title: Use of polymerase chain reaction for detection of adenovirus in children with or without wheezing.

text: Eighty percent of asthma attacks in children are accompanied by an upper respiratory tract viral infection. Adenovirus is one of the major viral causes of childhood bronchiolitis. As the polymerase chain reaction (PCR) is the most sensitive technique for documenting viral respiratory infections, the PCR method was performed on the throat swab samples of asthmatic children with and without wheezing to investigate the presence of the adenovirus genome in the upper respiratory tract. The frequencies of adenovirus in asymptomatic and symptomatic asthmatic patients, healthy controls and wheezy children were as follows: 33.3%, 71.4%, 37% and 62.96%, respectively. The adenovirus was detected in a significantly higher percentage in the upper airways of patients with asthma exacerbation and in children with wheezing than in patients without asthma exacerbation and in the healthy controls (p < 0.05). The frequency of adenovirus was not different between asthmatic patients receiving or not receiving inhaled corticosteroid. Adenovirus has the potential to precipitate asthma exacerbations in asthmatic patients; its frequency was not affected by the treatment of inhaled corticosteroid.


title: Novel immunofluorescence assay using recombinant nucleocapsid-spike fusion protein as antigen to detect antibodies against severe acute respiratory syndrome coronavirus.

text: Severe acute respiratory syndrome (SARS) is caused by a novel and highly infectious virus named SARS coronavirus (SARS-CoV). Among the serological tests currently available for the detection of SARS-CoV, a whole-virus-based immunofluorescence assay (IFA) was considered one of the most sensitive assays and served as a "gold standard" during the SARS epidemic in Singapore in 2003. However, the need to manipulate live SARS-CoV in the traditional IFA limits its wide application due to the requirement for a biosafety level 3 laboratory and the risk of laboratory infection. Previously, we have identified two immunodominant epitopes, named N195 and Sc, in the two major structural proteins, the N and S proteins, of SARS-CoV (Q. He, K. H. Chong, H. H. Chng, B. Leung, A. E. Ling, T. Wei, S. W. Chan, E. E. Ooi, and J. Kwang, Clin. Diagn. Lab. Immunol., 11:417-422, 2004; L. Lu, I. Manopo, B. P. Leung, H. H. Chng, A. E. Ling, L. L. Chee, E. E. Ooi, S. W. Chan, and J. Kwang, J. Clin. Microbiol. 42:1570-1576, 2004). In the present study, the N195-Sc fusion protein was highly expressed in insect (Sf9) cells infected with a recombinant baculovirus bearing the hybrid gene under the control of a polyhedrin promoter. An IFA based on Sf9 cells producing the fusion protein was standardized with 23 serum samples from patients with SARS, 20 serum samples from patients with autoimmune diseases, and 43 serum samples from healthy blood donors. The detection rates were comparable to those obtained with a commercial SARS-CoV IFA kit (EUROIMMUN, Gross Groenau, Germany) and a conventional IFA performed at the Singapore General Hospital. Our data showed that the newly developed IFA could detect SARS-CoV in 22 of the 23 SARS-CoV-positive serum samples and gave no false-positive results when the sera from patients with autoimmune diseases and healthy individuals were tested. The detection rate was identical to those of the two whole-virus-based IFAs. Thus, the novel N-S fusion antigen-based IFA could be an attractive alternative to present whole-virus-based IFAs for the diagnosis of SARS-CoV infection.


Commentary: Predicting the unpredictable: the future incidence of variant Creutzfeldt-Jakob disease.


title: Simultaneous determination of tocotrienols, tocopherols, retinol, and major carotenoids in human plasma.

text: BACKGROUND Epidemiologic evidence suggests that the concentrations of antioxidant vitamins in human plasma may play an important role in numerous chronic diseases, such as cancer and cardiovascular disease. However, methods for simultaneous measurement of these antioxidants are scarce. We developed and validated a new HPLC method for simultaneous determination of these vitamers in human plasma that uses a novel column-switching approach. METHODS The new method uses liquid-liquid extraction and isocratic separation with two monomeric C(18) columns maintained at 35 and 4 degrees C coupled with ultraviolet-visible and fluorometric detection. This method could separate 14 vitamers and 3 internal standards within 27 min. No additional modifier was required; the mobile phase was acetonitrile-methanol (65:35 by volume), and the flow rate was 1 mL/min. RESULTS For photodiode array detection, the detection limits (signal-to-noise ratio >3) were 0.02 mg/L for beta-carotene, lutein, zeaxanthin, and canthaxanthin; 0.01 mg/L for all-trans-retinol, beta-cryptoxanthin, alpha-carotene, and lycopene; and 0.1 mg/L for all tocopherols and tocotrienols. The detection limit was at least 25-fold lower (0.004 mg/L) when fluorometry was used for measurement of delta-, gamma-, and alpha-tocotrienol and delta-tocopherol compared with ultraviolet detection. The recovery and imprecision of the assay were generally >90% and <10%, respectively. CONCLUSIONS This new method separates a wide range of fat-soluble antioxidant vitamins in human plasma, including six carotenoids, three isoforms of tocotrienols and tocopherols (delta-, gamma-, and alpha-), and all-trans-retinol. The overall findings suggest that our method is faster, more sensitive, and more comprehensive than existing methods.


title: [Renin-angiotensin-aldosterone blockers and Covic-19 infection : friends or enemies ?]

text: ACE2 is not only an enzyme that counters the effects of the renin-angiotensin-aldosterone system (RAAS) but is also the entry receptor for SARS-CoV-2, the virus of the Covid-19 pandemic. Some experimental data suggest that ACE inhibitors and ARBs increase ACE2 levels, thus raising concerns on their security in Covid-19 positive patients. However, some studies have shown protection by these drugs in lower tract respiratory infections and ARDS. The actual consensus is to continue the treatment with RAAS inhibitors, abrupt withdrawal, especially in patients with cardiac or renal conditions, being hazardous in terms of cardiovascular outcomes, except in patients hospitalized in intensive care with hemodynamic instability. This position statement is actually unanimous among all international learned societies.


title: Uncomplicated acute bronchitis.

text: Acute bronchitis is an acute cough illness in otherwise healthy adults that usually lasts 1 to 3 weeks. This review describes the pathophysiology of the condition and provides a practical approach to the evaluation and treatment of adults with uncomplicated acute bronchitis. Practical points to be made are:1. Respiratory viruses appear to cause the large majority of cases of uncomplicated acute bronchitis.2. Pertussis infection is present in up to 10% to 20% of adults with cough illness of more than 2 to 3 weeks' duration. No clinical features distinguish pertussis from nonpertussis infection in adults who were immunized against pertussis as children.3. Transient bronchial hyperresponsiveness appears to be the predominant mechanism of the bothersome cough of acute bronchitis.4. Ruling out pneumonia is the primary objective in evaluating adults with acute cough illness in whom comorbid conditions and occult asthma are absent or unlikely. In the absence of abnormalities in vital signs (heart rate > 100 beats/min, respiratory rate > 24 breaths/min, and oral body temperature > 38 degrees C), the likelihood of pneumonia is very low.5. Randomized, placebo-controlled trials do not support routine antibiotic treatment of uncomplicated acute bronchitis.6. Randomized, placebo-controlled trials have shown that inhaled albuterol decreases the duration of cough in adults with uncomplicated acute bronchitis.7. Intervention studies suggest that antibiotic treatment of acute bronchitis can be reduced by using a combination of patient and physician education. Decreased rates of antibiotic treatment are not associated with increased utilization, return visits, or dissatisfaction with care.


title: Surgical mesh for ventral incisional hernia repairs: Understanding mesh design.

text: Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.


title: Human major group rhinoviruses downmodulate the accessory function of monocytes by inducing IL-10.

text: Human rhinoviruses (HRVs) are the predominant cause of the common cold. Although this disease is per se rather harmless, HRV infection is considered to set the stage for more dangerous pathogens in vivo. Here we demonstrate that HRV-14, a member of the major group HRV family, can efficiently inhibit antigen-induced T-cell proliferation and T-cell responses to allogeneic monocytes. HRV-14 triggered a significant downregulation of MHC class II molecules on monocytes. Moreover, supernatants from monocytes cultured in the presence of HRV-14 strongly reduced the allogeneic T-cell stimulatory property of untreated monocytes and monocyte-derived dendritic cells (md-DCs), whereas Epstein Barr virus-transformed B-lymphoblastoid cells were not sensitive. Analysis of the supernatant revealed that HRV-14 induced the production of significant amounts of the immunosuppressive cytokine IL-10. The important T-cell stimulatory cytokine IL-12 or the proinflammatory cytokines IL-1beta or TNF-alpha were not detected or were only minimally detected. Finally, monocytes pretreated with HRV-14 were greatly inhibited in their production of IL-12 upon stimulation with IFN-gamma/LPS. These observations suggest that altered cytokine production in mononuclear phagocytes upon interaction with HRV downmodulates appropriate immune responses during the viral infection.


title: Severe acute respiratory syndrome, a pathological immune response to the new coronavirus--implications for understanding of pathogenesis, therapy, design of vaccines, and epidemiology.

text: Findings coming from autopsies and serum of SARS patients suggest an important immune-inflammatory implication in the evolution to respiratory distress. Conditions such as HIV infection or treatment with immunosuppressors (in cancer or autoimmune diseases) are not among the bad prognosis factors for development of distress. To date, there have been no reported case fatalities in children, probably due to their more immature immune system. Our conclusions follow: (1) The milder form of SARS in children and the apparent protective factor that immunosupression represent rules out a significant viral cytopathic effect (they would be the most affected). (2) The evidence for immune implication in distress strongly supports immunomodulators for therapy: phosphodiesterase inhibitors (due to their down-modulating activity on proinflammatory cytokines); inhaled corticoids (aimed at producing a local immunomodulation); teophylline or nedocromil sodium (which prevents inflammatory cell recruitment into the airway wall). (3) An early immunomodulatory therapy, based on the levels of proinflammatory cytokines and clinical parameters to evaluate the respiratory function such as arterial oxygen saturation, could prevent the occurrence of distress. (4) Vaccine design should consider the immune origin of distress. (5) Physicians should be aware of mildly symptomatic patients (children, immuno-compromised hosts) to avoid transmission to immunocompetent adults.


