Occurrence and antibiotic resistance of coliform bacteria and antimicrobial residues in pasteurized cow's milk from Brazil.

In this study we examined the hygienic and sanitary quality of pasteurized cow's milk in the state of Paraná, Brazil, by determining the presence of coliforms and occurrence of antimicrobial residues. A total of 260 milk samples were collected from commercial establishments in different regions of the state. Coliform populations were estimated by the multiple-tube test, and antimicrobial residues were detected by enzyme-linked immunosorbent assay. Overall, 105 samples (40.4%) were unsuitable for consumption according to Brazilian legal standards. Among the coliforms, Escherichia coli and Klebsiella pneumoniae were respectively identified in 77.05 and 36.07% of the samples. The highest rates of resistance to antimicrobial agents were observed for ampicillin (19.2%), cephalothin (18.9%), and tetracycline (17.1%). Antimicrobial residues were detected in 80 samples (30.8%). Forty-eight samples (18.5%) were positive for tetracycline, 29 (17.4%) for neomycin, 9 (3.5%) for beta-lactams, 6 (2.3%) for gentamicin, 4 (1.5%) for chloramphenicol, and 1 (0.4%) for streptomycin-dihydrostreptomycin. The results demonstrate a high prevalence of coliforms and also a high occurrence of antimicrobial residues in pasteurized cow's milk from Paraná, Brazil.

Occurrence of antimicrobial residues in pasteurized milk commercialized in the state of Paraná, Brazil.

Milk containing antimicrobial residues presents a health risk to the human population. The objective of this study was to use an enzyme-immunoassay technique to determine the occurrence of antimicrobial residues in 151 samples of pasteurized milk sold in cities of the State of Paraná, Brazil, from March 2005 to April 2006. Fifty-nine (41.3%) of the 151 samples contained antimicrobial residues. Residues of neomycin, streptomycin, and/or dihydrostreptomycin and chloramphenicol were found in three, two, and four, respectively. None of the samples with neomycin residues had levels above the maximum residue limit (MRL) permitted in this country, which is 500 microg/kg. Only one sample had a higher level of streptomycin-dihydrostreptomycin (260 microg/kg) than the MRL (200 microg/kg). The four samples positive for chloramphenicol had levels above the zero tolerance level. In the qualitative analysis, 41 of 151 samples contained tetracyclines (tetracycline, chlortetracycline, and/or oxytetracycline), 4 of 82 samples contained gentamicin, and 5 of 151 samples contained beta-lactams (amoxicillin, ampicillin, ceftiofur, cephapirin, and/or penicillin G). It was not possible to determine whether the levels of the antimicrobials found in the qualitative analyses (tetracyclines, gentamicin, and beta-lactams) were above the MRLs because the detection limits were below the MRLs in Brazil. In nine samples, two or more antimicrobial residues were found. The results demonstrate the need for monitoring various antimicrobial residues in pasteurized milk to ensure safety, quality, and integrity and to protect the health of the Brazilian population.

Effect of different head positions on the jaw closing point during tapping movements.

This study aimed to investigate the effects of different head positions on jaw closing points during tapping movements. The jaw movements of 20 adult volunteers were assessed using a new jaw-tracking device. All subjects had stable maximal intercuspation with their natural dentitions. The subjects were asked to seat on a dental chair with their head upright, and tapping movements were recorded for 5 s without any further instructions. After the chair was reclined to the horizontal position, tapping movements were also recorded with the head in the supine position. The location of the tapping point was defined as the jaw position which was the most closed to the maximum intercuspal position during each tapping stroke. Fifteen tapping points were obtained from the upright and supine head positions of each subject. Six-hundred tapping points were compared to evaluate the effects of different head positions. With the head upright, tapping points were relatively stable and close to the jaw position at the maximum intercuspation. However, in the supine position, tapping points varied widely and shifted forward. The average distance between the positions of the incisal point at the maximum intercuspation and at the tapping points was 0.11 mm (SD, 0.10) in the upright position and 0.30 mm (SD, 0.08) in the supine position. A Wilcoxon signed rank test showed a significant difference (P < 0.01) between these distances. We conclude that tapping points shift anteriorly in the supine position.

Enhanced recovery after surgery for gastric cancer and an assessment of preoperative carbohydrate loading.

