Marked host association and molecular evidence of limited transmission of ticks and fleas between sympatric wild foxes and rural dogs.

Wild and domestic carnivores share ectoparasites, although molecular evidence is lacking. The goals of this study were to describe tick and flea infestation in sympatric free-ranging dogs Canis lupus familiaris (Linnaeus, 1758) (Carnivora: Canidae) and Andean foxes Lycalopex culpaeus (Molina, 1782) (Carnivora: Canidae) and to determine whether interspecific transmission occurs. Fleas and ticks retrieved from 79 foxes and 111 dogs in the human-dominated landscapes of central Chile were identified and a subset of specimens characterized by PCR and amplicon sequencing. Each ectoparasite species was clearly associated with a host: abundance and occurrence of Rhipicephalus sanguineus (Latreille 1806) (Acari: Ixodidae) and Ctenocephalides spp. (Siphonaptera: Pulicidae) were significantly higher in dogs than in foxes, whereas the opposite was true for Amblyomma tigrinum (Koch, 1844) (Acari: Ixodidae) and Pulex irritans (Linnaeus, 1758) (Siphonaptera: Pulicidae). Genetic analyses of a subset of ectoparasites revealed that dogs and foxes shared a limited number of nucleotide sequence types, suggesting that the interspecific transmission of these ectoparasites happens infrequently. Data also indicated that the ecological association and biological cycles of ticks and fleas determine the ectoparasite fauna of sympatric carnivores. In conclusion, our study shows that cross-species transmission should be assessed at a molecular level.

Pregnancy following Mustard or Senning correction of transposition of the great arteries: a retrospective study.

OBJECTIVE: To determine pregnancy outcome in women with atrial switch repair for transposition of the great arteries (TGA) and to compare follow up with a control group of childless women with the same repair. DESIGN: Retrospective cohort study. SETTING: Tertiary care medical centre. POPULATION: About 21 patients compared with 15 controls. METHODS: Review of records from joint cardiac-obstetric clinic 1993-2013. MAIN OUTCOME MEASURES: Occurrence of cardiovascular events: maternal death, heart failure, arrhythmia, thromboembolic events, worsening systemic ventricular function, worsening tricuspid valve regurgitation and newly detected baffle problems. RESULTS: There were 34 pregnancies in 21 women. Mean follow up was 100 months. No deaths or recurrence occurred. Events (few arrhythmias, thromboembolic events and baffle issues) were common in both groups: 13 (62%) patients and eight (53%) controls (P = 0.736). Worsening of ventricular function was similar in both groups: six (29%) patients and four (27%) controls (P = 0.899). Worsening tricuspid regurgitation was more common in patients [11 (52%)] than controls (0)] (P < 0.001). Labour was induced in 76% cases: 32% for cardiac deterioration, 37% to control timing of delivery, and 26% for intrauterine growth restriction. Delivery was vaginal in 84% cases. Median gestational age was 37 (30-40) weeks, median birthweight 2525 g (1460-3530). In all, 38% babies were premature and 38% were small-for-gestational-age. CONCLUSIONS: Cardiac events after atrial repair for TGA are equally common in pregnant women and non-pregnant controls, although worsening tricuspid regurgitation occurs more frequently in pregnancy. Induction of labour is to be expected but vaginal delivery is achievable in most cases. Infants are likely to be premature and small-for-gestational-age. TWEETABLE ABSTRACT: Pregnancy in atrial repair for TGA: cardiac events similar to controls, prematurity and small babies likely.

Emotional reactivity in bipolar depressed patients.

OBJECTIVE: Emotional reactivity in bipolar affective disorders has received increased attention as a relevant issue with regard to the ability to respond to emotional external stimuli for individual real world adaptation. We investigated emotional reactivity using the International Affective Picture System (IAPS) paradigm in bipolar patients during the depressive phase compared to healthy controls. METHOD: Twenty-three bipolar patients with a major depressive episode without manic symptoms and 27 healthy control subjects were recruited. They were asked to judge their emotional reactivity while viewing 90 pictures selected from the IAPS. Their ratings were categorized according to the emotional valence and arousal in response to pleasant, neutral, and unpleasant stimuli. RESULTS: The patients showed lower valence ratings for neutral pictures compared to healthy subjects. No significant between-group differences were found for the pleasant and unpleasant pictures. Higher activation for patients to all emotional stimuli was seen. CONCLUSION: Patients during the depressive phase gave more negative valence to neutral images. This can suggest that they are more pessimistic in the way they perceive the environment as more reactive to emotional cues.

