Absence of Hepatitis E virus circulation in wild rabbits (Oryctolagus cuniculus) and Iberian hares (Lepus granatensis) in Mediterranean ecosystems in Spain

In recent decades, cases of autochthonous hepatitis E (HE) have sharply increased in European countries where foodborne transmission is considered the main route of HE virus (HEV) transmission. Although rabbits are considered the main reservoir of the zoonotic HEV‐3ra subtype, information on the role of wild lagomorphs in the epidemiology of HEV remains scarce. The aim of this study therefore was to assess the circulation of HEV in European wild rabbits (Oryctolagus cuniculus) and Iberian hares (Lepus granatensis), the most important lagomorph species in Spanish Mediterranean ecosystems. Liver samples from 372 wild rabbits and 78 Iberian hares were analysed using a broad‐spectrum RT‐PCR that detects HEV genotypes 1–8. None of the 450 lagomorphs tested were positive for HEV infection. To the best of our knowledge, this is the first study to assess HEV circulation in wild rabbits in Spain and the first to evaluate HEV infection in Iberian hares. Our results indicate absence of HEV circulation in wild rabbits and Iberian hares in southern Spain during the study period, which suggests that the risk of transmission of HEV from wild lagomorphs to other species, including humans, is low.     

Estimating the between‐farm transmission rates for highly pathogenic avian influenza subtype H5N1 epidemics in Bangladesh between 2007 and 2013

Highly Pathogenic Avian Influenza (HPAI ) is classified by the World Organization for Animal Health as one of the notifiable diseases. Its occurrence is associated with severe socio‐economic impacts and is also zoonotic. Bangladesh HPAI epidemic data for the period between 2007 and 2013 were obtained and split into epidemic waves based on the time lag between outbreaks. By assuming the number of newly infected farms to be binomially distributed, we fit a Generalized Linear Model to the data to estimate between‐farm transmission rates (β). These parameters are then used together with the calculated infectious periods to estimate the respective basic reproduction numbers (R ₀). The change in β and R ₀ with time during the course of each epidemic wave was explored. Finally, sensitivity analyses of the effects of reducing the delay in detecting infection on a farm as well as extended infectiousness of a farm beyond the day of culling were assessed. The point estimates obtained for β ranged from 0.08 (95% CI : 0.06–0.10) to 0.11 (95% CI : 0.08–0.20) per infectious farm per day while R ₀ ranged from 0.85 (95% CI : 0.77–1.02) to 0.96 (95% CI : 0.72–1.20). Sensitivity analyses reveal that the estimates are quite robust to changes in the assumptions about the day in reporting infection and extended infectiousness. In the analysis allowing for time‐varying transmission parameters, the rising and declining phases observed in the epidemic data were synchronized with the moments when R ₀ was greater and less than one, respectively. From an epidemiological perspective, the consistency of these estimates and their magnitude (R ₀ ≈ 1) indicate that the effectiveness of the deployed control measures was largely invariant between epidemic waves and the trend of the time‐varying R ₀ supports the hypothesis of sustained farm‐to‐farm transmission that is possibly initiated by a few unique introductions.     

Neutralizing antibodies against Rift Valley fever virus in wild antelope in far northern KwaZulu‐Natal,South Africa,indicate recent virus circulation

Rift Valley fever (RVF) is a zoonotic viral disease of domestic ruminants in Africa and the Arabian Peninsula caused by a mosquito‐borne Phlebovirus. Outbreaks in livestock and humans occur after heavy rains favour breeding of vectors, and the virus is thought to survive dry seasons in the eggs of floodwater‐breeding aedine mosquitoes. We recently found high seroconversion rates to RVF virus (RVFV) in cattle and goats, in the absence of outbreaks, in far northern KwaZulu‐Natal (KZN), South Africa. Here, we report the prevalence of, and factors associated with, neutralizing antibodies to RVFV in 326 sera collected opportunistically from nyala (Tragelaphus angasii) and impala (Aepyceros melampus) culled during 2016–2018 in two nature reserves in the same area. The overall seroprevalence of RVFV, determined using the serum neutralization test, was 35.0% (114/326; 95%CI: 29.8%–40.4%) and tended to be higher in Ndumo Game Reserve (11/20; 55.0%; 95%CI: 31.5%–76.9%) than in Tembe Elephant Park (103/306; 33.6%; 95%CI: 28.4%–39.3%) (p = .087). The presence of antibodies in juveniles (6/21; 28.6%; 95%CI: 11.3%–52.2%) and sub‐adults (13/65; 20.0%; 95%CI: 11.1%–37.8%) confirmed that infections had occurred at least until 2016, well after the 2008–2011 RVF outbreaks in South Africa. Odds of seropositivity was higher in adults than in sub‐adults (OR = 3.98; 95%CI: 1.83–8.67; p = .001), in males than in females (OR = 2.66; 95%CI: 1.51–4.68; p = .001) and in animals collected ≤2 km from a swamp or floodplain compared with those collected further away (OR = 3.30; 95%CI: 1.70–6.38; p < .001). Under similar ecological conditions, domestic and wild ruminants may play a similar role in maintenance of RVFV circulation and either or both may serve as the mammalian host in a vector–host reservoir system. The study confirms the recent circulation of RVFV in the tropical coastal plain of northern KZN, providing the basis for investigation of factors affecting virus circulation and the role of wildlife in RVF epidemiology.     

