Virologically confirmed population-based burden of hospitalization caused by influenza a and b among children in Hong Kong

Background. We sought to determine the virologically confirmed hospitalization rates associated with influenza virus infection among Hong Kong children. Methods. Patients <18 years of age who lived on Hong Kong Island (a separate island within Hong Kong) and were admitted to either of the only 2 public hospitals on the island for a febrile acute respiratory infection on 1 fixed day of the week in each hospital from October 2003 through September 2006 were prospectively recruited. These 2 hospitals together accounted for 72.5% of all general pediatric admissions in Hong Kong Island with a known population denominator. Nasopharyngeal aspirates were obtained from all recruited patients and were tested for influenza A and influenza B viruses by direct antigen detection and culture. Results. All cases of influenza A during 2003-2004 were caused by H3N2 virus, whereas 85.7% of cases during 2004-2005 were due to H3N2 virus, and 93.5% during 2005-2006 were due to H1N1 virus. During 2004-2005, infants <1 year of age had the highest rate of hospitalization for influenza A (103.8 cases per 10,000 population), whereas children 1 year of age had the highest rate of hospitalization during the other 2 seasons (95.5 and 54.6 cases per 10,000 population during 2003-2004 and 2005-2006, respectively). A protection rate of 25%, presumably attributable to maternal antibodies, was seen in infants <1 year of age who were hospitalized during 2003-2004 with infection due to an H3N2 virus that had been in circulation. The hospitalization rates for influenza B were highest among children 2-4 years of age. Conclusions. This population-based study of hospitalizations due to virologically confirmed influenza demonstrated a very high burden of disease among young children in Hong Kong. The morbidity varied with virus type, subtype, and antigenic variants. © 2009 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio

In situ study of fiber structure development of poly(butylene terephthalate) in a continuous laser-heated drawing process

The structural development of poly(butylene terephthalate) (PBT) fibers was analyzed using in situ wide angle X-ray diffraction and fiber temperature measurements during CO2 laser-heated drawing, in which the necking position on the running fiber could be fixed by CO2 laser irradiation. The measured parameters were determined as functions of the elapsed time after necking with a time resolution of 0.3 ms. The as-spun PBT fibers, which exhibited a low-oriented alpha-crystalline structure, were drawn to a draw ratio of 5 using laser heating. The (001') reflection, which indicates a quasi-smectic fibrillar structure, was not observed before crystallization in contrast to measurements of poly(ethylene terephthalate) (PET) and poly(ethylene 2,6-naphthalene dicarboxylate) (PEN). The alpha-crystal was transformed into an oriented beta-form crystal at the necking position, and the developed beta-crystallites exhibited increased size and altered orientation <2 ms after necking. The fiber temperature increased rapidly at around T-g, and the rearrangement of the beta-crystal primarily occurred as the fiber's temperature rose from 100 to 160 degrees C. The oriented beta-crystal of the drawn fiber transformed into the oriented beta-crystal when the drawing tension was released. Polymer Journal (2012) 44, 1030-1035; doi: 10.1038/pj.2012.65; published online 18 April 2012ArticlePOLYMER JOURNAL. 44(10):1030-1035 (2012)journal articl

Low alanine aminotransferase and higher cardiovascular events in type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Aims Non-alcoholic fatty liver disease (NAFLD) is common in type 2 diabetes and associated with higher risk of cardiovascular disease. This study aimed to determine whether alanine aminotransferase (ALT) or gamma-glutamyltransferase (GGT), as markers of liver health and NAFLD, might predict cardiovascular events in this population. Methods Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (nonfatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years. Results ALT had a linear inverse relationship with the first cardiovascular event on study. After adjustment, for every standard deviation higher baseline ALT (13.2U/L), the risk of an event was 7%(95%CI 4–13, P=0.02) lower. Participants with ALT below and above the reference range 8–41 U/L for women and 9–59 U/L for men, had a hazard ratio of an event of 1.86(95%CI, 1.12–3.09) and 0.65(95%CI, 0.49–0.87), respectively (P=0.001). No relationship was found for GGT. Conclusions The data may indicate that in type 2 diabetes — associated with higher ALT due to prevalent NAFLD — lower ALT is a marker of hepatic or systemic frailty rather than health

Characterization of Fine Particulate Matter and Associations between Particulate Chemical Constituents and Mortality in Seoul, Korea

