Chronic Wasting Disease Monitoring in Italy 2017-2019: Neuropathological Findings in Cervids.

Chronic wasting disease (CWD) is a prion disease that affects cervids; it is classified under transmissible spongiform encephalopathies (TSEs). CWD is particularly contagious, making its eradication in endemic areas very difficult and creating serious problems for cervid conservation and breeding. It has recently become an emerging public health risk to be managed by health authorities. Starting in 2017, active CWD surveillance in Italy has intensified with the monitoring of wild and farmed cervids. The present study summarizes findings from a histopathological survey of the brains from wild ruminants collected via CWD monitoring between 2017 and 2019. A total of 113 brains from 62 red deer (Cervus elaphus) and 51 roe deer (Capreolus capreolus) were submitted for analysis at the National Reference Center for Animal Encephalopathies (CEA) to determine major patterns of neuropathological lesions and correlated pathogens. Brain lesions were detected in 20 animals, 10 brain samples were unsuitable for examination, and 83 presented no lesions. Neuropathological examination revealed non-suppurative encephalitis or meningoencephalitis in most cases (15/20). This brain study revealed evidence for the absence of CWD in Italy and provided a reference spectrum of neuropathological lesions for differential diagnosis in cervids.

Intracranial squamous cell carcinoma in an Ovis aries.

Squamous cell carcinoma (SCC) is a malignant mucoepithelial tumor that affects pets and farm animals. Common sites are dorsal areas and/or areas of poor skin pigmentation exposed to mutagenic ultraviolet (UV) radiation. Novel ovine papillomavirus (OaPV3) was recently described in SCC lesions in Sardinia breed ovines. In 2017, a 7­year­old half­breed aries was presented with symptoms compatible with a vestibular syndrome. The animal was euthanized 1 month after the onset of clinical signs due to a lack of response to treatment and poor prognosis. A complete postmortem examination was performed. Necropsy revealed only a loss of incisors, associated with alveolar necrotic osteomyelitis, and left unilateral purulent nasal discharge. No other thoracic or abdominal lesions were observed. Opening of the skull revealed a cauliflower­like space­occupying mass. Histological examination showed trabecules and islands of squamous, neoplastic epithelial cells with the formation of concentric keratin layers. This raised the suspicion of SCC, which was confirmed with cytokeratin­positive immunostaining. Simplex PCR on the frozen tissue mass was negative for OaPV1, OaPV2, and OaPV3. This case report suggests that SCC, although rare, should be included in the differential diagnosis of cases of vestibular disorder.

Effects of thermal treatment on walnut detection and allergenicity.

BACKGROUND: Peanuts and tree nut allergies pose an increasing food safety problem. The aim of our study was to test the accuracy of different commercial enzyme-linked immunosorbent assay (ELISA) kits in the detection of the presence of walnuts in untreated and heat exposed food samples. The effects of thermal treatment of samples were evaluated by exposing walnuts to different heat treatments. All samples were first analysed by two different commercial ELISA assays. Then, we performed a skin prick test (SPT) on nine patients with proven nut allergy using small walnut pieces from raw and treated samples. RESULTS: The presence of nuts proteins in thermally processed foods was not accurately detected by ELISA kits. All patients had a positive SPT reaction with raw walnut, while thermal treatments affected walnut allergenicity. The ELISA test gives a negative result in the case of strong thermal treatment, but at the same time allergic subjects react positively to stimulation with the same sample. CONCLUSION: This study suggests that commercial ELISA kits may not be able to accurately determine the amount of proteins present in thermally processed foods due to changes in the solubility and immunoreactivity of the target proteins. Finally, the clinical results highlight that thermal treatment might induce a reduction in walnut allergenicity. © 2018 Society of Chemical Industry.

Evaluation and validation of an alternative method to detect Campylobacter spp. in dairy products.

