An international inter-laboratory study to compare digital PCR with ISO standardized qPCR assays for the detection of norovirus GI and GII in oyster tissue

An optimized digital RT-PCR (RT-dPCR) assay for the detection of human norovirus GI and GII RNA was compared with ISO 15216-conform quantitative real-time RT-PCR (RT-qPCR) assays in an interlaboratory study (ILS) among eight laboratories. A duplex GI/GII RT-dPCR assay, based on the ISO 15216-oligonucleotides, was used on a Bio-Rad QX200 platform by six laboratories. Adapted assays for Qiagen Qiacuity or ThermoFisher QuantStudio 3D were used by one laboratory each. The ILS comprised quantification of norovirus RNA in the absence of matrix and in oyster tissue samples. On average, results of the RT-dPCR assays were very similar to those obtained by RT-qPCR assays. The coefficient of variation (CV%) of norovirus GI results was, however, much lower for RT-dPCR than for RT-qPCR in intra-laboratory replicates (eight runs) and between the eight laboratories. The CV% of norovirus GII results was in the same range for both detection formats. Had in-house prepared dsDNA standards been used, the CV% of norovirus GII could have been in favor of the RT-dPCR assay. The ratio between RT-dPCR and RT-qPCR results varied per laboratory, despite using the distributed RT-qPCR dsDNA standards. The study indicates that the RT-dPCR assay is likely to increase uniformity of quantitative results between laboratories.

Temperature Dependent Depuration of Norovirus GII and Tulane Virus from Oysters (Crassostrea gigas)

Raw oysters are considered a culinary delicacy but are frequently the culprit in food-borne norovirus (NoV) infections. As commercial depuration procedures are currently unable to efficiently eliminate NoV from oysters, an optimisation of the process should be considered. This study addresses the ability of elevated water temperatures to enhance the elimination of NoV and Tulane virus (TuV) from Pacific oysters (Crassostrea gigas). Both viruses were experimentally bioaccumulated in oysters, which were thereafter depurated at 12 °C and 17 °C for 4 weeks. Infectious TuV and viral RNA were monitored weekly for 28 days by TCID₅₀ and (PMAxx-) RT-qPCR, respectively. TuV RNA was more persistent than NoV and decreased by < 0.5 log₁₀ after 14 days, while NoV reductions were already > 1.0 log₁₀ at this time. For RT-qPCR there was no detectable benefit of elevated water temperatures or PMAxx for either virus (p > 0.05). TuV TCID₅₀ decreased steadily, and reductions were significantly different between the two temperatures (p < 0.001). This was most evident on days 14 and 21 when reductions at 17 °C were 1.3-1.7 log₁₀ higher than at 12 °C. After 3 weeks, reductions > 3.0 log₁₀ were observed at 17 °C, while at 12 °C reductions did not exceed 1.9 log₁₀. The length of depuration also had an influence on virus numbers. TuV reductions increased from < 1.0 log₁₀ after seven days to > 4.0 log₁₀ after 4 weeks. This implies that an extension of the depuration period to more than seven days, possibly in combination with elevated water temperatures, may be beneficial for the inactivation and removal of viral pathogens.

30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre

INTRODUCTION

Advances in surgical and anaesthesia technique have reduced length of stay for lumbar discectomy. Current evidence suggests that daycase surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. We present our microdiscectomy daycase protocol, together with 30-day postoperative complication rates and patient reported outcomes in an NHS setting.

METHODS AND METHODS

We retrospectively studied all patients that met a locally agreed daycase protocol for lumbar microdiscectomy and were operated upon and discharged on the same calendar day between 1 March 2013 and 31 December 2015.

RESULTS

A total of 134 patients underwent primary daycase microdiscectomy (70 males, 64 females). The cohort had a mean age of 41 years (range 16-82 years). Some 96% (n = 129) were single-level procedures, 93% were unilateral (n = 125) and 81% (n = 109) took place at either L4/L5 or L5/S1. All patients were discharged on the same day as admission and operation. Four patients re-presented to hospital within 30 days and three were discharged from the emergency department within four hours following a clinical review. One patient required an inpatient stay for a washout of a superficial postoperative infection. Significant improvements (P < 0.05) were found postoperatively for back pain and leg pain on self-reported visual analogue scores and Oswestry Disability Index.

