Acute pericarditis as a clinical manifestation in COVID-19 infection in a district hospital setting.

The global outbreak of coronavirus disease 2019(COVID-19) pandemic has heavily impacted the health service, leading to increased mortality and morbidity. Although known to manifest primarily as a respiratory illness, there are reports of cardiac involvement as extrapulmonary manifestation. We are reporting a case of pericarditis in a young patient who presented with only cardiac symptoms in COVID-19. He was admitted to the hospital for observation and treated with oral colchicine and oral ibuprofen. His conditions improved and subsequently discharged well. Acute pericarditis can present as part of the COVID-19 extrapulmonary spectrum. Therefore, it is important and challenging for clinicians to recognise the atypical presentations of COVID-19 to reduce morbidity and mortality.

[Clinical evaluation of dry chemical enzyme method for detecting Neisseria gonorrhoeae and analysis of external quality assessment results].

Objective:Neisseria gonorrhoeae in female cervix sample was detected by dry chemical enzymatic method and culture method. The detection effects of two detection methods were analyzed to provide reference for clinical detection. At the same time, strains were separated and identified to evaluate reliability of different methods. Methods: During October 2015 to December 2017, 8 860 samples of female cervix from the Third Affiliated Hospital of Zhengzhou University and Henan Provincial Peoples Hospital were detected by dry chemical enzymatic method and culture method. Because of the possible leak detection by culture method, the inconsistent results were supplemented by real-time PCR assay. The data were analyzed by SPSS 19.0. Fifteen strains of external quality assessment of Neisseria gonorrhoeae identification and validation during 2015 to 2017 years were identified by latex chromatography, culture method, dry chemical enzyme method and PCR- fluorescent probe method. Results: The positive rates of dry chemical enzymatic method and culture method for detection of Neisseria gonorrhoeae were 0.88% (78/8 860) and 0.41% (36/8 860), respectively. Among these, 26 samples were tested positive by dry chemical enzymatic method which were consistent with real-time PCR assay. Meanwhile, the culture method was negative. Dry chemistry enzyme method external quality assessment results of 3 years were accurate. Conclusion: The positive rate of dry chemical enzymatic method was markedly higher than that of culture method (P<0.05). The dry chemical enzymatic method, while exhibiting a high specificity, had high detection rate compared to culture method. And external quality assessment results are accurate. The clinical coincidence rate of dry chemical enzymatic detection was higher.

Homology-based analysis of the GRAS gene family in tobacco.

Members of the GRAS gene family are important transcriptional regulators. In this study, 21 GRAS genes were identified from tobacco, and were classified into eight subgroups according to the classification of Arabidopsis thaliana. Here, we provide a preliminary overview of this gene family in tobacco, describing the gene structure, gene expression, protein motif organization, phylogenetic analysis, and comparative analysis in tobacco, Arabidopsis, and rice. Using the sequences of 21 GRAS genes in Arabidopsis to search against the American tobacco genome database, 21 homologous GRAS genes in tobacco were identified. Sequence analysis indicates that these GRAS proteins have five conserved domains, which is consistent with their counterparts in other plants. Phylogenetic analyses divided the GRAS gene family into eight subgroups, each of which has distinct conserved domains and biological functions. Furthermore, the expression pattern of these 21 GRAS genes reveals that most are expressed in all six tissues studied; however, some have tissue specificity. Taken together, this comprehensive analysis will provide a rich resource to assist in the study of GRAS protein functions in tobacco.

The development and implementation of quality assurance programs to support nutritional measurements.

The National Institute of Standards and Technology administers quality assurance programs devoted to improving measurements of nutrients and related metabolites in foods, dietary supplements, and serum and plasma samples. These programs have been developed in collaboration with the National Institutes of Health to assist measurement communities in their efforts to achieve accurate results that are comparable among different laboratories and over time. Targeted analytes include micronutrients, botanical markers, nutritional elements, contaminants, fatty acids, and vitamin D metabolites.

