The spectrum of focal epithelial hyperplasia-a report of two cases.

Focal epithelial hyperplasia is a rare, benign, and asymptomatic disorder, characterized by soft papules on the oral cavity. It is primarily associated with human papillomavirus genotypes 13 and 32. It most commonly affects children and young adults. When it affects young adults, it is important to differentiate it from oral condyloma acuminata. Its diagnosis may be made clinically, but histologic examination and PCR genotyping are often useful. Treatment is not always mandatory.

Risk factors of brucellosis (re-)incidence in sheep and goat flocks in an endemic area of Portugal.

This study aimed to determinate the main risk factors of brucellosis recurrence or highest animal incidence in flocks, under pastoralism, in an endemic area of Northeast Portugal. An epidemiological survey was performed on 25 recurrent (n = 18) or highest seropositive (n = 7) sheep and mixed goat flocks and 19 historical (≥ 10 years) brucellosis-free flock, between 2014 and 2017, within the same epidemiological area presenting an average annual incidence around 6%. According to the multivariable logistic model (P < 0.001), the lack of neighboring brucellosis-free flocks (odds ratio OR = 7.79; CI % 1.49-65.06), the occurrence of more than 50% of lambing or kidding in common paths and pastures (OR = 24.17; CI % 3.0-606.54), and the animal replacement with Rev.1 non-vaccinated young animals (OR = 18.47; CI % 2.54-408.21) were the causes that influence the recurrence and highest animal incidence in flocks. In extensive production systems, the confinement of the peri-parturient and the small ruminant replacement with Rev.1 vaccinated young females seems to play a major role on brucellosis control and eradication.

Comparative assessment of different reconstructive techniques of distal femur in revision total knee arthroplasty.

PURPOSE: Bone loss is often encountered in revision total knee arthroplasty. In particular, when the cortex of distal femur is breached, the surgical decision on the reconstructive options to be taken is challenging due to the variety of defects and the lack of data from clinical or experimental studies that can support it. The aim of the present work was to test the hypothesis that for an identical defect and bone condition, each reconstructive technique option has a dissimilar stress and stability behaviour, which may be related to differing longevity of the revision procedure. METHODS: Triaxial strain gauges and video extensometer were used to measure distal cortex strains and implant stability in eight reconstructive techniques replicated with synthetic femur under a load of 2030N. To assess the cancellous bone strains, finite element models were developed and validated. RESULTS: The measured strains showed that the distal cortex is not immune to the different reconstructive techniques, when applied to an identical defect; however, significant differences (P < 0.05) were found only between bone graft and metal augment on the 12-mm larger distal defect. The stem addition improves the stability of all reconstructive techniques; however, significant differences (P = 0.03) were found only on the bone-graft technique. CONCLUSIONS: Cement-fill and metal-augment techniques, applied to the 4-mm smaller defect, are not associated with different structural behaviour, while for the 12-mm larger defect, the metal-augment and bone-graft techniques presented distinct biomechanical effects. These effects, by themselves, may not be sufficient to be associated with a different longevity of the revision procedure among techniques, when the stem is added to the bone-graft technique. These findings, based on independent scientific understanding and advanced prediction tools, can improve the surgical decision-making process, when the peripheral cortex of the distal femur is breached.

Investigation of a leptospirosis outbreak in triathlon participants, Réunion Island, 2013.

