ABSTRACT
Severe fever with thrombocytopenia syndrome virus (SFTSV) or Dabie bandavirus is an emerging pathogen responsible for SFTS. It is considered a novel threat to human health, given the high associated fatality. SFTSV is a segmented negative-strand RNA virus containing three single-stranded RNAs, with the M segment encoding the glycoproteins Gn and Gc. Gc is vital for viral entry into the host cell surface, along with the Gn protein. As the Gc is the surface-exposable antigen from virions, it is a critical diagnostic marker of infection. Although various SFTSV Gn or N protein-based sero-diagnostic methods have been developed, there are no commercially available sero-diagnostic kits. Therefore, we generated monoclonal antibodies (mAbs) against SFTSV Gc and explored their application in serum diagnostic tests to develop sensitive serodiagnostic tools covering broad-range genotypes (A to F). First, 10 SFTSV Gc antibody-binding fragments (Fabs) were isolated using a phage display system and converted into human IgGs. Enzyme-linked immunosorbent assays (ELISA) of the SFTSV and Rift Valley fever virus (RVFV: same genus as SFTSV) Gc antigens showed that all antibodies attached to the SFTSV Gc protein had high affinity. An immunofluorescence assay (IFA), to verify the cross-reactivity of seven antibodies with high affinities for various SFTSV genotypes (A, B2, B3, D, and F) and detect mAb binding with intact Gc proteins, revealed that five IgG type mAbs were bound to intact Gc proteins of various genotypes. Six high-affinity antibodies were selected using ELISA and IFA. The binding capacity of the six antibodies against the SFTSV Gc antigen was measured using surface plasmon resonance. All antibodies had high binding capacity. Consequently, these antibodies serve as valuable markers in the serological diagnosis of SFTSV.
ABSTRACT
Accurate detection of the levator scapulae muscle is critical for effective diagnostic and therapeutic interventions. The commonly used surface anatomy approach has not been validated and is less accurate than ultrasound-guided techniques. Therefore, we determined the needle insertion point for the levator scapulae using a new technique based on the anatomy of the scapula. This investigation used 15 fresh-frozen cadavers to explore the relationship between the acromial angle and medial tip of the scapular spine (O) of the scapular spine. Based on the x-axis (the distance [L] from Point O to point acromial angle) and the y-axis perpendicular to the x-axis passing through Point O, the barycentric coordinates were determined through the intersections of each axis and the superior angle of the scapula with the levator scapulae. Various ratios involving the established distance L) were ascertained, we compared the measurements and ratios between the male and female groups, and the accuracy of the new technique was compared with the conventional technique. The optimal site of the new technique was within 6 to 7% of distance L on the x-axis and 42 to 44% of distance L on the y-axis. This technique was significantly more accurate than the conventional technique (Pâ =â .006). Although ultrasound allows for accurate injections via real-time visualization, its unavailability in some cases highlights the importance of understanding surface anatomy landmarks. Our new technique, based on the anatomy of the scapula and relative measurements, is more accurate than the conventional technique. This should enable more precise detection of the levator scapulae for accurate and efficient diagnostic and therapeutic procedures.
Subject(s)
Cadaver , Scapula , Humans , Male , Female , Scapula/anatomy & histology , Scapula/diagnostic imaging , Injections, Intramuscular/methods , Aged , Aged, 80 and over , Muscle, Skeletal/anatomy & histology , Muscle, Skeletal/diagnostic imaging , Middle AgedABSTRACT
INTRODUCTION/AIMS: There are two conventional needle electromyography (EMG) approaches to the serratus anterior (SA), both of which can result in erroneous insertion into adjacent structures such as the latissimus dorsi (LD), teres major, or external oblique abdominis muscles and pose a risk of long thoracic nerve (LTN) injury. Therefore, we identified a novel needle insertion point for the SA in cadavers that avoids other muscles and LTN injury. METHODS: This study included 17 cadavers: 12 to devise the new method and 5 to verify its accuracy. Novel landmarks were the inferior angle of the scapula (I), sternal notch (S), and xiphoid process (X). The relationships of the LD, pectoralis major (PM), SA, and LTN were determined relative to these landmarks. RESULTS: When inserting a needle into the proximal one third along the line connecting points I and X, there were adequate safety margins around the LD, PM, and LTN, and the new method had excellent accuracy. DISCUSSION: Compared to the conventional midaxillary method, our novel method improved the accuracy of needle EMG of the SA. Follow-up studies using clinical imaging techniques are needed to verify whether above findings are equally applicable in living subjects.
