Preoperative Breast MRI: Surgeons' Patient Selection Patterns and Potential Bias in Outcomes Analyses.

OBJECTIVE: The purpose of this study is to determine which patient- and tumor-related and clinical variables influence dedicated breast surgeons' and general surgeons' referrals for preoperative breast MRI for patients with newly diagnosed breast cancer. MATERIALS AND METHODS: Surgeons who perform breast surgery responded to a survey from June 16, 2014, through August 11, 2014. Participants self-identified as breast or general surgeons and provided professional practice details. They used Likert scores (range, 1-7 with increasing likelihood to order MRI) to weigh numerous patient- and tumor-related and clinical variables. Mean likelihood scores were calculated and compared using a linear mixed model. A p ≤ 0.05 was considered statistically significant. RESULTS: Two hundred eighty-nine surveys from 154 (53%) breast surgeons and 135 (47%) general surgeons showed an overall likelihood to refer for patients with a BRCA mutation (mean Likert score, 6.17), familial (mean Likert score, 5.33) or personal (mean Likert score, 5.10) breast cancer history, extremely dense breasts (mean Likert score, 5.30), age younger than 40 years (mean Likert score, 5.24), axillary nodal involvement (mean Likert score, 6.22), tumor that is mammographically occult (mean Likert score, 5.62) or fixed to the pectoralis (mean Likert score, 5.49), tumor that is a candidate for neoadjuvant treatment (mean Likert score, 5.38), multifocal or multicentric disease (mean Likert score, 5.22), invasive lobular carcinoma (mean Likert score, 5.20), T3 (mean Likert score, 4.48) or T2 (mean Likert score, 4.41) tumor, triple-negative breast cancer (mean Likert score, 4.66), a patient who is a candidate for mastectomy requesting breast conservation therapy (mean Likert score, 5.27), and radiologists' recommendations (mean Likert score, 5.19). Across all patient ages, breast surgeons referred more often than did general surgeons (mean Likert score, 4.32 vs 3.92; p = 0.03), especially for patients with BRCA mutation (mean Likert score, 6.39 vs 5.93; p = 0.01) and tumors smaller than 1 cm (mean Likert score, 3.84 vs 3.40; p = 0.002). Breast surgeons referred less often than did general surgeons for multifocal or multicentric disease (mean Likert score, 5.02 vs 5.44; p = 0.001). Breast surgeons and general surgeons similarly weighed other variables. CONCLUSION: Preoperative breast MRI referral trended with certain higher risk patient- and tumor-related and clinical variables and were nonuniform between the breast surgeons and general surgeon cohorts. Selection bias could affect outcomes analyses for preoperative breast MRI.

Development of multitarget real-time PCR for the rapid, specific, and sensitive detection of Yersinia pestis in milk and ground beef.

Real-time PCR has been used previously to detect Yersinia pestis; this study applies this rapid, specific, and sensitive nucleic acid-based method to the detection and quantitation of Y. pestis specifically in food. Five sets of primers and corresponding TaqMan dual-labelled fluorogenic hybridization probes for Y. pestis were designed and optimized for specificity testing using genomic DNA from 71 bacterial strains. Four Y. pestis -specific primer and probe sets were developed, based on the virulence plasmid targets, and used to distinguish this bacterium from the various Yersinia and other bacterial species tested. An additional primer and probe set, based on a chromosomal gene target, distinguished Y. pestis and Yersinia pseudotuberculosis from the various Yersinia and other bacterial species tested. With optimized conditions, the quantitative detection limit of the probes for Y. pestis pure cultures ranged from 13 to 220 CFU. Standard curves were generated for the probes and used to determine the amplification efficiencies. The primers and probes demonstrated high amplification efficiencies, and their performance was evaluated using spiked milk and ground beef samples. The quantitative detection limit was 10(1) to 10(3) CFU/ml in milk and 10(2) to 10(5) CFU/g in ground beef without any preenrichment step. Testing the hybridization probes on food samples demonstrated the detection of Y. pestis in a foodborne application; this is the first such report, to our knowledge.

