Novel dual multiplex real-time RT-PCR assays for the rapid detection of SARS-CoV-2, influenza A/B, and respiratory syncytial virus using the BD MAX open system

SARS-CoV-2 has spread rapidly, causing deaths worldwide. In this study, we evaluated the performance of the BD MAX Open System module for identifying viral pathogens, including SARS-CoV-2, in nasopharyngeal specimens from individuals with symptoms of upper respiratory tract infection. We developed and validated a rapid total nucleic acid extraction method based on real-time reverse transcription-polymerase chain reaction (RT-PCR) for the reliable, high-throughput simultaneous detection of common cold viral pathogens using the BD MAX Platform. The system was evaluated using 205 nasopharyngeal swab clinical samples. For assessment of the limit of detection (LoD), we used SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV) RNA standards. The BD MAX dual multiplex real-time RT-PCR panel demonstrated a sensitivity comparable to that of the World Health Organization-recommended SARS-CoV-2 assay with an LoD of 50 copies/PCR. The LoD of influenza A/B and RSV was 100-200 copies/PCR. The overall percent agreement between the BD MAX panel and laboratory-developed RT-PCR test on 55 SARS-CoV-2-positive clinical samples was 100%. Among the 55 positive cases of COVID-19 analysed, no coinfection was detected. The BD MAX rapid multiplex PCR provides a highly sensitive, robust, and accurate assay for the rapid detection of SARS-CoV-2, influenza A/B, and RSV.

Novel automated sample-to-result SARS-CoV-2 laboratory-developed RT-PCR assay for high-throughput testing using LabTurbo AIO 48 system

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LabTurbo AIO 48 can accurately identify SARS-CoV-2 infection.

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LabTurbo AIO 48 can reduce by ~ 47.9% the sample-to-result time.

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LabTurbo AIO 48 is more sensitive than the reference detection assay.

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LabTurbo AIO 48 can provide high-throughput and reliable SARS-CoV-2 diagnostic results.

Background and aims

Immediate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for preventing the spread of coronavirus disease 2019 (COVID-19). The LabTurbo AIO 48 system is an automated platform that allows nucleic acid extraction and sample analysis on the same instrument, producing faster results without affecting their accuracy. We aimed to independently evaluate the LabTurbo AIO 48 (all-in-one system) for SARS-CoV-2 detection.

Materials and methods

Comparative limit of detection (LOD) was assessed on both the LabTurbo AIO 48 and current standard detection system based on real-time reverse transcriptase polymerase chain reaction (RT-PCR), using SARS-CoV-2 RNA control. Additional 125 primary clinical samples were assessed using both the protocols in parallel.

Results

The turnaround time from sample to results for 48 samples analyzed on LabTurbo AIO 48 was approximately 2.5 h, whereas that analyzed using the in-house RT-PCR protocol was 4.8 h. LabTurbo AIO 48 also demonstrated higher sensitivity than our reference RT-PCR assay, with a LOD of 9.4 copies/reaction. The overall percentage agreement between both the methods for 125 samples was 100%.

Conclusion

LabTurbo AIO 48 is a robust detection option for SARS-CoV-2, allowing faster results and, consequently, aiding in better control and prevention of COVID-19.

[How to construct clinical laboratory of the hospital in post epidemic time]

A novel coronavirus pneumonia outbreak in the world. The epidemic of the new coronavirus pneumonia has been preliminarily controlled successfully in China. At this time, how to construct the clinical laboratory in the hospital? This artical puts some forward thoughts, such as improve the construction of biological safety protection ability, detection ability, test platform construction, scientific research ability construction, personnel training and clinical communication ability, etc. These above advices could provide reference for the development direction of the clinical laboratory in post epidemic era.

Novel rapid identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by real-time RT-PCR using BD Max Open System in Taiwan

Coronavirus disease 2019 has become a worldwide pandemic. By April 7, 2020, approximately 1,279,722 confirmed cases were reported worldwide including those in Asia, European Region, African Region and Region of the Americas. Rapid and accurate detection of Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) is critical for patient care and implementing public health measures to control the spread of infection. In this study, we developed and validated a rapid total nucleic acid extraction method based on real-time RT-PCR for reliable, high-throughput identification of SARS-CoV-2 using the BD MAX platform. For clinical validation, 300 throat swab and 100 sputum clinical samples were examined by both the BD MAX platform and in-house real-time RT-PCR methods, which showed 100% concordant results. This BD MAX protocol is fully automated and the turnaround time from sample to results is approximately 2.5 h for 24 samples compared to 4.8 h by in-house real-time RT-PCR. Our developed BD MAX RT-PCR assay can accurately identify SARS-CoV-2 infection and shorten the turnaround time to increase the effectiveness of control and prevention measures for this emerging infectious disease.

