Adaptação de Escherichia coli enterotoxigênica ao eugenol / Adaptation of enterotoxigenic Escherichia coli to eugenol

O objetivo do trabalho foi verificar a capacidade de adaptação de ETEC- ATCC 35401 ao antimicrobiano eugenol. Para isso, a Concentração Mínima Bactericida (CMB) de eugenol foi determinada e em seguida,as células de ETEC foram expostas a concentrações subletais de eugenol (CMB/4, CMB/8 e CMB/16). Posteriormente testadas frente a diferentes concentrações do composto (CMB/2; CMB; 1,2CMB; 1,4CMB; 1,6CMB; 1,8CMB e 2CMB), estas foram incubadas e plaqueadas em TSA (Ágar Triptona de Soja) empregando a técnica de microgotas. As células de ETEC foram classificadas como capazes de se adaptarem quando essas cresceram em placas após cultivo em presença do componente em concentração igual ou maior que a CMB do eugenol (1,0% (v/v)). As células de ETEC apresentaram a capacidade de adaptação por crescerem na CMB, após exposta a CMB/16. Os resultados demonstram a necessidade de obtenção da concentração de uso adequado de eugenol a fim de evitar a adaptação.(AU)

Adaptação de Escherichia coli enterotoxigênica ao eugenol / Adaptation of enterotoxigenic Escherichia coli to eugenol

O objetivo do trabalho foi verificar a capacidade de adaptação de ETEC- ATCC 35401 ao antimicrobiano eugenol. Para isso, a Concentração Mínima Bactericida (CMB) de eugenol foi determinada e em seguida,as células de ETEC foram expostas a concentrações subletais de eugenol (CMB/4, CMB/8 e CMB/16). Posteriormente testadas frente a diferentes concentrações do composto (CMB/2; CMB; 1,2CMB; 1,4CMB; 1,6CMB; 1,8CMB e 2CMB), estas foram incubadas e plaqueadas em TSA (Ágar Triptona de Soja) empregando a técnica de microgotas. As células de ETEC foram classificadas como capazes de se adaptarem quando essas cresceram em placas após cultivo em presença do componente em concentração igual ou maior que a CMB do eugenol (1,0% (v/v)). As células de ETEC apresentaram a capacidade de adaptação por crescerem na CMB, após exposta a CMB/16. Os resultados demonstram a necessidade de obtenção da concentração de uso adequado de eugenol a fim de evitar a adaptação.

Virulence factors and antimicrobial resistance profile of Escherichia coli isolated from nursery piglets and drinking water

Background: One of the most frequent health problems in the swine industry is the post-weaning diarrhea in nursery pigs, which leads to significant losses due to weight loss, dehydration, cost of medication and mortality. Escherichia coli (E. coli) is one of the main bacterial agents of the post-weaning diarrhea. To investigate the possibility of enterotoxigenic E. coli (ETEC) transmission through drinking water to nursery piglets, the objective of this study was to isolate, characterize by virulence factors, and compare the antimicrobial resistance profiles of E. coli from drinking water samples in nurseries and from rectal swabs of their piglets presenting post-weaning colibacillosis.Materials, Methods & Results: Fifteen rectal swabs from diarrheic piglets in their first three weeks after weaning and one water sample were collected from each of ten nurseries located in Rio Grande do Sul State, south of Brazil. After enrichment with a commercial broth medium, water samples were cultured in blood agar, as well as the rectal swab samples, and the characteristic colonies were identified by standard biochemical analysis. Following isolation and identification of E. coli, the colonies from water samples and their corresponding piglets’ samples were characterized by multiplex PCR in order to determine specific ETEC fimbria and toxin genes. Finally, all E. coli isolates were submitted to antimicrobial susceptibility testing. Virulence factors and antimicrobial sensitivity could then be compared between water and piglets’ samples. The difference in the antimicrobial resistance frequency for each of the sample groups were compared using the multi comparison test. E. coli was isolated in four out of the ten water samples, although none of the water samples presented ETEC virulence factors.[...]

