A vanguard randomised feasibility trial comparing three regimens of peri-operative oxygen therapy on recovery after major surgery.

International recommendations encourage liberal administration of oxygen to patients having surgery under general anaesthesia, ostensibly to reduce surgical site infection. However, the optimal oxygen regimen to minimise postoperative complications and enhance recovery from surgery remains uncertain. The hospital operating theatre randomised oxygen (HOT-ROX) trial is a multicentre, patient- and assessor-blinded, parallel-group, randomised clinical trial designed to assess the effect of a restricted, standard care, or liberal peri-operative oxygen therapy regimen on days alive and at home after surgery in adults undergoing prolonged non-cardiac surgery under general anaesthesia. Here, we report the findings of the internal vanguard feasibility phase of the trial undertaken in four large metropolitan hospitals in Australia and New Zealand that included the first 210 patients of a planned overall 2640 trial sample, with eight pre-specified endpoints evaluating protocol implementation and safety. We screened a total of 956 participants between 1 September 2019 and 26 January 2021, with data from 210 participants included in the analysis. Median (IQR [range]) time-weighted average intra-operative Fi O2 was 0.30 (0.26-0.35 [0.20-0.59]) and 0.47 (0.44-0.51 [0.37-0.68]) for restricted and standard care, respectively (mean difference (95%CI) 0.17 (0.14-0.20), p < 0.001). Median time-weighted average intra-operative Fi O2 was 0.83 (0.80-0.85 [0.70-0.91]) for liberal oxygen therapy (mean difference (95%CI) compared with standard care 0.36 (0.33-0.39), p < 0.001). All feasibility endpoints were met. There were no significant patient adverse events. These data support the feasibility of proceeding with the HOT-ROX trial without major protocol modifications.

Antimicrobial and disinfectant resistance of Salmonella Heidelberg from Brazilian flocks did not increase for ten years (2006-2016)

ABSTRACT: Salmonella is a major cause of foodborne illness worldwide, and poultry and its derived products are the most common food products associated with salmonellosis outbreaks. Some countries, including Brazil, have experienced an increased prevalence of Salmonella Heidelberg among their poultry flocks. Some isolates have also presented high resistance to antimicrobial agents and persist in the poultry farm environment. This study aimed to compare the susceptibility of S. Heidelberg strains isolated in 2006 with those isolated in 2016 against disinfectants and antimicrobial agents. The results showed that all the strains were highly susceptible to sodium hypochlorite, regardless of the conditions and year of isolation. Resistance to benzalkonium chloride varied according to the conditions applied, but not to the year of isolation. Increased antimicrobial resistance from 2006-2016 was observed only for tetracycline. The results suggest that the antimicrobial and disinfectant resistance of S. Heidelberg did not increase for ten years (2006-2016). However, further analysis should include a larger number of S. Heidelberg isolates from poultry origin and additional antimicrobial agents for more precise conclusions about the increasing in antimicrobial resistance in the last years.

RESUMO: Salmonella é uma das principais causas das doenças transmitidas por alimento em todo o mundo, e a carne de frango e produtos derivados são os principais alimentos associados com surtos de salmonelose em humanos. Alguns países, incluindo o Brasil, têm observado um aumento da ocorrência de Salmonella Heidelberg nas suas granjas avícolas. Além disto, alguns isolados têm apresentado alta resistência aos antimicrobianos e têm persistido no ambiente de produção avícola. Neste contexto, o objetivo deste estudo foi comparar a susceptibilidade de cepas de S. Heidelberg isoladas em 2006 com aquelas isoladas em 2016 contra desinfetantes e agentes antimicrobianos. Os resultados demonstraram que as cepas foram altamente resistentes a hipoclorito de sódio, independentemente das condições e do ano de isolamento. A resistência ao cloreto de benzalcônio variou de acordo com as condições testadas, mas não com o ano de isolamento. Um aumento da resistência aos antimicrobianos de 2006 a 2016 foi observado apenas para tetraciclina. Os resultados sugerem que a resistência aos desinfetantes e aos antimicrobianos não aumentou em um período de dez anos (2006-2016). Entretanto, novas análises devem incluir um número maior de cepas de S. Heidelberg isoladas de fontes avícolas e outros agentes antimicrobianos para uma conclusão mais precisa sobre o aumento da resistência antimicrobiana nos últimos anos.