The ORION study: comparison of two sirolimus-based regimens versus tacrolimus and mycophenolate mofetil in renal allograft recipients.

Safety and efficacy of two sirolimus (SRL)-based regimens were compared with tacrolimus (TAC) and mycophenolate mofetil (MMF). Renal transplantation recipients were randomized to Group 1 (SRL+TAC; week 13 TAC elimination [n = 152]), Group 2 (SRL + MMF [n = 152]) or Group 3 (TAC + MMF [n = 139]). Group 2, with higher-than-expected biopsy-confirmed acute rejections (BCARs), was sponsor-terminated; therefore, Group 2 two-year data were limited. At 1 and 2 years, respectively, graft (Group 1: 92.8%, 88.5%; Group 2: 90.6%, 89.9%; Group 3: 96.2%, 95.4%) and patient (Group 1: 97.3%, 94.4%; Group 2: 95.2%, 94.5%; Group 3: 97.0%, 97.0%) survival rates were similar. One- and 2-year BCAR incidence was: Group 1, 15.2%, 17.4%; Group 2, 31.3%, 32.8%; Group 3, 8.2%, 12.3% (Group 2 vs. 3, p < 0.001). Mean 1- and 2-year modified intent-to-treat glomerular filtration rates (mL/min) were similar. Primary reason for discontinuation was adverse events (Group 1, 34.2%; Group 2, 33.6%; Group 3, 22.3%; p < 0.05). In Groups 1 and 2, delayed wound healing and hyperlipidemia were more frequent. One-year post hoc analysis of new-onset diabetes posttransplantation was greater in TAC recipients (Groups 1 and 3 vs. 2, 17% vs. 6%; p = 0.004). Between-group malignancy rates were similar. The SRL-based regimens were not associated with improved outcomes for kidney transplantation patients.

Promoting healthy exercise among older people in general practice: issues in designing and evaluating therapeutic interventions.

The potential health benefits derived from sustained physical activity in older people are numerous; however, whether exercise promotion should take place in general practice is unsubstantiated. Exercise promotion should use existing research evidence of the advantages of exercise for various conditions, and target those inactive individuals who currently have no intention of changing their level of physical activity. Research has also raised methodological issues and questions about the feasibility of exercise interventions which still need to be tested in exercise trials conducted in general practice.

Assessment of elderly people in general practice. 4. Depression, functional ability and contact with services.

The aim of this study was to look at the interrelationship between depression, physical disability and contact with services. In a random sample of 239 people aged 75 years and over from nine general practices in north London, depression (as measured by a shortened version of the comprehensive assessment and referral evaluation schedule) was found to be significantly associated with being a woman, and inability to perform a number of activities of daily living. Consumption of three or more prescribed medicines, a home visit by the general practitioner in the previous three months and contact with health visitors and home helps were all significantly more likely among depressed patients. There were also significant associations between loss of functional abilities, measured using items from an activities of daily living scale, and use of certain services: general practitioner home visits and reduced mobility indoors and both home help and district nurse visits to those with difficulty in bathing. Multiple logistic regression analysis suggested that contact with services was principally associated with loss of mobility, although contact with home helps was independently associated with depression, when adjustment was made for functional impairment.

Cloning and expression of an acidic pectin methylesterase from jelly fig (Ficus awkeotsang).

Pectin methylesterase (PME) is the key enzyme responsible for the gelation of jelly curd in the water extract of jelly fig (Ficus awkeotasang) achenes. The jelly fig PME extracted from achenes was isoelectrofocused at pH 2.5 and subjected to N-terminal amino acid sequencing. A cDNA fragment encoding the mature protein of this acidic PME was obtained by PCR cloning using a poly(T) primer and a degenerate primer designed according to the N-terminal sequence of the purified PME. The complete cDNA sequence of its precursor protein was further obtained by PCR using the same strategy. The PME clone was overexpressed in Escherichia coli, and its expressed protein was immunologically recognized as strongly as the original antigen using antibodies against purified PME. Fractionation analysis revealed that the overexpressed PME was predominantly present in the pellet and thus presumably formed insoluble inclusion bodies in E. coli cells.