Virulence factors and antimicrobial resistance profile of Escherichia coli isolated from nursery piglets and drinking water

Background: One of the most frequent health problems in the swine industry is the post-weaning diarrhea in nursery pigs, which leads to significant losses due to weight loss, dehydration, cost of medication and mortality. Escherichia coli (E. coli) is one of the main bacterial agents of the post-weaning diarrhea. To investigate the possibility of enterotoxigenic E. coli (ETEC) transmission through drinking water to nursery piglets, the objective of this study was to isolate, characterize by virulence factors, and compare the antimicrobial resistance profiles of E. coli from drinking water samples in nurseries and from rectal swabs of their piglets presenting post-weaning colibacillosis.Materials, Methods & Results: Fifteen rectal swabs from diarrheic piglets in their first three weeks after weaning and one water sample were collected from each of ten nurseries located in Rio Grande do Sul State, south of Brazil. After enrichment with a commercial broth medium, water samples were cultured in blood agar, as well as the rectal swab samples, and the characteristic colonies were identified by standard biochemical analysis. Following isolation and identification of E. coli, the colonies from water samples and their corresponding piglets samples were characterized by multiplex PCR in order to determine specific ETEC fimbria and toxin genes. Finally, all E. coli isolates were submitted to antimicrobial susceptibility testing. Virulence factors and antimicrobial sensitivity could then be compared between water and piglets samples. The difference in the antimicrobial resistance frequency for each of the sample groups were compared using the multi comparison test. E. coli was isolated in four out of the ten water samples, although none of the water samples presented ETEC virulence factors.[...](AU)

Virulence profiles of enterotoxigenic Escherichia coli isolated from piglets with post-weaning diarrhea and classification according to fecal consistency / Perfis de virulência de Escherichia coli enterotoxigênica isoladas de leitões desmamados com diarreia do Sul do Brasil e classificação das amostras de acordo com a consistência fecal

The aim of this study was to assess the frequency and association of virulence factors of Escherichia (E.) coli isolated from weaned piglets with diarrhea and to correlate it with fecal consistency. A total of 152 rectal swabs were collected from 25-40 day-old piglets with diarrhea, in farms of Southern Brazil. Phenotypical and molecular techniques were used for bacterial isolation, characterization and classification of enterotoxigenic E. coli (ETEC) pathotypes. Statistical analysis was carried out to determine the frequency of virulence factors and virotypes, of fimbriae F4, F5, F6, F18, F41 and toxins LT, STa, STb and STx2e. Out of 456 E. coli isolates, 287 (62.9%) samples showed significant growth of E. coli. Among them, 194 (67.6%) samples showed at least one virulence factor, indicating that ETEC is an important etiological agent of diarrhea in weaned piglets. Higher frequencies were found of fimbria F4 and F18 and enterotoxins LT, STa and STb. Significant association was found to F4, LT, STa and STb; between F18 and STa and STx2e; between F5 and LT, STa and STb. The most frequent virotypes were F18-STa, F4-LT-STa-STb, F4-STa, F4-LT-STb and F18-STa-STx2e. Beta-hemolysis was observed in 47.4% of samples and there was significant association between hemolytic samples and virulence factors F4, F18, STa and STx2e. Regarding fecal consistency, there was significant association of liquid feces and F4 fimbria, STa toxin and virotypes F4-STa and F4-F5-LT-STa-STb. Since there was significant association of ETEC and liquid feces in nursery piglets, it is important to prioritize the sampling of liquid feces for the diagnosis etiologic cause of diarrhea.(AU)

O objetivo deste estudo foi avaliar a frequência e associação de fatores de virulência de Escherichia (E.) coli isoladas de leitões desmamados com diarreia e correlacioná-la com consistência fecal. Suabes retais foram coletados em leitões com 25-40 dias de idade com sinal clínico de diarreia, em granjas do Sul do Brasil, totalizando 456 amostras. Foram utilizadas técnicas fenotípicas e moleculares para isolamento bacteriano, caracterização e classificação de patotipos de E. coli enterotoxigênica (ETEC). A análise estatística foi realizada para determinar a frequência de fatores de virulência e virotipos, de fímbrias F4, F5, F6, F18, F41 e toxinas LT, STa, STB e STx2e. Duzentas e oitenta e sete (62,9%) amostras apresentaram crescimento significativo de E. coli. Entre os quais, 194 (67,6%) amostras apresentaram pelo menos um fator de virulência, indicando que ETEC é um importante agente etiológico de diarreia em leitões desmamados. As frequências mais elevadas foram encontradas para as fímbrias F4 e F18 e enterotoxinas LT, STa e STb. Associação significativa foi encontrada para F4, LT, STa e STb; entre F18 e STa e STx2e; entre F5 e LT, STa e STb. Os virotipos mais frequentes foram F18-STa, F4-LT-STa-STb, F4-STa, F4-LT-STb e F18-STa-STx2e. Beta-hemólise foi observada em 47,4% das amostras e houve associação significativa entre amostras hemolíticas e fatores de virulência F4, F18, STa e STx2e. Quanto consistência fecal, houve associação significativa de fezes líquidas e fímbria F4, toxina STa e virotipos F4-STa e F4-F5-LT-STa-STb. A associação significativa da ETEC e fezes líquidas em leitões de creche, é importante para priorizar a amostragem de fezes com essa consistência para no diagnóstico etiológico da diarreia.(AU)

