Multiplexed detection of viral antigen and RNA using nanopore sensing and encoded molecular probes

We report on single-molecule nanopore sensing combined with position-encoded DNA molecular probes, with chemistry tuned to simultaneously identify various antigen proteins and multiple RNA gene fragments of SARS-CoV-2 with high sensitivity and selectivity. We show that this sensing strategy can directly detect spike (S) and nucleocapsid (N) proteins in unprocessed human saliva. Moreover, our approach enables the identification of RNA fragments from patient samples using nasal/throat swabs, enabling the identification of critical mutations such as D614G, G446S, or Y144del among viral variants. In particular, it can detect and discriminate between SARS-CoV-2 lineages of wild-type B.1.1.7 (Alpha), B.1.617.2 (Delta), and B.1.1.539 (Omicron) within a single measurement without the need for nucleic acid sequencing. The sensing strategy of the molecular probes is easily adaptable to other viral targets and diseases and can be expanded depending on the application required.

Idiopathic sudden sensorineural hearing loss and ménière syndrome: The role of cerebral venous drainage

OBJECTIVES

To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD).

DESIGN

Observational, prospective, cohort study.

SETTING

ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy).

PARTICIPANTS

We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD.

MAIN OUTCOME MEASURE

All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed.

RESULTS

No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage.

CONCLUSIONS

Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.

Maternal depression and anxiety predicts the pattern of offspring symptoms during their transition to adulthood

BACKGROUND

Episodes of depression and anxiety (D&A) during the transition from late adolescence to adulthood, particularly when persistent, are predictive of long-term disorders and associated public health burden. Understanding risk factors at this time is important to guide intervention. The current objective was to investigate the associations between maternal symptoms of D&A with offspring symptoms during their transition to adulthood.

METHOD

Data from a large population-based birth cohort study, in South Brazil, were used. Prospective associations between maternal D&A and offspring risk of these symptoms during the transition to adulthood (18/19, 24 and 30 years) were estimated.

RESULTS

Maternal D&A in adolescence was associated with offspring symptoms across the transition to adulthood, associations were consistently stronger for females than for males. Daughters whose mothers reported D&A were 4.6 times (95% confidence interval 2.71-7.84) as likely to report D&A at all three time-points, than daughters of symptom-free mothers.

CONCLUSIONS

Maternal D&A is associated with persistent D&A during the daughter's transition to adulthood. Intervention strategies should consider the mother's mental health.

Method for cotemporal and coplanar comparison of magnetic resonance imaging and neuropathology of formalin-fixed human brains

We describe the design and production of a mitre box that allows magnetic resonance imaging and pathological sectioning of a formalin-fixed brain so that the pathological and radiological slices are coplanar and therefore readily comparable.

Mobile phones, in combination with a computer locator system, improve the response times of emergency medical services in central London

INTRODUCTION

The aim of this study was to determine whether mobile phones and mobile phone locating devices are associated with improved ambulance response times in central London.

PATIENTS AND METHODS

All calls from the London Ambulance Service database since 1999 were analysed. In addition, 100 consecutive patients completed a questionnaire on mobile phone use whilst attending the St Thomas's Hospital Emergency Department in central London.

RESULTS

Mobile phone use for emergencies in central London has increased from 4007 (5% of total) calls in January 1999 to 21,585 (29%) in August 2004. Ambulance response times for mobile phone calls were reduced after the introduction of the mobile phone locating system (mean 469 s versus 444 s; P = 0.0195). The proportion of mobile phone calls made from mobile phones for life-threatening emergencies was higher after injury than for medical emergencies (41% versus 16%, P = 0.0063). Of patients transported to the accident and emergency department by ambulance, 44% contacted the ambulance service by mobile phone. Three-quarters of calls made from outside the home or work-place were by mobile phone and 72% of patients indicated that it would have taken longer to contact the emergency services if they had not used a mobile.

CONCLUSIONS

Since the introduction of the mobile phone locating system, there has been an improvement in ambulance response times. Mobile locating systems in urban areas across the UK may lead to faster response times and, potentially, improved patient outcomes.