Effect of physiological exercise on osteocalcin levels in subjects with adrenal incidentaloma.

AIM: In the present study, we have evaluated whether physical exercise affect low osteocalcin concentrations observed in patients with subclinical hypercortisolism. SUBJECTS AND METHODS: Sixteen patients (10 men and 6 women, age 38-55 yr) with adrenal incidentaloma were studied. Fifteen healthy volunteers matched for age (range 35-47 yr) were used as controls. Subjects were submitted to a 8-week exercise-training program with cycle-ergometer for 1 h/day 3-4 days/week at 60% of their individual VO2 max. Before and after this period, resting venous serum osteocalcin and GH concentrations were measured in the same batch. The blood sampling after 8 weeks of the training program were performed after resting for one day. All patients and controls underwent also the following endocrine evaluation: serum cortisol, plasma ACTH. RESULTS: Our results demonstrate a significant increase of osteocalcin after physical exercise and a positive correlation between osteocalcin and GH. This later might suggest a role of GH in the increased osteocalcin secretion. CONCLUSIONS: The data of the present study suggest a positive effect of physical exercise on bone metabolism in patients with adrenal incidentaloma.

Preoperative diagnosis of THYR 3 versus follicular lesion: malignant postoperative ratio.

AIM: In the evaluation of nodular thyroid lesions, cytology is the main diagnostic instrument, associated with ultrasound examination. METHODS: We prospectively categorized into a dedicated database, 612 patients submitted to thyroidectomy from January 2009 to December 2011. We selected two groups of patients: the cases with "follicular lesions" and the cases classified as "THYR 3" using Bethesda Classification. RESULTS: Of 612 patients submitted to TT, in 68 cases, 8 males (M) and 60 females (F), we recorded a preoperative cytological diagnosis compatible with THYR 3 class. In 56 cases, 82.4% of the patients (5 M, 51 F), we performed a thyroidectomy with Conventional technique (CT) and in 12 cases, 12.6% of the patients (3M, 9F) with video-assisted technique (MIVAT). In 39 cases (57.1%) of the THYR 3 patients treated, a benign disease was found while in the other 29 cases (42.9%) a differentiated thyroid cancer (DTC) were found. In patients with nodules classified as "follicular proliferation", treated in the same period and by the same surgical team, we recorded 97 cases (79 F, 18 M). The patients were treated with TT in 72 cases, with MIVAT in 22 cases; in 3 cases we performed a HT with traditional technique. Adenomatous hyperplasia was found in 51; DTC was found in 21 cases and adenoma in 25 cases. The analysis of the incidence of benign versus malignant disease between the 2 groups showed a P<0.0001. CONCLUSION: In our experience, we recommend surgery, TT or HT, for THYR 3 nodules analyzed for the first time by FNAB with sonographic pattern suspicious for malignancy.

A serosurvey for spotted fever group Rickettsia and Coxiella burnetii antibodies in rural dogs and foxes, Chile.

Antibodies against Spotted Fever Group (SFG) Rickettsia and Coxiella burnetii, investigated through indirect antibody immunofluorescence tests, were detected in serum samples from 3.1% and 0% of 358 rural dogs, respectively, and in none of 32 wild foxes tested. SFG Rickettsia seropositive dogs were only detected in the Mountain Desert (8%) and the Steppe-Mediterranean (9%) regions. Exposure in the Mountain Desert, where no ticks and fleas were found on any dog, could correspond to a new SFG Rickettsia sp. recently described in soft ticks or to a related agent. Our survey confirms low endemicity in the country of C. burnetii, as observed in recent serosurveys in humans.

Carbon and nitrogen isotopic similarity between the endangered Darwin's fox (Lycalopex fulvipes) and sympatric free-ranging dogs in Chiloé Island, Chile.

