Occurrence of contaminants of emerging concern in the Eerste River, South Africa: Towards the optimisation of an urban water profiling approach for public- and ecological health risk characterisation.

The study evaluated the presence and fate of various contaminants of emerging concern (CECs) from a South African wastewater treatment works (WWTW) and surface waters located around an urban setting. A total of 45 CECs were quantified from nine sampling locations over an 11-month period. Daily loads (g/day) of the target analytes in the WWTW showed persistence of some CECs, along with population-normalised daily loads (mg/day/1000inh) of pharmaceuticals and drugs of abuse (DOA) that were estimated for the first time in the study area. Multiple chemical markers were recorded in river water located upstream of the WWTW discharge throughout the study period, suggesting a high degree of diffuse pollution from urban communities in the study area that are not connected to sewage networks or where sanitation services are limited. The potential of using defined surface water locations to perform community-wide substance use profiling for non-sewered communities was also explored. Environmental risk characterisation for the WWTW effluent and surface waters throughout the study period provided multiple risk quotients (RQ) for the target list of CECs spanning over various sentinel trophic levels. High risk profiles (RQ > 1.0) with a frequency of exceedance (FoE) larger than 75 % were recorded for several CECs in both WWTW effluent and surface water locations that suggest potential long-term ecological health risk impacts of pollution hotspot areas in the river catchment situated around the urban area. We present challenges in surface water quality within the study area that is relatable, or may even present more challenging, in other low- or middle-income country (LMICs) settings. The study also highlighted some challenges and limitations associated with the much-needed application of wastewater-based epidemiology (WBE) intervention in non-sewered communities that can inform on public health and communal substance use profiles of the entire urban setting.

Faecal microbiota signatures of IBD and their relation to diagnosis, disease phenotype, inflammation, treatment escalation and anti-TNF response in a European Multicentre Study (IBD-Character).

METHOD: We examined faecal samples, using the GA-map™ Dysbiosis Test, to associate gut microbiota composition with Crohn's disease (CD) and ulcerative colitis (UC) and to identify markers for future biomarker identification. We conducted a prospective case-control study (EU-ref. no. 305676) in an inception cohort of 324 individuals (64 CD, 84 UC, 116 symptomatic non-IBD controls and 44 healthy controls) across five European centres and examined 54 predetermined bacterial markers. We categorized patients according to the Montreal Classification and calculated the dysbiosis index (DI). Non-parametric tests were used to compare groups and the Bonferroni correction to adjust for multiple comparisons. RESULTS: The fluorescent signals (FSSs) for Firmicutes and Eubacterium hallii were lower in inflammatory bowel disease (IBD) vs. symptomatic controls (p<.05). FSS for Firmicutes, Lachnospiraceae, Eubacterium hallii and Ruminococcus albus/bromii were lower, whereas the signal for Bacteroides Fragilis was higher in UC vs. symptomatic controls (p<.05). FSS was higher for Bifidobacterium spp., Eubacterium hallii, Actinobacteria and Firmicutes among patients with ulcerative proctitis, compared to extensive colitis (p<.05). In CD, we observed no association with disease location. The DI correlated with faecal-calprotectin in both CD and in UC (p<.001). In terms of treatment escalation and anti-TNF response, differences were observed for some bacterial markers, but none of these associations were statistically significant. CONCLUSION: Our data reveal that the GA-map™ Dysbiosis Test holds the potential to characterize the faecal microbiota composition and to assess the degree of dysbiosis in new-onset IBD. On the other hand, our results cannot demonstrate any proven diagnostic or predictive value of this method to support clinical decision making.

[Robotic-Assisted Oesophageal Surgery]. / Roboterchirurgie am Ösophagus.

