Targeted amplification-based whole genome sequencing of Monkeypox virus in clinical specimens.

IMPORTANCE: We present a protocol to efficiently sequence genomes of the MPXV-causing mpox. This enables researchers and public health agencies to acquire high-quality genomic data using a rapid and cost-effective approach. Genomic data can be used to conduct surveillance and investigate mpox outbreaks. We present 91 mpox genomes that show the diversity of the 2022 mpox outbreak in Ontario, Canada.

Organoid microphysiological system preserves pancreatic islet function within 3D matrix.

Three-dimensional (3D) multicellular organoids recapitulate the native complexities of human tissue better than traditional cellular monolayers. As organoids are insufficiently supported using standard static culture, microphysiological systems (MPSs) provide a key enabling technology to maintain organoid physiology in vitro. Here, a polydimethylsiloxane-free MPS that enables continuous dynamic culture and serial in situ multiparametric assessments was leveraged to culture organoids, specifically human and rodent pancreatic islets, within a 3D alginate hydrogel. Computational modeling predicted reduced hypoxic stress and improved insulin secretion compared to static culture. Experimental validation via serial, high-content, and noninvasive assessments quantitatively confirmed that the MPS platform retained organoid viability and functionality for at least 10 days, in stark contrast to the acute decline observed overnight under static conditions. Our findings demonstrate the importance of a dynamic in vitro microenvironment for the preservation of primary organoid function and the utility of this MPS for in situ multiparametric assessment.

Evaluating the use of whole genome sequencing for the investigation of a large mumps outbreak in Ontario, Canada.

In 2017 Ontario experienced the largest mumps outbreak in the province in 8 years, at a time when multiple outbreaks were occurring across North America. Of 259 reported cases, 143 occurred in Toronto, primarily among young adults. Routine genotyping of the small hydrophobic gene indicated that the outbreak was due to mumps virus genotype G. We performed a retrospective study of whole genome sequencing of 26 mumps virus isolates from early in the outbreak, using a tiling amplicon method. Results indicated that two of the cases were genetically divergent, with the remaining 24 cases belonging to two major clades and one minor clade. Phylogeographic analysis confirmed circulation of virus from each clade between Toronto and other regions in Ontario. Comparison with other genotype G strains from North America suggested that the presence of co-circulating major clades may have been due to separate importation events from outbreaks in the United States. A transmission network analysis performed with the software program TransPhylo was compared with previously collected epidemiological data. The transmission tree correlated with known epidemiological links between nine patients and identified new potential clusters with no known epidemiological links.

3-D physiomimetic extracellular matrix hydrogels provide a supportive microenvironment for rodent and human islet culture.

Organ-on-a-chip platforms serve as cost-efficient testbeds for screening pharmaceutical agents, mimicking natural physiology, and studying disease. In the field of diabetes, the development of an islet-on-a-chip platform would have broad implications in understanding disease pathology and discovering potential therapies. Islet microphysiological systems are limited, however, by their poor cell survival and function in culture. A key factor that has been implicated in this decline is the disruption of islet-matrix interactions following isolation. Herein, we sought to recapitulate the in vivo peri-islet niche using decellularized extracellular matrix (ECM) hydrogels. Sourcing from porcine bladder, lung, and pancreas tissues, 3-D ECM hydrogels were generated, characterized, and validated using both rodent and human pancreatic islets. Optimized decellularization protocols resulted in hydrogels with distinctive viscoelastic properties that correlated to their matrix composition. The in situ 3-D encapsulation of human or rat islets within ECM hydrogels resulted in improved functional stability over standard culture conditions. Islet composition and morphology were also altered, with enhanced retention of islet-resident endothelial cells and the formation of cord-like structures or sprouts emerging from the islet spheroid. These supportive 3-D physiomimetic ECM hydrogels can be leveraged within microfluidic platforms for the long-term culture of islets.

Canadian recommendations for laboratory interpretation of multiple or extensive drug resistance in clinical isolates of Enterobacteriaceae, Acinetobacter species and Pseudomonas aeruginosa.

