Plasma steroid concentrations during alternate-day treatment with prednisone

Plasma steroid concentrations were measured in asthmatic children 24 and 48 hours after administration of alternate-day treatment with prednisone, and the results were compared with those of control patients who did not receive corticosteroid treatment as well as those of patients who were treated with prednisone each day. It was found that 24 hours after administration of prednisone in any dose, plasma steroid concentrations were significantly lower than those of the control group. The degree of suppression in plasma steroid concentration was less marked in patients who received treatment on alternate days than in those who received the same doses of prednisone each day. Within 48 hours after administration of alternate-day treatment, plasma steroid concentrations approached the values observed in the control group and were independent of the magnitude of the prednisone dose. Although alternateday steroid treatment was associated with transient and incomplete suppression of pituitary-adrenal function, patients whose therapy was changed from a daily to an alternate-day regimen sometimes exhibited prolonged suppression of adrenal cortical function.     

Latency characteristics in specific pathogen-free chickens 21 and 35 days after intra-tracheal inoculation with vaccine or field strains of infectious laryngotracheitis virus

ABSTRACT

Latency is an important feature of infectious laryngotracheitis virus (ILTV) yet is poorly understood. This study aimed to compare latency characteristics of vaccine (SA2) and field (CL9) strains of ILTV, establish an in vitro reactivation system and examine ILTV infection in peripheral blood mononuclear cells (PBMC) in specific pathogen-free chickens. Birds were inoculated with SA2 or CL9 ILTV and then bled and culled at 21 or 35 days post-inoculation (dpi). Swabs (conjunctiva, palatine cleft, trachea) and trigeminal ganglia (TG) were examined for ILTV DNA using PCR. Half of the TG, trachea and PBMC were co-cultivated with cell monolayers to assess in vitro reactivation of ILTV infection. ILTV DNA was detected in the trachea of approximately 50% of ILTV‐inoculated birds at both timepoints. At 21?dpi, ILTV was detected in the TG only in 29% and 17% of CL9- and SA2-infected birds, respectively. At 35?dpi, ILTV was detected in the TG only in 30% and 10% of CL9- and SA2-infected birds, respectively. Tracheal organ co-cultures from 30% and 70% of CL9- and SA2-infected birds, respectively, were negative for ILTV DNA at cull but yielded quantifiable DNA within 6 days post-explant (dpe). TG co-cultivation from 30% and 40% of CL9-and SA2-infected birds, respectively, had detectable ILTV DNA within 6 dpe. Latency characteristics did not substantially vary based on the strain of virus inoculated or between sampling timepoints. These results advance our understanding of ILTV latency and reactivation.

RESEARCH HIGHLIGHTS

• Following inoculation, latent ILTV infection was detected in a large proportion of chickens, irrespective of whether a field or vaccine strain was inoculated.

• In vitro reactivation of latent ILTV was readily detected in tracheal and trigeminal ganglia co-cultures using PCR.

• ILTV latency observed in SPF chickens at 21 days post-infection was not substantially different to 35 days post-infection.

     

Identification of the membrane protein of porcine epidemic diarrhea virus

Sequence information on the genome of porcine epidemic diarrhea virus (PEDV) has only recently been determined. In contrast, very little is known about the viral proteins. In the present report we have identified the membrane glycoprotein (M) of PEDV by use of rabbit anti-peptide sera and transient expression of the cloned M gene in Vero cells and by expression in the baculovirus system. The native M protein of PEDV is incorporated into virions, is N-glycosylated, and migrates with a relative mobility (Mr) of 27 k in polyacrylamide gels. In contrast, the M protein synthesized by recombinant baculoviruses migrates with a Mr of 23 k, that is, with identical mobility as the deglycosylated product of PEDV. Thus, it appears that M protein specified by the recombinant baculovirus is poorly, if at all, glycosylated. Using monoclonal antibodies and rabbit antipeptide sera specific for the N and C termini of the M protein, we were able to show that a 19 k band detected in PEDV-infected cells but not in virions represented a fragment of M from which the C terminus had been cleaved off. Finally, by electron microscopy and immunogold labelling, the relative orientation of M within the virion envelope was determined as NexoCcyt. In conclusion, all of these data strongly support the hypothesis that PEDV should be classified with the group I coronaviruses.     

