Machine learning, deep learning and hernia surgery. Are we pushing the limits of abdominal core health? A qualitative systematic review.

INTRODUCTION: This systematic review aims to evaluate the use of machine learning and artificial intelligence in hernia surgery. METHODS: The PRISMA guidelines were followed throughout this systematic review. The ROBINS-I and Rob 2 tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis. RESULTS: A total of 13 articles were ultimately included for this review, describing the use of machine learning and deep learning for hernia surgery. All studies were published from 2020 to 2023. Articles varied regarding the population studied, type of machine learning or Deep Learning Model (DLM) used, and hernia type. Of the thirteen included studies, all included either inguinal, ventral, or incisional hernias. Four studies evaluated recognition of surgical steps during inguinal hernia repair videos. Two studies predicted outcomes using image-based DMLs. Seven studies developed and validated deep learning algorithms to predict outcomes and identify factors associated with postoperative complications. CONCLUSION: The use of ML for abdominal wall reconstruction has been shown to be a promising tool for predicting outcomes and identifying factors that could lead to postoperative complications.

Robotic versus open lateral abdominal hernia repair: a multicenter propensity score matched analysis of perioperative and 1-year outcomes.

PURPOSE: Lateral abdominal hernias are inherently challenging surgical entities. As such, there has been an increase in the adoption of robotic platforms to approach these challenging hernias. Our study aims to assess and compare outcomes between open (oLAHR) and robotic (rLAHR) lateral abdominal hernia repair using a national hernia-specific database. METHODS: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative was performed to include all adult patients who underwent elective lateral hernia repair. A propensity score match analysis was conducted, and univariate analyses were conducted to compare these two surgical modalities across perioperative timeframes. RESULTS: The database identified 2569 patients. Our analysis matched 665 patients to either the open or robotic groups. The median length of stay, surgical site occurrences (SSO), and surgical site occurrences requiring procedural interventions (SSOPI) were higher in the oLAHR versus the rLAHR group. Overall, oLAHR had a significantly higher rate of having any post-operative complications or any SSO/SSOPI. There was no difference in quality-of-life measures between groups at 30 days and 1 year. CONCLUSION: Robotic abdominal hernia repair is a safe alternative compared to the open repair of lateral abdominal hernias with better perioperative outcomes. Despite having a longer operative time, the robotic approach can offer a significantly shorter length of stay and an overall lower rate of complications. Ultimately, there is no difference in the quality-of-life measures both at 30 days and 1 year between the open and robotic approaches.

A comparison of outcomes between class-II and class-III obese patients undergoing robotic ventral hernia repair: a multicenter study.

BACKGROUND: Morbid obesity has been considered a contraindication to ventral hernia repair (VHR) in the past. However, the relationship between a greater body mass index (BMI) and adverse outcomes has yet to be established in the minimally invasive sphere, particularly with robotics, which may offer an effective surgical option in these high-risk patients. We sought to investigate this relationship by comparing the outcomes of class-II (BMI: 35-39.9 kg/m2) and class-III (BMI: ≥ 40 kg/m2) obese patients after robotic VHR (RVHR). METHODS: Data were analyzed from two centers and six surgeons who performed RVHR between 2013 and 2020. Patients with a BMI > 35 kg/m2 were included in the study. A 1:1 propensity score match (PSM) analysis was conducted to obtain balanced groups and univariate analyses were conducted to compare the two groups across preoperative, intraoperative, and post-operative timeframes. Postoperative complications and morbidity were reported according to the Clavien-Dindo Classification and comprehensive complication index (CCI®) systems. RESULTS: From an initial cohort of 815 patients, 228 patients with a mean BMI of 39.7 kg/m2 were included in the study. PSM analysis stratified these into 69 patients for each of the class-II and class-III groups. When comparing matched groups, there were no differences in any of the variables across all timeframes, except for a higher rate of Polytetrafluoroethylene (PTFE)-based mesh use in the class-III group (39.1% vs 17.4%, p = 0.008). The estimated recurrence-free time was 76.4 months (95% CI = 72.5-80.4) for the class-II group and 80.4 months (95% CI = 78-82.8) for the class-III group. CONCLUSION: This multicenter study showed no difference in outcomes after RVHR between matched class-II and class-III obese patients.