Darwin's fox is an opportunistic omnivorous predator native to Chile classified as endangered by the IUCN Red List. Habitat use by Darwin's foxes can be negatively affected by the presence of free-ranging dogs that range freely across native and non-native habitats and can be a source of fox mortality. The objective of this study was to analyze the isotopic similarity of Darwin's fox and sympatric free-ranging dogs in Chiloé Island to determine the impact of anthropogenic environmental alterations on wild predators. We use hair samples to characterise and compare their δ13C and δ15N values and to evaluate isotopic similarity and isotope niches overlap. A generalised linear model was used to associate the isotope value with landscape variables (forest cover and vegetation type) and distance to the nearest house. We found no significant differences in δ13C or δ15N values between foxes and dogs, and a marginally significant isotope niche overlap (59.4 %). None of the selected variables at landscape and site scale were related to isotope values. Although our study is not a probe of direct contact between foxes and free-ranging dogs, the high isotopic similarity highlights the risk of pathogen spillover from free-ranging dogs to Darwin's foxes.

Systemic oxytocin administration modulates NPY response to insulin-induced hypoglycemia in man.

The present study was undertaken to establish whether oxytocin (OT) is able to modify the NPY response to insulin-induced hypoglycemia in man. At 8:00 AM of 2 different days at least 1 week apart, 10 normal men were tested with insulin (0.15 IU/kg) and with the administration of OT (infused from time -15-60 min, at a constant rate of 2 mIU/ml) or placebo. Plasma NPY concentrations rose significantly during insulin tolerance test (ITT). Oxytocin treatment significantly reduced the NPY response to hypoglycemia. The finding demonstrates for the first time in humans that the systemic administration of OT exerts an inhibitory effect on the NPY rise caused by insulin-induced hypoglycemia.

Somatostatin reduces neuropeptide Y rise induced by physical exercise.

The effect of an i. v. infusion of somatostatin (SRIH) 4.1 µg/min×90 min on the basal secretion of NPY and on the NPY response to physical exercise was studied in normal men. Basal NPY secretion was not modified by SRIH infusion, whereas the NPY response to physical exercise was significantly lower in the presence of SRIH. These data suggest the involvement of a somatostatinergic mechanism in the regulation of NPY response to physical exercise.

Use of oxidized and regenerated cellulose in thyroid surgery: a prospective analysis as cause of postoperative hypocalcemia on 485 patients consecutively treated.

AIM: The intraoperative hemorrage determines an higher risk of parathyroid glands lesions, and laryngeal nerve injuries. We have examined if the use of oxidized and regenerated cellulose could be a cause of postoperative hypocalcemia because of the compression on the parathyroid glands or for tissue adhesions METHODS: From June 2009 to December 2010 we have examined 485 patients consecutively treated with total thyroidectomy. The cases examined were divided in two groups on the use of ionized cellulose (group A and B). 24 hours after surgical procedure, all patients were submitted to serum calcium evaluation. The data were analyzed with χ2 test and t-student test; P<0.05 was statistically significant. RESULTS: We have selected 372 cases out of 485 examined. We have registered after 10 hours from surgical procedure a case of hemorrhage with reintervention in group B (no use of cellulose). The cost of ionized cellulose is € 46; we have used this device in 212 cases on 372 patients undergone to total thyroidectomy, with a cost of € 9 752. The mean value of the serum calcium was statistically different between pre- and postoperative evaluation in all cases (P<0.0001) divided both on gender and on the use of hemostatic devices. CONCLUSION: In our experience, there isn't a statistically significant difference on incidence of postoperative hypocalcemia, related to use of ionized and regenerated cellulose on mean surgical time in all patients either treated with traditional surgery or with video-assisted procedure.

Can misdiagnosis in pre-operative FNAC of thyroid nodule influence surgical treatment?