BACKGROUND: We previously reported on the feasibility of enhanced recovery after surgery (ERAS) protocol for gastric cancer with a prospective phase II study, but the superiority of this approach over non-ERAS perioperative management remains unclear. Preoperative carbohydrate loading, an important element of the ERAS protocol, has been shown to reduce insulin resistance, but its effects on clinical endpoints in gastric cancer surgery remain controversial. The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery, with particular focus on preoperative carbohydrate loading. METHODS: In this ERAS case-control study, we enrolled 121 patients as a case group and 259 patients undergoing gastrectomy for gastric cancer with our conventional perioperative management as a control group. Matched-pair analysis was performed to balance the patients' characteristics for comparison analysis. RESULTS: After matching, 108 patients were included in each group. Postoperative hospital stay was significantly shorter in the ERAS group than in the control group (8 days vs. 9 days, p < 0.001), while the incidence of Clavien-Dindo classification grade II or more postoperative complication was similar between the groups (11.1% vs. 15.7%, p = 0.325). No significant differences were found in serum albumin level, body weight, or grip strength between the groups before surgery and at 1 week and 1 month after surgery. CONCLUSION: Use of the ERAS protocol for gastric cancer shortened the length of postoperative hospital stay without increasing complications. Preoperative carbohydrate loading didn't improve the postoperative nutritional status or maintain the muscle strength postoperatively.

Trace metal levels in serum and urine of a population in southern Brazil.

This study aimed to evaluate serum and urine concentrations of several trace metals of a non-directly exposed population in southern Brazil and establish reference values. Serum and urine samples were obtained from 240 volunteers (175 males and 65 females, age ranging from 18 to 74 years old). Levels of arsenic, chromium, cobalt, copper, lead, nickel, manganese and zinc were determined by means of dynamic reaction cell inductively coupled plasma mass spectrometry (DRC-ICP-MS). Comparison between genders resulted in no significant difference for all metals but serum copper, as concentrations are higher in females than males. For most metals assessed, a negative correlation between serum concentrations and age was found, but no significant correlation was found between urine concentrations and age.

Lymphangiogenesis and the vascular endothelial growth factor receptor (VEGFR)-3 in gastric cancer.

Vascular endothelial growth factor C (VEGF-C) is the only factor known to cause lymphangiogenesis. We studied the correlation between VEGF-C and vascular endothelial growth factor receptor-3 (VEGFR-3) expression of 85 primary gastric cancers by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemistry, and the results were correlated with the number of lymphatic vessels, stained with anti-VEGFR-3 antibody. RT-PCR and immunohistology demonstrated that VEGF-C was mainly produced from cancer cells, but not from stromal elements. Morphologically, VEGFR-3 expression was detected in the endothelial cells of the stromal lymphatic vessels. There was a statistically positive correlation between the incidence of VEGF-C and VEGFR-3 mRNA expression in the primary tumours (P=0.0002). The number of VEGFR-3-positive lymphatic vessels in VEGF-C mRNA positive tumours was significantly larger than that in VEGF-C-negative tumours. The number of VEGFR-3-positive vessels in the tumour stroma was closely related to the grade of lymphatic invasion of gastric cancer. These results strongly indicate that VEGF-C may induce the proliferation of lymphatic vessels in the stroma of primary gastric cancer via activation of VEGFR-3, expressed on the endothelial cells of lymphatic vessels. In these circumstances, cancer cells can easily invade the lymphatic vessel, because of the increase of the contact points of cancer cells with the lymphatic vessels.

Immunohistochemical study of MT-MMP tissue status in gastric carcinoma and correlation with survival analyzed by univariate and multivariate analysis.

Matrix metalloproteinase (MMP) expression is associated with advanced-stage cancer and contributes to tumor progression, invasion, and metastasis. Membrane type matrix metalloproteinase (MT-MMP) has a potential transmembrane domain at the C terminus and activates pro-MMP-2, which is mainly produced from interstitial fibroblasts. Its expression on the membrane of invasive tumor cells results in the pericellular space degradation at cell-matrix contact sites and renders cancer cells more invasive at the migration front. To elucidate the relationship between MT-MMP expression and metastasis and prognosis in gastric cancer patients, MT-MMP expression was analyzed immunohistochemically in 127 primary tumors and results were correlated with several prognostic parameters and patient's survival. MT-MMP immunoreactivity was stained on the cell membrane of cancer cells and fibroblasts in the invasion front. MT-MMP was detected in 72 tumors (57%) (MT-MMP-positive). MT-MMP expression was closely associated with macroscopically invasive type, nodal involvement, lymphatic invasion, vessel invasion, and peritoneal dissemination. Patients with MT-MMP-positive tumor had a significantly worse prognosis than those with MT-MMP-negative tumor (p<0.001). Multivariate analysis showed MT-MMP overexpression as an independent prognostic factor in gastric cancer patients. Immunohistochemical analysis for MT-MMP may be an indicator of metastatic potential or the prognosis of gastric cancer patients.

Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma.

BACKGROUND: This study examined the clinical value of intraoperative peritoneal lavage for cytological examination in patients with gastric cancer. Peritoneal dissemination is the most frequent mode of recurrence for this tumor. METHODS: A retrospective of lavage findings, other factors, and outcome was performed in 1,297 patients with gastric cancer who underwent intraoperative peritoneal lavage. RESULTS: The 5-year survival rate of patients with positive lavage cytology was only 2%. Patients who underwent curative resection and had negative cytology had a significantly better 5-year survival rate (P < 0.001). Even among patients with macroscopic peritoneal dissemination, the survival rate was significantly better with negative cytology, which reflected fewer free cancer cells in the peritoneal cavity. Serum concentrations of carcinoembryonic antigen and carbohydrate antigen 19-9 were significantly higher in patients with positive cytology. Multivariate analyses indicated that intraoperative cytological findings was an independent prognostic factor for survival, and was the most important factor for predicting peritoneal recurrence. CONCLUSIONS: Intraoperative peritoneal lavage cytology is important in predicting survival and peritoneal recurrence in gastric cancer.

Fatigue fracture of the ulna occurring in pitchers of fast-pitch softball.

We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.

Dye- and gamma probe-guided sentinel lymph node biopsy in breast cancer patients: using patent blue dye and technetium-99m-labeled human serum albumin.

BACKGROUND: Sentinel lymph node (SLN) biopsy is a promising method for the diagnosis of the axillary nodal status. We examined the availability of the SLN biopsy using two mapping procedures: the dye- and gamma probe-guided method, and preoperative lymphoscintigraphy by gamma camera imaging. METHODS: We enrolled 48 patients with breast cancer. Technetium-99m-labeled human serum albumin was injected into the subdermal tissue above the primary tumor or biopsy cavity, and preoperative gamma camera imaging was performed. After induction of general anesthesia, patent blue dye was injected into the peritumoral area prior to the surgical procedure. A handheld gamma-detection probe was used to assist in SLN detection. Careful dissection was performed to identify blue-stained afferent lymphatic vessels and nodes. An SLN was defined as any blue and/or radioactive node, and was excised. After SLN biopsy, axillary lymph node dissection of level I, II, and III was completed, in order to confirm the diagnostic ability of the SLN biopsy. RESULTS: Intraoperative SLN identification of axillary lesions was successful in 43 of 48 patients (90%). The dye- and gamma probe-guided method was successful in 25 patients (52%), the dye-guided method alone succeeded in 11 patients (23%), and the gamma probe-guided method alone succeeded in 7 patients (15%). Preoperative lymphoscintigraphy revealed axillary focal accumulations in 29 of 48 patients (60%). All patients who underwent successful preoperative SLN identification by lymphoscintigraphy had successful intraoperative SLN identification. A diagnostic accuracy of 95%, a sensitivity of 89%, and a specificity of 100% were achieved in the diagnosis of axillary metastasis. Internal mammary SLNs were identified in four patients intraoperatively, but we could not detect cancer metastasis in the internal mammary SLNs. CONCLUSIONS: The dye-guided and gamma probe-guided methods were complementary. Preoperative lymphoscintigraphy was useful to predict intraoperative SLN identification. Further study is necessary to assess the role of SLN biopsy of the internal mammary lymph nodes.

An auscultatory recording method for blood pressure measurement during exercise.

For inspective determination of blood pressure at rest and during exercise, simultaneous recordings of cuff pressure, Korotkov's sounds, and ECG by an electromagnetic oscillograph were necessary. We devised an apparatus in line with the requirement. Results obtained using this apparatus demonstrate that the auscultatory recording method is suitable to determine the blood pressure during submaximal bicycle exercise.

A new surgical approach (peritonectomy) for the treatment of peritoneal dissemination.