Foods implicated in human campylobacteriosis include raw or undercooked poultry and raw dairy products. Because Campylobacter spp. are the most frequently reported cause of bacterial infection in the European Union and because conventional methods are cumbersome, rapid methods for Campylobacter detection and quantification in food are needed. With this study we sought to validate, according to the standard procedure (UNI EN ISO 16140:2003), an alternative to the reference analytical method (UNI EN ISO 10272-1:2006) for official controls of Campylobacter spp. in raw milk and dairy products. Milk samples collected from 16 milk vending machines located throughout the Genoa metropolitan area were analyzed using two different methods, an enzyme-linked fluorescent assay (ELFA) and a real-time PCR assay, and evaluated in parallel against the reference method. In addition, a total of 460 samples of raw milk collected from milk vending machines were analyzed by ELFA. Results obtained with ELFA showed it was compliant with UNI EN ISO 10272-1:2006 criteria and that the immunoassay had 100% sensitivity, specificity, and accuracy. Regarding samples of milk vending machines, 5.0% (23/460) tested positive at ELFA screening and were subsequently confirmed as C. jejuni. Validation according to UNI EN ISO 16140:2003 of the ELFA method suggests it may be a useful alternative to conventional methods for detecting Campylobacter spp. in official controls.

Salmonella serovar-specific interaction with jejunal epithelial cells.

Gut is often a receptacle for many different pathogens in feed and/or the environment, such as Salmonella spp. The current knowledge about pathogenicity of Salmonella is restricted to few serotypes, whereas other important ones like S. Coeln, S. Thompson, S. Veneziana, have not been investigated yet in human and animal models. Therefore, the aim of our work was to verify the ability of widespread environmental Salmonella strains to penetrate and modulate innate immunity in pig intestinal IPEC-J2 cells. Our results outline the different ability of Salmonella strains to modulate innate immunity; the expression of the IFN-ß gene was increased by S. Typhimurium, S. Ablogame and S. Diarizonae 2, that also caused an inflammatory response in terms of Interleukin (IL)-1ß and/or IL-8 gene espression. In particular, IL-8 gene expression and protein release were significantly modulated by 5 Salmonella strains out of 7. Interestingly, S. Typhimurium, S. Coeln and S. Thompson strains, characterized by a peculiar ability to penetrate into IPEC-J2 cells, up-regulated both IL-8 and TNF-α gene expression. Accordingly, blocking IL-8 was shown to decrease the penetration of S. Typhimurium. On the contrary, S. Diarizonae strain 1, showing lesser invasion of IPEC-J2 cells, down-regulated the p38-MAPK pathway, and it did not induce an inflammatory response. Our results confirm that IPEC-J2 cells are a useful model to evaluate host-gut pathogen interaction and indicate IL-8 and TNF-α as possible predictive markers of invasiveness of Salmonella strains in enterocytes.

Innate immune responses of young bulls to a novel environment.

Animal welfare during transportation has been investigated in several studies, as opposed to post-transportation phases. In this study, we evaluated the effect of a novel environment after transportation on 26 Friesian bulls, 242 ± 42 day-old, from ten different dairy farms. Animals were shipped to a breeding center in different seasons, and selected parameters of innate immunity (serum bactericidal activity, hemolytic complement, serum albumin, α, ß, and γ-globulins, interleukin-6, TNF-α) were monitored before and after the arrival at days--4/0/4/15/30. Our results showed significant differences of IL-6 and TNF-α protein levels at destination in December (94 ± 1.3 pg/ml) and June (+788 pg/ml), respectively. Moreover, the serum levels of these cytokines increased between days 0 and 15 after the arrival, the modulation of IL-6 being in agreement with established models of physical and/or psychological stress. Concerning the modulation of albumin, alpha and beta-globulins, the highest levels were detected in April, whereas a significant decrease was observed between day 15 and 30 after arrival; on the contrary, γ-globulin levels significantly increased after day 15. The results of this study highlight the occurrence of innate immune responses of young bulls to the combined effects of climate (season) and novel farming conditions.

Characterisation of the Microflora Contaminating the Wooden Vats Used for Traditional Sicilian Cheese Production.

Traditional Sicilian cheese productions are carried out employing traditional wooden vats, called tina. Many studies have highlighted the beneficial role of wooden dairy equipment by contributing to enriching the milk microflora and improving the acidification processes. The present work was undertaken to evaluate the safety of the wooden vats used to coagulate milk. To this purpose, the different microbial populations hosted onto the internal surfaces of the vats used to produce two different stretched cheeses, namely Caciocavallo Palermitano and Vastedda della valle del Belìce DOP, were investigated for the presence of spoilage and pathogenic microorganisms as well as for bacteria with inhibitory effect in vitro against pathogenic microorganisms. A wide biodiversity of protechnological lactic acid bacteria (LAB), in terms of species, was revealed. Several LAB inhibited the growth of Listeria monocytogenes ATCC 7644. The wooden vats analysed resulted safe for three main findings: absence of the main pathogenic species, presence of high levels of LAB, anti-Listeria activity of many LAB.