title: Use of the Seeplex RV Detection kit for surveillance of respiratory viral outbreaks in Toronto, Ontario, Canada.

text: The Seeplex RV Detection kit was used to identify specific respiratory viruses from specimens collected during respiratory outbreaks in the Greater Toronto Area from 1 September 2007 to 1 February 2008. Two hundred-thirty-one patient samples (nasopharyngeal swabs) were collected from 63 respiratory outbreaks. The distribution of outbreaks characterized by molecular means was: 30% (n=19) no identification; 52.5% (n=33) one pathogen; 14.5% (n=9) two pathogens; and 3% (n=2) three pathogens. In contrast, culture-based protocols identified pathogens in fewer outbreaks: 63 % (n=40) no identification; 35% (n=22) 1 pathogen; and 2% (n=1) 2 pathogens (p<0.05). Compared to virus isolation, molecular testing identified a greater proportion of positive specimens for rhinovirus: 22% (n=51/231) vs 5% (n=12/231) (p=0.01); and RSV A/B: 12% (n=27/231) vs 5% (n=11/231) (p<0.05). Superiority of the molecular assay to detect rhinovirus and RSV outbreaks compared to culture is evident from this study.


title: [Preliminary analysis of treatment in 32 patients with critical severe acute respiratory syndrome].

text: OBJECTIVE To summarize the experience of treatment in 32 critical severe acute respiratory syndrome (SARS) patients. METHODS The age of 32 patients ranged from 19 to 72 years, the average was 43.06 years. Among them, 13 patients were having serious primary diseases, i.e. cardio-cerebral-vascular disease in 9 patients, diabetes in 2 patients, renal dysfunction in 1 patient, and chronic obstructive pulmonary disease (COPD) in 1 patient. The treatment included antiviral agents, glucocorticoid, mechanical ventilation, antibiotics and immunologic enhancement, etc. Cure rate, mortality and complications were analyzed. RESULTS Among 32 patients, 24 were cured, 2 died of respiratory failure, 6 died of their primary diseases, and the overall mortality was 25.00 percent. Superimposed infection occurred in 12 patients, and among 17 patients who required noninvasive ventilation, 3 patients were complicated by lung injury (mediastinal emphysema, pneumothorax). In addition, hyperglycemia was found in 4 patients, upper intestinal hemorrhage occurred in another 4 patients and cardiac failure occurred in 6 patients. CONCLUSION The treatment of the pre-existing diseases should be emphasized in the treatment of critical SARS. Glucocorticoid should not be used for a long-term. Vigilance should be paid to avoid lung injury during mechanical ventilation.


title: Comparison of ELISA and RT-PCR versus immune electron microscopy for detection of bovine torovirus (Breda virus) in calf fecal specimens.

text: Bovine Torovirus (BoTV) is an uncultivable enteric pathogen of cattle. Its failure to grow in vitro limits epidemiological studies, characterization of the virus, and development of diagnostic techniques. The objectives of this study were to develop and standardize an antigen-capture enzyme-linked immunosorbent assay (ELISA) and a reverse transcriptase-polymerase chain reaction (RT-PCR) assay for the detection of BoTV in fecal specimens. These assays were compared with immunoelectron microscopy (IEM) to evaluate their sensitivity, specificity, and efficiency as well as their advantages and limitations. Additionally, several methods to calculate ELISA cutoff values were used and compared using a statistical approach to obtain the optimal cutoff value for the ELISA. A plate cutoff ELISA value was determined to be the best method to calculate the cutoff value. The ELISA and RT-PCR assays developed in this study identified BoTV antigen and viral nucleic acids in feces without cross-reactions with the other calf enteric viruses examined. Both assays showed good agreement with IEM, with a Kappa value of 0.86 for ELISA and 0.85 for RT-PCR. The latter exhibited the higher analytical sensitivity. On the basis of the results obtained in this study, it is recommended that no single test should be used alone in an epidemiological survey because of the observed limitations of each assay. The fast and inexpensive ELISA combined with the highly specific and sensitive RT-PCR are a practical approach for future epidemiological studies of BoTV. These results should provide other researchers with the information needed to develop similar diagnostic assays for the study of BoTV.


title: Preventing needlestick injuries among healthcare workers: a WHO-ICN collaboration.

text: Effective measures to prevent infections from occupaonal exposure of healthcare workers to blood include mmunization against HBV, eliminating unnecessary injections, implementing Universal Precautions, eliminating needle recapping and disposing of the sharp into a sharps container immediately after use, use of safer devices such as needles that sheath or retract after use, provision and use of personal protective equipment, and training workers in the risks and prevention of transmission. Post-exposure prophylaxis with antiretroviral medications can reduce the risk of HIV transmission by 80%. In 2003, the World Health Organization and the International Council of Nurses launched a pilot project in three countries to protect healthcare workers from needlestick injuries. The results of the pilot will be disseminated worldwide, along with best policies and practices for prevention.


title: COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray.

text: SARS-CoV-2 is a novel virus that has now affected hundreds of thousands of individuals across the world. Amidst this global pandemic, maintaining a high index of suspicion, rapid testing capacity, and infection control measures are required to curtail the virus' rapid spread. While fever and respiratory symptoms have been commonly used to identify COVID-19 suspects, we present an elderly female who arrived to the hospital after a syncopal episode. She was afebrile with a normal chest X-ray and there was no suspicion of COVID-19. She then developed a fever and tested positive for COVID-19. Our unique case underscores the increasing diversity of COVID-19 presentations and potential for initial mis- diagnosis and delay in implementing proper precautions.


Pathogenic differences between various feline coronavirus isolates.


title: Hiding in the bunker: Challenges for a radiation oncology department operating in the Severe Acute Respiratory Syndrome outbreak.

text: In February 2003, one woman returned from Hong Kong to Singapore with a previously undescribed atypical pneumonia. Two months later, Singapore is facing its greatest ever threat to its population's health and the country's economy. The government has taken strong action to break the chain of infection of Severe Acute Respiratory Syndrome (SARS). As a radiation oncology department in Singapore, we have faced challenges in keeping staff and patients safe while continuing to provide a service to our patients. In this article, we outline the measures taken to curb SARS in Singapore and discuss the implications for Australasian radiation oncology departments.


title: 2009 pandemic influenza A (H1N1) in pregnant women requiring intensive care - New York City, 2009.

text: Pregnant women are at increased risk for severe illness and complications from infection with seasonal influenza and 2009 pandemic influenza A (H1N1). To characterize the severity of 2009 H1N1 infection in pregnant women, the New York City Department of Health and Mental Hygiene (DOHMH) conducted active and passive surveillance for cases of 2009 H1N1 infection in pregnant women requiring intensive care. This report summarizes the results of that surveillance, which found that, during 2009, 16 pregnant women and one who was postpartum were admitted to New York City intensive-care units (ICUs). Two women died. Of the 17 women, 12 had no recognized risk factors for severe influenza complications other than pregnancy. All 17 women received antiviral treatment with oseltamivir; however, treatment was initiated <or=2 days after symptom onset in only one woman and was begun >or=5 days after symptom onset in four women. Because initiation of antiviral treatment <or=2 days after onset is associated with better outcomes, pregnant women should be encouraged to seek medical care immediately if they develop influenza-like symptoms, and health-care providers should initiate empiric antiviral therapy for these women as soon as possible, even if >2 days after symptom onset. Health departments and health-care providers should educate pregnant and postpartum women regarding the risks posed by influenza and highlight the effectiveness and safety of influenza vaccination. Obstetricians and other health-care providers should offer influenza vaccination to their pregnant patients.


WHO issues global alert after grim report on HIV/AIDS.


title: Cloning and expression of FECV spike gene in vaccinia virus. Immunization with FECV S causes early death after FIPV challenge.

text: The spike gene of the feline enteric coronavirus (FECV), strain FECV-1683, was PCR amplified from total RNA extracted from FECV-infected cells and its sequence determined. A primary translation product of 1454 amino acids is predicted from the nucleotide sequence, containing a N-terminal signal sequence, a C-terminal transmembrane region and 33 potential N-glycosylation sites. The sequence shares 92% homology with the previously published feline infectious peritonitis virus, strain WSU-1146; however, several regions were identified that distinguished FECV from Feline Infectious Peritonitis virus, FIPV. The full length FECV S gene was cloned and expressed in vaccinia virus. Recombinants produced a 200 kD protein which was recognized by sera from cats infected with FIPV. When kittens were immunized with the vaccinia/FECV S recombinant, neutralizing antibodies to FIPV were induced. After challenge with a lethal dose of FIPV, the recombinant vaccinated animals died earlier than control animals immunized with vaccinia virus alone.


title: A deficient public health system as a contributing cause of Severe Acute Respiratory Syndrome (SARS) epidemic in mainland China.

text: SARS (Severe Acute Respiratory Syndrome) is a newly emerging infectious disease which spread over 32 countries and areas, infected more than 8,000 people and causing more than 900 deaths from November 2002 to August 2003. More than 90% of the SARS cases and death were reported from China. Nevertheless, we still know little about this disease, particularly in etiology. SARS, as an emergency of Public Health System (PHS), alarmed health workers throughout the world proving there is still the potential for an epidemic of an emerging infection both in developed and developing areas. Many reports indicated that the insufficiency of the PHS of China was one of the critical factors contributing to the outbreak of SARS. In this study, we attempt to demonstrate some of the categories of PHS that contributed to the SARS epidemic. Two of the categories studied were the living environment and health resources. In the living environment area, the population and population density were examined. Health resources include the medical facilities, health workers, and per capita public health expenditures. An understanding of these areas is important to prevent future epidemic.


title: Enhancing public health preparedness for a terrorist attack involving cyanide.

