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Background: The root of Cynanchum auriculatum Royle ex Wight has been traditionally used as a folk medicine in the eastern Asia. Objectives: In this study, we explored the immune-enhancing effect of the high-molecular weight fraction of C. auriculatum (CAHF) root extracts in RAW 264.7 macrophages and cyclophosphamide (CYP)-induced immune-suppressed mice. Materials and Methods: To obtain the CAHF, ultrafiltration was performed using 30-kDa molecular weight cutoff polyethersulfone membranes in a cross-flow microfiltration system. In vitro and in vivo experiments were performed to evaluate the immunostimulatory effects of CAHF. Results: CAHF increased the production of nitric oxide and immunostimulatory cytokines (interleukin-6 and tumor necrosis factor-α) in recombinant interferon-γ primed macrophages. In addition, the phagocytic activity of macrophage cells was enhanced by CAHF. Furthermore, CAHF treatment markedly restored the decreased body weight, immune organs (spleen and thymus) weight, natural killer cell activity, and T- and B-lymphocyte proliferation in CYP-induced immune-suppressed mice. Conclusion: These results suggest that CAHF is an effective immunostimulatory agent. [ABSTRACT FROM AUTHOR]

Abstract: Highly pathogenic (HP) H5N1 avian influenza has become endemic in several countries in Asia and Africa, and vaccination is being widely used as a control tool. However, there is a need for efficacious vaccines preferably utilizing a DIVA (differentiate infected from vaccinated animals) marker strategy to allow for improved surveillance of influenza in vaccinated poultry. Using a reverse genetics approach, we generated Asian rgH5N9 vaccine strain deriving the hemagglutinin gene from A/chicken/Indonesia/7/2003 (H5N1) with modification of the cleavage site to be low pathogenic (LP) and N9 neuraminidase gene from the North American LP A/turkey/Wisconsin/1968 (H5N9) virus. The recombinant rgH5N9, A/turkey/Wisconsin/1968 (H5N9) A/chicken/Hidalgo/232/1994 (H5N2), and wild type HP A/chicken/Indonesia/7/2003 (H5N1) viruses were used to prepare inactivated oil-emulsified whole virus vaccines. Two weeks after vaccination, chickens were challenged with either Asian HP H5N1 viruses, A/chicken/Indonesia/7/2003 (W.H.O. clade 2.1) or A/chicken/Supranburi Thailand/2/2004 (W.H.O. clade 1.0). The H5 HA1 of the North American vaccine strains exhibited 12% amino acid differences including amino acid changes in the major antigenic sites as compared to the Asian HP H5N1 challenge viruses, serologically exhibited substantial antigenic difference, but still provided 100% protection from mortality. However, challenge virus shedding was significantly higher in chickens immunized with antigenically distinct American lineage vaccines as compared to the antigenically matched Asian rgH5N9 and the wild type Asian H5N1 vaccine. The antibody response to the heterologous subtype neuraminidase proteins were discriminated in vaccinated and infected chickens using a rapid fluorescent 2′-(4-methylumbelliferyl)-α-d-N-acetylneuraminic acid sodium salt as substrate for neuraminidase inhibition assay. This study demonstrates the value of using a vaccine containing antigenically matched H5 hemagglutinin for control of HP H5N1 avian influenza in poultry and the potential utility of a heterologous neuraminidase as a DIVA marker. [Copyright &y& Elsevier]