In vitro effect of toothpaste with low fluoride combined with sodium trimetaphosphate on dentine erosion.

PURPOSE: This study sought to evaluate in vitro the effect of a dentifrice containing sodium trimetaphosphate (TMP) combined or not with low fluoride (500 ppm NaF) on dentine erosion of intrinsic origin. METHODS: Human root dentine blocks were selected based on surface microhardness and randomly allocated into five groups (n = 12): negative control (0 ppm F; no TMP); F500 (500 ppm NaF); F1500 (1500 ppm NaF-positive control); TMP (1% TMP); and F + TMP (500 ppm NaF + 1% TMP). The blocks were submitted to erosion cycles (3 ×/day) for 3 days (0.01 M HCl, pH 1.5-30 s), treatment (1 min-1:3 p/p dentifrice/distilled water) and remineralization (artificial saliva/120 min). Dentine alterations were determined according to the percentage of microhardness loss (%HL), surface loss (SL) and surface analysis by scanning electron microscopy. The data were analyzed using one-way ANOVA (p < 0.05). RESULTS: The values of SL and %HL in each group were, respectively: negative control (1.36 ± 0.36; 57.29 ± 14.14), F500 (1.46 ± 0.28; 65.66 ± 5.11), F1500 (1.52 ± 0.36; 61.66 ± 5.15), TMP (1.45 ± 0.45; 62.08 ± 3.83) and F + TMP (1.38 ± 0.42; 63.38 ± 6.47). There was no statistically significant difference in all the parameters (p = 0.873 and p = 0.152). CONCLUSION: The dentifrices containing TMP combined or not with fluoride were not able to prevent dentine erosion.

Does Medicaid payer status affect patient's shoulder outcomes after shoulder arthroplasty?

BACKGROUND: Low socioeconomic status and Medicaid insurance as a primary payer have been shown to influence resource utilization and risk-adjusted outcomes for total joint arthroplasty. The purpose of this study was to assess the effects of Medicaid primary payer status on outcomes following shoulder arthroplasty (SA). MATERIALS AND METHODS: A retrospective review of shoulder surgery patients was undertaken to identify a matched cohort of 51 patients who underwent SA and were stratified based on insurance type into two cohorts: 28 Medicaid (M) patients and 23 non-Medicaid (NM) patients. Baseline demographics, resource utilization, and outcomes were compared as well as pre-and-postoperative patient-reported outcomes (PRO) and functional scores. PRO scores included the American shoulder and elbow surgeons score (ASES), the Penn shoulder score (PSS), and the subjective shoulder value (SSV). RESULTS: There were no statistically significant differences in demographics, comorbidities, or preoperative baseline scores between the cohorts, except for age (M: 55.3 years; NM: 67.5 years; p ≤ 0.001) and smoking status (M: 13 patients; NM: 4 patients; p = 0.029). Medicaid patients showed a slightly higher rate of missed follow-ups (M: 1.1 vs. NM: 0.9; p = 0.370). All Medicaid and non-Medicaid patients experienced significant improvement on PRO scores and active forward flexion. Medicaid patients demonstrated equivalent final postoperative scores for ASES (M: 65; NM: 57; p = 0.454), PSS (M: 63; NM: 51; p = 0.242), SSV (M: 70; NM: 69; p = 1.0) and range of motion measurements. DISCUSSION: Overall results suggest that Medicaid patients can expect significant improvement after SA and the same level of PRO's compared to non-Medicaid-insured population. LEVEL OF EVIDENCE: Level III, Retrospective Comparative Design, Treatment Study.

Molecular characterisation of methicillin-resistant Staphylococcus aureus from chronically colonised cystic fibrosis paediatric patients in Brazil.

Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients has been associated with a more rapid decline in lung function, increased hospitalisation and mortality. The aim of this study was to evaluate the clonal relationships among 116 MRSA isolates from 12 chronically colonised CF pediatric patients over a 6-year period in a Rio de Janeiro CF specialist centre. Isolates were characterised by antimicrobial resistance, SCCmec type, presence of Panton-Valentine Leukocidin (PVL) genes and grouped according to DNA macrorestriction profile by pulsed-field gel electrophoresis (PFGE) and spa gene type. High resistance rates were detected for erythromycin (78%) and ciprofloxacin (50%) and SCCmec IV was the most common type (72.4%). Only 8.6% of isolates were PVL positive. High genetic diversity was evident by PFGE (39 pulsotypes) and of nine that were identified spa types, t002 (53.1%) and t539 (14.8%) were the most prevalent. We conclude that the observed homogeneity of spa types within patients over the study period demonstrates the persistence of such strain lineages throughout the course of chronic lung infection.

Relationship between hospital size and teaching status on outcomes for reverse shoulder arthroplasty.

BACKGROUND: The use of reverse shoulder arthroplasty (RSA) continues to grow with expanding indications and increased surgeon awareness. Previous data for other lower extremity joint replacements indicate that high-volume centers have better outcomes, with lower complication rates, decreased length of stay, and complications for both hemiarthroplasty and total shoulder arthroplasty. The purpose of this study is to evaluate the effects of hospital size and setting on adverse events for RSA. MATERIALS AND METHODS: The National Inpatient Sample database was queried for RSA performed using ICD-9 codes. Primary outcomes included length of stay (LOS), total hospital charges, discharge disposition, and postoperative complications. Odds ratios were used to assess the risk of inpatient postoperative complications. RESULTS: A weighted national estimate of 24,056 discharges for patients undergoing RSA was included in the study. Patients at larger hospitals experienced higher total charges, increased average LOS, and slightly higher complication rates compared to those of small and medium hospitals. Patients in larger hospitals had significantly increased rates of genitourinary and central nervous system complications, while patients in small/medium hospitals experienced higher rates of hematoma/seroma. CONCLUSION: Results from this study indicate that large and non-teaching hospitals overall tend to burden the patients with higher hospital charges, longer hospital stay, and more frequent non-routine discharges. Also, larger hospitals are associated with higher risk of genitourinary and central nervous system complications rates, whereas non-teaching hospitals are associated with lower risk of infection and higher risk of anemia after RSA. With the growth in RSA in the USA, continued attention needs to be placed on improving outcomes and resource utilization for RSA patients even in larger hospitals.

3D preoperative planning for humeral head selection in total shoulder arthroplasty.

BACKGROUND: Recreation of glenohumeral biomechanics and humeral anatomy has been shown to improve outcomes in shoulder arthroplasty. Recent research has focused on utilizing simulation software and intraoperative instrumentation to improve glenoid implant selection and positioning, but no study had evaluated the reliability of new features in 3D preoperative planning software for humeral planning in total shoulder arthroplasty. MATERIALS AND METHODS: Preoperative plans were created for 26 patients using three different simulation software programs: an independent preoperative planning simulation (IPPS) software (OrthoVis) and two automated manufacturers preoperative simulation systems: ArthrexVIP™ (AMPS I) and Tornier Blueprint™ 3D Planning (AMPS II). Preoperative plans were compared for reliability and consistency among different software systems based on available variables including humeral head diameter (HD) and head height (HH). RESULTS: The measured HD was consistent between the three systems with a maximum mean difference of 0.2 mm for HD among IPPS, AMPS I, and AMPS II (p = 0.964). There was a significant difference in measured humeral HH with 1.7 mm difference between IPPS and AMPS II (p ≤ 0.001). The strongest correlation when comparing humeral head measurements (diameter or height) obtained from all systems was seen between IPPS and AMPS I for humeral HD (r = 0.8; p ≤ 0.001). CONCLUSION: There was a high level of consistency between independent and manufacturer preoperative planning software for humeral head measurements. These preoperative planning systems can improve efficiency and workflow during surgery by guiding surgeons on implant size selection to optimally reconstruct the glenohumeral kinematics, in order to improve patient outcomes. LEVEL OF EVIDENCE: Level III, study of nonconsecutive patients and without a universally applied "gold" standard study of diagnostic test.