Effects of adding a preceding run-up on performance, blood lactate concentration and heart rate during maximal intermittent vertical jumping

In this study, we examined the effects of a prior run-up on intermittent maximal vertical jump performance. Seven regionally ranked male volleyball players volunteered to participate in the study. They performed three randomized tests: (1) six repeated intermittent maximal jumps (jump condition), (2) six repeated intermittent run-ups (run-up condition), and (3) six repeated run-ups followed by maximal jumps (run-up plus jump condition). All performances were assessed and blood lactate concentration and heart rate were measured before and after each of the tests. Mean ( +/- ) jump performance (64.7 +/- 2.3 cm) increased significantly (P = 0.02) over the course of the jump condition and was significantly higher (P < 0.001) than for the run-up plus jump condition (58.0 +/- 3.2 cm), which tended to decrease with repetition. Blood lactate concentration was significantly higher in the run-up plus jump condition (3.73 +/- 0.24 mmol . l(-1)) than in the jump (2.61 +/- 0.26 mmol . l(-1), P = 0.02) and run-up (2.86 +/- 0.18 mmol . l(-1), P = 0.03) conditions. The increase in heart rate was significantly higher both in the run-up plus jump condition (33 +/- 6 beats . min(-1), P = 0.05) and run-up condition (33 +/- 4 beats . min(-1), P = 0.02) than in the jump condition (21 +/- 3 beats . min(-1)). The results indicate that the addition of run-ups probably impeded performance in the repetition of vertical jumps.

Does the use of the Advanced Medical Priority Dispatch System affect cardiac arrest detection?

BACKGROUND

Cardiac arrest is the most widely recognised prehospital event that early intervention can directly affect. Chance of survival from this event decreases every minute that passes without treatment. To deliver a rapid ambulance response to these patients the early detection of cardiac arrest by control room staff is crucial. To achieve this, the London Ambulance Service (LAS) uses the Advanced Medical Priority Dispatch System. What impact has AMPDS had on identifying patients in cardiac arrest? Does compliance with AMPDS protocol influence the identification of patients in cardiac arrest?

METHODS

A two stage study was undertaken. The first, compared cases coded as "cardiac arrest" and found by the responding ambulance to be in cardiac arrest before the implementation of AMPDS. This was compared with cases triaged as "cardiac arrest" and found to be in cardiac arrest across three years after AMPDS implementation. The second stage compared AMPDS compliance, over a 32 month period against the percentage of cardiac arrest calls that were found to be cardiac arrest upon the ambulance arrival. The correlation coefficient was calculated and analysed for statistical significance.

FINDINGS

AMPDS resulted in a 200% rise in the number of patients accurately identified as suffering from cardiac arrest. A relation was identified between identification and AMPDS compliance (r(2) = 0.65, p = 0.001).

DISCUSSION

The implementation of AMPDS increased accurate identification of patients in cardiac arrest. Additionally, the relation between factors identified suggests compliance with protocol is an important factor in the accurate recognition of patient conditions.

Time-of-day effects in maximal anaerobic leg exercise in tropical environment: a first approach

The aim of this study was to establish the effect of time of day on maximal anaerobic leg power in a tropical environment (French West Indies). Twenty-three physical education students (15 males and 8 females) who trained 10.5 hours a week (SD 6) volunteered to participate in the study. Their mean age, height and body mass were 22.8 (SD 3) years, 172.6 (SD 8) cm, and 64.6 (SD 7) kg, respectively. The chronotype of all subjects was moderate or intermediate. Tests were scheduled at 08 : 00, 13 : 00 and 17 : 00 hours on separate days in random order and constant conditions (room temperature: 28.1 degrees C [SD 0.6], relative room humidity: 62.6 % [SD 3.4]). On test days, the subjects were first measured at rest for body mass, heart rate and rectal temperature and they then performed vertical jump tests and a force-velocity test. The results showed a time-of-day effect on rectal temperature, which was significantly (p < 0.005) higher by the afternoon (13 : 00 and 17 : 00) than the morning (08 : 00). However, our results failed to show any daytime variation in maximal anaerobic power under the influence of tropical climate, which suggests that a hot and humid environment may have blunted the time-of-day effect by a passive warm-up effect.

Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery

BACKGROUND

Compression stockings are recommended for prophylaxis against venous thromboembolism in patients undergoing neurosurgery, but anticoagulant agents have not gained wide acceptance because of concern about intracranial bleeding.

METHODS

In a multicenter, randomized, double-blind trial, we assessed the efficacy and safety of enoxaparin in conjunction with the use of compression stockings in the prevention of venous thromboembolism in patients undergoing elective neurosurgery. Enoxaparin (40 mg once daily) or placebo was given subcutaneously for not less than seven days beginning within 24 hours after the completion of surgery. The primary end point was symptomatic, objectively confirmed venous thromboembolism or deep-vein thrombosis assessed by bilateral venography, which was performed in all patients on day 8+/-1. Bleeding side effects were carefully assessed.