text: The US government considers cyanide to be among the most likely agents of chemical terrorism. Cyanide differs from many other biological or chemical agents for which little or no defense is available because its individual and public health effects are largely remediable through appropriate preparedness and response. Because the toxicity of the cyanide antidote currently available in the United States renders it ill-suited for use in terrorist incidents and other situations requiring rapid out-of-hospital treatment, hydroxocobalamin--an effective and safe cyanide antidote being used in other countries--has been introduced in the United States. Unlike the other available cyanide antidote, hydroxocobalamin can be administered at the scene of a cyanide disaster, and it need not be reserved for cases of confirmed cyanide poisoning but can be administered in cases of suspected poisoning. Both of these attributes facilitate the rapid intervention necessary for saving lives. To realize the potential benefits of hydroxocobalamin, progress also needs to be realized in other aspects of readiness, including but not limited to developing plans for ensuring local and regional availability of antidote, educating emergency responders and health care professionals in the recognition and management of cyanide poisoning, and raising public awareness of the potential for a chemical weapons attack and of how to respond.


title: Retractile mesenteritis presenting with malabsorption syndrome. Successful treatment with oral pentoxifylline.

text: Retractile mesenteritis is a rare benign inflammatory disease of the mesentery. Computed tomographic findings usually suggest the diagnosis, which is confirmed by surgical biopsies. Conservative treatment is empirical, based on corticosteroids, colchicine, immunosuppressive agents and progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. This report describes a 62-year old man with histologically proven retractile mesenteritis presenting with malabsorbtion syndrome, who presented pulmonary tuberculosis after initial therapy with corticosteroids. He was subsequently treated with oral pentoxifylline (800 mg/day), with substantial clinical and radiological improvement.


title: Pathology of experimental CV777 coronavirus enteritis in piglets. I. Histological and histochemical study.

text: Sixteen cesarean-derived colostrum-deprived piglets were infected oronasally with CV777 coronavirus on the second or third day of life. Two uninfected piglets were controls. They were killed at 96 and 120 hours after birth. After an incubation period of 22 to 36 hours, all principals showed severe diarrhea. The principals were killed between 12 and 120 hours after infection. Exfoliation of enterocytes were seen first in the piglet killed 24 hours after infection (two hours after the diarrhea began). From that time on, shortening and fusion of villi was present in all small intestinal parts. Affected cells showed vacuolation. The histochemical study showed that infected piglets had decreased activity of all four enzymes studied. The light microscope showed no lesions in the absorptive colonic epithelium. The significance of the lesions in relation to intestinal dysfunction is discussed, and lesions are compared to those of transmissible gastroenteritis and porcine rotavirus infection.


title: SARS: pharmacotherapy.

text: The pharmacotherapy for severe acute respiratory syndrome (SARS) is controversial and largely anecdotal. Most patients with suspected SARS should initially be treated with potent antibiotics before proceeding to 'anti-SARS' therapy. There is a spectrum of severity and rate of progression in SARS, and the stages of viral replication, inflammatory pneumonitis and residual pulmonary fibrosis are clinically non-distinct. Although now considered lacking in efficacy, ribavirin was used extensively in Hong Kong for treatment of SARS. Retrospective data suggest that the use of Kaletra (ritonavir and lopinavir), an anti-protease, could reduce mortality and improve outcomes, although the adverse reactions are also worrisome. Anecdotal experience strongly supports the use of steroid, at least in a subset of SARS patients, particularly with 'critical SARS' who display continued clinical instability or deterioration and progressive radiographic or HRCT deterioration. A retrospective study carried out of 72 probable SARS patients has shown that cases who received pulse methylprendisolone did not differ in cumulative steroid dosage or adverse reactions, although the former patients had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue pulse steroid therapy than their counterparts. Nevertheless, lower dosage of steroid as initial therapy in SARS had also been associated with good clinical outcomes. Poor responders to initial therapy might benefit from rescue steroid therapy or intravenous Pentaglobin. Other drug treatments had also been tried in desperate patients, including the use of convalescence serum and plasmapheresis. Secondary infections could be troublesome, particular for patients with prolonged hospitalization and mechanical ventilation.


title: [Viral gastroenteritis in children].

text: UNLABELLED PURPOSE OF THE TRIAL: To establish the involvement of viruses in the aetiology of diarrhoeal disorders in children, the incidence of individual viruses in various age groups and in different seasons, the impact of the aetiological agent on the clinical picture, the severity of the disorder, therapy and duration of hospital stay. The significance of intestinal viruses as nosocomial pathogens,a comparison of the sensitivity of latex agglutination and electron microscopy in the diagnosis of rotaviruses and adenoviruses. PATIENTS AND METHOD 496 children, aged 3 weeks to 15 years, admitted in 2002 to the 1st Dpt of Infectious Diseases of the Bulovka Teaching Hospital with a diarrhoeal disorder, were examined to establish the aetiology of their complaint. All the children had the usual faecies culture and a culture of Campylobacter jejuni; direct electron microscopy was used for the demonstration of viruses. Additionally, latex agglutination was used in the investigation of rotaviruses and adenoviruses. In indicated cases the stools were also investigated for the presence of Clostridium difficile and of parasites. RESULTS Viruses were the most frequent cause of diarrhoeal diseases in children. Some type of virus was found in 413 children (83.26 % of the patients). Pure bacterial aetiology was seen in 35 children (7.05 %), pure viral aetiology in 381 children (66.73 %). A mixed infection, due to a combination of a bacterium and a virus, was found in 82 subjects (16.53 %), in 45 children (9.07 %) the aetiology of the disease could not be established. Rotaviruses, the most frequent infectious agent, were found in 300 children (6.48 %), caliciviruses in 68 (13.7 %), adenoviruses in 63 (12.7 %), coronaviruses in 39 (7.86 %), astroviruses only in 2 children (0.40 %). Children aged 1 to 5 years were the age group most affected by all the viral agents. The incidence of all the viruses, with the exception of coronaviruses, was highest in the cold seasons, the highest incidence of rotaviruses was in April. The most severe course of the disease was seen in rotaviral infections; 74.07 % of the children presenting with rotaviral gastroenteritis required rehydration, either i.v. or with a nasogastric tube. The longest hospital stay (5.29 days) was with adenoviruses. Nosocomial infections caused by rotaviruses were found in 5 cases-they substantially prolonged the mean time of hospital stay (13 days). Electron microscopy proved more sensitive than latex agglutination in the diagnosis of rotaviruses and adenoviruses. CONCLUSIONS The results of our trial confirmed the key role of viruses in the aetiology of diarrhoeal disorders in children in the Czech Republic. Given their frequently severe course, especially in the case of rotaviral infections, it is advisable to launch regular vaccinations against rotaviruses, once the new vaccine is on the market. It would also be appropriate to improve the diagnosis of rotaviruses and their reporting in the Czech Republic and, last but not least, to apply-at least on a limited scale-modern procedures, i.e. molecular-genetic methods, in the diagnosis of viral intestinal disorders.


title: Clinical evaluation of a rapid colloidal gold immunochromatography assay for SARS-Cov-2 IgM/IgG.

text: BACKGROUND Since December 2019, there had been an outbreak of COVID-19 in Wuhan, China. At present, diagnosis COVID-19 were based on real-time RT-PCR, which have to be performed in biosafe laboratory and is unsatisfactory for suspect case screening. Therefore, there is an urgent need for rapid diagnostic test for COVID-19. OBJECTIVE To evaluate the diagnostic performance and clinical utility of the colloidal gold immunochromatography assay for SARS-Cov-2 specific IgM/IgG anti-body detection in suspected COVID-19 cases. METHODS In the prospective cohort, 150 patients with fever or respiratory symptoms were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang province, China, between January 20 to February 2, 2020. All patients were tested by the colloidal gold immunochromatography assay for COVID-19. At least two samples of each patient were collected for RT-PCR assay analysis, and the PCR results were performed as the reference standard of diagnosis. Meanwhile 26 heathy blood donor were recruited. The sensitivity and specificity of the immunochromatography assay test were evaluated. Subgroup analysis were performed with respect to age, sex, period from symptom onset and clinical severity. RESULTS The immunochromatography assay test had 69 positive result in the 97 PCR-positive cases, achieving sensitivity 71.1% [95% CI 0.609-0.797], and had 2 positive result in the 53 PCR-negative cases, achieving specificity 96.2% [95% CI 0.859-0.993]. In 26 healthy donor blood samples, the immunochromatography assay had 0 positive result. In subgroup analysis, the sensitivity was significantly higher in patients with symptoms more than 14 days 95.2% [95% CI 0.741-0.998] and patients with severe clinical condition 86.0% [95% CI 0.640-0.970]. CONCLUSIONS The colloidal gold immunochromatography assay for SARS-Cov-2 specific IgM/IgG anti-body had 71.1% sensitivity and 96.2% specificity in this population, showing the potential for a useful rapid diagnosis test for COVID-19. Further investigations should be done to evaluate this assay in variety of clinical settings and populations.


title: [Severe acute respiratory syndrome and avian flu].

text: Severe acute respiratoru syndrome (SARS) is a new disease that caused large ourbreaks in several countries in the first half of 2003, resulting in infection in more than 8.000 people and more than 900 deaths. The disease originated in southern China and a novel coronavirus (SARS CoV) has been implicated as the causative organism. We present an overview of the etiology, clinical presentation and diagnosis, based on the current state of knowledge derived from published studies and our experience in the National Microbiology Centre. Influenza is a zoonosis. This appreciation of influenza ecologyfacilitated recognition of the H5N1 'bird flu' incident in Hong Kong in 1997 in what was considered to be an incipient pandemic situation, the chicken being the source of virus for humans and. The current outbreak of avian influenza in South East Asia has resulted in a small number of human deaths. These findings highlight the importance of systematic virus surveillance of domestic poultry in recognizing changes in virus occurrence, host range and pathogenicity as signals at the avian level that could presage a pandemic.


title: Dental infection control and occupational safety in the Russian Federation.