Associação entre fatores de virulência e resistência antimicrobiana de Escherichia coli enterotoxigênicas isoladas de leitões com diarreia no Brasil / Association between virulence factors and antimicrobial resistance from enterotoxigenic Escherichia coli isolated from pigs with diarrhea in Brazil

Background: Enterotoxigenic Escherichia coli (ETEC) is the etiologic agent of post weaning colibacillosis, one of the most important diseases in pig farming. The pathogenesis of the disease is associated with two virulence factors (VF), fimbriae and enterotoxins. In veterinary medicine, the use of antibiotics can lead to the selection of resistant bacteria. The association of VF and antibiotic resistance is an important mechanism for bacterial survival under adverse conditions. This study aimed to determine the VF and antimicrobial susceptibility of ETEC isolates from piglets with diarrhea and analyze the association between these factors.Materials, Methods & Results: A total of 185 rectal swabs were collected from weaned piglets in Brazilian farms of the states of Rio Grande do Sul, Santa Catarina, Paraná, Minas Gerais and Goiás. The isolation of ETEC was carried out on blood and MacConkey Agar and characterization by biochemical tests and detection by PCR of fimbrial genes F4, F45, F6, F18 and F41, and toxins genes LT, STa, STb and STx2e. Antimicrobial susceptibility profiles were determined by Agar diffusion test for amoxicillin, ampicillin, ceftiofur, ciprofloxacin, colistin, doxycycline, enrofloxacin, florfenicol, gentamicin, neomycin, norfloxacin, oxytetracycline, streptomycin, tetracycline, lincomycin + spectinomycin and sulfamethoxazole + trimethoprim. The association between VF and antimicrobials resistance results was determined by Chi-square and Fisher test (P ≤ 0.05). A total of 376 isolates were analyzed. The frequencies of fimbriae and toxins amplified were: F4 (31.6%), F18 (18.9%), F5 (4.2%) and toxins STa (43.1%), STb (24.7%), LT (21.8%) and STx2e (5.3%). Antibiotic resistance was higher to tetracycline (96.3%), florfenicol (95.2%), oxytetracycline (93.62%) and doxycycline (90.7%). Lowest levels of resistance were to ceftiofur (2.1%), colistin (9.8%), lincomycin + spectinomicin (15.4%) and neomycin (23.1%).[...](AU)

Associação entre fatores de virulência e resistência antimicrobiana de Escherichia coli enterotoxigênicas isoladas de leitões com diarreia no Brasil / Association between virulence factors and antimicrobial resistance from enterotoxigenic Escherichia coli isolated from pigs with diarrhea in Brazil

