Head and Neck Radiation Therapy Patterns of Practice Variability Identified as a Challenge to Real-World Big Data: Results From the Learning from Analysis of Multicentre Big Data Aggregation (LAMBDA) Consortium.

Purpose: Outside of randomized clinical trials, it is difficult to develop clinically relevant evidence-based recommendations for radiation therapy (RT) practice guidelines owing to lack of comprehensive real-world data. To address this knowledge gap, we formed the Learning from Analysis of Multicenter Big Data Aggregation consortium to cooperatively implement RT data standardization, develop software solutions for data analysis, and recommend clinical practice change based on real-world data analyzed. The first phase of this "Big Data" study aimed at characterizing variability in clinical practice patterns of dosimetric data for organs at risk (OARs) that would undermine subsequent use of large-scale, electronically aggregated data to characterize associations with outcomes. Evidence from this study was used as the basis for practical recommendations to improve data quality. Methods and Materials: Dosimetric details of patients with head and neck cancer treated with radiation therapy between 2014 and 2019 were analyzed. Institutional patterns of practice were characterized, including structure nomenclature, volumes, and frequency of contouring. Dose volume histogram (DVH) distributions were characterized and compared with institutional constraints and literature values. Results: Plans for 4664 patients treated to a mean plan dose of 64.4 ± 13.2 Gy in 32 ± 4 fractions were aggregated. Before implementation of TG-263 guidelines in each institution, there was variability in OAR nomenclature across institutions and structures. With evidence from this study, we identified a targeted and practical set of recommendations aimed at improving the quality of real-world data. Conclusions: Quantifying similarities and differences among institutions for OAR structures and DVH metrics is the launching point for next steps to investigate potential relationships between DVH parameters and patient outcomes.

Multidimensional Outcomes of Selective Dorsal Rhizotomy for Children With Spastic Cerebral Palsy: Single-Level Laminectomy vs Multiple-Level Laminotomy Techniques.

BACKGROUND: Selective dorsal rhizotomy (SDR) reduces lower limb spasticity, improves gait patterns, and restores normal physical and social activity in children with spastic cerebral palsy. Single-level laminectomy (SLL) and multiple-level laminotomy (MLL) are 2 surgical approaches for SDR with limited clinical data comparing their postoperative outcomes. OBJECTIVE: To compare the differences in multidimensional outcomes after SDR between SLL and MLL for children with spastic cerebral palsy. METHODS: We retrospectively reviewed children who underwent SDR in our hospital from 1997 to 2016. The multidimensional outcomes in spasticity, joint range of motions, gait kinetics, gross motor activities, functional outcomes, and urological outcomes were assessed 1 year postoperatively. Hip dysplasia and scoliosis rate were compared as long-term outcomes. RESULTS: Sixty children underwent SDR, including 34 SLL patients and 26 MLL patients. Most improvements in multidimensional outcomes were comparable between SLL and MLL. Patients in the SLL group had larger improvements in ankle dorsiflexion in the midstance phase (SLL 7.59° ± 11.48° vs MLL 0.29° ± 11.30°, P = .027). The rate of scoliosis was similar between the 2 surgical approaches (SLL 12.1% vs MLL 15.4%, P = .722). CONCLUSION: SDR for children with spastic cerebral palsy could provide physical, functional, and urological improvements. SLL achieved a higher degree of improvement in ankle dorsiflexion in the midstance phase. The rate of scoliosis was not significantly increased by multiple-level laminotomy.

A Competency-Based Orientation (CBO) Protocol Enhances Competency Among Newly Hired Perianesthesia Nurses.

PURPOSE: The purpose of this quality improvement project was to develop a competency-based orientation (CBO) protocol based on the American Society of PeriAnesthesia Nurses Nursing Standards and CBO for perianesthesia nurses. DESIGN: Feasibility study with pre-post survey design. METHODS: A CBO protocol that included nursing care workflows for 11 common surgical cases was developed and used in orienting newly hired perianesthesia nurses. Newly hired nurses completed a pre-post self-assessment on their level of competency in caring for surgical patients. FINDINGS: Using Wilcoxon signed rank test, improved competency was found in all service areas except for pediatric care. CONCLUSIONS: Nursing competency in the perianesthesia area is critical in fulfilling one's role as a nurse. A robust CBO protocol for the perianesthesia nurse is important when integrating an employee into the organization and preparing the nurse for success.

