Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care.

OBJECTIVES: Hospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (ICD) codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute. METHODS: Independent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus. RESULTS: Among 6073 individuals with ILI qualifying for the QM programme, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD codes would have missed 61% (359/587) of influenza diagnoses. Of baseline ICD codes, 53.2% (2811/5282) were non-specific, most commonly J06 ('acute upper respiratory infection'). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO ILI case definition showed the highest overall sensitivities (84%-97% and 45%-68%, respectively) and the CDC ILI definition had the highest sensitivity for influenza infections (36%, 95% CI 31.4-40.8 for influenza A and 48%, 95% CI 40.5-54.7 for influenza B). CONCLUSIONS: Disease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI screening and surveillance in various age groups and settings. Diagnostic algorithms should be based on the WHO ILI case definition combined with targeted testing.

Sevoflurane reduces spinal reciprocal Ia-inhibition in humans.

BACKGROUND: Potentiation of inhibitory transmissions in the spinal cord is considered to be an important mechanism for the mediation of the immobilizing effects of anesthetics. However, the depressant effects on motoneurons could be counterbalanced by presynaptic effects that inhibit the depressant pathways. Here we investigated the effect of sevoflurane on a disynaptic inhibitory pathway onto motoneurons in a human reflex model. METHODS: The study was performed with 9 volunteers receiving sevoflurane anesthesia (end tidal: 0.8% sevoflurane). Reciprocal inhibition was estimated from the depression of the H-reflex following a conditioning stimulation of the muscle spindle afferents from the tibialis anterior muscle. Measurements were performed before, during and after drug administration. RESULTS: The inhibition (mean ± SE) amounted to 15.4% ± 6.8%, 1.9% ± 4.2% and 15.7% ± 8.8% for measurements before, during and after sevoflurane administration, respectively. Differences between the anesthetic state and the two controls were statistically significant (mixed-effect ANOVA, p<0.01). CONCLUSION: Sevoflurane reduces reciprocal Ia-inhibition on motoneurons in humans. These findings seem to contradict the accepted view that sevoflurane enhances inhibitory synaptic transmission. This contradiction might be explained by the inhibitory actions of sevoflurane within the disynaptic pathway prior to the final glycinergic transmission onto the motoneuron. Our results suggest that even in presumably simple pathways, postsynaptic effects of anesthetics could be superimposed by their presynaptic effects.

Selective enzymatic degradation of poly(epsilon-caprolactone) containing multiblock copolymers.

The hydrolytic and Pseudomonas lipase catalysed enzymatic degradation was studied for PDC multiblock copolymers consisting of poly(epsilon-caprolactone) (PCL) segments and poly(p-dioxanone) (PPDO) segments with variable composition. The enzymatic degradation of these multiblock copolymers is significantly accelerated by Pseudomonas lipase in contrast to the hydrolytic degradation where the degradation behaviour is determined by the PPDO segments. Degradation time intervals up to 200h are selected, where the PPDO segments remain stable and do not contribute to the degradation process. A linear correlation between weight loss and increasing PCL content of the multiblock copolymers was found. X-ray diffraction data confirm that both crystalline and amorphous PCL are attacked by the enzymes. SEM cross-section images reveal that Pseudomonas lipase penetrates into the PDC polymers. The present study impressively demonstrates that selective enzymatic degradation of PCL containing multifunctional polymers is a beneficial tool for controlling their degradation properties.

Enzymatic chain scission kinetics of poly(epsilon-caprolactone) monolayers.

The hydrolytic and enzymatic degradation behavior of poly(epsilon-caprolactone) (PCL) is investigated using the Langmuir monolayer technique, and an improved data acquisition and data reduction procedure is presented. Hydrolytic and enzymatic monolayer degradation experiments of PCL with various molecular weights by Pseudomonas cepacia lipase have been carried out to analyze the influence of subphase pH, subphase temperature, enzyme concentration, and the packing density of polymer chains on the degradation kinetics. The enzymatic monolayer degradation results in an exponential increase in the number of dissolved degradation fragments with increasing degradation time, which confirms random chain scission to be the dominant scission mechanism. The increase in the enzymatic scission rate constant with decreasing initial average molecular weight of the polymers is assigned to the influence of the area density of polar terminal groups on the substrate-enzyme complex formation.

Polyelectrolyte Complex Formation in Lamellar Liquid Crystalline Systems

The influence of polyelectrolytes on structure formation in liquid crystalline Na-dodecylsulfate/decanol/water systems was investigated by means of small angle X-ray diffraction, rheology, NMR spectroscopy, and microscopy. By adding Na-polyacrylate (PAA) into the mesophase, the one-phase region is left and phenomena of phase separation into a solvent-rich and a polymer/surfactant-rich phase occurs. By incorporating an anionic and cationic polyelectrolyte step by step the tendency of phase separation is increased drastically. The self-organization process can be regulated directly by varying the water content of the system. However, at a water content of 30% the properties of the resulting liquid crystal were changed drastically. X-ray diffraction shows a multitude of Bragg peaks, NMR shows a peak-splitting, and rheology shows a change from non-Newtonian to Newtonian-flow behavior. On the basis of the experimental results an ordered multilayer associate structure can be assumed.