Wild Type and Mutant 2009 Pandemic Influenza A (H1N1) Viruses Cause More Severe Disease and Higher Mortality in Pregnant BALB/c Mice

BACKGROUND: Pregnant women infected by the pandemic influenza A (H1N1) 2009 virus had more severe disease and higher mortality but its pathogenesis is still unclear. PRINCIPAL FINDINGS: We showed that higher mortality, more severe pneumonitis, higher pulmonary viral load, lower peripheral blood T lymphocytes and antibody responses, higher levels of proinflammatory cytokines and chemokines, and worse fetal development occurred in pregnant mice than non-pregnant controls infected by either wild type (clinical isolate) or mouse-adapted mutant virus with D222G substitution in hemagglutinin. These disease-associated changes and the lower respiratory tract involvement were worse in pregnant mice challenged by mutant virus. Though human placental origin JEG-3 cell line could be infected and proinflammatory cytokines or chemokines were elevated in amniotic fluid of some mice, no placental or fetal involvement by virus were detected by culture, real-time reverse transcription polymerase chain reaction or histopathological changes. Dual immunofluorescent staining of viral nucleoprotein and type II alveolar cell marker SP-C protein suggested that the majority of infected alveolar epithelial cells were type II pneumocytes. CONCLUSION: The adverse effect of this pandemic virus on maternal and fetal outcome is largely related to the severe pulmonary disease and the indirect effect of inflammatory cytokine spillover into the systemic circulation

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Harmonization of monographic standards is needed to ensure the quality of Chinese medicinal materials

This article provides an overview on the regulations of Chinese medicinal materials (CMMs) in various countries and regions. Harmonization of CMM monographs would provide standards for the quality control of CMM products and play an important role in the modernization and globalization of Chinese medicine. A harmonized regulatory system would improve the quality of CMMs thereby ensuring the safety of the products and assisting Chinese medicine practitioners in their practice. The fast growing demand worldwide for traditional medicines calls for harmonized monographic standards to safeguard the safety and quality of CMM products

Application of atmospheric pressure chemical ionisation mass spectrometry in the identification and differentiation of the Panax species

An HPLC-MS method using an atmospheric pressure chemical ionisation (APCI) source has been developed to assist in the differentiation of three ginseng species: Panax quinquefolium (American ginseng), P. ginseng (Chinese ginseng) and P. notoginseng (sanqi) species. The differentiation method relies on the identification of ginsenosides Rf and F11, and notoginsenoside R1. R1 is observed in both P. notoginseng and Chinese ginseng, whilst F11 is found exclusively in the American species. The presence of these compounds permits the definitive identification of the species to be made. The APCI ionisation source has been employed to tackle the matrix interference in analysing Chinese medicinal materials and to minimise the associated matrix effects that are commonly encountered with other ionisation modes. Moreover, the method allows direct interface to conventional HPLC systems. More importantly, chemical reference standards of ginsenosides are not required in this method. This technique provides an alternative approach to analysing high molecular weight polar compounds that typically encountered in complex matrices of Chinese medicinal materials

Identification and determination of the major constituents in traditional Chinese medicinal plant Polygonum multiflorum Thunb by HPLC coupled with PAD and ESI/MS

An HPLC–PAD–MS method has been developed for the qualitative and quantitative analysis of the major chemical constituents in Polygonum multiflorum Thunb. Chromatographic separation was conducted on an Alltima C18 column using water:acetonitrile:acetic acid as the mobile phase. Altogether nine compounds of various classes, including stilbene glucosides, anthraquinone glucosides and anthraquinone derivates, were identified by online ESI/MS. Their identities were ascertained by comparison with data derived from the literature and/or standard compounds. Five components were quantified by HPLC–PAD and the method was fully validated. All the linear regressions were acquired with R2 0.99 and the quantification limits (with a signal-to-noise ratio of 3) ranged from 0.63 and 1.57 ng. Repeatability was evaluated by intra- and inter-day assays and RSD value was within 2.47%. Recovery studies for the quantified compounds were found to be within the range 96.32–102.53% with RSD less than 2.35%. The overall procedure is rapid and reproducible and is considered suitable for qualitative and quantitative analysis of a large number of samples