Background: Enterotoxigenic Escherichia coli (ETEC) is the etiologic agent of post weaning colibacillosis, one of the most important diseases in pig farming. The pathogenesis of the disease is associated with two virulence factors (VF), fimbriae and enterotoxins. In veterinary medicine, the use of antibiotics can lead to the selection of resistant bacteria. The association of VF and antibiotic resistance is an important mechanism for bacterial survival under adverse conditions. This study aimed to determine the VF and antimicrobial susceptibility of ETEC isolates from piglets with diarrhea and analyze the association between these factors.Materials, Methods & Results: A total of 185 rectal swabs were collected from weaned piglets in Brazilian farms of the states of Rio Grande do Sul, Santa Catarina, Paraná, Minas Gerais and Goiás. The isolation of ETEC was carried out on blood and MacConkey Agar and characterization by biochemical tests and detection by PCR of fimbrial genes F4, F45, F6, F18 and F41, and toxins genes LT, STa, STb and STx2e. Antimicrobial susceptibility profiles were determined by Agar diffusion test for amoxicillin, ampicillin, ceftiofur, ciprofloxacin, colistin, doxycycline, enrofloxacin, florfenicol, gentamicin, neomycin, norfloxacin, oxytetracycline, streptomycin, tetracycline, lincomycin + spectinomycin and sulfamethoxazole + trimethoprim. The association between VF and antimicrobials resistance results was determined by Chi-square and Fisher test (P ≤ 0.05). A total of 376 isolates were analyzed. The frequencies of fimbriae and toxins amplified were: F4 (31.6%), F18 (18.9%), F5 (4.2%) and toxins STa (43.1%), STb (24.7%), LT (21.8%) and STx2e (5.3%). Antibiotic resistance was higher to tetracycline (96.3%), florfenicol (95.2%), oxytetracycline (93.62%) and doxycycline (90.7%). Lowest levels of resistance were to ceftiofur (2.1%), colistin (9.8%), lincomycin + spectinomicin (15.4%) and neomycin (23.1%).[...]

Eschechiria coli produtora da toxina shiga em bovinos: revisão

Esta revisão apresenta os aspectos epidemiológicos da bactéria Escherichia coli produtora da toxina shiga, (STEC) que é reconhecida no mundo todo como agente causador de toxinfecção. Os produtos de origem animal são frequentemente associados aos surtos da doença, mas os alimentos hortifrutigranjeiros também podem ser contaminados e causar toxinfecção em seus consumidores. A incidência da infecção em humanos no Brasil (STEC) é baixa, foi observada essa prevalência nos rebanhos bovinos, ovinos e aves. Por isso, a importância das boas práticas de manipulação do produtor e do consumidor para evitar possível contaminação dos alimentos. Este trabalho teve por objetivo revisar a literatura sobre a ocorrência de Escherichia coli produtora da toxina shiga. Frente aos limitados estudos realizados sobre os agentes etiológicos, novos estudos fazem-se necessários.(AU)

This review presents the aspects of shiga toxin-producing Escherichia coli, which are recognized worldwide as toxinfection agents in the world. Products of animal origin are often associated with outbreaks of disease, but horticultural crops can be contaminated and cause toxinfection as well. This study aims to review the literature on the occurrence of shiga toxin-producing Escherichia coli. The incidence of infection in humans in Brasil by STEC and low, prevalence was observed in cattle, sheep and poultry. Therefore, the importance of good practices of manipulation of the producer and the consumer to avoid possible food contamination. Faced with the limited studies of etiological agents, it is necessary to study the subject.(AU)

Phylogenetic and pathotype analysis of Escherichia coli swine isolates from Southern Brazil / Análise filogenética e de patotipos de Escherichia coli isoladas de suínos no Sul do Brazil

The current study evaluated the presence of virulence factors by a multiplex PCR technique and then phylogenetically classified the studied strains into groups A, B1, B2 and D, according to Clermont et al. (2000), in 152 intestinal and extraintestinal swine isolates of Escherichia coli. Seventy seven isolates tested were positive for virulence factors. Phylogenetic characterization placed 21 samples into group A, 65 into B1, 19 into B2 and 47 into D. Fourteen urine samples were classified as uropathogenic E. coli (UPEC), nine were both UPEC and enterotoxigenic E. coli (ETEC) and four were ETEC only. The most common phylogenetic classifications were B1 and D groups. Of the analyzed fecal samples, 25 were classified as ETEC. Phylogenetically, the group of higher occurrence was B1, followed by B2, A and D. For the small intestine samples, 20 were classified as ETEC. Phylogenetic analysis found groups B1 and A to be the most commons in these samples. Six isolated tissue samples were classified as ETEC and most of them were designated as group D by phylogenetic classification. The phylogenetic analysis could be employed in veterinary laboratories in the E. coli isolates screening, including the possibility of vaccine strain selection and epidemiological searches.(AU)

