More complex atherosclerotic plaques containing calcium present a

More complex atherosclerotic plaques containing calcium present additional challenges for interventional R428 procedures. The deposition of calcium within

these lesions reduces vessel elasticity and may create eccentric expansion during balloon angioplasty. This typically leads to increased perforation and/or dissection rates in this population [15]. Rotational atherectomy has been employed to treat patients with coronary arterial calcific disease by enlarging the vessel lumen. The mechanism of action, which uses a rotating, diamond-coated burr within the vessel has been shown to have potential utility to prepare calcified lesions for further treatment that will be used to prevent restenosis (e.g., stent) [5]. A recent study by Brogan et al. [16] highlighted the benefits of debulking

when treating patients with calcified coronary arteries. Using quantitative angiographic methods, they demonstrated the beneficial effects of calcium plaque reduction using rotational atherectomy. These benefits include increase in acute luminal gain, decreased vessel stretch and less elastic recoil resulting in procedural success in 37 of 41 patients (90%). Moussa et al. [17] treated 75 consecutive patients (106 lesions) with rotational atherectomy prior to coronary stenting and reported procedural success in 93.4% of lesions. In spite of these successes, other reports suggest that distal embolization of atherectomy fragments may result in no-reflow or slow flow, which can result Crizotinib chemical structure in serious complications such as adverse ischemic and clinical events including but not limited to microvascular spasm, MI and no-reflow [18]. The OAS has additional advantages over other atherectomy devices. The average particle size created by rotational atherectomy is 5–10 μm

[19] vs. particles averaging less than 2 μm when the OAS is used [20]. Particles ablated from the occluding plaque by the OAS are removed through the reticuloendothelial system. In addition, the orbit of the OAS crown can be regulated via the crown’s rotational speed, to achieve optimal plaque modification. This ability to treat the lesion with a single device may allow GBA3 for significant cost savings to be realized. Perforation rates of 0 to 1.5% have been reported with high-speed rotational atherectomy and differ based on technique [19]. In this single-center subset of ORBIT I trial patients, two minor dissections, one major dissection and two perforations occurred. Use of smaller crown sizes and improved technique is expected to reduce acute complications in the future. In comparison, the OAS used in this study did not cause slow flow or distal embolization. This may be due to the mechanism of action. The elliptical orbit allows blood and micro-debris to flow past the crown, thus continually dispersing the particulate, cooling the crown and reducing the risk of thermal injury to the target vessel.

2 Furthermore, thermometers are frequently reported to slip into

2 Furthermore, thermometers are frequently reported to slip into the female bladder during the patient’s attempts to determine the temperature in the vulva or urethra.3 Patients usually present with dysuria, poor urinary stream or retention, bloody or purulent urethral discharge, upper urinary tract infection, urgency, PLX3397 ic50 and/or pelvic pain.1 More importantly, patients occasionally have no symptoms or minimal discomfort. Foreign bodies, when left for a long time, act as a nidus for calculus formation. However, signs that should raise the

physician’s suspicion include undue anxiety during sexual history taking or attempts to avoid genital or rectal examination. Complications with intravesical foreign bodies include chronic and recurrent urinary tract infections, acute urinary retention, calcification, obstructive uropathy, scrotal gangrene, vesicovaginal fistula, squamous cell carcinoma, and even death by sepsis.4 Finally, intravesical foreign body–induced

bladder calculi resulting in obstructive renal failure has been reported in the literature.5 Complete removal of the foreign body should be tailored according to its nature and dimensions, while CCI-779 research buy causing minimal trauma to the bladder and urethra. Most foreign bodies can be removed transurethrally with cystoscopic grasping forceps. Open suprapubic cystostomy is sometimes required for large, impacted foreign body removal. Our patient underwent an open cysteotomy, as it was impossible to carry out endoscopic procedures. Detection of intravesical foreign bodies