We report herein the investigation of a leptospirosis outbreak occurring in triathlon competitors on Réunion Island, Indian Ocean. All participants were contacted by phone or email and answered a questionnaire. Detection and molecular characterization of pathogenic Leptospira was conducted in inpatients and in rodents trapped at the vicinity of the event. Of the 160 athletes competing, 101 (63·1%) agreed to participate in the study. Leptospirosis was biologically confirmed for 9/10 suspected cases either by real-time PCR or serological tests (MAT or ELISA). The total attack rate, children's attack rate, swimmers' attack rate, and the attack rate in adult swimmers were respectively estimated at 8·1% [95% confidence interval (CI) 4·3-14·7], 0%, 12·7% (95% CI 6·8-22·4) and 23·1% (95% CI 12·6-33·8). Leptospirosis cases reported significantly more wounds [risk ratio (RR) 4·5, 95% CI 1·6-13], wore complete neoprene suits less often (RR 4·3, 95% CI 1·3-14·5) and were most frequently unlicensed (RR 6·6, 95% CI 2·9-14·8). The epidemiological investigation supported that some measures such as the use of neoprene suits proved efficient in protecting swimmers against infection. PCR detection in rats revealed high Leptospira infection rates. Partial sequencing of the 16S gene and serology on both human and animal samples strongly suggests that rats were the main contaminators and were likely at the origin of the infection in humans.

Chronic action of lamivudine and ritonavir on maternal and fetal liver and kidney of albino pregnant rats (Rattus norvegicus albinus, Rodentia, Mammalia): morphological and biochemical aspects.

PURPOSE: To investigate the morphological and biochemical effects of lamivudine associated with ritonavir on maternal and fetal livers and kidneys throughout the pregnancy of albino rats. MATERIALS AND METHODS: Forty pregnant rats were divided into four numerically equal groups: control (C), experiment 1 (E1), experiment 2 (E2), and experiment 3 (E3). Only distilled water was given to the control group, while groups E1, E2, and E3 received, respectively, 5, 15 and 45 mg/kg of lamivudine associated with 20, 60, and 180 mg/kg of ritonavir, per day, throughout the pregnancy. On the 20th day of the pregnancy, the histological structure of the maternal and fetal livers and kidneys was analyzed by means of optical microscopy, along with the blood concentrations of AST, ALT, urea, and matrix creatinine. The numerical variables were analyzed using the Kruskal-Wallis test and Dunn's multiple comparison test. RESULTS: The histological alterations occurred in both the maternal livers and the maternal kidneys, particularly in group E3, which received the greatest therapeutic dosage (nine times). The blood levels ofALT in group E3 were significantly lower than in the other groups (p = 0.0037). The urea and creatinine levels in the blood were significantly lower in group E1 (p = 0.0420 andp = 0.0108, respectively). CONCLUSIONS: rhe association of lamivudine and ritonavir affected the histological structure of the kidneys of the matrices of group E3. There was a significant decrease in the blood values of urea e creatinine in group El.

Effect of six antiretroviral drugs (delavirdine, stavudine, lamivudine, nelfinavir, amprenavir and lopinavir/ritonavir in association) on albino pregnant rats (Rattus norvegicus Albinus, Rodentia, Mammalia): biological assay.

OBJECTIVE: To compare the chronic effects of antiretrovirals (lamivudine, stavudine, delavirdine, nelfinavir, amprenavir and an association of lopinavir/ritonavir) on albino pregnant rats. DESIGN: Review. SETTING: Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. METHODS: This was a comparative retrospective study formed by 18 groups of 10 pregnant rats each, which were nearly three months of age and weighed 200 g. All of them were medicated every day using a stomach probe, while the control group was given 1 mL of distilled water. The study groups received lamivudine (at 5, 15 and 45 mg/kg/day); stavudine (at 1, 3 and 9 mg/kg/day); nelfinavir (at 40, 120 and 360 mg/kg/day); amprenavir (at 46, 138 and 414 mg/kg/day); lopinavir/ritonavir (at 12.8/3.2, 38.4/9.6 and 115/28.8 mg/kg/day) and delavirdine (at 20 and 60 mg/kg/day). These represented 1, 3 and 9 times the human therapeutic dose, except for the last drug, for which the 9-times dose was not used. Maternal, litter and placental weights, implantation and reabsorption numbers, major external fetal malformations and fetal and maternal deaths were evaluated. The Kruskal-Wallis test was used to compare quantitative variables and the chi-square test was used to compare qualitative variables. RESULTS: At all three doses, stavudine increased the maternal weight (p=0.001), while lamivudine at 3- and 9-times doses reduced it (p<0.001). Amprenavir at all of the doses, and lopinavir/ritonavir at 3- and 9-times doses, caused higher rates of maternal death (p<0.001). Regarding the fetuses, none of the antiretroviral drugs studied were harmful with regard to implantation, reabsorption, teratogenity and mortality (p>0.05). Stavudine at all doses reduced the litter weights (p<0.001); however, lamivudine at the usual and 3-times doses, delavirdine at 3-times dose, and amprenavir at 3-times dose increased the litter weight (p<0.001). CONCLUSION: In the maternal compartment, we observed lethal toxicity in the pregnant rats that received amprenavir and ritonavir/lopinavir; and maternal weight change with lamivudine and stavudine. In the fetal compartment, adverse effects were observed in relation to litter weight from stavudine, lamivudine, delavirdine and amprenavir.