Single-access laparoscopic rectal resection versus the multiport technique: a retrospective study with cost analysis.

BACKGROUND: Single-access laparoscopic surgery is not used routinely for the treatment of colorectal disease. The aim of this retrospective cohort study is to compare the results of single-access laparoscopic rectal resection (SALR) versus multiaccess laparoscopic rectal resection with a mean follow-up of 24 months. METHODS: This retrospective cohort study enrolled 42 patients. Between January 2010 and June 2012, 21 SALRs were performed. These patients were compared with a group of 21 other patients who had undergone multiport laparoscopic rectal resection. This control group had the same exclusion criteria and patient demographics. Short-term outcomes were reassessed with a mean follow-up of 2 years. Statistical analysis included the Student t test and Fisher's exact test. Finally, we performed a differential cost analysis between the 2 procedures. RESULTS: Exclusion criteria, patient demographics, and indication for surgery were similar in both groups. The conversion rate was 0% in both groups. There were no intraoperative complications or deaths. Bowel recovery was similar in both groups. No interventions, readmissions, or deaths were recorded at 30 days' follow-up. At a mean follow-up of 24 months, all the patients with a preoperative diagnosis of cancer are still alive and disease free. Considering the selected 3 items, the mean cost per patient for single-access laparoscopic surgery and multiple-access laparoscopic surgery were estimated as 7213 and 7495 Euros, respectively. CONCLUSION: We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.

Single-access laparoscopic subtotal spleno-pancreatectomy for pancreatic adenocarcinoma.

Laparoscopic distal or subtotal pancreatectomy can be performed safely and effectively unless there is a clear reason why not to do so. With the aim of reducing postoperative trauma and improving the cosmesis, single-access laparoscopic surgery has been introduced into daily practice. We report the first case of distal single-access laparoscopic pancreasectomy for an adenocarcinoma. The procedure was carried out in 170 minutes without postoperative complications. Despite some technical difficulties, we think that a single-access laparoscopic approach could be adequate for a pancreatic resection. However, an adequate analysis of cost-effectiveness as well as regarding the reproducibility should be carried out.

Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results.

BACKGROUND: Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an "open" access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. METHODS AND DESIGN: The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment.The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. DISCUSSION: The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon's experience. TRIAL REGISTRATION: Current Controlled Trials ISRCTN93729016.

Spleen rupture: an unusual postoperative complication after laparoscopic cholecystectomy.

INTRODUCTION: Laparoscopic cholecystectomy is the gold standard in the surgical treatment of symptomatic cholelithiasis and other benign gallbladder diseases. Laparoscopic cholecystectomy isn't devoid by some complications such as intra and post-operative bleeding, biliary injury, bile leakage, surgical site infection, port-site hernia and visceral injury. After an extensive literature research, we find only one case study in which the patients required a splenectomy after laparoscopic cholecystectomy. We present a case of uneventful laparoscopic cholecystectomy requiring an open splenectomy during the postoperative course. CASE REPORT: The Authors report a case of ruptured spleen during the second post-operative day after an uncomplicated laparoscopic cholecystectomy. At 36 hours after the operation, the patient referred a sudden upper abdominal pain. We performed a splenectomy, intra-abdominal lavage and two drainages have been placed. The patient was discarged in the 7th post-operative day in good clinical condition. CONCLUSION: As best of our Knowledge we report the second case of spleen rupture after a cholecystectomy, which is reported in the literature. We think that the splenic injury should not be due to direct trauma after or at the time of cholecystectomy, but it should be due to some adherences stretched by the pneumoperitoneum induction.

Single access laparoscopic right hemicolectomy.