Antimicrobial and disinfectant resistance of Salmonella Heidelberg from Brazilian flocks did not increase for ten years (2006-2016) / A resistência a desinfetantes e a antimicrobianos não aumentou em um período de 10 anos (2006 a 2016) em Salmonella Heidelberg isoladas de granjas avícolas brasileiras

Salmonella is a major cause of foodborne illness worldwide, and poultry and its derived products are the most common food products associated with salmonellosis outbreaks. Some countries, including Brazil, have experienced an increased prevalence of Salmonella Heidelberg among their poultry flocks. Some isolates have also presented high resistance to antimicrobial agents and persist in the poultry farm environment. This study aimed to compare the susceptibility of S. Heidelberg strains isolated in 2006 with those isolated in 2016 against disinfectants and antimicrobial agents. The results showed that all the strains were highly susceptible to sodium hypochlorite, regardless of the conditions and year of isolation. Resistance to benzalkonium chloride varied according to the conditions applied, but not to the year of isolation. Increased antimicrobial resistance from 2006-2016 was observed only for tetracycline. The results suggest that the antimicrobial and disinfectant resistance of S. Heidelberg did not increase for ten years (2006-2016). However, further analysis should include a larger number of S. Heidelberg isolates from poultry origin and additional antimicrobial agents for more precise conclusions about the increasing in antimicrobial resistance in the last years.(AU)

Salmonella é uma das principais causas das doenças transmitidas por alimento em todo o mundo, e a carne de frango e produtos derivados são os principais alimentos associados com surtos de salmonelose em humanos. Alguns países, incluindo o Brasil, têm observado um aumento da ocorrência de Salmonella Heidelberg nas suas granjas avícolas. Além disto, alguns isolados têm apresentado alta resistência aos antimicrobianos e têm persistido no ambiente de produção avícola. Neste contexto, o objetivo deste estudo foi comparar a susceptibilidade de cepas de S. Heidelberg isoladas em 2006 com aquelas isoladas em 2016 contra desinfetantes e agentes antimicrobianos. Os resultados demonstraram que as cepas foram altamente resistentes a hipoclorito de sódio, independentemente das condições e do ano de isolamento. A resistência ao cloreto de benzalcônio variou de acordo com as condições testadas, mas não com o ano de isolamento. Um aumento da resistência aos antimicrobianos de 2006 a 2016 foi observado apenas para tetraciclina. Os resultados sugerem que a resistência aos desinfetantes e aos antimicrobianos não aumentou em um período de dez anos (2006-2016). Entretanto, novas análises devem incluir um número maior de cepas de S. Heidelberg isoladas de fontes avícolas e outros agentes antimicrobianos para uma conclusão mais precisa sobre o aumento da resistência antimicrobiana nos últimos anos.(AU)

Head and neck squamous cell cancer associated with lymphoproliferative malignancies is aggressive.

BACKGROUND: Patients with non-Hodgkin's lymphoma and chronic lymphocytic leukaemia are at an elevated risk of further malignancy. Head and neck squamous cell carcinoma often presents with cervical lymph node metastasis, and can pose a diagnostic challenge in patients with non-Hodgkin's lymphoma or chronic lymphocytic leukaemia who may have pre-existing palpable neck nodes. METHODS: A retrospective case review of a health board was conducted to identify patients with head and neck squamous cell carcinoma with a previous diagnosis of non-Hodgkin's lymphoma or chronic lymphocytic leukaemia. RESULTS: Four patients with head and neck squamous cell carcinoma that developed after non-Hodgkin's lymphoma or chronic lymphocytic leukaemia were identified. Two patients had a background of non-Hodgkin's lymphoma treated with chemotherapy. The remaining two patients had a background of chronic lymphocytic leukaemia under active surveillance. Three out of the four patients died within 30 months of diagnosis. CONCLUSION: Head and neck squamous cell carcinoma following non-Hodgkin's lymphoma or chronic lymphocytic leukaemia is aggressive. A heightened clinical suspicion is essential to facilitate early diagnosis and treatment of head and neck squamous cell carcinoma in patients with dual pathology.

The natural history of canine occult Grade II medial patellar luxation: an observational study.

OBJECTIVES: To determine the risk of lameness and the rate of subsequent medial patellar luxation surgery in dogs that present with occult Grade II medial patellar luxation. MATERIALS AND METHODS: Retrospective owner survey and review of clinical records of adult dogs diagnosed with Grade II medial patellar luxation that were initially asymptomatic and managed non-surgically that had a minimum of 4-year follow-up. Clinical notes and owner questionnaires identified dogs that subsequently developed lameness and required surgery on the previously asymptomatic stifle. RESULTS: Thirty-eight dogs were included with an average follow-up of 51 months. Seventeen dogs re-presented for unscheduled contralateral medial patellar luxation surgery at an average of 15 months after initial presentation. A further two dogs had chronic contralateral limb lameness after an average of 33 months after initial surgery and may have been potential surgical candidates. CLINICAL SIGNIFICANCE: Fifty percent of adult dogs presenting with occult Grade II medial patellar luxation subsequently developed chronic lameness or required surgery.