Influence of two collection frequency intervals on sperm quality of standard and miniature bull Terriers during short breeding periods: A clinical field study.

Background and Aims: The quality of canine sperm can be influenced by many factors, such as breed, body weight, age, ejaculatory frequency, nutrition, and environment. In the UK, it is common practice for standard Bull Terriers (SBT) and miniature Bull Terriers (MBT) to require male donors during a short breeding period. The aim of this study was to evaluate the effect of semen collection frequency on ejaculate volume and nine sperm parameters in SBT and MBT males, considering age and body condition score (BCS). Materials and Methods: Ejaculates from six adult SBTs and four MBTs were collected 5 times at two consecutive intervals (Time Series [TS]1, 24 h vs. TS2, 48 h), 1 week apart. Ejaculate volume, concentration, total output, viability (live sperm), subjective total motility, vigor, and total morphological defects, including head, midpiece, and tail defects of sperm, were evaluated. A multivariable mixed linear model for repeated measures was used to analyze the effects of semen collection frequency, age, breed, and BCS on ejaculate volume and sperm parameters. Results: Semen collection frequency, age, and, to a lesser extent, breed, and BCS significantly affected sperm parameters. Semen collection frequency affected all sperm parameters (p < 0.05) but not ejaculate volume (p > 0.05). Total sperm output, sperm vigor, total motility, and tail defects decreased (p < 0.05) at the end of TS1. However, sperm parameters remained relatively constant (p > 0.05) in TS2 between semen collection sessions. Overall, poorer sperm parameters were observed in older dogs (aged 5-8 years) than in younger dogs (aged 4 years). MBT produced less (p < 0.001) ejaculate volume (3.2 ± 0.2 mL vs. 4.3 ± 0.2 mL: Least Squares Mean ± Standard Error of Mean), lower total sperm output (221.8 ± 19.2 × 106 vs. 348.6 ± 19.2 × 106) and lower total morphological defects (25.0 ± 1.1% vs. 31.3 ± 0.9%), and a higher percentage of live sperm (77.0 ± 1.4% vs. 71.7 ± 1.1%) than SBT. In addition, a BCS of 4 positively influenced (p < 0.05) viability, vigor, and total sperm motility. Conclusion: Despite differences in age, breed, and BCS, better sperm parameter values were observed in all semen collection sessions. However, intensive semen collection (TS1) appears to be less effective in maintaining good sperm quality. For breeding or artificial insemination purposes, a 48-h interval between collection sessions is recommended for both breeds. The results of this study could be used to further optimize assisted reproductive technologies in both breeds.

Acute hepatitis E complicated by Guillain-Barre syndrome in Portugal, December 2012--a case report.

Autochthonous hepatitis E virus (HEV) infection has been increasingly reported in Europe and the United States, mostly arising from genotype 3 and less frequently genotype 4. We report here on a patient with HEV genotype 3a infection complicated by Guillain-Barré syndrome in Portugal in December 2012. We draw attention to the diagnosis of autochthonous HEV infection and to its rare, but important, neurological complications.

Improved stability with intramedullary stem after anterior femoral notching in total knee arthroplasty.