O presente estudo teve por objetivo avaliar a presença de diferentes fatores de virulência em 152 isolados de Escherichia coli intestinais e extra-intestinais provenientes de suínos pela técnica de PCR multiplex e classificá-los nos grupos filogenéticos A, B1, B2 e D, de acordo com Clermont et al. (2000). Setenta e sete isolados foram positivos para pelo menos um fator de virulência. Através da caracterização filogenética, 21 isolados foram caracterizados como pertencentes ao grupo A, 65 ao grupo B1, 19 ao grupo B2 e 47 isolados ao grupo D. Quatorze isolados de urina foram caracterizados como E. coli uropatogênica (UPEC); nove apresentaram fatores de UPEC e E. coli enterotoxigênica (ETEC) simultaneamente e quatro foram classificados como ETEC. Na classificação filogenética, os isolados provenientes de amostras de urina classificaram-se principalmente nos grupos D e B1. Das amostras de fezes analisadas, 25 demonstraram fatores de virulência característicos do patotipo ETEC. Filogeneticamente, o grupo de maior ocorrência foi o B1 seguido de B2, A e D. Em relação às cepas isoladas de intestino delgado, 20 foram caracterizadas como ETEC. Pela filogenia, 23 isolados classificaram-se nos grupos A ou B1. Seis isolados de tecidos foram qualificados como ETEC e a maioria deles foram designados como pertencentes ao grupo D, pela classificação filogenética. A análise filogenética pode ser empregada em laboratórios de diagnóstico veterinário como um screening para isolados de E. coli, incluindo a possibilidade de seleção de cepas vacinais e levantamentos epidemiológicos.(AU)

Citocinas IL-1β, IL-6, TNF-α e IFN-γ no sangue e colostro de fêmeas bovinas da raça Holandesa. Importância na transferência de imunidade passiva / Cytokines IL-1β, IL-6, TNF-α and IFN-γ in blood and colostrum of Holstein cows. Importance in the immune passive transfer

O colostro bovino contém fatores imunológicos, como imunoglobulinas, leucócitos e citocinas, absorvidos pela mucosa intestinal do neonato até 48 horas de vida, no entanto, pouco se conhece sobre a função de alguns desses componentes, como as citocinas, participantes da resposta imune inata e adaptativa. Acredita-se que estas substâncias possuem papel importante na imunidade dos neonatos nos seus primeiros dias de vida. Assim, os objetivos específicos desta pesquisa foram: determinar as concentrações das citocinas IL-1β, IL-6, IFN-γ e TNF-α no soro sanguíneo e colostro de fêmeas bovinas da raça Holandesa; verificar a liberação de citocinas pelas células mononucleares do colostro e sangue bovino "in vitro" antes e após a estimulação com Escherichia coli enterotoxigênica (ECET); avaliar a transferência das citocinas IL-1β, IL-6 e TNF-α do colostro aos bezerros neonatos, por meio da determinação das concentrações destas citocinas no soro sanguíneo dos bezerros, durante os quinze primeiros dias de vida. O trabalho foi realizado em duas etapas, em duas propriedades distintas: (1) avaliação do soro sanguíneo e colostro de primeira ordenha proveniente de 22 fêmeas; (2) avaliação das citocinas sanguíneas de 11 bezerros, antes e após a mamada de colostro. Nesta pesquisa foi possível determinar as medianas da concentração de citocinas IL-1β, IL-6, IFN-γ e TNF-α no colostro bovino e soro sanguíneo, correspondente a 70,5 e 41,5; 86,1 e 13,5; 41 e 57,9; 139,9 e 20,8 pg/mL, respectivamente, verificando menores valores de IFN-γ no colostro e TNF-α e IL-6 no soro sanguíneo. Observou-se diferença entre as citocinas no colostro e ...

Bovine colostrum contains immunological factors, such as immunoglobulins, leukocytes and cytokines, which are absorbed by the intestinal mucous membrane of the neonate up to 48 hours of life. However, little is known about the function of some of these components, such as cytokines, which take part in innate and adaptive immune responses. It is believed that these substances have important roles in neonate immunity on their first days of life. Therefore, the specific objectives of this study were: to determine the concentration of cytokines IL-1β, IL-6, IFN-γ and TNF-α in serum and colostrum of Holstein cows; to assess the in vitro release of cytokines by mononuclear cells of colostrum and blood before and after stimulation with enterotoxigenic Escherichia coli (ECET); to evaluate IL-1β, IL-6 and TNF-α transfer from colostrum to neonate calves by determining cytokine concentrations in calf blood during the first 15 days of life. The study was carried out in two stages, in different farms: (1) evaluation of blood and first milking colostrum in 22 females; (2) evaluation of blood cytokines of 11 calves, before and after colostrum intake. In this study, it was possible to determine the medians of IL-1β, IL-6, IFN-γ and TNF-α concentration in blood and colostrum as equal to 70.5 and 41.5; 86.1 and 13.5; 41 and 57.9; 139.9 and 20.8 pg/mL, respectively. The lowest values of IFN-γ were observed in colostrum, and of TNF-α and IL-6, in serum. TNF-α concentration was different in serum and in blood. It was observed colostrum and blood cells of the cows produced cytokines spontaneously and by means of ECET, with a tendenc...

