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Four hundred fifty volunteers participated in a placebo-controlled, double-blind, randomized trial of the prophylactic effects of rimantadine and amantadine during an outbreak of influenza A. The subjects received drugs orally at a dose of 100 mg twice a day for six weeks. Influenza-like illness occurred in 41 per cent of the subjects receiving placebo but in only 14 per cent of those receiving rimantadine and 9 per cent of those receiving amantadine (P<0.001 for either drug vs. placebo). Laboratory-documented influenza occurred in 21 per cent of placebo recipients, 3 per cent of rimantadine recipients, and 2 per cent of amantadine recipients (P<0.001). These findings represent efficacy rates of 85 per cent for rimantadine and 91 per cent for amantadine, as compared with placebo. More recipients of amantadine (13 per cent) than recipients of rimantadine (6 per cent; P<0.05) or placebo (4 per cent; P<0.01) withdrew from the study because of Central-nervous-system side effects. On the basis of this study, rimantadine appears to be the drug of choice for the prophylaxis of influenza A. (N Engl J Med. 1982; 307: 580–4.) AMANTADINE hydrochloride (1-adamantanamine hydrochloride) was licensed in 1966 for the prophylaxis of infections with influenza A viruses of the H2N2 subtype, and it has subsequently been approved for the prophylaxis of infections with all influenza A subtypes. Despite accumulated evidence of the efficacy of amantadine in the prophylaxis of influenza in human beings, 1 2 3 4 5 6 the drug has received relatively little use for this purpose. In part, this has been a result of continued challenges to the evidence of its efficacy by some workers, 7 as well as concern over its reported side effects, which have varied considerably in frequency from study to . . .

Norwalk virus infection is a common cause of gastroenteritis in humans. The clinical features and virologic and immunologic responses following oral administration of Norwalk virus to 50 volunteers were monitored. New ELISAs using recombinant virus particles as the antigen source were used to assess the pattern of virus shedding and the specific immune responses. Forty-one subjects (82%) became infected; 68% were symptomatic and 32% were asymptomatic. The proportion of subjects infected was similar for those with and without preexisting antibody (82% vs. 60%; P > .2). The magnitude of seroconversion was highest in subjects who had vomiting. The peak of viral shedding was between 25 and 72 h, and virus first appeared in stool at 15 h. Specimens collected 7 days after inoculation remained positive. These results show a higher infection rate, more subclinical infections, and longer virus excretion following Norwalk virus inoculation than previously recognized.

Considerable information has recently emerged regarding certain “groups” of novel viruses associated with gastroenteritis in humans. The viruses reviewed here are 20–35 nm in diameter and can be detected in the stools of acutely ill individuals with gastroenteritis. These viruses can be conveniently divided into four “groups”: (1) Norwalk-like agents, (2) caliciviruses, (3) astroviruses, and (4) other small round viruses. The evidence for the etiologic association of these agents with gastroenteritis varies from agent to agent but is most extensive for the Norwalk-like agents, of which the Norwalk serotype is a major cause of epidemic gastroenteritis. Human caliciviruses appear to be relatively common causes of gastroenteritis in children, particularly in Japan and the United Kingdom. Astroviruses have been reported as occasional causes of gastroenteritis in children and adults in various parts of the world. The epidemiological significance of the other small round viruses is unknown. Because of the difficulty of cultivating these agents in vitro, biochemical and antigenic characterization of these agents is incomplete. An understanding of the pathogenesis of disease and of the roles of immune responses to infection is similarly at a primitive stage. The recent development of sensitive and efficient assays for detection of several of these agents and the reports that certain strains of human caliciviruses and astroviruses can be cultivated in vitro should facilitate characterization and epidemiological studies of these agents. Systematic, prospective epidemiological studies of these agents in well-defined populations of various age groups are sorely needed for definition of the relative importance of each agent in human disease. Such information is essential for the consideration of appropriate control measures.

The Snow Mountain agent (SMA) is a 27- to 32-nm noncultivatable virus that causes acute gastroenteritis in humans. SMA is morphologically similar to but immunologically distinct from the Norwalk agent. SMA has been partially purified from the stool of experimentally infected volunteers and contains a single structural protein of Mr 62,000 as well as one or more non-virion-associated soluble proteins. Further characterization of this important human pathogen and other Norwalk-like viruses has been hindered by the lack of reagents with which to study them. To further characterize SMA, we developed a monoclonal antibody to SMA using in vitro immunization--a technique that permitted use of small quantities of antigen for immunization. The monoclonal antibody, SM-4, was specific for SMA and did not react with the Norwalk or Hawaii agents. In addition, SM-4 reacted with purified virion but not with the soluble protein. SM-4 also blocked the ability of labeled postinfection human IgG to bind to purified virion. Finally, both SM-4 and human postinfection sera specifically recognized the Mr 62,000 virion-associated protein. Thus, SM-4 is directed against an epitope present on the SMA structural protein that is not shared by the Norwalk or Hawaii agents and that is not present on the soluble protein. The availability of a monoclonal antibody against SMA should facilitate further purification and characterization of this agent. The techniques utilized in these studies provide a method for the production of additional monoclonal antibodies to this group of viruses and also should be useful for the study of other occult viral agents.

A review.

We examined real-world evidence on whether Lumosity, a remote digital health technology designed to deliver cognitive training to healthy adults, can improve cognition and reduce inattention in adults who reported having received a prior (lifetime) diagnosis of ADHD. Over the course of Lumosity training, this cohort of commercial users was assessed repeatedly online with a neuropsychological test battery (NCPT) and a scale of attention and mood in real-world contexts (BAMS-7). More Lumosity training between successive assessments led to greater improvements on the NCPT composite measure and the attentional subscale of the BAMS-7. This positive dose-response relation was found for six of eight NCPT subtests and three of four BAMS-7 attentional items. Additional findings support the participants’ clinical status and sensitivity of the assessments to ADHD symptoms. These findings provide evidence of cognitive and attentional benefits in a real-world cohort of adults reporting a lifetime diagnosis of ADHD from training with Lumosity under real-world conditions.