Detection and genetic characterization of enteric viruses in diarrhoea outbreaks from swine farms in Spain.

BACKGROUND: The aim of this work was to study the prevalence and distribution of Porcine astrovirus (PAstV), Porcine kobuvirus (PKoV), Porcine torovirus (PToV), Mammalian orthoreovirus (MRV) and Porcine mastadenovirus (PAdV) as well as their association with widely recognized virus that cause diarrhoea in swine such as coronavirus (CoVs) and rotavirus (RVs) in diarrhoea outbreaks from Spanish swine farms. Furthermore, a selection of the viral strains was genetically characterized. RESULTS: PAstV, PKoV, PToV, MRV and PAdV were frequently detected. Particularly, PAstV and PKoV were detected in almost 50% and 30% of the investigated farms, respectively, with an age-dependent distribution; PAstV was mainly detected in postweaning and fattening pigs, while PKoV was more frequent in sucking piglets. Viral co-infections were detected in almost half of the outbreaks, combining CoVs, RVs and the viruses studied, with a maximum of 5 different viral species reported in three investigated farms. Using a next generation sequencing approach, we obtained a total of 24 ARN viral genomes (> 90% genome sequence), characterizing for first time the full genome of circulating strains of PAstV2, PAstV4, PAstV5 and PToV on Spanish farms. Phylogenetic analyses showed that PAstV, PKoV and PToV from Spanish swine farms clustered together with isolates of the same viral species from neighboring pig producing countries. CONCLUSIONS: Although further studies to evaluate the role of these enteric viruses in diarrhoea outbreaks are required, their wide distribution and frequent association in co-infections cannot be disregard. Hence, their inclusion into routine diagnostic panels for diarrhoea in swine should be considered.

Infectious abortions in small domestic ruminants in the Iberian Peninsula: Optimization of sampling procedures for molecular diagnostics.

Introduction: Infectious abortions have a major impact on small domestic ruminant farms, i.e., sheep and goats, both in terms of profitability and health status. Therefore, rapid and sensitive diagnosis is essential to minimize losses. Currently, molecular techniques, such as qPCR, are routinely used for their diagnosis, which imply the need to manipulate all abortive material, with consequent biosafety risks. Here, we evaluate the frequency of the main abortifacient pathogens in small domestic ruminants in the Iberian Peninsula and also assess an alternative approach for the optimization of sampling for molecular diagnosis. Results: A total of 392 clinical cases were analyzed from April 2020 to May 2021, evidencing that the main causative agents of abortion detected were Coxiella burnetii (49.0%), Chlamydia abortus (38.3%) and, to a lesser extent, Toxoplasma gondii (10.2%), Salmonella enterica (7.1%) and Campylobacter spp. (6.1%). An uneven distribution of these pathogens was observed between ruminant species, with a higher frequency (p < 0.05) of T. gondii, S. enterica and Campylobacter spp. in sheep than goat abortions, and among geographic areas, highlighting the higher frequency (p < 0.05) of T. gondii and Campylobacter spp. in the north compared to southeastern Spain. The alternative sampling method, consisting on the use of fetal tongues and placental swabs in replacement of the whole fetus and placental tissue, offered a very good agreement with the classical method for all pathogens, except for low concentrations of C. burnetii, which seems to have a doubtful role in abortion when its concentration in the abortifacient material is low. Conclusions: This study reveals a high frequency of infectious etiology in abortions of small domestic ruminants in the Iberian Peninsula and validates for the first time an alternative sampling method for molecular diagnosis that will help to provide rapid and accurate results while minimizing biosafety risks.

Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up.

The purpose of the present study was to compare the clinical and subjective outcomes of anterior cruciate ligament (ACL) reconstruction using an autologous hamstring double bundle (DB) with a single bundle (SB) after a 10-year follow-up. A prospective comparative cohort study was performed of 47 consecutive patients with ACL rupture included between May 2006 and March 2008. Inclusion criteria were less than 2 years since the injury date, no previous surgery on the affected knee, and having closed growth plates. Patients were divided into two groups: (1) SB group (n = 25) and (2) DB group (n = 22). Patients underwent evaluation before surgery and at 1 and 10 years postoperatively. The clinical evaluation included the International Knee Documentation Committee (IKDC) Questionnaire, pivot shift test, and single hop test, as well as X-rays (anterior drawer X-rays on a Telos stress radiography). Range of motion (ROM) was assessed at 10-year follow-up. Both groups were similar in terms of baseline characteristics. Post hoc power analysis showed that among 30 and 226 patients would be needed for statistical significance, depending on the outcome. With the numbers available, no significant differences were observed in subjective IKDC, anterior stability (measured with Telos), and functional test outcomes (single hop test) between both groups at 1 and 10 years postoperatively. Regarding rotational instability (pivot-shift test), DB group was significantly superior (p = 0.002). Regarding ROM, no significant differences were observed between groups. No failure was registered in any of the groups. ACL reconstruction (ACLR) with an autologous hamstring, both with bundles and DB, shows overall better outcomes compared with the status before surgery. DB ACLR provides better rotational control of the knee, an outcome that is maintained after 10 years.

