Intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis.

INTRODUCTION: The efficacy of intravenous immunoglobulin (IVIg) for toxic epidermal necrolysis (TEN) remains controversial, particularly for high-dose IVIg. In the present study, we conducted a SCORTEN (SCORe of Toxic Epidermal Necrosis)-based standardized mortality ratio (SMR) meta-analysis, with a focus on the efficacy of high-dose IVIg. EVIDENCE ACQUISITION: A systematic review and meta-analysis of the literature published between January 01, 2000 and April 30, 2016 was conducted. Studies with >9 TEN patients receiving IVIg treatment with SCORTEN scores were included. EVIDENCE SYNTHESIS: Mortality rate and pooled SMR were calculated for all TEN patients and adult TEN patients receiving IVIg. Eleven studies met the inclusion criteria. The overall mortality rate of TEN patients treated with IVIg was 24.2%, with a pooled SMR of 1.00 (95% CI, 0.76-1.32; I2=0%, P=0.67). The mortality rate among adult patients treated with high-dose IVIg was 11.7%. Sub-analysis of adult patients treated with high-dose IVIg showed a pooled SMR of 0.99 (95% CI, 0.60-1.63; I2=0%, P=0.78). CONCLUSIONS: The findings of the present meta-analysis do not support the clinical benefits of IVIg for TEN, even at high-doses. Additional randomized controlled trials are required to validate this result.

A photoionization mass spectroscopic study on the formation of phosphanes in low temperature phosphine ices.

Isovalency rationalizes fundamental chemical properties of elements in the same group, but often fails to account for differences in the molecular structure due to the distinct atomic sizes and electron-pair repulsion of the isovalent atoms. With respect to main group V, saturated hydrides of nitrogen are limited to ammonia (NH3) and hydrazine (N2H4) along with ionic and/or metal-bound triazene (N3H5) and potentially tetrazene (N4H6). Here, we present a novel approach for synthesizing and detecting phosphanes formed via non-classical synthesis exploiting irradiation of phosphine ices with energetic electrons, subliming the newly formed phosphanes via fractionated sublimation, and detecting these species via reflectron time-of-flight mass spectrometry (ReTOF) coupled with vacuum ultraviolet (VUV) single photon ionization. This approach is able to synthesize, to separate, and to detect phosphanes as large as octaphosphane (P8H10), which far out-performs the traditional analytical tools of infrared spectroscopy and residual gas analysis via mass spectrometry coupled with electron impact ionization that could barely detect triphosphane (P3H5) thus providing an unconventional tool to prepare complex inorganic compounds such as a homologues series of phosphanes, which are difficult to synthesize via classical synthetic methods.

Proteasome inhibition reduces avian reovirus replication and apoptosis induction in cultured cells.

The interplay between avian reovirus (ARV) replication and apoptosis and proteasome pathway was studied in cultured cells. It is shown that inhibition of the proteasome did not affect viral entry and host cell translation but had influence on ARV replication and ARV-induced apoptosis. Evidence is provided to demonstrate that ubiquitin-proteasome blocked ARV replication at an early step in viral life cycle. However, viral transcription and protein translation were also reduced markedly after addition of proteasome inhibitor MG132. Treatment of BHK-21 cells with the MG132 markedly decreased virus titer as well as prevented virus-induced apoptosis. The expression of ARV proteins sigmaC, sigmaA, and sigmaNS was also reduced markedly, suggesting that suppression of virus replication is due to down-regulation of these ARV proteins by ubiquitin-proteasome system. MG132 was also shown to suppress ARV sigmaC-induced phosphrylation of p53 on serine 46, caspase 3 activities, and DNA fragmentation leading to complete inhibition of ARV-induced apoptosis.

Development of a reliable assay protocol for identification of diseases (RAPID)-bioactive amplification with probing for detection of avian reovirus.

Avian reovirus (ARV) causes several disease syndromes in poultry including arthritis, malabsorption syndrome and chronic respiratory disease that result in major economic losses. Early detection is very important for the control of the ARV-induced infections. This study was therefore aimed at developing a reliable assay protocol for identification of diseases (RAPID)-bioactive amplification with probing (BAP) assay for detection of ARV. This assay combines nested polymerase chain reaction (PCR) and magnetic bead-based DNA probing systems greatly increasing its sensitivity and specificity. Alignment of ARV S2 gene from different ARV genotypes and serotypes was done to find the highly conserved regions for primer and probe design. Two reverse transcription (RT)-PCR primer pairs, six nested PCR primer pairs, and one magnetic probe were tested to find the most specific ones for ARV detection. The optimal conditions for RT-PCR, nested PCR, and hybridization of magnetic probe were established. The optimal annealing temperatures for RT-PCR and nested PCR were 62.1 and 54.8 degrees C, respectively. The optimal hybridization temperature was 51.2 degrees C using hybridization buffer (5x SSC and 0.5% SDS). The sensitivity of the kit was 5 copies/microl of ARV genomic RNA. The kit was very specific as all negative controls failed to show any positive reactions. The kit shows good reproducibility with intra- and inter-assay coefficient of variation (CV) of 1.3 and 1.7%, respectively. In addition, different serotypes and genotypes of ARV were tested by RAPID-BAP assay to estimate the practicability of the kit in clinical samples. All of ARV serotypes and genotypes tested could be detected by this kit proving that the kit is suitable for clinical application.

