Genotype prevalence and risk factors for severe clinical adenovirus infection, United States 2004-2006.

BACKGROUND: Recently, epidemiological and clinical data have revealed important changes with regard to clinical adenovirus infection, including alterations in antigenic presentation, geographical distribution, and virulence of the virus. METHODS: In an effort to better understand the epidemiology of clinical adenovirus infection in the United States, we adopted a new molecular adenovirus typing technique to study clinical adenovirus isolates collected from 22 medical facilities over a 25-month period during 2004-2006. A hexon gene sequence typing method was used to characterize 2237 clinical adenovirus-positive specimens, comparing their sequences with those of the 51 currently recognized prototype human adenovirus strains. In a blinded comparison, this method performed well and was much faster than the classic serologic typing method. RESULTS: Among civilians, the most prevalent adenovirus types were types 3 (prevalence, 34.6%), 2 (24.3%), 1 (17.7%), and 5 (5.3%). Among military trainees, the most prevalent types were types 4 (prevalence, 92.8%), 3 (2.6%), and 21 (2.4%). CONCLUSIONS: For both populations, we observed a statistically significant increasing trend of adenovirus type 21 detection over time. Among adenovirus isolates recovered from specimens from civilians, 50% were associated with hospitalization, 19.6% with a chronic disease condition, 11% with a bone marrow or solid organ transplantation, 7.4% with intensive care unit stay, and 4.2% with a cancer diagnosis. Multivariable risk factor modeling for adenovirus disease severity found that age <7 years (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4-7.4), chronic disease (OR, 3.6; 95% CI, 2.6-5.1), recent transplantation (OR, 2.7; 95% CI, 1.3-5.2), and adenovirus type 5 (OR, 2.7; 95% CI, 1.5-4.7) or type 21 infection (OR, 7.6; 95% CI, 2.6-22.3) increased the risk of severe disease.     

The impact of a screening mammography program on Sydney general practitioners

Abstract: The aim of this study was to determine changes in Sydney general practitioners' (GPs) knowledge about, attitude towards and intention to recommend screening mammography over the two years since a screening mammography program was first implemented in the Central Sydney Health Service (CSHS) area. 123 GPs from the CSHS area were selected from a list maintained by the Breast X-ray Programme, while 127 GPs from the rest of Sydney were selected from the Yellow Pages telephone directory. The overall response rate was 84 per cent. Outcomes were assessed by a self-administered questionnaire covering knowledge, attitudes and beliefs, self-report of recent referral practice, intention to recommend, and sources of information about mammography screening. Demographic data were also collected. Results showed that overall knowledge has increased both inside and outside the CSHS area, but important deficiencies in knowledge remain in both areas. Attitudes to screening mammography have improved in the CSHS area, especially regarding the efficacy of screening mammography and patient compliance. Importantly, positive views of screening mammography have declined outside the CSHS area, especially about whether screening mammography can save women's lives. GPs in both areas remain concerned about costs. The presence and strategies of the Breast X-ray Programme have had some positive effect on the attitudes of GPs towards, but not knowledge of, screening mammography.     

Additive effects of CD59 expression in Gal knockout mice in vitro but not in an ex vivo model

Abstract: Transgenic expression of the human complement regulatory molecule CD59 in mice and genetic deletion of the major xenoantigen galactose α 1,3 galactose (Gal KO) each resulted in partial protection of spleen cells from lysis by human serum. These protective effects were additive when the two genetic modifications were combined. However, when the effects of these genetic modifications were examined in an ex vivo model in which mouse hearts were perfused with human plasma, it was Gal KO which was the modification which determined protection. CD59 expression alone was not protective and CD59 expression in combination with Gal knockout did not result in a significant additional increase in protection over and above that provided by Gal knockout alone. The likely explanation for this discrepancy between the in vitro and ex vivo data is that the H2-K^b promoter used to drive CD59 expression results I in substantially less expression on endothelium than on spleen cells.