Spatial ecology of little egret (Egretta garzetta) in Hong Kong uncovers preference for commercial fishponds.

Many natural wetlands have been converted to human-influenced wetlands. In some instances, human-influenced wetlands could provide complementary habitats for waterbirds, compensating for the loss of natural wetlands. Inner Deep Bay in Hong Kong is composed of both natural and human-influenced wetlands and is under immense development pressure. From an ecology perspective, we need to understand if different wetland types play the same ecological role. To achieve this, we tracked nine little egrets (Egretta garzetta) using GPS loggers for 14 months to study their spatial ecology, home range, movement and habitat use. We found that over 88% of the home range of all individuals comprised of wetlands (commercial fishponds, mangrove, gei wai, channel, and intertidal mudflat). Among these wetland types, nearly all (seven of nine) individuals preferred commercial fishponds over other habitats in all seasons. Little egrets exhibited seasonal movement and habitat use among seasons, with largest home range, greatest movement, and most frequent visits to commercial fishponds in winter compared to spring and autumn. Our results highlight the significant role of commercial fishponds, providing a feeding ground for little egrets. However, other wetland types cannot be ignored, as they were also used considerably. These findings underscore the importance of maintaining a diversity of wetland types as alternative foraging and breeding habitats.

Risk for Thyroid Cancer Recurrence Is Higher in Men Than in Women Independent of Disease Stage at Presentation.

Background: Well-differentiated thyroid cancer (DTC) presents at a more advanced stage in men than in women, and the mortality in men is higher than that in women. However, it is not clear whether DTC recurrence is affected by sex independent of stage at presentation. The objective of the present study was to assess if male sex is an independent risk factor for recurrence of DTC. Methods: The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe patterns of care for thyroid cancer. We included patients from the CANNECT registry with DTC diagnosed at age 18 or older between 2000 and 2010. We compared men and women with respect to presentation, management, and recurrence risk, stratified for American Joint Committee on Cancer (AJCC) stage. Results: We included 2595 patients, 2067 (79.7%) women and 528 (20.3%) men. Men presented with more advanced AJCC stage (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), and M stage (p = 0.002) There was no difference in follow-up duration between women (7.7 ± 4.0 [mean ± standard deviation] years) and men (7.7 ± 4.0 years, p = 0.985). Overall recurrence was 2.2% (n = 46) for women and 8.5% (n = 45) for men (p < 0.001). In multivariate analysis adjusted for AJCC stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.72 [95% confidence interval [CI] 1.78-4.20]; p < 0.001). In multivariate analysis adjusted for tumor-node-metastasis (TNM) stage, men were at significantly greater risk for DTC recurrence than women (adjusted hazard ratio 2.31 [CI 1.48-3.60]; p < 0.001). Conclusions: Our study confirms that the risk for recurrence of DTC is higher in men than in women. Although men tend to present with more advanced-stage disease, the difference in recurrence risk persists when adjusted for stage of presentation. It needs to be determined whether sex should influence follow-up intensity and/or duration.

Pre-clinical development of a cryopreservable megakaryocytic cell product capable of sustained platelet production in mice.