Aquatic macrophytes and trophic interactions: a scientometric analyses and research perspectives / Macrofitas aquáticas e interações tróficas: análise cienciométrica e perspectivas nas pesquisas

Abstract Aquatic macrophytes have a recognized role in ecosystem structuring and an important position in trophic cascades interactions, whose understanding is to improve water quality. In recent years, the number of studies on the role of aquatic macrophytes in trophic webs and interactions has increased, but South America has made little progress in research in the area. In this study, we investigated the main gaps and perspectives for future studies on macrophytes and trophic interactions, analyzing global publications, especially those conducted by South American researchers. We accessed publications using an international database (Thomson Reuters ISI-Web of Knowledge-(formerly Institute for Scientific Information)) from 1980 to 2015. We ranked each article by ecosystem and study approach, biological organization and interacting taxonomic groups (phytoplankton, periphyton, zooplankton, aquatic invertebrates, fish and birds), countries publishing in cooperation and affiliations. The results showed that published studies (n = 242) emphasizing aquatic plants in trophic interactions increased in 35 years. Comparing the contributions of the 32 countries investigated, those from South America as first affiliation, had few publications (n = 26) and in cooperation (n = 7). The largest volume of articles indexed by the researchers dealt with the dynamics and structure of aquatic assemblages, webs and trophic interactions. Ecosystems such reservoirs and wetlands have received little attention. Large numbers of studies have encompassed community-wide aquatic approaches, including in South American studies, the interactions between macrophytes, zooplankton and phytoplankton were the second most studied interactions of all indexed articles. Knowledge about trophic cascade and interactions has been successfully enhanced in several countries with the purpose of restructuring communities and restore water quality of many ecosystems. In summary, we conclude that studies in the area of trophic interactions mediated by macrophytes may be directed in a way to attenuate international asymmetries, encouraging the increase of scientific productivity in South America.

Resumo Macrófitas aquáticas tem reconhecida função na estruturação de ecossistemas e importante papel nas interações tróficas em cascata, cujo entendimento é chave para melhorar a qualidade da água. Nos últimos anos, o número de estudos sobre o papel das macrófitas aquáticas nas interações e teia trófica aumentaram mas, a América do Sul progrediu pouco em pesquisas na área. Nesse estudo investigamos as principais lacunas e perspectivas para estudos futuros sobre macrófitas e interações tróficas analisando publicações mundiais, especialmente aquelas conduzidas por pesquisadores sul-americanos. Acessamos publicações usando base de dados internacional (Thomson Reuters ISI Web of Knowledge) entre 1980 a 2015. Computamos para cada artigo a organização biológica e grupos taxonômicos em interação (fitoplâncton, perifíton, zooplâncton, invertebrados aquáticos, peixes e aves), ecossistema estudado e abordagem de pesquisa, a cooperação entre países da América do Sul e demais, além das filiações. Os resultados mostraram que estudos publicados (n = 242) enfatizando plantas aquáticas em interações tróficas cresceram em 35 anos. Comparando as contribuições dos 32 países investigados, aqueles da América do Sul apresentaram baixo número de indexações (n= 26), poucos em cooperação (n= 7). O maior volume de publicações indexadas pelos pesquisadores trataram sobre a dinâmica e estrutura das assembléias aquáticas, teias e interações tróficas. Reservatórios e áreas alagadas têm recebido pouca atenção. Grande número de estudos compreeenderam abordagems de toda comunidade aquática e interações entre macrófitas, fitoplâncton, zooplâncton e peixes. Em síntese, concluimos que estudos enfatizando as interações tróficas mediadas pelas macrófitas poderão ser direcionados de maneira a atenuar assimetrias internacionais, encorajando o aumento da produtividade científica na América do Sul. O conhecimento sobre as interações tróficas em cascata tem sido desenvolvido com sucesso em diversos países cujas finalidades tem sido reestruturar comunidades e restaurar a qualidade da água de muitos ecossistemas.