Measurement uncertainty for total ash and acid-insoluble ash determination of Chinese materia medica

The total ash and acid-insoluble ash contents of Chinese material medica (CMM) have been widely used as one of the indices to illustrate the quality as well as purity of herbal medicines. Such an approach has also been adopted by many official organizations in writing monographs for pharmacopoeia worldwide. In the present study, a full validation on the methodology was conducted with the inclusion of various commonly encountered matrices in herbs, namely, leaf, flower, fruit, stem and root. The practice ensures method suitability for a wider scope of matrix variation in CMM. Moreover, in order to comply with the technical requirement of International Organization of Standardization 17025 quality assurance system, the concept of measurement uncertainty has also been incorporated in the present study. Measurement uncertainties for total ash and acid-insoluble ash contents have been estimated

(Determination of free ferulic acid and total ferulic acid in Chuanxiong by high-performance liquid chromatography for quality assessment)

Ferulic acid (FA) is one of the main bioactive compounds in Chuanxiong (CX), the dried rhizome of Ligusticum chuanxiong, but its amount in this herb is difficult to determine accurately. An accurate quantificational method was developed to investigate on the available amount of FA (free FA and total FA). Herbal samples were extracted in methanol-formic acid (95:5) and methanol-0.24 mol·L-1 sodium hydrogen carbonate in water (95:5), respectively and then quantitatively analyzed by HPLC method. Thirty three CX samples were quantified on free and total FA. Total FA was found more abundant than free FA with an average ratio of 2.38 (n=32) in the range of 1.03-4.98 in 32 CX herbs, and a highest ratio of 19.6 was estimated in a rhizome seedling. Results showed that total FA content would be a better marker for the quality assessment of CX herbs. Fifteen CX typical samples were collected from the trueborn cultivating areas in Sichuan province of China. The amount of total FA in these herbs was estimated to be 1.42 mg·g-1 (n=15). The proposed limit of total FA in CX samples should not less than 1.25 mg·g-1 calculated on the dried basis. It was also found that the level of total FA was related to the quality, processing method and store duration of CX samples

Whole-genome array CGH evaluation for replacing prenatal karyotyping in Hong Kong.

OBJECTIVE: To evaluate the effectiveness of whole-genome array comparative genomic hybridization (aCGH) in prenatal diagnosis in Hong Kong. METHODS: Array CGH was performed on 220 samples recruited prospectively as the first-tier test study. In addition 150 prenatal samples with abnormal fetal ultrasound findings found to have normal karyotypes were analyzed as a 'further-test' study using NimbleGen CGX-135K oligonucleotide arrays. RESULTS: Array CGH findings were concordant with conventional cytogenetic results with the exception of one case of triploidy. It was found in the first-tier test study that aCGH detected 20% (44/220) clinically significant copy number variants (CNV), of which 21 were common aneuploidies and 23 had other chromosomal imbalances. There were 3.2% (7/220) samples with CNVs detected by aCGH but not by conventional cytogenetics. In the 'further-test' study, the additional diagnostic yield of detecting chromosome imbalance was 6% (9/150). The overall detection for CNVs of unclear clinical significance was 2.7% (10/370) with 0.9% found to be de novo. Eleven loci of common CNVs were found in the local population. CONCLUSION: Whole-genome aCGH offered a higher resolution diagnostic capacity than conventional karyotyping for prenatal diagnosis either as a first-tier test or as a 'further-test' for pregnancies with fetal ultrasound anomalies. We propose replacing conventional cytogenetics with aCGH for all pregnancies undergoing invasive diagnostic procedures after excluding common aneuploidies and triploidies by quantitative fluorescent PCR. Conventional cytogenetics can be reserved for visualization of clinically significant CNVs

Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review

Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility