Anatomic characteristics associated with superior mesenteric artery stent graft placement during fenestrated para/suprarenal aneurysm repair.

OBJECTIVE: According to the instructions for use, fenestrated endovascular aortic aneurysm repair (FEVAR) with the Zenith fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) requires ≥4 mm of nonaneurysmal infrarenal neck length, and superior mesenteric artery (SMA) stenting is optional. In the present study, we evaluated the outcomes of FEVAR with SMA stent grafting relative to SMA scallops or unstented fenestrations and their anatomic differences. METHODS: We performed a single-institution retrospective analysis of patients who had undergone FEVAR with an SMA scallop or large fenestration with and without SMA stent grafting from June 2012 to May 2020 after institutional review board approval. RESULTS: Of the 203 aneurysms repaired with ZFENs, 127 were included in our analysis. Of these 127 aneurysms, 55 had stent grafted SMA fenestrations, 38 unstented SMA fenestrations, and 34 SMA scallops. Technical success was achieved in all patients. The operative times were longer (335.5 ± 16.4 minutes vs 265.0 ± 12.8 minutes vs 269.0 ± 12.7 minutes; P < .001) and the transfusion rates were higher (33% vs 8% vs 18%; P = .01) in the SMA stent graft group. However, the fluoroscopy time (65.4 ± 3.76 minutes vs 58.3 ± 3.94 minutes vs 51.4 ± 4.75 minutes; P = .05) and contrast volume (92.2 ± 5.17 mL vs 87.1 ± 6.73 mL vs 93.1 ± 5.89 mL; P = .84) were not significantly different. Anatomically, the patients who had undergone FEVAR with a ZFEN and SMA stent grafting had had shorter infrarenal neck (1.73 ± 1.18 mm vs 4.92 ± 1.16 mm vs 6.28 ± 1.42 mm; P = .03) and infra-SMA neck (10.3 ± 1.39 mm vs 23.9 ± 1.24 mm vs 26.8 ± 1.67 mm; P < .001) lengths. In the SMA stent graft group, one patient had developed small bowel necrosis after embolization of an intraoperatively perforated jejunal branch and two had developed colonic ischemia of unclear etiology with patent SMA stent grafts found on imaging. Endograft migration and SMA occlusion with bowel ischemia occurred in one patient in the SMA fenestration group. Overall mortality (24% vs 21% vs 18%; P = .82) and 30-day mortality (5% vs 3% vs 3%; P = .80) were comparable between the three groups. In addition, the incidence of type III endoleak (5% vs 3% vs 3%; P = .45) and the need for reintervention (20% vs 18% vs 12%; P = .60) were similar across all three groups. The mean follow-up duration was longer for the SMA scallop group, which can be attributed to 82% of these occurring in the first one half of the study period. CONCLUSIONS: Despite the added technical complexity, SMA stenting enabled FEVAR in patients with pararenal and suprarenal aneurysms with high rates of technical success and no increased risk of mortality, major adverse events, type III endoleaks, or reintervention.

Recent Advances in Forward Brillouin Scattering: Sensor Applications.

In-fiber opto-mechanics based on forward Brillouin scattering has received increasing attention because it enables sensing the surrounding of the optical fiber. Optical fiber transverse acoustic resonances are sensitive to both the inner properties of the optical fiber and the external medium. A particularly efficient pump and probe technique-assisted by a fiber grating-can be exploited for the development of point sensors of only a few centimeters in length. When measuring the acoustic resonances, this technique provides the narrowest reported linewidths and a signal-to-noise ratio better than 40 dB. The longitudinal and transverse acoustic velocities-normalized with the fiber radius-can be determined with a relative error lower than 10-4, exploiting the derivation of accurate asymptotic expressions for the resonant frequencies. Using this technique, the Poisson's ratio of an optical fiber and its temperature dependence have been measured, reducing the relative error by a factor of 100 with respect to previously reported values. Using a single-point sensor, discriminative measurements of strain and temperature can be performed, achieving detection limits of ±25 µÎµ and ±0.2 °C. These results show the potential of this approach for the development of point sensors, which can be easily wavelength-multiplexed.

Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms.

