Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases.

BACKGROUND: Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. OBJECTIVES: To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). METHODS: Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. RESULTS: Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. CONCLUSIONS: This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.

The Personalized Parkinson Project: examining disease progression through broad biomarkers in early Parkinson's disease.

BACKGROUND: Our understanding of the etiology, pathophysiology, phenotypic diversity, and progression of Parkinson's disease has stagnated. Consequently, patients do not receive the best care, leading to unnecessary disability, and to mounting costs for society. The Personalized Parkinson Project (PPP) proposes an unbiased approach to biomarker development with multiple biomarkers measured longitudinally. Our main aims are: (a) to perform a set of hypothesis-driven analyses on the comprehensive dataset, correlating established and novel biomarkers to the rate of disease progression and to treatment response; and (b) to create a widely accessible dataset for discovery of novel biomarkers and new targets for therapeutic interventions in Parkinson's disease. METHODS/DESIGN: This is a prospective, longitudinal, single-center cohort study. The cohort will comprise 650 persons with Parkinson's disease. The inclusion criteria are purposely broad: age ≥ 18 years; and disease duration ≤5 years. Participants are followed for 2 years, with three annual assessments at the study center. Outcomes include a clinical assessment (including motor and neuro-psychological tests), collection of biospecimens (stool, whole blood, and cerebrospinal fluid), magnetic resonance imaging (both structural and functional), and ECG recordings (both 12-lead and Holter). Additionally, collection of physiological and environmental data in daily life over 2 years will be enabled through the Verily Study Watch. All data are stored with polymorphic encryptions and pseudonyms, to guarantee the participants' privacy on the one hand, and to enable data sharing on the other. The data and biospecimens will become available for scientists to address Parkinson's disease-related research questions. DISCUSSION: The PPP has several distinguishing elements: all assessments are done in a single center; inclusion of "real life" subjects; deep and repeated multi-dimensional phenotyping; and continuous monitoring with a wearable device for 2 years. Also, the PPP is powered by privacy and security by design, allowing for data sharing with scientists worldwide respecting participants' privacy. The data are expected to open the way for important new insights, including identification of biomarkers to predict differences in prognosis and treatment response between patients. Our long-term aim is to improve existing treatments, develop new therapeutic approaches, and offer Parkinson's disease patients a more personalized disease management approach. TRIAL REGISTRATION: Clinical Trials NCT03364894 . Registered December 6, 2017 (retrospectively registered).

Expanding the view of Clock and cycle gene evolution in Diptera.

We expanded the view of Clock (Clk) and cycle (cyc) gene evolution in Diptera by studying the fruit fly Anastrepha fraterculus (Afra), a Brachycera. Despite the high conservation of clock genes amongst insect groups, striking structural and functional differences of some clocks have appeared throughout evolution. Clk and cyc nucleotide sequences and corresponding proteins were characterized, along with their mRNA expression data, to provide an evolutionary overview in the two major groups of Diptera: Lower Diptera and Higher Brachycera. We found that AfraCYC lacks the BMAL (Brain and muscle ARNT-like) C-terminus region (BCTR) domain and is constitutively expressed, suggesting that AfraCLK has the main transactivation function, which is corroborated by the presence of poly-Q repeats and an oscillatory pattern. Our analysis suggests that the loss of BCTR in CYC is not exclusive of drosophilids, as it also occurs in other Acalyptratae flies such as tephritids and drosophilids, however, but it is also present in some Calyptratae, such as Muscidae, Calliphoridae and Sarcophagidae. This indicates that BCTR is missing from CYC of all higher-level Brachycera and that it was lost during the evolution of Lower Brachycera. Thus, we can infer that CLK protein may play the main role in the CLK\CYC transcription complex in these flies, like in its Drosophila orthologues.

Runs of homozygosity: current knowledge and applications in livestock.