[Characteristics of electromyography in 111 patients with generalized myasthenia gravis: a retrospective study]

Objective: To retrospectively analyze the characteristics of the electromyography (EMG) study in generalized myasthenia gravis (gMG) patients. Methods: A total of 111 gMG patients were enrolled. Patients were divided into two groups: 36 severe patients discontinuing pyridostigmine bromide (PB) for 8 hours were included in 8 h group, and 75 g MG patients discontinuing PB for at least 18 hours were included in>18 h group. The clinical information and EMG study data were collected and analyzed. Results: There were statistically significant differences in the initial location of the myasthenia muscle (P=0.027), the affected muscle detected by the EMG (P=0.015) and quantitative myasthenia gravis (QMG) score (P<0.01) between the two groups. Comparisons in each group revealed that the highest positive rate of low-frequency repetitive nerve stimulation (RNS) of facial in 8 h group and>18 h group was 94.4% and 60.0%, respectively. Comparisons between the two groups showed that the positive rate of low-frequency RNS in 8 h group was significantly higher than that in>18 h group (94.4% vs 70.7%, χ(2)=8.115, P=0.004). In particular, the positive rate of RNS in facial nerves and the extent of the amplitude decrease under different electrical stimulations (1 Hz, 3 Hz, and 5 Hz) were dramatically higher in the 8 h group (P<0.01). Conclusions: For gMG patients, the facial and accessory nerve detection can improve the positive rate of RNS. Different muscles had various sensitivity to PB, and orbicularis oculi muscle seemed the least sensitive muscle to PB. For suspect MG patients in severe condition, only discontinuing PB medication for 8 h before low-frequency RNS testing can avoid the deterioration and also obtain similar positive rate.

Tai Chi with music improves quality of life among community-dwelling older persons with mild to moderate depressive symptoms: A cluster randomized controlled trial

Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P < 0.001, η_p²= 0.435, F = 18.696, P < 0.001, η_p²= 0.364, F = 17.473, P< 0.001, η_p²= 0.348, and F = 29.576, P < 0.001, η_p²= 0.475 for physical, psychological, social, and environment domains respectively). This intervention represents an economically viable solution to better QOL and healthy ageing in a highly populous developing nation.

The Impact of Combined Music and Tai Chi on Depressive Symptoms Among Community-Dwelling Older Persons: A Cluster Randomized Controlled Trial

BACKGROUND

The effectiveness of pharmacological treatment may be limited in older persons. Several studies using Tai Chi or music therapy separately confirmed positive effects in the reduction of depressive symptoms. We conducted a cluster randomized controlled trial to evaluate the possible synergistic effect of combined music and Tai Chi on depressive symptoms.

METHODS

One hundred and seven older adults with mild to moderate depressive symptoms were recruited from Ya'an city. Fifty-five participants were cluster randomized to combined music and Tai Chi group for three months, while the other fifty-two individuals were randomized to the control group that entailed routine health education delivered monthly by community nurses. The primary outcome of depressive symptoms was measured with the Geriatric Depression Scale (GDS) at baseline and monthly for three months.

RESULTS

At three-month follow-up, a statistically significant improvement in depressive symptoms was found in the intervention group compared with control group (F(3,315) = 69.661, P < 0.001). Following adjustments for socio-demographic data, the true effect of intervention on depressive symptoms was significant (F = 41.725, P < 0.01, η_p² = 0.574).

CONCLUSIONS

Combined music and Tai Chi reduced depressive symptoms among community-dwelling older persons. This represents an economically viable solution to the management of depression in highly populous developing nations.

Solid-phase photocatalytic degradation of polyethylene-goethite composite film under UV-light irradiation

A novel photodegradable polyethylene-goethite (PE-goethite) composite film was prepared by embedding the goethite into the commercial polyethylene. The degradation of PE-goethite composite films was investigated under ultraviolet light irradiation. The photodegradation activity of the PE plastic was determined by monitoring its weight loss, scanning electron microscopic (SEM) analysis and FT-IR spectroscopy. The weight of PE-goethite (1 wt%) sample steadily decreased and led to the total 16% reduction in 300 h under UV-light intensity for 1 mW/cm(2). Through SEM observation there were some cavities around the goethite powder in the composite films, but there were few changes except some surface chalking phenomenon in pure PE film. The degradation rate could be controlled by changing the concentration of goethite particles in PE plastic. The degradation of composite plastic initiated on PE-goethite interface and then extended into polymer matrix induced by the diffusion of the reactive oxygen species generated on goethite particle surface. The photocatalytic degradation mechanism of the composite films was briefly discussed.