BACKGROUND: Abdominothoracic oesophageal resections, also known as Ivor Lewis procedures, are complex visceral surgery procedures. In recent years, substeps have increasingly been performed using minimally invasive techniques. However, intrathoracic anastomosis is still a challenge given the instrumental and technological possibilities available to date. This article provides a detailed description of the use of the Da Vinci robotic system and our techniques in oesophageal surgery. METHODS: In a prospective data collection, we analysed the robotic-assisted oesophageal surgeries performed at the University Hospital of Schleswig-Holstein, Campus Kiel, between November 2013 and November 2015. RESULTS: A total of 56 patients underwent robotic-assisted oesophageal surgery, with 43 patients undergoing the Ivor Lewis technique, 10 patients undergoing the McKeown procedure and 3 patients undergoing enucleation of a leiomyoma. A complete tumour resection (R0 margin) was achieved in 53 patients (93.4%); the mean number of resected lymph nodes was 23 (14-75). Forty-five (80.5%) patients received an induction therapy. Mean operative time was 412 min (120-610); mean hospital stay was 19 days (4-145). A conversion to open surgery was necessary in 19 (34.1%) cases, most notably in the thoracic part of the surgical procedure (17 patients). Forty-three patients received intrathoracic oesophagogastrostomy; 4 out of 5 patients with an initial side-to-side anastomosis developed a leakage, whereupon the technique was switched to a hand-sewn procedure (leakage in 3 out of 20 patients). Other major morbidities included leakage of the gastric conduit in 2 patients (3.6%), airway fistula in 2 patients (3.6%), mesenteric ischaemia in one patient (1.8%), and peritonitis due to a dislocated feeding tube in one other patient. Pulmonary complications occurred in 19 patients (34%). Four patients (7.1%) died of pulmonary embolism, heart attack, and septic organ failure. CONCLUSION: Robotic-assisted, minimally invasive oesophagectomy is a feasible and useful approach for oncological surgery. This technique should be implemented in a structured program with an extensive and critical evaluation of the users' own results and an exchange with other experienced work teams. This helps to avoid pitfalls and to speed up the learning curve. Further technological developments and increasing experience might lead to a more widespread use of this technique.

TNF-receptor-1 adaptor protein FAN mediates TNF-induced B16 melanoma motility and invasion.

BACKGROUND: Locomotion of cancer cells can be induced by TNF and other motogenic factors secreted by cells of the tumour microenvironment such as macrophages. Based on our recent findings that the TNF receptor adaptor protein FAN mediates TNF-induced actin reorganisation and regulates the directed migration of immune cells responding to chemotactic cues, we addressed the role of FAN in cancer cell motility and the formation of invadopodia, a crucial feature in tumour invasion. METHODS: In B16 mouse melanoma cells, FAN was downregulated and the impact on FAN on cell motility and invasion was determined using in vitro assays and in vivo animal models. RESULTS: Like FAN(-/-) murine embryonic fibroblasts, FAN-deficient B16 melanoma cells showed defective motility responses to TNF in vitro. In vivo FAN-deficient B16 melanoma cells produced significantly less disseminated tumours after i.v. injection into mice. Danio rerio used as a second in vivo model also revealed impaired spreading of FAN-deficient B16 melanoma cells. Furthermore, FAN mediated TNF-induced paxillin phosphorylation, metalloproteinase activation and increased extracellular matrix degradation, the hallmarks of functionally active invadopodia. CONCLUSION: The results of our study suggest that FAN through promoting melanoma cellular motility and tumour invasiveness is critical for the tumour-promoting action of TNF.

Medullary decompression of the radius as treatment for lameness in a horse.

Increased intraosseous pressure (IOP) is a well-characterized source of pain in humans that can be successfully treated by medullary decompression. This report describes the clinical and diagnostic findings, treatment and successful outcome of a horse with a four week long, non-weight bearing lameness secondary to suspected traumatically-induced increased IOP in the left radius. Scintigraphic examination characterized by severe increase in radiopharmaceutical uptake within the affected radius aided in the initial localization of the source of lameness. Decompression of the affected radius was performed by drilling two 3.2 mm tracts through the lateral bone cortex into the medullary cavity. Intramedullary pressure in the radius was measured (37-39 mmHg). Dramatic clinical improvement was observed after surgical decompression of the affected bone and the horse showed full recovery and returned to previous exercise use by 12 months after treatment. Gradual decrease in radial radiopharmaceutical uptake was observed during the following year. Increased IOP should be considered as a cause of lameness in horses and scintigraphic examination may aid in its diagnosis. Medullary decompression may be a successful treatment in some cases.

A comparison of continuous non-invasive arterial pressure with invasive radial and femoral pressure in patients undergoing cardiac surgery.