Genomic Insights into the Mobilome and Resistome of Sentinel Microorganisms Originating from Farms of Two Different Swine Production Systems.

Antimicrobial resistance (AMR) is a threat to public health due to long-term antimicrobial use (AMU), which promotes the bacterial acquisition of antimicrobial resistance determinants (ARDs). Within food-producing animals, organic and extensive Iberian swine production is based on sustainable and eco-friendly management systems, providing an excellent opportunity to evaluate how sustained differences in AMU impact the development and spread of AMR. Here, through a whole-genome sequencing approach, we provide an in-depth characterization of the resistome and mobilome and their interaction in 466 sentinel bacteria, namely, Escherichia coli, Enterococcus spp., Campylobacter coli, and Staphylococcus spp., recovered from 37 intensive and organic-extensive pig farms. Both ARDs and mobile genetic elements (MGEs) were primarily taxon-associated, with higher similarities among bacteria which were closely phylogenetically related. E. coli exhibited the most diverse resistome and mobilome, with 85.4% mobilizable ARDs, 50.3% of which were plasmid-associated. Staphylococcus spp. exhibited a broad repertoire of ARDs and MGEs, with 52.3% of its resistome being mobilizable. Although Enterococcus spp. carried the highest number of ARDs per isolate and its plasmidome was similar in size to that of E. coli, 43.7% of its resistome was mobilizable. A narrow spectrum of ARDs constituted the C. coli resistome, with point mutations as its main AMR driver. A constrained AMU, as observed in organic-extensive herds, determined a reduction in the quantitative composition of the resistome and the complexity of the resistome-mobilome interaction. These results demonstrate taxon-associated AMR-MGE interactions and evidence that responsible AMU can contribute to reducing AMR pressure in the food chain. IMPORTANCE This study provides the first integral genomic characterization of the resistome and mobilome of sentinel microorganisms for antimicrobial resistance (AMR) surveillance from two different swine production systems. Relevant differences were observed among taxa in the resistomes and mobilomes they harbored, revealing their distinctive risk in AMR dissemination and spread. Thus, Escherichia coli and, to a lesser extent, Staphylococcus spp. constituted the main reservoirs of mobilizable antimicrobial resistance genes, which were predominantly plasmid-associated; in contrast to Campylobacter coli, whose resistome was mainly determined by point mutations. The reduced complexity of mobilome-resistome interaction in Enterococcus spp. suggested its limited role in AMR dissemination from swine farms. The significant differences in antimicrobial use among the studied farms allowed us to assess the suitability of whole-genome sequencing as a rapid and efficient technique for the assessment of mid- to long-term on-farm interventions for the reduction of antimicrobial use and the evaluation of AMR status.

Characterization and cross-protection of experimental infections with SeCoV and two PEDV variants.

