Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Motion correction in MRI of the brain

Subject motion in MRI is a relevant problem in the daily clinical routine as well as in scientific studies. Since the beginning of clinical use of MRI, many research groups have developed methods to suppress or correct motion artefacts. This review focuses on rigid body motion correction of head and brain MRI and its application in diagnosis and research. It explains the sources and types of motion and related artefacts, classifies and describes existing techniques for motion detection, compensation and correction and lists established and experimental approaches. Retrospective motion correction modifies the MR image data during the reconstruction, while prospective motion correction performs an adaptive update of the data acquisition. Differences, benefits and drawbacks of different motion correction methods are discussed.

Demonstration of group C rotaviruses in fecal samples of diarrheic dogs in Germany

Three out of 9 fecal samples from diarrheic dogs, which were positive for rotavirus by electron microscopy, revealed RNA-migration patterns identical to those of porcine group C rotavirus when studied by polyacrylamide gel electrophoresis (PAGE). The results were further confirmed by solid phase immuno electron microscopy (SPIEM). This is the first report of the occurrence of group C rotaviruses in dogs.

Investigation of skin samples from red foxes (Vulpes vulpes) in eastern Brandenburg (Germany) for the detection of Borrelia burgdorferi s. l

During earlier investigations a high prevalence of Borrelia (B.) burgdorferi s. l. in unfed Ixodes (I.) ricinus ticks in the Federal State of Brandenburg has been demonstrated. In the present study skin samples were obtained from 100 red foxes (Vulpes vulpes) from the districts where the highest B. burgdorferi prevalences had previously been found (i.e. Uckermark, Barnim, Märkisch-Oderland, Oder-Spree). BSK- and MKP-medium including inhibitory substances were used for cultivation of spirochaetes. Non-motile spirochaete-like organisms were observed in 26% of the samples. Additionally, by subcultures it was not possible to obtain motile helical forms characteristic for B. burgdorferi. On tryptose agar, the bacteria which produced nonmotile forms appeared as corynebacterium-like-colonies. Investigations by electron microscopy showed that the immobile spiral forms were giant whips (flagellae) which belonged to the contaminant flora. These forms proved to be negative for B. burgdorferi s. l. by the use of a nested-PCR. In a further study, the same skin samples were investigated for the presence of B. burgdorferi s. l.-DNA using a nested-PCR. Seven out of 100 samples were positive.

Hypocomplementaemic urticarial vasculitis: successful treatment with cyclophosphamide-dexamethasone pulse therapy

Systemic hypocomplementaemic urticarial vasculitis unresponsive to several immunosuppressive and immunomodulatory drugs was seen in two women aged 43 and 45 years. Cyclophosphamide-dexamethasone pulse therapy was started in both patients and resulted in significant clinical improvement. The pulse treatment was well tolerated in both patients and no major adverse effects occurred. These cases indicate that cyclophosphamide-dexamethasone pulse therapy is efficient in the treatment of hypocomplementaemic urticarial vasculitis.

[Dermatomycosis caused by Trichophyton verrucosum in mother and child]

In recent years, there has been an epidemiological renaissance of zoophilic dermatophytoses caused by a variety of factors. At present, the most important causative organisms are Microsporum canis, Trichophyton mentagrophytes var. granulosum and, as in the present case, Trichophyton verrucosum. These are formerly notifiable pathogens which are highly virulent and contagious. The example of an extensive, originally unrecognized tinea corporis et faciei in mother and child presented here shows the current importance of Trichophyton verrucosum, but also the diagnostic difficulties in dealing with a formerly rare infection disease. The inflammatory symptoms of deep trichophytosis with imminent danger of scar formation was the basis of synergistic combination therapy in the two patients. The source of infection for zoophilic dermatomycosis at the beginning of the epidemiological increase were looked for almost exclusively in Mediterranean countries. However, there are now increased indications of indigenous pools. In view of the neglect of consistent immunization of livestock and the lack of a requirement to notify the disease, a further rise in the number of cases in humans is to be expected.

[Use of a fast test to detect rotavirus in feces]

The commercially available immunoassay "OnSite Rotavirus" was used for the detection of animal rotaviruses in 113 faecal samples. The sensitivity of the test was 88% and the specificity 96% compared with reference methods (EIA, EM). This test would detect approximately 4.4 x 10(6) to 1.8 x 10(7) virus particles per ml. The presence of virus could be demonstrated in fresh faecal samples from cattle, horses and pigs within a few minutes. The rotaviruses of group A were identified independently of the virus serotype. Further results and additional problems of using this test kit are described.

