl)caffeine, whereas the CGS21680-induced cAMP response was monophasic. Blocking with 8-(3-chlorostyryl)caffeine abolished most of the CGS21680-elicited contractile or cAMP response while attenuating only part of the adenosine- or NECA-stimulated responses. Blocking with the A2b-selective antagonists 1,3-diethyl-8-phenylxanthine or alloxazine caused a more pronounced inhibititon of the contractile or cAMP response by adenosine or NECA than by CGS21680. Affinity of the A2a receptor was 60-fold higher than that of the A2b receptor. These data demonstrate that a functional A2b receptor is expressed on the heart cell and is capable of mediating augmentation of cardiac myocyte contractility and that adenosine A2a and A2b receptors, with greatly different affinity, coexist and are coupled to the same functional responses. Taken together, the data suggest a novel feature of heart cell regulation, where the high-affinity A2a receptor can play an important modulatory role in the presence of a low level of adenosine, whereas the low-affinity A2b receptor becomes functionally important when the adenosine level is high.


title: Meeting threats to global health: a call for American leadership.

text: Although the application of major biomedical advances has yielded spectacular results for individual health, there has been little improvement in the health of whole populations. There is a "back to the future" irony in the fact that at the inception of the 21st century, the eruption and spread of a multitude of "old" and "new" infectious diseases has become the most serious global threat to the health of humankind. At this historical juncture, the United States is the country with the most potential for favorably influencing global health and health care. Although there are historical, cultural, economic, and political factors that impede the United States from rising to this challenge, there is both a moral imperative and a rational long-term self-interest basis for the U.S. medical profession and government to exercise leadership in facing the health challenges of tragic and genocidal proportions that threaten everyone in an increasingly interdependent world.


Points & Pearls: Novel 2019 Coronavirus SARS-CoV-2 (COVID-19) An Overview for Emergency Clinicians.


title: Sugar-free zinc gluconate glycine lozenges (Cold-Eeze) do not adversely affect glucose control in patients with type 1 or type 2 diabetes mellitus.

text: Several controlled clinical trials have shown that zinc gluconate glycine lozenges can reduce symptom severity and duration of symptoms in patients with the common cold. Over-the-counter zinc lozenges are used commonly by the general population, including people with diabetes. The purpose of this study was to assess the effects of sugar-free Cold-Eeze (The Quigley Corp., Doylestown, PA), a commonly used zinc preparation, on glucose control in patients maintained on stable antidiabetic therapy. Forty-eight patients with either type 1 (n = 3) or type 2 (n = 45) diabetes were randomized in a 3:1 ratio to receive either zinc lozenges (four to six lozenges/day for 10 days) or matching placebo. The primary endpoint was change in serum fructosamine concentration. Secondary endpoints included daily home glucose and fasting blood glucose monitoring (baseline, days 10 and 21). The mean age for all patients was 54 years (range, 25 to 76), with slightly more women (60%). The treatment groups did not differ with respect to age, sex, body mass index, duration of diabetes, baseline hemoglobin A1C level, or fasting plasma glucose level. The patients treated with placebo (n = 13) and zinc (n = 34) had similar fructosamine levels (mean +/- SD) at baseline (318 +/- 90 versus 297 +/- 86 micromol/l, respectively). After 10 days of dosing, both groups showed modest reductions in serum fructosamine (-7 +/- 42 and -9 +/- 90 micromol/l). These changes were not statistically significant. In conclusion, these findings suggest that sugar-free zinc lozenges can be administered safely to patients with diabetes without deleterious effects on glycemic control.


title: Cell Entry of Porcine Epidemic Diarrhea Coronavirus Is Activated by Lysosomal Proteases.

text: Porcine epidemic diarrhea coronavirus (PEDV) is currently devastating the United States pork industry by causing an 80-100% fatality rate in infected piglets. Coronavirus spike proteins mediate virus entry into cells, a process that requires the spike proteins to be proteolytically activated. It has been a conundrum which proteases activate PEDV entry. Here we systematically investigated the roles of different proteases in PEDV entry using pseudovirus entry, biochemical, and live virus infection assays. We found that the PEDV spike is activated by lysosomal cysteine proteases but not proprotein convertases or cell surface serine proteases. Extracellular trypsin activates PEDV entry when lysosomal cysteine proteases are inhibited. We further pinpointed cathepsin L and cathepsin B as the lysosomal cysteine proteases that activate the PEDV spike. These results advance our understanding of the molecular mechanism for PEDV entry and identify potential antiviral targets for curbing the spread of PEDV.


title: Coccidioidomycosis among cast and crew members at an outdoor television filming event--California, 2012.