BACKGROUND: Non-invasive continous monitoring of finger arterial pressure has gained increasing interest. The aim of the present study was to compare the accuracy of non-invasive reconstructed brachial artery pressure by the Nexfin™ device (NFAP) with invasive femoral (IFAP) and radial (IRAP) artery pressure before and after cardiopulmonary bypass (CPB). METHODS: Fifty patients scheduled for elective coronary surgery were studied before and after CPB, respectively. Each patient was monitored with the non-invasive system, and both an indwelling femoral and radial arterial catheter. A passive leg raising maneuver was also performed before and after CPB. Measurements included mean (MAP), systolic (SAP) and diastolic (DAP) arterial pressure by NFAP (MAP,SAP,DAP(NFAP)), IFAP (MAP,SAP,DAP(IFAP)) and IRAP (MAP,SAP,DAP(IRAP)). Percentage changes of MAP for all measurement sites were also calculated. RESULTS: There was a moderate correlation between MAP(NFAP) and MAP(IFAP) both before (r=0.64, P<0.0001) and after (r=0.57, P<0.0001) CPB, with a percentage error (PE) of 29% and 27%, respectively. Correlation coefficients between MAP(NFAP) and MAP(IRAP) were r=0.53, P<0.0001 (PE 34%) before and r=0.54, P<0.0001 (PE 29%) after CPB. There was a significant correlation in percentage changes between ∆MAP(NFAP) and ∆MAP(IFAP) before (r=0.70, P<0.0001) and after (r=0.71, P<0.0001) CPB and for ∆MAP(NFAP) and ∆MAP(IRAP) (r=0.67, P<0.0001; r=0.74, P<0.0001), respectively. CONCLUSION: Non-invasive, reconstructed brachial artery pressure showed moderate correlation compared with both invasive femoral and radial artery pressure. Furthermore, the non-invasive monitoring system was able to reflect percentage changes in mean arterial pressure in a moderate fashion.

Radiographic changes in Thoroughbred yearlings in South Africa.

This study involves the evaluation of pre-purchase radiographic studies of South African Thoroughbred yearlings. Radiographic changes were recorded and compared with similar international studies. The study differs from other studies in that a lower prevalence of pedal osteitis (1.26%), dorsal osteochondral fragmentation of the metatarsophalangeal joint (1.60%), distal metacarpal sagittal ridge changes (15.7%), ulnar carpal bone lucencies (8.33%), carpal osteophytes (1.19%), distal intertarsal and tarsometatarsal joint radiographic changes (9.92%), tarsal osteochondrosis lesions (4.40%) and stifle osteochondrosis lesions (0.4%) was found. The prevalence of dorsal osteochondral fragments in the metacarpophalangeal joint was similar to other studies (1.60%). A higher prevalence of vascular channels as well as irregular borders and lucencies was evident in the proximal sesamoid bones. There was a higher prevalence of palmar metacarpophalangeal and plantar metatarsophalangeal osteochondral fragments (2% and 7.10% respectively). Palmar metacarpal disease, metacarpal supracondylar lysis, proximal sesamoid bone fractures and carpal osteochondral fragmentation were absent in the current study. Additional findings recorded in the current study were proximal interphalangeal joint hyperextension (left front 15.13%, right front 18.91%), the solar angle (right front 2.38 degrees, left front 2.79 degrees), the prevalence of carpal bone 1 (30.95%) and carpal bone 5 (1.59%). Management, nutrition and genetics in the various groups of Thoroughbred yearlings should be further investigated in order to explain the reasons for the differences recorded in the current study.

Antebrachial chondrodysplasia in New Zealand white rabbits (Oryctolagus cuniculus).

Rabbits obtained from a South African rabbit breeder exhibited deformities of the distal forelimbs. The clinical, radiological and histological presentation of mid-antebrachial valgus formation (a.k.a distal foreleg curvature) in these rabbits was consistent with an autosomal recessive trait associated with a chondrodystrophic lesion of the distal ulna epiphysis 1st described in the 1960s. The impact this might have on South African farming enterprises and laboratory facilities has not been established, but the heritability and welfare implications of this condition make it a concern. Mildly affected animals can adapt to the deformity with some housing adjustments, but severely affected animals may require humane euthanasia.

[Naturopathic practitioners and the public health system. Legal principles as well as experience from naturopathic practitioner candidate tests and hygiene inspections of naturopathic practitioner's practices in the Rhine-Main area in 2004-2007]. / Heilpraktiker und öffentliches Gesundheitswesen. Gesetzliche Grundlagen sowie Erfahrungen aus den Uberprüfungen der Heilpraktikeranwärter und der infektionshygienischen Uberwachung von Heilpraktiker-Praxen im Rhein-Main-Gebiet 2004-2007.