PURPOSE: To report 5-year results of the prospective, multicenter study designed to evaluate the Zenith Fenestrated AAA Endovascular Graft (William A. Cook Australia, Brisbane, Australia) for juxtarenal abdominal aortic aneurysms (AAAs). METHODS: Sixty-seven patients (54 male, mean age 74 ± 8 years) were prospectively enrolled at 14 U.S. centers from 2005 to 2012. Fenestrated stent grafts were used in patients with infrarenal aortic neck lengths of 4 to 14 mm to target 178 renal-mesenteric arteries with a mean of 2.7 vessels per patient. At 5 years, 42 of the 67 patients completed the final study follow-up, with clinical examination obtained in 41 and computed tomography imaging in 39. Outcomes adjudicated by a clinical events committee included all-cause and aneurysm-related mortality, major adverse events, renal stent occlusion/stenosis, renal function changes and renal infarcts, aneurysm sac enlargement (>5 mm), device migration (≥10 mm), type I/III endoleak, and secondary interventions. RESULTS: Median follow-up was 59.8 months (range, 0.1-67.5 months). There were seven deaths, including one (1.5%) within 30 days (procedure-related) and six beyond 30 days (not procedure-related in five, indeterminate in one). At 5 years, freedom from all-cause mortality was 88.8 ± 4.2% and freedom from aneurysm-related mortality was 96.8 ± 2.3%. There were no aneurysm ruptures or conversions to open surgery. Of the 129 renal arteries targeted by fenestrations, five (4%) occluded and 14 (11%) developed in-stent stenosis. Treatment included redo stenting/angioplasty in 13 vessels, renal artery bypass in 2 vessels, and failed thrombectomy in 1 vessel. Primary and secondary renal target patency was 82.7 ± 4.1% and 95.7 ± 2.1% at 5 years, respectively. Dialysis was required in one patient who had pre-existing chronic kidney disease. During the 5 years, there was 1 type IA endoleak (1.5%), 1 type IB endoleak (1.5%), 2 device migrations (3%), and 4 aneurysm sac enlargements (6%). Overall, 81% of patients had sac shrinkage at 5 years. Of 20 patients who underwent secondary interventions, 12 were for renal in-stent stenosis or occlusion, 7 were for endoleak, and 1 was for both indications. Freedom from secondary intervention was 63.5 ± 7.2% at 5 years. CONCLUSIONS: These 5-year results confirm the safety and effectiveness of the Zenith Fenestrated AAA stent graft with no late graft- or aneurysm-related deaths. In-stent stenosis of bare metal renal stents was the most frequent indication for secondary intervention. The low rate of type IA endoleak, sac enlargement, and device migration support its use in patients with juxtarenal AAAs.

Efficacy of nisin derivatives with improved biochemical characteristics, alone and in combination with endolysin PlyP100 to control Listeria monocytogenes in laboratory-scale Queso Fresco.

Nisin is an antimicrobial peptide that is commonly used as a food preservative and capable of inhibiting the pathogen Listeria monocytogenes. However, nisin is ineffective in controlling L. monocytogenes in Queso Fresco (QF). To address the challenge, in this work, we used synthetic biology strategies to create a series of nisin A derivatives by substituting residues 27, 30, 31 and 32 with positively charged amino acids (H, K and R). Our results showed that nisin derivatives exhibited reduced antilisterial activity in vitro compared to nisin A; however, they were all more stable under QF-like experimental conditions (pH 7 + 22% milk fat), notably H27/31K. Compared to nisin A, the derivatives H31K and V32K exhibited slight antilisterial improvement in QF and H27/31K was able to reduce the initial population of L. monocytogenes by up to 1.5 Log CFU/g. L. monocytogenes isolates exhibited similar susceptibility to nisin A or H27/31K after 7 or 14 days of nisin exposure in QF. Notably, when combined with endolysin PlyP100, the application of H27/31K resulted in non-enumerable levels of L. monocytogenes after 14 days of cold storage. Our results highlight the potential of bioengineered nisin derivatives for stabilized and enhanced control of L. monocytogenes in QF.

Computed Tomography Identifies Clinically Unsuspected Acute Necrotizing Pancreatitis Complicating Abdominal Aortic Repair.