text: In March 2013, the California Department of Public Health (CDPH) identified two Doctor's First Reports of Occupational Injury or Illness (DFRs) regarding Los Angeles County residents who had worked at the same jobsite in January 2012 and had been evaluated for possible work-associated coccidioidomycosis (valley fever). Occupational exposure to Coccidioides, the causative fungi, typically is associated with soil-disrupting activities. The physicians noted that both workers were cast or crew members filming a television series episode, and the site of possible exposure was an outdoor set in Ventura County, California. On the basis of their job titles, neither would have been expected to have been engaged in soil-disrupting activities. Los Angeles County Department of Public Health (LACDPH) conducted an outbreak investigation by using CDPH-provided occupational surveillance records, traditional infectious disease surveillance, and social media searches. This report describes the results of that investigation, which identified a total of five laboratory-confirmed and five probable cases linked to this filming event. The employer and site manager were interviewed. The site manager stated that they would no longer allow soil-disruptive work at the site and would incorporate information about the potential risk for Coccidioides exposure onsite into work contracts. Public health professionals, clinicians, and the television and film industry should be aware that employees working outdoors in areas where Coccidioides is endemic (e.g., central and southern California), even those not engaged in soil-disruptive work, might be at risk for coccidioidomycosis.


Public health strategies for pandemic influenza: ethics and the law.


THE CONGRESS OF THE UNITED STATES.


Acute otitis media.


title: Duration of growth depression and pathogen shedding in experimentally reproduced poult enteritis syndrome.

text: An experimental study was conducted to determine the duration of growth depression and virus shedding in turkey poults after oral inoculation with intestinal contents from birds affected with poult enteritis syndrome (PES). Poults at day 14 of age were divided into four groups (groups A, B, C, and D) of 40 poults each and inoculated orally with unfiltered supernatant, filtered supernatant, sediment suspended in phosphate-buffered saline (PBS), or PBS alone (control), respectively. The poults were observed daily for clinical signs, and their growth response, pathology, and pathogen shedding were examined at 10, 20, 30, 40, and 50 days postinoculation (DPI). Body weights of eight poults in each group were recorded at each of these intervals followed by euthanasia. Dullness, depression, and diarrhea were observed in birds inoculated with supernatant or sediment suspension. All three treatments significantly reduced body weight gain of poults compared with the control group; average weight loss was 14%. Gross pathologic changes consisted of pale distended intestines with watery contents and distended ceca with frothy and watery contents. Astrovirus and rotavirus were detected in the inoculum by reverse transcription (RT)-PCR, whereas Salmonella was identified on bacterial isolation. Both viruses were detected in treated poults by RT-PCR for up to 10 and 40 DPI, respectively. Of the three treatments, sediment suspension caused maximal decrease in weight gain as well as greatest pathologic lesions followed by unfiltered supernatant and filtered supernatant. These findings suggest a role for bacteria in increasing the severity of PES. Lower weight gain in treated poults (compared with controls) at 9 wk of age also indicates that PES-affected poults may not reach normal weight at marketing, leading to economic losses for the producer.


title: A previously undescribed coronavirus associated with respiratory disease in humans.

text: The etiology of acute respiratory tract illnesses is sometimes unclear due to limitations of diagnostic tests or the existence of as-yet-unidentified pathogens. Here we describe the identification and characterization of a not previously recognized coronavirus obtained from an 8-mo-old boy suffering from pneumonia. This coronavirus replicated efficiently in tertiary monkey kidney cells and Vero cells, in contrast to human coronaviruses (HCoV) 229E and OC43. The entire cDNA genome sequence of the previously undescribed coronavirus was determined, revealing that it is most closely related to porcine epidemic diarrhea virus and HCoV 229E. The maximum amino acid sequence identity between ORFs of the newly discovered coronavirus and related group 1 coronaviruses ranged from 43% to 67%. Real-time RT-PCR assays were designed to test for the prevalence of the previously undescribed coronavirus in humans. Using these tests, the virus was detected in four of 139 individuals (3%) who were suffering from respiratory illness with unknown etiology. All four patients suffered from fever, runny nose, and dry cough, and all four had underlying or additional morbidity. Our data will enable the development of diagnostic tests to study the prevalence and clinical impact of this virus in humans in more detail. Moreover, it will be important to discriminate this previously undescribed coronavirus from HCoV 229E and OC43 and the severe acute respiratory syndrome coronavirus.


title: Blood glucose testing.

text: Data presented in this study indicates that the following systems; Eyetone-Ames, Dextrometer-Ames, Chemstrip bG-BioDynamics, and Stat Tek-BioDynamics, perform with accuracy in the estimation of blood glucose as compared to the results of the Beckman Auto-Analyzer. The Dextrostix-Ames system did not provide the accuracy necessary for blood glucose screening.


title: CD66 identifies the biliary glycoprotein (BGP) adhesion molecule: cloning, expression, and adhesion functions of the BGPc splice variant.