In Germany, the naturopathic practitioner, the "Heilpraktiker", is allowed to practice medicine, like medically trained physicians. The German heilpraktiker, a specific German phenomenon embedded in the country's history, practices medicine without being obliged to undertake any medical teaching or training. Anybody 25 years old or older, with a secondary school certificate, and free of disease can participate in a test, conducted by the local health authorities to "exclude danger to the health of the nation." In the case of failure, this test can be repeated ad libitum. Having passed this test, the heilpraktiker is allowed to practice the whole realm of medicine, except for gynecology, dentistry, prescription of medication, and healing infectious diseases. There is no more state control during the heilpraktiker's working life, except in those practices applying invasive methods, such as infusions, injections, oxygen therapy, and acupuncture. These practices are inspected by the public health department based on the Infection Protection Act. Although several cases of fatal errors in treatment are known, the greatest risk in the heilpraktiker's practice is the omission of proper diagnostics and therapies, which is risk by omission. In this paper, the history of the heilpraktiker in Germany as well as the task of the Public Health Departments in testing the candidates are shown. The data of 345 tests from 2004-2007 in the Rhein-Main area are presented, with 53% of the participants failing. Concerning the hygiene control visits, a concept for hygiene was lacking in 79% of 109 practices, while in 49% a concept for cleaning and disinfection was also missing. In 60% of the practices, a dispenser for hand disinfection was lacking. Recommended improvements were quickly performed in most practices. In conclusion, the current legal regulation, i.e., testing the candidates only once before practicing for a lifetime, does not sufficiently protect the population against danger caused by false diagnostics and (invasive) therapy of the heilpraktiker. Considering the population's increasing interest and use of complementary and alternative medicine (CAM) with a heilpraktiker being frequently consulted, there are growing concerns in health services, regarding (1) how to regulate CAM professions and natural health procedures, (2) how to incorporate safe CAM into school medicine, and (3) how best to protect the public from a wide range of possible CAM-conventional medicine interactions.

The impact of ultrasound during emergency after-hour admissions of horses.

Clinical use of diagnostic ultrasound at point-of-care or emergency situations, although common, has not been well documented in veterinary medicine. Medical records of after-hour emergency equine admissions during a 10-year period were reviewed and horses that received ultrasound scans were identified. Data sheets for each ultrasound scan performed during emergency clinical evaluation were collected and reviewed. Data extracted included anatomical region imaged, body system affected, documented ultrasonographic diagnosis and final diagnosis. Six hundred and nine records were available of which 108 horses had an ultrasound diagnostic procedure performed. The most common reason for emergency ultrasonography was to investigate gastrointestinal abnormalities, the largest proportion of these being large intestinal disorders. A complete ultrasound report was documented in 57% of evaluations, of which 79% correlated with a final diagnosis. Incomplete reporting made accurate interpretation of records difficult. Results indicate that the use of ultrasound in the emergency setting may be of diagnostic benefit and impact on patient management. Ultrasound training should be provided to residents in order to gain proficiency, especially with regard to the gastrointestinal system.

Limb fracture during recovery from general anaesthesia: an often tragic complication of equine anaesthesia.

A 10-year-old Thoroughbred mare was presented for lameness of the left hindlimb as a result of an apical fracture of the lateral proximal sesamoid bone. The mare was ultimately euthanased after suffering catastrophic fractures of the 3rd and 4th metatarsal bones of the contra-lateral hindlimb during an uncoordinated attempt to rise during recovery from general anaesthesia after undergoing arthroscopic surgery. The case report focuses mostly on horse anaesthesia-related mortality, anaesthetic procedure in the horse, possible causes of fractures in horses during recovery and ways in which rate of occurrence of these fractures can be minimised.

Changes in sheep oesophageal diameter and function during Geigeria ornativa (vermeerbos) poisoning and subsequent recovery.

Changes in the oesophageal diameter and function together with changes in body weight, feed intake and the cardiac pulmonary flow index were investigated during experimentally induced poisoning with Geigeria ornativa and subsequent recovery. This was performed under varying conditions for individual sheep. Results showed an increase in the oesophageal diameter index (ODI) during vermeersiekte, accompanied with a decrease in oesophageal function (OF). Cessation of G. ornativa intake resulted in a considerable although incomplete recovery of the ODI. Recovery of the OF for the different sheep, however, varied between 0 and 100%. Detrimental changes in the oesophageal diameter and function were also measured in sheep receiving only subclinical doses of G. ornativa. Decreases in body weight and feed intake commenced 1 to 3 weeks before the onset of vermeersiekte, while indications of a decline in these 2 parameters were also noticed with ingestion of subclinical amounts of G. ornativa. An increase in the cardiac pulmonary flow index (CPFI) to a value indicating the onset of heart failure was found in 1 of the sheep showing clinical signs of vermeersiekte. The CPFI returned to normal after termination of G. ornativa intake.