The aim of this study was to characterize the infection of weaned pigs with swine enteric coronavirus (SeCoV) - a chimeric virus most likely originated from a recombination event between porcine epidemic diarrhoea virus (PEDV) and transmissible gastroenteritis virus, or its mutant porcine respiratory coronavirus - and two PEDV G1b variants, including a recently described recombinant PEDV-SeCoV (rPEDV-SeCoV), as well as to determine the degree of cross-protection achieved against the rPEDV-SeCoV. For this purpose, forty-eight 4-week-old weaned pigs were randomly allocated into four groups of 12 animals. Piglets within each group were primary inoculated with one of the investigated viral strains (B: PEDV; C: SeCoV and D: rPEDV-SeCoV) or mock-inoculated (A), and exposed to rPEDV-SeCOV at day 20 post-infection; thus, group A was primary challenged (-/rPEDV-SeCoV), groups B and C were subjected to a heterologous re-challenge (PEDV/rPEDV-SeCoV and SeCoV/rPEDV-SeCoV, respectively), and group D to a homologous re-challenge (rPEDV-SeCoV/rPEDV-SeCoV), Clinical signs, viral shedding, microscopic lesions and specific humoral and cellular immune responses (IgG, IgA, neutralizing antibodies and IgA and IFN-γ-secreting cells) were monitored. After primo-infection, all three viral strains induced an undistinguishable mild-to-moderate clinical disease with diarrhoea as the main sign and villus shortening lesions in the small intestine. In homologous re-challenged pigs, no clinical signs or lesions were observed, and viral shedding was only detected in a single animal. This fact may be explained by the significant high level of rPEDV-SeCoV-specific neutralizing antibodies found in these pigs before the challenge. In contrast, prior exposure to a different PEDV G1b variant or SeCoV only provided partial cross-protection, allowing rPEDV-SeCoV replication and shedding in faeces.

Combined in-vitro and on-farm evaluation of commercial disinfectants used against Brachyspira hyodysenteriae.

BACKGROUND: Swine dysentery (SD) is a severe infectious disease with a relevant impact on pig production usually caused by Brachyspira hyodysenteriae, although B. hampsonii causes an identical clinical picture. SD control relies on antimicrobials, good management practices and strict biosecurity with cleaning and disinfection as crucial tools to avoid the pathogen transmission. This study evaluates the in-vitro efficacy of an array of commercial disinfectants against a collection of B. hyodysenteriae isolates using broth tests. The efficacy of cleaning and disinfection protocols was also evaluated on two farms with endemic SD using surface swabs collected in emptied pens before and after cleaning and disinfection procedures, using both real-time PCR and bacterial microbiological culture. RESULTS: Most of the commercial disinfectants evaluated were effective against all B. hyodysenteriae isolates tested, with a reduction of more than 5.00 log10 CFU/mL (bactericidal efficacy of 99.999%). However, some isolates exhibited reduced susceptibility to Virkon-S and Limoseptic disinfectants. The evaluation of cleaning and disinfection protocols on farms with SD outbreaks showed that approximately half the pens tested (n = 25) were positive by real-time PCR after pigs removal (mean B. hyodysenteriae counts 5.72 ± 1.04 log10 CFU/mL) while almost 20% of the pens remained positive after cleaning (n = 7) and disinfection (n = 5) procedures although with significantly lower, mean estimates (4.31 ± 0.43 log10 CFU/mL and 4.01 ± 0.55 log10 CFU/mL, respectively). CONCLUSIONS: These results show the efficacy of disinfectants against B. hyodysenteriae but also stress the need to implement adequately the cleaning and disinfection protocols on pig farms and review and revise their efficiency periodically.

In vitro activity of essential oils against microbial isolates from otitis externa cases in dogs.

Despite the number of studies focused on the potential use of essential oils (EOs) as an alternative to conventional treatments of canine external otitis, there is controversy about their antimicrobial activity which could be explained by differences in technical or biological aspects. This study focuses on the antimicrobial activity of three single EO compounds (thymol, cinnamaldehyde and carvacrol) and two EOs (clove and oregano) against clinical isolates recovered from canine otitis externa cases (14 bacterial isolates belonging to five different genera and six Malassezia pachydermatis isolates). All compounds showed activity and cinnamaldehyde exhibited the highest bactericidal and fungicidal activity. The susceptibility was lower among bacterial isolates than fungal isolates, being this difference more evident for Gram-positive bacteria. No relationship between antibiotic multi-resistant profile and susceptibility to compounds was observed. To sum up, our results provide appropriate information about appropriate concentrations of promising candidates for the topic treatment of canine otitis.

Microbial colonization and resistome dynamics in food processing environments of a newly opened pork cutting industry during 1.5 years of activity.

