Pathogenicity of severe fever with thrombocytopenia syndrome virus in mice regulated in type I interferon signaling Severe fever with thrombocytopenia and type I interferon / 한국실험동물학회지

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonotic disease, which causes high fever, thrombocytopenia, and death in humans and animals in East Asian countries. The pathogenicity of SFTS virus (SFTSV) remains unclear. We intraperitoneally infected three groups of mice: wild-type (WT), mice treated with blocking anti-type I interferon (IFN)-α receptor antibody (IFNAR Ab), and IFNAR knockout (IFNAR−/−) mice, with four doses of SFTSV (KH1, 5 × 105 to 5 × 102 FAID50). The WT mice survived all SFTSV infective doses. The IFNAR Ab mice died within 7 days post-infection (dpi) with all doses of SFTSV except that the mice were infected with 5 × 102 FAID50 SFTSV. The IFNAR−/− mice died after infection with all doses of SFTSV within four dpi. No SFTSV infection caused hyperthermia in any mice, whereas all the dead mice showed hypothermia and weight loss. In the WT mice, SFTSV RNA was detected in the eyes, oral swabs, urine, and feces at 5 dpi. Similar patterns were observed in the IFNAR Ab and IFNAR−/− mice after 3 dpi, but not in feces. The IFNAR Ab mice showed viral shedding until 7 dpi. The SFTSV RNA loads were higher in organs of the IFNAR−/− mice compared to the other groups. Histopathologically,coagulation necrosis and mononuclear inflammatory cell infiltration in the liver and white pulp atrophy in the spleen were seen as the main lesions in the IFN signaling lacking mice. Immunohistochemically, SFTSV antigens were mainly detected in the marginal zone of the white pulp of the spleen in all groups of mice, but more viral antigens were observed in the spleen of the IFNAR−/− mice. Collectively, the IFN signaling-deficient mice were highly susceptible to SFTSV and more viral burden could be demonstrated in various excreta and organs of the mice when IFN signaling was inhibited.

Pathogenicity of severe fever with thrombocytopenia syndrome virus in mice regulated in type I interferon signaling Severe fever with thrombocytopenia and type I interferon / 한국실험동물학회지

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonotic disease, which causes high fever, thrombocytopenia, and death in humans and animals in East Asian countries. The pathogenicity of SFTS virus (SFTSV) remains unclear. We intraperitoneally infected three groups of mice: wild-type (WT), mice treated with blocking anti-type I interferon (IFN)-α receptor antibody (IFNAR Ab), and IFNAR knockout (IFNAR−/−) mice, with four doses of SFTSV (KH1, 5 × 105 to 5 × 102 FAID50). The WT mice survived all SFTSV infective doses. The IFNAR Ab mice died within 7 days post-infection (dpi) with all doses of SFTSV except that the mice were infected with 5 × 102 FAID50 SFTSV. The IFNAR−/− mice died after infection with all doses of SFTSV within four dpi. No SFTSV infection caused hyperthermia in any mice, whereas all the dead mice showed hypothermia and weight loss. In the WT mice, SFTSV RNA was detected in the eyes, oral swabs, urine, and feces at 5 dpi. Similar patterns were observed in the IFNAR Ab and IFNAR−/− mice after 3 dpi, but not in feces. The IFNAR Ab mice showed viral shedding until 7 dpi. The SFTSV RNA loads were higher in organs of the IFNAR−/− mice compared to the other groups. Histopathologically,coagulation necrosis and mononuclear inflammatory cell infiltration in the liver and white pulp atrophy in the spleen were seen as the main lesions in the IFN signaling lacking mice. Immunohistochemically, SFTSV antigens were mainly detected in the marginal zone of the white pulp of the spleen in all groups of mice, but more viral antigens were observed in the spleen of the IFNAR−/− mice. Collectively, the IFN signaling-deficient mice were highly susceptible to SFTSV and more viral burden could be demonstrated in various excreta and organs of the mice when IFN signaling was inhibited.