Período de adaptação a dietas com baixa ou alta fibra sobre a digestibilidade e as características fecais em cães / Adaptation period to diets with low or high fiber on digetibility and faecal characteristics in dogs

Objetivou-se avaliar três períodos de adaptação, cinco, 10 e 15 dias, a dietas com baixa ou alta fibra sobre a digestibilidade e características fecais. Foram utilizadas duas dietas, uma contendo 0% de casca de soja (0%CS) e outra com 15% de casca de soja (15%CS), fornecidas a 12 cães adultos. Ao final de cada período, houve coleta total de fezes para avaliação dos coeficientes de digestibilidade aparente (CDA), energia metabolizável (EM) e características fecais. Além disso, foi avaliada a palatabilidade das dietas. Como resultado, não houve efeito do período de adaptação sobre a digestibilidade das dietas (P>0,05). A dieta 15%CS apresentou menor CDA da matéria seca (MS) e EM, em relação à dieta 0%CS (P<0,05). A consistência fecal dos cães não diferiu entre as dietas e os períodos (P>0,05). Houve redução no pH e na amônia fecal dos cães alimentados com a dieta 15%CS (P<0,05), após 10 dias de alimentação. Não houve diferença na palatabilidade das dietas (P>0,05). Períodos de adaptação à dieta superiores a cinco dias não alteram a digestibilidade e a maioria das características fecais de cães, exceto a amônia fecal. A inclusão de 15%CS na dieta reduz a digestibilidade da MS e a EM, bem como o pH e a amônia fecal.(AU)

This study aimed to evaluate three periods of adaptation, 5, 10 and 15 days, to diets with low or high fiber on digestibility and fecal characteristics. Two diets were used, one containing 0% (0% SH) and one containing 15% soybean hulls (15% SH). Diets were provided to 12 adult dogs. At the end of each period there was total collection of feces to evaluate the apparent digestibility coefficients (ADC), metabolizable energy (ME) and fecal characteristics. We also evaluated diet palatability. There was no effect of the adaptation period on digestibility of diets (P> 0.05). The 15% SH diet reduced ADC of dry matter (DM) and ME, compared to the 0% SH diet (P< 0.05). Fecal consistency of the dogs did not differ among diets and periods (P> 0.05). There was a decrease in fecal pH and ammonia in dogs fed the diet with 15% SH (P< 0.05) after 10 days of feeding (P< 0.05). There was no difference in diet palatability (P> 0.05). Diet adaptation longer than 5 days did not alter the digestibility and most fecal characteristics of dogs, except for fecal ammonia. The inclusion of 15% SH in diet reduces DM digestibility and fecal pH and ammonia in dogs.(AU)

Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study.

BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.

Relación entre el piso del seno maxilar y las raíces de las piezas posteriores superiores, mediante tomografía computada / Relationship between maxillary sinus floor and the posterior upper teeth roots, by means of computed tomography

Objetivo: El objetivo de este estudio fue evaluar la frecuencia con que las raíces de premolares y molares superiores se encuentran dentro del seno maxilar. Conocer la relación entre dichas estructuras es importante para planificar los procedimientos endodónticos y quirúrgicos a ser realizados en esa región. Materiales y métodos: Se realizó el análisis cualitativo dinámico de 82 tomografías computadas de haz cónico (CBCT) unilaterales, analizándose 738 raíces correspondientes a premolares y molares de una sola hemiarcada superior. Se utilizó sala con iluminación controlada y la observación fue realizada por un solo examinador. El criterio de inclusión requería que la cortical inferior del seno maxilar debía ser visible para poder establecer la relación. Se utilizaron los tres planos tomográficos de visualización, permitiendo ajustes de brillo y contraste. La escala de clasificación de cada raíz consideró su relación como: dentro o fuera del seno maxilar. Los datos obtenidos fueron sometidos a las pruebas de Chi-cuadrado y Test Exacto de Fisher. Resultados: el primer premolar superior mostró una proyección hacia el interior del seno maxilar significativamente menor que las otras piezas dentarias posteriores (p>0.05), observándose su raíz vestibular sin proyección. La raíz palatina del primer premolar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% del total de las raíces analizadas (p<0,05). El segundo molar superior mostró considerable proximidad con el seno maxilar, pero con menor incidencia con relación a la raíz palatina del primer molar. Conclusión: los procedimientos endodónticos o quirúrgicos a realizarse en cercanía al seno maxilar deben considerar siempre la relación raíz/seno, para evitar maniobras que lo invadan. La raíz palatina del primer molar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% (AU)

Immunosuppressive monocytes (CD14+/HLA-DRlow/-) increase in childhood precursor B-cell acute lymphoblastic leukemia after induction chemotherapy.