should be included in the differential diagnosis of patients with chronic lower urinary tract problems, even in cases with obstructive Endonuclease renal failure, without history of foreign bodies insertion. The most suitable method for removal depends on the nature of the foreign body, age of the patient, adequate expertise, and equipment. “
“Splenogonadal fusion (SGF), abnormal connection between spleen and gonad or derivatives of the mesonephros, is a rare congenital anomaly. SGF is more frequent in men, 9:1 or 5:1, according to various authors and as reported by Alvarez.1 The real incidence is unknown and probably underestimated. Two types of SGF are described as follows: in continuous type (55%) the normal spleen is connected to the gonad with a cord of splenic tissue or a fibrous band containing small islands of ectopic spleen; in discontinuous type (45%) ectopic splenic tissue is attached to the gonad, but has not connection with the orthotopic spleen. Presentation is usually as scrotal mass or as an incidental finding during orchiopexy or inguinal hernia repair. In most cases reported until recently, the diagnosis was made at pathologic examination of the removed testicle or at autopsy (16.8%). Most anomalies are associated with the continuous type of SGF, including limb defects: splenogonadal fusion limb defect (SGFLD syndrome), micrognathia, and skull anomalies.

In our investigation, all saponins increased the IgG1 antibodies

In our investigation, all saponins increased the IgG1 antibodies. This humoral response is induced Ribociclib purchase by whole saponins [23] but seems to be correlated to the carbohydrate deprived sapogenin nuclei [14] and [17]. A global increase of IgM and IgG3 antibodies by all adjuvants was described which is expected to occur in

response to carbohydrate enriched antigens [35] and saponins [14] and [17]. The sugar side chain in saponins may be essential to their adjuvanticity [reviewed in 22]. Soyasaponins that comprise sugar chain(s) have shown adjuvanticity stimulating anti-OVA total-IgG and IgG1 antibody responses while their corresponding aglycones soyasapogenols A and B, did not. The CP05 saponin of C. pulcherrima induced a strong antibody response that was maintained after removal of its monoterpene hydrophobic moiety but not after removal of the BMS-354825 datasheet C-28 and or the C-3 attached glycosidic chains [14]. With the removal of these glycosidic chains the CP05 aglycone only sustained the IgG1 and the IgM response [14]. Oda et al. [25] described that the adjuvanticity of saponins increases with their hydrophile–lipophile balance (HLB). Indeed, the capability of saponins to induce antibody responses increases with their hydrophilicity. Among bidesmosidic (two sugar

chains) soyasaponins, soyasaponin A1 with three sugars attached to C-3 induced stronger total-IgG and IgG1 antibody responses than soyasaponin A2 with only two sugar attached to C-3 Phosphoprotein phosphatase [25]. An identical conclusion was obtained by Bernardo et al. [19] working with the PSAGLE saponin of Albizia saman. For monodesmosidic (one sugar chain) soyasaponins, the ranking in terms of antibody response was soyasaponin I (-glcA-gal-rha) > soyasaponin II (-glcA-ara-rha) > soyasaponin III (-glcA-gal) [25]. This means that a trisaccharide (soyasaponin I and II) chain is more potent than a disaccharide one (soyasaponin I), and that a residue of galactose in the trisaccharide chain of soyasaponin I that exposes one OH group turns the saponin more potent than a residue of arabinose which lacks this

OH group (soyasaponin II) [25]. Therefore, among saponins of the same sugar chain length, the more hydrophilic the sugar components are, the more potent the humoral response is. The C-28 attached chain of the C. alba CA3 saponin is composed of arabinose–rhamnose–apiose. The addition of one additional apiose sugar unit in the CA4 saponin is then expected to add hydrophilicity to the saponin [25] increasing its adjuvant potential. Our results with saponins of C. alba therefore, strongly support the previous conclusions of Oda et al. [25] stating that the adjuvant activity tended to increase with the sugar side chain length and the HLB value. Indeed, this investigation reported HLB values of 15.8 and 19.9 for CA3 and CA4 saponins, respectively.

Mice were returned to normal water for a further two weeks follow

Mice were returned to normal water for a further two weeks following the cessation of treatment, to flush any residual in vivo antibiotics inhibiting bacterial culture. At the end of each treatment regimen, bacterial burden in the individual organs/tissues was determined as described previously; with the inclusion

of the liver as an additional potential reservoir of bacilli. Fig. 2A shows that 1 month of treatment was sufficient to clear residual bacilli from the spleen; but a further 2 months of treatment were required to consistently clear persistent BCG from the d.LNs in all animals. The pre-treatment burdens observed in both the spleen and d.LNs were equivalent to previous experiments learn more (Fig. 2A cf. Fig. 1A). BCG in lungs and liver were undetectable in this experiment. As further experiments were critically dependant on consistent efficacy of treatment, a further experiment included