Functional inhibition and release: unilateral tachistoscopic performance and stereoelectroencephalographic activity in a case with left limbic status epilepticus

During prolonged nonconvulsive unilateral left limbic status epilepticus, a natural model of functional hemispheric inhibition, we performed two tachistoscopic experiments, a lexical decision task associated with a RVF (left hemisphere) superiority and a facial matching task associated with a LVF (right hemisphere) superiority. We found that epileptic activity in the left hemisphere, especially rhythmic high-frequency "tonic" discharges, inhibited performance on the lexical task but not on the facial matching task. This suggests that only cognitive activity in the discharging hemisphere is inhibited. Strikingly, the best performance of the right hemisphere was obtained while the left hemisphere was most inhibited, suggesting a functional balance of inhibition and release.     

Qualitative and quantitative evaluation of the exercise electrocardiogram in assessing the degree of coronary heart disease

Exercise-induced changes in the ST segments of the electrocardiogram were compared with the results of coronary arteriography in 73 consecutive patients referred for preoperative evaluation of coronary artery disease. Eighteen patients had single-, 25 double-, and 30 triple-vessel disease. Thirteen were taking digitalis alone, 28 were taking beta blockers alone, 21 had beta blockers and digitalis and 11 had no cardiac drugs. Exercise induced elevation of the ST segment in 11 patients, all with a predominant lesion in the left anterior descending coronary artery. ST depression with an upsloping ST segment was observed in patients with one-, two-, and three-vessel disease and it was the most common type of ST change in patients with single-vessel disease. Horizontal ST depression was most common in two-vessel disease and downsloping ST segment in three-vessel disease. There was a good correlation between the number of stenosed vessels and ST changes caused by exercise, expressed as the sum of ST segment displacements in twelve leads recorded immediately after the end of exercise (sigma/ST/) or as ST depression per unit increase in heart rate during exercise ("m" (ST/HR]. The latter was obtained by linear regression of ST displacement and heart rate measured at three or four different workloads in the lead with the greatest displacement of the ST segment. The mean values of sigma/ST/ were 0.58 +- 0.030 mV in single-vessel, 0.97 +- 0.41 mV in double-vessel and 1.58 +- 0. 46 mV in triple-vessel disease. The mean values of "m" (ST/HR) were 0.0024 +- 0.0013 mV X min-1 X beat-1 in single-vessel, 0.0042 +- 0.0012 in double-vessel, and 0.0078 +- 0.0033 in triple-vessel disease. These differences were highly significant (p less than 0.01 - 0.001) and there was only minimal overlap between the single- and triple-vessel groups. Digitalis caused a slight (statistically nonsignificant) increase in sigma/ST/ but not in "m" (ST/HR).     

Ejaculatory incompetence: a theoretical formulation and case illustration

Three theoretical formulations of ejaculatory incompetence have been proposed in the literature. They include: (1) aversive conditioned inhibition of the ejaculatory reflex, (2) an "autosexual" orientation associated with discrepant levels in the cognitive and physiological dimensions of sexual arousal, and (3) a discriminative learning model. These three models are discussed in relation to their theoretical and therapeutic implications. Clinical data supporting the discriminative view is presented.     