The goal of this document was to provide Canadian laboratories with a framework for consistent reporting and monitoring of multidrug resistant organisms (MDRO) and extensively drug resistant organisms (XDRO) for common gram-negative pathogens. This is the final edition of the interim recommendations, which were modified after one year of broad consultative review. This edition represents a consensus of peer-reviewed information and was co-authored by the Canadian Public Health Laboratory Network and the Canadian Association of Clinical Microbiology and Infectious Diseases. There are two main recommendations. The first recommendation provides standardized definitions for MDRO and XDRO for gram-negative organisms in clinical specimens. These definitions were limited to antibiotics that are commonly tested clinically and, to reduce ambiguity, resistance (rather than non-susceptibility) was used to calculate drug resistance status. The second recommendation identifies the use of standardized laboratory reporting of organisms identified as MDRO or XDRO. Through the broad consultation, which included public health and infection prevention and control colleagues, these definitions are ready to be applied for policy development. Both authoring organizations intend to review these recommendations regularly as antibiotic resistance testing evolves in Canada.

Lessons learnt from the Indian H1N1 (swine flu) epidemic: Predictors of outcome based on epidemiological and clinical profile.

INTRODUCTION: Influenza A (H1N1) virus has caused serious respiratory illness (swine flu) and death over the years. The first confirmed case of swine flu H1N1 in India was documented in May 2009, but huge numbers of cases were reported thereafter. In 2015, swine flu outbreak in India had led to significant morbidity and mortality. OBJECTIVE: to study details of swine flu patients admitted in a rural tertiary care center in western India in 2015 and to identify predictors of mortality. METHODOLOGY: Retrospective data of swine flu cases admitted at a tertiary care teaching hospital in 2015 and their outcome as either cured or expired was recorded. RESULT: Out of 65 confirmed cases of severe swine flu that required hospitalization, 40(61%) were male. 55 of 65 (84.61%) patients [mean (SD) age: 50(15)] were cured while 10 patients [mean (SD) age 51(15)] expired. Overall mean (SD) age was 50.23(15) years with average (SD) days of hospitalization were 6.32(3.3) days. The commonest symptoms were cough (100%) followed by throat pain (96.9%), common-cold, fever (93.8%), and breathlessness (83.1%). 40% of patients needed non invasive ventilator support while 16.9% patient required invasive ventilator. Mean temperature on presentation was (99.96'F), RR (25.89/min), SpO2 on room air was 82.06%. Average White Blood Cells were 8274/mm3 with neutrophils were 79.58%. Mean procalcitonin was 0.83 ng/ml. It was found through univariate analysis that sputum production (P = 0.013), chest pain (P = 0.04), Respiratory Rate (P = 0.013), SpO2 on presentation at room air (P = 0.001), Days of non invasive ventilator (P = 0.001), intubation and invasive ventilator (P = 0.001) were statistically significantly associated with outcome but through multivariate analysis it was revealed that only requirement of intubation (invasive ventilator) was significantly predicting mortality(Odds ratio=234) (P = 0.0001). CONCLUSION: Requirement of intubation was associated with poor outcome.

The continued rise of Lyme disease in Ontario, Canada: 2017.

BACKGROUND: Lyme disease is an infection caused by the spirochete Borrelia burgdorferi and, in most of North America, is transmitted by the blacklegged tick Ixodes scapularis. Climate change has contributed to the expansion of the geographic range of blacklegged ticks in Ontario, increasing the risk of Lyme disease for Ontarians. OBJECTIVE: To identify the number of cases and incidence rates, as well as the geographic, seasonal and demographic distribution of Lyme disease cases reported in Ontario in 2017, with comparisons to historical trends. METHODS: Data for confirmed and probable Lyme disease cases with episode dates from January 1, 2012, through December 31, 2017, were extracted from the integrated Public Health Information System (iPHIS). Data included public health unit (PHU) of residence, episode date, age and sex. Population data from Statistics Canada were used to calculate provincial and PHU-specific incidence rates per 100,000 population. The number of cases reported in 2017 by PHU of residence, month of occurrence, age and sex was compared to the 5-year averages for the period 2012-2016. RESULTS: There were 959 probable and confirmed cases of Lyme disease reported in Ontario in 2017. This was three times higher than the 5-year (2012-2016) average of 313. The provincial incidence rate for 2017 was 6.7 cases per 100,000 population, although this varied markedly by PHU. The highest incidence rates were found in Leeds-Grenville and Lanark District (128.8 cases per 100,000), Kingston-Frontenac, Lennox and Addington (87.2 cases per 100,000), Hastings and Prince Edward Counties (28.6 cases per 100,000), Ottawa (18.1 cases per 100,000) and Eastern Ontario (13.5 cases per 100,000). Cases occurred mostly from June through September, were most common among males, and those aged 5-14 and 50-69 years. CONCLUSION: In 2017, Lyme disease incidence showed a marked increase in Ontario, especially in the eastern part of the province. If current weather and climate trends continue, blacklegged ticks carrying tick-borne pathogens, such as those causing Lyme disease, will continue to spread into suitable habitat. Monitoring the extent of this geographic spread will inform future clinical and public health actions to detect and mitigate the impact of Lyme disease in Ontario.