BACKGROUND: Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision. MATERIALS AND METHODS: We selected the most recent 825 surgical thyroid procedures performed in our institution from January 2004 to June 2007; 776 were total thyroidectomies, 23 were lobe-isthmectomies, and 26 were radical neck dissections. We distributed the data based on pre-operative cytology. Each cytological diagnosis was compared to results obtained by definitive histology. Tumors were called incidentalomas if they consisted of a neoplastic focus with a low grade of aggressiveness, as demonstrated by dimension <5 mm, non-aggressive histological subtype. RESULTS: Of the 541 cases of benign disease, 417 were confirmed as benign. The other 124 cases are listed as follows: 29 follicular adenoma; 76 papillary carcinoma (35 found as incidentalomas), and 19 follicular carcinoma (3 incidentalomas). Cytology suggestive of papillary carcinoma was correct in 95.2% of cases (119/125). The 135 tumors termed "follicular neoplasm" were staged on pathology thus: 56 adenoma (41.4%), 26 carcinoma (19.2%), 13 (9.6%) absence of follicular proliferation, 38 (28.1%) papillary follicular variant, 2 (1.4%) undifferentiated cells. Medullary carcinomas were both confirmed. The "suspicious group" exhibited no malignancy on fine needle aspiration cytology (12 of 21; 57%). CONCLUSIONS: Cytology has good reliability in malignant lesions. Incidental tumors occurring in benign disease have little impact on clinical and surgical management; "follicular neoplasm" posed two problems - the impossibility of identifying the nature of the tumor, as well as the newer difficulty in distinguishing papillary follicular subtype.

Preoperative PTH as a marker of risk for post-thyroidectomy hypocalcemia.

AIM: There are no common guidelines to identify the population at risk to develop hypocalcemia preoperatively or early in the postoperative course in thyroidectomized patients, therefore the authors suggest to examine the PTH value preoperatively. METHODS: We divided 391 patients in two groups according to the preoperative PTH level (normal, ≤ 72 pg/mL vs. increased >73 pg/mL). RESULTS: In 92/391 cases (23.52%) preoperative PTH was increased (mean PTH level 112.4+/-24.8 pg/mL; normal range 12-72 pg/mL). Out of these, 43 (46.7%) had hypocalcaemia postoperatively. In 18 out of the 43 patients clinical hypocalcemia also developed. The mean follow-up was of 148+/-13 days. Of the 299 patients with normal preoperative PTH, 127 (42.47%) developed postoperative hypocalcemia (mean calcium level 7.4+/-0.33 mg/dL). In 30 patients it was also clinically evident. The difference in terms of incidence of symptomatic hypocalcemia was statistically significant (increased preoperative PTH 19.5% vs. normal preoperative PTH 10.03% , P=0.036). CONCLUSION: All candidates to thyroidectomy should be investigated for preoperative PTH abnormalities.

Can we use ionized calcium in the evaluation of post-thyroidectomy hypocalcemia?

AIM: The postoperative hypocalcaemia has the higher incidence as complications related to thyroidectomy. METHODS: From 1 June 2006 to 30 June 2008, we examined 492 patients operated on consecutively in our unit with a total thyroidectomy for thyroid disease. We evaluated the values of ionized calcium in all the cases, matching these with the preoperative and postoperative values of serum calcium. The pre- and postoperative (24 hours after treatment) data for ionized calcium and serum calcium were examined statistically with the Student's t-test; results with a P-value <0.05 were considered to be statistically significant. RESULTS: Two-hundred-and-twenty-three of the 492 patients (45.2%) treated with total thyroidectomy had preoperative values of ionized calcium lower than 1.13 mmol/L (normal values 1.13-1.32 mmol/L), while the ionized calcium values were lower than 1.10 mmol/L in 154 of the 223 patients. The mean value of ionized calcium in all 223 cases was 1.04+/-0.07 mmol/L. The mean serum calcium value in these patients was 9.13+/-0.291 mg/dL (normal values 8.3-10.5 mg/dL). In the other 259 cases, the values of ionized calcium and serum calcium were 1.21+/-0.03 mmol/L and 9.1+/-0.29 mg/dL, respectively. In 75 cases on 223 with symptomatic hypocalcemia, the mean value of ionized calcium was 0.88+/-0.05 mmol/L, while, in the remaining 148 cases, the mean value was equal to 0.97+/-0.08 mmol/L (P<0.001). We compared this, in both groups, with the values of postoperative serum calcium; in the 75 cases with clinical hypocalcemia, the value of serum calcium was 7.32+/-0.35 mg/dL, while the value was equal to 8.4+/-0.34 mg/dL in the other cases (P<0.001). CONCLUSIONS: The values of ionized calcium must not be used as marker of hypocalcemia but must be seen as a diagnostic aid linked to others laboratory values, such as serum calcium.