Biofilm formation capacity of Salmonella serotypes at different temperature conditions / Capacidade de produção de biofilme por cepas de diferentes sorovares de Salmonella em quatro temperaturas de incubação

Salmonella spp. are one of the most important agents of foodborne disease in several countries, including Brazil. Poultry-derived products are the most common food products, including meat and eggs, involved in outbreaks of human salmonellosis. Salmonella has the capacity to form biofilms on both biotic and abiotic surfaces. The biofilm formation process depends on an interaction among bacterial cells, the attachment surface and environmental conditions. These structures favor bacterial survival in hostile environments, such as slaughterhouses and food processing plants. Biofilms are also a major problem for public health because breakage of these structures can cause the release of pathogenic microorganisms and, consequently, product contamination. The aim of this study was to determine the biofilm production capacity of Salmonella serotypes at four different temperatures of incubation. Salmonella strains belonging to 11 different serotypes, isolated from poultry or from food involved in salmonellosis outbreaks, were selected for this study. Biofilm formation was investigated under different temperature conditions (37°, 28°, 12° and 3°C) using a microtiter plate assay. The tested temperatures are important for the Salmonella life cycle and to the poultry-products process. A total of 92.2% of the analyzed strains were able to produce biofilm on at least one of the tested temperatures. In the testing, 71.6% of the strains produced biofilm at 37°C, 63% at 28°C, 52.3% at 12°C and 39.5% at 3°C, regardless of the serotype. The results indicate that there is a strong influence of temperature on biofilm production, especially for some serotypes, such as S. Enteritidis, S. Hadar and S. Heidelberg. The production of these structures is partially associated with serotype. There were also significant differences within strains of the same serotype, indicating that biofilm production capacity may be strain-dependent.(AU)

Salmonella spp. são um dos mais importantes agentes causadores de doenças transmitidas por alimentos em vários países, inclusive no Brasil. Produtos avícolas e ovos são os principais alimentos envolvidos na transmissão dos sorovares de Salmonella que são responsáveis por surtos de salmonelose em humanos. Salmonella possui a capacidade de formar biofilmes em diversas superfícies. O processo de formação de biofilme depende da interação entre as células bacterianas, a superfície de adesão e as condições do ambiente onde a bactéria se encontra. Estas estruturas favorecem a sobrevivência bacteriana em ambientes hostis, como em matadouros-frigoríficos e em indústrias processadoras de alimentos. Biofilmes são um grande problema em saúde pública, pois a ruptura destas estruturas pode provocar a liberação de microrganismos patogênicos e, consequentemente, a contaminação dos produtos. O objetivo deste estudo foi avaliar a capacidade de produção de biofilme por diferentes sorovares de Salmonella submetidos a quatro temperaturas de incubação. Cepas de Salmonella de 11 sorovares foram selecionadas. A produção de biofilme foi avaliada através do método de incubação em microplacas de poliestireno incubadas a 37°, 28°, 12° e 3°C. Estas temperaturas são importantes durante o ciclo de vida de Salmonella e para o processamento de produtos avícolas. Do total de cepas avaliadas, 92,2% foram capazes de produzir biofilme em pelo menos uma das quatro temperaturas testadas. Neste estudo, 71,6% das cepas produziram biofilme a 37°C, 63% a 28°C, 52,3% a 12°C e 39,5% a 3°C, independentemente do sorovar. Os resultados indicam uma forte influência da temperatura na produção de biofilme, especialmente para os sorovares S. Enteritidis, S. Hadar e S. Heidelberg. A produção de biofilme está parcialmente associada com o sorovar da cepa. Também foi observado que existe variação quanto à produção destas estruturas dentro de um mesmo sorovar, indicando que possivelmente a produção de biofilme é cepa-dependente.(AU)

The lesser spotted pregnant surgeon.

With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. It is important for women in surgery to know that it is possible to continue their training while pregnant so they do not feel pressured into changing to a less demanding specialty or even leaving medicine entirely. It is also important for other professionals to understand the risks and choices faced by pregnant surgeons so that they can better support them in the workplace.