Subject(s)
Muscle, Skeletal , Superficial Back Muscles , Humans , Electromyography/methods , Scapula/innervation , Axilla , Pectoralis Muscles/diagnostic imagingABSTRACT
Severe fever with thrombocytopenia syndrome virus was first discovered in 2009 as the causative agent of severe fever with thrombocytopenia syndrome. Despite its potential threat to public health, no prophylactic vaccine is yet available. This study developed a heterologous prime-boost strategy comprising priming with recombinant replication-deficient human adenovirus type 5 (rAd5) expressing the surface glycoprotein, Gn, and boosting with Gn protein. This vaccination regimen induced balanced Th1/Th2 immune responses and resulted in potent humoral and T cell-mediated responses in mice. It elicited high neutralizing antibody titers in both mice and non-human primates. Transcriptome analysis revealed that rAd5 and Gn proteins induced adaptive and innate immune pathways, respectively. This study provides immunological and mechanistic insight into this heterologous regimen and paves the way for future strategies against emerging infectious diseases.
Subject(s)
Adenoviruses, Human , Severe Fever with Thrombocytopenia Syndrome , Viral Vaccines , Animals , Mice , Viral Vaccines/genetics , Vaccination/methods , T-Lymphocytes , Genetic Vectors/genetics , Antibodies, Viral , Immunization, Secondary/methodsABSTRACT
The Voice Handicap Index (VHI) is a patient-centered evaluation tool specifically designed for assessing voice-related quality of life. Although the VHI has been extensively used in patients with voice disorders, its applicability in stroke patients has not been fully established. This prospective cross-sectional study aimed to investigate the feasibility of using the VHI questionnaire in identifying stroke patients with voice problems. The study included a cohort of acute to subacute first-ever stroke patients (n = 48), with or without voice problems, as well as other non-stroke patients (n = 31) who agreed to complete the VHI questionnaire. Stroke patients with self-reported voice problems demonstrated significantly higher VHI scores and poorer life quality scores compared to the control groups. These patients also had lower Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), and Euro-QoL-5D-5L (EQ-5D-5L) scores. Spearman correlation analysis revealed an inverse association between VHI scores and EQ-5D-5L (rho = -0.77, p < 0.001), Korean Mann Assessment of Swallowing Ability (rho = -0.51, p < 0.001), and other functional parameters, including the National Institutes of Health Stroke Scale, MMSE, and MBI scores. Multiple regression analysis indicated that the VHI score was the biggest contributing factor to EQ scores. This is the first study to demonstrate that stroke patients with voice problems may experience reduced quality of life, even after controlling for other confounding factors such as dysphagia or neurological deficits. Future studies are needed whether addressing these issues by implementing the VHI may facilitate the improvement of patients' quality of life.
ABSTRACT
BACKGROUND: Viral haemorrhagic fevers (VHF) cause significant economic and public health impact in Sub-Saharan Africa. Community knowledge, awareness and practices regarding such outbreaks play a pivotal role in their management and prevention. This study was carried out to assess community knowledge, attitude and practices regarding VHF in five geo-ecological zones in Tanzania. METHODS: A cross-sectional study was conducted in Buhigwe, Kalambo, Kyela, Kinondoni, Kilindi, Mvomero, Kondoa and Ukerewe districts representing five geo-ecological zones in Tanzania. Study participants were selected by multistage cluster sampling design. A semi-structured questionnaire was used to collect socio-demographic and information related to knowledge, attitude and practices regarding VHFs. Descriptive statistics and logistic regression were used for the analysis. RESULTS: A total of 2,965 individuals were involved in the study. Their mean age was 35 (SD ± 18.9) years. Females accounted for 58.2% while males 41.8%. Most of the respondents (70.6%; n = 2093) had never heard of VHF, and those who heard, over three quarters (79%) mentioned the radio as their primary source of information. Slightly over a quarter (29.4%) of the respondents were knowledgeable, 25% had a positive attitude, and 17.9% had unfavourable practice habits. The level of knowledge varied between occupation and education levels (P < 0.005). Most participants were likely to interact with a VHF survivor or take care of a person suffering from VHF (75%) or visit areas with known VHF (73%). There were increased odds of having poor practice among participants aged 36-45 years (AOR: 3.566, 95% CI: 1.593-7.821) and those living in Western, North-Eastern and Lake Victoria zones (AOR: 2.529, 95% CI: 1.071-6.657; AOR: 2.639, 95% CI: 1.130-7.580 AOR: 2.248, 95% CI: 1.073-3.844, respectively). CONCLUSION: Overall, the knowledge on VHF among communities is low, while a large proportion of individuals in the community are involved in activities that expose them to the disease pathogens in Tanzania. These findings highlight the need for strengthening health educational and promotion efforts on VHF targeting specific populations.