RESULTS

Among the 307 patients assigned to treatment groups, 129 of the 154 patients receiving placebo (84 percent) and 130 of the 153 patients receiving enoxaparin (85 percent) had venographic studies adequate for analysis. An additional patient in the placebo group died before venography of autopsy-confirmed pulmonary embolism. In this analysis, 42 patients given placebo (32 percent) and 22 patients given enoxaparin (17 percent) had deep-vein thrombosis (relative risk in the enoxaparin group, 0.52; 95 percent confidence interval, 0.33 to 0.82; P=0.004). The rates of proximal deep-vein thrombosis were 13 percent in patients receiving placebo and 5 percent in patients receiving enoxaparin (relative risk in the enoxaparin group, 0.41; 95 percent confidence interval, 0.17 to 0.95; P=0.04). Two patients in the placebo group died of autopsy-confirmed pulmonary embolism on days 9 and 16. Major bleeding occurred in four patients receiving placebo (intracranial bleeding in all four) and four patients (intracranial bleeding in three) receiving enoxaparin (3 percent of each group).

CONCLUSIONS

Enoxaparin combined with compression stockings is more effective than compression stockings alone for the prevention of venous thromboembolism after elective neurosurgery and does not cause excessive bleeding.

[Tuberculosis and immigrants. A study of its prevalence in the Umbria region]

In 1995, 463 patients were admitted in the medical service of Perugia (Sanitary District n. 6). Only 20% of them were enrolled in the TBC programme. Mantoux was: < 10 mm in 35%, 10-15 mm in 25%, > 15 mm in 40%. Chest Rx in 30 subjects demonstrated: normality in 19; old TBC in 7, active TBC in 4 (miliary, bilateral upper lobe pneumonitis, left subapical upper lobe pneumonitis and right lobitis of the upper lobe). All patients were admitted in hospital and showed positive sputum culture for Mycobacterium Tuberculosis. They were treated with isoniazid, rifampin, pyrazinamide, ethambutol/streptomycin for 2 months and with isoniazid, rifampin for other 4-8 months. Two patients showed Mycobacterium tuberculosis with isoniazid resistance. Seven patients were treated with isoniazid chemoprophylaxis without side effects. Migrants should receive information about health care service and be encourage to register themselves with a general practitioner. Skin test screening and chest radiographs for those with positive results should be provided at a convenient location.

Intramuscular dermatan sulfate MF701 in patients with hip fracture: relationship between pharmacokinetics and antithrombotic efficacy

Two groups of 23 and 84 patients with hip fracture received intramuscularly 100 and 300 mg dermatan sulfate (MF701) b.i.d., respectively, for the prophylaxis of deep vein thrombosis. Median duration of treatment was 17 and 16 days, respectively. Four blood samples were collected from each patient while under treatment. Plasma levels of dermatan sulfate were determined by a chromogenic substrate assay. A one-compartment model for multiple doses was employed to estimate the pharmacokinetic parameters. Fitting was applied to mean plasma concentrations calculated for each sampling time and weighted according to the number of samples available at each time. Thrombin clotting time was measured on the same plasma samples. Antithrombotic efficacy was assessed by bilateral venography. Plasma levels of dermatan sulfate increased gradually throughout the treatment, indicating a marked accumulation process. Time to reach steady-state was 14 or 9 days with 100 or 300 mg b.i.d., respectively. This was due to an apparent prolonged terminal half-life (68 or 43 h), which actually reflected slow absorption from the injection sites. The clinical efficacy of MF701 in preventing DVT was found to be dependent on the plasma concentration of the drug and also, but less significantly, on the prolongation of thrombin clotting time. Dermatan sulfate plasma levels greater than 9 micrograms/ml are advisable to optimize efficacy in hip fracture patients.

Magnetic resonance angiography monitoring of streptokinase in occlusion of the middle cerebral artery

A 77 year old woman was hospitalized one hour after the onset of right hemiplegia and aphasia. Magnetic resonance imaging (MRI) examination was negative and MRA indicated occlusion of the left middle cerebral artery. Treatment with streptokinase was instituted (a 60 minute intravenous infusion of 1.5 MU of streptokinase in 100 ml of saline solution). Two hours after infusion, the patient's motor function clearly improved. An MRA examination performed six hours later showed partial recanalization of the obstructed vessel. Our report demonstrates the potential usefulness of MRA monitoring during thrombolytic therapy.