Molecular cloning of 11S globulin and 2S albumin, the two major seed storage proteins in sesame.

Insoluble 11S globulin and soluble 2S albumin, conventionally termed alpha-globulin and beta-globulin, are the two major storage proteins and constitute 80-90% of total seed proteins in sesame. Two full-length cDNA clones were sequenced and deduced to encode sesame 11S globulin and 2S albumin precursors, respectively. Deduced amino acid composition reveals that 2S albumin, but not 11S globulin, is a sulfur-rich protein. Three abundant polypeptides of 50-60 kDa were resolved on SDS-PAGE when seed-purified 11S globulin was prepared in nonreducing conditions. Immunological analysis suggests that these three polypeptides are encoded by homologous genes. Immunodetection on the overexpressed protein of the 11S globulin clone in Escherichia coli indicates that this clone encodes the precursor protein of one of the three purified 11S globulin polypeptides.

Evaluation of general practice computer templates. Lessons from a pilot randomised controlled trial.

We conducted a pilot randomised trial of computerised templates for the management of asthma and diabetes in general practice in six general practices in North London. Uptake of the guidelines by general practitioners and practice nurses was assessed using qualitative (semi-structured interviews designed to assess the users' views) and quantitative (change in use of the template during the study period) outcome measures. The practice nurses used the templates frequently but general practitioners rarely used them. Several reasons were offered for non-use of the templates, such as the length of the template and non-involvement in the care of asthma or diabetes. Despite this, however, health professionals were favourably disposed to the use of templates for general clinical care. Pilot investigations of computerised templates are best achieved by observational or quasi-experimental methods rather than a randomised controlled trial. The use of both qualitative and quantitative methods in this study allowed exploration of the barriers to use of computers.

Determination of 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid in a urine-based standard reference material by isotope-dilution liquid chromatography-mass spectrometry with electrospray ionization.

A new method is presented for the determination of 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid (THC-9-COOH) in urine-based standard reference materials (SRMs) for marijuana metabolite. This method is based on isotope-dilution liquid chromatography-mass spectrometry (LC-MS) using electrospray for ionization (ESI). An isotopically labeled compound, 5',11-nor-delta9-THC-9-carboxylic acid-d3, was used as an internal standard. Solid-phase extraction (SPE) was used to prepare samples for LC-MS analyses. LC was performed on a C18 column with an isocratic mobile phase consisting of 0.05 M of ammonium acetate in methanol/water (75:25). Electrospray ionization in the negative ion mode was used to monitor the [M-H]- ions at m/z 343 and 346 for THC-9-COOH and its labeled internal standard, respectively. Samples of SRM 1507b (THC-9-COOH in freeze-dried urine) were prepared and measured on three separate sets. The within-set coefficients of variation ranged from 0.32% to 2.77%. The correlation coefficients of the regression lines were 0.999 to 1.000. The detection limit for THC-9-COOH with this method is estimated to be 5 pg/mL. This method compared well with the gas chromatography-mass spectrometry method used for certification, and results were within the certified values of THC-9-COOH for SRM 1507b.

Certification of phencyclidine in lyophilized human urine reference materials.

The National Institute of Standards and Technology (formerly the National Bureau of Standards), in cooperation with the College of American Pathologists (CAP), has certified the concentrations of phencyclidine (PCP) in two new reference materials (RMs). One of these materials is Standard Reference Material (SRM) 1511, Multidrugs of Abuse in Freeze-dried Urine, and the other material is a CAP PCP RM. In order to minimize the possibility of undetected bias, two independent analytical methods, employing gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry, were used to certify PCP in these materials. Results from the two methods were in good agreement and were statistically combined to yield certified values of 23.8 ng/mL for PCP in SRM 1511 and 11.9, 23.4, and 49.5 ng/mL for three levels of PCP in the CAP RM. A round-robin study of SRM 1511 among five military laboratories demonstrated the suitability of the SRM for its intended purpose.