Single Access Laparoscopic Colectomy (SALC) were reported in several studies. The first Single Access laparoscopic right colectomy was descibed by Remzi et Al. We report our experience in SALC describing our approach for Right Colectomy. In our experience we perform as well an extracorporeal side-to-side anastomosis, in contrast wit a conventional laparoscopic right colectomy in which we perform an intra-corporeal anastomosis. We think that an important limit of this approach is represented by the difficult to perform a safe intra-corporeal anastomosis. In conclusion we think that right SALC is a safe and feasible approach. However, many issues will be established, as well as technological, economical and educational aspects, before its introduction in the daily clinical practice.

[Chron's disease and cancer]. / Malattia di Crohn e cancro.

INTRODUCTION: The patients with Crohn's disease (CD) have a greater risk of gastrointestinal and hemopoietic cancers compared with background population. Identify groups of people affected by CD with exposition to factors that play a role in the development of cancer could be useful to plan correct diagnostic and therapeutic methods. METHODS: A reaserch on "pubmed" with "Risk factors for cancer in patients with Crohn's disease", "Cancer and Crohn's disease" Crohn's disease and cancer risk" as key-words was conducted. We identified 35 studies and analized also references reported inside each single work. RESULTS: Patients with CD have a higher risk of colorectal cancer (CRC). The risk of colon cancer alone was found to be increased, with no significant increase in the risk of rectal cancer. Factors that play a role in the development of CRC are: diagnosis of CD before 25-years-old, duration of disease, severity of inflammation, habit to cigarette's smoke, a familial history of CRC and immunosuppressive therapies. The risk of small bowel cancer was found to be increased, even if overall risk remains low. Although the role of immunosuppressive therapies remain to clarify yet, patients with CD have a higher risk of development lymphoma compared with background population. CONCLUSION: Patients with CD are at high risk of large bowel, small bowel, extraintestinal and hemopoietic cancers. Selected patients with extensive colonic disease, which has been present from a young age, are at high risk of cancer and should be candidates for colonscopic surveillance.

Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience.

BACKGROUND: The objective of this study was to evaluate outcomes of mesh versus primary suture procedures for repair of anterior abdominal wall midline hernias. RESULTS: Between 1995 and 2005, 98 patients (46 males) underwent repair of umbilical (69 cases) or epigastric (29 cases) hernias. Primary suture of the defect was performed in 34 cases (group 1). A polypropylene mesh was positioned in 64 cases (group 2). Overall, mean aponeurotic defect diameter was 2.5 cm (range 0.5 +/- 10 cm). Procedures were carried out under local anesthesia in 76 instances (71% group 1 vs. 81% group 2). Complications occurring in group 2 comprised three seromas, one hematoma and one prosthetic infection. Follow up was scheduled yearly up to the fifth postoperative year. Recurrence rate in group 1 was 14.7% compared to 3.1% in group 2 (logrank test p 0.0475). CONCLUSIONS: Anterior preperitoneal mesh repair of abdominal wall midline hernias under local anesthesia seems to be a safe and effective technique that can be performed as a day surgery procedure. A slightly increased risk of postoperative local complications following mesh repair is offset by a reduced rate of recurrence in comparison to suture repair.

Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up.

BACKGROUND: The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). METHODS: Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,. RESULTS: Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 +/- 4.5 days. Patients were followed for a mean of 24.7 +/- 10.9 months (range: 6-42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change. CONCLUSIONS: According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.

[Crohn's disease surgery: problems of postoperative recurrence]. / La chirurgia della malattia di Crohn: problematiche delle recidive postoperatorie.

Crohn's disease is associated with high rates of postoperative recurrence. By 10 years postoperatively a high percentage of patients suffer clinical relapses (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, among the various potentially predictive factors, those which today can be considered real risk factors for postoperative recurrence. A review of the literature of the last two decades was carried out. Factors related to the patient, disease, type of surgery and pharmacological treatment were analysed. The relapse rate we recorded was 41.17% (28 of 62 patients operated on in the last 20 years and included in an average 6-year follow-up (range: 1-19 years). Significant predictive factors, in adition to duration of the follow-up and smoking, are also the location of the disease in the colon, extent more than 100 cm and the absence of postoperative pharmacological prophylaxis. The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow-up (clinical, laboratory and instrumental monitoring). Identifying patients at increased risk would enable physicians to implement a rational pharmacological prophylaxis.