Three cases of osteoma and an osseous fibroma of the paranasal sinuses of horses in South Africa.

Four horses were presented to the Onderstepoort Veterinary Academic Hospital with histories of facial asymmetry, nasal discharge or obstruction of normal nasal passage airflow. Radiographic examination of the maxillary sinuses of 2 cases revealed well circumscribed, unilateral, mineralised masses; the other 2 cases showed less mineralisation. The masses were accessed for further investigation by surgically created frontonasal bone flaps or trephination of the maxillary sinuses. Diagnosis of osteoma was confirmed histopathologically in 3 of the cases and of ossifying fibroma in the 4th. Two horses were euthanased directly after surgical intervention due to poor prognosis. Osteomas are by nature expansile tumours and follow the complex communication of the sinuses, and therefore are not all amenable to surgical removal. Osseous fibromas are large, solitary, expansile lesions that are rare in all species but reported most frequently in horses. They have an apparent predilection for the rostral mandible of the horse.

Eustachian tube diverticulum chondroids and neck abscessation in a case of Streptococcus equi subsp. equi.

A 12-year-old, grey, crossbred pony mare was presented with a swelling in the neck over the area of the 2nd cervical vertebra (C2), which was found to be painful on palpation. The neck was held stiffly. Radiography of the cervical region showed a focal area of increased radio-opacity over the dorsal, caudal and lateral aspect of the dorsal spinous process of C2. Ultrasound confirmed the presence of a hypoechoic area approximately 15 cm in diameter superimposed over the dorsal spinous process of C2. An aspirate was taken of the mass, which revealed purulent exudate confirming the diagnosis of an abscess. The abscess was lanced with a scalpel blade and samples of the purulent material revealed a pure culture of Streptococcus equi subsp. equi. The guttural pouches (Eustachian tube diverticulae (ETD)) were then evaluated endoscopically and multiple chondroids were seen filling most of the right ETD. Surgery was subsequently performed and 189 chondroids were removed via a right-sided hyovertebrotomy. The ETDs were flushed and penicillin installed into both ETDs on 3 different occasions via a catheter introduced using a fibre optic scope. This procedure was repeated until a negative culture status was achieved in order to eliminate the carrier status.

In vitro comparison of three materials as apical sealants of equine premolar and molar teeth.

REASONS FOR PERFORMING STUDY: Surgical endodontic therapy is a conservative dental technique used in horses with some degree of clinical success. Failure of this procedure can partially be explained by inadequate sealing of the root apices with resultant microleakage in the periapical area. OBJECTIVES: To assess and compare in vitro sealing ability of 3 different dental restorative materials used as apical sealants during equine surgical endodontics. METHODS: Thirty extracted equine cheek teeth were divided randomly into 3 groups and subjected to apicoectomy and apical sealing using 3 materials: reinforced zinc oxide-eugenol cement; intermediate restorative material (IRM); a resin-modified glass ionomer; and amalgam. After apical sealing, the teeth were submerged in a solution of Procion Brilliant Cresyl Blue stain for a period of 7 days. The teeth were then washed, embedded in resin, sectioned and assessed microscopically for dye leakage around the apical restorations. RESULTS: Although the materials proved effective as apical sealants, some dye leakage was encountered in all 3 groups with no statistical difference (P = 0.114). CONCLUSIONS AND POTENTIAL RELEVANCE: IRM, a resin-modified glass ionomer and amalgam all showed comparative features as apical sealants when used in vitro in equine teeth. IRM is currently regarded as the superior material in clinical situations due to its ease of handling and lesser sensitivity to environmental moisture during placement compared to the other 2 materials.

Diagnostic value of magnetic resonance imaging and computed tomography for oral masses in dogs.

The purpose of this study was to determine the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in oral masses of dogs. Nineteen dogs underwent clinical, MR and CT examinations. Eleven malignant and ten non-malignant masses were evaluated. Osteosarcoma was the most commonly found malignant oral mass and gingival hyperplasia was the most commonly found benign mass. The results showed that MRI provided more accurate information regarding the size of the masses and invasion of adjacent structures although MRI and CT show similar accuracy in assessment of bone invasion. Calcification and cortical bone erosion was better seen on CT images. Whereas contrast-MRI provided useful additional information, contrast-CT had no added benefit. In general, oral masses located in the caudal mandible, oropharynx and maxilla are better evaluated using MRI, once the histological type has been verified.