text: BACKGROUND In the recent past, the Russian Federation has seen a considerable increase in HIV caseload. A high level committee was formed to assess the status of dental infection control and safety (IC&S) in Russia. This article is one of the outcomes to assess the status of IC&S and is the research of a doctoral student (PhD) in public health. PURPOSE To assess needs in Dental Infection Control and Occupational Safety in the Moscow Metropolitan Region of the Russian Federation. MATERIALS AND METHODS A survey with variables assessing knowledge, attitude and practice of IC&S was administered to dentists practicing and or teaching in Moscow city and suburban areas on a convenience sample of dental practitioners. RESULTS The total number of completed questionnaires were 303. Over 67% had up to three significant exposures to blood and potentially infectious materials (OPIM), but less than 30% got tested for HIV in the previous 3 months. Use of personal protective equipment was not based on anticipated exposure. Less than 10% had an understanding of Spaulding's classification with respect to sanitization, disinfection and sterilization. Only about 34% stated that there was a potential for infectious disease transmission through a percutaneous route and about 61% double gloved while treating patients with infectious diseases. Only about 61% disinfected impressions and most (83%) used alcohol for disinfection purposes. While 34% still used glass-bead sterilizers, about 13% did not sterilize handpieces between patients. CONCLUSION Results from this study indicated a disparity in the practice of infection control and safety procedures requiring formulation of nationwide dental safety standards. Further, there is a need in implementation of a standardized dental safety curriculum for dental schools and continuing dental education requirements in dental safety for practicing dentists in the Russian Federation.


title: Effects of infection with transmissible gastroenteritis virus on concomitant immune responses to dietary and injected antigens.

text: Normal piglets weaned onto soy- or egg-based diets generated antibody responses to fed protein. Concurrent infection with transmissible gastroenteritis virus (TGEV) did not affect the responses to dietary antigens at weaning, nor did it affect the subsequent development of tolerance. However, TGEV infection did enhance the primary immunoglobulin M (IgM) and IgG1, but not IgG2, antibody responses to injected soy in comparison to those of uninfected animals. Paradoxically, TGEV-infected animals showed an enhanced primary IgG1 antibody response to injected soy at 4 weeks of age, but they subsequently showed a reduced secondary response after an intraperitoneal challenge at 9 weeks of age in comparison to uninfected animals. The results suggest that an enteric virus, either used as a vaccine vector or present as a subclinical infection, may not have significant effects on the development of dietary allergies but may have effects both on the primary response and on the subsequent recall response to systemic antigens to which the animal is exposed concurrently with virus antigens.


Clinical Insights and Management Recommendations for COVID-19 Patients Hospitalized in Internal Medicine Departments: Recommendations by the Corona Department Heads in Israel.


title: Genome of porcine transmissible gastroenteritis virus.

text: The Purdue strain of transmissible gastroenteritis virus, a porcine coronavirus, was grown to titers of greater than 10(8) PFU/ml in a swine testicle cell line, and the RNA was isotopically labeled with [3H]uridine. The RNA was extracted from purified virus and was found to have the following properties. (i) It consisted primarily of a homogeneous large-molecular-weight species which electrophoretically migrated with an apparent molecular weight of 6.8 X 10(6) under denaturing conditions. (ii) It migrated electrophoretically at the same rate on nondenaturing gels before and after heat denaturation, suggesting that it does not consist of subunits. (iii) It was susceptible to pancreatic RNase A digestion in high (0.3 M) NaCl. (iv) It was polyadenylated to the extent that greater than 60% of the native RNA bound to oligodeoxythymidilic acid-cellulose under conditions of high (0.5 M) NaCl. RNA extracted from virions was infectious. This coronavirus can therefore be characterized as a positive-strand RNA virus.


title: Co-infection with SARS-CoV-2 and Human Metapneumovirus.

text: The novel coronavirus (now called SARS-CoV-2) initially discovered in Wuhan, China, has now become a global pandemic. We describe a patient presenting to an Emergency Department in Rhode Island on March 12, 2020 with cough and shortness of breath after a trip to Jamaica. The patient underwent nasopharyngeal swab for a respiratory pathogen panel as well as SARS-CoV-2 RT-PCR. When the respiratory pathogen panel was positive for human metapneumovirus, the patient was treated and discharged. SARS-CoV-2 RT-PCR came back positive 24 hours later. Although respiratory viral co-infection is thought to be relatively uncommon in adults, this case reflects that SARS-CoV-2 testing algorithms that exclude patients who test positive for routine viral pathogens may miss SARS-CoV-2 co-infected patients.


Remembering Jonathan M. Mann in a world ajar.


title: Bovine viral diarrhea virus quasispecies during persistent infection.

text: Analysis of viral genome sequences from two calves persistently infected with bovine viral diarrhea virus revealed a quasispecies distribution. The sequences encoding the glycoprotein E2 were variable, translating to a number of changes in predicted amino acid sequences. The NS3 region was found to be highly conserved in both animals. The number of E2 clones showing variant amino acids increased with the age of the animal and comparison of the consensus sequences at the different time points confirmed differences in the predicted E2 sequences over time. The immune tolerance that allows the lifelong persistence of this viral infection is highly specific. It is likely that some of the variant viruses generated within these animals will differ antigenically from the persisting virus and be recognized by the immune system. Evidence of an immune response to persisting virus infection was gathered from a larger sample of cattle. Serum neutralizing antibodies were found in 4 of 21 persistently infected animals. Accumulations of viral RNA in the lymph nodes of all animals examined, particularly in the germinal center light zone, may represent antigenic variants held in the form of immune complexes on the processes of follicular dendritic cells.


title: A transcriptional signaling pathway in the IFN system mediated by 2'-5'-oligoadenylate activation of RNase L.

text: Virus replication in higher vertebrates is restrained by IFNs that cause cells to transcribe genes encoding antiviral proteins, such as 2'-5' oligoadenylate synthetases. 2'-5' oligoadenylate synthetase is stimulated by dsRNA to produce 5'-phosphorylated, 2'-5'-linked oligoadenylates (2-5A), whose function is to activate RNase L. Although RNase L is required for a complete IFN antiviral response and mutations in the RNase L gene (RNASEL or HPC1) increase prostate cancer rates, it is unknown how 2-5A affects these biological endpoints through its receptor, RNase L. Presently, we show that 2-5A activation of RNase L produces a remarkable stimulation of transcription (>/=20-fold) for genes that suppress virus replication and prostate cancer. Unexpectedly, exposure of DU145 prostate cancer cells to physiologic levels of 2-5A (0.1 muM) induced approximately twice as many RNA species as it down-regulated. Among the 2-5A-induced genes are several IFN-stimulated genes, including IFN-inducible transcript 1/P56, IFN-inducible transcript 2/P54, IL-8, and IFN-stimulated gene 15. 2-5A also potently elevated RNA for macrophage inhibitory cytokine-1/nonsteroidal antiinflammatory drug-activated gene-1, a TGF-beta superfamily member implicated as an apoptotic suppressor of prostate cancer. Transcriptional signaling to the macrophage inhibitory cytokine-1/nonsteroidal antiinflammatory drug-activated gene-1 promoter by 2-5A was deficient in HeLa cells expressing a nuclease-dead mutant of RNase L and was dependent on the mitogen-activated protein kinases c-Jun N-terminal kinase and extracellular signal-regulated kinase, both of which were activated in response to 2-5A treatments. Because 2-5A and RNase L participate in defenses against viral infections and prostate cancer, our findings have implications for basic cellular mechanisms that control major pathogenic processes.


title: Evaluation of cow-level risk factors for the development of winter dysentery in dairy cattle.

text: OBJECTIVE To identify exposures to etiologic agents and to identify characteristics that could explain risk of disease for adult cattle in herds affected by winter dysentery (WD). ANIMALS 229 lactating and nonlactating adult cattle (125 case and 104 control cattle) selected from 12 dairy herds. PROCEDURE A case-control study, using multivariate conditional logistic regression and controlling for herd effects, was used to develop a model for risk factors associated with disease for each cow. RESULTS Likelihood of developing disease increased as the ELISA value for bovine coronavirus (BCV) antigen detectable in feces increased (odds ratio [OR] = 2.94 for each 0.100 increase in BCV antigen ELISA value). Pregnant cattle were less likely to develop WD, compared with nonpregnant herdmates. Cows with high acute BCV antibody titers that seroresponded had greater odds of developing disease, compared with seroresponding cows with low acute titers. However, among those cows that did not serorespond, high acute antibody titers were associated with lower odds of developing the disease. CONCLUSION In herds affected by WD, ill cows were more likely to shed detectable amounts of BCV antigen in their feces, and pregnancy appeared to protect cattle from the disease. The measured interaction between BCV seroresponse and acute BCV antibody titer may be evidence of an immunopathologic condition, but could also have been attributable to dynamics of the ELISA or study design. CLINICAL RELEVANCE Factors that explained a cow's risk for illness within WD-affected herds may have been surrogate measures for that cow's nonspecific and BCV-specific immune profile.


title: The emerging role of angiotensin-converting enzyme-2 in the kidney.

text: PURPOSE OF REVIEW The intrarenal renin-angiotensin system contributes to the progression of chronic kidney disease. Angiotensin-converting enzyme-2 is a recently identified protein that is highly expressed in the kidney and results in formation of angiotensin-(1-7). This manuscript highlights current information on the localization and function of angiotensin-converting enzyme-2 in the kidney, along with recent studies on the role of the enzyme in hypertension, glomerulosclerosis, and diabetic nephropathy. RECENT FINDINGS Angiotensin-converting enzyme-2 is expressed in relative abundance in the proximal tubule and metabolizes angiotensin II to angiotensin-(1-7). Angiotensin-converting enzyme-2 also catalyzes conversion of angiotensin I to angiotensin-(1-9), which is cleaved to angiotensin-(1-7) by angiotensin-converting enzyme. In mice, gene deletion of angiotensin-converting enzyme-2 elevates blood pressure responses to angiotensin II, and increases renal angiotensin II levels. Male angiotensin-converting enzyme-2-deficient mice exhibit accelerated glomerulosclerosis. In early diabetic nephropathy, proximal tubular angiotensin-converting enzyme-2 expression and activity are increased, suggesting that the enzyme may counterregulate the effects of local angiotensin II. SUMMARY Angiotensin-converting enzyme-2 appears to be critical in determining the balance between the intrarenal effects of angiotensin II and angiotensin-(1-7). Angiotensin-converting enzyme-2 could thereby represent a target for novel therapeutic approaches in a variety of kidney disorders.