The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer?

AIM: The association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature. The aim of this study was to examine this association evaluating the lesser or greater neoplastic aggressiveness. METHODS: One hundred and eighty-nine patients were examined from June 2004 to June 2007; they were divided into two groups: Group A included all the patients affected by PTC without CLT and Group B all the patients affected by PTC with CLT association. The surgical treatment was in all the patients the total thyroidectomy (TT). For the study age, sex, tumour features (dimensions, angioinvasion, capsular infiltration, multifocality and lymphnode metastases) were taken into consideration. The analysis was carried on with Student t test and chi squared analysis (statistically significant P<0.05). RESULTS: Group A included 117 patients; Group B 72 patients. No statistical difference in sex (P=0.989), age (P=0.480); tumour dimension (P=0.832). The capsular infiltration was present in 23 cases in Group A and 19 in Group B (P=0.368). The difference in average diameter was found to be 1.161+/-0.5812 and 1.485+/-1.082 cm in Group A and in Group B (P=0.290), respectively. The angioinvasion was found in 9 cases of Group A and in 3 cases in Group B (P=0.510). Multifocality was found in 35 patients in Group A and in 26 in Group B (P=0.469). CONCLUSION: The CLT may have only a minimum impact in the development of the tumour. In this study the association does not modify the aggressiveness.

Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy--results of a prospective outcome study.

BACKGROUND: Substantial modifications in surgical treatment of thyroid disease have changed the postoperative management of thyroidectomized patients. The reduction of postoperative pain permit a short-stay surgery. MATERIALS AND METHODS: We have analyzed the patients treated in our Unit from July 2006 to December 2006, with minimally invasive cervicotomy and mini-invasive video-assisted thyroidectomy. We have registered the postoperative pain applying an evaluation protocol numeric scale. The results were analyzed by t test. RESULTS: One hundred thirteen patients were divided in two groups: group A, minimally invasive cervicotomy (15 male and 46 female patients); group B, mini-invasive video-assisted thyroidectomy (9 male and 43 female patients). Upon returning to the ward, the pain scale group A vs B was 2.77 +/- 1.16 vs 2.5 +/- 0.762 (p = 0.22) .At 24 h after surgery, the pain scale in group A was 1.82 +/- 1.258 vs 1.031 +/- 0.8608 (p < 0.005). CONCLUSIONS: Both methods are safe, but mini-invasive video-assisted thyroidectomy gives not only a better cosmetic result but a reduction of postoperative pain especially at 24 h.

Minimally invasive video-assisted thyroidectomy: the learning curve.

BACKGROUND: MIVAT (minimally invasive video-assisted thyroidectomy) is a recent technique that requires a learning curve. MATERIALS AND METHODS: From July 2005 to December 2006, we treated 100 from a total of 467 thyroidectomy patients with MIVAT. We divided the patients into 3 groups. The first 2 groups consisted of 25 patients each: group A (cases 1-25) and group B (26-50). We also divided patients into 2 groups based on our surgical experience: group A + B (cases 1-50) and group C (cases 51-100). RESULTS: The operative times for groups A and B were 101.7 and 84.6 min, respectively (p < 0.03); those for groups A + B and C were 91.07 and 63.06 min, respectively (p < 0.004). Complications of hypocalcemia were observed in 6 cases (4 in the first 50 cases and 2 in the second 50), and complications of nerve palsy were observed in 2 cases from group A. CONCLUSIONS: After 25 cases, we observed that the MIVAT procedure allows for a lower mean operative time and a reduction of complications.

Localization of pathological gland's site in primary hyperparathyroidism: ten years experience with MIBI scintigraphy.

