Sonographic Anatomy and Imaging of the Extracranial Component of the Hypoglossal Nerve (CNXII)

ABSTRACT The hypoglossal nerve (HN) provides motor innervation to tongue muscles responsible for tongue movement, speech, mastication, swallowing, respiratory functions and management of oral secretions. Injury, compression, entrapment or lesions of the HN at any point along its path can result in HN palsy and subsequent dysphagia, dysarthria and tongue muscular atrophy. A combined imaging approach is required to investigate the HN and causes of HN palsy. Magnetic resonance imaging (MRI) and computed tomography (CT) imaging are used to investigate the intracranial HN and where it emerges in the upper neck. The extracranial HN can be assessed by sonographic imaging along with the muscles directly and indirectly innervated by the HN. Ultrasound imaging can be challenging without an appropriate understanding of the detailed relative anatomy of the HN and the muscles it innervates, the associated sonographic technique and sonographic appearances, all of which are outlined in this paper.

Alterations in Cellular Gene Expression Due to Co‐Infection With Kaposi's Sarcoma‐Associated Herpesvirus and SARS‐CoV‐2: Implications for Disease Severity

ABSTRACT An outbreak of the novel coronavirus SARS‐CoV‐2, the causative agent of COVID‐19 pandemic, has resulted in over 7 million confirmed deaths. In addition to severe respiratory and systematic symptoms, several comorbidities increase the risk of fatal outcomes. Therefore, it is essential to investigate the impact of COVID‐19 on pre‐existing conditions in patients, such as cancer and other infectious diseases. Recent clinical studies have reported the reactivation of human herpesviruses, including Kaposi's sarcoma‐associated herpesvirus (KSHV), in severe COVID‐19 patients or vaccinated individuals. To support these clinical observations, we established a KSHV/SARS‐CoV‐2 co‐infection system in A549‐hACE2 cells. Our findings indicate that co‐infection with live SARS‐CoV‐2 sharply induces KSHV lytic reactivation. Transcriptomic analysis revealed significant changes in global cellular gene expression in KSHV‐infected A549‐hACE2 cells, both with and without SARS‐CoV‐2 co‐infection. These data provide a molecular basis for understanding whether patients with pre‐existing oncogenic herpesvirus infections are at increased risk for more severe COVID‐19 or for developing virus‐associated cancers even after full recovery from COVID‐19.

Modulation of Cell Cycle Kinases by Kaposi's Sarcoma‐Associated Herpesvirus

ABSTRACT The cell cycle is governed by kinase activity that coordinates progression through a series of regulatory checkpoints, preventing the division of damaged cells. The Kaposi's sarcoma‐associated herpesvirus (KSHV) encodes multiple genes that modulate or co‐opt the activity of these kinases, shaping the cellular environment to promote viral persistence. By advancing the cell cycle, KSHV facilitates latent replication and subsequent transmission of viral genomes to daughter cells, while also contributing to the establishment of multiple cancer types. Conversely, during viral lytic replication, KSHV extends the resting phase of the cell cycle to prevent cellular DNA synthesis that would otherwise compete for essential replication precursors. This review will examine the mechanisms KSHV has evolved to control the kinase activity regulating host cell cycle progression.

Systematic Molecular Influenza A/B Screening Upon Hospital Admission in Belgium, January–April 2022: Positivity Ratios and Viral Loads According to Symptomatology, Age, and Vaccination Status

ABSTRACT Three hospitals implemented molecular point‐of‐care tests (POCTs) to screen patients for SARS‐CoV‐2 infection upon admission during the 2021/2022 influenza season, which in Belgium lasted from January to April 2022. The samples were simultaneously tested for influenza A/B. Influenza positivity at admission was examined in relation to patient characteristics and symptomatology. Influenza POCTs were performed on all patients requiring urgent hospitalization, regardless of the admission reason. A total of 9327 patients were included in the study, of which 411 (4.4%) tested positive for influenza A/B. Asymptomatic infection and mild illness accounted for respectively 11.2% (95% CI: 8.5%–14.6%), and 43.3% (95% CI: 38.6%–48.1%) of the cases. A total of 66% (95% CI: 60%–72%) of all patients in these symptom categories (asymptomatic and mild illness) showed a high viral load (cycle threshold [Ct] < 24). Only in 30 (7.3%, 95% CI: 5.2%–10.2%) of all cases and in two (4.4%, 95% CI: 1.2%–14.5%) of the asymptomatic cases, the symptomatology worsened during hospital stay. Coinfections with both influenza and SARS‐CoV‐2 occurred in 35 patients (8.5% of all influenza positive patients). There was no difference in symptomatology between patients with co‐infections and those with an influenza mono‐infection. Patients could not be reliably categorized into carriers with low versus high viral loads based on symptomatology, age, and vaccination status. More than half of the influenza‐positive individuals were either asymptomatic or had mild symptoms upon admission, while often carrying high viral loads. Our results show that without screening of patients at hospital admission, a considerable number of patients with a high viral load may be incorrectly classified as being not infectious.