title: Effect of specific humoral immunity and some non-specific factors on resistance of volunteers to respiratory coronavirus infection.

text: Thirty-three volunteers were inoculated intranasally with coronavirus 229 E, and their responses monitored by antibody rises, symptomatology and virus excretion. These were related to their pre-trial immune status as indicated by concentrations of specific antibodies and non-specific proteins in serum and nasal washings. Both circulating and local specific antibodies were associated with protection from infection and disease, but only specific IgA antibodies of either type appeared to shorten the period of virus shedding. Although total secretory IgA was significantly associated only with reduction of symptoms, total protein in nasal washings appeared to protect against infection also, indicating that other locally produced proteins, not identified, may be associated with resistance. Two of the many factors which may affect the concentration of circulating and local protective proteins and thus influence the outcome of virus inoculation, namely, sex of the volunteer and the interval since the previous cold, were examined. Male volunteers or volunteers who had had evidence of a recent respiratory infection were less likely to be infected, but if they were infected, they had lower clinical scores and stopped shedding virus earlier than the rest. These groups possessed higher concentrations of specific antibodies and non-specific proteins in their pre-challenge sera and/or nasal washings. The significance of these findings is discussed.


title: Outbreak of severe acute respiratory syndrome in southern Taiwan, 2003.

text: This study describes the epidemiologic features of the severe acute respiratory syndrome (SARS) outbreak in southern Taiwan in 2003. According to the official files of reported cases of SARS from February 21 to June 19, 2003, there were 586 cases in southern Taiwan. Symptom onset occurred between February 21 and June 19 in reported cases, between March 13 and May 30 in probable cases, and between March 17 and May 23 in polymerase chain reaction (PCR)-positive probable cases. Dates of symptom onset were earliest for six imported cases, followed by 53 cases related to nosocomial infections and 51 cases without known sources of infection. The positive rates of the PCR for these three groups decreased from 50.0% to 28.3% to 3.9% , respectively (P < 0.001, by chi-square test for linear trend). Three other cases resulted from exposure to contaminated hospitals in northern Taiwan, one of which was the index case of the nosocomial infection. Imported cases following nosocomial infection were the major cause of SARS infections in southern Taiwan. Due to the low positive rate of the PCR for SARS coronavirus, and the low positive predictive value of reported cases, the factuality of cases with unknown sources of infection should be further verified.


title: Risk factors associated with poult enteritis mortality syndrome-positive turkey flocks.

text: Poult enteritis mortality syndrome (PEMS) has been an economically devastating disease in North Carolina since the early 1990s. Though much is known about the disease, many questions remain unanswered about the syndrome, including its cause, transmission of causative agent(s), and control methods. This study was designed to investigate the association between PEMS and farm management factors. A prospective longitudinal study was conducted by collecting farm data and monitoring weekly mortality in 54 commercial turkey flocks raised in PEMS-affected regions. Univariate and multivariate statistical analyses revealed that enhancing rodent control methods was negatively associated (P = 0.0228) with PEMS.


title: Ventilation of wards and nosocomial outbreak of severe acute respiratory syndrome among healthcare workers.

text: OBJECTIVE To identify valid measures for preventing outbreaks of severe acute respiratory syndrome (SARS) among protected healthcare workers in isolation units. METHODS Architectural factors, admitted SARS cases and infection of healthcare workers in different isolation wards between January 30 and March 30, 2003 were analyzed. RESULTS Four types of isolation wards were analyzed, including the ward where the thirty-first bed was located on the twelfth floor, the laminar flow ward in the Intensive Care Unit where the tenth bed was located on the fifteenth floor, the ward where the twenty-seventh bed was located on the thirteenth floor of the Lingnan Building, and thirty wards on the fourteenth to eighteenth floors of the Zhongshan Building. The ratios (m(2)/m(3)) of the area of the ventilation windows to the volume of the rooms were 0, 0, 1:95 and 1:40, respectively. Numbers of SARS cases in the wards mentioned above were 1, 1, 1 and 96, respectively. Total times of hospitalization were 43, 168, 110 and 1272 hours, respectively. The infection rates of the healthcare workers in the areas mentioned above were 73.2%, 32.1%, 27.5% and 1.7%, respectively. The difference in the infection rates was of statistical significance. CONCLUSIONS Isolating SARS cases in wards with good ventilation could reduce the viral load of the ward and might be the key to preventing outbreaks of SARS among healthcare workers along with strict personal protection measures in isolation units.


title: Murine coronavirus with an extended host range uses heparan sulfate as an entry receptor.

text: Only a relatively few mutations in its spike protein allow the murine coronavirus to switch from a murine-restricted tropism to an extended host range by being passaged in vitro. One such virus that we studied had acquired two putative heparan sulfate-binding sites while preserving another site in the furin-cleavage motif. The adaptation of the virus through the use of heparan sulfate as an attachment/entry receptor was demonstrated by increased heparin binding as well as by inhibition of infection through treatment of cells and the virus with heparinase and heparin, respectively.


title: Sequence determination of the nucleocapsid protein gene of the porcine epidemic diarrhoea virus confirms that this virus is a coronavirus related to human coronavirus 229E and porcine transmissible gastroenteritis virus.

text: The nucleotide sequence of 1.7 kbp cDNA, comprising the region nearest the 3' end of the genome of the porcine epidemic diarrhoea virus (PEDV), has been independently determined for two European isolates of PEDV. Almost identical results were obtained for the two isolates, which were derived from cases of PEDV infection in Belgium and Britain in 1977 and 1987, respectively. The sequences contained a 1323 nucleotide (nt) open reading frame (ORF), which showed moderate identity to the nucleocapsid (N) gene of other coronaviruses. The greatest similarity at both the nucleic acid and protein levels was to the human coronavirus 229E. The PEDV N gene was, however, notably larger than that of the human 229E and porcine transmissible gastroenteritis viruses. This reflects the presence of a putative insertion of approximately 135 nt located towards the middle of the N gene. A second 336 nt ORF, which might encode a leucine-rich protein similar to, but shorter than, the bovine coronavirus internal protein was found within the PEDV N gene. Several RNA motifs typical of coronaviruses were also observed. These results confirm the earlier provisional classification of PEDV as a coronavirus.


title: Viral, parasitic and prion diseases of farmed deer and bison.

text: The most important viral disease of farmed deer and bison is malignant catarrhal fever. The other herpesviruses which have been isolated from these species are briefly described. Other viral agents that are recognised in these animals, including adenovirus, parapox, foot and mouth disease, bluetongue, epizootic haemorrhagic disease, bovine virus diarrhoea, rotavirus and coronavirus, are also discussed. Ectoparasites of importance in this group in various parts of the world include a variety of ticks, as well as lice, keds, Oestridae, mange mites and fire ants. Helminth parasites include liver flukes (Fascioloides and Fasciola), gastrointestinal nematodes of the family Trichostrongylidae, pulmonary lungworms of the genus Dictyocaulus and extra-pulmonary lungworms of the family Protostrongylidae. Chronic wasting disease is principally important in North America, where the disease occurs in wild cervids in a limited area and has been reported in farmed deer in a small number of states in the United States of America and one province in Canada. These diseases are summarised in terms of their classification, epidemiology, clinical signs, pathology, diagnosis, treatment and control.


title: Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection.

text: Infection is the leading cause of morbidity and mortality in immunocompromised patients such as hematopoietic/solid organ transplant recipients and individuals with human immunodeficiency virus. Community respiratory virus infections are increasingly recognized as a significant threat to these patients. This article reviews current information in the clinical field of community respiratory viruses, including several newly discovered respiratory viruses. Respiratory syncytial virus, influenza viruses, parainfluenza viruses, and adenoviruses cause the most serious disease in immunocompromised hosts, but other respiratory viruses are becoming increasingly appreciated as a cause of both upper and lower respiratory tract disease. The clinical impact of these new viruses, including human metapneumovirus, non-SARS human coronaviruses, and human bocavirus, is not yet clear. Modern molecular technology has made the discovery of new viruses possible; the use of these new technologies in direct patient care is not yet standard but is becoming increasingly utilized. Clinicians should appreciate the potential for the development of antiviral resistance to influenza antivirals in immunocompromised patients.


title: Experimental infection of macaques with the human reovirus BYD1 strain: an animal model for the study of the severe acute respiratory syndrome.

text: Experimental studies were performed to determine the role of a newly isolated reovirus (ReoV) from a severe acute respiratory syndrome (SARS) patient in the etiology of this newly described serious respiratory syndrome. Four cynomologus macaques were inoculated with this reovirus (BYD1) in an attempt to replicate the infection and pathology observed in SARS. The body temperature of the infected monkeys was monitored three times a day, and blood and fecal samples were periodically collected for specific immunology determinations. On days 7 and 33 after inoculation, necropsies for pathological accessment and pathogen isolation were performed. The four infected macaques developed a fever on days 3 and 4 after inoculation, and maintainted a febrile state for 4-6 days. The highest temperature in the animals recorded was 40.4 degrees C. After a recovery phase, the macaques developed a second febrile condition. Antibody titers against the reovirus injected by the intravenous route occurred in higher number than those in the nasal cavity. Four macaque monkeys demonstrated diffuse alveolar damage, characterized by hemorrhagic pneumonia, serosanguineous exudates, formation of hyaline membranes, and type II pneumocyte hyperplasia, which were similar to those that have been noted in SARS patients. Lymphocytes decreased in the cortex of the lymph node and in the white pulp of the spleen. ReoV was detected in pneumonic tissue by virus isolation and RT-PCR. The macaques infected with the newly isolated reovirus developed a fever, diffuse alveolar damage and pulmonary interstitial inflammation similar to that noted in SARS patients. This evidence demonstrates that ReoV might have a primary role in the etiology of SARS.


title: Analysis of putative recombination hot sites in the S gene of canine coronaviruses.