Subject(s)
Health Knowledge, Attitudes, Practice , Hemorrhagic Fevers, Viral , Male , Female , Humans , Adult , Tanzania/epidemiology , Cross-Sectional Studies , Hemorrhagic Fevers, Viral/epidemiology , Hemorrhagic Fevers, Viral/prevention & control , Disease Outbreaks , Surveys and QuestionnairesABSTRACT
Introduction: Despite vaccine development, the COVID-19 pandemic is ongoing due to immunity-escaping variants of concern (VOCs). Estimations of vaccine-induced protective immunity against VOCs are essential for setting proper COVID-19 vaccination policy. Methods: We performed plaque-reduction neutralizing tests (PRNTs) using sera from healthcare workers (HCWs) collected from baseline to six months after COVID-19 vaccination and from convalescent COVID-19 patients. The 20.2% of the mean PRNT titer of convalescent sera was used as 50% protective value, and the percentage of HCWs with protective immunity for each week (percent-week) was compared among vaccination groups. A correlation equation was deduced between a PRNT 50% neutralizing dose (ND50) against wild type (WT) SARS-CoV-2 and that of the Delta variant. Results: We conducted PRNTs on 1,287 serum samples from 297 HCWs (99 HCWs who received homologous ChAdOx1 vaccination (ChAd), 99 from HCWs who received homologous BNT162b2 (BNT), and 99 from HCWs who received heterologous ChAd followed by BNT (ChAd-BNT)). Using 365 serum samples from 116 convalescent COVID-19 patients, PRNT ND50 of 118.25 was derived as 50% protective value. The 6-month cumulative percentage of HCWs with protective immunity against WT SARS-CoV-2 was highest in the BNT group (2297.0 percent-week), followed by the ChAd-BNT (1576.8) and ChAd (1403.0) groups. In the inter-group comparison, protective percentage of the BNT group (median 96.0%, IQR 91.2-99.2%) was comparable to the ChAd-BNT group (median 85.4%, IQR 15.7-100%; P =0.117) and significantly higher than the ChAd group (median 60.1%, IQR 20.0-87.1%; P <0.001). When Delta PRNT was estimated using the correlation equation, protective immunity at the 6-month waning point was markedly decreased (28.3% for ChAd group, 52.5% for BNT, and 66.7% for ChAd-BNT). Conclusion: Decreased vaccine-induced protective immunity at the 6-month waning point and lesser response against the Delta variant may explain the Delta-dominated outbreak of late 2021. Follow-up studies for newly-emerging VOCs would also be needed.
Subject(s)
COVID-19 , Viral Vaccines , Antibodies, Neutralizing , Antibodies, Viral , BNT162 Vaccine , COVID-19/prevention & control , COVID-19/therapy , COVID-19 Vaccines , Cohort Studies , Humans , Immunization, Passive , Kinetics , Pandemics , Prospective Studies , Republic of Korea/epidemiology , SARS-CoV-2 , Vaccination , COVID-19 SerotherapyABSTRACT
For the clinical application of semi-quantitative anti-SARS-CoV-2 antibody tests, the analytical performance and titer correlation of the plaque reduction neutralization test (PRNT) need to be investigated. We evaluated the analytical performance and PRNT titer-correlation of one surrogate virus neutralization test (sVNT) kit and three chemiluminescent assays. We measured the total antibodies for the receptor-binding domain (RBD) of the spike protein, total antibodies for the nucleocapsid protein (NP), and IgG antibodies for the RBD. All three chemiluminescent assays showed high analytical performance for the detection of SARS-CoV-2 infection, with a sensitivity ≥ 98% and specificity ≥ 99%; those of the sVNT were slightly lower. The representativeness of the neutralizing activity of PRNT ND50 ≥ 20 was comparable among the four immunoassays (Cohen's kappa ≈ 0.80). Quantitative titer correlation for high PRNT titers of ND50 ≥ 50, 200, and 1,000 was investigated with new cut-off values; the anti-RBD IgG antibody kit showed the best performance. It also showed the best linear correlation with PRNT titer in both the acute and convalescent phases (Pearson's R 0.81 and 0.72, respectively). Due to the slowly waning titer of anti-NP antibodies, the correlation with PRNT titer at the convalescent phase was poor. In conclusion, semi-quantitative immunoassay kits targeting the RBD showed neutralizing activity that was correlated by titer; measurement of anti-NP antibodies would be useful for determining past infections.