Evaluation of the biofilm formation capacity of Pasteurella multocida strains isolated from cases of fowl cholera and swine lungs and its relationship with pathogenicity / Avaliação da capacidade de formação de biofilme por cepas de Pasteurella multocida isoladas de casos de cólera aviária e de pulmões de suínos e sua relação com a patogenicidade

Pasteurella multocida is a Gram-negative bacillus that causes economic losses due to the development of respiratory diseases in several animal species. Among the mechanisms of virulence, the formation of biofilms is an important factor for bacterial survival in hostile environments. Studies of biofilm formation by P. multocida are needed because P. multocida is an important pathogen involved in respiratory infections. However, in contrast to other microorganisms, few studies of biofilm formation have examined P. multocida. Studies comparing the pathogenicity of microbial strains as a function of their biofilm production capacity are also rare. Consequently, the aim of this study was to evaluate the biofilm formation capacity of 94 P. multocida strains isolated from cases of fowl cholera and from swine lungs on polystyrene plates. The associations of the biofilm formation capacity with the pathogenicity index (PI) in vivo and with the presence of four genes (screened by PCR) of the tad locus (tadB, tadD, tadE and tadG), described as adhesion markers, were also determined. Strains from both animal origins were able to form biofilms. However, most of the specimens (52.13%) were classified as weak producers, and more than 40% of the strains of P. multocida (40.42%) did not produce biofilms. There was no significant difference (p>0.05) in the degree of biofilm production between the two sources of isolation. Of the analyzed strains, 56.52% contained all four genes (tadB, tadD, tadE and tadG). The PI arithmetic mean of the strains classified as non-biofilm producers was significantly different (p<0.05) from the PI of moderate-producer strains. The PI of specimens classified as weak biofilm producers also differed significantly (p<0.05) from that of the moderate-producer strains. The results indicate that even though the P. multocida strains isolated from cases of fowl cholera and swine lungs formed biofilms on polystyrene surfaces, adhesion was usually weak. The genes tadB, tadD, tadE and tadG were not significantly associated (p>0.05) with the production of biofilms and with the origin of a given strain. Finally, low virulence strains may suggest a higher biofilm formation capacity on polystyrene plates.(AU)

Pasteurella multocida é um bacilo Gram negativo que ocasiona perdas econômicas, geralmente associadas a doenças respiratórias em diversas espécies animais. Entre os mecanismos de virulência existentes, a formação de biofilmes demonstra ser um importante fator para a proteção e para a sobrevivência bacteriana em ambientes hostis. Estudos relacionados à formação de biofilmes por P. multocida são necessários, uma vez que este é um importante patógeno envolvido em infecções respiratórias. Entretanto, ainda são poucos os estudos desenvolvidos nesta área, quando comparados com aqueles envolvendo outros microrganismos. Também são os raros os estudos que comparam a patogenicidade das cepas com a sua capacidade de produção de biofilme. Neste contexto, o objetivo deste estudo foi avaliar a capacidade de formação de biofilme em placas de poliestireno de 94 cepas de P. multocida isoladas de casos de cólera aviária e de pulmões de suínos, associando-se com o índice de patogenicidade (IP) in vivo e com a presença de quatro genes do locus tad (tadB, tadD, tadE e tadG), descritos como marcadores de adesão e pesquisados através de PCR. As cepas de ambas as origens foram capazes de formar biofilme. Contudo, a maioria dos exemplares (52,12%) foi classificada como fracamente produtora e mais de 40% das cepas de P. multocida (40,42%) não produziram biofilme. Não foi observada diferença estatística (p>0,05) quanto ao grau de produção de biofilme entre as duas origens de isolamento. 56,52% das cepas analisadas apresentaram os quatro genes (tadB, tadD, tadE e tadG) concomitantemente. O IP médio das cepas classificadas como não produtoras de biofilme apresentou diferença estatística (p˂0,05) em relação ao IP das cepas moderadamente produtoras. Os exemplares classificados como fracamente produtores de biofilme diferiram significativamente (p˂0,05) do grupo de cepas moderadamente produtoras. Os resultados obtidos indicaram que, apesar de as cepas de P. multocida isoladas de casos de cólera aviária e do pulmão de suínos apresentarem capacidade de formar biofilme em superfícies de poliestireno, a adesão ocorreu geralmente de forma fraca. Os genes tadB, tadD, tadE e tadG, pertencentes ao locus tad, não apresentaram associação significativa com a produção de biofilme e nem com a origem de isolamento da cepa. Por fim, observou-se que as cepas de menor patogenicidade apresentaram uma maior capacidade de formação de biofilme em placas de poliestireno.(AU)

Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting.

AIM: To assess the diagnostic accuracy of contrast-enhanced spectral mammography (CESM), and gauge its "added value" in the symptomatic setting. MATERIALS AND METHODS: A retrospective multi-reader review of 100 consecutive CESM examinations was performed. Anonymised low-energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Histopathology data were obtained for all cases. Differences in performance were assessed using receiver operator characteristic (ROC) analysis. Sensitivity, specificity, and lesion size (versus MRI or histopathology) differences were calculated. RESULTS: Seventy-three percent of cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 0.93 versus 0.83 (p<0.025). CESM showed increased sensitivity (95% versus 84%, p<0.025) and specificity (81% versus 63%, p<0.025) compared to LE alone, with all five readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases, CESM was deemed a useful or significant aid to diagnosis. CONCLUSION: CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity, and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation.