[Legal principles in criminal and regulatory infringements-- proceedings of the view of the public prosecutor]

In legal proceedings referring to animal welfare, an effective collaboration between Veterinary officials, public prosecutor and police authorities is of eminent significance. Intensive communication among all authorities involved helps to solve the relevant facts and thus leads to a just ruling. Only by this way an effective prosecution of infringements and criminal proceedings will be ensured.

[Endomycoses--a problem in the diagnosis of Chlamydia psittaci infections in chickens]

Two hens, which died at an age of 42 respectively 45 weeks, showed firstly lesions of endomycosis as sole cause of illness or death at necropsy and in light microscopic investigations. With peroxidase-antiperoxidase-(PAP-)technique and in electron microscopic investigations, however, Chlamydia psittaci were also found in very large numbers in both chickens, and occurred here particularly in lungs, liver, kidneys, spleen, myocard and ovary. The results showed, that endomycosis and chlamydial infections can occur in chickens simultaneously. In such cases of mixed infections the PAP-technique may be very helpful for rapid and reliable detection of Chlamydia psittaci in formalin-fixed and paraffin-embedded chicken tissues.

Invasive metastasing pulmonary aspergillosis under polychemotherapy

We report on a female patient who received a polychemotherapy because of an extensive pemphigus vulgaris. Under this therapy, the general condition of the patient worsened. Noncharacteristic symptoms, such as dyspnoea and tachycardia occurred. In spite of comprehensive, also invasive diagnostics, pulmonary foci demonstrable by X-ray morphology and computer tomography could not be specified. In the course of treatment, a cerebral compression symptomatology developed. Post mortem, a pulmonary aspergillosis with abscess-formation in the brain was found. The antigen identification completed the diagnosis. The increasing significance of Aspergillus infections is pointed out. The results of clinical examination and the differential diagnosis as well as the possibility of the diagnosis of pulmonary aspergillosis are demonstrated.

[Predictive value of electron microscopy studies in virological diagnosis]

The negative staining techniques in transmission electron microscopy have been used as a routine tool in viral diagnosis since 30 years. In a short review, different preparation techniques, fields of application, advantages and disadvantages of electron microscopy in rapid diagnostic are discussed. The application of electron microscopy depends on availability of other more effective methods. Some viruses, specially in faecal samples, are identifiable only by electron microscopy till now. Sensitivity and specificity are improved by immune electron microscopy comprising suspension, immunosorbent and immunogold techniques. Using rapid embedding techniques, ultrahistology is a valuable tool in identifying viruses in biopsy samples, too.

Atypical human rotaviruses in the G.D.R

Following the aetiologic agent of diarrhoea in children aged one to three years we found in the stools a large number of rotaviruses by electron microscopy (EM), although ELISA was negative; the sensitivity of ELISA had been confirmed in previous investigations. In 141 children with diarrhoea 10 conventional (group A) and 21 antigenically distinct rotaviruses were detected. The presence of atypical rotaviruses could be confirmed by electrophoretic analysis of their RNA migration profiles. The electropherotype pattern corresponded to the group C rotaviruses reported by others.

Unusual mitochondrial reaction in psoriatic keratinocytes

Electron microscopic investigation of skin biopsies revealed that keratinocytes in clinically uninvolved skin from psoriatic patients show the same mitochondrial ring phenomenon after the application of dithranol as has been observed in the cutaneous lesions proper. In various other skin diseases no mitochondrial reaction was evident after dithranol treatment, nor was it seen in chronic dermatitis when dithranol was not applied. It appears, therefore, that this morphological phenomenon is specific to psoriasis and may provide information concerning functional alterations in the pathogenesis of this disease.

Functional and structural analysis of the ribonucleoprotein complexes of different human influenza virus strains

Ribonucleoprotein (RNP) cores were prepared from various strains of human influenza virus by treating the purified or spikeless virus particles with non-ionic detergents such as Nonidet P-40 and centrifugation in continuous linear glycerol gradients. In addition to RNA, the purified complexes contained viral nucleoprotein (NP) and the three P proteins (PA, PB1, PB2) as determined by polyacrylamide gel electrophoresis (PAGE) under denaturing conditions. Contaminations with other viral polypeptides, especially HA1, HA2 and M were below 1%. All RNP complexes were transcriptionally active in vitro. Comparison of the polymerase activity of purified complexes revealed considerable differences depending not only on the content of polymerase proteins. The activity of RNP complexes was enhanced for all strains tested by adding of ApG.