A Case of Recurrent Urticaria Due to Formaldehyde Release from Root-Canal Disinfectant

Although formaldehyde is well known to cause type 4 hypersensitivity, immunoglobulin E (IgE)-mediated hypersensitivity to formaldehyde is rare. Here, we report a case of recurrent generalized urticaria after endodontic treatment using a para-formaldehyde (PFA)-containing root canal sealant and present a review of previous studies describing cases of immediate hypersensitivity reactions to formaldehyde. A 50-year-old man visited our allergy clinic for recurrent generalized urticaria several hours after endodontic treatment. Prick tests to latex, lidocaine, and formaldehyde showed negative reactions. However, swelling and redness at the prick site continued for several days. The level of formaldehyde-specific IgE was high (class 4). Thus, the patient was deemed to have experienced an IgE-mediated hypersensitivity reaction caused by the PFA used in the root canal disinfectant. Accordingly, we suggest that physicians should pay attention to type I hypersensitivity reactions to root canal disinfectants, even if the symptoms occur several hours after exposure.

Acebrophylline-induced generalized fixed drug eruption confirmed by an oral provocation test

The diagnosis of fixed drug eruption is straightforward because of characteristic findings, including recurrence of similar lesions at the same site and healing with residual hyperpigmentation. However, generalized or multiple fixed drug eruption, a rare variant form, can be a diagnostic challenge. Acebrophylline is a widely prescribed oral bronchodilator with mucosecretolyic and anti-inflammatory activity and is known to be relatively safe. A 34-year-old woman presented with recurrent numerous erythematous patches after ingestion of cold medications containing clarithromycin, loxoprofen, acebrophylline, and pseudoephedrine. Skin biopsy results showed vacuolar degeneration of the basal cell layer, scattered necrotic keratinocytes in the epidermis, and perivascular lymphohistiocytic infiltration in the upper dermis. A patch test showed negative results. However, in an oral challenge with acebrophylline 3 hours later, lesions reappeared at the same sites. To the best of our knowledge, this is the first case report of acebrophylline-induced generalized fixed drug eruption.

Comparison of Injury Patterns between All-terrain Vehicles and Motorbike Riders in Jeju Island

PURPOSE: As the usage rate of all-terrain vehicles (ATV) the number of injuries caused by ATVs is also surging. This has led to an increase in social attention to the safety of ATVs and the law for ATV safety standards was revised in 2009 and 2011. The purpose of this study was to evaluate the characteristics of ATV injury compared with motorbike injury after implementation of the ATV safety policy. METHODS: A retrospective cross-sectional observation study was conducted using emergent department (ED)-based indepth injury surveillance system data from 2011 January to 2014 December. Demographics, injury-related characteristics, injury severity, and outcomes of patients related to ATV and motorbike injury visiting our ED were analyzed. Multivariate logistic regression was used for major adverse event (MAE), which was defined as any intensive care, emergent operation, or death between ATV and motorbike related injury adjusted for covariates. RESULTS: During the study period, there were 101 ATV- and 584 motorbike-related injuries. Females had more ATV-related injuries (63.4% vs 32.9%, p<0.001) during leisure activities (93.1%) with higher helmet usage (73.3% vs 62.0%, p=0.01) and lower usage in terms of emergency medical service (23.8% vs 46.4%, p<0.001), automobile insurance (10.9% vs 54.1%, p<0.001) compared with motorbike-related injuries. MAE in ATV-related injuries was less likely in a univariate logistic model (unadjusted odd ratios [ORs] 0.489, 95% confidential intervals [Cis] 0.282 to 0.848), but the multivariate logistic model showed no significant difference (adjusted ORs 1.018, 95% CIs 0.376 to 1.414). CONCLUSION: Results of this study showed no significant difference in occurrence of clinical major adverse events between motorbikes and ATVs-related injury on Jeju Island. However, considering the high injury prevalence in young age, female, and passengers during leisure activities, development of an education and injury prevention program will be needed for this vulnerable population.