Vancomycin-Variable Enterococcal Bacteremia.

Vancomycin-variable enterococcus (VVE) is an emerging pathogen. VVE isolates initially appear phenotypically susceptible to vancomycin but possesses the vanA gene and can develop in vitro and in vivo resistance to vancomycin. We report a case of VVE bacteremia and describe how VVE poses diagnostic and therapeutic dilemmas.

Presence of left atrial diverticula, accessory appendages, and normal variant pulmonary venous anatomy diagnosed using MDCT and adverse outcomes following radiofrequency catheter ablation therapy in patients with drug-refractory atrial fibrillation: an exploratory study.

AIM: To determine the frequency of normal variation left atrial anatomy (NVLAA) (diverticula, accessory appendages) and normal variation pulmonary venous anatomy (NVPVA) in patients with atrial fibrillation (AF), and to determine whether the presence of these entities is associated with an increased recurrence of atrial arrhythmias following radiofrequency catheter ablation (RFCA). MATERIALS AND METHODS: All cardiac MDCT images performed prior to RFCA between November 2009 and May 2011 in patients with drug-refractory AF were retrospectively evaluated. The presence, type, and location of NVLAA and NVPVA, and outcome of RFCA were recorded. Success was defined as restoration of sinus rhythm. RESULTS: Forty-six consecutive patients with a mean age of 59.8 (±9.7) years (76.1% male) underwent cardiac MDCT for anatomical planning prior to RFCA procedures. Fourteen (30.4%) patients had NVLAA, 35% of patients had NVPVA. Thirty (65%) patients had successful RFCA: 57% of these had a NVLAA, 67% had NVPVA. Sixteen (35%) patients had unsuccessful RFCA: 63% of these had a NVLAA, 56% had NVPVA. There was no significant association between the presence of NVLAA (p = 0.699), NVPVA (p = 0.197), or "NVLAA in the presence of normal pulmonary venous anatomy" (p = 0.589) and the outcome of RFCA. CONCLUSION: The presence of NVLAA and NVPVA appears unrelated to adverse outcome in patients undergoing RFCA for the treatment of drug-refractory AF.

Inhibition of Lck enhances glucocorticoid sensitivity and apoptosis in lymphoid cell lines and in chronic lymphocytic leukemia.

Glucocorticoids are used as part of front-line therapy to treat lymphoid malignancy because of their remarkable ability to induce apoptosis. Yet, in T cells, glucocorticoid-induced apoptosis is readily inhibited by lymphocyte activation and signaling. We have previously shown that the Src family kinase, Lck (lymphocyte cell-specific tyrosine kinase), which is predominantly expressed in T cells, interacts with IP3 receptors to facilitate calcium signaling. Here, we discovered that dexamethasone downregulates Lck, which, in turn, suppresses lymphocyte activation by inhibiting pro-survival calcium oscillations. Moreover, stable expression of shRNAs that selectively targeted Lck or treatment with the Src inhibitor dasatinib (BMS-354825) enhanced apoptosis induction by dexamethasone. To investigate the effect of Lck inhibition in a primary leukemia model, we employed chronic lymphocytic leukemia (CLL) cells that aberrantly expressed Lck and were relatively insensitive to dexamethasone. Lck expression was correlated with resistance to dexamethasone in CLL cells, and its inhibition by dasatinib or other inhibitors markedly enhanced glucocorticoid sensitivity. Collectively, these data indicate that Lck protects cells from glucocorticoid-induced apoptosis and its inhibition enhances sensitivity to dexamethasone. Small-molecule inhibitors of Lck, such as dasatinib, may function to reverse glucocorticoid resistance in some lymphoid malignancies.

Laundering of hospital staff uniforms at home.