BACKGROUND: Pancreatitis rarely complicates aortic repair. The aim of the study was to examine the role of imaging in identifying this complication and to characterize pancreatitis occuring in this setting. METHODS: The radiology information system queried reports for terms pancreatitis, fluid collection, peripancreatic fluid, and aortic/aneurysm/endovascular/open repair from January 2010 through May 2018 and yielded 243 unique patients. Aortic repair and pancreatitis did not occur in temporal proximity (within 30 days) in 227 patients, and three patients had invalid medical record numbers. The final population was 13 patients. Surgical data included indication for repair and surgical approach. Clinical/imaging data points included method of diagnosis, type of pancreatitis, location, management of collections, and patient outcome. RESULTS: Thirteen patients (n = 9 male, age 58-76 years) met inclusion criteria. All patients underwent open repair, 9 electively. Acute pancreatitis was first identified by computed tomography in 10 (77%) patients and by serum lipase levels in 3 patients (23%). Necrotizing pancreatitis was present in 10 patients (77%), eight with infected collections (one not sampled). Four patients (31%) had collections fistulizing to the aortic sac, and there was one case of aortic anastomotic pseudoaneurysm. There were 7 deaths (4 septic shock, 1 hemorrhagic pancreatitis, 1 pulmonary embolism, and 1 multiorgan failure) despite 5 of these patients undergoing drainage of collections. In surviving patients, 4 underwent drainage of collections, 1 necrosectomy, and 1 no intervention. CONCLUSIONS: Pancreatitis complicating aortic repair occurs after open repair and is often necrotizing. Pancreatitis is more often first detected by imaging rather than serum lipase levels. High mortality is more attributable to complications of pancreatitis rather than failure of the aortic repair.

Trends of vascular surgery procedures in Marfan syndrome and Ehlers-Danlos syndrome.

OBJECTIVES: Marfan syndrome and Ehlers-Danlos syndrome represent two connective tissue vascular diseases requiring unique consideration in their vascular surgical care. A comprehensive national review encompassing all hospitalizations for the Marfan Syndrome and Ehlers-Danlos syndrome patient population is lacking. METHODS: The National (Nationwide) Inpatient Sample from 2010 to 2014 was reviewed for all inpatient vascular surgery procedures including those with a diagnosis of Marfan syndrome and Ehlers-Danlos syndrome. National estimates of vascular surgery rates were generated from provided weights. Patient demographics, procedure type, and outcomes were assessed. RESULTS: There were 3103 Marfan syndrome and 476 Ehlers-Danlos syndrome vascular procedures identified as well as 3,895,381 vascular procedures in the remainder of population (control group). The percent of aortic procedures from all vascular procedures in Marfan syndrome (23.5%) and Ehlers-Danlos syndrome (23.5%) were 2.5-fold higher than controls (9.1%), p < 0.0001. Open aortic aneurysm repair was also significantly greater in both Marfan syndrome (16.8%) and Ehlers-Danlos syndrome (11.2%) compared to controls (4.4%), p < 0.0001. Endovascular aortic repair (p < 0.2302) was similar among the groups. Marfan syndrome (7.7%) and Ehlers-Danlos syndrome (5.1%) had more thoracic endovascular aortic repair performed than controls (0.7%), p < 0.0001. Percutaneous procedures were fewer in Marfan syndrome (6.3%) than controls (31.3%) and Ehlers-Danlos syndrome (26.3%), p < 0.0001, while repair of peripheral arteries was greater in Marfan syndrome (5.9%) and Ehlers-Danlos syndrome (4.1%) than controls (1.5%), p < 0.0001. For total aortic procedures, the mean age of aortic procedures was 68.2 years in controls vs 45.8 years in Marfan syndrome and 55.3 years in Ehlers-Danlos syndrome, p < 0.0001. Marfan syndrome and Ehlers-Danlos syndrome had fewer comorbidities overall, while controls had significantly higher rates of coronary artery disease (controls 39.9% vs Marfan syndrome 8.3% and Ehlers-Danlos syndrome 13.0%, p < 0.0001), peripheral vascular disease (controls 34.5% vs Marfan syndrome 4.2% and Ehlers-Danlos syndrome 8.7%, p < 0.0001), and diabetes (controls 20.6% vs Marfan syndrome 6.6 and Ehlers-Danlos syndrome 4.4%, p < 0.0001). Marfan syndrome and Ehlers-Danlos syndrome had higher overall complication rate (65.5% and 52.2%) compared to controls (44.6%), p < 0.0001. Postoperative hemorrhage was more likely in Marfan syndrome (42.9%) and Ehlers-Danlos syndrome (39.1%) than controls (22.2%), p < 0.0001. Increased respiratory failure was noted in Marfan syndrome (20.2%) vs controls (10.7%) and Ehlers-Danlos syndrome (8.7%), p = .0003. Finally, length of stay was increased in Marfan syndrome 12.5 days vs Ehlers-Danlos syndrome 7.4 days and controls 7.2 days (p < 0.0001) as well as a higher median costs of index hospitalization in Marfan syndrome ($57,084 vs Ehlers-Danlos syndrome $22,032 and controls $26,520, p < 0.0001). CONCLUSIONS: Patients with Marfan syndrome and Ehlers-Danlos syndrome differ from other patients undergoing vascular surgical procedures, with a significantly higher proportion of aortic procedures including open aneurysm repair and thoracic endovascular aortic repair. While they are younger with fewer comorbidities, due to the unique pathogenesis of their underlying connective tissue disorder, there is an overall higher rate of procedural complications and increased length of stay and cost for Marfan syndrome patients undergoing aortic surgery.