The certification of morphine and codeine in a human urine standard reference material.

The National Institute of Standards and Technology (NIST, formerly the National Bureau of Standards) has developed and certified a Standard Reference Material, SRM 2381, for use in testing for bias in determinations of morphine and codeine in human urine. Each unit of this SRM consists of three vials with different levels of morphine and codeine in lyophilized urine. Three different analytical methods, employing GC/MS, LC/MS, and MS/MS, were used to certify the concentrations of each analyte. Results from the three methods were in good agreement and, therefore, were statistically combined to yield certified values of 138, 293, and 578 ng/mL for morphine and 134, 283, and 591 for codeine. A round-robin study on this material among nine military laboratories demonstrated the suitability of the SRM for its intended purpose.

The certification of cocaine and benzoylecgonine in a human urine standard reference material.

The concentrations of cocaine and benzoylecgonine (BE) in Standard Reference Material (SRM) 1508, cocaine and metabolites in freeze-dried human urine, were determined at the National Institute of Standards and Technology (NIST, formerly NBS) by two independent methods. For cocaine, one method was based on gas chromatography/mass spectrometry (GC/MS); the other was based on high-performance liquid chromatography (HPLC). For BE, one method was based on GC/MS; the other was based on flow injection analysis/thermospray mass spectrometry (FIA/MS). The results for each pair of methods were statistically evaluated. Concentrations were determined in the SRM for three levels of cocaine and three levels of benzoylecgonine. Methylecgonine, although present in the material, was not determined. For cocaine, the concentrations were 90, 263, and 429 ng/mL of human urine. For BE, the concentrations were 103, 259, and 510 ng/mL of human urine.

Manipulating biological samples for environmental scanning electron microscopy observation.

Biological samples having different characteristics were observed by environmental scanning electron microscopy (ESEM). The environmental conditions for untreated biological samples was determined by optimizing sample temperature and chamber pressure. When the temperature was at 4 degrees - 6 degrees C and chamber pressure was 5.2-5.9 Torr, the relative humidity in the specimen chamber was about 85%. Under these conditions, the surface features of the sample were completely exposed and did not exhibit charging. The images obtained from the untreated samples at different ESEM conditions were also compared with fixed and coated samples observed under high vacuum.

Promoting physical activity in general practice: should prescribed exercise be free?

In the UK there are numerous schemes whereby general practitioners can prescribe exercise programmes, usually based in leisure centres. Of the factors that discourage adherence to such programmes in the USA, cost has proved important. We collected demographic and questionnaire data from 152 inner-London patients (108 women, 44 men) before they started an exercise programme on a National Health Service prescription, and analysed the results according to whether they dropped out of the programme (78%) or not. Use of logistic regression revealed only one previous barrier to exercise, 'not knowing about local exercise facilities', as a significant positive determinant of adherence (adjusted odds ratio 3.51, 95% confidence interval, 1.04 to 11.86). For 'lack of money' patients were more likely to drop out of the programme (adjusted odds ratio 0.25, 95% CI 0.07-0.85). The very low cost of participation in this scheme, did not encourage adherence, particularly by those who had cited 'lack of money' as a previous barrier. The case of making prescribed exercise free or even low-cost remains unproven.

Are elderly people living alone an at risk group?