Inactivation gating determines nicotine blockade of human HERG channels

We have previously found that nicotine blocked multiple K+ currents, including the rapid component of delayed rectifier K+ currents (IKr), by interacting directly with the channels. To shed some light on the mechanisms of interaction between nicotine and channels, we performed detailed analysis on the human ether-à-go-go-related gene (HERG) channels, which are believed to be equivalent to the native I(Kr) when expressed in Xenopus oocytes. Nicotine suppressed the HERG channels in a concentration-dependent manner with greater potency with voltage protocols, which favor channel inactivation. Nicotine caused dramatic shifts of the voltage-dependent inactivation curve to more negative potentials and accelerated the inactivation process. Conversely, maneuvers that weakened the channel inactivation gating considerably relieved the blockade. Elevating the extracellular K+ concentration from 5 to 20 mM increased the nicotine concentration (by approximately 100-fold) needed to achieve the same degree of inhibition. Moreover, nicotine lost its ability to block the HERG channels when a single mutation was introduced to a residue located after transmembrane domain 6 (S631A) to remove the rapid channel inactivation. Our data suggest that the inactivation gating determines nicotine blockade of the HERG channels.

Poisoning by Datura leaves used as edible wild vegetables

The causes of Datura intoxication include medication overdose, misuse of edible vegetables, deliberate abuse as a hallucinogen, homicidal or robbery and accidental intoxication from contaminated food. We report an incident of 14 people with Datura intoxication caused by ingesting wild Datura suaveolans for food. The incubation period was 15 to 30 min. The symptoms/signs were dizziness, dry mouth, flushed skin, palpitation, nausea, drowsiness, tachycardia, blurred vision, mydriasis, hyperthermia, disorientation, vomiting, agitation, delirium, urine retention, hypertension and coma. Three patients were hospitalized for 2-3 days. Thirteen persons received supportive fluid therapy. One patient did not receive medical therapy, he induced vomiting and drank a lot of water. Four patients presented with delirium/coma and 3 received physostigmine therapy with good response. One patient was intubated because of coma and respiratory depression. Three persons needed Foley catheterization for urine retention or coma status. One patient had a complication of urinary tract infection and antibiotic management. All patients recovered with no sequelae.

THE ORIGIN OF THE FIVE ELEMENTS IN THE TRADITIONAL THEOREM OF ACUPUNCTURE: A PRELIMINARY BRIEF HISTORIC ENQUIRY

Five Xing is an important integral in the traditional theoretic basis of acupuncture and traditional Chinese medicine. The word Xing has been translated as Element. However, it actually denotes movement and activity. The word element implies a stationary state. Some of the evidence in ancient Chinese literature was reviewed to support the hypothesis that Five Xing were originally meant to be the Five Xing Xin (Moving Stars, i.e., Planets). By the 4th century B.C., associations of the Stars with human events gradually evolved. However, between the 4th and the 6th century A.D., when the Taoist scholar-physicians expanded the Five Xing into abstractive concepts, they used the five basic materials as their representatives. Since they were basically alchemists and not astronomers, they apparently minimized the relationship between the Five Moving Stars and the human illnesses. It is, therefore, proposed that the usage of the word Element be discontinued and the word Xing be employed as is.

ACUPUNCTURE FOR LOW BACK PAIN IN HUANG DI NEI JING SU WEN

In Huang Di Nei Jing Su Wen, among the materials which heretofore have no English translation, there are three Chapters on pain. One of them was devoted entirely to the low back pain. This is certainly an indication of its importance even more than 2,300 years ago. Since it still plagues us nowadays, we have translated that Chapter of this medical classic to see what we can learn from the ancients. We attempted to second guess the ancients in the diagnosis of the various sets of symptoms, in the light of western medicine. We discussed the difficulties in interpreting the archaic text. We pointed out that there were associations of the Mais (i.e., the Meridians) with various sets of symptoms but the loci of puncture were rather vaguely described and had no names. We inserted our selections of currently used acupoints to match the described loci. We would like to solicit our readers' comments.

ACUPUNCTURE TREATMENT FOR PSORIASIS: A RETROSPECTIVE CASE REPORT

We treated 61 cases of psoriasis with acupuncture, including 25 patients with complications of joint involvement and two cases with scleroderma additionally. All of the patients had failed to respond to their prior conventional western medical management. 25 patients were males and 36 were females. Their ages ranged from 22 to 84 years, with an average of about 52 years. There was no significant difference of the average ages between the sexes. Most of them (about 61%) had quite extensive involvement of the body. The average of duration of their illness was over 16 years, ranging from two to 65 years. They received an average of about nine sessions of acupuncture treatment, ranging from one to 15. Almost one third (19) of them had eleven to thirteen sessions. With the acupuncture treatment, about one-half (30) of the 61 patients had complete or almost complete clearance of the skin lesions. About a quarter (14 patients) of them had a clearance of about two thirds of the skin lesions. Eight of them had a clearance of one third of the skin lesions. Nine patients had minimal or no improvement. Our experience indicates that acupuncture is induced an effective therapeutic modality for psoriasis, particularly when the western medical management is unsuccessful. We speculated about the possible involvement of the cutaneous reticuloendothelial system in the clearance of the skin lesions.