BACKGROUND: Primary hyperparathyroidism (PHPT) is characterised by pathological hyperfunctioning of one or more of the parathyroid glands leading to excessive parathyroid hormone (PTH) secretion. The aim of this study was to assess the diagnostic capacity of scintigraphy with MIBI, considering the surgical findings and the level of agreement with the result of cervical ultrasonography. PATIENTS AND METHODS: In the period January 1996 to January 2006, 84 cases with PHPT were included in the study, in which scintigraphy with MIBI was used in addition to cervical ultrasonography. All were hospitalised as "short stay surgery" patients and then seen as outpatients at follow-up visits (at 7, 14 and 30 days), during which calcium, phosphorus and PTH values were measured. RESULTS: In 55 cases (65.5%), the site of the pathology was suspected on the basis of the cervical ultrasonography. Scintigraphy with MIBI was positive in 76 cases (90.4%) and negative in the other eight (9.6%). In six of these eight cases the site had been detected by the cervical ultrasonography. In the remaining two cases (2.4%), neither of these examinations gave positive diagnostic findings. In 58 patients we proceeded with the removal of a single adenoma, in 19 cases with the removal of two out of the four glands, and in seven cases with the removal of three out of the four glands, the single formations removed not showing clearly-defined macroscopic characteristics; in two of the seven patients in whom three of the four glands were removed, the preoperative diagnostic examinations had not shown any evidence of gland pathology. CONCLUSIONS: We regard scintigraphy with MIBI as a preoperative diagnostic examination that has modified the surgical approach to PHPT, inclining surgeons towards a mini-invasive surgical procedures. We consider CT, MRI and SPECT techniques to be indicated only in cases of relapse of PHPT, possibly associated with ectopic localisation of the parathyroid gland not identified in the course of previous surgical procedures.

Effect of systemic oxytocin administration on dexamethasone-induced leptin secretion in normal and obese men.

To establish whether the regulatory mechanism of leptin secretion is sensitive to oxytocin (OT), seven healthy nonobese men were tested with dexamethasone (dex; 4 mg, iv, at 0730 h) in feeding (2000 Cal given at 3 meals over 7 h) conditions either in the absence (iv normal saline infusion) or in the presence of a constant iv infusion of OT (1, 2, or 4 mIU/min from 0730 h for 10 h). In six additional subjects under similar experimental conditions, normal saline or OT (1, 2, or 4 mIU/min from 0730 h for 10 h) were infused iv without the previous treatment with dexamethasone. Serum leptin concentrations were measured in samples taken at 60-min intervals during infusion. Leptin levels remained constant during the infusion of normal saline or OT (1, 2, or 4 mIU/min) alone. In contrast, serum leptin concentrations rose significantly from the baseline after dex administration. The leptin response to dex was not modified by the concomitant infusion of 1 mIU/min OT, whereas it was completely abolished by the administration of 2 or 4 mIU/min OT. These findings led us to evaluate the secretory pattern of leptin in 12 obese patients in similar experimental conditions. In all patients basal leptin levels were significantly higher than those in normal weight subjects. In 6 obese subjects, the infusion of OT alone (1, 2, or 4 mIU/min) was unable to change serum leptin levels. In the remaining 6 obese subjects, dex administration significantly increased serum leptin levels; however, the leptin response to dex was not modified by the concomitant infusion of 1, 2, or 4 mIU/min OT. These data show inhibition by elevated circulating OT levels of glucocorticoid-induced, but not basal, leptin secretion in normal weight subjects, suggesting a possible role for OT in the regulatory control of leptin. Furthermore, the results obtained in obese subjects indicate that this regulation is disrupted in obesity.

Cerebellar vermal size in schizophrenia: a male effect.

Magnetic resonance (MR) was used to examine the cerebellar vermis in 23 patients with schizophrenia and 16 matched controls. MR midsagittal images were processed with computerized image analysis to control partial volume effects as precisely as possible. No between-group differences were found for vermal-to-cerebrum ratio. When gender differences were examined, male patients showed a lower vermal-to-brain ratio than their female counterparts, mainly because of a reduction of the lobules I-V.

Cortical and subcortical computed tomographic study in schizophrenia.

Thirty-six chronic schizophrenics and 24 controls, all males, were evaluated by computed tomography (CT) scans. The lateral, third and fourth ventricles, the Sylvian fissure and the largest sulcus from each lobe were measured. In the schizophrenic patients there was a significant increase in third ventricle, ventricular brain ratio (VBR) and cortical measures. The possible implications of these findings in the aetiopathology of schizophrenia are discussed.