Inactivation of 2009 Pandemic Human Influenza A Virus H1N1 by Photocatalyst Under UV Irradiation

A large-scale pandemic by human influenza virus H1N1 in 2009 caused severe health, social, and economic impacts. In this study, a photocatalyst technology based on TiO2, was evaluated for inactivation of a human influenza virus H1N1 isolated from a patient. The virus titer was reduced by 103.16-fold within 24 h and more than 104.31-fold inactivation within 48 h and 72 h. These results suggest that the tested photocatalyst technology based on TiO2 can be used for reduction of influenza A virus adherence to other surfaces with Hizen-s inside diverse buildings, enabling effective control of its indirect contact infection. The photocatalyst is expected also to reduce level of the aerosol transmission of the virus.

Can an EMT Apply the Ottawa Ankle Rules to Patients with Ankle Injury?

PURPOSE: The Ottawa ankle rule (OAR) is a clinical decision rule to detect bony injury in patients with a recent ankle injury. We evaluated the ability of emergency medical technicians (EMTs) to accurately apply and interpret the OAR. METHODS: This prospective study was done from October 2009 to February 2010 in a secondary teaching hospital. Patients >18 years of age presenting at the emergency department within 48 hours of a single ankle injury were included. Seven EMTs and three emergency medicine residents were trained in the application of the OAR through one hour educational session prior to this study. They examined the patient's ankle and recorded the data separately. Sensitivity and specificity of the OAR and interobserver agreement using the Kappa statistic were determined. RESULTS: Fifty-one patients were enrolled, mean age was 40.9 years, and 33 (64.7%) were male. Substantial to good agreement were found for all criteria of the OAR (p<0.001). The sensitivity of the OAR was 100% with a specificity of 27.8% in both of them. CONCLUSION: To the best of our knowledge, our study is the first to assess the ability of EMTs working in an emergency center to evaluate and interpret the OAR in adult patients with acute ankle injury. Even less-experienced EMTs can accurately apply and interpret the OAR. The incorporation of the OAR into the EMT's assessment of ankle-injury patients may be a useful physical examination tool for prehospital and hospital triage.

Antibody Production of Baculovirus-expressed VP6 from Porcine Group C Rotavirus

The emerging pathogen, group C rotavirus (RVC) has been reported to cause acute diarrhea. But there was the limitation on the detection and monitoring for the absence of rapid sensitive diagnosis system. For the molecular biology study and diagnostic system development, we could detect porcine RVC by reverse transcriptase PCR (RT-PCR) analyses from 60 diarrheal disease porcine stool samples. VP6 full length RT-PCR product (CA-2 RVC, 1352 bp) was cloned and compared the nucleotide and deduced amino acid sequences with those of previously reported other porcine, human, and bovine rotavirus group A, B and C strains. Analyses data showed >82% homology on the nucleotide sequences and >90% homology on the deduced amino acid sequences with other RVCs. Recombinant baculovirus was prepared with cloned PCR product corresponding to VP6 coding sequence (CDS) (position 22~1206) into BaculoDirect(TM) C-term linear DNA, and used for the transfection of insect cells. The polyclonal antibody was produced from mice with purified recombinant VP6 and confirmed with western blot. Both of VP6 antigen and antibody, are useful for the development of rapid diagnostic system against RVC.