The cleavage of the hemagglutinin protein of H5N2 avian influenza virus in yeast.

Influenza viruses belonging to the Orthomyxoviridae family are enveloped viruses with segmented negative sense RNA genome surrounded by a helical symmetry shell. Influenza viruses, especially the highly pathogenic avian influenza virus (HPAI) such as H5 or H7 subtype are important pathogens for the poultry industry. Due to genetic reassortments between avian and human influenza viruses, global pandemics may emerge and the naive human immunity could not be ready for them. The full-length HA-encoding gene of H5N2 AIV was inserted into a secretory pPICZalphaA vector and integrated into the genome of Pichia pastoris by heterologous recombination. The HA protein secretion into the medium was induced with methanol. Besides the expected 69kDa protein, another smaller fragment about 47kDa was recognized by an anti-AIV-HA monoclonal antibody in Western blot assay. This is the first report on the cleavage of HA(0) into HA(1) and HA(2) in the methylotrophic yeast P. pastoris. This possibly was due to digestion by proteases from P. pastoris based on the amino acid sequences at the predicted cleavage site, (326)R-X-K-R(329). With similar modifications to the eukaryotes, large quantity, proper antigenicity, and low cost, this expression system may provide a simple tool to produce HA proteins for further use in preparation of ELISA kits and subunit vaccines.

Suppression of bovine ephemeral fever virus by RNA interference.

RNA interference (RNAi) was used to suppress bovine ephemeral fever virus (BEFV). Plasmids expressing continuously shRNAs were used against G gene of BEFV to induce RNA interference in cultured cells. A GFP reporter assay was established to determine the efficiency and specificity of siRNA and the potential of BEFV to hamper RNAi. Two of five small interfering RNAs (siRNAs) were shown to suppress BEFV. Suppression of the G gene of BEFV corresponded with reduction of viral plaques and progeny titer. The results suggest that RNAi has the potential for use in suppression of BEFV infection with possible therapeutic implications.

Avian reovirus-induced apoptosis related to tissue injury.

Apoptosis plays an important role in pathogenesis of many viral infections. Infection of chicken with avian reovirus S1133 causes tissue injury related to virus-induced apoptosis. To determine whether avian reovirus (ARV) induced apoptosis in chicken tissues, six 3-week-old specific pathogen free White Leghorn chicks were inoculated with ARV S1133. Tissues were dual-labelled for the simultaneous detection of viral antigen containing and apoptotic cells. DNA laddering was detected in ARV-infected but not mock-infected chicken tissues. Dual-labelling assay revealed that the majority of antigen-expressing cells were not apoptotic. Surprisingly, some apoptotic but non-antigen-expressing cells were frequently located in the vicinity of antigen-expressing cells. Syncytium formation in ARV-infected chicken tissues undergoing apoptosis was apparent, suggesting a correlation between virus replication and apoptosis in chicken tissues.

Use of polymerase chain reaction for early detection and management of hepatitis C virus infection after needlestick injury.

Infection with hepatitis C virus (HCV) is a matter of great concern because of its potentially grave consequences. Instead of relying on the conventional anti-HCV antibody test to detect HCV infection after needlestick incidents, we used the polymerase chain reaction (PCR) to achieve earlier detection, to manage a patient more effectively, and to exclude possible infection more quickly. Fourteen incidents were studied in which the source patients were positive for both the anti-HCV antibody and HCV RNA, and the exposed subjects were negative for anti-HCV antibody at the time of the incidents. In one of the exposed subjects, a nurse, the result of the PCR test for HCV RNA was positive at 2 wk after the needlestick incident; the nurse's viral load was very low (800 copies/ml) and she responded well to immediate medical treatment. She never developed acute hepatitis C; her serum anti-HCV antibody level and alanine aminotransferase (ALT) activity did not become elevated, and results of her PCR test for HCV RNA were negative following treatment. In the other 13 needlestick incidents, the results of PCR tests of the exposed subjects were negative for HCV RNA throughout the study and possible infections were quickly ruled out.