Atraumatic suture of the mucoperiosteal flap in the transsphenoidal approach. A new technique

Fifty-three patients were operated on with the transsphenoidal approach and a biologic tissue adhesive was used, in order to fix the mucoperiosteal flap. Results and advantages of the technique are discussed.

Relationship of chemical structures of anthraquinones with their effects on the suppression of immune responses

A series of 37 anthraquinones were evaluated for their ability to inhibit the induction of cytolytic T-lymphocytes in a mixed lymphocyte culture system, useful as a preliminary screen for immunosuppressive agents. These compounds were also tested for their ability to prevent the production of antibody in mice. It was demonstrated that 1,4-bis [(2-aminoethyl)amino]-5, 8-dihydroxy-9,10-anthracenedione dihydrochloride (AEAD, 2) derived from mitoxantrone (MX, 1) by removing hydroxyethyl groups from both side chains was extremely active in depressing immune responses in vitro and in vivo. Four additional anthraquinones related to AEAD were also identified to share similar suppressive activity. They include a Schiff base, 1,4-dihydroxy-5,8-bis[[2-[(3-pyridinylmethylene)amino]ethyl]amino] -9,10-anthracenedione; a dimer with N-terminals methylated, 1,1-[ethylenebis (iminoethyleneimino)]-bis [5,8-dihydroxy-4-[(2-methylamino-ethyl)amino] anthraquinone tetrahydrochloride; an oxazolidine, 1,4-dihydroxy-5,8-bis [[2-(2-propyl-3-oxazolidinyl)ethyl]amino] anthraquinone; and its polymeric oxazolidine, poly [5,8-dihydroxy-1,4-anthraquinonyleneiminoethylene-3,2-oxazolidine- diyltrimethylene-2,3-oxazolidinediylethyleneimino]. These compounds may warrant further consideration as candidates for the treatment of refractory autoimmune diseases and in organ transplantation.

Primary malignant melanoma of the esophagus in a young adult

A 31-year-old white man presented with a 30-day history of dysphagia without weight loss. Esophagogram revealed a lobulated mass at the junction of the middle and lower third of the esophagus. Esophagoscopy showed the presence of a pigmented tumor at that level. Histological examination indicated that the tumor was a primary malignant melanoma. Partial esophagectomy was performed through a right thoracotomy incision, revealing hilar lymph nodes invaded by tumor. One month postoperatively, the patient died from extensive brain metastases.

On-line computer analysis of chemiluminescent reactions, with application to a luminescent immunoassay for free cortisol in urine

We interfaced a microcomputer on-line with a luminometer to acquire the light signal of chemiluminescent reactions from a photomultiplier and then compute significant parameters of light emission and kinetic "shape" indices. Using this system to study interferences from biological samples on the measurement of chemiluminescent reactions, we observed that such effects are usually associated with modifications of the shape of the light-emission kinetics. These results suggest that a simultaneous evaluation of the shape of a chemiluminescent reaction and the measurement of light emission can be combined to assess luminescent immunoassays as an internal control of the interferences in measurements of the chemiluminescent tracer. As an example of this approach, we developed and validated a luminescent immunoassay for free cortisol in diluted urine. Dextran-coated charcoal is used for bound-free separation.

On-line computer analysis of chemiluminescent reactions, with application to a luminescent immunoassay for free cortisol in urine

We interfaced a microcomputer on-line with a luminometer to acquire the light signal of chemiluminescent reactions from a photomultiplier and then compute significant parameters of light emission and kinetic "shape" indices. Using this system to study interferences from biological samples on the measurement of chemiluminescent reactions, we observed that such effects are usually associated with modifications of the shape of the light-emission kinetics. These results suggest that a simultaneous evaluation of the shape of a chemiluminescent reaction and the measurement of light emission can be combined to assess luminescent immunoassays as an internal control of the interferences in measurements of the chemiluminescent tracer. As an example of this approach, we developed and validated a luminescent immunoassay for free cortisol in diluted urine. Dextran-coated charcoal is used for bound-free separation.

Synthesis of 3,6-bis(aminoalkoxy)acridines and their effect on the immune System

A series of 3,6-bis(aminoalkoxy)acridines (2) was prepared and shown to have a protective antiviral effect against an interferon-sensitive virus (Columbia SK) and to partially restore an antibody response to a T-cell-dependent antigen in leukemic immunosuppressed mice. The presence of circulating interferon and the stimulation of natural killer cell activity in mice was observed for 21.