Norwalk virus (NV) was first isolated from an outbreak of winter vomiting disease, or acute gastroenteritis, at an elementary school in Norwalk, Ohio, in 1968 (1). Subsequent adult volunteer challenge studies with infectious stool filtrate from the Norwalk outbreak demonstrated that NV readily infects susceptible people, causing an acute illness associated with diarrhea, vomiting, myalgia, nausea, and fever within 15 to 24 h after exposure and lasting 24 to 72 h (16). Although these initial studies demonstrated that most people are highly susceptible to NV, presently no cell culture systems or animal models of infection exist, which limits the study of NV replication and pathogenesis.NV is the prototype nonenveloped, positive-stranded RNA human virus in the genus Norovirus of the family Caliciviridae. Noroviruses are a major cause of acute gastroenteritis throughout the world and cause virtually all outbreaks of nonbacterial gastroenteritis in adults in the United States (18, 39). Furthermore, there are an increasing number of reports of gastroenteritis cases and outbreaks in children and the elderly caused by noroviruses, in part due to increased surveillance and better detection methods (15,26,39).NV virions are detected in low numbers in infected stool. The virions are 27 to 38 nm in diameter, including 4.5-nm radial protrusions extending from the capsid shell that create the calix, or cup-like structures, apparent by electron microscopy (33, 44). The NV capsid proteins (open reading frames 2 and 3, which produce the structural viral proteins VP1 and VP2, respectively) spontaneously self-assemble into virus-like particles (VLPs) when synthesized in a recombinant baculovirus expression system. These recombinant NV VLPs (rNV VLPs) are structurally and antigenically similar to the capsids of native NV and are useful in modeling virus-cell interactions (27, 53).Hemagglutination (HA) is one method that has been helpful in identifying cell-binding receptors for many viruses, such as influenza A virus and parvovirus B19 (7, 45). The VLPs from human parvovirus B19, JC human polyomavirus, and SA11 simian rotavirus have HA properties that are similar to those of their virions (8,14,42). This is the first report of HA by VLPs from a human calicivirus. Our data demonstrate that the H type 2 histo-blood group antigen is the rNV VLP HA receptor on human type O red blood cells (RBCs) and that the rNV VLPs also bind to synthetic H and structurally related Lewis carbohydrate antigens. MATERIALS AND METHODSrNV VLP purification. rNV VLPs were synthesized and purified by using methods described previously (53). Briefly, spinner flasks containing 3.5 ϫ 10 6 Sf9 insect cells per 200 ml of Grace's insect cell medium were infected with pVL-NV ORF(2 ϩ 3) recombinant baculovirus at a multiplicity of infection of 5. At 7 days postinfection the rNV VLPs were harvested from supernatants of spinner flask cultures. Cells were pelleted and discarded. The VLPs in the supernatant were pelleted by ultracentrifugation through a 30% sucrose cus...
Objectives There is conflicting evidence on the efficacy of Traditional Chinese Acupuncture (TCA), and the role of placebo effects elicited by acupuncturists’ behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA to sham acupuncture, and examine the effects of acupuncturists’ communication style. Methods Acupuncturists were trained to interact in one of two communication styles: ‘high’ or ‘neutral’ expectations. Patients were randomized to one of 3 groups: waiting list, ‘high’ or ‘neutral’, and nested within style, TCA or sham acupuncture over 6 weeks. Sham acupuncture was performed in non-meridian points, with shallow needles and minimal stimulation. Primary outcome measures were: Joint-specific Multidimensional Assessment of Pain (J-MAP), Western Ontario McMaster Osteoarthritis Index (WOMAC), and satisfaction. Results 455 patients who received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP and WOMAC pain compared to the waiting group (-1.1, -1.0, and -0.1, p<0.001; -13.7, -14, -1.7, p<0.001). Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the ‘high’ expectations group. Fifty-two percent and 43% in the TCA and sham groups thought they had received TCA (kappa=0.05), suggesting successful blinding. Conclusion TCA was not superior to sham acupuncture. However, acupuncturists’ style had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.
This study assessed self-reported adherence in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) from underserved healthcare settings. We conducted a cross-sectional survey of 102 ethnically diverse patients--70 with RA and 32 with SLE--attending rheumatology clinics at publicly funded hospitals in Houston, Texas; 43% were Hispanic, 32% African-American, and 25% White. Treatment adherence was evaluated using the compliance questionnaire rheumatology (CQR; 0, low adherence and 100, high adherence) and the questionnaire of the Adult AIDS Clinical Trials Group (AACTG). The patients were also asked how often they forgot to take their prescribed medications or discontinued them on their own. Mean patient age was 48.5 years; 75% were female, 32% were African-American, 43% Hispanic, and 25% White. Only one third reported never forgetting to take their medications; 40% reported having stopped their medications on their own because of side effects, and 20% because of lack of efficacy. Mean CQR score was 69.1 +/- 10.5, suggesting moderate adherence overall. Differences were also observed across ethnic groups: 23% of ethnic minority patients had problems taking their medications at specified times compared to 11% of Whites (p = 0.03). Lower education and side effects were associated with lower adherence. No differences were observed between RA and SLE patients. Many patients with RA and SLE report problems with treatment adherence. These appear to be more prevalent in African Americans and Hispanics than Whites; the impact of decreased adherence on outcomes could be significant and should be considered when treating patients with RA and SLE.
Objective. To identify components of the patient-doctor relationship associated with trust in physicians. Methods. We assessed 102 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) seen at publicly funded hospitals in Houston, Texas. Patients completed a self-response survey examining patient perceptions of the medical encounter and trust in their physicians. Evaluated components of physicians' behaviors included: informativeness, sensitivity to concerns, reassurance and support, patient-centeredness, and participatory decision-making style. Scales were scored 0 to 10, with higher numbers indicating more positive perceptions of communication.Results. Seventy patients had RA and 32 SLE; 25% were white, 43% Latino, 31% African American, and 75% were female. Mean scores for the medical interaction and trust scales ranged from 6.2-7.1, indicating moderate degrees of positive perceptions. All components were highly and positively correlated with each other, and with trust, suggesting that these traits are all elements of a positive style of doctor-patient communication. In multivariate analysis, ethnicity, physicians' informativeness, physicians' sensitivity to concerns, patient-centeredness, disease activity, and patient trust in the US health care system were independent predictors of trust in physicians. A separate model examined the predictors of patient disclosure of information. Patient perceptions of physicians' patient-centeredness and severity of disease activity were independently predictive of patient disclosure of information. Conclusion. In patients with SLE and RA, trust in physicians is significantly associated with patients' ethnicity and their perceptions about specific components of physicians' communication style. Trust in physicians can be improved by using a patient-centered approach, being sensitive to patient concerns, and providing adequate clinical information. Furthermore, patients appear to be more willing to disclose concerns when physicians use a patient-centered communication style.
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