In tumor microenvironment, immunosuppression is a common event and results from the inhibition of activated immune cells and generation of cells with immunosuppressive capacity, as some subtypes of monocytes. The aim of this study was to evaluate the presence of immunosuppressive CD14+/HLA-DRlow/- monocytes in pediatric patients with the diagnosis of B-cell acute lymphoblastic leukemia (B-ALL) and, moreover, verify whether the chemotherapeutic treatment has any effect on these cells. Peripheral blood (PB) and bone marrow (BM) samples were collected from 15 untreated pediatric patients. The presence of CD14+/HLA-DRlow/- monocytes was evaluated at diagnosis and in the end of induction chemotherapy by flow cytometry. CD14+/HLA-DRlow/- monocytes increase was observed in 60% (9/15) of the patients at the end of the induction therapy. We were able to detect an increase in CD14+/HLA-DRlow/- monocytes values in BM and PB samples of pediatric patients with B-ALL. This increase was observed in the end of induction chemotherapy, which leads us to believe that these changes probably could have been induced by the inflammatory process engendered by the cytotoxic treatment or by drugs used in the chemotherapy treatment. This finding may be useful to guide new therapeutic approaches contemplating immunomodulatory drugs that act in the depletion of immunosuppressive monocytes.

The effect of Medicaid payer status on patient outcomes following repair of massive rotator cuff tears.

BACKGROUND: The influence of socioeconomic status and insurance type has not been studied extensively for RCR, particularly not in the high risk massive RCT population. The purpose of this study is to identify relationships between Medicaid payer status and patient outcomes following massive RCR. METHODS: A retrospective review of shoulder surgery database identified 29 patients undergoing massive rotator cuff repair. Patients were stratified based on insurance type into two cohorts, Medicaid (14 patients) and non-Medicaid (15 patients). Missed routine follow-up appointments and comorbidities were recorded and compared between groups. Group comparisons were made for pre- and postoperative patient-reported and functional outcomes. Outcome scores included American Shoulder and Elbow Shoulder Score (ASES), the Penn Shoulder Score, and the Subjective Shoulder Value (SSV). A p value of < 0.05 was considered significant for all statistical analyses. RESULTS: Medicaid patients were on average 7.1 years younger than non-Medicaid patients (49.8 vs. 56.9 years, respectively), and remaining demographics were comparable between groups. Preoperative patient-reported outcomes were only significantly different for ASES and ASES pain (p = 0.010, 0.037). There was excellent average improvement for Medicaid patients but no significant differences compared to non-Medicaid patients for ASES (p = 0.630), PENN scores (p = 0.395), and SSV (p = 0.198). Medicaid patients also had a higher number of missed and canceled appointments (28%) compared to non-Medicaid patients (18%). CONCLUSION: Medicaid coverage will expand to millions of uninsured Americans under current healthcare reform. Medicaid patients with massive RCT appear to significantly improve with surgical treatment.

Species distribution, sequence types and antimicrobial resistance of Acinetobacter spp. from cystic fibrosis patients.

