PURPOSE: The influenza B virus diverges into two antigenically distinct lineages: B/Yamagata and B/Victoria. Influenza B is the dominant circulating virus during some influenza seasons, and recent data demonstrated that influenza A and B infection similarly cause severe clinical symptoms in hospitalized patients. Nucleoprotein (NP) is a good target for a universal influenza vaccine. This study investigated whether NP epitope variation within two lineages affects the dominant cytotoxic T lymphocyte (CTL) responses induced by vaccination and the resultant protective immunity. MATERIALS AND METHODS: The NP of B/Yamagata/16/1988, the representative strain of the Yamagata lineage, includes a dominant CTL epitope, FSPIRITFL, while B/Shangdong/7/1997 from the Victoria lineage has one amino acid difference in this sequence, FSPIRVTFL. Two recombinant replication-deficient adenovirus (rAd)-vectored vaccines expressing either NP were prepared (rAd/B-NP(I) and rAd/B-NP(V), respectively) and administered to BALB/c mice intranasally. To examine the efficacy of vaccination, antibody responses, CTL responses, and morbidity/mortality after challenge were measured. RESULTS: Both vaccines induce similar antibody and CD8 T-cell responses cross-reacting to both epitopes, and also confer cross-protection against both lineages regardless of amino acid difference. CONCLUSION: The rAd-vectored vaccine expressing the NP could be developed as universal influenza B vaccine which provides broader protection.
Adenoviridae ; Animals ; Antibody Formation ; Epitopes ; Humans ; Influenza B virus* ; Influenza Vaccines ; Influenza, Human* ; Lymphocytes ; Mice ; Nucleoproteins* ; Seasons ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic* ; Vaccination ; Vaccines ; Victoria

BACKGROUND AND OBJECTIVES: Elevated endothelin (ET)-1 level is strongly correlated with the pathogenesis of pulmonary arterial hypertension (PAH). Expression level of nicotinamide adenine dinucleotide phosphate oxidase (NOX) 4 is increased in the PAH patients. Ambrisentan, a selective endothelin receptor A (ERA) antagonist, is widely used in PAH therapy. The current study was undertaken to evaluate the effects of ambrisentan treatment in the monocrotaline (MCT)-induced PAH rat model. METHODS: Rats were categorized into control group (C), monocrotaline group (M) and ambrisentan group (Am). The M and Am were subcutaneously injected 60 mg/kg MCT at day 0, and in Am, ambrisentan was orally administered the day after MCT injection for 4 weeks. The right ventricle (RV) pressure was measured and pathological changes of the lung tissues were observed by Victoria blue staining. Protein expressions of ET-1, ERA, endothelial nitric oxide synthase (eNOS) and NOX4 were confirmed by western blot analysis. RESULTS: Ambrisentan treatment resulted in a recovery of the body weight and RV/left ventricle+septum at week 4. The RV pressure was lowered at weeks 2 and 4 after ambrisentan administration. Medial wall thickening of pulmonary arterioles and the number of intra-acinar arteries were also attenuated by ambrisentan at week 4. Protein expression levels of ET-1 and eNOS were recovered at weeks 2 and 4, and ERA levels recovered at week 4. CONCLUSIONS: Ambrisentan administration resulted in the recovery of ET-1, ERA and eNOS protein expression levels in the PAH model. However, the expression level of NOX4 remained unaffected after ambrisentan treatment.
Animals ; Arteries ; Arterioles ; Blotting, Western ; Body Weight ; Endothelin Receptor Antagonists ; Endothelins ; Gene Expression ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Lung ; Models, Animal ; Monocrotaline ; NADP ; NADPH Oxidase ; Nitric Oxide Synthase Type III ; Oxidoreductases ; Rats ; Receptors, Endothelin ; Victoria