BACKGROUND: The microorganisms that inhabit food processing environments (FPE) can strongly influence the associated food quality and safety. In particular, the possibility that FPE may act as a reservoir of antibiotic-resistant microorganisms, and a hotspot for the transmission of antibiotic resistance genes (ARGs) is a concern in meat processing plants. Here, we monitor microbial succession and resistome dynamics relating to FPE through a detailed analysis of a newly opened pork cutting plant over 1.5 years of activity. RESULTS: We identified a relatively restricted principal microbiota dominated by Pseudomonas during the first 2 months, while a higher taxonomic diversity, an increased representation of other taxa (e.g., Acinetobacter, Psychrobacter), and a certain degree of microbiome specialization on different surfaces was recorded later on. An increase in total abundance, alpha diversity, and ß-dispersion of ARGs, which were predominantly assigned to Acinetobacter and associated with resistance to certain antimicrobials frequently used on pig farms of the region, was detected over time. Moreover, a sharp increase in the occurrence of extended-spectrum ß-lactamase-producing Enterobacteriaceae and vancomycin-resistant Enterococcaceae was observed when cutting activities started. ARGs associated with resistance to ß-lactams, tetracyclines, aminoglycosides, and sulphonamides frequently co-occurred, and mobile genetic elements (i.e., plasmids, integrons) and lateral gene transfer events were mainly detected at the later sampling times in drains. CONCLUSIONS: The observations made suggest that pig carcasses were a source of resistant bacteria that then colonized FPE and that drains, together with some food-contact surfaces, such as equipment and table surfaces, represented a reservoir for the spread of ARGs in the meat processing facility. Video Abstract.

In vitro Assessment of Antiviral Effect of Natural Compounds on Porcine Epidemic Diarrhea Coronavirus.

Organic acid and essential oils (EOs), well-known antimicrobials, could also possess antiviral activity, a characteristic which has not been completely addressed up to now. In this study, the effect of two organic acids (formic acid and sodium salt of coconut fatty acid distillates) and two single EO compounds (thymol and cinnamaldehye) was evaluated against porcine epidemic diarrhea virus (PEDV). The concentration used for each compound was established by cytotoxicity assays in Vero cells. The antiviral activity was then evaluated at three multiplicities of infection (MOIs) through visual cytopathic effect (CPE) evaluation and an alamarBlue assay as well as real-time reverse-transcription PCR (RT-qPCR) and viral titration of cell supernatants. Formic acid at at a dose of 1,200 ppm was the only compound which showed antiviral activity, with a weak reduction of CPE caused by PEDV. Through the alamarBlue fluorescence assay, we showed a significant anti-CPE effect of formic acid which could not be observed by using an inverted optical microscope. RT-qPCR and infectivity analysis also showed that formic acid significantly reduced viral RNA and viral titers in a PEDV MOI-dependent manner. Our results suggest that the antiviral activity of formic acid could be associated to its inhibitory effect on viral replication. Further studies are required to explore the anti-PEDV activity of formic acid under field conditions alone or together with other antiviral agents.

Detection and Genetic Diversity of Porcine Coronavirus Involved in Diarrhea Outbreaks in Spain.

Porcine enteric coronaviruses include some of the most relevant viral pathogens to the swine industry such as porcine epidemic diarrhea virus (PEDV) or porcine transmissible gastroenteritis virus (TGEV) as well as several recently identified virus such as swine enteric coronavirus (SeCoV), porcine deltacoronavirus (PDCoV) or swine enteric alphacoronavirus (SeACoV). The aim of this study is the identification and characterization of enteric coronaviruses on Spanish pig farms between 2017 and 2019. The study was carried out on 106 swine farms with diarrhea outbreaks where a viral etiology was suspected by using two duplex RT-PCRs developed for the detection of porcine enteric coronaviruses. PEDV was the only coronavirus detected in our research (38.7% positive outbreaks, 41 out of 106) and neither TGEV, SeCoV, PDCoV nor SeACoV were detected in any of the samples. The complete S-gene of all the PEDV isolates recovered were obtained and compared to PEDV and SeCoV sequences available in GenBank. The phylogenetic tree showed that only PEDV of the INDEL 2 or G1b genogroup has circulated in Spain between 2017 and 2019. Three different variants were detected, the recombinant PEDV-SeCoV being the most widespread. These results show that PEDV is a relevant cause of enteric disorders in pigs in Spain while new emerging coronavirus have not been detected so far. However, the monitoring of these virus is advisable to curtail their emergence and spread.

Antimicrobial resistance in commensal Escherichia coli and Enterococcus spp. is influenced by production system, antimicrobial use, and biosecurity measures on Spanish pig farms.