BACKGROUND: Platelet (PLT) transfusions are the most effective treatments for patients with thrombocytopenia. The growing demand for PLT transfusion products is compounded by a limited supply due to dependency on volunteer donors, a short shelf-life, risk of contaminating pathogens, and alloimmunization. This study provides preclinical evidence that a third-party, cryopreservable source of PLT-generating cells has the potential to complement presently available PLT transfusion products. STUDY DESIGN AND METHODS: CD34+ hematopoietic stem/progenitor cells derived from umbilical cord blood (UCB) units were used in a simple and efficient culture system to generate a cell product consisting of megakaryocytes (MKs) at different stages of development. The cultures thus generated were evaluated ex vivo and in vivo before and after cryopreservation. RESULTS: We generated a megakaryocytic cell product that can be cryopreserved without altering its phenotypical and functional capabilities. The infusion of such a product, either fresh or cryopreserved, into immune-deficient mice led to production of functional human PLTs which were observed within a week after infusion and persisted for 8 weeks, orders of magnitude longer than that observed after the infusion of traditional PLT transfusion products. The sustained human PLT engraftment was accompanied by a robust presence of human cells in the bone marrow (BM), spleen, and lungs of recipient mice. CONCLUSION: This is a proof-of-principle study demonstrating the creation of a cryopreservable megakaryocytic cell product which releases functional PLTs in vivo. Clinical development of such a product is currently being pursued for the treatment of thrombocytopenia in patients with hematological malignancies.

Pilot Study of the Safety and Tolerability of a Subconjunctival Penciclovir Implant in Cats Experimentally Infected with Herpesvirus.

PURPOSE: To assess safety and tolerability of a subconjunctival penciclovir implant in cats infected with feline herpesvirus type 1 (FHV-1). METHODS: Subconjunctival blank (n = 4 cats) or penciclovir-impregnated (n = 6) silicone implants were placed bilaterally in 10 normal, FHV-1-naive cats 7-8 days before viral inoculation. Outcomes included disease score, FHV-1 serology, conjunctival viral load, Schirmer tear tests (STT), tear film break-up times (TFBUTs), conjunctival histology, goblet cell density (GCD), body weight, tear and plasma penciclovir concentration, and corneal ulcer evaluation. RESULTS: Both groups had similar clinical and histologic disease scores, STT values, TFBUTs, GCD, FHV-1 titers, viral loads, and body weight changes. No ocular or systemic signs of toxicity were noted. Tear penciclovir concentration varied widely among cats and across time points. Tear penciclovir concentrations exceeded the lowest published half maximal inhibitory concentration (IC50) in 5/6 treated cats. Plasma penciclovir concentrations remained below 10 ng/mL. Cats with higher tear penciclovir concentrations at inoculation and/or time of peak disease had fewer corneal ulcers than cats in which tear penciclovir concentrations were inconsistent, low, or unrecordable. CONCLUSIONS: Subconjunctival blank and penciclovir-impregnated implants were well tolerated at the ocular surface and not associated with systemic toxicity, adverse effect, or appreciable plasma penciclovir concentrations. Tear penciclovir concentrations >IC50 were sometimes achieved, especially during burst release soon after implant placement. Further study is necessary to determine efficacy of locally delivered penciclovir when penciclovir concentration is consistently maintained above IC50. This will be especially useful in patients unable to receive systemic therapy.

A Survey of Perianesthesia Nursing Electronic Documentation.

PURPOSE: Electronic health records have become a common part of the perianesthesia care workflow, particularly for data gathering and documentation. The purpose of this survey of perianesthesia nurses was to examine patterns of adoption of electronic health records and their effect on clinical documentation and patient care. DESIGN: A survey was sent to nurses who are members of the American Society of Perianesthesia Nursing (ASPAN). METHODS: The electronic documentation survey was sent to the e-mail addresses of 13,339 ASPAN members representing various practice environments across the United States. Results were examined through descriptive statistics. FINDINGS: About two thirds (66.02%) of the respondents indicated that they could capture 80% of their clinical interactions with the patient. Few nurses indicated that adoption of the EHR was done using a standardized terminology. Respondents (63.99%) overwhelmingly indicated that they spent less time interacting with patients and families because of electronic documentation demands. CONCLUSIONS: The results pertaining to the impact of the EHR on their practice were fairly mixed with some indication that there was greater access to important patient data, but with a trade-off of less satisfaction and efficiency. Improvements and evaluation of clinical documentation are being done, but ongoing optimization and improvements to the EHR based on the knowledge needs of nurses will help realize the promise of greater quality, safety, and access to data.