CONCLUSION

In this study, we present a safe and effective protocol for day case lumbar microdiscectomy. Our 30-day postoperative complication rate of under 1% is comparable to that of traditional inpatient primary lumbar microdiscectomy. Patient-reported outcome measures revealed significant improvement in both pain and functional scores.

Single primer isothermal amplification (SPIA) combined with next generation sequencing provides complete bovine coronavirus genome coverage and higher sequence depth compared to sequence-independent single primer amplification (SISPA)

Coronaviruses are of major importance for both animal and human health. With the emergence of novel coronaviruses such as SARS and MERS, the need for fast genome characterisation is ever so important. Further, in order to understand the influence of quasispecies of these viruses in relation to biology, techniques for deep-sequence and full-length viral genome analysis are needed. In the present study, we compared the efficiency of two sequence-independent approaches [sequence-independent single primer amplification (SISPA) and single primer isothermal amplification (SPIA, represented by the Ovation kit)] coupled with high-throughput sequencing to generate the full-length genome of bovine coronavirus (BCoV) from a nasal swab. Both methods achieved high genome coverage (100% for SPIA and 99% for SISPA), however, there was a clear difference in the percentage of reads that mapped to BCoV. While approximately 45% of the Ovation reads mapped to BCoV (sequence depth of 169–284 944), only 0.07% of the SISPA reads (sequence depth of 0–249) mapped to the reference genome. Although BCoV was the focus of the study we also identified a bovine rhinitis B virus (BRBV) in the data sets. The trend for this virus was similar to that observed for BCoV regarding Ovation vs. SISPA, but with fewer sequences mapping to BRBV due to a lower amount of this virus. In summary, the SPIA approach used in this study produced coverage of the entire BCoV (high copy number) and BRBV (low copy number) and a high sequence/genome depth compared to SISPA. Although this is a limited study, the results indicate that the Ovation method could be a preferred approach for full genome sequencing if a low copy number of viral RNA is expected and if high sequence depth is desired.

Ocular Lesions in Red-Tailed Hawks (Buteo jamaicensis) With Naturally Acquired West Nile Disease

Ocular lesions are common in red-tailed hawks with West Nile (WN) disease. These lesions consist of pectenitis, choroidal or retinal inflammation, or retinal necrosis, but detailed investigation of the ocular lesions is lacking. Postmortem examination of the eyes of 16 red-tailed hawks with naturally acquired WN disease and 3 red-tailed hawks without WN disease was performed using histopathology, immunohistochemistry for West Nile virus (WNV) antigen, glial fibrillary acid protein, cleaved caspase-3, and the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method. Retinal lesions were classified as type I or type II lesions. Type I lesions were characterized by lymphoplasmacytic infiltrates in the subjacent choroid with degeneration limited to the outer retina (type Ia lesion) or with degeneration and necrosis of the outer retina or outer and inner retina (type Ib lesion) while retinal collapse, atrophy, and scarring were hallmarks of type II lesions. Type II retinal lesions were associated with a more pronounced choroiditis. Although not statistically significant, WNV antigen tended to be present in larger quantity in type Ib lesions. Type I lesions are considered acute while type II lesions are chronic. The development of retinal lesions was associated with the presence of an inflammatory infiltrate in the choroid. A breakdown of the blood-retina barrier is suspected to be the main route of infection of the retina. Within the retina, virus appeared to spread via both neuronal and Müller cell processes.

Potential role of periodontal infection in respiratory diseases - a review

Respiratory diseases are responsible for a significant number of deaths and considerable suffering in humans. Accumulating evidence suggests that oral disorders, particularly periodontal disease, may influence the course of respiratory infections like bacterial pneumonia and chronic obstructive pulmonary disease (COPD). Oral periodontopathic bacteria can be aspirated into the lung causing aspiration pneumonia. The teeth may also serve as a reservoir for respiratory pathogen colonization and subsequent nosocomial pneumonia. The overreaction of the inflammatory process that leads to the destruction of the connective tissue is present in both periodontal disease and emphysema. This overreaction may explain the association between periodontal disease and chronic obstructive pulmonary disease. The mechanisms of infection could be the aspiration into the lung of oral pathogens capable of causing pneumonia, colonization of dental plaque by respiratory pathogens followed by aspiration, or facilitation of colonization of the upper airway by pulmonary pathogens by periodontal pathogens. The present article briefly reviews the epidemiologic evidence & role of periodontopathogens in causing respiratory infections.