Subject(s)
COVID-19 , Antibodies, Viral , COVID-19/diagnosis , Humans , Immunoassay , Neutralization Tests , Nucleocapsid Proteins , SARS-CoV-2ABSTRACT
BACKGROUND: In recent years there have been reports of viral haemorrhagic fever (VHF) epidemics in sub-Saharan Africa where malaria is endemic. VHF and malaria have overlapping clinical presentations making differential diagnosis a challenge. The objective of this study was to determine the prevalence of selected zoonotic VHFs and malaria co-infections among febrile patients seeking health care in Tanzania. METHODS: This facility-based cross-sectional study was carried out between June and November 2018 in Buhigwe, Kalambo, Kyela, Kilindi, Kinondoni, Kondoa, Mvomero, and Ukerewe districts in Tanzania. The study involved febrile patients seeking health care from primary healthcare facilities. Blood samples were collected and tested for infections due to malaria, Crimean-Congo haemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF) and yellow fever (YF). Malaria infections were tested using rapid diagnostics tests while exposure to VHFs was determined by screening for immunoglobulin M antibodies using commercial enzyme-linked immunosorbent assays. The Chi-square test was used to compare the proportions. RESULTS: A total of 308 participants (mean age = 35 ± 19 years) were involved in the study. Of these, 54 (17.5%) had malaria infection and 15 (4.8%) were positive for IgM antibodies against VHFs (RVF = 8; CCHF = 2; EBV = 3; MBV = 1; YF = 1). Six (1.9%) individuals had both VHF (RVF = 2; CCHF = 1; EVD = 2; MVD = 1) and malaria infections. The highest co-infection prevalence (0.6%) was observed among individuals aged 46â60 years (P < 0.05). District was significantly associated with co-infection (P < 0.05) with the highest prevalence recorded in Buhigwe (1.2%) followed by Kinondoni (0.9%) districts. Headache (100%) and muscle, bone, back and joint pains (83.3%) were the most significant complaints among those infected with both VHFs and malaria (P = 0.001). CONCLUSIONS: Co-infections of VHF and malaria are prevalent in Tanzania and affect more the older than the younger population. Since the overlapping symptoms in co-infected individuals may challenge accurate diagnosis, adequate laboratory diagnosis should be emphasized in the management of febrile illnesses.
Subject(s)
Coinfection , Hemorrhagic Fever Virus, Crimean-Congo , Hemorrhagic Fever, Crimean , Hemorrhagic Fever, Ebola , Hemorrhagic Fevers, Viral , Malaria , Adolescent , Adult , Animals , Antibodies, Viral , Coinfection/epidemiology , Cross-Sectional Studies , Delivery of Health Care , Fever/epidemiology , Fever/etiology , Hemorrhagic Fever, Crimean/epidemiology , Hemorrhagic Fevers, Viral/diagnosis , Hemorrhagic Fevers, Viral/epidemiology , Humans , Immunoglobulin M , Malaria/diagnosis , Malaria/epidemiology , Middle Aged , Tanzania/epidemiology , Young AdultABSTRACT
Severe fever with thrombocytopenia syndrome virus (SFTSV) is an emerging, tick-borne Bandavirus that causes lethal disease in humans. As there are no licensed vaccines and therapeutics for SFTSV, there is an urgent need to develop countermeasures against it. In this respect, a reverse genetics (RG) system is a powerful tool to help achieve this goal. Herein, we established a T7 RNA polymerase-driven RG system to rescue infectious clones of a Korean SFTSV human isolate entirely from complementary DNA (cDNA). To establish this system, we cloned cDNAs encoding the three antigenomic segments into transcription vectors, with each segment transcribed under the control of the T7 promoter and the hepatitis delta virus ribozyme (HdvRz) sequences. We also constructed two helper plasmids expressing the nucleoprotein (NP) or viral RNA-dependent RNA polymerase (RdRp) under the control of the T7 promoter and the encephalomyocarditis virus (EMCV) internal ribosome entry site (IRES). After co-transfection into BHK/T7-9 cells with three transcription and two helper plasmids, then passaging in Vero E6 or Huh-7 cells, we confirmed efficient rescue of the recombinant SFTSV. By evaluating the in vitro and in vivo virological properties of the parental and rescued SFTSVs, we show that the rescued virus exhibited biological properties similar to those of the parental virus. This system will be useful for identifying molecular viral determinants of SFTSV infection and pathogenesis and for facilitating the development of vaccine and antiviral approaches.