Clinical and Analytical Evaluation of the Abbott Alinity m HR HPV Assay in a New Generation First‐Void Urine Collector

ABSTRACT Urine‐based self‐sampling approaches can simplify cervical screening programs whilst increasing response. This study reports on the performance of Abbott Alinity m HR HPV on urine, self‐collected at home using a new generation first‐void urination device that is suitable for postal delivery (Novosanis Colli‐Pee Small Volumes). First‐void urine and paired cervical samples from 297 females attending colposcopy (age 25–65, NCT04530201) were analysed for the presence of Human Papillomavirus (HPV) DNA. Cervical disease was confirmed by colposcopy and/or histology. HPV testing on first‐void urine was less sensitive for high‐grade cervical intraepithelial neoplasia (CIN2 +; ratio 0.91; 95% CI: 0.83–0.99), though equally specific (< CIN2; ratio 1.04; 95% CI: 0.92–1.19) compared to cervical samples at the manufacturer established cut‐off for cervical samples. Adjusting the cut‐off for first‐void urine improved sensitivity for CIN2+ (ratio 0.96; 95% CI: 0.90–1.03), whilst maintaining equal specificity compared to cervical samples (ratio 1.00; 95% CI: 0.88–1.14). Cohen's kappa agreements of HPV outcomes between sample pairs were good to excellent at both cut‐offs (range: 0.64–0.85). Using the HPV test's adjusted cutoff for first‐void urine, no difference in clinical sensitivity or specificity was observed between first‐void urine and cervical samples. These data highlight the importance of evaluating self‐sample‐specific cut‐offs for HPV assays, previously validated on cervical samples.

Accuracy of Liferiver HarmoniaHPV and VenusHPV Assays on Urine and Vaginal Self‐Samples

ABSTRACT In this report, the clinical performance of Liferiver HarmoniaHPV and Liferiver VenusHPV was evaluated under the VALHUDES framework. Five hundred and twenty‐three women collected first‐void urine (FVU) with Colli‐Pee and vaginal samples with Evalyn Brush or Qvintip. Cervical samples were taken with the Cervex Brush by a clinician. Both vaginal and cervical samples were resuspended in 20 mL ThinPrep. Triplet samples from 499 women were tested with HarmoniaHPV and VenusHPV tests. The clinical accuracy of HarmoniaHPV did not differ in FVU and vaginal self‐samples versus cervical samples. The relative sensitivity for CIN2+ on FVU and vaginal samples was 0.95 [95% CI 0.89–1.02] and 0.95 [95% CI 0.88–1.02], respectively. Relative specificity for < CIN2 was 0.95 [0.86–1.04] on FVU and 0.93 [0.86–1.01] on vaginal samples. VenusHPV demonstrated lower sensitivity on both self‐sample types, whereas the specificity was similar to cervical samples. Post‐hoc adjustment of the VenusHPV C t ‐values improved sensitivity (ratio FVU/cervical = 0.94 [95% CI 0.88–1.00]; ratio vaginal/cervical = 0.96 [95% CI 0.92–1.01]) without compromising specificity (ratio FVU/cervical = 1.00 [0.92–1.09]; ratio vaginal/cervical = 0.95 [95% CI 0.88–1.02]) on both self‐samples. In conclusion, HarmoniaHPV and VenusHPV tests demonstrated similar clinical accuracy on FVU and vaginal self‐ versus cervical samples, although VenusHPV test required cut‐off optimization.