BACKGROUND: Antimicrobial resistance (AMR) is a global public health threat consequence of antimicrobial use (AMU) in human and animal medicine. In food-producing animals factors such as management, husbandry or biosecurity may impact AMU. Organic and extensive Iberian swine productions are based on a more sustainable and eco-friendly management system, providing an excellent opportunity to evaluate how sustained differences in AMU impact the AMR in indicator bacteria. Here, we evaluate the usefulness of commensal Escherichia coli and Enterococcus spp. isolates as AMR bioindicators when comparing 37 Spanish pig farms from both intensive and organic-extensive production systems, considering the effect of AMU and biosecurity measures, the last only on intensive farms. RESULTS: The production system was the main factor contributing to explain the AMR differences in E. coli and Enterococcus spp. In both bacteria, the pansusceptible phenotype was more common (p < 0.001) on organic-extensive farms when compared to intensive herds. The microbiological resistance in commensal E. coli was, for most of the antimicrobials evaluated, significantly higher (p < 0.05) on intensive farms. In enterococci, the lincosamides usage revealed the association between AMR and AMU, with an increase in the AMR for erythromycin (p < 0.01), quinupristin-dalfopristin (p < 0.01) and the multidrug-resistant (MDR) phenotype (p < 0.05). The biosecurity measures implemented on intensive farms influenced the AMR of these bioindicators, with a slightly lower resistance to sulfamethoxazole (p < 0.01) and the MDR phenotype (p < 0.05) in E. coli isolated from farms with better cleaning and disinfection protocols. On these intensive farms, we also observed that larger herds had a higher biosecurity when compared to smaller farms (p < 0.01), with no significant associations between AMU and the biosecurity scores. CONCLUSIONS: Overall, this study evidences that the production system and, to a lesser extent, the biosecurity measures, contribute to the AMR development in commensal E. coli and Enterococcus spp., with antimicrobial usage as the main differential factor, and demonstrates the potential value of these bacteria as bioindicators on pig farms in AMR surveillance programs.

First identification and characterization of rotavirus H in swine in Spain.

Rotaviruses (RVs) are classified into nine species or groups (RVA-RVD and RVF-RVJ). RVA, RVB and RVC are well-recognized as etiological agents of enteric disease on swine farms and have been identified in all countries with a relevant pork production. Contrarily, RVH has only been identified on swine farms from Japan and more recently from Brazil, USA, South Africa and Vietnam but not yet in Europe. The occurrence of RVH was investigated in 103 Spanish pig herds. Nine farms were positive and we achieved a complete nucleotide sequences in three isolates while another RVH isolate was partially sequenced. Mean nucleotide identities with the RVH sequences available in GenBank ranged between 69.4% and 93.7%. Phylogenetically, all genomic segments of Spanish RVH isolate clustered closely with other porcine RVH strains but were distantly related to human RVH as well as bat RVH strain. To the best of our knowledge, this is the first report of RVH on swine farms in Europe including its characterization by means of complete genome sequencing.

Association Between Stability and Urologic Lesions in Pelvic Ring Fractures. A Case Series Report.

PURPOSE: Pelvic ring fractures represent a subgroup of potentially serious injuries due to the fractures themselves, as well as the associated injuries. In fact, over 4% of cases have concomitant lower urinary tract injuries. The aim of this study was to analyze the relationship between the instability of pelvic ring fractures and the presence of lower urinary tract lesions. MATERIALS AND METHODS: A retrospective review of patients with pelvic ring fractures at our center between 2007 and 2015 was performed. Fractures were categorized according to the Tile classification system. Patients with lower urinary tract lesions were selected and categorized according to the lower urinary tract lesion identified (urinary bladder, urethral or combined). Subsequently, a statistical analysis was carried out to assess the association between these variables. RESULTS: 614 patients with pelvic ring fracture were included, corresponding to 260 (42.3%) men and 354 (57.7%) women. 25 patients (4.1%) were diagnosed of lower urinary tract injury (17 bladder injuries, 8 urethral injuries and 0 combined injuries). Urethral injuries were more frequent among men (1.9% incidence in men vs 0.8% in women). A lower incidence of lower urinary tract lesions was detected in stable pelvic ring fractures (type A, p 0.02). Overall, type C3 showed the highest incidence of lower urinary tract lesions (22.2% incidence, p = 0.04). CONCLUSION: In our series, a greater incidence of higher urinary tract injuries was observed in patients with unstable pelvic ring fractures (Tile type B and C) with respect to stable fractures (Tile type A). Therefore, a high index of suspicion should be maintained in order to identify high risk patients.

Effect of antimicrobial use and production system on Campylobacter spp., Staphylococcus spp. and Salmonella spp. resistance in Spanish swine: A cross-sectional study.