Antiviral Activity of Lactobacillus spp. and Polysaccharide

Lactobacillus species have been widely used in both human and animals to prevent or treat gastrointestinal disorders. Recently, it was reported that Lactobacillus spp. inhibited infections by respiratory and gastroenteric viruses; however, its mechanism is not clear. Lactobacillus spp. play direct and indirect roles in the inhibitory effects of viral replication. 1) In vitro study: Highest protection effects were showed with the known probiotics L. rhamnosus GG (LGG) and L. casei Shirota against both rotavirus (RV) and transmissible gastroenteritis virus (TGEV). 2) In vivo study: L. acidophilus had significant immunopotentiating effects, and was therefore recommended for use as a safe oral adjuvant for rotavirus vaccines in pigs. Oral administration of lactobacilli, such as LGG and L. gasseri, might protect a host animal from influenza virus (IFV) infection. Polysaccharides are regarded to be potentially useful and biologically active as an ingredient for pharmaceutical uses due to a variety of biological activities. Especially, sulphated polysaccharides exhibit broad-spectrum antiviral activity against enveloped viruses in vitro. With respect to human immunodeficiency virus type 1 (HIV-1), its in vitro antiviral activity is, specifically, the inhibition of virus-cell attachment, the first step in the infection process. Recently, it was reported that sulphated polysaccharides exhibited antiviral activity against HBV, HCMV, HSV and IFV. In conclusion, Lactobacillus spp. and polysaccharides with antiviral activity against diverse viruses are potential candidates as ingredients for probiotics and medicine candidate for the prevention and treatment of viral infections in animals and humans.

A Case of Penetrating Eye Injury Induced by Taser Gun

Taser guns are considered less lethal weapon than pistols. However, several cases and animal experiments reported injuries associated with Taser guns. This report describes the case of a patient who suffered a penetrating eye injury after being shot by a Taser gun. It is important for the emergency physician to understand potential injuries that can be caused by Taser guns.

PANSS and Cognition Change in D-Cycloserine Compination Treatment of Schizophrenia / 대한정신약물학회지

OBJECTIVE: Recently, there are many reports that glutamate receptors have close relationships with a pathophysiology of schizophrenia. The purpose of this study was to assess the effects of D-cycloserine, which is glycine site partial agonist in NMDA receptor on psychopathologic symptoms and cognitive functions. METHODS: This study was done for chronic schizophrenic inpatients taking typical antipsychotics for more than 4 months. Exclusion criteria were patients with over 8 points according to Simpson-Angus scale for EPS or those with over 17 points of Hamilton Depression Scale. Patients were randomized to classify into two groups; D-cycloserine group (n=13) and placebo group (n=13). Each group received D-cycloserine 100 mg or placebo separately for 8 weeks. Psychopathology was evaluated with PANSS at baseline, 2nd week, fourth week and eighth week. Cognitive function was evaluated with KWIS at baseline and eighth week. RESULTS: Total 26 patients completed this trial. The average period of morbidity was 10.39+/-3.87 years and the average doses of antipsychotic was 1228.35+/-720.30 mg based on chlorpromazine equivalent. In positive subscale, negative subscale, general psychopathology subscale, total PANSS scale and KWIS, there were no significant differences between D-cycloserine and placebo groups. However, negative subscale scores had decreased from 24.92+/-3.64 (Baseline) to 23.46+/-3.41 (week 8) (p=0.077). CONCLUSION: There were no clear changes in positive symptom, negative symptom, memory, language function, and performance intelligence when D-cycloserine 100 mg was given with antipsychotic medication. However, some patients showed clear improvement in negative symptom, especially blunted affect. Therefore, D-cycloserine combination therapy could be effective for negative symptom. In future, study that can show effectiveness in psychopathology and cognitive function according to drug dosage is needed.

The Effect of Caudal Block with Morphine Sulfate on Postoperative Pain Levels in Lumbar Spinal Surgery

In 38 of 70 patients who underwent lumbar spinal surgery, we performed a randomized, prospective double-blind study of the effect of caudal block with morphine sulfate on postoperative pain levels. Age, sex, clinical features, postoperative analgesic consumption, pain score, adverse effects and patient satisfaction on discharge were recorded. The consumption of parenteral analgesics on the 1st, 2nd and 3rd days was significantly lower in the morphine sulfate group(p<0.05), than in the control group. Caudal block with morphine sulfate also led to marked reductions in pain levels and thus increases patients satisfaction during the postoperative period(p<0.05). Transient respiratory depression occurred in three of 38 patients(7.9%), but further treatment was not needed. Seventeen patients(44.7%) developed urinary retention, but this recovered spontaneously. The present study demonstrates that caudal block with morphine sulfate leads to a highly significant reduction in pain during postoperative periods and a corresponding reduction in the need for additional postoperative analgesics, in addition, patients are more satisfied.