vaccinated mice given an additional 3 months rest after cessation of 3 months treatment. In contrast to immunised, untreated mice (which had a burden of 2.7 log10 CFU (±0.6) in the d.LNs ∼7.5 months p.i.), no viable BCG were detected in the treatment group (Fig. 2B) confirming the efficacy of antimicrobial treatment. To evaluate the effect of persistent BCG bacilli on specific IFN-γ responses, groups of mice were immunized with BCG or placebo control for 6 weeks, prior to treatment with antibiotics or placebo for 3 months. To ensure that: (a) analyses were

not influenced selleck chemical by short-lived effector T cell responses; and (b) BCG bacilli were effectively cleared, animals were from rested for 3 months after treatment. The frequency of BCG-specific IFN-γ secreting cells in the spleen was then evaluated by ex vivo ELISPOT stimulated with the defined protein cocktail. Fig. 2C shows that the significant IFN-γ response induced by BCG immunization (613 SFU/million cells) was completely abrogated in BCG abbreviated animals (p < 0.001). These data clearly demonstrate that, the persisting IFN-γ responses observed in BCG immunized animals were due to persistent BCG bacilli, rather than long-term memory. To further investigate whether this ablation of the IFN-γ responses (ELISPOT) in BCG abbreviated mice was specific to CD4 T cells and of what memory phenotype, the CD4 T cell responses specific to BCG in spleen and lung were assessed by intracellular cytokine staining (ICS) after stimulation with defined protein cocktail (Fig. 3). Fig. 3A shows BCG immunization induces significant populations of multifunctional CD4 T cells (IFN-γ+/IL-2+/TNF-α+, IFN-γ+/TNF-α+ and IL-2+/TNF-α+), in both spleen and lung-derived cells, with frequencies considerably higher in the lungs as reported previously [9]. ICS performed on d.LN samples of BCG immunized mice in previous experiments were unable to detect significant populations of cytokine producing cells (data not shown), and so were not performed here.

The availability of a fast and automated analytics platform will

The availability of a fast and automated analytics platform will expand the scope, robustness, and evolution of Design of Experiment (DOE) studies. It is envisaged

that this will lead to expanded use of Quality by Design (QbD) approaches AZD2281 in vaccine process development. Currently, the development of purification processes for vaccine polysaccharides is exceedingly complex, time-consuming, and laborious. HTPD of polysaccharides has lagged significantly behind current developmental archetypes for other biologicals such as monoclonal antibodies. The lack of simple, high throughput analytical tools has played a role in hindering the evolution of HTPD for polysaccharides. Purification process development does not require the exquisite accuracy demanded of release

assays. Instead, speed, simplicity, and precision are paramount. Especially in the context of high throughput process development, the desire to find the best conditions on a microplate, relative to the other wells, is critical. Excluding affinity separations, the maximum purification factor that can be achieved in a single-stage equilibrium experiment is typically 2 logs, obviating the need for extremely sensitive analytics. Accuracy is more important in the subsequent scale-up and demonstration of promising purification conditions. Polysaccharides, endotoxin, proteins, and nucleic acids are the buy Temozolomide major components found in harvested bacterial fermentation broths employed in industrial polysaccharide vaccine manufacturing. Their critical importance is underscored by the Linifanib (ABT-869) inclusion of the respective assays in the batch release package for product characterization. In the current work, analytical techniques for quantifying polysaccharides, endotoxin, and proteins were qualified. In selecting methods, emphasis was given to procedural simplicity, amenability to automation, robustness,

and precision over accuracy. In addition, the qualification process included evaluating the impact of impurities commonly encountered alongside the carbohydrate product as well as a diverse library of polysaccharides. Novel procedures were described to simplify methods and facilitate automation. A phenol sulphuric acid assay was optimized for high throughput quantitation of mono-, di-, and poly-saccharides. The assay requires only 25 μL of sample and involves no heating steps that can stymie automation. The described procedure also reduces the quantities of hazardous chemicals such as phenol and sulphuric acid, requiring only 150 μL total per sample. A linear range of approximately 2 logs (e.g. glucose: 8–1000 μg/mL) was observed for every tested carbohydrate, with the actual range derived from the specific composition of reactive sugars present. The precision of the described assay was found to be 10%. The PyroGene™ assay was simplified to a single measurement while removing a heated incubation step.