Acinetobacter spp. are important healthcare pathogens, being closely linked to antibiotic resistance and outbreaks worldwide. Although such species are rarely observed in patients with cystic fibrosis (CF), we describe the characteristics of 53 strains of Acinetobacter spp. isolated from the sputum of 39 Brazilian patients with CF. The species distribution was A. baumannii (n = 29), A. pittii (n = 13), A. nosocomialis (n = 8), A. seifertii (n = 1), A. soli (n = 1) and A. variabilis (n = 1) determined by partial rpoB gene sequencing. Sixteen strains (10 A. baumannii, 3 A. pittii and 3 A. nosocomialis) were multidrug-resistant (MDR) by disk diffusion test (30%) and eight MDR carbapenem-resistant A. baumannii strains harboured the bla OXA-23-like oxacillinase gene. Thirty-three sequence types (STs) were identified by multilocus sequence typing of which eight were novel (A. baumannii: 843, 844, 845, 847, 848; A. pitti: 643; A. nosocomialis: 862 and A. seifertii: 846); six STs (2 A. baumannii, 3 A. pittii and 1 A. nosocomialis) were found in more than one patient. Four strains of A. baumannii were assigned to two common clonal complexes (CCs), namely, CC1 (ST1, ST20 and ST160), and CC79 (ST79). This study underlines the extensive species diversity of Acinetobacter spp. strains in CF lung infections which may present difficulties for therapy due to significant antimicrobial resistance.

Fertility Life Table of Tetranychus palmarum Flechtmann & Noronha (Acari: Tetranychidae) in Oil Palm.

Some species of spider mites belonging to the Tetranychidae family are known to associate with oil palm (Elaeis guineensis Jacq. - Arecaceae). The occurrence of Tetranychus palmarum Flechtmann & Noronha (Acari, Tetranychidae) was verified on oil palm seedlings under greenhouse conditions in the State of Pará in Northern Brazil. Plants with colonies of T. palmarum presented yellowish spots on leaflets and leaves with chlorosis. The objective of this study was to access the biology and fertility life table of T. palmarum in E. guineensis leaves. The experiment was conducted under four constant temperatures, 22, 25, 28, and 31°C, at 70 ± 10% RH under a 12:12 LD photoperiod. The duration of the egg-to-adult period was 18.4 and 9.8 days, at 22 and 31°C, respectively. The parameters of the fertility life table showed that 28°C is most suitable for the development and reproduction of T. palmarum, with higher values for reproductive parameters (R o , r m , and λ) and lower values for duplicating the population (TD). Therefore, it is apparent that the best temperature conditions for the development of T. palmarum are found in the warmer regions of Brazil, such as those observed in northern Brazil.

Phylogenetic analysis, biofilm production, and antimicrobial resistance profile of Escherichia coli isolated from slaughtered pigs / Análise filogenética, produção de biofilme e perfil de resistência antimicrobiana de Escherichia coli isoladas de suínos abatidos

Enteric diseases of bacterial origin are frequent in the pig industry, of particular notoriety are the colibacillosis that mainly affect piglets and cause great damage to the swine industry worldwide. The aim of the study was to analyze phylogenetics, to detect biofilm production, and to determine antimicrobial resistance profile in 126 strains of Escherichia coli isolated from swabs obtained from fragments of the small intestines of 235 healthy pigs killed in slaughterhouses in Pernambuco (Brazil) using polymerase chain reaction (PCR), adherence to microplates test and disc diffusion technique. Of the analyzed samples, 88.10% (111/126) were classified in phylogenetic group B1; 4.76% (6/126) in group D; 3.97% (5/126) in group B2 and, 3.17% (4/126) in group A. Antimicrobial resistance rates observed were: lincomycin 100% (126/126), erythromycin 100% (126/126), chlortetracycline 94.44% (119/126), cephalothin 51.59% (65/126), ampicillin 38.89% (49/126), sulfamethoxazole + trimethoprim 37.3% (47/126), ciprofloxacin 19.84% (25/126), norfloxacin 14.29% (18/126), gentamicin 8.73% (11/126) and, chloramphenicol 5.55% (7/126). Multiple antibiotic resistance (MAR) ranged from 0.2 to 0.9. Of the strains tested 46.03% (58/126) produced biofilm, and 99.21% (125/126) of the strains exhibited multi-resistance. Further studies are required to elucidate the importance of each phylogenetic group in pigs and to prevent the propagation of multi-resistant E. coli strains.(AU)