Classification of antimicrobial resistance using artificial neural networks and the relationship of 38 genes associated with the virulence of escherichia coli isolates from broilers

Avian pathogenic Escherichia coli (APEC) is responsible for various pathological processes in birds and is considered as one of the principal causes of morbidity and mortality, associated with economic losses to the poultry industry. The objective of this study was to demonstrate that it is possible to predict antimicrobial resistance of 256 samples (APEC) using 38 different genes responsible for virulence factors, through a computer program of artificial neural networks (ANNs). A second target was to find the relationship between (PI) pathogenicity index and resistance to 14 antibiotics by statistical analysis. The results showed that the RNAs were able to make the correct classification of the behavior of APEC samples with a range from 74.22 to 98.44%, and make it possible to predict antimicrobial resistance. The statistical analysis to assess the relationship between the pathogenic index (PI) and resistance against 14 antibiotics showed that these variables are independent, i.e. peaks in PI can happen without changing the antimicrobial resistance, or the opposite, changing the antimicrobial resistance without a change in PI.

Escherichia coli patogênica (APEC) para as aves é responsável por vários processos patológicos em aves, sendo considerado como uma das principais causas de morbidade e mortalidade, associado com perdas econômicas para a indústria avícola. O objetivo do presente trabalho foi demonstrar que é possível predizer a resistência antimicrobiana de 256 amostras de APEC utilizando 38 genes responsáveis por distintos fatores de virulência, através de um programa computacional de redes neurais artificiais (RNAs). O segundo objetivo foi verificar por análise estatística a relação entre o índice de patogenicidade (IP) e a resistência aos 14 antimicrobianos. Os resultados demostraram que as RNAs foram capazes de realizar a classificação correta do comportamento das amostras APEC com uma amplitude de 74,22 a 98,44%, desta forma tornando possível predizer a resistência antimicrobiana. A análise estatística realizada para verificar a relação entre o IP e a resistência aos antimicrobianos demostrou que estas variáveis são independentes, ou seja, podem haver picos no IP sem alteração na resistência, ou até mesmo o contrário, alteração na resistência antimicrobiana sem mudança no IP.

Evaluation of bursal lymphoid depletion: comparison between the conventional histology method and digital lymphocyte depletion evaluation system / Avaliação da depleção linfóide bursal: comparação entre a histologia convencional e o sistema de avaliação digital da depleção linfocitária

Fifty-five bursa of Fabricius (BF) were evaluated by optical microscopy for three different avian histopathologists (H1, H3 and H4) to determine the degree of lymphoid depletion. One histologist evaluated the same slides at two different times (H1 and H2) with four-months interval between the observations. The same BFs were evaluated using the system of Digital Lymphocyte Depletion Evaluation (ADDL), being performed by three differents operators of the system, not histopathologists. The results showed was a significant difference between the histopathologists and between the scores established by the same expert (H1 and H2). However, there were not significant differences between the scores with the ADDL system, obtained using ADDL. The results make clear the fragility of the subjective lymphocyte depletion score classification by the traditional histologic method, while the ADDL system proves to be more appropriated for the assessment of the lymphoid loss in the BF.(AU)

Cinquenta e cinco bursas de Fabricius (BF) foram avaliadas através da microscopia óptica por três diferentes histopatologistas aviários (H1, H3 e H4) para determinar o grau de depleção linfóide. Um histopatologista avaliou as amostras em dois momentos distintos (H1 e H2) com quatro meses de intervalo entre as observações. As mesmas BF foram avaliadas utilizando-se o sistema de Avaliação Digital da Depleção Linfocitária (ADDL), sendo realizadas por três diferentes operadores do sistema, não histopatologistas. Os resultados mostraram diferenças significativas entre os histopatologistas e entre um mesmo histopatologista (H1 e H2). Contudo, não houve diferenças significativas entre os escores obtidos utilizando-se ADDL. Estes resultados caracterizam a fragilidade da classificação subjetiva em escores de depleção linfóide, enquanto o sistema ADDL prova ser um sistema robusto de avaliação da perda linfocitária na BF.(AU)

Detection of virulence-associated genes in Salmonella Enteritidis isolates from chicken in South of Brazil / Detecção de genes associados à virulência em cepas de Salmonella Enteritidis isoladas de frangos na região sul do Brasil