Invited review: Advances in nisin use for preservation of dairy products.

Dairy product safety is a global public health issue that demands new approaches and technologies to control foodborne pathogenic microorganisms. Natural antimicrobial agents such as nisin can be added to control the growth of pathogens of concern in dairy foods, namely Listeria monocytogenes and Staphylococcus aureus. However, several factors affect the antimicrobial efficacy of nisin when directly added into the food matrix such as lack of stability at neutral pH, interaction with fat globules, casein, and divalent cations. To overcome these limitations, new and advanced strategies are discussed including nisin encapsulation technology, addition to active packaging, bioengineering, and combination with other antimicrobials. This review highlights advanced technologies with potential to expand and improve the use of nisin as a dairy preservative.

Evaluation of combinations of nisin, lauric arginate, and ε-polylysine to control Listeria monocytogenes in queso fresco.

Listeria monocytogenes contamination is of great concern in queso fresco (QF), and listeriosis outbreaks linked to consumption of QF continue to happen. Hurdle approaches such as combining antimicrobials provide an alternative to improve QF safety. In this work, the efficacy of antimicrobial combinations of nisin (NIS), lauric arginate (LAE), and ε-polylysine (EPL) to inhibit L. monocytogenes growth in QF was evaluated. First, antimicrobials were screened for potential synergy in vitro. Later, antimicrobial treatments were challenged in QF inoculated with ∼4 log10 cfu/g of L. monocytogenes 5-strain cocktail and stored for 28 d at 4°C. Our results showed that combinations of NIS-LAE and EPL-LAE were synergistic in vitro. Limited antilisterial control was observed in QF treated with NIS, LAE, and NIS-LAE; however, EPL and EPL-LAE exhibited listeristatic effect in QF for up to 14 and 28 d of cold storage, respectively. Additionally, L. monocytogenes QF isolates had similar susceptibility to EPL or LAE. A consumer panel was able to distinguish between QF added with EPL (250 µg/g) + LAE (66.66 µg/g) and control QF, most likely associated with manufacturing and storage rather than antimicrobials' taste. Our results support the use of EPL-LAE combination to control L. monocytogenes growth in QF.

Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young.

Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners' and coroners' offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents.

Results from a prospective multicenter feasibility study of Zenith p-Branch stent graft.