Doenças entéricas de origem bacteriana são frequentes na indústria de suínos, destacando-se a colibacilose, que afeta principalmente leitões e causa grandes danos à indústria suína em todo o mundo. Cento e vinte e seis cepas de Escherichia coli foram isoladas de swabs obtidos de fragmentos de intestino delgado de 235 suínos saudáveis abatidos em matadouros de Pernambuco (Brasil). O objetivo do presente estudo foi analisar filogeneticamente essas cepas, bem como detectar a produção de biofilme e determinar o perfil de resistência antimicrobiana delas, utilizando-se a reação em cadeia da polimerase (PCR), o teste de adesão em microplacas e a técnica de disco-difusão. 88,10% (111/126) das amostras foram classificadas no grupo filogenético B1; 4,76% (6/126) no grupo D; 3,97% (5/126) no grupo B2; e 3,17% (4/126) no grupo A. As taxas de resistência antimicrobiana observadas foram: lincomicina 100% (126/126), eritromicina 100% (126/126), clortetraciclina 94,44% (119/126), cefalotina 51,59% (65/126), ampicilina 38,89% (49/126), sulfametoxazol + trimetoprima 37,3% (47/126), ciprofloxacina 19,84% (25/126), norfloxacina 14,29% (18/126), gentamicina 8,73% (11/126) e cloranfenicol 5,55% (7/126). O índice de resistência múltipla (IRMA) variou de 0,2 a 0,9. Entre as amostras, 46,03% (58/126) produziram biofilme e 99,21% (125/126) foram multirresistentes. São necessários mais estudos para elucidar a importância de cada grupo filogenético em suínos e evitar a propagação de estirpes de E. coli multirresistentes.(AU)

Anticorpos anti-Toxoplasma gondii em carcarás (Caracara plancus) procedentes da região aeroportuária do Recife, Pernambuco, Brasil / Antibodies to Toxoplasma gondii in Crested Caracara (Caracara plancus) from Recife Airport, Pernambuco, Brazil

Objetivou-se com este estudo pesquisar a ocorrência de anticorpos anti-Toxoplasma gondii em carcarás (Caracara plancus) capturados no Aeroporto Internacional do Recife/Guararapes Gilberto Freyre, Pernambuco, Brasil. Foram analisadas 115 amostras de soros sanguíneos pelo teste de aglutinação modificada (IgG, MAT≥25) utilizando taquizoítos inativados em formalina. Do total de amostras analisadas, 5,21% (6/115) foram positivas para presença de anticorpos anti-T. gondii, 16,67% com título 1:25 (1/06) e 83,33% (5/06) com título 1:50. A ocorrência de anticorpos em carcarás procedentes de região aeroportuária fomenta a preocupação em relação a aspectos ainda pouco elucidados, relacionados principalmente à inserção de aves silvestres na cadeia epidemiológica da toxoplasmose conectada à ação antrópica, tornando próxima a interação entre animais silvestres, domésticos e o homem. Dessa forma, é notória a necessidade de estudos relacionados à dinâmica de transmissão entre os diferentes genótipos existentes nessa tríade e sua relação com o meio ambiente, a fim de determinar a influência dessa espécie animal na cadeia epidemiológica da toxoplasmose.(AU)

The objective of this study was to investigate the occurrence of antibodies against Toxoplasma gondii in carcarás (Caracara plancus) captured in the Recife/Guararapes Gilberto Freyre International Airport, in the State of Pernambuco, Brazil. 115 samples of blood sera were tested by the Modified Agglutination Test technique (IgG, MAT > 25) using tachyzoites inactivated in formalin. Of the total of the analyzed samples, 5,21% (6/115) were positive for the presence of antibodies against T. gondii, 16,67% with a titer of 1:25 (1/06) and 83,33% (5/06) with a titration of 1:50. The occurrence of antibodies in caracaras coming from airport region generate concern about aspects still poorly understood, mainly related to the inclusion of wild birds in the epidemiological chain of toxoplasmosis connected to human action, making close interaction between wild animals, domestic and man. Thus, the need for studies related to the dynamics of transmission between the different existing genotypes in this triad is evident as is its relationship with the environment to determine the influence of this animal species in the epidemiological chain of toxoplasmosis.(AU)