Salmonella spp. are considered the main agents of foodborne disease and Salmonella Enteritidis is one of the most frequently isolated serovars worldwide. The virulence of Salmonella spp. and their interaction with the host are complex processes involving virulence factors to overcome host defenses. The purpose of this study was to detect virulence genes in S. Enteritidis isolates from poultry in the South of Brazil. PCR-based assays were developed in order to detect nine genes (lpfA, agfA, sefA, invA, hilA, avrA, sopE, sivH and spvC) associated with the virulence in eighty-four isolates of S. Enteritidis isolated from poultry. The invA, hilA, sivH, sefA and avrA genes were present in 100% of the isolates; lpfA and sopE were present in 99%; agfA was present in 96%; and the spvC gene was present in 92%. It was possible to characterize the isolates with four different genetic profiles (P1, P2, P3 and P4), as it follows: P1, positive for all genes; P2, negative only for spvC; P3, negative for agfA; and P4, negative for lpfA, spvC and sopE. The most prevalent profile was P1, which was present in 88% of the isolates. Although all isolates belong to the same serovar, it was possible to observe variations in the presence of these virulence-associated genes between different isolates. The characterization of the mechanisms of virulence circulating in the population of Salmonella Enteritidis is important for a better understanding of its biology and pathogenicity. The frequency of these genes and the establishment of genetic profiles can be used to determine patterns of virulence. These patterns, associated with in vivo studies, may help develop tools to predict the ability of virulence of different strains.

Salmonella spp. estão entre os principais agentes causadores de doenças transmitidas por alimentos, e o sorovar Salmonella Enteritidis é o mais frequentemente isolado no mundo. A virulência de Salmonella spp. e a sua interação com o hospedeiro são processos complexos que envolvem fatores de virulência para sobreviver às defesas do hospedeiro. O objetivo deste estudo foi detectar genes de virulência em cepas de S. Enteritidis isoladas a partir de fontes avícolas no sul do Brasil. Ensaios de PCR foram desenvolvidos para a detecção de nove genes (lpfA, agfA, sefA, invA, hilA, avrA, sopE, sivH e spvC) associados à virulência em oitenta e quatro amostras de S. Enteritidis. Os genes invA, hilA, sivH, sefA e avrA estavam presentes em 100% dos isolados; lpfA e sopE estavam presentes em 99%; agfA em 96%; e o gene spvC estava presente em 92%. Foi possível caracterizar os isolados em quatro perfis genéticos distintos (P1, P2, P3 e P4), sendo P1 positivo para todos os genes; P2 negativo apenas para spvC; P3 negativo para agfA e P4 negativo para lpfA, spvC e sopE. O perfil de maior frequência foi P1, presente em 88% dos isolados. Apesar de todos os isolados pertencerem ao mesmo sorovar, foi possível observar variações na presença de genes associados à virulência entre os mesmos. A caracterização dos mecanismos de virulência circulantes na população de Salmonella Enteritidis é importante para um maior entendimento da sua biologia e patogenicidade. A frequência destes genes e o estabelecimento de perfis genéticos podem ser utilizados para determinar os padrões de virulência dos isolados. Estes padrões, associados a estudos in vivo, podem auxiliar na elaboração de ferramentas que permitam predizer a capacidade de virulência das diferentes cepas.

Increased expression of miR-221 is associated with shorter overall survival in T-cell acute lymphoid leukemia.

BACKGROUND: CD56 expression has been associated with a poor prognosis in lymphoid neoplasms, including T-cell acute lymphoblastic leukemia (T-ALL). MicroRNAs (miRNAs) play an important role in lymphoid differentiation, and aberrant miRNA expression has been associated with treatment outcome in lymphoid malignancies. Here, we evaluated miRNA expression profiles in normal thymocytes, mature T-cells, and T-ALL samples with and without CD56 expression and correlated microRNA expression with treatment outcome. METHODS: The gene expression profile of 164 miRNAs were compared for T-ALL/CD56+ (n=12) and T-ALL/CD56- (n=36) patients by Real-Time Quantitative PCR. Based on this analysis, we decided to evaluate miR-221 and miR-374 expression in individual leukemic and normal samples. RESULTS: miR-221 and miR-374 were expressed at significantly higher levels in T-ALL/CD56+ than in T-ALL/CD56- cells and in leukemic blasts compared with normal thymocytes and peripheral blood (PB) T-cells. Age at diagnosis (15 or less vs grater than 15 years; HR: 2.19, 95% CI: 0.98-4.85; P=0.05), miR-221 expression level (median value as cut off in leukemic samples; HR: 3.17, 95% CI: 1.45-6.92; P=0.004), and the expression of CD56 (CD56-vs CD56+; HR: 2.99, 95% CI: 1.37-6.51; P=0.006) were predictive factors for shorter overall survival; whereas, only CD56 expression (HR: 2.73, 95% CI: 1.03-7.18; P=0.041) was associated with a shorter disease-free survival rate. CONCLUSIONS: miR-221 is highly expressed in T-ALL and its expression level may be associated with a poorer prognosis.