This review presents a broader approach to the implementation and study of runs of homozygosity (ROH) in animal populations, focusing on identifying and characterizing ROH and their practical implications. ROH are continuous homozygous segments that are common in individuals and populations. The ability of these homozygous segments to give insight into a population's genetic events makes them a useful tool that can provide information about the demographic evolution of a population over time. Furthermore, ROH provide useful information about the genetic relatedness among individuals, helping to minimize the inbreeding rate and also helping to expose deleterious variants in the genome. The frequency, size and distribution of ROH in the genome are influenced by factors such as natural and artificial selection, recombination, linkage disequilibrium, population structure, mutation rate and inbreeding level. Calculating the inbreeding coefficient from molecular information from ROH (FROH ) is more accurate for estimating autozygosity and for detecting both past and more recent inbreeding effects than are estimates from pedigree data (FPED ). The better results of FROH suggest that FROH can be used to infer information about the history and inbreeding levels of a population in the absence of genealogical information. The selection of superior animals has produced large phenotypic changes and has reshaped the ROH patterns in various regions of the genome. Additionally, selection increases homozygosity around the target locus, and deleterious variants are seen to occur more frequently in ROH regions. Studies involving ROH are increasingly common and provide valuable information about how the genome's architecture can disclose a population's genetic background. By revealing the molecular changes in populations over time, genome-wide information is crucial to understanding antecedent genome architecture and, therefore, to maintaining diversity and fitness in endangered livestock breeds.

Keratinocytes and neutrophils are important sources of proinflammatory molecules in hidradenitis suppurativa.

BACKGROUND: The pathogenesis of the chronic inflammatory skin disease hidradenitis suppurativa (HS, also known as acne inversa) involves epidermal alterations such as psoriasiform epidermal hyperplasia and keratin plugging. Keratinocytes are an important source of proinflammatory molecules in inflammatory skin diseases and can be stimulated by interleukin (IL)-17(+) cells. OBJECTIVES: To explore the possible role of the epithelium in the pathogenesis of HS. METHODS: We performed immunohistochemical stainings and Western blot experiments to investigate the localization and expression of inflammation-associated molecules, including the cytokine IL-17, components of the inflammasome including caspase-1, and the endogenous danger-associated molecular pattern molecules S100A8 and S100A9 (calprotectin). To examine a possible effect of upregulated proinflammatory cytokines on the inflammatory infiltrate, differences in the cellular composition of perifollicular and deep dermal infiltrates were analysed. RESULTS: The number of IL-17(+) cells is increased in lesional and perilesional HS skin. The epidermis produces proinflammatory molecules and shows an upregulated expression of components of the NLRP3 inflammasome, activated caspase-1 and expression of S100A8/S100A9. Additionally, the course of the inflammatory process in HS involves influx of innate immune cells, particularly IL-17-expressing neutrophils. CONCLUSIONS: IL-17-producing cells are present in lesional and perilesional HS skin and may contribute to the initiation of inflammatory processes. Furthermore, the epidermis is a source of proinflammatory cytokines, shows inflammasome activation and expresses S100A8/S100A9, thereby possibly contributing to the propagation of inflammation. A massive influx of IL-17-expressing neutrophils is observed in the deep infiltrate.

Effects of packaging, mineral oil coating, and storage time on biogenic amine levels and internal quality of eggs.

This study was carried out with the aim of evaluating the effects of mineral oil application on eggshells and the use of plastic packages with lids on the physical-chemical and microbiological quality and biogenic amine contents of eggs stored under refrigeration for up to 125 d. A total of 1,920 eggs from 46-wk-old Hyline W36 laying hens were randomly distributed into 4 groups soon after classification: (i) 480 eggs were stored in pulp carton tray packages; (ii) 480 eggs were stored in plastic packages with lids; (iii) 480 eggs were stored in carton packages after the application of mineral oil; and (iv) 480 eggs were stored in plastic packages with lids after the application of mineral oil. The internal quality was measured by Haugh units, by the counts of mesophilic and psychrotrophic microorganisms, by the most probable number of total and thermal-tolerant coliforms, by the counts of molds and yeasts, by the analysis of Salmonella spp. and Staphylococcus spp., and by the levels of biogenic amines in the egg yolk and albumen. The application of mineral oil to the eggshell resulted in higher Haugh unit values throughout storage, and the use of plastic packages altered the internal quality. The application of mineral oil and the use of packaging had no effects on the microbiological and biogenic amine results. Microbiological analyses showed the absence of Salmonella spp., Staphylococcus aureus, thermal-tolerant coliforms, and fungi. However, the highest counts of mesophilic (1.1 × 10(7) cfu/g) and psychrotrophic (6.7 × 10(7) cfu/g) microorganisms were recorded. The highest values of biogenic amines detected and quantified were putrescine (2.38 mg/kg) and cadaverine (7.27 mg/kg) in the egg yolk and putrescine (1.95 mg/kg), cadaverine (2.83 mg/kg), and phenylethylamine (2.57 mg/kg) in the albumen. Despite these results, the biogenic amine levels recorded were considered low and would not be harmful to consumer health.

Bioactive amines and microbiological quality in pasteurized and refrigerated liquid whole egg.

The objective of this study was to evaluate the correlation between the levels of bioactive amines and the microbiological quality of liquid pasteurized egg stored under refrigeration. Pasteurized whole egg liquid was obtained from 2 types of different raw materials, fresh eggs, and commercial fertile eggs. They were stored under refrigeration over a period of 21 d. The treatments were arranged in a completely randomized split plot, with the plots being the 2 types of liquid pasteurized egg, and the subplots being the 4 storage periods (1, 7, 14, and 21 d). The storage period did not contribute to the increase (P > 0.05) of contamination by mesophilic aerobic microorganisms and total coliforms in commercial liquid pasteurized egg. However, for fertile eggs, the storage period led to an increase (P < 0.05) in the numbers of microorganisms. Levels of the amines putrescine, cadaverine, and tyramine were detected only in fertile liquid pasteurized egg, and the storage period contributed to the increase (P < 0.05) in the levels of these amines. There was a high correlation between total coliform most probable number and cadaverine levels, and a moderate correlation between the numbers of aerobic mesophilic microorganisms and tyramine levels. It was concluded that the most contaminated liquid pasteurized eggs were the fertile liquid pasteurized eggs and this caused the highest levels of bioactive amines in them compared with all the eggs that had been subjected to pasteurization and refrigerated storage.

Enteric, hepatic and muscle tissue development of goat kids fed with lyophilized bovine colostrum.

The objective of this study was to investigate the development of the enteric, hepatic and muscle tissues in goat kids fed with lyophilized bovine colostrum in the transition period of passive immunity to early active immunity. At 0, 7 and 14 h of life, 15 male newborns received 5% of their body weight of lyophilized bovine colostrum and 14 male newborns received goat colostrum, both with 55 mg/ml of IgG. Samples of the duodenum, jejunum, ileum, liver and muscle were collected at 18, 36 and 96 h of life to quantify total protein, DNA and RNA contents. In the jejunum and ileum, the highest levels of total protein and higher protein/RNA ratio were observed at 18 h (p < 0.05). There were no differences in DNA contents in any intestinal segment (p > 0.05). At 96 h, maximum levels of RNA were observed in the jejunum and ileum (p < 0.05) and higher RNA/DNA ratio in the three intestinal segments (p < 0.05), showing increased ability to synthesize intracellular RNA and proteins. The LBC group showed higher protein content and higher protein/DNA and protein/RNA ratios in the jejunum, a higher DNA content in the liver (p < 0.05) and a higher protein/RNA ratio in the muscle tissue (p < 0.05). In the muscle, higher protein and DNA levels were also found at 96 h (p < 0.05). Indicators of cellular activity suggest greater absorption of proteins from lyophilized bovine colostrum and increased cell maturity in the enteric and muscle tissues in the first hours of goat kids' life.

Feeding resource partitioning between two understorey insectivorous birds in a fragment of Neotropical cloud forest.

The food habits and niche overlap based on diet composition and prey size of two species of understorey insectivorous birds were investigated in an area of montane rain forest in the state of Minas Gerais, southeastern Brazil. A total of 43 birds were captured: 33 individuals of Conopophaga lineata (Conopophagidae) with 13 recaptures, and 10 individuals of Myiothlypis leucoblephara (Parulidae) with 12 recaptures, from which were obtained respectively 33 and 10 fecal samples. Fragments of 16 groups of arthropods, plus insect eggs, were identified in these samples. Conopophaga lineata predominantly consumed Formicidae (32%) and Isoptera (23.6%). However, the index of alimentary importance (AI) of Isoptera (3.53) was lower than other groups such as Formicidae (AI = 61.88), Coleoptera (AI = 16.17), insect larvae (AI = 6.95) and Araneae (AI = 6.6). Myiothlypis leucoblephara predominantly consumed Formicidae (28.2%) and Coleoptera (24.4%), although Coleoptera and Hymenoptera non-Formicidae had the highest values of AI (38.71 and 22.98 respectively). Differences in the proportions of the types of arthropods consumed by birds were not enough to reveal their separation into feeding niches (overlap = 0.618, p observed ≤ expected = 0.934), whereas differences in the use of resources was mainly due to the size of the prey (p<0.001), where C lineata, the species with the highest body mass (p<0.001) consumed larger prey. It is plausible that prey size is an axis of niche dimension that allows the coexistence of these species.

Exophiala jeanselmei causing late endophthalmitis after cataract surgery.

PURPOSE: To report two cases of late endophthalmitis caused by Exophiala jeanselmei after cataract surgery. METHODS: Case reports, including clinical evaluation, direct examination, and culture of the aqueous humor. RESULTS: In each case, samples from the anterior chamber had positive growth of yeasts with toruloid hyphae and pseudohyphae. Intravitreal and anterior chamber amphotericin B were used in both cases. Apparent clinical resolution was achieved, but after 3 months in one case and 6 months in the other the infection recurred more aggressively, with severe endophthalmitis leading to ocular atrophy. CONCLUSION: E. jeanselmei causes a severe intraocular infection and isolation, and identification of the agent ensures proper diagnosis and treatment. After clinical resolution of the infection, careful and long-term follow-up is recommended to promptly detect relapse and immediately reintroduce treatment.

Early rhegmatogenous retinal detachment following laser in situ keratomileusis for high myopia.

PURPOSE: Four eyes had early rhegmatogenous retinal detachment within 3 months of laser in situ keratomileusis (LASIK) for correction of high myopia using the microkeratome, Clear Corneal Molder. METHODS: In two eyes, retinal detachment resulted from horseshoe tears, one occurring in an otherwise normal region of the retina and the other at the margin of an area of lattice degeneration detected during preoperative examination. The first eye was treated with retinopexy using a 287 encircling scleral exoplant, drainage of subretinal fluid, and laser photocoagulation by indirect ophthalmoscopy. The other eye was treated with pneumatic retinopexy and cryotherapy. In the other eyes, retinal detachment was the result of giant tears with no evidence of prior retinal degeneration. These eyes were treated with pars plana vitrectomy, fluid-gas exchange with 15% perfluoropropane (C3F8), endolaser photocoagulation, and a 42 encircling scleral exoplant. RESULTS: After treatment, the first two eyes achieved spectacle-corrected visual acuity of 20/40. In the last two eyes, final spectacle-corrected visual acuity was 20/400 in one eye and light perception in the other. CONCLUSIONS: Although no cause-effect relationship between LASIK and retinal detachment can be stated, these cases suggest that LASIK may be associated with retinal detachment, particularly in highly myopic eyes. Further studies are necessary to determine high-risk patient characteristics.

Decontamination of human sclera: an in vitro study.

PURPOSE: The human sclera is frequently used in ophthalmic surgeries and must be preserved in disinfectants that prevent its contamination. In this study the efficiency of glycerin, absolute alcohol (ethanol), and benzalkonium chloride (1:5,000) as human sclera disinfectants were compared. METHODS: Fresh human scleras were trephined, the scleral disks divided into three groups and contaminated with Staphylococcus aureus (ATCC 29213), Pseudomonas aeruginosa (ATCC 27853), or Bacillus cereus (ATCC 11778) for 24 h. Thereafter they were transferred to preservation vials each containing glycerin, absolute alcohol, benzalkonium chloride diluted in 70% alcohol (1:5,000) or Trypticase Soy Broth (control), respectively, and stored at room temperature. From each vial, two scleral disks were removed after 1, 2, 3, 4, 7, 10, and 14 days of immersion. Both were plated on blood agar, one being macerated, and both incubated at 37 degrees C for 48 h. RESULTS: Pseudomonas aeruginosa, S. aureus, and B. cereus were recovered from the glycerin-immersed scleral disks until the second, fourth, and fourteenth days, respectively. Bacillus cereus was recovered from those immersed in absolute alcohol until the fourteenth day, whereas disks infected with the other microorganisms and immersed in absolute alcohol presented no growth since the very first day of immersion. Bacillus cereus was recovered from scleral disks immersed in benzalkonium chloride diluted in 70% alcohol (1:5,000) only on the first day. CONCLUSION: Resistant microorganisms can survive in scleral tissue preserved in glycerin and absolute alcohol. We conclude that benzalkonium chloride diluted in 70% alcohol (1:5,000) in vitro is the best disinfectant for human sclera after 24 h.

Aerobic bacterial conjunctival flora in diabetic patients.

OBJECTIVE: To study the aerobic conjunctival flora of diabetic patients and its relation to the presence and level of diabetic retinopathy and the duration of the disease. METHODS: One hundred three patients from the diabetic retinopathy screening program of the Federal University of São Paulo with no evidence of ocular surface disease were included. The diabetic patient cohort was compared with 60 nondiabetic subjects. All patients underwent slit-lamp evaluation, conjunctival scrapings, and indirect ophthalmoscopy. RESULTS: The frequency of positive conjunctival cultures was significantly higher in the diabetic group (94.18%) than in the nondiabetic group (73.33%). Among diabetic patients, a significantly higher frequency of positive cultures was detected in those with diabetic retinopathy than in those without retinopathy. Neither the duration of the diabetes nor the hypoglycemic therapy correlated with the culture results. Coagulase-negative Staphylococcus was the most common microorganism isolated, and its identification was more frequent in patients with retinopathy than in those without diabetic retinopathy. CONCLUSION: Diabetic patients have a significantly higher number of positive conjunctival cultures. The presence of diabetic retinopathy was correlated with an increase in positive cultures and a higher proportion of coagulase-negative Staphylococcus.

Transretinal feeder vessel ligature in von Hippel-Lindau disease.

PURPOSE: To present a new technique called transretinal feeder vessel ligature for the treatment of retinal angiomas. METHODS: Case report of a patient with peripheral retinal angiomas previously treated unsuccessfully with photocoagulation who responded to this new, alternative surgical treatment. RESULTS: The retinal angiomas decreased in size although two new feeder vessels appeared and the lesions showed a regression pattern after additional laser therapy over the vascular tumors. CONCLUSIONS: A transretinal feeder vessel ligature in association with vitrectomy and photocoagulation may be useful for some advanced or non-responsive cases of retinal angiomas.

Case report: Long-term outcome of class II division 1 malocclusion treated with rapid palatal expansion and cervical traction.

A case of a Class II Division 1 malocclusion with reduced transpalatal width and unfavorable axial inclinations of the posterior teeth is reported. Rapid palatal expansion (RPE) was used for maxillary enhancement and molar distalization therapy to correct the anteroposterior dental discrepancy. This case report illustrates the results of the method of treatment used with a long-term (16-year-posttreatment) follow-up.

[Amyotrophic lateral sclerosis with deafness: report of a case and review of the literature]. / Esclerose lateral amiotrófica com surdez: relato de um caso e revisão da literatura.

A case of chronic bulb-pontine paralysis with deafness, with early onset, coursing along nine years is reported. There seem to be histopathologic and electromyographic evidences on which is concluded to be a variant form of juvenile amyotrophic lateral sclerosis (Van Laere form).

[Evaluation of inflammatory activity in chronic osteomyelitis. Contribution of scintigraphy with polyclonal antibodies]. / Avaliação de atividade inflamatória na osteomielite crônica. Contribuição da cintilografia com anticorpos policlonais.

BACKGROUND: Active chronic osteomyelitis or complicating osteomyelitis are difficult to be diagnosed by radiological imaging modalities, such as plain radiograph and CT. They frequently cause increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater infection avidity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99m. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. MATERIAL AND METHODS: 23 bone segments with suspected active chronic osteomyelitis or violated bone osteomyelitis were studied by Tc-99m-IgG scintigraphy. All patients underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs, compared with clinical evaluation and laboratory tests values. RESULTS: Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc-99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%, 88 and 82%. CONCLUSION: Tc-99m-IgG may be usefull in the scintigraphic evaluation of osteomyelitis.

Viabilidade econômica da produção de frangos de corte sob diferentes estruturas de governança / Economic viability of broiler production under different governance structures

Objetivou-se verificar a viabilidade econômica da produção de frangos de corte sob mecanismos de governança híbrida e hierárquica. Estudos de caso foram escolhidos para avaliação da atividade em núcleos de empresas integradoras e de produtores rurais integrados. Realizou-se pesquisa de campo para coleta de dados em 36 unidades de produção em Minas Gerais. Informações provenientes de 216 lotes produzidos entre agosto de 2015 e agosto de 2016 foram utilizadas nas análises econômicas. O cálculo dos custos baseou-se na metodologia proposta pela Embrapa - CNPSA e IEA - SP. As análises econômicas se realizaram conforme proposto pelo DAE - Ufla e pela Conab. Constatou-se que o custo com mão de obra causou maior impacto sobre o desempenho econômico de núcleos com estruturas de governança distintas. No modelo de produção via governança hierárquica, mesmo se considerando receitas secundárias ao processo de produção de aves, verificou-se prejuízo financeiro na atividade. Concluiu-se que a estrutura de governança híbrida representou melhor alternativa econômica que a internalização do processo de criação de frangos pelas empresas integradoras. Assim, sugere-se que empresas integradoras esgotem as possibilidades de produção via contrato de integração antes de investirem recursos em instalações próprias de criação.(AU)

The objective was to verify the economic feasibility in the production of broilers under hybrid and hierarchical governance mechanisms. Case studies were used to evaluate the activity of the integrating company and the integrated rural producers. The primary data about costs, income, and zootechnical indicators were collected in 36 poultry production units belonging to an integrated company and five rural producers, in state of Minas Gerais. Data from 216 batches of broilers produced between August 2015 and August 2016 were used in the economic analysis. Costs calculation was based on the methodology proposed by EMBRAPA - CNPSA and IEA - SP. The economic analyzes were carried out as proposed by DAE UFLA and CONAB. It was verified that the cost of labor caused the greatest impact on the economic performance of cores with different governance structures. In all breeding sites via hierarchical governance, even considering secondary revenues, there was a financial loss in the activity. It was concluded that the hybrid governance represented a better economic alternative than the internalization of the broiler production by integrating companies. Thus, it is suggested that integrating companies deplete the production possibilities through an integration contract before investing resources in their own breeding facilities.(AU)

[Microbiology of diabetic foot infections: role of ertapenem]. / Microbiologia das infecções no pé diabético: o papel do ertapenem.

Many patients with diabetes develop foot ulcers that are very susceptible to infections which may place the patients at risk for lower-limb amputation. Such infections require adequate management with antibiotics. The authors performed a systematic analysis and critical review of studies with the dual aim of assessing bacterial profiles and antimicrobial susceptibility patterns in patients with diabetic foot infections using various methods for sample collection and evaluating the safety and efficacy of ertapenem as initial empirical treatment for such infections. Following a selection of only studies with adequate description of methods for pathogen isolation and antibiogram determination, nine studies were included. The need for adequate prospective multicenter studies to assess the value of empirical antibiotic regimens for diabetic foot became evident and the conclusions were as follows: proper identification of causative agents, appropriate antibiotic therapy and management of complications in these infections are essential to achieve a successful outcome; the sampling procedure is extremely important in the evaluation of the microbial flora of the foot ulcer; susceptibility testing should be performed routinely at least for those species with unpredictable resistance; and ertapenem has been shown to be useful in the treatment of a wide range of moderate-to-severe lower extremity infections in a broad spectrum of patients.