OBJECTIVE: To evaluate the Cook Zenith p-Branch stent graft (William A. Cook Australia, Brisbane, Queensland, Australia) for the treatment of patients with asymptomatic juxtarenal or pararenal abdominal aortic aneurysms in a prospective, nonrandomized, multicenter, feasibility study conducted in the United States. METHODS: The off-the-shelf p-Branch endograft incorporates a celiac scallop, superior mesenteric artery (SMA) fenestration, and two conical-shaped pivot renal fenestrations. Patients were eligible if the aneurysm did not extend above the distal margin of the SMA and the anatomy of renal and visceral arteries were compatible with one of the two p-Branch configurations (configuration A, renal fenestrations at the same longitudinal position; configuration B, offset renal fenestration). RESULTS: A total of 30 patients (93% men; mean age, 73 years; mean aneurysm diameter, 64.7 ± 11.4 mm) were enrolled from January 2013 to June 2015. The mean follow-up period was 28.7 ± 12.5 months (as of October 2017). The technical success rate was 93% (28/30), with technical failure occurring in the first two study cases (device deliberately repositioned below the renal arteries because of difficulty in cannulating the renal arteries in one and an inability to place a renal stent in the other; both patients survived the procedure and withdrew from the study before the 12-month follow-up visit). No additional technical failures occurred after these first two cases, when an updated physician training and proctoring program was implemented. No 30-day mortality occurred. Of the remaining 28 patients, three died during the follow-up period; none within 30 days and none related to the device or procedure as determined by Clinical Events Committee adjudication. No treated aneurysm ruptures, conversion, or core laboratory-reported migration, or stent fracture were reported. The primary renal artery patency (interval to occlusion or reintervention for stenosis) rate was 88.6% ± 4.4% at 1 and 2 years. Two patients (7%) developed renal insufficiency secondary to a right renal artery stenosis in one patient and progression of chronic renal insufficiency in one patient. No patient required dialysis or developed mesenteric ischemia. Of the 28 patients, nine (32%) had undergone 13 secondary interventions for renal artery occlusion (n = 2), SMA occlusion (n = 1), renal or SMA stenosis (5 interventions in 4 patients), renal stent kinking (n = 1), lower extremity claudication (n = 2 in the same patient), type III endoleak between the p-Branch and renal stent (n = 1), and type II endoleak (n = 1). CONCLUSIONS: These early and intermediate results, which incorporated physician learning curves, support the safety and feasibility of the off-the-shelf Zenith p-Branch device. Follow-up examinations through 5 years will continue to assess the long-term results.

Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates after Limb Revascularization.

BACKGROUND: Postoperative subtherapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency and decrease the risk of thrombosis. However, the safety of this management strategy is unknown. METHODS: From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Patients were grouped by receipt of LDHI within the first 24-hour postoperative period. Preoperative demographics, comorbidities, intraoperative measures, 30-day postoperative complications, arterial patency rates, and amputation rates were analyzed for each group. RESULTS: We identified 379 patients who received extremity revascularization, and 56 (14.8%) of them had received LDHI. Patients who received LDHI were less likely to have an elective admission on presentation (26.8% vs. 56%, P < 0.001) or an admission from home (69.6% vs. 81.7%, P = 0.04). They were more likely to have preoperative bleeding (44.6% vs. 22%, P < 0.01) and need for emergent operation (23.2% vs. 11.8%, P = 0.04). Postoperatively, although patients who received LDHI demonstrated a trend toward increased bleeding (48.2% vs. 33.7%, P = 0.053), they did not demonstrate an increase in 30-day mortality (1.79% vs. 1.24%, P = 0.55) or reoperation (19.7% vs. 12.4%, P = 0.21). Multivariable analysis demonstrated that LDHI did not have a significant association with immediate postoperative bleeding (P = 0.99), survival (P = 0.13), primary patency (P = 0.872), and amputation-free survival (P = 0.387). CONCLUSIONS: Although LDHI was more likely to be administered in patients who received emergent operations, risk-adjusted analysis demonstrated that it was not associated with increased postoperative bleeding, mortality, short-term need for reintervention, or amputation after extremity arterial revascularization.

Anesthetic Considerations for Aortic Arch Stenting.

With advances in modern day imaging techniques for the aorta, there has been an increasing incidence of vascular diseases involving the aortic arch. Historically, the only treatment option for arch disease has been open arch replacement under circulatory arrest conditions with or without selective cerebral perfusion. However, this open procedure has significant morbidity and mortality, especially in elderly patients with multiple comorbidities. To potentially mitigate the risks associated with open replacement, endovascular arch repair has gained momentum as an alternative treatment option. Currently, aortic arch stenting is being trialed in multiple international medical centers across Europe and the United States. The outcomes data available thus far are promising, which suggest that there likely will be an increase in patients being referred for aortic arch stenting procedures in the future. In this emerging technology review, multiple aspects of the aortic arch stenting procedure are discussed including the currently available endovascular arch devices, the unique surgical and anesthetic considerations for arch stent implantation, and the early outcomes data published to date.