ABSTRACT
This study compared the lethality of severe acute respiratory syndrome coronavirus 2 variants belonging to the S, V, L, G, GH, and GR clades using K18-human angiotensin-converting enzyme 2 heterozygous mice. To estimate the 50% lethal dose (LD50) of each variant, increasing viral loads (100-104 plaque-forming units [PFU]) were administered intranasally. Mouse weight and survival were monitored for 14 days. The LD50 of the GH and GR clades was significantly lower than that of other clades at 50 PFU. These findings suggest that the GH and GR clades, which are prevalent worldwide, are more virulent than the other clades.
Subject(s)
Angiotensin-Converting Enzyme 2/genetics , COVID-19/mortality , Receptors, Virus/genetics , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Viral Load/genetics , Amino Acid Sequence , Angiotensin-Converting Enzyme 2/metabolism , Animals , Base Sequence , Body Weight , COVID-19/pathology , COVID-19/virology , Chlorocebus aethiops , Gene Expression , Humans , Lethal Dose 50 , Male , Mice , Mice, Transgenic , Phylogeny , Receptors, Virus/metabolism , SARS-CoV-2/classification , SARS-CoV-2/metabolism , Severity of Illness Index , Survival Analysis , Transgenes , Vero Cells , Viral Plaque Assay , VirulenceABSTRACT
OBJECTIVE: To determine the seroprevalence of selected zoonotic viral hemorrhagic fevers (VHFs) and their associated risk factors in Tanzania. METHODS: Blood samples were collected from consenting outpatients and community members in eight districts selected from five ecological zones of Tanzania. Serum was harvested and tested for the presence of immunoglobulin G (IgG) and M (IgM) antibodies against Crimean-Congo hemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF), and yellow fever (YF). RESULTS: The presence of IgM and IgG antibodies against CCHF, EVD, MVD, RVF, and YF was detected in 64 of 500 samples (12.8%). The prevalences of IgM and IgG antibodies to CCHF, EVD, MVD, RFV, and YF were 2.0%, 3.4%, 1.2%, 4.8%, and 1.4%, respectively. Contact with wild animals (OR = 1.2, CI = 1.3-1.6) and keeping goats (OR = 1.3, CI = 1.5-1.9) were significantly associated with RVF, while contact with bats (OR = 1.2, CI = 1.1-1.5) was associated with MVD. CONCLUSION: The findings of this study provide evidence of exposure to CCHF, EVD, MVD, RVF, and YF in Tanzania. Since most of these VHFs occurred without apparent clinical forms of the disease, these findings call for the need to strengthen the surveillance system and management of febrile illnesses in Tanzania.
Subject(s)
Hemorrhagic Fever Virus, Crimean-Congo , Hemorrhagic Fever, Crimean , Hemorrhagic Fevers, Viral , Rift Valley fever virus , Animals , Antibodies, Viral , Enzyme-Linked Immunosorbent Assay , Hemorrhagic Fever, Crimean/epidemiology , Risk Factors , Seroepidemiologic Studies , Tanzania/epidemiologyABSTRACT
Severe fever with thrombocytopenia syndrome (SFTS), a newly emerging tick-borne viral disease, has been detected in Asia since 2009, and person-to-person transmission is possible. SFTS is characterized by atypical signs, including mild to severe febrile illness similar to that associated with hemorrhagic fever, with 16.2 to 30% mortality. We found that the titers of neutralizing antibodies, play an important role in protective immunity, to SFTS virus (SFTSV) in survivors and healthy residents who lived in endemic areas and who were positive for SFTSV IgG, were higher than those in non-survivor patients. Moreover, the titers were maintained in surviving patients and healthy residents but not in non-surviving patients in South Korea.