BACKGROUND/AIMS: Despite the improvements of chemotherapy and surgical techniques, treatment results of peritoneal dissemination still remain pessimistic. METHODOLOGY: During a 10-year period, 106 patients with peritoneal dissemination from gastric cancer were treated with chemo-hyperthermic peritoneal perfusion (CHPP), peritonectomy + CHPP, systemic PMUE therapy, and surgery alone in 51, 15, 13, and 27 patients, respectively. In peritonectomy, disseminated nodules were resected as much as possible in combination with the combined resection of the abdominal organs and parietal peritoneum covering diaphragm, pelvis and abdominal wall. After resection, the abdominal cavity was treated with heated saline at 42-43 degrees, containing cisplatinum (CDDP), Mitomycin C (MMC), and etoposide for 1 hour. PMUE therapy was administered with one course of i.v. infusion of 75 mg/m2 of CDDP and 30 mg/body of MMC on the 1st day, followed by etoposide 50 mg/body on the 3rd, 4th, and 5th day, and with oral intake of 400 mg/body of UFT every day from the 1st day. RESULTS: No post-operative or chemotherapeutic deaths were observed. Systemic PMUE therapy showed no survival improvement, and survival of the peritonectomy + CHPP group was the best, following CHPP, systemic PMUE and surgery alone. CONCLUSIONS: Peritonectomy and CHPP may be the best choice for the treatment of peritoneal dissemination.

[A case of stage IVb (H2P0N4T4) gastric cancer successfully treated with neoadjuvant chemotherapy (PMFE therapy)].

A 69-year-old man was examined at our hospital because of a sense of upper abdominal fullness. He was diagnosed as having stage IVb (H2P0N4T4) gastric cancer and treated with neoadjuvant chemotherapy. One course of the regimen consisted of 10 mg CDDP (day 1-5), 10 mg MMC (day 1), 250 mg 5-FU (day 1-20) and 50 mg ETP (day 6, 7). The patient underwent the regimen three times in succession. After the chemotherapy, his hepatic metastases showed necrotic changes and the swelling of the para-aortic lymph nodes disappeared on a CT scan. A histological examination revealed that the cancer cells had completely vanished both at the site of the hepatic tumor and the para-aortic lymph nodes. This combination chemotherapy, named PMFE therapy, is considered effective without serious side effects for gastric cancer in patients with non-curative factors.

[A case report: modified PMUE therapy might be effective for advanced gastric carcinoma with pulmonary carcinomatous lymphangitis].

A regimen featuring a combination of CDDP, MMC, 5-FU and ETP (Modified-PMUE) was given to a patient with advanced gastric cancer containing pulmonary carcinomatous lymphangitis. This procedure made his carcinomatous lymphangitis disappear and primary and metastatic lesions reduce in size. The subsequent palliative reduction surgery for gastric carcinoma, proximal gastrectomy was feasible. Nevertheless, postoperative Modified-PMUE was ineffective: carcinomatous lymphangitis reappeared and progressed to death of respiratory failure postoperative 68 days. The SDI test, a sensitivity test for carcinostatic agent showed neither CDDP, MMC, 5-FU nor ETP sensitive to resected carcinoma cells. Therefore, we concluded that the Modified PMUE kills carcinoma cells sensitive to the agents and allows carcinoma cells resistant to the agents to grow.

Intake of aflatoxins through the consumption of peanut products in Brazil.

To estimate daily intake of aflatoxins from peanut products consumed by the population of Paraná State (Brazil), 100 samples of peanut products were collected between July 2006 and April 2007. Aflatoxins were determined by an HPLC method with fluorescence detection. There was a 50% occurrence of aflatoxins (B1, B2, G1 and G2) in concentrations ranging from 0.5 to 113 ng g(-1), with 13 samples with levels above 20 ng g(-1). Intake was calculated for average and high adult consumers of peanut products and it was compared with provisional maximum tolerable daily intake (PMTDI). The estimated probable daily intake (PDI) for aflatoxin B1 (AFB1) varied from 0.6 to 10.4 ng kg(-1) bw day(-1), exceeding the PMTDI of 0.4 ng kg(-1) bw day(-1) for carriers of hepatitis B virus.

Relationship between occlusal tooth contact patterns and tightness of proximal tooth contact.

The aim of this study was to investigate the relationship between occlusal tooth contact patterns and the tightness of proximal tooth contact (TPTC) during clenching. Twenty young adult volunteers with healthy dentition participated in the study. TPTC between the left second premolar (P2) and the first molar (M1) was measured during clenching at the 50% maximum voluntary contraction level in the intercuspal position (ICP). A silicone impression material was used to make an interocclusal record at the ICP in each subject, and interocclusal records were analysed using an image-processing system. Subjects were classified according to the presence or absence of each type (A, B or C) of occlusal contact. Statistical analysis was performed using the Mann-Whitney U-test. The results of this study exhibited a relationship between B-type contact and the TPTC of maxillary teeth. The experimental group with a lack of B-type contact on maxillary P2 and/or M1 showed a statistically greater TPTC than the group with B-type contact on both of these teeth (P < 0.01). These results suggest that occlusal tooth contact patterns have an influence on TPTC during clenching.