Survival and clinical outcome of SB Charite III disc replacement for back pain

Between January 1990 and December 2000 we carried out 226 SB Charité III disc replacements for lumbar disc degeneration in 160 patients. They were reviewed at a mean follow-up of 79 months (31 to 161) to determine the clinical and radiological outcome. The clinical results were collected by an independent observer, who was not involved in patient selection, treatment or follow-up, using a combination of outcome measures, including the Oswestry Disability Index. Pain was recorded using a visual analogue score, and the most recent radiographs were reviewed. Survival of the device was analysed by the Kaplan-Meier method and showed a cumulative survival of 35% at 156 months when radiological failure was taken as the endpoint. The mean improvement in the Oswestry disability index scores after disc replacement was 14% (6% to 21%) and the mean improvement in the pain score was 1.6 (0.46 to 2.73), both falling below the clinically significant threshold. Removal of the implant was required in 12 patients, four because of implant failure. These poor results indicate that further use of this implant is not justified.

Modulation of macrophages by infectious bursal disease virus

Infectious bursal disease is one of the most important naturally occurring viral diseases of chickens worldwide. The causative agent, infectious bursal disease virus (IBDV), belongs to the family Birnaviridae. This virus causes an acute, highly contagious and immunosuppressive disease in chickens. The virus infects and destroys actively dividing IgM-bearing B cells. Although B cells are the principal targets for IBDV, recent data show that the virus also infects macrophages. IBDV-infected macrophages produce various cytokines and chemokines which may play an important role in the protection and/or pathogenesis of IBDV. In this review, the modulatory effects of IBDV on macrophages will be discussed.

In VivoActivation of Chicken Macrophages by Infectious Bursal Disease Virus

Infectious bursal disease virus (IBDV) infects and replicates in the dividing B lymphocytes of chickens. In the present study, the in vivo effect of IBDV infection on chicken macrophage populations and macrophage activation were examined. Specific-pathogen-free chickens were exposed to virulent IBDV and splenic macrophages were recovered during the acute phase of the disease. At 3 and 5 days post-infection (dpi), spleens of virus-exposed chickens had fewer macrophages than those of virus-free controls (p < 0.05). Confocal microscopic examination revealed cells that were positive for both KUL01 (macrophage surface marker) and R63 (IBDVVP2), indicating presence of the virus in macrophages. MQ-NCSU cells, an avian macrophage cell line, were susceptible to replication of IBDV. In addition, splenic macrophages were activated and had temporarily increased levels of mRNA transcripts of pro-inflammatory mediators, including IL-1beta, IL-6, IL-18, and iNOS. The robust expression of proinflammatory cytokine transcripts, along with a decrease in macrophage numbers, suggest that IBDV activates and may lead to a reduction of resident macrophages in vivo.

Souter-Strathclyde total elbow arthroplasty in rheumatoid arthritis

We present the outcome of 47 Souter-Strathclyde replacements of the elbow with a mean follow-up of 82 months (12 to 129). The clinical results were assessed using a condition-specific outcome measure. The mean total score (maximum 100) before the operation was 47.21 and improved to 79.92 (p < 0.001). The mean pain score (maximum 50) improved from 21.41 to 46.70 (p < 0.001) and the mean functional component of the score (maximum 30) from 11.19 to 18.65 (p < 0.001). There was negligible change in the score for the range of movement although a significant improvement in mean flexion from 124° to 136° was noted (p < 0.001).

Revision surgery was required in four patients, for dislocation, wound dehiscence and early infection in one, late infection in two and aseptic loosening in one. The cumulative survival was 75% at nine years for all causes of failure and 97% at ten years for aseptic loosening alone. Our study demonstrates the value of the Souter-Strathclyde total elbow arthroplasty in providing relief from pain and functional improvement in rheumatoid patients.

A comparative assessment of subgingival temperature in bleeding and non-bleeding sites before and after periodontal treatment

Periodontal disease has affected human kind since times unknown. Various parameters are available to determine whether the tissue has been affected by the disease or not. In this study the reliance of subgingival temperature to be one of the parameters to determine the same has been evaluated.