In the second approach, persons who respond only after considerab

In the second approach, persons who respond only after considerable effort from the survey administrators – late respondents – are compared with early respondents. Differences in prevalence between early and late respondents

serve as the basis for inferences about non-respondents, on the assumption that non-respondents lie beyond the late respondents on the continuum of resistance. The method requires accurate documentation of efforts to elicit, and the timing of, the survey response. In one such study, a web-based I-BET151 cost survey of alcohol use at a New Zealand university, with 82% response (Kypri et al., 2004a), utilising several evidence-based methods (Edwards et al., 2002), late respondents drank more, had a higher prevalence of heavy drinking, and more alcohol-related problems Doxorubicin manufacturer than early respondents (Kypri et al., 2004b). On the basis of these studies,

we hypothesised that people who do not comply with health guidelines on drinking, smoking, diet and physical activity, and have greater body mass, would be less inclined to participate in a health behaviour survey. New Zealand has eight universities and 19 polytechnic colleges which provide vocational training and some degree courses. All eight universities were invited to participate in a web-based study, and five accepted, representing six campuses (one of them providing data from two campuses in different cities). Ten of the polytechnic colleges were invited to participate in order to maximise geographic coverage of the country for a study aimed at examining environmental determinants of various health behaviours (i.e., polytechnics in the same cities as universities were not invited). Six of the invited polytechnics accepted, bringing the total number of tertiary education institutions involved in the study to 12. Māori (the indigenous people of New Zealand) comprise 15% of the New Zealand population, 10% Resveratrol of university students and 18% of polytechnic students (Ministry of Education, 2011). We sought to invite random samples of 430 Māori and

430 non-Māori students aged 17–25 years from each campus in order to maximise the explanatory power of the study for Māori, who have traditionally been poorly served by population surveys despite bearing a considerably greater disease burden (Wellington School of Medicine and Health Sciences, 2002). There was no stratification of the samples by age and sex. All members of the study population had an institution assigned e-mail address which we used to issue the invitation to participate. The questionnaire was offered in Māori and English and users could switch between languages at any stage by clicking a button. Students were invited by personalised letter to complete a web survey of their alcohol use, using a procedure described in detail elsewhere (Kypri et al., 2004a and Kypri et al., 2009). Sample weighting was used to account for the proportions of Māori and non-Māori at each campus.

A ‘data point’ was defined as a pre- or post-introduction prevale

A ‘data point’ was defined as a pre- or post-introduction prevalence in a single year, age group, and population. A ‘data set’ was

defined as two data points, separated in time, from the same age group and population, typically one pre- and one post- introduction. Where possible, the ‘pre’ period was before PCV licensing in the country, excluding the year licensed unless that year’s pre-data were drawn only from months prior to introduction (Appendix B.1); the ‘post’ period began no earlier than the year following introduction. GW-572016 cost Year of introduction was based on a compilation of data from WHO [19] and VIMS [20] databases which identified the year in which PCV was widely adopted on a national or relevant regional scale. In the few cases with significant lag time between national licensure and wide adoption, the breakpoint identified by the author was used (low-coverage vs. high-coverage, or pre-licensure vs. post-licensure.) Percentage change in outcome measures was calculated by comparing the most recent pre-introduction data available to each available post-introduction time point. For data presented as incidence rates and case counts, percentage change was calculated as

(pre-introduction – post-introduction)/pre-introduction × 100%, where negative learn more values for percentage change denote an increase. If the study outcome was the proportion VT of all IPD cases, percentage change was transformed into a comparable measure based on incidence rates and case counts as follows: Percentage change = [1 − ((%VT IPD post) × (%NVT IPD pre))/(%VT IPD pre) × (%NVT IPD post)] × 100%. Data were stratified by elapsed years since introduction to assess trends with time, and by age group (<5, 5 to <18, 18 to <50, 50 to <65, ≥65 years) to assess differential effects across age categories. Points not fitting within a single age stratum with minimal overlap

were classified based on the oldest stratum included. Where a data point represented multiple post-introduction else years (i.e., “2001–2003”), the midpoint was used to calculate the number of years since PCV introduction. Where possible, data were also stratified into populations receiving booster doses and those without, and indigenous versus general populations. Effects of different primary dose schedules are addressed elsewhere [21], [22], [23] and [24]. When both IPD and carriage were available, we compared their percentage changes to assess their relationship. When both VT-IPD and PCV coverage levels in the community over time were available, we evaluated the relationship between PCV uptake and VT-IPD impact. Countries that implemented a catch-up schedule in those <2 or <5 years were identified; since catch-up coverage is generally less than complete, we did not further distinguish the magnitude of indirect effects by use of catch-up but considered these mixed populations.