Recent studies on the characterization of Anaplasma marginale isolated from North American bison.

Anaplasma marginale (Rickettsiales: Anaplasmataceae), a tick-borne pathogen of cattle, is endemic in tropical and subtropical regions of the world. Many geographic isolates of A. marginale occur worldwide that have been identified by major surface protein (MSP) 1a, which varies in sequence and molecular weight owing to different numbers of tandem 28-29 amino acid repeats. Although serologic tests have identified American bison, Bison bison, as being infected with A. marginale, the present studies were undertaken to confirm A. marginale infection in bison, to characterize bison isolates, and to compare the phylogenetic relationship of the bison isolates with other A. marginale isolates from North America. Nine A. marginale isolates derived from Canadian bison possessed identical msp4 sequences with one characteristic silent nucleotide change. The sequence of MSP1a was determined for one Canadian and two U.S. bison isolates of A. marginale, and these isolates contained 4 and 5 tandem repeats, respectively. One U.S. bison isolate tested for infectivity proved to be infective for cattle and transmitted by Dermacentor variabilis ticks. the results of this study demonstrated that these A. marginale isolates obtained from bison were similar to ones derived from naturally infected cattle.

Characterization of Anaplasma marginale isolated from North American bison.

Anaplasma marginale (Rickettsiales: Anaplasmataceae), a tick-borne pathogen of cattle, is endemic in tropical and subtropical regions of the world. Although serologic tests have identified American bison, Bison bison, as being infected with A. marginale, the present study was undertaken to confirm A. marginale infection and to characterize isolates obtained from naturally infected bison in the United States and Canada. Major surface protein (MSP1a and MSP4) sequences of bison isolates were characterized in comparison with New World cattle isolates. Blood from one U.S. bison was inoculated into a susceptible, splenectomized calf, which developed acute anaplasmosis, demonstrating infectivity of this A. marginale bison isolate for cattle. The results of this study showed that these A. marginale isolates obtained from bison were similar to ones from naturally infected cattle.

Verification of the level of Microbiological Control for the Slaughter and Cooling Processes of Beef Carcass Production at a High-line-Speed Abattoir.

Methods are described which were used to verify the microbiological adequacy of the processes of production and chilling of carcasses at a high-line-speed abattoir. Ten excision samples (5 by 5 by 0.2 cm) were taken from each of 16 to 20 carcasses for each evaluation of these processes. Twelve monthly evaluations were made for the slaughter of steers, heifers, and cows and additional evaluations for each of the slaughter of cows and the chill process of carcasses. The ranges of the estimated mean log10 most probable number of growth units per square centimeter (LMPN, for 236 carcasses) and Escherichia coli per square centimeter (LEC, for 240 carcasses) enumerated by hydrophobic-grid membrane filter technology for the 12 monthly evaluations of the slaughter floor were 1.11 to 1.62 (LMPN) for single samples and 0.20 to 0.65 (LEC) for pooled samples. Based on a published advisory scale for the slaughter floor the aerobic bacterial counts reflect a cleanliness level of "excellent" to "good." For single evaluations of cow carcasses at the end of slaughter and of chilled carcasses the mean LMPN was 1.78 ("good") and 1.40 respectively. From pooled samples of each of the 236 steer, heifer, and cow carcasses the pathogen E. coli O157:H7 was identified by polymerase chain reaction on one carcass whereas Listeria monocytogenes was identified on 14 carcasses. Verocytoxigenic E. coli (6 isolates) and L. monocytogenes were not isolated from the same carcasses. These low isolation rates dictate a large sample size and therefore these pathogens are excluded from use to routinely verify the workings of hazard analyses and critical control point (HACCP) systems for beef slaughter processes in Alberta. Alternatively the use of aerobic bacterial counts to directly measure cleanliness or of E. coli counts to indirectly measure fecal contamination appears to be more practical than the use of specific pathogen counts for regulatory agencies to verify the workings of quality control programs, including HACCP systems.