Quantifying the potential pathways and locations of Rift Valley fever virus entry into the United States

The global invasion of West Nile virus, chikungunya virus and Zika virus in the past two decades suggests an increasing rate of mosquito‐borne virus (arbovirus) dispersal. Rift Valley fever virus (RVFV ) is an arbovirus identified as a high‐consequence threat to the United States (USA ) because of the severe economic and health consequences associated with disease. Numerous studies demonstrate that the USA is receptive to RVFV transmission based on the widespread presence of competent mosquito species and vertebrate species. In this study, the potential pathways and locations of RVFV entry into the USA were quantitatively estimated to support a priori surveillance and RVFV prevention strategies. International movement data, ecological data and epidemiological data were combined to estimate the number of RVFV ‐infected mosquitoes entering the USA . Results suggest infected humans travelling by plane pose the highest risk of importing RVFV into the USA , followed by the unintentional transport of infected adult mosquitoes by ship and airplane. Furthermore, New York, New York, Washington DC, Atlanta, Georgia, and Houston, Texas, are implicated as the most likely regions of RVFV entry. Results are interpreted and discussed to support the prediction and mitigation of RVFV spread to the USA .     

Inter‐epidemic Rift Valley fever virus seroconversions in an irrigation scheme in Bura,south‐east Kenya

Rift Valley fever (RVF ) is an acute mosquito‐borne viral zoonosis whose outbreaks are often associated with prolonged rainfall and flooding, during which large numbers of vectors emerge. Recent studies into the inter‐epidemic maintenance of RVF virus (RVFV ) suggest that both vertical transmission in vectors and direct transmission between hosts act in combination with predisposing factors for persistence of the virus. A comparative longitudinal survey was carried out in Tana River County, Kenya, in irrigated, riverine and pastoral ecosystems from September 2014–June 2015. The objectives were to investigate the possibility of low‐level RVFV transmission in these ecosystems during an inter‐epidemic period (IEP), examine variations in RVFV seroprevalence in sheep and goats and determine the risk factors for transmission. Three hundred and sixteen small ruminants were selected and tested for immunoglobulin G antibodies against RVFV nucleoprotein using a competitive ELISA during six visits. Data on potential risk factors were also captured. Inter‐epidemic RVFV transmission was evidenced by 15 seroconversions within the irrigated and riverine villages. The number of seroconversions was not significantly different (OR  = 0.66, CI  = 0.19–2.17, p  = .59) between irrigated and riverine areas. No seroconversions were detected in the pastoral ecosystem. This study highlights the increased risk of inter‐epidemic RVFV transmission posed by irrigation, through provision of necessary environmental conditions that enable vectors access to more breeding grounds, resting places and shade, which favour their breeding and survival.     

Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among haemodialysis and CAPD patients: evidence for environmental transmission

Hepatitis B virus (HBV) serum markers (HBsAg, anti-HBs, anti-HBc)and antihepatitis C antibody (anti-HCV) were prospectively followedin haemodialysis and CAPD patients. From January 1987 to January1990, 185 patients on haemodialysis and 124 on CAPD were analysed.Among patients susceptible to HBV (69 on haemodialysis and 70on CAPD), there were 17 HBsAg seroconversions on haemodialysis(0.19/patient-year) and 1 on CAPD (0.01/patient-year). A Coxproportional hazards model showed that haemodialysis treatmentwas the only risk factor significantly associated with HBV infection,thus suggesting transmission through the environment. Regarding hepatitis C, 83 anti-HCV-negative patients on haemodialysisand 46 on CAPD were followed. There were 18 seroconversionson haemodialysis (0.15/patient-year) and two seroconversionson CAPD (0.03/patient-year). Haemodialysis treatment was alsothe only risk factor significantly associated with a higherrisk of HCV infection. The hazard ratio for HCV infection inhaemodialysis patients was 5.7 compared to CAPD patients. Nevertheless,for one patient on CAPD treatment transfusions were the onlypossible source of HCV infection. In conclusion, both viruses were transmitted mainly throughthe haemodialysis environment, but the role of transfusionscould not be excluded.     

单侧双通道内镜下腰椎融合术后隐性失血的危险因素分析

【摘要】 目的：观察单侧双通道内镜下腰椎融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion,UBE-TLIF）术后的隐性失血情况,并对其相关危险因素进行分析。方法：回顾性分析2020年1月~2021年6月在我院行UBE-TLIF治疗的59例腰椎退行性疾病患者的临床资料,收集患者一般资料如年龄、性别、体质指数（body mass index,BMI）、学习曲线、疾病类型以及是否合并有高血压、糖尿病;手术相关资料如病变节段、手术时间、显性失血量、美国麻醉师协会麻醉分级（American Society of Anesthesiologists,ASA）;实验室检查如凝血酶原时间、活化部分凝血活酶时间、血小板计数、纤维蛋白原、血红蛋白（hemoglobin,Hb）和红细胞压积（hematocrit,Hct）。根据Gross公式计算总失血量,并由此计算患者的术后隐性失血量,采用单因素方差分析和Pearson相关性检验探讨患者的特征与术后隐性失血之间的相关性,采用多元线性回归分析确定术后隐性失血的独立危险因素,构建危险因素的受试者工作特征（receiver operating characteristic,ROC）曲线以分析危险因素的预测价值。结果：手术时间为128.22±22.88min,总失血量为607.32±186.78ml,隐性失血量为393.83±173.42ml,占总失血量的（62.13±11.73）%。术后Hb、Hct均较术前明显降低（P<0.05）。单因素方差分析中性别、高血压、糖尿病、手术节段、疾病类型与隐性失血无明显相关性（P>0.05）,学习曲线和ASA分级与隐性失血具有相关性（P<0.001）。Pearson相关性分析显示,年龄、BMI、凝血酶原时间、活化部分凝血活酶时间、血小板计数与隐性失血无相关性（P>0.05）,手术时间、纤维蛋白原与隐性失血具有相关性（P<0.001）。多元线性回归分析显示,手术时间（B=2.236,P<0.01）、学习曲线（B=-109.781,P<0.01）、ASA分级（B=77.589,P<0.01）和纤维蛋白原（B=81.762,P<0.01）是隐性失血的独立危险因素。ROC曲线显示手术时间预测严重隐性失血的ROC曲线下面积（area under curve,AUC）为0.813（95%CI：0.688~0.938,P<0.001）,最佳截点为139.5min;纤维蛋白原的AUC为0.794（95%CI：0.654~0.934,P<0.001）,最佳截点为2.65g/L。结论：UBE-TLIF治疗腰椎退行性疾病存在较大的术后隐性失血,手术时间、学习曲线、ASA分级和纤维蛋白原是术后隐性失血的独立危险因素。     

An analysis of potential risk factors for early complications from fiberoptic bronchoscopy in lung transplant recipients

Several reviews exist describing the safety of bronchoscopy in lung transplant recipients. However, the incidence of bronchoscopic complications in lung transplant recipients in relation to trainee involvement, and clinical characteristics such as pre‐transplant diagnosis and transplant type, has not been described. We performed a retrospective cohort study of all lung transplant recipients undergoing flexible fiberoptic bronchoscopy (n = 259) at the University of California, San Francisco, between January, 2003, and June, 2009. Complications included bleeding, pneumothorax, aspiration, oversedation, and hypoxemia. From 2003 to 2009, 3734 flexible fiberoptic bronchoscopies were performed, including 2111 (57%) with transbronchial biopsies. Trainees were involved in 2102 bronchoscopies (56%), including 1046 transbronchial biopsies (49.5%). Complications occurred in 27 bronchoscopies [0.7% (95% Confidence Interval [CI]: 0.4–1.0)], with 10 involving a trainee (37%). Twenty (74%) occurred during bronchoscopies with transbronchial biopsies. Six of these involved a trainee, while 14 involved an attending alone (P = 0.03). We did not find differences in pre‐transplant diagnosis, transplant type, lung, or renal function between subjects who suffered a complication and those who did not (P ≥ 0.30). The involvement of trainees, pre‐transplant diagnosis, and transplant type do not significantly impact the rate of bronchoscopic complications in lung transplant recipients.     

Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children

BACKGROUND: Asthma exacerbation is the most common cause of hospital admission in children. A study was undertaken to investigate the importance of allergen exposure in sensitised individuals in combination with viral infections and other potentially modifiable risk factors precipitating asthma hospital admission in children. METHODS: Eighty four children aged 3-17 years admitted to hospital over a 1 year period with an acute asthma exacerbation (AA) were matched for age and sex with two control groups: stable asthmatics (SA) and children admitted to hospital with non-respiratory conditions (IC). Risk factors were assessed by questionnaires and determination of allergen sensitisation, home allergen exposure, pollen exposure, and respiratory virus infection. RESULTS: Several non-modifiable factors (atopy, duration of asthma) were associated with increased risk. Among the modifiable factors, pet ownership, housing characteristics, and parental smoking did not differ between the groups. Regular inhaled corticosteroid treatment was significantly less common in the AA group than in the SA group (OR 0.2, 95% CI 0.1 to 0.6; p = 0.002). A significantly higher proportion of the AA group were virus infected (44%) and sensitised and highly exposed to sensitising allergen (76%) compared with the SA (18% and 48%) and IC groups (17% and 28%; both p<0.001). In a multiple conditional logistic regression (AA v SA), allergen sensitisation and exposure or virus detection alone were no longer independently associated with hospital admission. However, the combination of virus detection and sensitisation with high allergen exposure substantially increased the risk of admission to hospital (OR 19.4, 95% CI 3.7 to 101.5, p<0.001). CONCLUSIONS: Natural virus infection and real life allergen exposure in allergic asthmatic children increase the risk of hospital admission. Strategies for preventing exacerbations will need to address these factors.     

HIV/AIDS合并肺结核患者抗结核分枝杆菌治疗肝毒性的危险因素

目的探讨人类免疫缺陷病毒感染/获得性免疫缺乏综合征（HIV/AIDS）合并肺结核患者抗结核分枝杆菌治疗肝毒性的危险因素。 方法收集201年8月至2015年5月西安市第八医院收治的321例HIV/AIDS合并肺结核患者的全血及临床资料,并于患者抗结核分枝杆菌治疗后随访4个月。检测患者N-乙酰化转移酶2（NAT2）基因型。Logistic回归分析患者抗结核分枝杆菌治疗肝毒性的影响因素。 结果321例HIV/AIDS合并肺结核患者失访96例,剩余225例患者中73例（32.4%）发生药物性肝毒性（肝毒性组）,152例（67.6%）未发生药物性肝毒性（无肝毒性组）。两组患者身体质量指数（BMI）（χ² = 0.830、P = 0.003）、NAT2基因型（χ² = 7.361、P = 0.025）、CD4细胞计数（χ² = 4.380、P = 0.036）以及氟康唑治疗患者数（χ² = 9.924、P = 0.002）差异均具有统计学意义。BMI、NAT2基因型和氟康唑治疗均为患者抗结核分枝杆菌治疗肝毒性的独立危险因素（P均< 0.05）。 结论低BMI、慢乙酰型NAT2基因型HIV/AIDS合并肺结核患者抗结核分枝杆菌治疗易发生肝毒性,建议慎重同时使用抗结核分枝杆菌治疗药物和氟康唑。     