None of the eyes had clinical signs of hypotony, like Descemet wr

None of the eyes had clinical signs of hypotony, like Descemet wrinkling or choroidal folds. All cases of hypotony had undergone 25-gauge vitrectomy. In 9 eyes (7.8%), the IOP was increased, defined as an IOP of 25 mm Hg or more. These were treated with topical antiglaucoma medication, and in all cases,

IOP returned to normal within 3 weeks after operation. Postoperative day 1 IOP was significantly higher after 20-gauge vitrectomy (mean, 16.2 mm Hg) than after 25-gauge vitrectomy (mean, 13.3 mm Hg; P = .011, Mann–Whitney U test). Thirty-six cases were phakic without cataract (31%), 54 cases (46.6%) were pseudophakic, and in 26 cases (22.4%), the vitrectomy was combined with cataract extraction. In the phakic cases, cataract developed during follow-up in 18 GSK1120212 nmr (50%). In 9 cases, the cataract already was treated before the end of follow-up. A macular pucker developed in 2 cases, 1 in a primary floater case and 1 in a case after uveitis. A choroidal hemorrhage occurred during 1 operation. The hemorrhage developed during the vitrectomy, but remained anterior to the equator and resolved spontaneously. RRD occurred in 3 cases (2.5%), all within 3 months after surgery. All 3 cases were operations Alisertib purchase for primary floaters. Two cases were attached after 1 operation and retained good VA. In 1 case, proliferative vitreoretinopathy developed,

requiring 3 retinal attachment procedures and ending with very poor visual function (VA of hand movements). In none of the 10 patients who had an RRD before the procedure did an RRD developed during follow-up. There were no cases of endophthalmitis in our series. Overall, the mean logMAR VA improved from 0.20 to 0.13 (P < .001, Wilcoxon signed-rank test). Improvement was significantly greater in cases where a combined vitrectomy and phacoemulsification was performed. Mean logMAR VA change was −0.06 for the phakic eyes (n = 36),

−0.02 for the pseudophakic eyes (n = 54), and −0.22 for the combined procedures (n = 26). This difference in improvement of VA was statistically significant (P < .001, Kruskal-Wallis test). Preoperative VA was on average MTMR9 lower in secondary cases (0.37) than in primary cases (0.15; P < .001, Mann–Whitney U test). We compared VA change between the primary and the secondary cases. In the 86 primary cases, the mean logMAR VA change was −0.058, and in the 30 secondary cases, the mean logMAR VA change was −0.127. Thus, in the secondary cases, the mean VA seemed to improve more than in the primary cases. This difference was not statistically significant (P = .192, Mann–Whitney U test). Despite the controversy surrounding vitrectomy for floaters, patients more and more demand recognition of their symptoms. Previous studies primarily have focused on outcome in terms of patient satisfaction. Using standardized questionnaires, all concluded that patient satisfaction after this procedure is high.

By RT-qPCR, mRNA of IL-8 showed an immediate down-regulation foll

By RT-qPCR, mRNA of IL-8 showed an immediate down-regulation followed by a slow up-regulation which was statistically significant (P = 0.02) in a regression model against time ( Fig. 1). There was no discernible effect of vaccination on IL-1β ( Fig. 2) or IFNγ ( Fig. 3). TNFα expression was undetectable in a considerable number of samples: in 6 cases there was no detectable expression before or after vaccination; in 5 cases mRNA was detected only before vaccination, and in 5 cases only after vaccination. In the remaining 5 cases, there

was a modest down-regulation, but this was not statistically significant in view of the small number of data pairs. HIV-infected participants did not differ from HIV-uninfected selleckchem participants with