text: The S gene sequence of Canine coronavirus strain 1-71 (CCoV 1-71) was cloned, sequenced, and compared to those of other CCoVs, Transmissible gastroenteritis virus (TGEV), and Feline coronavirus (FCoV). The sequence analysis showed that CCoV 1-71 displayed a 98.8-99.8% identity with CCoVs strains V1, K378, and GP. Four putative recombination sites were found at the 5'-end of the S gene, namely at nt 53, 75, 425, 991. Both sequences flanking each site were significantly different. Three recombination hot regions were found on the S gene, namely at nt 337-437, 1545-3405, and 4203-4356, which shared a common recombination signal with Group 2 coronaviruses. The G/CTAAAAA/GT sequence downstream of the recombination site may represent a specific recombination signal in CCoVs. The CCoV 1-71 S protein sequence was found to be similar to those of other CCoVs except for several N-glycosylation sites at the N-terminus of the S protein, which could be related to the differences in virulence and cell tropism in individual CCoVs. This study indicated that the similarity of CCoVs in virulence and tropism was mostly acquired by the homologous RNA recombination and not only by simple mutation and selection.


title: Emerging occupational lung infections.

text: Recent experiences of emerging infections, such as severe acute respiratory syndrome (SARS) and avian influenza (H5N1), have highlighted the risks of serious pulmonary infections from occupational exposures. Occupationally acquired human immunodeficiency virus (HIV) infection could also result in life-threatening, opportunistic lung infections as a result of host immunosuppression. These three occupationally acquired infections are major public health problems that carry with them enormous economic and societal implications. The present review discusses their microbiology, epidemiology and mode of transmission, clinical features, treatment and, more importantly, prevention. Health care workers (HCWs), who are a valuable health care resource especially in the developing nations, are at high risk for acquiring these diseases. Drugs for the treatment of HIV infection are expensive and not widely available in the developing world where they are most needed. As there is no well-recognised effective treatment for SARS and avian influenza, prevention of infection is most important. HCWs should be aware of occupationally acquired infections and know how to protect themselves. Regular training should be provided by all health care institutions on infection control measures and the use of personal protective equipment.


title: Periprosthetic infections after total hip and knee arthroplasty--a review.

text: Periprosthetic joint infections (PJI) in orthopedic surgery are considered to be very serious and dangerous complications of total joint arthroplasty. PJI becomes a long-lasting medical problem and a heavy burden on patient and his family. Patients with such a complication are a significant financial burden for the health care system. Recognizing this issue, investing in scientific research and simultaneously developing technologies in medicine are efforts taken to increase successfulness in preventing and treating PJI. Each year the number of total joint arthroplasties increases which entails a rise in the number of complications among which infections are the leading ones. Sometimes, in the worst case scenarios, infections can endanger patients' lives. New procedural algorithms and new diagnostic possibilities help us make accurate and early diagnoses of postoperative PJI with a great degree of certainty. These diagnostic methods include laboratory tests, imaging, histopathology and microbiological analyses. Treatment options depend on many factors which include the onset of symptoms, patients'general physical condition and type of pathogen. The approach to treating PJI is complex and it requires a multidisciplinary approach in order to ensure the most successful treatment possible. For adequate and successful treatment we need to take into account antibiotic therapy, one-stage or two-stage revision, Girdlestone operation, athrodesis and amputation. In this review we will try to sum up all relevant findings and suggest further steps in management of PJI.


title: Penile cancer: Clinical Practice Guidelines in Oncology.

text: Squamous cell carcinoma of the penis represents approximately 0.5% of all cancers among men in the United States and other developed countries. Although rare, it is associated with significant disfigurement, and only half of the patients survive beyond 5 years. Proper evaluation of both the primary lesion and lymph nodes is critical, because nodal involvement is the most important factor of survival. The NCCN Clinical Practice Guidelines in Oncology for Penile Cancer provide recommendations on the diagnosis and management of this devastating disease based on evidence and expert consensus.


A SARS commentary.


title: Intratracheal inoculation of severe acute respiratory syndrome coronavirus in monkeys Macaca rhesus.

text: An animal model for infection with Severe acute respiratory syndrome coronavirus (SARSCoV) was evaluated in monkeys Macaca rhesus. The monkeys were inoculated into the trachea with NS-I strain of SARS-CoV and the clinical manifestation of the illness was monitored. The clinical samples collected from infected monkeys were examined by immumnofluorescence assay (IFA), pathological inspection, RTPCR, and by virus isolation. The infected animals demonstrated mild clinical symptoms including fever. Two of the six infected monkeys developed fever (1.5 above the level before challenge) on the day 10 post inoculation (p.i.). Although the severe clinical symptoms or mortality were not observed, the virological and histopathological evidences of the illness were evident. The specimens collected from the infected animals showed the presence of SARS-CoV detected by RT-PCR, IFA, and by virus isolation. From the organs examined postmortem, a major pathological change was observed in the lungs. The walls of the alveoli were thicker, infiltrated with inflammation cells and an exudative fluid was found in the alveolar spaces. In addition, some alveolar spaces showed hyaline membrane lining. The results showed that the monkeys infected with SARS-CoV developed the typical SARS according to clinical, virological, and pathological findings.


Project Lazarus: an innovative community response to prescription drug overdose.


SARS- and other coronaviruses.


title: SARS-CoV-2: the emergence of a viral pathogen causing havoc on human existence.

text: Coronavirus disease 2019 was first reported from Wuhan district of China and has spread to 210 countries across the world claiming over 97,602 human lives as on 10 April 2020 by 21:06 pm. Currently, there is no specific treatment for this virus and the treatment is mainly relied on controlling symptoms. Here we discuss our current understanding of SARS-CoV-2 with respect to its receptor recognition and how this knowledge could be useful in treatment using clinically known inhibitory drugs. We have also discussed the diagnosis, treatment and preventive measures that are currently being employed for controlling further spread of the virus.


Background paper: functions of coronavirus glycoproteins.


title: Protective immunity and antibody-secreting cell responses elicited by combined oral attenuated Wa human rotavirus and intranasal Wa 2/6-VLPs with mutant Escherichia coli heat-labile toxin in gnotobiotic pigs.

text: Two combined rotavirus vaccination regimens were evaluated in a gnotobiotic pig model of rotavirus infection and disease and were compared to previously tested rotavirus vaccination regimens. The first (AttHRV/VLP2x) involved oral inoculation with one dose of attenuated (Att) Wa human rotavirus (HRV), followed by two intranasal (i.n.) doses of a rotavirus-like particle (2/6-VLPs) vaccine derived from Wa (VP6) and bovine RF (VP2) rotavirus strains. The 2/6-VLPs were coadministered with a mutant Escherichia coli heat-labile toxin, LT-R192G (mLT) adjuvant. For the second regimen (VLP2x/AttHRV), two i.n. doses of 2/6-VLPs+mLT were given, followed by one oral dose of attenuated Wa HRV. To compare the protective efficacy and immune responses induced by the combined vaccine regimens with individual rotavirus vaccine regimens, we included in the experiments the following vaccine groups: one oral dose of attenuated Wa HRV (AttHRV1x and Mock2x/AttHRV, respectively), three oral doses of attenuated Wa HRV (AttHRV3x), three i.n. doses of 2/6-VLPs plus mLT (VLP3x), three i.n. doses of purified double-layered inactivated Wa HRV plus mLT (InactHRV3x), mLT alone, and mock-inoculated pigs. The isotype, magnitude, and tissue distribution of antibody-secreting cells (ASCs) in the intestinal and systemic lymphoid tissues were evaluated using an enzyme-linked immunospot assay. The AttHRV/VLP2x regimen stimulated the highest mean numbers of intestinal immunoglobulin A (IgA) ASCs prechallenge among all vaccine groups. This regimen induced partial protection against virus shedding (58%) and diarrhea (44%) upon challenge of pigs with virulent Wa HRV. The reverse VLP2x/AttHRV regimen was less efficacious than the AttHRV/VLP2x regimen in inducing IgA ASC responses and protection against diarrhea (25% protection rate) but was more efficacious than VLP3x or InactHRV3x (no protection). In conclusion, the AttHRV/VLP2x vaccination regimen stimulated the strongest B-cell responses in the intestinal mucosal immune system at challenge and conferred a moderately high protection rate against rotavirus disease, indicating that priming of the mucosal inductive site at the portal of natural infection with a replicating vaccine, followed by boosting with a nonreplicating vaccine at a second mucosal inductive site, may be a highly effective approach to stimulate the mucosal immune system and induce protective immunity against various mucosal pathogens.


title: Acute respiratory tract infections: when are antibiotics indicated?

text: Inappropriate prescribing of antibioticsfor acute respiratory tract infections contributes to the increasing prevalence of antibiotic resistance. In this second article of a series on antibiotic resistance, the authors discuss common respiratory infectious processes. A CDC campaign to educate both clinicians and the public about the judicious and effective use of antibiotics is described. A CDC campaign to educate both clinicians and the public about the judicious and effective use of antibiotics is described.


title: Understanding the risk of an avian flu pandemic: rational waiting or precautionary failure?

text: The precautionary principle (PP) has been proposed as the proper guide for the decision-making criteria to be adopted in the face of the new catastrophic risks that have arisen in the last decades. This article puts forward a workable definition of the PP based on the so-called alpha-maximin expected utility approach, applying it to the possible outbreak of the avian flu disease among humans. Moreover, it shows how the shortage and/or lack of effective drugs against the infection of the virus A(H5N1) among humans can be considered a precautionary failure.


title: Kissing interaction between 3' noncoding and coding sequences is essential for porcine arterivirus RNA replication.

text: We used an infectious cDNA clone of porcine reproductive and respiratory syndrome virus (PRRSV) to investigate the presence of essential replication elements in the region of the genome encoding the structural proteins. Deletion analysis showed that a stretch of 34 nucleotides (14653 to 14686) within ORF7, which encodes the nucleocapsid protein, is essential for RNA replication. Strand-specific reverse transcription-PCR analysis of viral RNA isolated from transfected BHK-21 cells revealed that this region is required for negative-strand genomic RNA synthesis. The 34-nucleotide stretch is highly conserved among PRRSV isolates and folds into a putative hairpin. A 7-base sequence within the loop of this structure was suggested to base-pair with a sequence present in the loop of a hairpin located in the 3' noncoding region, resulting in a kissing interaction. Mutational analyses confirmed that this kissing interaction is required for RNA replication.