Subject(s)
Bunyaviridae Infections , Phlebovirus , Severe Fever with Thrombocytopenia Syndrome , Antibodies, Neutralizing , Asia , Humans , Republic of Korea , SurvivorsABSTRACT
In order to diagnose the infectious disease from clinical samples, the various protocols such as culturing microorganism, rapid diagnostic test using chromatographic method, ELISA, conventional PCR are developed. Since a novel strain of avian influenza can be cross-infected human as well as birds and livestock due to genetic reassortment, some strains of influenza such as H7N9 and H5N1 have emerged as a severe virus which can be threaten the health of poultry as well as human. Therefore, we explored the development of simultaneously and rapid diagnostic tool for seasonal influenza (A/H1N1, A/H3N2, B) and highly pathogenic avian influenza (A/H5N1, A/H7N9). We analyzed the unique nucleotide sequences of influenza types including three seasonal influenza, A/H7N9, and A/H5N1, and distinguished each type of influenza and diagnosed through One Step RT-PCR. In the results, Chip-based PCR technique can be diagnosed rapidly and directly from naked eye with EvaGreen the influenza also respiratory specimens within 23 min 15 s, including reverse transcription. The Chip-based PCR is a point-of-care system, and it is expected to reduce diagnosis time and to develop a diagnostic kit. Furthermore the Chip based PCR technique can be used for high risk pathogen in bioterror and/or biological warfare in the field.
Subject(s)
Influenza, Human/diagnosis , Molecular Diagnostic Techniques/methods , Orthomyxoviridae/isolation & purification , Point-of-Care Systems , Polymerase Chain Reaction/methods , Humans , Orthomyxoviridae/genetics , Time FactorsABSTRACT
Peripheral or central nerve injury is a frequent cause of chronic pain and the mechanisms are not fully understood. Using newly generated transgenic mice we show that progranulin overexpression in sensory neurons attenuates neuropathic pain after sciatic nerve injury and accelerates nerve healing. A yeast-2-hybrid screen revealed putative interactions of progranulin with autophagy-related proteins, ATG12 and ATG4b. This was supported by colocalization and proteomic studies showing regulations of ATG13 and ATG4b and other members of the autophagy network, lysosomal proteins and proteins involved in endocytosis. The association of progranulin with the autophagic pathway was functionally confirmed in primary sensory neurons. Autophagy and survival were impaired in progranulin-deficient neurons and improved in progranulin overexpressing neurons. Nerve injury in vivo caused an accumulation of LC3b-EGFP positive bodies in neurons of the dorsal root ganglia and nerves suggesting an impairment of autophagic flux. Overexpression of progranulin in these neurons was associated with a reduction of the stress marker ATF3, fewer protein aggregates in the injured nerve and enhanced stump healing. At the behavioral level, further inhibition of the autophagic flux by hydroxychloroquine intensified cold and heat nociception after sciatic nerve injury and offset the pain protection provided by progranulin. We infer that progranulin may assist in removal of protein waste and thereby helps to resolve neuropathic pain after nerve injury.