High-pathogenicity (HP) avian influenza (AI) virus of the H5N1 subtype has caused an unprecedented epizootic in birds within nine Asian countries/regions since it was first reported in 1996. Vaccination has emerged as a tool for use in managing the infection in view of future eradication. This study was undertaken to determine whether two divergent H5N2 commercial vaccine strains, one based on a European and the other a North American low-pathogenicity AI virus, could protect chickens against a recent Asian H5N1 HPAI virus. The North American and European vaccine viruses had 84 and 91% deduced amino acid sequence similarity to the HA1 segment of haemagglutinin protein of Indonesia H5N1 HPAI challenge virus, respectively. Both vaccine strains provided complete protection from clinical signs and death. The vaccines reduced the number of chickens infected and shedding virus from the respiratory and intestinal tracts at the peak of virus replication. In addition, the quantity of virus shed was reduced by 10 4 to 10 5 median embryo infectious doses. The use of specific neuraminidase inhibition tests allowed identification of infected chickens within the vaccinated groups. These data indicate that the currently available H5 vaccines of European and North American lineages will protect chickens against the Asian H5N1 HPAI virus and reduce environmental contamination by the H5N1 HPAI virus. They will be an adjunct to biosecurity measures to reduce virus transmission. Les vaccins inactivés à virus influenza aviaire H5N2 européen et nord américain protègent les poulets contre le virus influenza aviaire H5N1 asiatique hautement pathogène Le virus influenza aviaire (AI) hautement pathogène (HP) de sous type H5N1 a causé une épizootie sans précédent chez les oiseaux de neuf régions/pays asiatiques depuis sa première déclaration en 1996. La vaccination est apparue comme un outil à utiliser pour contrôler l'infection en vue de son éradication future. Cette étude a été entreprise pour déterminer si deux souches divergentes H5N2, de vaccins du commerce, dérivées de virus AI de faible pathogénicité l'un européen et l'autre nord américain, pouvaient protéger les poulets contre un virus asiatique récent HPAI H5N1. Les virus vaccinaux nord américain et européen avaient une séquence déduite en acides aminés qui présentait respectivement 84% et 91% de similarité au niveau du segment HA1 de la protéine de l'hémagglutinine avec le virus d'épreuve HPAI H5N1 indonésien. Les deux souches vaccinales ont conféré une protection complète au regard des symptômes et de la mortalité. Les vaccins ont réduit le nombre de poulets infectés et la diffusion du virus à partir des tractus respiratoire et intestinal, au pic de réplication du virus. De plus, la quantité de virus diffusé a été réduite de 10 4–5 doses infectieuses 50 pour l'embryon (EID 50 ). L'utilisation de tests d'inhibition spécifiques de la neuraminidase a permis l'identification de poulets infectés au sein des groupes vaccinés. Ces données indiquent que les vaccins H5 actuellement disponibles des lignages européen et nord américain protègent les poulets contre le virus HPAI H5N1 asiatique et réduisent la contamination environnementale par le virus HPAI H5N1. Ils représentent un complément aux mesures de biosécurité pour réduire la transmission du virus. Inaktivierte Vakzine mit nordamerikanischem oder europäischem H5N2 aviärem Influenzavirus schützen Hühner vor dem hochpathogenen asiatischen H5N1 aviären Influenzavirus Hochpathogenes (HP) aviäres Influenza (AI)-Virus des H5N1 Subtyps hat seit der Erstbeschreibung im Jahr 1996 eine noch nie da gewesene Epizootie bei Vögeln in neun asiatischen Ländern/Regionen hervorgerufen. Die Vakzination hat sich als ein Mittel zur Bekämpfung der Infektion im Hinblick auf die spätere Eradikation erwiesen. Diese Studie wurde durchgeführt, um festzustellen, ob zwei verschiedene kommerzielle H5N2-Vakzinestämme, einer basierend auf einem europäischen und der andere auf einem nordamerikanischen schwach pathogenen AI-Virus, Hühner gegen das neue asiatische H5N1-HPAI-Virus schützen kann. Das nordamerikanische und das europäische Vakzinevirus hatten eine 84- bzw. 91 %ige Übereinstimmung der Aminosäurensequenz mit dem HA1-Segment des Hämagglutininproteins des indonesischen H5N1-HPAI-Challengevirus. Beide Vakzinestämme schützten vollständig vor Erkrankung und Tod. Zum Zeitpunkt der größten Virusvermehrung reduzierten die Vakzinen die Anzahl der infizierten und damit die Anzahl der über den Respirations- und Intestinaltrakt virusausscheidenden Hühner. Außerdem wurde die Quantität der Virusausscheidung um 10 4–5 Embryo infektiöse Dosen 50 (EID 50 ) vermindert. Die Anwendung von Neuraminidaseinhibitionstests erlaubte die Identifizierung infizierter Hühner innerhalb der vakzinierten Gruppen. Diese Ergebnisse weisen darauf hin, dass die zur Zeit verfügbaren H5-Vakzinen europäischer und nordamerikanischer Herkunft Hühner gegen das asiatische H5N1-HPAI-Virus schützen und die Kontamination der Umgebung mit diesem Virus reduzieren können. Sie können eine Unterstützung der Sicherheitsmaßnahmen zur Reduktion der Virusübertragung sein. Vacunas de virus inactivados de Influenza Aviar H5N2 de América del norte y Europa protegen a los pollos frente al Virus de Influenza Aviar de Alta Patogenicidad H5N2 de Asia El virus de influenza aviar (AI) de alta patogenicidad (HP) del subtipo H5N1 ha causado una epizootía sin precedentes en aves de nueve países/regiones Asiáticos desde su primera descripción en 1996. La vacunación se ha convertido en una herramienta en uso para el control de la infección en vistas de una futura erradicación. Este estudio se llevó a cabo para determinar si dos cepas vacunales H5N2 distintas, una basada en una cepa Europea y la otra en una cepa Norte Americana del virus AI de baja patogenicidad,, podían proteger a pollos frente al virus asiático H5N1 HPAI. Los virus vacunales de Norte América y Europa mostraban un 84% y 91% de similitud en las secuencias aminoacídicas deducidas respecto el segmento HA1 de la proteína de la hemaglutinina del virus campo de Indonesia H5N1 HPAI, respectivamente. Ambas cepas vacunales proporcionaron protección completa frente a signos clínicos y mortalidad. Las vacunas redujeron el número de pollos infectados y la excreción de virus vía tracto respiratorio e intestinal en el momento de máxima replicación viral. Además, la cantidad de virus excretado se redujo hasta 10 4–5 dosis infectivas embrionarias medias (EID 50 ). El uso de pruebas específicas de inhibición de la neuraminidasa permitió la identificación de las aves infectadas en los grupos vacunados. Estos resultados indican que las vacunas H5 disponibles actualmente, procedentes de líneas Europeas y Norte Americanas protegerán a los pollos frente al virus H5N1 HPAI Asiático y reducirán la contaminación del medio por este virus. Estas vacunas podrán sumarse a las medidas de bioseguridad para reducir la transmisión vírica. [ABSTRACT FROM AUTHOR]