Detection of virulence-associated genes of Pasteurella multocida isolated from cases of fowl cholera by multiplex-PCR / Pesquisa de genes associados à virulência em cepas de Pasteurella multocida isoladas em casos de cólera aviária através da técnica de multiplex-PCR

The current systems of breeding poultry, based on high population density, increase the risk of spreading pathogens, especially those causing respiratory diseases and those that have more than one host. Fowl Cholera (FC) is one such pathogen, and even though it represents one of several avian diseases that should be considered in the differential diagnosis of notifiable diseases that present with sudden death, the pathogenesis and virulence factors involved in FC are still poorly understood. The objective of this study was to investigate twelve genes related to virulence in 25 samples of Pasteurella multocida isolated from FC cases in the southern region of Brazil through the development of multiplex PCR protocols. The protocols developed were capable of detecting all of the proposed genes. The ompH, oma87, sodC, hgbA, hgbB, exBD-tonB and nanB genes were present in 100% of the samples (25/25), the sodA and nanH genes were present in 96% (24/25), ptfA was present in 92% (23/25), and pfhA was present in 60% (15/25). Gene toxA was not identified in any of the samples studied (0/25). Five different genetic profiles were obtained, of which P1 (negative to toxA) was the most common. We concluded that the multiplex-PCR protocols could be useful tools for rapid and simultaneous detection of virulence genes. Despite the high frequency of the analyzed genes and the fact that all samples belonged to the same subspecies of P. multocida, five genetic profiles were observed, which should be confirmed in a study with a larger number of samples.

Os atuais sistemas de criação na avicultura, baseados na alta densidade populacional, aumentam os riscos de disseminação de patógenos, especialmente das doenças respiratórias e daquelas cujos agentes etiológicos possuam mais de um hospedeiro. A Cólera Aviária (CA) apresenta estas características e apesar de representar uma das patologias aviárias que deve ser considerada para o diagnóstico diferencial de enfermidades com notificação obrigatória que cursam com morte súbita, a patogenia e os fatores de virulência envolvidos na CA ainda estão pouco elucidados. O objetivo deste trabalho foi pesquisar doze genes associados à virulência em 25 amostras de Pasteurella multocida isoladas de casos de CA na região sul do Brasil através do desenvolvimento de protocolos de multiplex-PCR. Os protocolos de multiplex-PCR desenvolvidos foram capazes de detectar todos os genes propostos. Os genes ompH, oma87, sodC, hgbA, hgbB, exBD-tonB, nanB estiveram presentes em 100% das amostras (25/25). Os genes sodA e nanH em 96% (24/25), o gene ptfA em 92% (23/25) e o gene pfhA em 60% (15/25). O gene toxA não foi identificado em nenhuma das amostras pesquisadas (0/25). Foram obtidos cinco diferentes perfis genéticos, sendo P1 (negativo para o gene toxA) o mais comum. Com este trabalho, concluiu-se que os protocolos de multiplex-PCR desenvolvidos tornam-se uma ferramenta bastante útil e rápida para a detecção simultânea dos genes de virulência. Apesar da alta frequência dos genes estudados e de todas as amostras pertencerem à mesma subespécie de P. multocida, foram observados cinco perfis genéticos, os quais devem ser confirmados em um estudo com um maior número de amostras.

Does the insertion of a gel-based marker at stereotactic breast biopsy allow subsequent wire localizations to be carried out under ultrasound guidance?

AIM: To investigate whether the insertion of a gel-based marker at the time of stereotactic breast biopsy allows subsequent preoperative localization to be performed under ultrasound guidance. MATERIALS AND METHODS: One hundred consecutive women who underwent either a 10 G stereotactic vacuum-assisted breast biopsy or 14 G stereotactic core biopsy with marker placement, followed by wire localization and surgical excision were identified. All had mammographic abnormalities not initially visible with ultrasound. The method of preoperative localization was recorded and its success judged with reference to the wire position on the post-procedure films relative to the mammographic abnormality and the marker. Histopathology data were reviewed to ensure the lesion had been adequately excised. RESULTS: Eighty-three women (83%) had a successful ultrasound-guided wire localization. Successful ultrasound-guided localization was more likely after stereotactic vacuum biopsy (86%) compared to stereotactic core biopsy (68%), although this did not quite reach statistical significance (p=0.06). CONCLUSION: The routine placement of a gel-based marker after stereotactic breast biopsy facilitates preoperative ultrasound-guided localization.