Subject(s)
Autophagy/genetics , Intercellular Signaling Peptides and Proteins/metabolism , Neuralgia/pathology , Sensory Receptor Cells/metabolism , Activating Transcription Factor 3/metabolism , Animals , Apoptosis Regulatory Proteins/metabolism , Autophagy-Related Proteins/metabolism , CD11b Antigen/metabolism , Calcium-Binding Proteins/metabolism , Cysteine Endopeptidases/metabolism , Disease Models, Animal , Ganglia, Spinal/pathology , Gene Ontology , Granulins , Green Fluorescent Proteins/genetics , Green Fluorescent Proteins/metabolism , Intercellular Signaling Peptides and Proteins/genetics , Lysosomal-Associated Membrane Protein 1/metabolism , Mice , Mice, Inbred C57BL , Mice, Transgenic , Microfilament Proteins/metabolism , Microtubule-Associated Proteins/metabolism , Pain Measurement , ProgranulinsABSTRACT
World Health Organization has asserted that mental illness is the greatest overriding burden of disease in the majority of developed countries, and that the socioeconomic burden of mental disease will exceed that of cancer and cardiovascular disorders in the future. The life-time prevalence rate for mental disorders in Korea is reported at 27.6 %, which means three out of 10 adults experience mental disorders more than once throughout their lifetime. Korea's suicide rate has remained the highest among Organization for Economic Cooperation and Development (OECD) nations for 10 consecutive years, with 29.1 people out of every 100,000 having committed suicide. Nevertheless, a comprehensive study on the mental health services and the Research and Development (R&D) status in Korea is hard to find. Against this backdrop, this paper examines the mental health services and the R&D status in Korea, and examines their shortcomings and future direction. The paper discusses the mental health service system, budget and human resources, followed by the mental health R&D system and budget. And, by a comparison with other OECD countries, the areas for improvement are discussed and based on that, a future direction is suggested. This paper proposes three measures to realize mid and long-term mental health promotion services and to realize improvements in mental health R&D at the national level: first, establish a national mental health system; second, forecast demand for mental health; and third, secure and develop mental health professionals.
ABSTRACT
BACKGROUND: One of the most typical and chronic problem in Korean mental health system is the prolonged length of hospital stay. In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage of community resources, lack of care-givers' awareness and so on, there are just few mechanisms to handle this issue such as Mental Health Review Board (MHRB) which is based on Mental Health Act since 1995. However, the discharge order rate was very low and there community care system after discharge order is still very weak. CASE DESCRIPTION: The Korean government has revised the Mental Health Act in 2008 and changed the operating principals of the MHRB from a regional level to a local level to strengthen the function of MHRB. However, the discharge order rate versus the whole evaluation requests still remains at a very low level or less than 5%. And it is still very difficult to execute a discharge order against a patient whose symptoms and conditions become psychiatrically stabilized enough for discharge, due to a shortage of community care facilities and a lack of social support system. These results are exactly same with former studies. DISCUSSION: Any policies to promote psychiatric discharge including MHRB are needed to take the comprehensive factors into consideration, such as payment program, community infrastructure, increasing care-givers' acceptance and so on. CONCLUSION: Despite of the political trial of Korean government to reduce length of stay of chronic psychiatric patients, it was not successful. Still it had failed to propose a detailed policy measure in terms of the above-mentioned prerequisites. Therefore, new system and program developments including reform of payment system which reflect prior studies' recommendations are essential.
ABSTRACT
AIMS: The present study assessed the functions of the transcription factor hypoxia-inducible factor (HIF) in sensory neurons in models of acute, inflammatory, ischemic, and neuropathic pain. The alpha subunit, HIF1α, was specifically deleted in neurons of the dorsal root ganglia by mating HIF1α(fl/fl) mice with SNScre mice. RESULTS: SNS-HIF1α(-/-) mice were more sensitive to noxious heat and cold pain stimulation than were HIF1α(fl/fl) control mice. They also showed heightened first-phase nociceptive responses in the formalin and capsaicin tests with increased numbers of cFos-positive neurons in the dorsal horn, and intensified hyperalgesia in early phases after paw inflammation and hind limb ischemia/reperfusion. The behavioral cold and heat pain hypersensitivity was explained by increased calcium fluxes after transient receptor potential channel activation in primary sensory neurons of SNS-HIF1α(-/-) mice and lowered electrical activation thresholds of sensory fibers. SNS-HIF1α(-/-) mice however, developed less neuropathic pain after sciatic nerve injury, which was associated with an abrogation of HIF1-mediated gene up-regulation. INNOVATION: The results suggest that HIF1α is protective in terms of acute heat and cold pain but in case of ongoing activation in injured neurons, it may promote the development of neuropathic pain. CONCLUSION: The duality of HIF1 in pain regulation may have an impact on the side effects of drugs targeting HIF1, which are being developed, for example, as anticancer agents. Specifically, in patients with cancer neuropathy, however, temporary HIF1 inhibition might provide a welcome combination of growth and pain reduction.