• Sarcopenia is well recognized, and the importance of its proper management is well understood. • However, there is a gap in case detection and management in clinical practice. • Management proficiency rates were higher among medical doctors (especially geriatricians) than allied health professionals. • This finding highlights the need to educate healthcare professionals to bridge Asia's knowledge–practice gap. This study aimed to (1) investigate the clinical practice for the management of sarcopenia among healthcare professionals in Asia, (2) determine the characteristics of clinical care provided by geriatricians versus by other healthcare professionals, and (3) clarify the awareness of sarcopenia. From December 1 to 31, 2022, an online survey was completed by 1990 healthcare professionals in Asia. The survey comprises demographics and institutional characteristics, basic sarcopenia-related details, and sarcopenia-related assessment and treatment details. The mean respondent age was 44.2 ± 10.7 years, 36.4% of the respondents were women, and the mean years of experience in clinical practice were 19.0 ± 10.6 years. The percentages of respondents who were aware of the term "sarcopenia", its definition and the importance of its management were high, at 99.3%, 91.9%, and 97.2%, respectively. The percentages of respondents who had screened patients for, diagnosed patients with, and treated patients for sarcopenia were 42.4%, 42.9%, and 58.8%, respectively. Medical doctors had higher performance rates compared to allied health professionals (45.5% vs. 40.5% for screening, 56.8% vs. 34.5% for diagnosis, and 65.0% vs. 55.0% for treatment) (P < 0.001). Especially, among medical doctors, geriatricians had significantly higher rates compared to non-geriatricians (64.3% vs. 34.1% for screening; 76.7% vs. 44.8% for diagnosis; 82.7% vs. 54.4% for treatment, respectively) (P < 0.001). Although the importance of the concept and management of sarcopenia is well recognized, there is a gap in its detection and management in clinical practice between medical doctors and allied health professionals, and also between geriatricians and non-geriatricians. Many geriatricians collaborate with other healthcare professionals to appropriately manage sarcopenia. In the future, educating all medical staff on the proper management of sarcopenia is necessary. [ABSTRACT FROM AUTHOR]

Abstract: Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m2 for men and 5.4 kg/m2 for women by using dual X-ray absorptiometry, and 7.0 kg/m2 for men and 5.7 kg/m2 for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia. [Copyright &y& Elsevier]

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m 2 in men and <5.4 kg/m 2 in women; and bioimpedance, <7.0 kg/m 2 in men and <5.7 kg/m 2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)