Citocinas IL-1β, IL-6, TNF-α e IFN-γ no sangue e colostro de fêmeas bovinas da raça Holandesa. Importância na transferência de imunidade passiva / Cytokines IL-1β, IL-6, TNF-α and IFN-γ in blood and colostrum of Holstein cows. Importance in the immune passive transfer

O colostro bovino contém fatores imunológicos, como imunoglobulinas, leucócitos e citocinas, absorvidos pela mucosa intestinal do neonato até 48 horas de vida, no entanto, pouco se conhece sobre a função de alguns desses componentes, como as citocinas, participantes da resposta imune inata e adaptativa. Acredita-se que estas substâncias possuem papel importante na imunidade dos neonatos nos seus primeiros dias de vida. Assim, os objetivos específicos desta pesquisa foram: determinar as concentrações das citocinas IL-1β, IL-6, IFN-γ e TNF-α no soro sanguíneo e colostro de fêmeas bovinas da raça Holandesa; verificar a liberação de citocinas pelas células mononucleares do colostro e sangue bovino "in vitro" antes e após a estimulação com Escherichia coli enterotoxigênica (ECET); avaliar a transferência das citocinas IL-1β, IL-6 e TNF-α do colostro aos bezerros neonatos, por meio da determinação das concentrações destas citocinas no soro sanguíneo dos bezerros, durante os quinze primeiros dias de vida. O trabalho foi realizado em duas etapas, em duas propriedades distintas: (1) avaliação do soro sanguíneo e colostro de primeira ordenha proveniente de 22 fêmeas; (2) avaliação das citocinas sanguíneas de 11 bezerros, antes e após a mamada de colostro. Nesta pesquisa foi possível determinar as medianas da concentração de citocinas IL-1β, IL-6, IFN-γ e TNF-α no colostro bovino e soro sanguíneo, correspondente a 70,5 e 41,5; 86,1 e 13,5; 41 e 57,9; 139,9 e 20,8 pg/mL, respectivamente, verificando menores valores de IFN-γ no colostro e TNF-α e IL-6 no soro sanguíneo. Observou-se diferença entre as citocinas no colostro e ...(AU)

Bovine colostrum contains immunological factors, such as immunoglobulins, leukocytes and cytokines, which are absorbed by the intestinal mucous membrane of the neonate up to 48 hours of life. However, little is known about the function of some of these components, such as cytokines, which take part in innate and adaptive immune responses. It is believed that these substances have important roles in neonate immunity on their first days of life. Therefore, the specific objectives of this study were: to determine the concentration of cytokines IL-1β, IL-6, IFN-γ and TNF-α in serum and colostrum of Holstein cows; to assess the in vitro release of cytokines by mononuclear cells of colostrum and blood before and after stimulation with enterotoxigenic Escherichia coli (ECET); to evaluate IL-1β, IL-6 and TNF-α transfer from colostrum to neonate calves by determining cytokine concentrations in calf blood during the first 15 days of life. The study was carried out in two stages, in different farms: (1) evaluation of blood and first milking colostrum in 22 females; (2) evaluation of blood cytokines of 11 calves, before and after colostrum intake. In this study, it was possible to determine the medians of IL-1β, IL-6, IFN-γ and TNF-α concentration in blood and colostrum as equal to 70.5 and 41.5; 86.1 and 13.5; 41 and 57.9; 139.9 and 20.8 pg/mL, respectively. The lowest values of IFN-γ were observed in colostrum, and of TNF-α and IL-6, in serum. TNF-α concentration was different in serum and in blood. It was observed colostrum and blood cells of the cows produced cytokines spontaneously and by means of ECET, with a tendenc... (AU)