Human iPSC-Derived Neuronal Model of Tau-A152T Frontotemporal Dementia Reveals Tau-Mediated Mechanisms of Neuronal Vulnerability.

Frontotemporal dementia (FTD) and other tauopathies characterized by focal brain neurodegeneration and pathological accumulation of proteins are commonly associated with tau mutations. However, the mechanism of neuronal loss is not fully understood. To identify molecular events associated with tauopathy, we studied induced pluripotent stem cell (iPSC)-derived neurons from individuals carrying the tau-A152T variant. We highlight the potential of in-depth phenotyping of human neuronal cell models for pre-clinical studies and identification of modulators of endogenous tau toxicity. Through a panel of biochemical and cellular assays, A152T neurons showed accumulation, redistribution, and decreased solubility of tau. Upregulation of tau was coupled to enhanced stress-inducible markers and cell vulnerability to proteotoxic, excitotoxic, and mitochondrial stressors, which was rescued upon CRISPR/Cas9-mediated targeting of tau or by pharmacological activation of autophagy. Our findings unmask tau-mediated perturbations of specific pathways associated with neuronal vulnerability, revealing potential early disease biomarkers and therapeutic targets for FTD and other tauopathies.

Direct Reprogramming of RESTing Astrocytes.

Understanding the mechanisms underlying neuronal fate determination will provide important insights into brain development and regenerative approaches to neurological diseases. Now in Cell Stem Cell, Masserdotti et al. (2015) use neuronal conversion of astrocytes to dissect transcriptional mechanisms of fate determination and identify circuits that mediate cellular identity.

Stem cell therapy for Alzheimer's disease and related disorders: current status and future perspectives.

Underlying cognitive declines in Alzheimer's disease (AD) are the result of neuron and neuronal process losses due to a wide range of factors. To date, all efforts to develop therapies that target specific AD-related pathways have failed in late-stage human trials. As a result, an emerging consensus in the field is that treatment of AD patients with currently available drug candidates might come too late, likely as a result of significant neuronal loss in the brain. In this regard, cell-replacement therapies, such as human embryonic stem cell- or induced pluripotent stem cell-derived neural cells, hold potential for treating AD patients. With the advent of stem cell technologies and the ability to transform these cells into different types of central nervous system neurons and glial cells, some success in stem cell therapy has been reported in animal models of AD. However, many more steps remain before stem cell therapies will be clinically feasible for AD and related disorders in humans. In this review, we will discuss current research advances in AD pathogenesis and stem cell technologies; additionally, the potential challenges and strategies for using cell-based therapies for AD and related disorders will be discussed.

In vitro cytotoxicity and antiviral efficacy against feline herpesvirus type 1 of famciclovir and its metabolites.

OBJECTIVES: To assess in vitro the antiviral efficacy against feline herpesvirus (FHV-1) and cytotoxicity for cultured feline cells of famciclovir and its metabolites, BRL 42359 and penciclovir. To investigate the effect of timing of penciclovir application on in vitro antiviral activity. PROCEDURES: Plaque reduction assays were used to estimate antiviral efficacy of all compounds and the effect of penciclovir exposure before or after exposure to a FHV-1 field isolate. Cytotoxicity was evaluated by assessing cell morphology and viable cell number for 72 h following exposure to each compound. RESULTS: The penciclovir concentration that inhibited FHV-1-induced plaque formation by 50% (IC50 ) was 0.86 µg/mL (3.4 µm). Famciclovir and BRL 42359 had no antiviral effect against FHV-1 at any concentration assessed. Antiviral activity was significantly enhanced when cells were exposed to 4 µm penciclovir (approximate IC50 ) for 1 h but not for 24 h before viral adsorption. Delaying exposure of cells to penciclovir for 1, 2, or 4 h after viral adsorption significantly enhanced antiviral activity. Relative to untreated control wells, >88% of cells remained viable when exposed to famciclovir (100 µm), BRL 42359 (1.06 mm), or penciclovir (40 µm) for 72 h. No morphologic evidence of cytotoxicity was noted. CONCLUSIONS: Penciclovir demonstrates potent antiviral activity against FHV-1 and may be effective at lower tissue, tear, and plasma concentrations than previously targeted. The duration of in vitro antiviral effect of penciclovir suggests that frequent famciclovir administration may be necessary in vivo. Famciclovir and BRL 42359 showed no signs of in vitro cytotoxicity.