Effect of vaccination in the field with the Theileria annulata (Hisar) cell culture vaccine on young calves born during the winter season

The responses were monitored of young crossbred calves vaccinated against tropical theileriosis during the winter against a field tick challenge in the disease season. Thirty-eight calves below 2 months of age, born after the end of the disease season, were selected at an organized farm. Twenty-five animals were vaccinated with Theileria annulata (Hisar) cell culture vaccine (developed at CCS HAU Hisar laboratory) after the end of the disease season and 13 calves were kept as non-vaccinated controls. These calves were observed for their susceptibility to theileriosis in the new disease season. There was an increase in antibody titre in 18 of the 25 vaccinated animals one month after vaccination. The antibody titre then declined gradually, but remained higher than those of the non-vaccinated animals at month 0. No fever or other clinical signs of tropical theileriosis were observed in any of the vaccinated animals. Nine out of 25 (36%) vaccinated calves showed occasional piroplasms (<0.5%) in blood smears. All the vaccinated animals withstood the field tick challenge. On the other hand, 9 of the 13 (69%) unvaccinated calves exhibited occasional piroplasms, and included three clinical cases of tropical theileriosis. These observations suggest that young crossbred calves vaccinated with the T. annulata (Hisar) cell culture vaccine at the end of the disease season were relatively resistant during the next disease season.

Prevalence of nocardiosis and use of Modified Thayer Martin medium

5 cases of pulmonary and 1 case of cerebral nocardiosis in the form of abscess caused by Nocardia asteroides were detected in a study of 498 clinical specimens from 428 patients of suspected tuberculosis and mycoses, giving an overall prevalence of 1.4 percent. Modified Thayer Martin Medium was useful for recovery of two isolates of N. asteroides from 100 patients. These isolates also grew on other media but on MTM, no hampering admixture of commensals occurred.

Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation

BACKGROUND

The effective aortic regurgitant orifice area varies with aortic pressure in animal models of acute aortic regurgitation. The purpose of this study was to determine whether the aortic regurgitant orifice area changes during diastole in patients with chronic aortic regurgitation.

METHODS AND RESULTS

Two-dimensional and Doppler echocardiography were performed immediately before and after magnetic resonance velocity mapping using a cine phase contrast sequence in 17 patients with chronic aortic regurgitation. ECG-gated continuous-wave Doppler velocity time integrals and magnetic resonance flow rates were measured 16 times per cardiac cycle. The mean aortic regurgitant orifice area (centimeters squared) was calculated by the continuity equation. The regurgitant orifice area was also determined for each diastolic acquisition interval. Changes in the regurgitant orifice area during diastole were modeled using an asymptotic exponential decay model to determine the static and dynamic components of the orifice. The regurgitant orifice area increased directly with regurgitant fraction (y[cm2] = 0.0072[cm2/%]*x[%]-0.0409[cm2]; r = .86, P < .0001). In 15 of 17 (88%) patients, the regurgitant orifice area decreased during diastole. The dynamic component of the regurgitant orifice area decreased with increasing regurgitant fraction (y[%] = -0.98x[%]+96.9[%]; r = -.90, P < .0001). There were no significant differences in heart rate, systolic or diastolic blood pressures, or continuous-wave Doppler velocity time integrals measured before or after the magnetic resonance examination.

CONCLUSIONS

The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.

Actinomyces species associated with intrauterine contraceptive devices and pelvic inflammatory disease

Swabs from 112 removed intrauterine contraceptive devices (IUCD), endocervical swabs from these women and from 65 women with pelvic inflammatory disease (PID) were studied for actinomyces, using direct fluorescent antibody test and culture. Endocervical swabs from 50 control subjects were also studied. Actinomyces species could be detected in 23 (20.5 percent) of IUCD wearers and 8 (12.3 percent) of patients with PID. In control cases, no actinomyces were detected. The isolation rate using a selective medium (Actino Blood Agar) was 71.4 percent. Actinomyces israelii, Actinomyces naeslundii and Actinomyces viscosus were isolated.

Microbiological study of mycetoma patients from Bombay with special reference to actinomyces immunofluorescence

17 of the 21 clinically diagnosed mycetoma and actinomycosis cases studied yielded positive cultures. Foot, leg, inguinal region, chest wall, jaw and scalp were the affected sites. 15 of the patients were from Bombay, 13 of them had infection due to Nocardia species and 2 had Actinomyces israelii infection. The other two patients from South India had Madurella mycetomi infection. N.brasiliensis was commonest isolate (8). Other isolates were N.asteroides (2), N.pelletieri (2), N.caviae (1) and A.israelii (2). A direct fluorescent antibody test to detect actinomyces was used in selected cases (4). Two of whom gave positive immunofluorescence with A.israelii FITC labeled globulin, in primary smears as well as in cultures.