Few hospitals now launder staff uniforms. Staff are expected to use their own domestic machines, most of which run with 40 degrees C cycles. However, there is little information on the effectiveness of home laundering. This study demonstrates that domestic washing machines reduce viable counts of Staphylococcus aureus to below detectable levels from an inoculum of 10(8)-10(12) colony-forming units (>or=10(6)-fold reduction), even using low temperature (40 degrees C) programmes. Environmental organisms, predominantly Gram-negative flora, were introduced from the machine itself but were destroyed by tumble drying or ironing. Domestic laundering of uniforms is an acceptable alternative to hospital laundering if combined with tumble drying or ironing.

Fatal haemorrhage following a low-energy fracture of the pubic ramus.

We report a case of fatal haemorrhage following a low-energy fracture of the pubic ramus in an 85-year-old woman.

Mathematical modeling of retinal birefringence scanning.

Retinal birefringence scanning (RBS) is a new technique that is used to detect the fixation of the eye remotely and noninvasively. The method is based on analysis of polarization changes induced by the retina. In this study, the principles of RBS were mathematically modeled to facilitate a better understanding of the origins of the signals obtained. Stokes vector analysis and Mueller matrix multiplication were augmented with Poincaré sphere representation. The cornea was modeled as a linear retarder. The foveal area was modeled as a radially symmetric birefringent medium. The model accurately predicted the frequency and phase of RBS signals obtained during central and paracentral fixation. The signal that indicates central fixation during RBS likely results from a combination of the radial birefringence of the Henle fibers and the overlying corneal birefringence.

Automated detection of foveal fixation by use of retinal birefringence scanning.

Foveal fixation was monitored in normal subjects remotely and continuously by use of a noninvasive retinal scan. Polarized infrared light was imaged onto the retina and scanned in a 3 degrees annulus at 44 Hz. Reflections were analyzed by differential polarization detection. In all 32 eyes studied, the detected signal was predominantly 88 Hz during central fixation (within +/-1 degree) and 44 Hz during paracentral fixation. Phase shift at 44 Hz correlated with the direction of eye displacement. Potential applications of this technique include screening for eye disease, eye position monitoring during clinical procedures, and use of eye fixation to operate devices.

Evidence for normal aging of the septo-hippocampal cholinergic system in apoE (-/-) mice but impaired clearance of axonal degeneration products following injury.

The association of the epsilon4 allele of apoE with increased risk for Alzheimer's disease (AD) and with poor clinical outcome after certain acute brain injuries has sparked interest in the neurobiology of apoE. ApoE (-/-) mice provide a tool to investigate the role of apoE in the nervous system in vivo. Since integrity of the basal forebrain cholinergic system is severely compromised in AD, with severity of dysfunction correlating with apoE4 gene dosage, the present study tested the hypothesis that apoE is required to maintain the normal integrity of basal forebrain cholinergic neurons (BFCNs). Histological and biochemical analyses of the septo-hippocampal cholinergic system were performed in apoE (-/-) mice during aging and following injury. Using unbiased quantitative methods, there was little or no evidence for defects in the septo-hippocampal cholinergic system, as assessed by p75(NTR)-immunoreactive neuron number and size in the medial septum, cholinergic fiber density in the hippocampus, and choline acetyltransferase activity in the hippocampus, cortex, and striatum in aged apoE (-/-) mice (up to 24 months of age) as compared to age-matched wild-type mice of the same strain. In addition, cholinergic neuronal survival and size following fimbria-fornix transection in apoE (-/-) mice did not differ from controls. However, following entorhinal cortex lesion, there was persistence of degeneration products in the deafferented hippocampus in apoE (-/-) mice. These data suggest that although apoE is not required for the maintenance of BFCNs in vivo, it may play a role in the clearance of cholesterol-laden neurodegeneration products following brain injury.

Glial fibrillary acidic protein-apolipoprotein E (apoE) transgenic mice: astrocyte-specific expression and differing biological effects of astrocyte-secreted apoE3 and apoE4 lipoproteins.