Genetic correction of tauopathy phenotypes in neurons derived from human induced pluripotent stem cells.

Tauopathies represent a group of neurodegenerative disorders characterized by the accumulation of pathological TAU protein in brains. We report a human neuronal model of tauopathy derived from induced pluripotent stem cells (iPSCs) carrying a TAU-A152T mutation. Using zinc-finger nuclease-mediated gene editing, we generated two isogenic iPSC lines: one with the mutation corrected, and another with the homozygous mutation engineered. The A152T mutation increased TAU fragmentation and phosphorylation, leading to neurodegeneration and especially axonal degeneration. These cellular phenotypes were consistent with those observed in a patient with TAU-A152T. Upon mutation correction, normal neuronal and axonal morphologies were restored, accompanied by decreases in TAU fragmentation and phosphorylation, whereas the severity of tauopathy was intensified in neurons with the homozygous mutation. These isogenic TAU-iPSC lines represent a critical advancement toward the accurate modeling and mechanistic study of tauopathies with human neurons and will be invaluable for drug-screening efforts and future cell-based therapies.

Transcriptional regulation of TRKC by SOX2 in human embryonic stem cells.

Human embryonic stem (hES) cells have the dual ability to self-renew and differentiate into specialized cell types. However, in order to realize the full potential of these cells it is important to understand how the genes responsible for their unique characteristics are regulated. In this study we examine the regulation of the tropomyosin-related kinase (TRK) genes which encode for receptors important in hES cell survival and self-renewal. Although the TRK genes have been studied in many neuronal cell types, the regulation of these genes in hES cells is unclear. Our study demonstrates a novel regulatory relationship between the TRKC gene and the transcription factor SOX2. Our results found that hES cells highly express full-length and truncated forms of the TRKC gene. However, examination of the related TRKB gene showed a lower overall expression of both full-length and truncated forms. Through RNA interference, we knocked down expression levels of SOX2 in hES cells and examined the expression of TRKC, as well as TRKB. Upon loss of SOX2 we found that TRKC mRNA levels were significantly downregulated but TRKB levels remained unchanged, demonstrating an important regulatory dependence on SOX2 by TRKC. We also found that TRKC protein levels were also decreased after SOX2 knock down. Further analysis found the regulatory region of TRKC to be highly conserved among many mammals with potential SOX binding motifs. We confirmed a specific binding motif as a site that SOX2 utilizes to directly interact with the TRKC regulatory region. In addition, we found that SOX2 drives expression of the TRKC gene by activating a luciferase reporter construct containing the TRKC regulatory region and the SOX binding motif.

A novel role for an RNA polymerase III subunit POLR3G in regulating pluripotency in human embryonic stem cells.

The pluripotency of human embryonic stem cells (hESC) could have great potential for the development of cell replacement therapies. Previous studies have converged on the finding that OCT4, SOX2, and NANOG serve as key regulators in the maintenance of hESC. However, other signals that regulate hESC maintenance remain poorly studied. Here we describe a novel role of an RNA polymerase III (Pol III) subunit, POLR3G, in the maintenance of pluripotency in hESC. We demonstrate the presence of POLR3G in undifferentiated hESC, human induced pluripotent stem cells (hiPSC), and early mouse blastocysts. Downregulation of POLR3G is observed on differentiation of hESC and hiPSC, suggesting that POLR3G can be used as a molecular marker to readily identify undifferentiated pluripotent stem cells from their differentiated derivatives. Using an inducible shRNA lentiviral system, we found evidence that decreased levels of POLR3G result in loss of pluripotency and promote differentiation of hESC to all three germ layers but have no effect on cell apoptosis. On the other hand, overexpression of POLR3G has no effect on pluripotency and apoptosis in undifferentiated hESC. Interestingly, hESC expressing elevated levels of POLR3G are more resistant to differentiation. Furthermore, our experimental results show that POLR3G is a downstream target of OCT4 and NANOG, and our pharmacological study indicated that POLR3G expression can be readily regulated by the Erk1/2 signaling pathway. This study is the first to show an important role of POLR3G in the maintenance of hESC, suggesting a potential role of Pol III transcription in regulating hESC pluripotency.