Antimicrobial behavior of phage endolysin PlyP100 and its synergy with nisin to control Listeria monocytogenes in Queso Fresco.

Hispanic-style fresh cheeses, such as Queso Fresco (QF), have been linked to numerous listeriosis outbreaks in the United States. In this work, we have studied the antilisterial behavior and effectiveness of the Listeria phage endolysin PlyP100 in QF, as well as the potential synergy between PlyP100 and nisin. PlyP100 showed similar bacterial reduction regardless of varying L. monocytogenes inoculum size in QF, and when the inoculation size was 1 Log CFU/g, no pathogen recovery after cheese enrichment was observed. PlyP100 was stable in QF for up to 28 days of cold storage exhibiting similar antilisterial activity regardless of when contamination with L. monocytogenes occurred. PlyP100 alone exhibited a strong listeriostatic effect in QF, on the contrary, nisin alone was not effective to control the pathogen in QF during cold storage. The combination of nisin and PlyP100 showed a strong synergy in QF with non-enumerable levels of L. monocytogenes after 4 weeks of refrigerated storage. Moreover, L. monocytogenes isolates from cheeses treated with nisin, PlyP100, and their combination did not develop resistance to nisin or PlyP100. Our results support the use of PlyP100 combined with nisin as an efficient L. monocytogenes control measure in QF.

Microbial analysis of commercially available US Queso Fresco.

Queso Fresco (QF), a fresh Hispanic-style cheese, is often associated with Listeria monocytogenes outbreaks and recalls. Queso Fresco's susceptibility to bacterial contamination is partially due to its high pH and moisture content as well as Listeria's tolerance for the salt content typical for QF. Nine different brands of US QF, 2 packages from 4 different lots (to account for temporal variability), were sampled. The pH, salt content, and moisture content were analyzed in addition to microbial testing including yeasts and molds, coliforms, lactic acid bacteria enumeration, and L. monocytogenes counts. The cheeses were also inoculated with a cocktail of 5 food and human isolates of food-borne outbreak-associated Listeria monocytogenes strains to evaluate how the differences between brands influenced Listeria growth. Three of the cheeses underwent additional genus-level microbial analysis using extracted 16S rDNA, allowing for phylogenetic analysis between bacterial taxa including diversity and relative abundance. We found little variation between the sampled QF pH (range = 6.62-6.86), salt content (1.53-2.01%), and moisture content (43.90-54.50%). Yeasts and molds were below the detection limit of enumeration in all of the cheeses and coliforms were below the detection limit across the first 3 lots, but were detected at varying levels in the fourth lot (>3.0 most probable number/g) for 3 of the brands. Listeria monocytogenes was not isolated after enrichment in any of the samples. All cheeses tested positive for the presence of lactic acid bacteria, with only 1 of the cheeses being labeled as produced with added cultures having substantial counts. Fourteen days after inoculation with L. monocytogenes, at least 2.5 log10 cfu/g of growth was found for all QF brands stored at 4°C. Microbial genus analysis showed that, among the 3 brands, the microbial community was more similar within brand than when compared with the other 2 brands. Thermus, Anoxybacillus, and Streptococcus accounted for the dominant genera of brands A, B, and C, respectively. These variations within the microbial community may account for sensory differences and help manufacturers determine quality control consistency more readily than culture-based methods.

Prevalence of Low Vitamin D in Patients with Breast Cancer in a Predominantly Hispanic Population at the American-Mexican Border.