Subject(s)
Cold Temperature , Hot Temperature , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Pain Threshold , Animals , Female , Hypoxia-Inducible Factor 1, alpha Subunit/deficiency , Male , Mice , Mice, KnockoutABSTRACT
Damaging of peripheral nerves may result in chronic neuropathic pain for which the likelihood is increased in the elderly. We assessed in mice if age-dependent alterations of endocannabinoids contributed to the heightened vulnerability to neuropathic pain at old age. We assessed nociception, endocannabinoids and the therapeutic efficacy of R-flurbiprofen in young and aged mice in the spared nerve injury model of neuropathic pain. R-flurbiprofen was used because it is able to reduce neuropathic pain in young mice in part by increasing anandamide. Aged mice developed stronger nociceptive hypersensitivity after sciatic nerve injury than young mice. This was associated with low anandamide levels in the dorsal root ganglia, spinal cord, thalamus and cortex, which further decreased after nerve injury. In aged mice, R-flurbiprofen had only weak antinociceptive efficacy and it failed to restore normal anandamide levels after nerve injury. In terms of the mechanisms, we found that fatty acid amide hydrolase (FAAH) which degrades anandamide, was upregulated after nerve injury at both ages, so that this upregulation likely did not account for the age-dependent differences. However, enzymes contributing to oxidative metabolism of anandamide, namely cyclooxygenase-1 and Cyp2D6, were increased in the brain of aged mice, possibly enhancing the oxidative breakdown of anandamide. This may overwhelm the capacity of R-flurbiprofen to restore anandamide homeostasis and may contribute to the heightened risk for neuropathic pain at old age.
Subject(s)
Aging , Arachidonic Acids/deficiency , Disease Models, Animal , Endocannabinoids/deficiency , Neuralgia/etiology , Peripheral Nerves/metabolism , Amidohydrolases/biosynthesis , Amidohydrolases/metabolism , Animals , Arachidonic Acids/metabolism , Behavior, Animal/drug effects , Brain/drug effects , Brain/growth & development , Brain/metabolism , Cyclooxygenase 1/biosynthesis , Cyclooxygenase 1/metabolism , Cyclooxygenase Inhibitors/blood , Cyclooxygenase Inhibitors/pharmacokinetics , Cyclooxygenase Inhibitors/therapeutic use , Cytochrome P-450 CYP2D6/biosynthesis , Cytochrome P-450 CYP2D6/metabolism , Endocannabinoids/metabolism , Enzyme Induction , Flurbiprofen/blood , Flurbiprofen/pharmacokinetics , Flurbiprofen/therapeutic use , Male , Membrane Proteins/biosynthesis , Membrane Proteins/metabolism , Mice , Mice, Inbred C57BL , Nerve Tissue Proteins/biosynthesis , Nerve Tissue Proteins/metabolism , Neuralgia/blood , Neuralgia/drug therapy , Neuralgia/metabolism , Peripheral Nerves/drug effects , Peripheral Nerves/growth & development , Polyunsaturated Alkamides/metabolism , Spinal Cord/drug effects , Spinal Cord/growth & development , Spinal Cord/metabolism , StereoisomerismABSTRACT
GTP cyclohydrolase (GCH1) is the key-enzyme to produce the essential enzyme cofactor, tetrahydrobiopterin. The byproduct, neopterin is increased in advanced human cancer and used as cancer-biomarker, suggesting that pathologically increased GCH1 activity may promote tumor growth. We found that inhibition or silencing of GCH1 reduced tumor cell proliferation and survival and the tube formation of human umbilical vein endothelial cells, which upon hypoxia increased GCH1 and endothelial NOS expression, the latter prevented by inhibition of GCH1. In nude mice xenografted with HT29-Luc colon cancer cells GCH1 inhibition reduced tumor growth and angiogenesis, determined by in vivo luciferase and near-infrared imaging of newly formed blood vessels. The treatment with the GCH1 inhibitor shifted the phenotype of tumor associated macrophages from the proangiogenic M2 towards M1, accompanied with a shift of plasma chemokine profiles towards tumor-attacking chemokines including CXCL10 and RANTES. GCH1 expression was increased in mouse AOM/DSS-induced colon tumors and in high grade human colon and skin cancer and oppositely, the growth of GCH1-deficient HT29-Luc tumor cells in mice was strongly reduced. The data suggest that GCH1 inhibition reduces tumor growth by (i) direct killing of tumor cells, (ii) by inhibiting angiogenesis, and (iii) by enhancing the antitumoral immune response.