PURPOSE: It has been hypothesized that femoral notching in total knee arthroplasties weakens the cortex of the femur, which can predispose to femoral fractures in the postoperative period. Some authors suggest that patients who sustain inadvertent notching should have additional protection in the postoperative period, and consideration should be given to the use of prophylactic femoral stems. In this case, a question can be raised: Is the use of femoral stem in an anterior femoral notching an effective way to reduce the fracture risk? We hypothesized that for a larger notch, the use of a femoral stem does not decrease considerably the stress-riser at the notch edge, and the use of stem is not enough to reduce the risk of fracture. METHODS: In the present in vitro study, twelve synthetic femurs were selected and used for the experiments under two load scenarios. Femoral components with and without femoral stems were implanted in femurs with different notch sizes to predict experimentally the strain levels at the notch edge with the use of fiber Bragg gratings and at notch region with strain gauges. RESULTS: Despite the global strain reduction in stemmed condition, at the notch edge, the strain behavior was dissimilar for the different notch depths. For notch depths lower than 5 mm, the use of stem reduces the strain level at the notch edge to values below the intact femur condition, while for depths greater or equal to 5 mm, the strain levels at the notch edge were higher than the intact femur condition with values ranging from +10 to +189%. CONCLUSIONS: The present study suggests the use of a prophylactic stem for notch depths greater than 5 mm. For notch depths below 5 mm, the fracture risk due to strain increase at the notch edge seems to be low in the stemless condition.

The use of Taguchi technique to optimize the compression moulding cycle to process acetabular cup components.

Taguchi technique is a powerful method of solving engineering problems in order to improve the performance of a process and to enhance the productivity. The methodology for the design of the experiment is proposed in order to find the best parameters for better experimental results with less number of experiments as possible. In this study, Taguchi technique was applied to optimize the compression moulding cycle for processing the Acetabular cup prototype. For the design of the experiments, three main factors such as processing temperature, pressure and the time of compaction were identified which directly influence the quality of the final product. For each factor three levels were considered and an orthogonal array L9 was associated. With the L9 orthogonal array, a total of 9 trial experiments have been performed and the optimum parameters were identified. An experimental test was performed in order to validate the founded conditions. The optimized conditions encountered were: processing temperature of 160 degrees C, processing pressure of 1000 psi and the compaction time of 90 s. With these optimized parameters, the acetabular cup prototypes were processed for nanocomposites having ultra-high molecular weight (UHMWPE) reinforced with different volume fractions of carbon nanotubes (CNTs) in the range of 0.2 to 2.0 vol.%.

Biomechanical analysis comparing natural and alloplastic temporomandibular joint replacement using a finite element model.

PURPOSE: Prosthetic materials and bone present quite different mechanical properties. Consequently, mandible reconstruction with metallic materials (or a mandible condyle implant) modifies the physiologic behavior of the mandible (stress, strain patterns, and condyle displacements). The changing of bone strain distribution results in an adaptation of the temporomandibular joint, including articular contacts. MATERIALS AND METHODS: Using a validated finite element model, the natural mandible strains and condyle displacements were evaluated. Modifications of strains and displacements were then assessed for 2 different temporomandibular joint implants. Because materials and geometry play important key roles, mechanical properties of cortical bone were taken into account in models used in finite element analysis. RESULTS: The finite element model allowed verification of the worst loading configuration of the mandibular condyle. Replacing the natural condyle by 1 of the 2 tested implants, the results also show the importance of the implant geometry concerning biomechanical mandibular behavior. The implant geometry and stiffness influenced mainly strain distribution. CONCLUSION: The different forces applied to the mandible by the elevator muscles, teeth, and joint loads indicate that the finite element model is a relevant tool to optimize implant geometry or, in a subsequent study, to choose a more suitable distribution of the screws. Bone screws (number and position) have a significant influence on mandibular behavior and on implant stress pattern. Stress concentration and implant fracture must be avoided.

Household transmission of haemolytic uraemic syndrome associated with Escherichia coli O104:H4, south-western France, June 2011.

