[Impact of the ''Enhanced Recovery After Surgery'' program in knee arthroplasty at the institutional level]. / Impacto del programa ''Enhanced Recovery After Surgery'' en artroplastía de rodilla a nivel institucional.

INTRODUCTION: total knee arthroplasty has gained popularity over decreasing pain, restoring mobility and improving patients' quality of life. At the institutional level, there is no multidisciplinary model in the treatment of our patients, and in our environment, physical rehabilitation starts late, making it difficult for patients to reincorporate and attain adequate pain control. MATERIAL AND METHODS: a controlled, randomized, prospective and longitudinal study was conducted, 55 patients underwent total knee arthroplasty, assigned to two study groups: the ERAS (enhanced recovery after surgery) group (n = 27) and the usual group (n = 28). Inclusion criteria were patients with Kellgren-Lawrence classification grade 4 gonarthrosis, age between 30-70 years and follow-up for six months. Descriptive statistics were performed using medians and interquartile range, while inferential statistics were performed using the Kruskal-Wallis test. RESULTS: the results obtained at six months showed no statistically significant differences in age (p = 0.327) and gender (p = 0.588). The results obtained in the scales of VAS, WOMAC and IKDC showed statistically significant difference (p = 0.000). The rapid recovery group with a 120° flexion median and the usual group with 90° flexion, both groups with 0° extension. CONCLUSIONS: the enhanced recovery after surgery pathway in joint replacement procedures showed good results on pain, function, mobility and complications compared to patients undergoing usual management.

INTRODUCCIÓN: la artroplastía total de rodilla ha ganado popularidad sobre la disminución del dolor, restablecer la movilidad y mejorar la calidad de vida de los pacientes. A nivel institucional, no existe un modelo multidisciplinario en el tratamiento de nuestros pacientes y en nuestro medio la rehabilitación física se inicia de manera tardía, dificultando la reincorporación de los pacientes y el control analgésico. MATERIAL Y MÉTODOS: se realizó un estudio clínico controlado, aleatorizado, prospectivo y longitudinal que incluyó 55 pacientes sometidos a artroplastía de rodilla, asignados a dos grupos de estudio: el grupo ERAS (Enhanced Recovery After Surgery) (n = 27) y el grupo habitual (n = 28). Los criterios de inclusión fueron pacientes con gonartrosis grado IV de Kellgren y Lawrence, edad comprendida entre 30-70 años y seguimiento de seis meses. La estadística descriptiva se realizó mediante medianas y rango intercuartílico, mientras la estadística inferencial mediante la prueba de Kruskal-Wallis. RESULTADOS: los resultados obtenidos a los seis meses no mostraron diferencias estadísticas significativas de edad (p = 0.327) y género (p = 0.588). Los resultados obtenidos en las escalas de EVA, WOMAC e IKDC mostraron diferencia estadística significativa (p = 0.000). El grupo de recuperación rápida con una mediana de flexión de 120° y el grupo habitual con flexión de 90°, ambos grupos con extensión de 0°. CONCLUSIONES: el programa de recuperación rápida en procedimientos de remplazo articular, mostró buenos resultados sobre el dolor, función, movilidad y complicaciones en comparación con los pacientes sometidos al manejo habitual.

[Functional results of a rapid recovery program compared to the usual protocol in total knee arthroplasty]. / Resultados funcionales de un programa de recuperación rápida comparado con el protocolo habitual en artroplastía total de rodilla.

INTRODUCTION: rapid recovery programs in joint replacement surgery are effective in developed countries; The objective of this study was to evaluate the functional outcomes of a rapid recovery program in our population and to compare them with the results of the usual protocol. MATERIAL AND METHODS: a randomized single blinded clinical trial was conducted with patients who were candidates for total knee arthroplasty (n = 51) recruited from May 2018 to December 2019. group A (n = 24) received a rapid recovery program and group B (n = 27) received the usual protocol, with follow-up for 12 months. For statistical analysis, the Student's t test (parametric continuous variables), Kruskal-Wallis (nonparametric continuous variables) and the chi-square test (categorical variables) were used. RESULTS: statistically significant differences were found between groups in pain at two months (group A 3.4 ± 1.3 vs group B 4.2 ± 1.4, p = 0.04) and six months (1 ± 0.8 vs 1.7 ± 1.2, p = 0.01), with the WOMAC questionnaire at two months (group A 74.5 ± 7.2 vs group B 67.2 ± 7.5, p 0.01), six months (88.7 ± 5.3 vs 83.0 ± 4.8, p 0.01) and 12 months (90.1 ± 4.5 vs 86.7 ± 4.3, p 0.01), and with the IDKC questionnaire at two months (group A 62.9 ± 7.0 vs group B 55.9 ± 6.1, p 0.01), six months (74.3 ± 2.7 vs 71.1 ± 3.9, p 0.01) and 12 months (75.4 ± 3.0 vs 72.6 ± 3.5, p 0.01). CONCLUSIONS: the results obtained in this study suggest that the implementation of these programs can be a safe and effective alternative in terms of reducing pain and functional capacity in our population.

INTRODUCCIÓN: los programas de recuperación rápida en cirugía de reemplazo articular son eficaces en países desarrollados; el objetivo de este estudio fue evaluar los resultados funcionales de un programa de recuperación rápida en nuestra población y comprarlos con los resultados del protocolo habitual. MATERIAL Y MÉTODOS: se realizó un ensayo clínico no ciego simple aleatorizado con pacientes candidatos a artroplastía total de rodilla (n = 51) reclutados de Mayo de 2018 a Diciembre de 2019. El grupo A (n = 24) recibió un programa de recuperación rápida y el grupo B (n = 27) recibió el protocolo habitual, con seguimiento durante 12 meses. Para el análisis estadístico se utilizó la prueba de t de Student (variables continuas paramétricas), Kruskal-Wallis (variables continuas no paramétricas) y la prueba de 2 (variables categóricas). RESULTADOS: se encontraron diferencias estadísticamente significativas entre grupos en el dolor a los dos meses (grupo A 3.4 ± 1.3 versus grupo B 4.2 ± 1.4, p = 0.04) y seis meses (1 ± 0.8 versus 1.7 ± 1.2, p = 0.01), con el cuestionario WOMAC a los dos meses (grupo A 74.5 ± 7.2 versus grupo B 67.2 ± 7.5, p 0.01), seis meses (88.7 ± 5.3 versus 83.0 ± 4.8, p 0.01) y 12 meses (90.1 ± 4.5 versus 86.7 ± 4.3, p 0.01) y con el cuestionario IDKC a los dos meses (grupo A 62.9 ± 7.0 versus grupo B 55.9 ± 6.1, p 0.01), seis meses (74.3 ± 2.7 versus 71.1 ± 3.9, p 0.01) y 12 meses (75.4 ± 3.0 versus 72.6 ± 3.5, p 0.01). CONCLUSIONES: los resultados obtenidos en este estudio sugieren que la implementación de estos programas puede ser una alternativa segura y eficaz en cuanto a la disminución del dolor y a la capacidad funcional en nuestra población.

Experimental transmission of a herpesvirus in Greek tortoises (Testudo graeca).

An experimental transmission study aimed at fulfilling Koch's postulates for a herpesvirus-associated stomatitis-rhinitis in Mediterranean tortoises is presented. Clinical, pathologic, serologic, and molecular studies were performed linking tortoise herpesvirus with the pathogenesis of stomatitis-rhinitis. Four adult Greek tortoises received either intranasally or intramuscularly two tortoise herpesvirus isolates by primary experimental infection and secondary challenge 11 months later. After the primary experimental infection and the secondary challenge, clinical signs of illness developed, which included conjunctivitis, diphtheritic oral plaques, and oral discharge. At 4 weeks after the secondary challenge, all tortoises were humanely euthanatized and evaluated. Although neutralizing antibodies developed after the primary experimental infection, they apparently did not prevent the later development of recurrent clinical signs. Polymerase chain reaction (PCR) and reverse transcription-PCR analyses allowed sensitive characterization of the systemic distribution of the herpesvirus DNA sequences and their presence in the cranial nerves and brains of the infected tortoises. Despite the failure to recover the herpesviruses used in the transmission study, the findings support the premise that tortoise herpes-virus is a primary pathogen of Greek tortoises.

Fate of plasmid DNA encoding infectious bursal disease virus VP2 capsid protein gene after injection into the pectoralis muscle of the chicken.

The objective of this study was to determine whether recombinant plasmid DNA injected intramuscularly into chickens expressed the gene of interest in vivo and could be subsequently detected in primary and secondary lymphoid tissues with polymerase chain reaction (PCR). The VP2 capsid protein gene of the standard challenge strain (STC) of infectious bursal disease virus (IBDV) was cloned into a eukaryotic plasmid, and purified DNA was prepared. Fourteen 2-wk-old chickens were injected in the pectoral musculature with 500 microg of plasmid DNA dissolved in sterile PBS. Seven chickens were similarly injected with PBS alone. Pectoral muscle, thymus, spleen, bursa of Fabricius, and cecal tonsils were collected at 12, 24, 36, 48, 72, 96, and 168 h postinjection for detection of protein expression (in muscle) and to extract total DNA for PCR amplification of the VP2 capsid gene. Expression of VP2 was demonstrated in muscle tissue at 12 and 24 h postinjection by using an indirect immunofluorescence assay. PCR amplification with primers specific for the VP2 gene showed that the DNA was present in the thymus, spleen, and bursa of Fabricius but not in cecal tonsils. These results demonstrate that plasmid DNA injected directly into the pectoral muscle of chickens is transcribed and translated at the injection site and promptly distributed to primary and secondary lymphoid tissues.

Expression of the major core structural protein (VP7) of bluetongue virus, by a recombinant capripox virus, provides partial protection of sheep against a virulent heterotypic bluetongue virus challenge.

A recombinant capripox virus was constructed containing a cDNA copy of genome segment 7 of bluetongue virus (BTV) serotype 1 from South Africa (BTV 1SA), which expressed high levels of the major BTV core protein VP7 in infected lamb testis (LT) cells. Sheep vaccinated with this recombinant virus developed antibodies to VP7 (detected by ELISA) but no neutralizing antibodies to either the homologous or heterologous BTV serotype, prior to challenge (BTV 1 or BTV 3, respectively). Following challenge with a virulent heterotypic strain of BTV (BTV3 SA), all of the animals developed clinical signs of disease, indicating that they were infected and that the challenge virus did replicate. While all of the control animals died, six of the eight animals that were vaccinated with the recombinant capripox virus expressing VP7 recovered fully. This is the first report of a significant level of cross serotype protection against the lethal effects of a challenge with virulent BTV, produced by vaccination with a single BTV core protein, which did not generate a neutralizing antibody response.

Recombinant capripoxvirus expressing the hemagglutinin protein gene of rinderpest virus: protection of cattle against rinderpest and lumpy skin disease viruses.

A cDNA clone containing the complete coding sequence of the hemagglutinin (H) protein gene of the RBOK vaccine strain of rinderpest virus, under the control of the vaccinia late promoter p11, was inserted by homologous recombination into the thymidine kinase gene of the KS-1 strain of capripoxvirus. The recombinant virus produced authentic H protein as judged by its electrophoretic mobility, transport to the cell surface of infected lamb testis cells, and reactivity with monoclonal antibodies specific for the H protein of rinderpest virus. The recombinant virus induced significant levels of rinderpest virus neutralizing antibodies in vaccinated cattle and protected them from clinical rinderpest after challenge with a lethal dose of a highly virulent heterologous strain of the virus. Protection was achieved using vaccine doses lower than those used with a similar recombinant expressing the fusion protein gene of rinderpest. The parental KS-1 virus is widely used as a vaccine against capripox viruses and so the rinderpest recombinant acts as a dual vaccine to protect cattle against both rinderpest and lumpy skin disease.

Protection of cattle against rinderpest and lumpy skin disease with a recombinant capripoxvirus expressing the fusion protein gene of rinderpest virus.

Cattle were protected against challenge with rinderpest and lumpy skin disease viruses by vaccination with a recombinant capripoxvirus containing the fusion protein (F) gene of rinderpest virus. The minimum protective immunising doses for rinderpest and lumpy skin disease were 5.5 x 10(4) plaque forming units (pfu) and 1.5 x 10(3) pfu, respectively.

Single capripoxvirus recombinant vaccine for the protection of cattle against rinderpest and lumpy skin disease.

A recombinant capripoxvirus has been constructed containing a full-length cDNA of the fusion protein gene of rinderpest virus. The gene was inserted in the thymidine kinase gene of the capripox genome under the control of the vaccinia virus major late promoter p11 together with the Escherichia coli gpt gene in the opposite orientation under the control of the vaccinia early/late promoter p7.5. A vaccine prepared from this recombinant virus protected cattle against clinical rinderpest after a lethal challenge with a virulent virus isolate. In addition, the vaccine protected the cattle against lumpy skin disease.

Non-pathogenic strains of Aujeszky's disease virus are not reactivated in swine after corticosteroid treatment

The Bartha-K and NIA-4 strain of Aujeszky's disease virus (ADV) were readily isolated from oropharyngeal swabs up to 7 days after intranasal vaccination of young piglets. Neither strain could be reisolated 14 days after starting treatment with 10 mg of the corticosteroid isoflupredone acetate per kg of body weight, administered intramuscularly for 4 consecutive days when pigs were 7-9 months of age. Similar treatment with corticosteroid pigs infected with two virulent ADV strains resulted in the reactivation of infection and recovery of ADV from oropharyngeal swabs. Serum neutralizing antibodies were present in all pigles vaccinated twice (2 week interval) intranasally with the attenuated ADV strains, 4 weeks after primary vaccination. However, these antibodies were no longer detectable in some pigs at 12(NIA-4) and 20(Bartha-K) weeks of age even in undilluted sera. Neutralizing antibodies resulting from infection virulent ADV were always detectable, were higher in titer than those produced by the vaccine strains and did not vary in a clear pattern after corticosteroid treatment. These results indicated that the Bartha-K and NIA-4 strains undergo little or no latency in swine and confirm the latency of virulent strains of ADV

Experimental transmission of bovine leukosis virus by leucocytes recovered from the stable fly Stomoxys calcitrans L.

1. Wild stable flies (Stomoxys calcitrans) feeding on heifers infected with bovine leukosis virus (BLV) carried viable bovine leucocytes in the midgut and proboscis that, when inoculated by the subcutaneous route into lambs aged 5 to 60 days, elicited the development of antibodies to glycoprotein (gp51) and polypeptide 25 (p25). 2. Antibodies were detected as early as one month later and persisted for an experimental period of 24 or 36 months. Uninoculated control lambs reared together with the experimental animals did not acquire the infection, indicating the lack of horizontal transmission. 3. S. calcitrans reared in the laboratory were intermittently allowed to feed on the skin of BLV-infected heifers and on five lambs over a period of 3-10 months. Although some of these lambs were bitten about 500 times, none developed antibodies to BLV (gp51 or p25) over observation periods of 30 or 36 months.

Experimental transmission of bovine leukosis virus by leucocytes recovered from the stable fly Stomoxys calcitrans L

1. Wild stable flies (stomoxys calcitrans) feeding on heifers infected with bovine leukosis virus (BLV) carried viable bovine leucocytes in the midgut and proboscis that, when inoculated by the subcutaneous route into lambs aged 5 to 60 days, elicited the development of antibodies to glycoprotein (gp51) and polipeptide 25 (p25). 2. Antibodies were detected as early as one month later and persisted for an experimental period of 24 or 36 months. Uninoculated control lambs reared to gether with the experimental animals did not acquire the infection, indicating the lack of horizontal transmission. 3. S. calcitrans reared in the laboratory were intermittently allowed to feed on the skin of BLV-infected heifers and on five lambs over a period of 3-10 months. Although some of these lambs were bitten about 500 times, none developed antibodies to BLV (gp51 or p25) over observation periods of 30 or 36 months

Experimental vaccination of rabbits with non-pathogenic strains of Aujeszky's disease virus

1. The Bartha K and NIA-4 strains of Aujeszky's disease virus (ADV) were non-pathogenic for rabbits vaccinated once or twice by nasal instillation or intramuscular injection. Neutralizing antibodies were detected in 68% of the rabbits two weeks after primary vaccination and in al rabbits at challenge. 2. Challenge doses of virulent ADV greater than 10**5.0 median tissue culture infective doses (TCID50) resulted in the death of most vaccinated and all unvaccinated rabbits with typical signs of Aujeszky's disease withing 4 days. ADV was recovered from braim and lung suspensions of vaccinated and unvaccinated rabbits who had died as a result of the challenge. 3. When the challenge dose was reduced to approximately 10**3.0 TCID50, rabbits vaccinated twice survived while al unvaccinated controls died within 3 days

Transmission of bovine leukaemia virus in milk.

Nineteen calves born to dams free of bovine leukaemia virus (BLV) did not possess maternally derived precipitating antibody to BLV in their sera after the ingestion of colostrum. Eight of these calves remained serologically negative after being fed milk from BLV-free cows while three (27.3%) of 11 similar calves that had been fed milk from BLV-infected cows developed antibody. Forty-four of 47 calves born to BLV-infected dams acquired maternal antibody to BLV after ingesting colostrum. Two (8.7%) of the 23 calves fed milk from BLV-free cows developed antibody to BLV probably as a result of transplacental or colostrum infection whereas four (16.7%) of the 24 calves fed milk from BLV-infected cows developed antibody. It is concluded that milk transmission of BLV is responsible in part for the high rates of infection encountered in our dairy herds and that calves lacking specific maternal antibody are more susceptible to BLV infection through the ingestion of milk than are calves with maternal antibody.

Transmission of bovine leukemia virus through milk ingestion.

Foi utilizada a prova de imunodifusao para detectar a presenca de anticorpos contra a glicoproteina maior (gp 51) do virus da leucemia bovina (VLB), para avaliar o desenvolvimento da infeccao em bezerros alimentados com leite de vacas livres e infectadas com o virus da leucemia. Os bezerros recem-nascidos receberam o colostro das maes durante cinco dias e depois tres litros de leite, diariamente, por periodos que variaram entre 11 e 49 dias. Todos os animais em experimentacao foram sangrados mensalmente ate os oito meses de idade, para acompanhar o aparecimento dos anticorpos como evidencia da infeccao. O VLB foi transmitido a um dos quatro bezerros (25,0%) sem anticorpos maternos, depois da ingestao de leite de vacas infectadas. Como testemunhos foram utilizados tres bezerros sem anticorpos maternos e 10 com anticorpos maternos que nao adquiriram a infeccao pelo VLB, apos a ingestao de leite de vacas nao-infectadas, por periodos similares. Concluiu-se que o VLB e eliminado no leite de vacas infectadas e se constitui numa fonte de infeccao para bezerros recem-nascidos

Enzootic bovine leukosis virus in Brazil.

A sero-epidemiological survey for antibodies to the glycoprotein of enzootic bovine leukosis virus showed that the infection is widely disseminated in the State of Rio de Janeiro, Brazil. Sero from 1,290 females and 154 males from 12 dairy herds were tested by the agar gel precipitin test. Seven hundred and one females (54.3%) and 68 males (44.2%) were found to have specific antibodies. These antibodies were demonstrated in all 7 age groups tested. The older age groups contained the highest percentage of reactors. The results are briefly discussed in relation to management practices and environmental conditions.

Prevalencia de anticorpos contra o virus da papilomatose bovina no Estado do Rio de Janeiro. / Bovine papilloma virus antibodies in the State of Rio de Janeiro

Soros de 1174 bovinos, de 10 rebanhos leiteiros do Estado do Rio de Janeiro, foram testados para anticorpos contra o virus de papillomatose bovina, utilizando-se a microprova de imunodifusao em agar. A especificidade das reacoes foi confirmada quando grupos de particulas virais foram observados nas linhas de precipitacao, pela microscopia eletronica. Anticorpos de origem materna foram demonstrados em 18,3% dos bezerros, menores de tres meses de idade, enquanto que anticorpos so foram demonstrados em 2,0% dos bezerros, entre quatro e seis meses de idade. Anticorpos tambem foram demonstrados em 21,5% dos bezerros, entre sete e 12 meses de idade; em 25% dos animais, entre 13 e 18 meses de idade; em 21,2% dis animais, entre 19 e 30 meses de idade; em 23,7% dos animais, entre 31 e 48 meses de idade e em 23,1% dos animais, maiores de 49 meses de idade

The prevention of natural and experimental avian lymphoid leukosis with the androgen analogue mibolerone.

The development of lymphoid leukosis tumours induced by RAV-1, RAV-2, and field lymphoid leukosis viruses was prevented in chickens by feeding a diet containing the androgen analogue mibolerone (17beta-hydroxy-7a, 17-dimethylestr-4-en-3-one) at low levels during the first 7 weeks of life. Chickens fed mibolerone developed neutralising antibodies after inoculation with RAV-1, RAV-2, and after contact exposure to viraemic-tolerant chickens. Mibolerone did not affect the immunological tolerance status of chickens which were viraemic when hatched. Moreover, mibolerone did not seem to change the pattern of shedding of lymphoid leukosis viruses or group specific antigen in unincubated chicken eggs from infected hens. Mibolerone, thus, prevents the development of lymphoid leukosis tumours without interfering with the cycle of infection of lymphoid leukosis viruses.

Vaccination immunity to selected diseases in chickens fed the androgen analog mibolerone.

Chickens fed the androgen analog mibolerone during the first 7 weeks of life regress their bursa of Fabricius but can be properly immunized by vaccination against avian pathogens of major economic importance such as Newcastle disease virus, infectious laryngotracheitis virus, avian encephalomyelitis virus, infectious bronchitis virus, fowl pox virus, Marek's disease virus, and Pasteurella multocida, the pathogen causing fowl cholera. These findings on immunocompetence to infectious agents are important because we have previously shown that the administration of mibolerone prevents the development of lymphoid leukosis tumors.