BACKGROUND: The titer of influenza vaccine-induced antibodies declines over time, and younger children have lower immunogenicity and shorter duration of immunity. This study aimed to compare persistence of antibody at 6 months after influenza vaccination according to influenza virus strains, vaccine type, antigen dose, and primed status in children aged 6 to 35 months. METHODS: A total 124 healthy children aged 6 to 35 months were enrolled from September to December 2016 at 10 hospitals in Korea and randomly assigned to either a full dose of quadrivalent influenza vaccine or a half dose of trivalent influenza vaccine with Victoria B strain group. Hemagglutination inhibition antibody titers (that measure the seroprotection rates) were assessed for the recommended influenza strains at 6 months post vaccination. RESULTS: The seroprotection rates at 6 months for strains A (H1N1), A (H3N2), B/Yamagata, and B/Victoria were 88.7%, 97.4%, 36.6%, and 27.6%, respectively. The seroprotection rates for A (H1N1), A (H3N2) and B (Victoria) were 91.4%, 98.7% and 27.5% in a full dose of quadrivalent vaccine vs. 83.7%, 94.6% and 27.9% in a half dose trivalent vaccine, respectively. The seroprotection rate for the B (Yamagata) strain was 23.8% in the quadrivalent group and 14.0% in the trivalent group. CONCLUSION: Persistence of antibodies at 6 months was more favorable against the influenza A strains than against the B strains. Persistence of antibodies to additional B strain at 6 months was superior in the quadrivalent vaccine group. The immunity of primed children with different B strains was not superior to that of the unprimed group with another B strain.
Antibodies ; Child ; Hemagglutination ; Humans ; Influenza Vaccines ; Influenza, Human ; Korea ; Orthomyxoviridae ; Vaccination ; Victoria

Schistosoma mansoni is highly endemic in Tanzania and affects all age groups at different degrees. However, its control approach does not include adult individuals who are equally at risk and infected. To justify the inclusion of adult individuals in MDA programs in Tanzania, the present study focused on determining the prevalence of S. mansoni infection and its related morbidities among adult individuals. This was a cross sectional study conducted among 412 adult individuals aged 18–89 years living in selected villages of Rorya and Butiama districts located along the shoreline of the Lake Victoria. A pretested questionnaire was used to collect socio-demographic and socio-economic information of participants. Ultrasonographic examinations were conducted for all study participants using the Niamey protocol. A single stool sample was obtained from all study participants and examined for S. mansoni using the Kato-Katz technique. The study revealed a high prevalence of S. mansoni (56.3%), and the majority of infected individuals had a light intensity of infection. Ultrasonographic findings revealed that 22.4% of adult individuals had periportal fibrosis (PPF) (grade C–F), with 18.4% having grade C and D and 4% having grade E and F. Males had the highest prevalence of PPF (31.7% vs 10.8%, P < 0.001). Organomegaly was common with 28.5% and 29.6% having splenomegaly and hepatomegaly, respectively. S. mansoni infection and its related morbidities included PPF, hepatomegaly, and splenomegaly were common among adult individuals. To reduce the level of transmission of S. mansoni infection, planned mass drug administration campaigns should include adult individuals living in these villages.
Adult* ; Fibrosis ; Hepatomegaly ; Humans ; Lakes ; Male ; Prevalence ; Schistosoma mansoni* ; Schistosoma* ; Schistosomiasis mansoni* ; Splenomegaly ; Tanzania* ; Ultrasonography ; Victoria

Preterm birth (PTB) is defined as birth before 37 completed weeks of gestation, which occurs in approximately 10% of all pregnancies. Prior PTB history and short cervical length (CL) are the most significant predictors of PTB. Prior PTB history can increase the risk of recurrence of PTB more than two-fold in the next pregnancy. A short CL of less than 25 mm as measured by ultrasound between 16 and 24 weeks of gestation has been shown to be the most reliable predictor of an increased risk of PTB. Progesterone is one of the few proven effective methods of preventing PTB in women with a previous history of spontaneous PTB and women with a short CL. Progestins are available in natural micronized or synthetic formulations for intramuscular or vaginal (tablet or gel) administration. Several studies have reported that 17 hydroxyprogesterone caproate injection can prevent recurrent PTB in women with a previous history of PTB. Vaginal micronized natural progesterone has also been shown to be effective in preventing PTB in women with previous PTB history or with a short CL. At present, we are performing a multi-center, randomized trial in Korea (a multicenter, randomized, open-label, investigator-initiated trial of vaginal compared with intramuscular progesterone for the prevention of PTB in high-risk pregnant women: VICTORIA protocol) to compare the efficacy between vaginal progesterone and intramuscular injection of progesterone in women with a previous preterm history or short CL. This study will provide important information to both obstetricians and patients on whether a vaginal or intramuscular regimen is better for prevention of a recurrent PTB.
17-alpha-Hydroxyprogesterone ; Female ; Humans ; Injections, Intramuscular ; Korea ; Parturition ; Pregnancy ; Pregnant Women ; Premature Birth* ; Progesterone* ; Progestins ; Recurrence ; Ultrasonography ; Victoria