The epsilon4 allele of apolipoprotein E (apoE) is associated with increased risk for Alzheimer's disease (AD) and poor outcome after brain injury. In the CNS, apoE is expressed by glia, predominantly astrocytes. To define the potential biological functions of different human apoE isoforms produced within the brain, transgenic mice were generated in which human apoE3 and apoE4 expression is under control of the astrocyte-specific glial fibrillary acidic protein (GFAP) promoter. These animals were then bred back to apoE knock-out mice. Human apoE protein is found within astrocytes and the neuropil throughout development and into the adult period, as assessed by immunocytochemistry and immunoblot analysis in several GFAP-apoE3 and E4 lines. Cultured astrocytes from these mice secrete apoE3 and apoE4 in lipoproteins that are high-density lipoprotein-like in size. When primary hippocampal neurons are grown in the presence of astrocyte monolayers derived from these transgenic mice, there is significantly greater neurite outgrowth from neurons grown in the presence of apoE3-secreting astrocytes compared with apoE4-secreting or apoE knock-out astrocytes. These effects are not dependent on direct astrocyte-neuron contact and appear to require the low-density lipoprotein receptor-related protein. These data suggest that astrocyte-secreted, apoE3-containing lipoproteins have different biological effects than apoE4-containing lipoproteins. In addition to providing information regarding the role of astrocyte-secreted apoE lipoproteins in the normal brain, these animals will also be useful in models of both AD and CNS injury.

Hippocampal tissue transplants reverse lesion-induced spatial memory deficits in zebra finches (Taeniopygia guttata).

The avian hippocampal formation (Hf) plays an important role in spatial memory for food storing. Here we examined the effects of excitotoxic lesions of the Hf and subsequent neural transplantation on a one-trial associative memory task in zebra finches. The results showed (1) that small ibotenic acid lesions of the dorsal Hf of zebra finches produced significant spatial memory impairments compared with controls, sham-lesioned birds, and prelesion performance; and (2) that Hf-lesioned birds given transplants of embryonic hippocampal (H) tissue, but not those given transplants of embryonic anterior telencephalon (AT) tissue, showed a significant reversal of the performance deficits on the spatial memory task. Lesioned-only birds and lesioned birds given H or AT transplants that did not survive did not show behavioral improvement. Sham-lesioned and untreated control birds maintained good performance throughout the experiment. The H and AT transplants were found to be growing partially within the Hf and partially within the underlying ventricle. The transplants appeared healthy and contained neurons with beaded and unbeaded fibers (shown by immunohistochemistry with antibodies to parvalbumin, substance P, and a 200 kDa neurofilament protein). Blood vessels and erythrocytes were also present within the transplants. The results show that neural transplants can survive within the bird brain and that small lesions of the Hf produce significant spatial memory deficits that can only be reversed by surviving homologous H transplants, and not by heterologous telencephalon transplants.

Nerve growth factor effects on the song control system of zebra finches.

The aim of this experiment was to test whether or not nerve growth factor (NGF) is involved in cholinergic processes in the avian brain, by injecting NGF into the higher vocal center (HVC) and examining its effects on adult male zebra finch song. Since NGF has been hypothesized to protect cells after injury, some birds received both NGF and ibotenic acid (IBO) lesions of HVC, while others received either NGF or IBO or neither (SHAM). Only the IBO-treated birds showed alterations in song. Although there was no evidence of cell preservation in the immunocytochemical and morphological analysis NGF appears to prevent the IBO induced impairment in song augmenting the activity of the remaining neurons and enhancing brain repair.

Spatial learning induces neurogenesis in the avian brain.

It is known from previous work that neurones are born continuously in the ventricular zone of the bird brain. In this study, we show that the amount of cell proliferation in the ventricular zone of the hippocampus (HP) and the hyperstriatum ventrale (HV) is influenced by behavioural experience. Two groups of birds (marsh tits) were compared: those allowed to store and retrieve food once every 3 days between days 35 and 56, and age-matched controls treated in an identical way, except that they were not allowed to store and retrieve food. After three trials of storing and retrieval, between days 35 and 41 posthatch, experienced birds showed a significantly higher rate of cell proliferation than did controls. The experienced birds also showed a significant increase in total cell and neuronal number by day 56 posthatch, after eight trials of storing and retrieval. There were no significant differences in the amount of programmed cell death in the hippocampus in this study. In a novel analysis of the data we demonstrate that the effect of experience between days 35 and 41 was to increase the daily rate of neurogenesis in the ventricular zone from 3.9 to 10%, and that this change could account for the increase in total hippocampal neuronal number by day 56 in the experienced birds. Thus, the observed increase in hippocampal volume and neuronal number as a result of food storing and retrieval, may be caused by an increase in neurogenesis in the first few trials of food storing experience.