Background: Numerous studies have linked fine particles [≤ 2.5 µm in aerodynamic diameter (PM2.5)] and health. Most studies focused on the total mass of the particles, although the chemical composition of the particles varies substantially. Which chemical components of fine particles that are the most harmful is not well understood, and research on the chemical composition of PM2.5 and the components that are the most harmful is particularly limited in Asia

High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15

Introduction: It is unclear whether high- dose influenza vaccine (HD) is more effective at reducing mortality among seniors. Aim: This study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. Methods: We linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard- dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. Results: Among 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24-59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23-32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations. Discussion: The HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period

Changes in urinary metabolomic profile during relapsing renal vasculitis

Current biomarkers of renal disease in systemic vasculitis lack predictive value and are insensitive to early damage. To identify novel biomarkers of renal vasculitis flare, we analysed the longitudinal urinary metabolomic profile of a rat model of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis. Wistar-Kyoto (WKY) rats were immunised with human myeloperoxidase (MPO). Urine was obtained at regular intervals for 181 days, after which relapse was induced by re-challenge with MPO. Urinary metabolites were assessed in an unbiased fashion using nuclear magnetic resonance (NMR) spectroscopy, and analysed using partial least squares discriminant analysis (PLS-DA) and partial least squares regression (PLS-R). At 56 days post-immunisation, we found that rats with vasculitis had a significantly different urinary metabolite profile than control animals; the observed PLS-DA clusters dissipated between 56 and 181 days, and re-emerged with relapse. The metabolites most altered in rats with active or relapsing vasculitis were trimethylamine N-oxide (TMAO), citrate and 2-oxoglutarate. Myo-inositol was also moderately predictive. The key urine metabolites identified in rats were confirmed in a large cohort of patients using liquid chromatography-mass spectrometry (LC-MS). Hypocitraturia and elevated urinary myo-inositol remained associated with active disease, with the urine myo-inositol:citrate ratio being tightly correlated with active renal vasculitis

Developing and implementing an integrated delirium prevention system of care:a theory driven, participatory research study

Background: Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods: We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results: Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. Conclusions: Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly

Viewpoint on Emv2, the onlhy endogenous ecotropic murine leukemia virus of C57BL/6 mice

Here I comment on the articles by Lee and colleagues (Retrovirology 2011, 8:82) and Lee and Cho (Retrovirology 2012, 9:23) dealing with an endogenous ecotropic mouse leukemia virus found in C57BL mice

Unique case of esophageal rupture after a fall from height

<p>Abstract</p> <p>Background</p> <p>Traumatic ruptures of the esophagus are relatively rare. This condition is associated with high morbidity and mortality. Most traumatic ruptures occur after motor vehicle accidents.</p> <p>Case Presentation</p> <p>We describe a unique case of a 23 year old woman that presented at our trauma resuscitation room after a fall from 8 meters. During physical examination there were no clinical signs of life-threatening injuries. She did however have a massive amount of subcutaneous emphysema of the chest and neck and pneumomediastinum. Flexible laryngoscopy revealed a lesion in the upper esophagus just below the level of the upper esophageal sphincter. Despite preventive administration of intravenous antibiotics and nutrition via a nasogastric tube, the patient developed a cervical abscess, which drained spontaneously. Normal diet was gradually resumed after 2.5 weeks and the patient was discharged in a reasonable condition 3 weeks after the accident.</p> <p>Conclusions</p> <p>This case report presents a high cervical esophageal rupture without associated local injuries after a fall from height.</p

Multidetector row CT for imaging the paediatric tracheobronchial tree

The introduction of multidetector row computed tomography (MDCT) scanners has altered the approach to imaging the paediatric thorax. In an environment where the rapid acquisition of CT data allows general hospitals to image children instead of referring them to specialist paediatric centres, it is vital that general radiologists have access to protocols appropriate for paediatric applications. Thus a dramatic reduction in the delivered radiation dose is ensured with optimal contrast bolus delivery and timing, and inappropriate repetition of the scans is avoided. This article focuses on the main principles of volumetric CT imaging that apply generically to all MDCT scanners. We describe the reconstruction techniques for imaging the paediatric thorax and the low-dose protocols used in our institution on a 16-slice detector CT scanner. Examples of the commonest clinical applications are also given