title: Evaluation of rapid antigen detection kits for diagnosis of equine rotavirus infection.

text: We evaluated antigen detection kits for human rotavirus with regard to their usefulness for diagnosing equine rotavirus infection. Limiting dilution analyses showed that of the seven kits investigated the Dipstick `Eiken' Rota (Dipstick) had the highest sensitivity to two serotypes of equine rotavirus. The Dipstick did not cross-react with several equine intestinal pathogens. An investigation using 249 fecal samples indicated that the sensitivity of the Dipstick was 81.9% and 47.3%, and its specificity was 98.2% and 99.0%, and its concordance rate was 92.8% and 68.3%, compared with values obtained using reverse transcription polymerase chain reaction and reverse transcription loop-mediated isothermal amplification, respectively. Although a negative result does not preclude the possibility of equine rotavirus infection, the Dipstick would be useful as routine test for diagnosing equine rotavirus infection in daily clinical practice because of its ease of handling.


title: Replicase genes of murine coronavirus strains A59 and JHM are interchangeable: differences in pathogenesis map to the 3' one-third of the genome.

text: The important roles of the spike protein and other structural proteins in murine coronavirus (MHV) pathogenesis have been demonstrated; however, the role of the replicase gene remains unexplored. We assessed the influence of the replicase genes of the highly neurovirulent MHV-JHM strain and the hepatotropic and mildly neurovirulent A59 strain in acute infection of the mouse. Analysis of chimeric A59/JHM recombinant viruses indicates that the replicase genes are interchangeable and that it is the 3' end of the genome, encoding the structural proteins, rather than the replicase gene, that determines the pathogenic properties of these chimeras.


title: Hybrid arch debranching and endograft repair in a patient with a ruptured thoracic aortic aneurysm.

text: Recent advances in hybrid techniques of aortic arch debranching allow for the repair of thoracic aortic arch aneurysm without requiring cardiopulmonary bypass or hypothermic circulatory arrest. We describe the repair of a ruptured proximal descending thoracic aortic aneurysm, using off-pump aortic arch debranching and antegrade transaortic deployment of a thoracic endograft in an elderly patient.


Organization of the IBV genome.


title: Structure-based design of enzyme inhibitors and receptor ligands.

text: With the ongoing progress in protein crystallography and NMR, structure-based drug design is adopting increasing importance in the search for new drugs. Modeling starts from the 3D structure of a target protein in order to construct molecules which are complementary to a binding site, in their geometry as well as in the pattern of their physicochemical properties around the molecules. The rational design process is accompanied by 3D structure determinations of different ligand-protein complexes. Most often, significantly improved binding affinities of the ligands are observed after several cycles of 3D structure determinations, the design of compounds with appropriate structural modifications, synthesis, and testing of the new drug candidates. As an alternative, pharmacophore models are derived from the 3D structures of active analogs. A risk with lead structure optimization by structure-based design is the neglect of other important biological properties, such as bioavailability and metabolic stability. Recent applications of structure-based design, as well as success stories in the search for new, potent and selective HIV protease inhibitors, thrombin inhibitors, neuraminidase inhibitors and integrin receptor antagonists, are reviewed.


title: Which bio-weapons might be used by terrorists against the United Kingdom?

text: The properties of potential biological weapon agents for bioterrorism include a consistent effect at low dosage and short incubation period in a population of low immunity, being difficult to treat, able to be produced in bulk, stable in storage and readily disseminated. Possible agents include smallpox, haemorrhagic fever viruses, anthrax, tularaemia and plague. The example of Severe Acute Respiratory Syndrome (SARS) demonstrates the possible consequences of an act of bioterrorism, but also the necessary global response. There is scepticism about the practicability of surveillance schemes and the global elimination of biological weapons though the Biological and Toxin Weapons Convention remains urgent.


title: [An interpretation on perinatal and neonatal management plan for prevention and control of SARS-CoV-2 infection (2nd Edition)].

text: The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues so far. The cases of SARS-CoV-2 infection have been reported in pregnant women and neonates as special groups. Perinatal and neonatal management plan for prevention and control of SARS-CoV-2 infection (2nd Edition) has been worked out by the Editorial Committee of Chinese Journal of Contemporary Pediatrics. This paper presents an interpretation on the 2nd Edition of the management plan, so as to facilitate readers to better understand it.


title: CD147 inhibits the nuclear factor of activated T-cells by impairing Vav1 and Rac1 downstream signaling.

text: CD147 is a transmembrane protein that plays crucial roles in the development and function of the reproductive, visual, and nervous systems. CD147 also exerts positive and negative actions in T-cells by still obscure mechanisms. In this study, we have analyzed the expression, localization, and function of CD147 during T-cell receptor signaling responses. We show here that CD147 is an integral component of the T-cell immune synapse and that its overexpression leads to the inhibition of NF-AT (nuclear factor of activated T-cells) activity induced by Vav1, a Rac1 exchange factor. This inhibitory activity is mediated by the CD147 intracellular tail and is totally independent of its extracellular or transmembrane regions. The molecular dissection of the influence of CD147 on the Vav1 pathway indicates that its inhibitory action takes place downstream of Vav1 and Rac1 but upstream of the serine/threonine kinases JNK and Pak1. The interference of CD147 with these pathways is highly specific because the overexpression of CD147 does not affect the activity of other GDP/GTP exchange factors or the stimulation of the ERK cascade. Finally, we show that the CD147 knockdown in Jurkat cells promotes higher levels of NF-AT stimulation and Pak1 phosphorylation upon T-cell receptor cross-linking. Instead, the lack of CD147 does not affect other signaling cascades that participate in the same cellular response. Taken together, these results indicate that CD147, via the selective inhibition of specific downstream elements of the Vav1/Rac1 route, contributes to the negative regulation of T-cell responses.


title: Community acquired pneumonia in the tropics.

text: PURPOSE OF REVIEW Due to the exponential growth of international exchange, millions of travelers are exposed to respiratory pathogens in the tropics and may return ill. Community-acquired pneumonia is one of the more prevalent infections. RECENT FINDINGS The acquisition of infections in the tropics, including community-acquired pneumonias, has been described for several centuries. During recent decades some microorganisms have been disclosed as causative of the disease (Legionella pneumophila in 1976 and hantavirus in 1990); other microorganisms are real new pathogens that were not previously demonstrated to have a pathogenic role in humans (e.g. severe acute respiratory syndrome coronavirus producing an outbreak in 2003 and H5N1 avian influenza virus producing an increasing number of human cases over the last few years). SUMMARY A number of microorganisms may produce pneumonia in people who live or have traveled to tropical zones. History, including geography and epidemiology, physical exam and complementary workout are precious tools for the diagnosis, therapy and prevention. Exposure to microorganisms in tropical areas may show different patterns. A high index of suspicion, detailed investigation of travel, exposure history of the patient, and a basic understanding of the incubation periods and distribution of the various potential pathogens are imperative for the diagnosis.


title: All but the shortest polymorphic forms of the viral receptor DC-SIGNR assemble into stable homo- and heterotetramers.

text: Polymorphisms that affect the length of the extracellular neck region of the endothelial receptor DC-SIGNR (dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin-related protein) have been linked to differences in susceptibility to infection by enveloped viruses. We have characterized the effects of these polymorphisms on the ability of DC-SIGNR to form tetramers containing the clusters of sugar-binding sites needed for binding to viral envelope glycoproteins. Chemical cross-linking and analytical ultracentrifugation experiments have been used to show that only the smallest form of DC-SIGNR is defective in homotetramer assembly. A novel affinity-tagging approach has been employed to demonstrate that, contrary to previous speculation, heterotetramers can be assembled efficiently from DC-SIGNR polypeptides of different lengths. The heterotetramers are stable and can be detected in fibroblasts transfected with multiple forms of DC-SIGNR. These results provide a molecular basis for interpreting the way polymorphisms affect interactions with viruses.


title: Monopolar active accessories can be connected to Covidien ForceTriad electrosurgical generators incorrectly, disabling coagulation mode.

text: The monopolar output receptacle on the Covidien ForceTriad electrosurgical generator is designed in such a way that users can unknowingly connect active accessories in the wrong orientation, disabling the system's coagulation function. The manufacturer is developing labeling for ForceTriad production units that depicts the proper orientation in which to connect the accessory during setup. Covidien is currently considering how it will address units already in the field.


title: Novel coronavirus associated with severe respiratory disease: case definition and public health measures.

text: Two cases of rapidly progressive acute respiratory infection in adults associated with a novel coronavirus have generated an international public health response. The two infections were acquired three months apart, probably in Saudi Arabia and Qatar. An interim case definition has been elaborated and was published on the World Health Organization website on 25 September 2012.