Evaluation of educational interventions is often focused on immediate and/or short-term metrics associated with knowledge and/or skills acquisition. We developed an educational intervention to support international medical graduates working in rural Victoria. We wanted an evaluation strategy that included participants' reactions and considered transfer of learning to the workplace and retention of learning. However, with participants in distributed locations and limited program resources, this was likely to prove challenging. Elsewhere, we have reported the outcomes of this evaluation. In this educational development report, we describe our evaluation strategy as a case study, its underpinning theoretical framework, the strategy, and its benefits and challenges. The strategy sought to address issues of program structure, process, and outcomes. We used a modified version of Kirkpatrick's model as a framework to map our evaluation of participants' experiences, acquisition of knowledge and skills, and their application in the workplace. The predominant benefit was that most of the evaluation instruments allowed for personalization of the program. The baseline instruments provided a broad view of participants' expectations, needs, and current perspective on their role. Immediate evaluation instruments allowed ongoing tailoring of the program to meet learning needs. Intermediate evaluations facilitated insight on the transfer of learning. The principal challenge related to the resource intensive nature of the evaluation strategy. A dedicated program administrator was required to manage data collection. Although resource-intensive, we recommend baseline, immediate, and intermediate data collection points, with multi-source feedback being especially illuminating. We believe our experiences may be valuable to faculty involved in program evaluations.
Administrative Personnel ; Data Collection ; Education, Medical ; Educational Measurement ; Humans ; Learning ; Program Evaluation ; Retention (Psychology) ; Students, Medical ; Transfer (Psychology) ; Victoria

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

BACKGROUND: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). METHODS: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. RESULTS: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. CONCLUSION: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.
Hand ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Lymphadenitis ; Mycobacterium tuberculosis ; Pleurisy ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

The aim of this study was to evaluate the influence of light energy on the tooth whitening effect of bleaching agent in vitro. Extracted human mandibular molars were sectioned to 2 fragments(mesial, distal) and lingual portions of crown were used in this study. All specimens were stained using a red wine for 24 hours and immersed in artificial saliva. Specimens divided into four groups, group 1 and 2 light-activated by LumaCool (LED, LumaLite, Inc., Spring Valley, USA), group 3 and 4 light-activated by FlipoWhite2 (Plasma acr lamp, Lokki, Australia). Group 1 and 3 bleached with LumaWhite(LumaLite, Inc., Spring Valley, USA), group 2 and 4 bleached with Polaoffice(SDI, Victoria, Australia). Bleaching treatment performed during 10 minutes every 24 hours and repeated 6 times. During bleaching treatment , distal fragments was light-activated(L) but mesial fragments was not(NL). Shade assessment employed before and after bleaching treatment using spectrophotometer. The results of the change in shade was compared and analysed between NL and L by using paired-sample T test with 95% level of confidence. There were no significant differences between NL and L with a few exceptions. In group 2, a* value more change in L, in group 3, b* value more change in L, in group 4, a* value less change in L. After bleaching, L* value and DeltaE increased in all groups and the value of a* and b* decreased in all groups. Within the limitation of this test conditions, the results of this study indicate that the light energy has no obvious improving impact on the tooth whitening effect of a bleaching agent.
Crowns ; Humans ; Hydrogen Peroxide ; Light ; Molar ; Saliva, Artificial ; Tooth Bleaching ; Victoria ; Wine

OBJECTIVES : The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally ill. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. METHODS : Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals. RESULTS : The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate discharge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. CONCLUSION : The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.
Australia ; Developed Countries ; England ; Financing, Organized ; Human Rights ; Humans ; Japan ; Jurisprudence ; Korea ; Mental Disorders ; Mental Health ; Mental Health Services ; Mentally Ill Persons ; Michigan ; Scotland ; United States ; Victoria