Antimicrobial resistance is a worldwide public health threat; hence, current trends tend to reduce antimicrobial use in food-producing animals and to monitor resistance in primary production. This study aimed at evaluating the impact of antimicrobial use and production system on swine farms in the antimicrobial resistance of Campylobacter, Salmonella and Staphylococcus, the main zoonotic pathogens in pig herds, in order to assess their potential value as sentinel microorganisms in antimicrobial resistance surveillance schemes. A total of 37 Spanish swine farms, 18 intensive and 19 organic/extensive farms, were included in the study. The antimicrobial resistance of 104 Campylobacter, 84 Staphylococcus and 17 Salmonella isolates was evaluated using Sensititre plates following the EUCAST guidelines. Mixed-effects logistic regression was used to evaluate the influence of production system and antimicrobial use in resistant and multidrug-resistant (MDR) phenotypes to the antimicrobials tested. The results showed that antimicrobial use was higher (p < .001) on intensive farms than on organic/extensive farms. MDR in Campylobacter and Staphylococcus was lower on organic/extensive farms (OR < .01p < .001). Antimicrobial resistance in Campylobacter and Staphylococcus isolates was, also for most of the antimicrobials studied, significantly higher in intensive than organic/extensive pig herds. Tetracycline resistance was associated with total antimicrobial consumption in both microbial species (p < .05), and some cross-associations between distinct antimicrobial substances were established, for instance resistance to erythromycin was associated with macrolide and phenicol consumption. No significant associations could be established for Salmonella isolates. The results demonstrate the link between antimicrobial consumption and resistance in zoonotic bacteria and evidence the potential value of using Campylobacter and Staphylococcus species in monitoring activities aimed at determining the impact of antimicrobials use/reduction on the occurrence and spread of antimicrobial resistance.

Translation and validation of the new knee society knee scoring system into Spanish: Spanish KSS translation.

PURPOSE: The aim of the study was to translate and validate the English version of the 'Knee Society Knee Scoring System' developed in 2011 (2011 KSS) into Spanish. This new KSS version considers patient satisfaction and expectations before and after knee arthroplasty. Moreover, the questionnaire allows a better characterization of a younger and more diverse population. METHODS: A cross-cultural adaptation process was carried out to obtain the Spanish version of the questionnaire. After that, patients undergoing primary knee arthroplasty answered the translated questionnaire before and 6 months after surgery. Psychometric properties including feasibility, validity, reliability, and sensitivity to change were then assessed, and the questionnaire was compared with prior KSS, as well as with SF-12 and WOMAC, all of them already validated to Spanish. RESULTS: In the cross-cultural adaptation process, alternative translations of some items in 'Patient Expectative' and 'Functional Activities' sections were suggested. One hundred and seventy-six patients answered the resulting 1.0 version. Feasibility: 'Charnley Functional Classification', 'Deduction for flexion contracture and extensor lag', the question 'Do you use these aids because of your knees?', and 'Advanced activities (total)' obtained a high number of missing items. Eighty-eight patients (50%) in the preoperative visit and 141 patients (86.5%) after surgery had at least one missing answer. Internal validity: although the analysis suggests the presence of more than one dimension, there was a dimension that explained a higher percentage of variance, which was more noticeable in the postoperative visit. Convergent validity: correlation coefficients with prior KSS, SF-12, and WOMAC confirm the questionnaire's validity. Reliability: Cronbach's alpha for the new KSS was 0.841 and 0.861 in visit 1 and 2, respectively, and higher than that for prior KSS. Sensitivity to change: statistically, significant differences were found between the mean scores between both visits. CONCLUSION: The proposed Spanish version of 2011 KSS is valid, reliable, and sensible to change in patients undergoing primary knee arthroplasty. Moreover, it has higher internal consistency (reliability) than the prior KSS. It should be emphasized its correct filling by both health professional and patients LEVEL OF EVIDENCE: II.

In-depth in vitro Evaluation of the Activity and Mechanisms of Action of Organic Acids and Essential Oils Against Swine Enteropathogenic Bacteria.