INTRODUCTION: Low level of vitamin D (VD) has been linked with a higher risk of cancers. The aim of this study was to assess the prevalence of low VD in patients with breast cancer in a predominantly Mexican Hispanic/Latino patient population, a fast growing and relatively understudied population. MATERIALS/METHODS: We sought to evaluate the serum VD levels in breast cancer patients diagnosed at the Texas Tech University Breast Cancer Center in El Paso, TX, between May 2013 and May2014 via a retrospective chart review of the Electronic Medical Records. RESULTS: We identified a total of 83 consecutive breast cancer patients with available VD levels. Mean age 57 yr, 94% were Hispanics. VD was insufficient (<30 ng/ml) in 86% of patients (95% CI: 0.76-0.92) and it was deficient (<20 ng/ml) in 39% (95% CI: 0.28-0.50). CONCLUSION: VD deficiency is widely prevalent in Hispanic/Latino patients with breast cancer. This is quite alarming in view of possible increased risk of cancer with low VD and potentially worse cancer outcomes. This calls for increased efforts to screen for, diagnose, and treat VD deficiency in this patient population. Further pharmacogenomics studies are warranted to explore the underlying etiology of VD deficiency in this paradoxically sunny region.

Hot topic: Antilisterial activity by endolysin PlyP100 in fresh cheese.

Our objective was to assess the antimicrobial efficacy of a Listeria bacteriophage endolysin that may address limitations of current antilisterial processes for fresh cheeses. Listeria monocytogenes is highly problematic in the manufacture and processing of ready-to-eat foods due to its environmental persistence and its ability to grow under refrigerated storage. Special care must be taken to prevent listerial contamination during the production of fresh cheeses, as their delicate flavor and texture are incompatible with many of the antimicrobial processes and additives commonly used for other foods. Bacteriophage-derived cell wall hydrolytic enzymes, known as endolysins, comprise one possible intervention that may not suffer from the high strain specificity of their parent bacteriophages or the development of resistant strains. We recombinantly expressed endolysin PlyP100 and compared its lytic activity in vitro across several environmental parameters and target organisms, then incorporated it into a fresh cheese model challenged with a cocktail of L. monocytogenes. We show that PlyP100 demonstrates optimal activity under pH and salt concentrations consistent with a low-acid food matrix such as fresh cheese. Furthermore, we show that PlyP100 exhibits target specificity for gram-positive organisms with directly crosslinked peptidoglycan and displays considerable inhibitory activity against L. monocytogenes in fresh cheese for at least 4 wk under refrigerated storage. As PlyP100 demonstrates considerable promise for preventing the propagation of L. monocytogenes in fresh cheeses, this novel preservation method could help safeguard consumer health and the market expansion of an otherwise high-risk food with few other viable preservatives.

The presence of genomic imbalances is associated with poor outcome in patients with burkitt lymphoma treated with dose-intensive chemotherapy including rituximab.

The introduction of Rituximab has improved the outcome and survival rates of Burkitt lymphoma (BL). However, early relapse and refractoriness are current limitations of BL treatment and new biological factors affecting the outcome of these patients have not been explored. This study aimed to identify the presence of genomic changes that could predict the response to new therapies in BL. Forty adolescent and adult BL patients treated with the Dose-Intensive Chemotherapy Including Rituximab (Burkimab) protocol (Spanish Programme for the Study and Treatment of Haematological Malignancies; PETHEMA) were analysed using array-based comparative genomic hybridization (CGH). In addition, the presence of TP53, TCF3 (E2A), ID3 and GNA13 mutations was assessed by next-generation sequencing (NGS). Ninety-seven per cent of the patients harboured genomic imbalances. Losses on 11q, 13q, 15q or 17p were associated with a poor response to Burkimab therapy (P = 0·038), shorter progression-free survival (PFS; P = 0·007) and overall survival (OS; P = 0·009). The integrative analysis of array-CGH and NGS showed that 26·3% (5/19) and 36·8% (7/19) of patients carried alterations in the TP53 and TCF3 genes, respectively. TP53 alterations were associated with shorter PFS (P = 0·011) while TCF3 alterations were associated with shorter OS (P = 0·032). Genetic studies could be used for risk stratification of BL patients treated with the Burkimab protocol.

A telephone call 1 week after hospitalization can identify risk factors for vascular surgery readmission.