非手术指征颈动脉斑块患者缺血性脑卒中的危险因素分析

目的:探讨颈动脉狭窄≤50%的颈动脉斑块患者的MRI斑块特征及临床因素与发生缺血性脑卒中的关系。方法:选取2014年9月—2016年2月超声筛选颈动脉狭窄≤50%的颈动脉斑块患者43例,所有患者行核磁共振黑血成像检查,分析MRI斑块特征及其他危险因素与缺血性脑卒中的关系。结果:43例患者的颈动脉斑块狭窄程度5%～50%,随访时间1.9～19.4个月。随访期间发现脑梗死患者共4例。单因素与多因素Logistic回归分析结果显示,仅MRI的斑块内出血与缺血性脑卒中的发生有明显关系(OR=297.797,95%CI=2.638～33620,P=0.018),而其他斑块特征及临床因素均无明显关系(均P0.05)。Kaplan-Meier生存分析显示,有斑块内出血者较无斑块内出血者的中位无脑卒中时间明显缩短(14.3个月vs. 18.6个月,P=0.001);有冠心病者较无冠心病者的中位无脑卒中时间也明显缩短(12.1个月vs. 18.7个月,P=0.029);Cox回归分析显示,斑块内出血(HR=18.2,95%CI=2.7～123.3,P=0.003)及冠心病(HR=27.4,95%CI=1.6～464.3,P=0.022)是缺血性脑卒中发生的独立危险因素。结论:在颈动脉狭窄≤50%的颈动脉斑块患者中,斑块内出血与冠心病是缺血性卒中的发生密切相关。     

甲状腺微小癌颈淋巴结转移危险因素分析及手术范围的探讨

目的:探讨影响甲状腺微小癌(TMC)颈淋巴结转移的危险因素以及颈淋巴结清扫的范围。方法:回顾性分析2009年1月—2013年6月收治的269例TMC患者资料,患者均在原发灶根治的同时行中央区淋巴结清扫,27例患者行颈侧区淋巴结清扫,分析患者各临床病理因素与颈淋巴结转移的关系。结果:269例患者中107例(39.8%)发生颈淋巴结转移,其中中央区淋巴结转移103例(96.3%),颈侧区淋巴结转移25例(23.4%)。单因素分析显示,男性、肿瘤直径5.0 mm、包膜侵犯与TMC颈淋巴结转移有关(均P0.05);多因素分析显示,肿瘤直径5.0 mm(OR=3.358,P0.05)、包膜侵犯(OR=5.230,P0.05)是颈淋巴结转移的独立危险因素。结论:对于肿瘤直径5.0 mm或有包膜侵犯的TMC患者,中央区淋巴结转移的几率增加,行中央区淋巴结清扫是必要的。     

Torque teno virus for risk stratification of graft rejection and infection in kidney transplant recipients—A prospective observational trial

The nonpathogenic and ubiquitous torque teno virus (TTV) is associated with immunosuppression in solid organ transplant recipients. Studies in kidney transplant patients proposed TTV quantification for risk stratification of graft rejection and infection. In this prospective trial (DRKS00012335) 386 consecutive kidney transplant recipients were subjected to longitudinal per‐protocol monitoring of plasma TTV load by polymerase chain reaction for 12 months posttransplant. TTV load peaked at the end of month 3 posttransplant and reached steady state thereafter. TTV load after the end of month 3 was analyzed in the context of subsequent rejection diagnosed by indication biopsy and infection within the first year posttransplant, respectively. Each log increase in TTV load decreased the odds for rejection by 22% (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.62‐0.97; P = .027) and increased the odds for infection by 11% (OR 1.11, 95% CI 1.06‐1.15; P < .001). TTV was quantified at a median of 14 days before rejection was diagnosed and 27 days before onset of infection, respectively. We defined a TTV load between 1 × 10⁶ and 1 × 10⁸ copies/mL as optimal range to minimize the risk for rejection and infection. These data support the initiation of an interventional trial assessing the efficacy of TTV‐guided immunosuppression to reduce infection and graft rejection in kidney transplant recipients.     

Full‐length genome sequence analysis of an avian leukosis virus subgroup J (ALV‐J) as contaminant in live poultry vaccine: The commercial live vaccines might be a potential route for ALV‐J transmission

One avian leukosis virus subgroup J (ALV ‐J) strain was isolated from 67 commercial live poultry vaccines produced by various manufacturers during 2013–2016 in China. The complete genomes of the isolate were sequenced and it was found that the genes gag and pol of the strain were relatively conservative, while the gp85 gene of the strain GX 14YYA 1 had the highest similarities with a field strain GX 14ZS 14, which was isolated from the chickens of a farm that had once used the same vaccine as the one found to be contaminated with the GX 14YYA 1. This is the first report of ALV ‐J contaminant in live poultry vaccine in China. Our finding demonstrates that vaccination of the commercial live vaccines might be a potential new route for ALV ‐J transmission in chickens and highlights the need for more extensive monitoring of the commercial live vaccines in China.