Alternative antimicrobials require a deep understanding of their action mechanisms by in vitro assays which support science-based field use. This study focuses on the characterization of bactericidal mechanisms of potential antimicrobial compounds, two organic acids and three single essential oil (EO) compounds against swine enteropathogenic bacteria Escherichia coli, Salmonella enterica subsp. enterica serovar Typhimurium, and Clostridium perfringens. Target concentrations of the compounds were evaluated using the inhibitory potential of the vapor phase and bacterial viability after short-term exposure, while cell targets were disclosed using flow cytometry (FC), Fourier-transform infrared (FTIR) spectroscopy, and scanning electron microscopy (SEM). All tested compounds exhibited vapor phase activity against the three bacterial species, except sodium salt of coconut fatty acid distillates against C. perfringens. Survival test results evidenced that effects on bacterial viability were concentration dependent and higher in single EO compounds than in organic acids. In detail, thymol and its isomer carvacrol were the most effective compounds. Further characterization of thymol and cinnamaldehyde activity revealed that thymol main target was the cell membrane, since it caused striking damages in the membrane permeability, integrity and composition evidenced by FC and FTIR in the three enteric pathogens. In contrast, cinnamaldehyde was more effective against enterobacteria than against C. perfringens and only caused slightly damages at the highest concentration tested. Its target at the molecular level differed between enterobacteria and C. perfringens isolates. The SEM micrographs allowed us to confirm the results previously obtained for both EO compounds by other techniques. Altogether, the study showed the straight effect of these antimicrobials, which could constitute relevant information to optimize their feed inclusion rates in field studies or field use.

Antimicrobial use and production system shape the fecal, environmental, and slurry resistomes of pig farms.

BACKGROUND: The global threat of antimicrobial resistance (AMR) is a One Health problem impacted by antimicrobial use (AMU) for human and livestock applications. Extensive Iberian swine production is based on a more sustainable and eco-friendly management system, providing an excellent opportunity to evaluate how sustained differences in AMU impact the resistome, not only in the animals but also on the farm environment. Here, we evaluate the resistome footprint of an extensive pig farming system, maintained for decades, as compared to that of industrialized intensive pig farming by analyzing 105 fecal, environmental and slurry metagenomes from 38 farms. RESULTS: Our results evidence a significantly higher abundance of antimicrobial resistance genes (ARGs) on intensive farms and a link between AMU and AMR to certain antimicrobial classes. We observed differences in the resistome across sample types, with a higher richness and dispersion of ARGs within environmental samples than on those from feces or slurry. Indeed, a deeper analysis revealed that differences among the three sample types were defined by taxa-ARGs associations. Interestingly, mobilome analyses revealed that the observed AMR differences between intensive and extensive farms could be linked to differences in the abundance of mobile genetic elements (MGEs). Thus, while there were no differences in the abundance of chromosomal-associated ARGs between intensive and extensive herds, a significantly higher abundance of integrons in the environment and plasmids, regardless of the sample type, was detected on intensive farms. CONCLUSIONS: Overall, this study shows how AMU, production system, and sample type influence, mainly through MGEs, the profile and dispersion of ARGs in pig production. Video Abstract.

Radiation Exposure from Fluoroscopy during Hip Arthroscopy.

Objective Hip arthroscopy for femoroacetabular impingement treatment is a procedure that is not exempted from complications. The most common complications are related to the arthroscopic portals and the traction system. The use of fluoroscopy helps in hip arthroscopy; however, the radiation exposure is a risk that has not yet been studied. Materials and Methods A retrospective study with 100 arthroscopies was performed. Surgical indication in all cases was femoroacetabular impingement. Surgical times and radiation exposure during the procedure had been recorded and reviewed for the present study. Results A mean of 138.20 cGy cm 2 radiation exposures was observed per patient and procedure for a mean time of radiation exposure of 0.36 minutes. These values are much lower than the values described as being at risk by the nuclear security commissions. Conclusions Radiation exposure in a hip arthroscopy due to femoroacetabular impingement is in margins well below the limits at risk for the patient.

Avascular Necrosis of the Femoral Head.

About 250000 patients are operated on annually for hip arthroplasty in the USA alone. Of this number, about 10% the cause of their osteoarthritis is the avascular necrosis of the femoral head. But the causes of necrosis are multiple and many of them are still unknown. That is why small advances in etiopathogenesis, diagnosis and treatment of different causes are very important in order to reduce the number of affected patients. It may seem that small changes, studies focused on the details of different diseases do not bring great changes to science, but it is these small changes that end up adding great evolutions in our knowledge. In addition, the changes of recent years, are not focused on our specialty in technical or anatomical evolutions exclusively, but are often based on biological bases, which is the branch that evolves more within trauma and orthopedics. That is why open and constant minds are what help us move forward.