Virus Monitoring in Denmark: A Community‐Based Self‐Sampling System to Surveil Respiratory Viruses and Associated Symptoms

ABSTRACT This study presents findings captured in the first 1.5 years of the Virus Monitoring in Denmark (VMD) surveillance system. It describes trends in respiratory viruses, related symptoms, and participant demographics and behaviors. VMD used self‐swabbing and self‐reported symptoms to monitor respiratory viruses in the general population. Participants were recruited via digital invitations to a representative sample of the population or through workplaces. Symptomatic participants could self‐swab and register their samples and report their symptoms via a dedicated smartphone web app. With 30 627 participants and 12 642 samples analyzed, VMD had a broad demographic representation. SARS‐CoV‐2 was the most frequently detected virus, with positivity rates peaking at over 50% in late 2023. Participants commonly self‐swabbed because of fever, cough, and rhinorrhea, with influenza A linked to the highest median number of symptoms. Participants only provided samples after reaching a specific symptom threshold, and participation affected the health‐seeking behaviors and work attendance of a few individuals. VMD continuously provided real‐time insights into respiratory virus trends and symptomatology in the general non‐healthcare‐seeking population. Its accessibility – available to anyone with a Danish identification number, a smartphone, and an invitation – highlights its potential as a pandemic preparedness tool.

Serological Response to Mpox and Direct Virus Detection in Asymptomatic Patient Prior to the First Diagnosed Case: A Retrospective Study of the 2022 Montpellier Epidemic

ABSTRACT The Mpox (formerly monkeypox) outbreak in 2022 presented unprecedented challenges, including widespread transmission in non‐endemic regions, particularly among men who have sex with men. This study examines Mpox infections in Montpellier, France, focusing on diagnostic testing, serological profiles, and potential asymptomatic cases, based on data from Montpellier University Hospital. We retrospectively analyzed results from 91 patients tested positive for Mpox DNA. Antibody responses were monitored using novel Mpox virus peptide‐based serological assays. Our findings highlight that MPXV antibodies can develop early in infection, peaking within 2 weeks to 3 months, though responses varied by antigen type. Additionally, asymptomatic Mpox infections were suggested, with virus detected in blood, urine, anal, oral and genital swabs screened Sexual Transmitted Infection samples. Notably, viral presence was confirmed in Montpellier samples as early as mid‐May 2022, before the first known symptomatic case in Hospital, in the same period as the first official case in France. This study underscores the need for expanded screening in high‐risk clinics to control Mpox spread and supports the potential utility of serological assays for broad immune profiling. Enhanced diagnostic tools and proactive surveillance in sexual health settings are recommended to improve outbreak response and prevent further transmission.

Characterization of a Novel Fungus‐Infecting RNA Virus, Magoulivirus , in Vaginal Secretions

Persistent Symptoms in SARS‐CoV‐2‐Infected and Non‐Infected Household Members: A Prospective Cohort Study

ABSTRACT This prospective study assessed the prevalence, type, and consequences of persistent symptoms following a nonhospitalized SARS‐CoV‐2 infection by comparing infected and noninfected children and adults of Dutch households. Two comparable prospective household studies were conducted during two pandemic phases. At baseline, all household members were tested for SARS‐CoV‐2 with 10 consecutive saliva samples during a 6‐week period using RT‐PCR. Questionnaires assessing persistent symptoms, health‐related quality of life (HRQoL), anxiety, and depressive symptoms were collected at 6 and 12 months. Of the 297 included participants (median age 34 years, IQR 12–48), 201 (67.7%) tested positive for SARS‐CoV‐2. At 6 months, only one child reported persistent symptoms. SARS‐CoV‐2‐infected adults (> 18 years) reported more pulmonary symptoms (15.2% vs. 3.4%, p  = 0.023), and tended to report more fatigue (12.8% vs. 3.4%, p  = 0.061) and exertion‐related symptoms (8.8% vs. 1.7%, p  = 0.107) compared to the negative adults. Adult participants with persistent symptoms reported decreased HRQoL and increased anxiety and depressive symptoms. This study found that SARS‐CoV‐2‐positive adults tended to have higher prevalence of respiratory symptoms, fatigue, and exertion‐related symptoms 6 months after SARS‐CoV‐2 infection, whereas children rarely reported persistent symptoms. Persistent symptoms were associated with a reduced HRQoL and increased anxiety and depression.