A survey of current UK practice regarding the biopsy of clinically and radiologically benign breast masses in young women.

AIM: To determine current practice in the UK of needle sampling of clinically and radiologically benign breast masses in young women. METHOD: A questionnaire regarding needle sampling practice in young women with clinically and radiologically benign breast masses was sent to 481 members of the Royal College of Radiologists Breast Group. This included questions on whether a written protocol is in place to allow avoidance of biopsy, and if so, the clinical and radiological criteria used. RESULTS: Responses were available for analysis from 80 units. Forty-two (53%) units had no written policy in place, whilst 38 (47%) adhered to a written policy. Of those with a policy, an age criterion for safe avoidance of biopsy was present in 36 out of the 38 units (95%). The age limit used ranged from <25 years to <35 years. Twenty-seven (71%) written policies included clinical criteria but only four (10%) policies included a size criterion. Radiological criteria were present in all policies and the majority (74%) adhered to full Stavros criteria. Seven units (18%) used a revised form of the Stavros criteria and three units used their own criteria. CONCLUSION: There is little concordance between symptomatic breast clinics regarding the criteria for avoidance of breast biopsy in this young patient group. Given the very low incidence of breast carcinoma in women less than 25 years old it is considered safe and feasible to adopt a standardized protocol across the UK and avoid the often-unnecessary benign biopsies in these patients.

Evaluation of follicular lymphoid depletion in the Bursa of Fabricius: an alternative methodology using digital image analysis and artificial neural networks / Avaliação da depleção linfóide folicular da Bursa de Fabricius: uma metodologia alternativa utilizando análise digital de imagem e redes neurais artificiais

Fifty Bursa of Fabricius (BF) were examined by conventional optical microscopy and digital images were acquired and processed using Matlab® 6.5 software. The Artificial Neuronal Network (ANN) was generated using Neuroshell® Classifier software and the optical and digital data were compared. The ANN was able to make a comparable classification of digital and optical scores. The use of ANN was able to classify correctly the majority of the follicles, reaching sensibility and specificity of 89 percent and 96 percent, respectively. When the follicles were scored and grouped in a binary fashion the sensibility increased to 90 percent and obtained the maximum value for the specificity of 92 percent. These results demonstrate that the use of digital image analysis and ANN is a useful tool for the pathological classification of the BF lymphoid depletion. In addition it provides objective results that allow measuring the dimension of the error in the diagnosis and classification therefore making comparison between databases feasible.

Cinquenta Bursa de Fabrícius (BF) foram examinadas através de microscopia óptica convencional e imagens digitais foram obtidas e processadas através do software Matlab® 6.5. Redes Neurais Artificiais (ANN) foram geradas com a utilização do software Neuroshell® Classifier, e os dados das análises óptica e digital foram comparados. A ANN classificou corretamente a maioria dos folículos, atingindo sensibilidade e especificidade de 89 por cento e 96 por cento, respectivamente. Quando os folículos foram agrupados de forma binária houve um aumento da sensibilidade para 90 por cento e obteve-se um valor máximo para a especificidade de 92 por cento. Estes resultados demonstram que o uso da análise digital de imagem associada à ANNé uma ferramenta bastante útil para a classificação patológica da depleção linfóide da BF. Além disso, fornece resultados objetivos que permitem medir a dimensão do erro classificatório, tornando possível a comparação entre distintos bancos de dados.

Mid-term results of the modular ANCA-Fit femoral component in total hip replacement.

We report the minimum five-year follow-up of 352 primary total hip replacements using the uncemented hydroxyapatite-coated ANCA-Fit femoral component with a modular neck and head. The series comprised 319 patients (212 men, 107 women) with a mean age at operation of 64.4 years (28 to 97). The principal diagnosis was osteoarthritis. A total of 18 patients (21 hips) died before their follow-up at five years, nine patients (11 hips) were lost to follow-up, and four (four hips) declined further follow-up. Patient-reported outcomes have been recorded for 288 patients (316 hips). Their mean Oxford Hip Score improved significantly from 41 points (16 to 57) pre-operatively to 20 points (12 to 44) at five-year follow-up. Radiological assessment showed good bony stability in 98% of implants. There were two cases of aseptic loosening of the femoral component. There were no clinical or radiological complications related to modularity. In our series we did not see the high rate of intra-operative fracture previously reported for this implant. This medium-term follow-up study demonstrates that the clinical outcome of the ANCA-Fit femoral component is, to date, comparable with that of other metaphyseal loading femoral components.