Reframing HIV and AIDS.


title: [Variability analysis of S2 gene of SARS-CoV].

text: OBJECTIVE To determine the sequence of S2 gene of SARS-associated coronavirus (SARS-CoV) GD322 and analyze the phyletic evolution of S2 gene. METHOD S2 gene fragment was amplified from SARS-CoV GD322 genome with RT-PCR and ligated to pGEM-T vector for sequence analysis after transformation of the plasmid into E. coli DH5a. The variability of S2 genes and S2 proteins from 12 strains isolated in the early, intermediate and advanced stages of the SARS outbreak were analyzed and the phylogenetic tree was constructed with Lasergene, Clustal X, DNAman and Treeview. T cell antigen epitopes of S2 protein were predicted on the basis of Internet database. RESULT With the epidemic spread of SARS-CoV, the S2 genes of the virus tended to become stable. Homology of S2 genes of SARS-CoV isolated in advanced stage of the outbreak reached 99.9%. Prediction of T cell antigen epitope showed that mutation at the 57th amino acid effected T cell antigen epitope. CONCLUSION S2 gene of GD322 SARS-CoV is relatively stable during the epidemic spread of the virus, and mutation at the 57th amino acids of S2 protein may affect the T cell antigen epitope.


title: Malaria surveillance--United States, 2001.

text: PROBLEM/CONDITION Malaria is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles sp. mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. In the United States, cases can occur through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. PERIOD COVERED This report covers cases with onset of illness in 2001. DESCRIPTION OF SYSTEM Malaria cases confirmed by blood film are reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS CDC received reports of 1,383 cases of malaria with an onset of symptoms in 2001 among persons in the United States or one of its territories. This number represents a decrease of 1.4% from the 1,402 cases reported for 2000. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 50.1%, 27.8%, 4.5%, and 3.6% of cases, respectively. Fourteen patients (1.0% of total) were infected by >/=2 species. The infecting species was unreported or undetermined in 179 (12.9%) cases. Compared with 2000, the number of reported malaria cases acquired in Africa increased by 13.2% (n = 886), whereas the number of cases acquired in Asia (n = 163) and the Americas (n = 240) decreased by 31.5% and 11.4%, respectively. Of 891 U.S. civilians who acquired malaria abroad, 180 (20.2%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Two patients became infected in the United States, one through congenital transmission and one whose infection cannot be linked epidemiologically to secondary cases. Eleven deaths were attributed to malaria, 10 caused by P. falciparum and one caused by P. ovale. INTERPRETATION The 1.4% decrease in malaria cases in 2001, compared with 2000, resulted primarily from a decrease in cases acquired in Asia and the Americas, but this decrease was offset by an increase in the number of cases acquired in Africa. This decrease probably represents year-to-year variation in malaria cases, but also could have resulted from local changes in disease transmission, decreased travel to malaria-endemic regions, fluctuation in reporting to state and local health departments, or an increased use of effective antimalarial chemoprophylaxis. In the majority of reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country in which they acquired malaria. PUBLIC HEALTH ACTIONS Additional information was obtained concerning the 11 fatal cases and the two infections acquired in the United States. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel, and travelers should use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently develops a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet site at http://www.cdc.gov/travel.


title: Single-stage full-thickness scalp reconstruction using acellular dermal matrix and skin graft.

text: Full-thickness scalp defects with exposed calvarium pose a reconstructive challenge, particularly in patients with extensive comorbidities. A single-stage acellular dermal matrix and split-thickness skin graft reconstruction represents a simple and valuable surgical approach to achieving durable scalp coverage without requiring a donor-site or prolonged treatment. Reconstruction of full-thickness scalp defects with exposed calvarium is a difficult problem that generally requires local or free flap reconstruction. However, patients with significant medical comorbidities present a further challenge given the risks of a major surgical procedure. Simple skin graft directly onto bone frequently fails and does not provide durable coverage, while combined artificial skin substitute and split-thickness skin graft approach involves a prolonged treatment period with multiple-staged procedures. Herein, we present a case of an 82-year-old female patient with complex medical comorbidities with a large scalp defect and calvarial exposure following Moh's surgery. She was successfully treated with a single-stage acellular dermal matrix and a STSG reconstruction. Her treatment period was effectively shortened, and she had an excellent clinical outcome.


title: Acute exacerbation of chronic bronchitis: a primary care consensus guideline.

text: OBJECTIVE To develop consensus on appropriate treatment for acute exacerbation of chronic bronchitis (AECB). CHARACTERISTICS AND ETIOLOGY: Patients with chronic bronchitis have an irreversible reduction in maximal airflow velocity and a productive cough on most days of the month for 3 months over 2 consecutive years. An AECB is characterized by a period of unstable lung function with worsening airflow and other symptoms. Most (80%) cases of AECB are due to infection, with half due to aerobic bacteria. The remaining 20% are due to noninfectious causes such as environmental factors or medication nonadherence. MANAGEMENT Supportive care should be provided to all patients, which might include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy. Antibacterial treatment should be reserved for patients with at least 1 key symptom (ie, increased dyspnea, sputum production, sputum purulence) and 1 risk factor (ie, age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value, > or = 4 AECBs in 12 months, 1 or more comorbidities). A newer macrolide, extended-spectrum cephalosporin, or doxycycline is appropriate for an exacerbation of moderate severity, and high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone should be used for a severe exacerbation. There has been increasing antibacterial resistance by the 3 most prevalent pathogens (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis). CONCLUSION Although all AECB patients should receive supportive care, only patients with at least 1 key symptom and 1 risk factor should receive antibiotic therapy.


title: Neospora caninum infection in birds: experimental infections in chicken and embryonated eggs.

text: Neospora caninum causes economical impact in cattle-raising farms since it is implicated as the major cause of bovine abortions. Although infection by the parasite has been widely described in mammals, the role of birds in its life-cycle is still obscure. Therefore, this work aimed to evaluate the infection by N. caninum in different chicken models. Experimental infections were conducted in 7-day-old chicks, laying hens and embryonated eggs, where samples were analysed for parasite burden, IgG antibodies and lesions promoted. Chickens demonstrated an asymptomatic infection, although with seroconversion and systemic replication of the parasite. In laying hens, no signs of vertical transmission were observed. However, embryonated eggs inoculated by the allantoic cavity route demonstrated susceptibility to infection, with mortality rates around 50% independent of the inoculum dose. Additionally, dogs became infected after ingestion of different amounts of inoculated eggs, producing either oocysts or specific IgG antibodies. The results herein presented demonstrate that chickens may be intermediate hosts of N. caninum and that embryonated eggs could be a useful model to study the parasite's biology.


title: Portable power supply options for positive airway pressure devices.

text: INTRODUCTION Patients with obstructive sleep apnea (OSA) often face the challenge of how to power their positive airway pressure (PAP) devices when alternating current power supplies are not available in remote areas with lack of electricity or frequent power outages. This article elucidates portable power supply options for PAP devices with the aim to increase alternative power source awareness among medical providers. METHODS A search of scientific databases (Medline, Scopus, Web of Science, Google Scholar, and the Cochrane Library) was carried out on the topic of alternative portable power supply options for treatment of OSA. RESULTS Scientific databases listed above yielded only limited results. Most articles were found via Google search. These articles were reviewed for alternative power supply options for OSA patients when alternating current is not available. The power supply options in this article include lead-acid batteries (starter, marine and deep-cycle batteries), lithium ion batteries, solar kits, battery packs, backup power systems, portable generators, and travel-size PAP devices. CONCLUSIONS There are several options to power PAP devices with direct current when alternating current is not available. Knowledgeable primary care physicians especially in rural and remote areas can help OSA patients improve PAP compliance in order to mitigate morbidity and long-term complications of OSA.


title: Severe acute respiratory syndrome and its lesions in digestive system.

text: Severe acute respiratory syndrome (SARS) is an infectious atypical pneumonia that has recently been recognized in the patients in 32 countries and regions. This brief review summarizes some of the initial etiologic findings, pathological description, and its lesions of digestive system caused by SARS virus. It is an attempt to draw gastroenterologists and hepatologists' attention to this fatal illness, especially when it manifests itself initially as digestive symptoms.


title: Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study : Midazolam plasma concentration after anesthesia premedication.

text: BACKGROUND Midazolam is commonly used as a pre-anesthesia anxiolytic. It`s elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction. METHODS The study was conducted prospectively with consent of the local ethics committee (Ethikkomission Kanton Thurgau, Switzerland) and carried out with written informed consent of each patient. Female patients aged 20 to 60 years undergoing elective procedures with general anesthesia were included, and were divided in two groups according to the planned surgical time: group S (<30 min) and group L (90-120 min), respectively. All patients received 7.5 mg Midazolam po as premedication. Blood samples were drawn at anesthesia induction, and at the end of surgery. Data were compared with t-test (independent samples; significance level p <0.05). RESULTS Twenty-five patients per group were included. Four patients were excluded from analysis, since midazolam was not detectable in any samples. Time of premedication to the 1st blood sample was not statistically different between groups, neither were Midazolam plasma levels at this time point (p = 0.94). None of the patients from group L (n = 24), but five patients in group S (n = 22) did have a higher plasma level of Midazolam at the end of the case compared to the beginning. CONCLUSIONS The elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia. TRIAL REGISTRATION German Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00005429 ; date of registration 3rd January 2014.


title: Hepatobiliary pathology.

text: PURPOSE OF REVIEW Liver biopsy continues to be an essential component in the evaluation of many widely prevalent liver diseases, including chronic hepatitis C, fatty liver, and liver tumors. This annual review of publications in hepatobiliary pathology highlights recent pathologic studies that can be applied to the daily practice of interpreting liver biopsy, explant, and postmortem specimens. RECENT FINDINGS The problem of the fatty liver was the subject of many studies. In chronic hepatitis C, genotype 3 infection results in moderate to marked fat that is ameliorated with successful antiviral therapy. In nonalcoholic steatohepatitis, in which the metabolic syndrome is often operative, gene microarray analysis showed altered expression of genes involved in insulin sensitivity and maintenance of mitochondrial function. Pathologic changes affecting centrilobular regions were described in the context of heart disease, Budd-Chiari syndrome, and the sinusoidal obstruction syndrome (venoocclusive disease). A mutation in ferroportin 1 produced a form of hemochromatosis with excessive iron in hepatocytes and also in Kupffer cells and macrophages. Immunostains for Hep Par 1 and polyclonal carcinoembryonic antigen remain important cornerstones in the immunohistochemical diagnosis of hepatocellular carcinoma and its distinction from metastatic adenocarcinoma and cholangiocarcinoma. SUMMARY This report reviews recent articles addressing hepatobiliary pathology. In the areas of viral and drug hepatitis, fatty liver, hemochromatosis, Wilson disease, several biliary tract disorders, and pathology of liver tumors, the emerging data have important diagnostic applications.


title: Involvement of a stem-loop structure in the location of junction sites in viral RNA recombination.

text: Recombination between RNAs associated with turnip crinkle virus is thought to occur during plus-strand synthesis at motifs resembling the 5'-ends of genomic, subgenomic and satellite RNAs. Common structural regions encompassing the motifs have been found for major crossover sites on two different minus-strand templates, with junctions preferentially located in a single-stranded region at the 3' base of a hairpin. Base changes, deletions and compensatory alteration constructed in and around the hairpin in the region of the turnip crinkle virus genomic RNA involved in recombination support the importance of the hairpin for normal crossover site selection. This region of the genomic RNA is also important for replication of the viral genomic RNA in plants and protoplasts, suggesting a common link between sequences required for recombination and viral replication.