OBJECTIVE: To test the hypothesis that elderly people living alone are an at risk group with a high level of morbidity that makes high demands on health and social services. DESIGN: Secondary analysis of data from a community survey of 239 people aged 75 and over, identified from general practitioners' age-sex registers. SETTING: Nine practices in the London boroughs of Brent and Islington. MAIN OUTCOME MEASURES: Scores on the mini-mental state examination; stated satisfaction with life; assessment of mobility; numbers of diagnoses of major physical problems; numbers of prescribed drugs taken; urinary incontinence; alcohol consumption; contacts with general practitioners and hospital outpatient and inpatient services; contact with community health and social services. RESULTS: There were significantly more women among those living alone (93/120 (78%) v 63/119 (53%); p < 0.0005) and the median age of elderly people living alone was higher (81 v 80; p < 0.04). Those living alone and those living with others showed no significant differences in measures of cognitive impairment, numbers of major physical diagnoses, impaired mobility, or use of general practitioner or hospital services. Stated satisfaction with life was somewhat higher in those living alone. Elderly people living alone were significantly more likely to have contact with chiropody, home help, and meals on wheels services and less likely to have someone they could contact in an emergency or at night. Living alone increased the likelihood of contact with one or more community health professionals (district nurses, health visitors, or chiropodists) considered as a group and also increased the likelihood of contact with social services as a whole. There was a tendency for more of those living alone than those living with others to have home visits from their general practitioners, but there were no significant differences in contact with hospital services between the two groups. CONCLUSIONS: Elderly people living alone do not have an excess of morbidity compared with those living with others and do not seem to be an at risk group requiring specifically targeted assessments. More help is needed to provide elderly people living alone with a point of contact in case of emergency.

Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care.

OBJECTIVE: To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes. DESIGN: Randomised controlled trial. SETTING: 26 general practices in the United Kingdom. PARTICIPANTS: 205 women considering hormone replacement therapy. INTERVENTION: Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES: Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status. RESULTS: Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used. CONCLUSIONS: An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.

Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care.

OBJECTIVE: To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use. DESIGN: Randomised controlled trial. SETTING: 33 general practices in the United Kingdom. PARTICIPANTS: 112 men with benign prostatic hypertrophy. INTERVENTION: Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES: Patients' and general practitioners' perceptions of who made the decision, decisional conflict scores, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status. RESULTS: Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%, 95% confidence interval 14% to 41%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months (2.3 v 2.6; -0.3, -0.5 to -0.1, P<0.01) and this was maintained at nine months. No differences were found between the groups for anxiety, general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment). CONCLUSIONS: The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply by the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.

A multidisciplinary approach for improving services in primary care: randomised controlled trial of screening for haemoglobin disorders.

OBJECTIVE: To investigate the feasibility of improving screening for carriers of haemoglobin disorders in general practice by using a nurse facilitator to work with primary care teams and the relevant haematology laboratories; to identify problems in communication between all those involved in delivering the service, and to implement solutions. DESIGN: Two year, practice based randomised controlled trial. SETTING: North London area where 29% of residents and 43% of births are in ethnic groups at risk for haemoglobin disorders. SUBJECTS: 26 of the 93 practices using the services of the area's haematology laboratory agreed to take part and were randomly divided into control and intervention practices. MAIN OUTCOME MEASURE: Change in number of requests for screening tests for haemoglobin disorders made by control and intervention practices in baseline and intervention years. RESULTS: The number of screening tests requested varied from 0-150 in the 93 practices in the baseline year. Study practices tended to have made a moderate number of requests (10-50) during this period. During the intervention year intervention practices made 292 more requests (99% increase) and control practices made 74 fewer requests (23% decrease; P=0.001 for difference in median change). Four practices, three of which were singlehanded, accounted for 75% of the increase. The number of requests from intervention practices, adjusted for baseline requests, was 3.2 times higher than control practices (P<0.0001). CONCLUSION: General practitioners and practice nurses are willing to undertake a new genetic screening service (or expand an existing one) if they are persuaded that it benefits the health of a significant proportion of their practice population. They need appropriate tools (for example, information materials for carriers and groups at risk), and the laboratory must be sensitive to their needs. Preconceptional carrier screening and counselling need to be coupled with antenatal screening.