Following the outbreak of haemolytic uraemic syndrome (HUS) on June 2011 in south-western France, household transmission due to Escherichia coli O104:H4 was suspected for two cases who developed symptoms 9 and 10 days after onset of symptoms of the index case. The analysis of exposures and of the incubation period is in favour of a secondary transmission within the family. Recommendations should be reinforced to prevent person-to-person transmission within households.

Finite element modelling and experimental validation of a total implanted shoulder joint.

Background Replicating a total shoulder arthroplasty in laboratory is a difficult task due to complex geometry of the structures and degrees of freedom of the joint. Implanted joint shoulders have been investigated using numerical tools, but models developed lack of experimental validation. The objective of this study was to develop a finite element model that replicated correctly an experimental simulator of an implanted joint shoulder based on the comparison of measured and calculated strains. The methods used include a non-cemented Anatomical Comprehensive© Total Shoulder System that was implanted in 4th generation composite bones. The finite element model designed replicates adequately the experimental model. Both models included the most important muscles of shoulder abduction and the same boundary conditions (loads, fixation, and interface conditions). Strain gauge rosettes were used to measure strain responses on the shoulder in 90° abduction. The results of linear regression analysis between numerical and experimental results present a high correlation coefficient of 0.945 and a root-mean-square-error of 35 µÎµ, suggesting adequate agreement between the experimental and the numerical models. Small strains were obtained and changes in load distribution from posterior to anterior region were observed. As conclusion we can say that the experiments allowed good replication of the finite element model, and the use of strain gauges is suitable for numerical-experimental validation of bone joints.

The impact of tinnitus distress on cognition.

Tinnitus is the chronic perception of a phantom sound with different levels of related distress. Past research has elucidated interactions of tinnitus distress with audiological, affective and further clinical variables. The influence of tinnitus distress on cognition is underinvestigated. Our study aims at investigating specific influences of tinnitus distress and further associated predictors on cognition in a cohort of n = 146 out-ward clinical tinnitus patients. Age, educational level, hearing loss, Tinnitus Questionnaire (TQ) score, tinnitus duration, speech in noise (SIN), stress, anxiety and depression, and psychological well-being were included as predictors of a machine learning regression approach (elastic net) in three models with scores of a multiple choice vocabulary test (MWT-B), or two trail-making tests (TMT-A and TMT-B), as dependent variables. TQ scores predicted lower MWT-B scores and higher TMT-B test completion time. Stress, emotional, and psychological variables were not found to be relevant predictors in all models with the exception of small positive influences of SIN and depression on TMT-B. Effect sizes were small to medium for all models and predictors. Results are indicative of specific influence of tinnitus distress on cognitive performance, especially on general or crystallized intelligence and executive functions. More research is needed at the delicate intersection of tinnitus distress and cognitive skills needed in daily functioning.

Review: Managing sheep and goats for sustainable high yield production.

This review discusses the most relevant aspects of nutritional, reproductive and health management, the three pillars of flock efficiency, production and sustainability regarding the intensification of production in sheep and goats. In small ruminants, reproductive management is dependent on seasonality, which in turn depends on breed and latitude. Nutrition represents the major cost for flocks and greatly affects their health, the quality of their products and their environmental impact. High-yielding sheep and goats have very high requirements and dietary intake, requiring nutrient-dense diets and sophisticated nutritional management that should always consider the strong interrelationships among nutrition, immunity, health, reproduction, housing and farm management. The reproductive pattern is to a great extent assisted by out-of-season breeding, facilitating genetic improvement schemes, and more recently by advanced reproductive technologies. Heath management aims to control or eradicate economic and zoonotic diseases, ensuring animal health and welfare, food safety and low ecosystem and environmental impacts in relation to chemical residues and pathogen circulation. In highly producing systems, nutrition, genetic and hazard factors assume a complex interrelationship. Genomic and management improvement research and technological innovation are the keys to sustain sheep and goat production in the future.