[The effect of ion pair formation on the pharmacokinetics of drugs. 2. The effect of hexylsalicylic acid on the pharmacokinetics of quinine]

The influence of the hexylsalicylic acid (2) on the pharmacokinetic of the quinine (1), was studied using rabbits. It could be observed that after i.v. application the mean resistance time (MRT) of 1 was increased by means of ion-pair-formation with 2. But the AUC of 1 was not influenced. After rectal application of the combination 1/2 an acceleration of the 1 absorption could be pointed out. The kinetic parameters of 2 were not increased significantly if 1 was applicated simultaneously.

The intestine of ferret--a possible site of influenza virus replication

Anal virus shedding and stimulation of the immune response were observed in ferrets after oral and rectal administration of influenza A/Hongkong/1/68 (H3N2) virus. Despite of the low pH in the stomach, the virus had reached the intestines after oral administration and was found in high concentration in faeces and in mucosal cells lining the colon. Using immunofluorescent staining, the virus antigen was detected in cytoplasm of columnar epithelial cells. Virus replication also occurred in the respiratory tract, probably as result of inhalation of anally shedded virus. However, the virus replication in the lungs did not seem essential for virus isolation from the intestines. Taking into account the very short food passage time in ferrets the results could indicate the replication of influenza A/Hongkong/1/68 virus in the digestive tract of ferrets.

[Psoriasis arthropathica and seronegative rheumatoid arthritis--differential diagnostic considerations]

For differential-diagnostic considerations concerning seronegative arthritides two groups of patients with 25 patients each of the disease groups psoriasis arthropathica and serologically negative rheumatoid arthritis were selected. The differentiation of the two diseases was performed by clinical, paraclinical and radiological findings. When there are no typical psoriatic changes of skin and/or nails and there is an empty family anamnesis concerning this dermatosis, respectively, the coordination of seronegative arthritides is considerably rendered more difficult. Here the radiomorphological investigations particularly of the sacroiliacal joint and/or of the spine essentially contribute, since the arthritis of the sacroiliacal joint is to seen in high incidence in psoriasis arthropathica. Out of the number of the paraclinical values the determination of the complement factor C 4 and of immunoglobulin M gets the importance of a sign of differentiation, in which case C 4 in the psoriasis arthropathica and the immunoglobulin M in the seronegative rheumatoid arthritis are statistically significantly increased. The problems of the often difficult differential diagnosis between the two groups of disease can be clarified only by complex clinical examinations, paraclinical parameters and subtile radiodiagnosis. A close interdisciplinary cooperation between experienced dermatologists, rheumatologists and radiologists seems reasonable.

Electron microscopic investigations of rotavirus morphogenesis in cell cultures

The replication of simian rotavirus SA11 in GMK cells and of bovine rotavirus in calf kidney cells was studied by electron microscopy. By 30 min post-inoculation (p.i.) SA11 virus was absorbed to the cell membrane in the absence of trypsin and became engulfed into the cell; clusters of viral particles were internalized also into cytoplasmic vacuoles. At 2 hr p.i., viral particles were seen in lysosomes and 6 hr p.i., the first progeny virus was found in the cisternae of endoplasmic reticulum (ER). Precursor virus particles budded from viroplasm into the cisternae of endoplasmic reticulum, where they became enveloped reaching a diameter of 80-90 nm. There was no difference between SA11 virus and bovine rotavirus. Although the budding of rotavirus particles is essential for acquiring of glycoproteins, the envelopment of capsids was transient. After stripping off the envelope, mature particles were formed 65-70 nm in diameter, consisting of either smooth or rough capsids. The final cytocidal stage of cell infection is described.

[Roentgen diagnostic studies of peripheral joints, sacroiliac joints and the spine in psoriasis arthropathy]

The secure diagnosis "psoriasis arthropathica" must always be the result of a clinical examination, paraclinical and radiological findings. In 150 patients with arthropathic psoriasis X-ray examinations of peripheral joints, of the sacroiliac joints and of the spine were performed. As a result of subtle evaluations of the findings X-ray-morphological criteria on the skeleton of hand and foot, on the sacroiliac joints and on the spine may be derived. On the basis of the experiences gathered recommendations for the practice in form of radiographic objects of an X-ray-diagnostic basic programme in primary diagnostics and in repeated examinations are proposed. An optimum diagnostics of the arthropathic psoriasis can be achieved only ba close co-operation and by constant mutual informations between rheumatologists, dermatologists and radiologists.

[The manifestation of psoriasis arthropathica in later life]

The article deals with a group of 12 patients (8 females and 4 males), who generally first developed arthralgia as a feature of psoriasis beyond the age of 60. In all cases psoriasis arthropatica was diagnosed on the basis of physical, laboratory and X-ray examinations. Radiomorphological changes in the skeletal system are described in detail. The article also contains information on the treatment given, which in later life should be chiefly symptomatic on account of the increased risk of side-effects.