Nucleofection of human embryonic stem cells.

The ability to realize the full potential of human pluripotent stem cells (hPSCs) as tools for -understanding human development and advancing the field of regenerative medicine is dependent on efficient methods to genetically manipulate these cells. There are several methods for introducing foreign DNA into cells such as electroporation, lipid-based transfection technology, and viral transduction. We describe here a method to transfect human embryonic stem cells (hESCs) using nucleofection technology. This unique method uses the Nucleofector II Device that combines the use of a cell type-specific Nucleofector Solution and preprogrammed electrical parameters to efficiently deliver DNA into the cell nucleus. The use of this technology allows high-efficiency transfer of nucleic acids into hESCs enabling both transient and stable manipulation of gene expression in these cells.

L1TD1 is a marker for undifferentiated human embryonic stem cells.

BACKGROUND: Human embryonic stem cells (hESC) are stem cells capable of differentiating into cells representative of the three primary embryonic germ layers. There has been considerable interest in understanding the mechanisms regulating stem cell pluripotency, which will ultimately lead to development of more efficient methods to derive and culture hESC. In particular, Oct4, Sox2 and Nanog are transcription factors known to be important in maintenance of hESC. However, many of the downstream targets of these transcription factors are not well characterized. Furthermore, it remains unknown whether additional novel stem cell factors are involved in the establishment and maintenance of the stem cell state. METHODOLOGY/PRINCIPAL FINDINGS: Here we show that a novel gene, L1TD1 (also known as FLJ10884 or ECAT11), is abundantly expressed in undifferentiated hESC. Differentiation of hESC via embryoid body (EB) formation or BMP4 treatment results in the rapid down-regulation of L1TD1 expression. Furthermore, populations of undifferentiated and differentiated hESC were sorted using the stem cell markers SSEA4 and TRA160. Our results show that L1TD1 is enriched in the SSEA4-positive or TRA160-positive population of hESC. Using chromatin immunoprecipitation we found enriched association of Nanog to the predicted promoter region of L1TD1. Furthermore, siRNA-mediated knockdown of Nanog in hESC also resulted in downregulation of L1TD1 expression. Finally, using luciferase reporter assay we demonstrated that Nanog can activate the L1TD1 upstream promoter region. Altogether, these results provide evidence that L1TD1 is a downstream target of Nanog. CONCLUSION/SIGNIFICANCE: Taken together, our results suggest that L1TD1 is a downstream target of Nanog and represents a useful marker for identifying undifferentiated hESC.

Expression of cyclooxygenase-2 in canine uveal melanocytic neoplasms.

OBJECTIVE: To determine whether cyclooxygenase-2 (COX-2) is expressed in benign or malignant canine uveal melanocytic neoplasms and whether expression correlates with malignancy. SAMPLE POPULATION: Tissue sections from 71 globes; 57 with benign (n = 15), malignant (34), or mixed (8) uveal melanocytic neoplasms; 10 with nonneoplastic disease; and 4 with no abnormalities. PROCEDURES: Bleached sections from all globes and canine kidney were incubated with mouse monoclonal antibody directed against rat COX-2 protein or mouse antibody isotype control. Location, intensity, and percentage of immunolabeled cells were scored. RESULTS: Expression of COX-2 was detected in all but 5 globes, all of which contained neoplasms. Expression of COX-2 was detected in regions infiltrated by neoplasia in 21 globes; however, definitive labeling of tumor cells was detected in only 2 of those. In the remaining 19 globes, COX-2 expression was detected in areas also labeled in globes without disease and globes with nonneoplastic disease, especially the aqueous outflow tract and ciliary body. However, only globes with uveal malignant melanomas had detectable COX-2 expression in the iris. Expression of COX-2 was detected in the ciliary body of more globes with uveal malignant melanoma (20/34) than in those without disease (1/4), with nonneoplastic disease (4/10), or with melanocytoma (3/15) or mixed neoplasms (3/8). CONCLUSIONS AND CLINICAL RELEVANCE: Canine globes with uveal melanocytic neoplasia appeared to express COX-2 in similar sites and with similar intensity as globes without neoplasia. Differentiation of benign from malignant canine uveal melanocytic neoplasms was not possible.