The discovery of neuronopathy and neuropathy as a cause of progressive paralysis in childhood. The historical origins of modern differential diagnosis in neuromuscular disease

The concept of the differential diagnosis has a central place in all clinical medicine. In neurology and paediatrics, evolution of thought concerning the differential diagnosis of the child presenting with symptoms of neuromuscular disease was far in advance of similar diagnostic approaches to problems of infectious, infective and neoplastic disease; and as such forms a significant historical model for the development of modern clinical approaches to the sick or disabled child. The account presented in this paper provides a detailed historical review of the development of thought relating to the causes of neuromuscular disease. Nosological developments concerning diseases of the motor unit can be conveniently classified into three periods: (a) a "state of the art" period to 1850; (b) 1850-1890 - a period of parallel and interdependent advances in both normal neuro-anatomy and neurophysiology, and diseases recognized as variations from such norms. In this era Duchenne was the first to write about the differential diagnosis of the progressive muscular paralysis in childhood; and Gowers was the first to write specifically on the hereditary transmission of this group of diseases; (c) in 1891 was described the first case of childhood neuronopathy recognized as such, and with this development was ushered in the modern era of clinical differential diagnosis of childhood neuromuscular disease. The "splitters" have won the great debate concerning the clinical approach to neurological diseases. The continual further refining of an exact diagnosis is the only way in which a realistic prognosis can be forecast, correct genetic counseling can be offered, and (if the condition is treatable) optimal therapy can be introduced.     

2005-2019年理塘县法定传染病疫情分析

目的了解理塘县近15年法定传染病疫情形势及流行特征,为政府制定防控措施提供科学依据。方法对2005—2019年理塘县法定传染病疫情进行描述性流行病学分析。采用ArcGIS 10.3软件绘制各乡镇发病情况分布图,SPSS 21.0软件进行χ²检验、趋势性χ²检验。结果2005—2019年理塘县共计报告甲乙丙类传染病21种6154例,年均发病率为644.33/10万,发病呈上升趋势。死亡37例,年均死亡率3.87/10万,病死率0.60%。呼吸道传染病发病最高(341.12/10万);发病前3位的病种为肺结核(271.91/10万)、乙肝(103.24/10万)及包虫病(67.22/10万);肺结核、其他感染性腹泻病、艾滋病/HIV、梅毒发病呈上升趋势。3月、9月分别出现1次发病高峰;20~29岁、30~39岁和10~19岁组发病居前3位;男女性别比为1.24∶1;发病以农民、牧民及学生为主。结论2005-2019年理塘县法定传染病发病率较高且呈上升趋势,应针对高发传染病、上升趋势明显的传染病、重点人群进行分析研究,采取针对性措施控制疫情。     

道路交通安全执法对医院质控的启示

道路交通安全执法对机动车的管理井然有序,而行人违规过马路现象却比比皆是。医院质控也常常出现类似的现象。文章比较了道路交通安全执法对机动车管理与行人管理的异同,认为道路交通安全执法与医院质控虽然属于不同的领域,但拥有相同或相似的功能和流程,可以作为跨行业功能性标杆来学习。道路交通安全执法对医院质控的启示为:（1）医院质控必须遵循结构质量—过程质量—结果质量（SPO）三维质量评价模型,且有机协同;（2）有效的质量控制必须符合热炉法则;（3）质控工作的重心应放在监控和改进上,即“有时去应急,常常去改进,总是去监控”;（4）遵循规章制度的自律文化的养成是良好质控的保证。     

四川省内中医医院医疗费用结构变动分析

目的分析四川省内中医医院医疗费用结构变动情况,为促进中医医院医疗费用精细化管理提供依据。方法采用描述性分析法和结构变动度方法对四川省内中医医院2014年-2019年门诊和住院医疗费用结构变动情况进行分析。结果门诊收入中,中药收入平均占比最高（31.46%）,手术收入平均占比最低（1.32%）;检查收入在2016年-2019年、中药收入和其他收入在2018年-2019年为负向变动;治疗收入贡献率呈先上升后下降特点,手术收入的贡献率和拉动力处于最小状态。住院收入中,其他收入平均占比最高（34.88%）,手术收入平均占比最低（5.41%）;检查收入从2016年起、治疗收入从2017年起、手术收入从2018年起为正向变动;中药收入贡献率和拉动力不断增强,手术收入的拉动力在2019年明显提升。结论住院中药收入占比较低,应拓展中医药服务项目;治疗收入和手术收入结构变动贡献率较小,要加强中医医院服务能力建设;检查收入和其他收入拉动力较大,要加强对医务人员医疗行为的监管。