OBJECTIVE: Compared with other populations, patients who undergo vascular surgery have higher 30-day hospital readmission rates of up to 25%. Postdischarge telephone call assessments have demonstrated utility in patients with significant medical comorbidities and traditionally high readmission rates. Therefore, we hypothesized that a 1-week postdischarge telephone call evaluation can identify risk factors for readmission among vascular surgery patients. METHODS: Patients who underwent a vascular surgery procedure during a 1-year period by a single vascular surgeon at one hospital received a postdischarge telephone call questionnaire to review postoperative pain, surgical site, constitutional symptoms, and follow-up arrangement. The primary outcome measure was frequency of postoperative symptoms as collected on the telephone call questionnaire. The secondary outcome measure was 30-day hospital readmission rates. RESULTS: Among 167 patients, 131 (78%) received a telephone call after discharge. Calls identified pain relieved by prescription medication (odds ratio, 6.67; confidence interval, 0.82-53.81; P = .05) and continued dressing application (odds ratio, 9.55; confidence interval, 0.54-166.6; P = .04) as risk factors for 30-day readmission. The 30-day readmission was not statistically different in patients who were successfully and not successfully contacted with a postdischarge telephone call (8% and 17%, respectively; P = .37). CONCLUSIONS: Vascular surgery patients are at higher risk of 30-day readmission than are patients in other surgical subspecialties. For the majority of patients, implementing a 1-week postdischarge telephone call for short-term follow-up evaluation is feasible and can help identify potential risk factors for hospital readmission within 30 days.

Multiple Intracranial Arteriovenous Fistulas in Cowden Syndrome.

Cowden syndrome is a rare autosomal dominant disease. It is characterized by multiple noncancerous tumorlike growths called hamartomas, which typically are found in the skin, oral mucosa, thyroid, breast, and gastrointestinal tract. It carries with it a potential risk of malignant transformation, especially of the breast and thyroid. In 80% of the cases, the human tumor suppressor gene, phosphatase and tensin homolog (PTEN), is mutated in the germ line. We report a patient with Cowden syndrome who presented with generalized seizure and left anterior temporal hemorrhage and a nontraumatic subarachnoid hemorrhage due to multiple intracranial arteriovenous fistulas (AVFs). We discuss previous reports about vascular malformations in patients with Cowden syndrome and PTEN mutations. Importantly, we hypothesize that the production of multiple AVFs in our patient was associated with PTEN mutation.

Impaired oxidative metabolism and calcium mishandling underlie cardiac dysfunction in a rat model of post-acute isoproterenol-induced cardiomyopathy.

Stress-induced cardiomyopathy, triggered by acute catecholamine discharge, is a syndrome characterized by transient, apical ballooning linked to acute heart failure and ventricular arrhythmias. Rats receiving an acute isoproterenol (ISO) overdose (OV) suffer cardiac apex ischemia-reperfusion damage and arrhythmia, and then undergo cardiac remodeling and dysfunction. Nevertheless, the subcellular mechanisms underlying cardiac dysfunction after acute damage subsides are not thoroughly understood. To address this question, Wistar rats received a single ISO injection (67 mg/kg). We found in vivo moderate systolic and diastolic dysfunction at 2 wk post-ISO-OV; however, systolic dysfunction recovered after 4 wk, while diastolic dysfunction worsened. At 2 wk post-ISO-OV, cardiac function was assessed ex vivo, while mitochondrial oxidative metabolism and stress were assessed in vitro, and Ca(2+) handling in ventricular myocytes. These were complemented with sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA), phospholamban (PLB), and RyR2 expression studies. Ex vivo, basal mechanical performance index (MPI) and oxygen consumption rate (MVO2) were unchanged. Nevertheless, upon increase of metabolic demand, by ß-adrenergic stimulation (1-100 nM ISO), the MPI versus MVO2 relation decreased and shifted to the right, suggesting MPI and mitochondrial energy production uncoupling. Mitochondria showed decreased oxidative metabolism, membrane fragility, and enhanced oxidative stress. Myocytes presented systolic and diastolic Ca(2+) mishandling, and blunted response to ISO (100 nM), and all these without apparent changes in SERCA, PLB, or RyR2 expression. We suggest that post-ISO-OV mitochondrial dysfunction may underlie decreased cardiac contractility, mainly by depletion of ATP needed for myofilaments and Ca(2+) transport by SERCA, while exacerbated oxidative stress may enhance diastolic RyR2 activity.