Acupuncture treatment for herpes simplex infections. A clinical case report

Herpes simplex is a common skin disorder. There is no effective cure. The recent introduction of drugs, such as acyclovir, is indeed a great advance in its therapeutics. However, these drugs may only modestly reduce the length of an attack, but do not lengthen the remission nor prevent recurrences. Our very limited experience in two cases of herpes oral-labialis and three cases of herpes genitalis with acupuncture treatment seemed to indicate the possibility of a marked reduction of an episode, a lengthening of the remission, and a prevention of recurrences. We hope our report would encourage our colleagues to try acupuncture in the clinical management of herpes cases and to study its immunologic effects.

Acupuncture for poison ivy contact dermatitis. A clinical case report

Poison ivy contact dermatitis is fairly common in the suburbia of this country among amateur gardeners and children. It commonly inflicts its poison on the exposed parts of the limbs. The vesicular or bullous skin lesions are quite disturbingly itchy. Scratching the itchy lesions often spreads the condition by transplanting the remanent resinous toxin to other parts of the body. Though they are usually self-limiting, the intense itch is the main motivation for a patient to seek medical care. The conventional treatment is basically ineffective. During the summer of 1987 we treated four such cases of dermatitis with acupuncture upon their request to mollify their unbearable itch. They originally consulted with us for other problems. There were three males and one female. Their ages were between 29 and 63. Three cases were relatively mild and the fourth one was fairly severe. In the milder cases, their itch subsided in a few hours and skin lesions were healed in about two days after one treatment. In the severe case the itch subsided in about two days and most of the skin lesions dried up in four days after the first treatment and were healed almost completely after three sessions of acupuncture treatment. The plausible anti-inflammatory mechanism of acupuncture with the involvement of ACTH and/or cortisol was discussed.

Acupuncture and tele-electronic infra-red thermography

The re-introduction of acupuncture into the United States rekindled the interest in the management of chronic pain. Thermography has been shown to be a simple, non-invasive, reliable, and objective method to study pain. Our investigation included 81 patients with a variety of chronic pain conditions, one pain-free patients with left hemiparesis, and two normal subjects as controls. When pain was alleviated by acupuncture, thermography consistently demonstrated an increase of the infra-red radiation (IRR) of the affected parts of the body. Even though a patient might not report any reduction of pain, an elevation of the IRR of the affected site by acupuncture might imply the patient's denial of such an occurrence subconsciously or consciously. Acupuncture applied to pain-free patients tended to cause either no remarkable change of the infra-red pattern, or sometimes a slight decrease of the IRR if they experienced discomfort from needling. If normal thermographic patterns were observed in a patient with subjective pain, it practically excludes an actual existence of the complaint. The cooling effect of needling discomfort could be due to vasovagal over-activities. In conclusion, our investigation seemed to confirm that thermography indeed offered a simple, non-invasive, objective technique to study chronic pain and to provide an accurate measure of the effectiveness of acupuncture.

Recent advances in the understanding of acupuncture

The controversy about acupuncture is familiar to us since its recent reintroduction into this country. Much of its philosophical concepts were taken at their face values as the bases for condemnation. Since I last reviewed these antiquated concepts in the light of modern medicine, much has developed. It seems that if the effects of acupuncture were transmitted along the peripheral nerves to the central nervous system, it would be more effective if applied segmentally to the site of noxious stimulation. Disruption of extralamniscal pathways would abolish its analgesic effect. The distant and nonsegmentally located acupuncture points exert their influences through the integrative efforts of the reticular formation and the thalamus. The demonstration of transmissibility of acupuncture analgesia through blood and cerebrospinal fluid in animals implicates the involvement of humoral factors. Since such an effect can be suppressed by naloxone or by hypophysectomy, endorphins are thought to be involved. Such laboratory evidences indeed begin to shed some light on a possible neurohumoral mechanism of acupuncture. The differences between acupuncture and hypnosis are discussed. Acupuncture points were compared with referred pain, trigger points and motor points of the skeletal muscles. Its possible uses for other than pain, such as drug addiction, alcoholism, etc. are also reviewed.