text: Within the hematopoietic lineage, the monoclonal antibody (MoAb) CD66 reacts with cells of the granulocyte lineage, but not with the majority of progenitor cells from human bone marrow. Our previous studies have shown that CD66 binds specifically to at least three carcinoembryonic antigen (CEA) superfamily members, ie, CEA itself, nonspecific cross-reacting antigen (NCA), and CGM1, but not to CGM6 (NCA-95). In this report, we show that CD66 will also identify the biliary glycoproteins (BGP). A full-length cDNA for the BGPc molecule (a cytoplasmic splice variant of BGPa) was isolated by expression cloning using the CD66 MoAbs. This protein has an identical extracellular and transmembrane sequence to BGPa with one N-terminal IgV like domain, three IgC-like extracellular domains (A1, B1, and A2), plus a transmembrane domain, but the cytoplasmic domain is spliced by 53 nucleotides. Reverse transcriptase-polymerase chain reaction experiments show that this splice variant can be detected in colonic carcinoma cell lines, in primary colonic adenocarcinomas, and in myeloid and B-cell lines to varying degrees. Quantitative analyses of BGPc RNA expression by RNase protection indicate that abundant levels occur only in the colonic, but not in the hematopoietic, cell lines tested. Studies presented here show that BGPc mediates homotypic adhesion and suggest that the cytoplasmic splicing does not alter the initial homotypic adhesion properties of BGPa.


title: Diagnosis and pharmacotherapy of severe acute respiratory syndrome: what have we learnt?

text: In 2003, the onset of severe acute respiratory syndrome (SARS) caused worldwide chaos. Although SARS was eradicated by isolation towards the end of 2003, sporadic cases have been reported in Singapore, Taiwan and mainland China. In this review, SARS is discussed as a disease, as well as its diagnosis, management and pharmacotherapy. Respiratory physicians and healthcare professionals have to be aware of advances in the understanding of the diagnosis and management of severe acute respiratory syndrome. More research is required in order to prepare for if this respiratory infection recurs, but there are concerns that adequate pharmaceutical support may be lacking for the development of a vaccine.


title: NK cell activation in visceral leishmaniasis requires TLR9, myeloid DCs, and IL-12, but is independent of plasmacytoid DCs.

text: Natural killer (NK) cells are sentinel components of the innate response to pathogens, but the cell types, pathogen recognition receptors, and cytokines required for their activation in vivo are poorly defined. Here, we investigated the role of plasmacytoid dendritic cells (pDCs), myeloid DCs (mDCs), Toll-like receptors (TLRs), and of NK cell stimulatory cytokines for the induction of an NK cell response to the protozoan parasite Leishmania infantum. In vitro, pDCs did not endocytose Leishmania promastigotes but nevertheless released interferon (IFN)-alpha/beta and interleukin (IL)-12 in a TLR9-dependent manner. mDCs rapidly internalized Leishmania and, in the presence of TLR9, produced IL-12, but not IFN-alpha/beta. Depletion of pDCs did not impair the activation of NK cells in L. infantum-infected mice. In contrast, L. infantum-induced NK cell cytotoxicity and IFN-gamma production were abolished in mDC-depleted mice. The same phenotype was observed in TLR9(-/-) mice, which lacked IL-12 expression by mDCs, and in IL-12(-/-) mice, whereas IFN-alpha/beta receptor(-/-) mice showed only a minor reduction of NK cell IFN-gamma expression. This study provides the first direct evidence that mDCs are essential for eliciting NK cell cytotoxicity and IFN-gamma release in vivo and demonstrates that TLR9, mDCs, and IL-12 are functionally linked to the activation of NK cells in visceral leishmaniasis.


title: Acute disseminated encephalomyelitis: an update.

text: Acute disseminated encephalomyelitis (ADEM) is a monophasic autoimmune demyelinating disease of the central nervous system that typically follows a febrile infection or a vaccination. Children are predominantly affected. A plethora of viral and bacterial pathogens and a number of vaccinations have been associated with ADEM. Experimental animal studies indicate that both primary and secondary autoimmune responses contribute to central nervous system inflammation and subsequent demyelination. The clinical diagnosis of ADEM is strongly suggested by a close temporal relationship between an infectious incident or an immunization and the onset of leukoencephalopathic neurological symptoms. Paraclinical tests may support the diagnosis. Particularly helpful are acute signs of newly developed extensive, multifocal, subcortical white matter abnormalities on magnetic resonance images of the brain. The cerebrospinal fluid may disclose a mild lymphocytic pleocytosis and elevated albumin levels. Oligoclonal bands are not always present in ADEM and, if so, may be transient. The major differential diagnosis of ADEM is multiple sclerosis. Treatment options for ADEM consist of anti-inflammatory and immunosuppressive agents. In general, the disease is self-limiting and the prognostic outcome favorable. In the absence of widely accepted clinical or paraclinical diagnostic guidelines, a number of recently conducted observational case series have substantially broadened our understanding about the clinical phenotype, diagnosis, and prognosis of ADEM.