Assessment of viremia associated with experimental primary feline herpesvirus infection or presumed herpetic recrudescence in cats.

OBJECTIVE: To detect feline herpesvirus type 1 (FHV-1) in blood of cats undergoing experimental primary herpetic disease or with spontaneous disease presumed to be caused by FHV-1 reactivation. ANIMALS: 6 young specific-pathogen-free (SPF) cats and 34 adult cats from a shelter. PROCEDURES: Conjunctiva and nares of SPF cats were inoculated with FHV-1, and cats were monitored for 21 days. Periodically, blood was collected for CBC, serum biochemical analyses, and detection of FHV-1 DNA via PCR assay. For shelter cats, a conjunctival swab specimen was collected for FHV-1 PCR assay, and blood mononuclear cells were tested via virus isolation (with or without hydrocortisone) and FHV-1 PCR assay. RESULTS: All SPF cats developed clinical and clinicopathologic evidence of upper respiratory tract and ocular disease only. Via PCR assay, FHV-1 DNA was detected in blood of all SPF cats at least once between 2 and 15 days after inoculation. Feline herpesvirus type 1 DNA was detected in conjunctival swabs of 27 shelter cats; 25 had clinical signs of herpetic infection. However, virus was not isolated from mononuclear cell samples of any shelter cat regardless of passage number or whether hydrocortisone was present in the culture medium; FHV-1 DNA was not detected in any mononuclear cell sample collected from shelter cats. CONCLUSIONS AND CLINICAL RELEVANCE: A brief period of viremia occurred in cats undergoing primary herpetic disease but not in cats undergoing presumed recrudescent herpetic disease. Viremia may be important in the pathogenesis of primary herpetic disease but seems unlikely to be associated with recrudescent disease.

Effects of sampling instrument and processing technique on DNA yield and detection rate for feline herpesvirus-1 via polymerase chain reaction assay.

OBJECTIVE: To assess effects of disease severity, sampling instrument, and processing technique on extracted DNA yield and detection rate for feline herpesvirus-1 (FHV-1) via PCR assay. SAMPLE POPULATION: Crandell-Rees feline kidney (CRFK) cells grown in vitro and conjunctival samples from 40 eyes of 20 cats. PROCEDURES: Samples of CRFK cells (collected by use of a swab or cytology brush, with or without suspension in PBS solution) underwent DNA extraction; DNA yield was quantified spectrophotometrically. In affected cats, signs of herpetic disease were subjectively assessed. Conjunctival swab and brush samples were collected bilaterally for measurement of DNA concentration; a defined mass (DM) of DNA and defined volume (DV) of sample were assessed for FHV-1 via PCR assays. RESULTS: For CRFK cells, DNA yields from unsuspended swabs and brushes were greater than for suspended swabs and brushes; suspended swab samples yielded less DNA than suspended brush samples. For conjunctival samples, DNA yields from swabs were greater than for brushes. Clinical score was not correlated with double-stranded DNA yield collected via either sampling instrument; however, cats with FHV-1-positive assay results had higher clinical scores than cats with FHV-1-negative results. Detection of FHV-1 in swab and brush samples was similar. Double-stranded DNA yield and FHV-1 detection were inversely related via DM-PCR assay. The DV-PCR assay had a significantly higher FHV-1 detection rate than the DM-PCR assay. CONCLUSIONS AND CLINICAL RELEVANCE: The DV-PCR assay of DNA extracted from an unsuspended swab sample was the preferred method for assessment of conjunctival shedding of FHV-1 in cats.