respect to changes in cytokine expression following vaccination, and those biopsies in which TNFα expression was not detectable were not more likely to come from HIV-infected participants (data not shown). The safety of live, attenuated vaccines in HIV infected people is of paramount importance if vaccines are to play any role in reducing the burden of common diseases in tropical populations. In this study we found that in 34 HIV seropositive adults given a total of 58 courses of three live, attenuated oral vaccines there was no evidence of serious adverse events: no hospitalisations, no episodes of diarrhoea requiring treatment, no significant febrile illnesses, and no increase in symptoms such as abdominal pain, nausea or loss of appetite. There was no evidence of haematological toxicity. If we accept that oral vaccines do not over cause diarrhoea after 7 days have elapsed beyond the final dose of vaccine, there was no increase in diarrhoea. The interpretation of diarrhoea data in this setting is difficult if we use HIV seronegative adults as the comparison group, as at any given point

in time HIV infected adults have a higher incidence rate of diarrhoeal disease [19]. We believe that this explains the higher diarrhoea incidence after 7 days following vaccination. Our data are compatible with the hypothesis that these vaccines lead to a modest increase in mild, transient episodes of diarrhoea beyond 1 week in HIV infected adults. They are also explicable with there being a consistently increased risk of diarrhoea in HIV throughout the period of observation. We found no evidence that vaccines induce intestinal inflammation. IL-8 is a chemokine expressed by epithelial cells on contact with potentially invasive bacteria. The other, pro-inflammatory, cytokines showed no change in expression over the week following vaccination. While these data do not rule out a pathogenic effect of these vaccines, they offer considerable reassurance that rotavirus vaccine does not induce inflammation.

Lineage designation for phylogenetic dendrograms of G1, G2, G9 an

Lineage designation for phylogenetic dendrograms of G1, G2, G9 and G12 strains were based on those reported in previous studies [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41] and [42]. Complete nucleotide sequences of VP7 gene of the strains detected during this

study were submitted to the GenBank database under the accession numbers: KF723263–KF723287 [KF723263–KF723268 (G1); KF723269–KF723275 (G2); KF723276–KF723283 (G9); KF723284–KF723287 (G12)]. Among the 830 fecal samples from hospitalized children and 1000 samples from OPD cases, 443 (53.4%) and 475 (47.5%), respectively, were positive for RVAs (Table 1). A distinct seasonal variation in rotavirus

incidence was observed in both hospitalized and OPD Proteasome inhibitor cases, with low Endocrinology antagonist levels of positivity (10–25%) throughout the year (November–February: Winter season; March–June: Summer season; July–October: Rainy season), and the peak in incidence (70–80%) during winter season (December–February) (Fig. 1A and B). Monthwise genotype variation was also analyzed though no correlation between seasonality and increased frequency of particular genotype was observed (Fig. 1). In hospitalized children, G9 strains were observed at 25–55% frequency (Fig. 1A) whereas 10–45% incidence rate was observed in OPD children throughout the study period (Fig. 1B). Thiamine-diphosphate kinase G2 was observed at 10-55% frequency in hospitalized (Fig. 1A) and at 30–55% frequency among OPD children (Fig. 1B). G1 and G12 were observed at 10–40% and 0–20% frequency in both hospitalized and OPD children (Fig. 1A and B). In both the severe or mild diarrhea cases, the maximum number of rotavirus positivity was found in the age group of 6–12 months followed by 12–24months of children (Fig. 2). Rotavirus genotypes were detected by multiplex semi-nested PCR method using G–P type specific primers and confirmed by full length sequencing of the VP7 genes and partial sequencing of the VP4 genes of strains representing different genotypes. Among 443 RVA positive samples from

hospitalized children (<5 years), G9 in conjunction with P[4] and P[8], was most prevalent (40%), followed by G2P[4] (39.6%). G1P[8] and G12 genotype combined with P[8]/P[4]/P[6] were 16.4% and 5.6%, respectively. Other lesser common genotypes such as G1P[6], G2P[6], G2P[8], G4P[8] were observed at low frequencies (Table 2A). Among 475 rotavirus positive cases from the OPD, the most prevalent strain was G2 in combination with P[4] (40.3%), followed by G1P[8] and G9 combined with P[4]/P[8] genotypes at 25.5% and 22.8%, respectively. G12 strains with either P[6] or P[8] genotypes occurred at 9.3%. Other uncommon strains like G1P[4], G1P[6], G2P[8] were also detected at low frequency (Table 2B).