The role of migration barriers for dispersion of Proliferative Kidney Disease-Balance between disease emergence and habitat connectivity.

Natural and uninterrupted water courses are important for biodiversity and fish population stability. Nowadays, many streams and rivers are obstructed by artificial migration barriers, often preventing the migration of fish. On the other hand, distribution of pathogens by migrating fishes is still a point of concern. Pathogen transport and transmission is a driving force in the dynamics of many infectious diseases. The aim of the study was to investigate the possible consequences of the removal of an artificial migration barrier for the upstream transport of Tetracapsuloides bryosalmonae, the causative agent of Proliferative Kidney Disease (PKD) in brown trout, by migrating fish. To test this question, a river system was selected with a migration barrier separating a PKD positive river from a PKD negative tributary. After removal of the barrier, PKD prevalence and pathology was examined during five years after elimination of the barrier. In the tributary, no PKD was recorded at any time of the survey. By means of unidirectional PIT (passive integrated transponder)-tagging, we confirmed upstream migration of adult brown trout into the tributary during the cold season, presumably for spawning. By eDNA, we confirmed presence of T. bryoalmonae and Fredericella sp., the definitive host, DNA in water from the PKD positive river stretch, but not in the PKD negative tributary. Our study illustrates the importance of the connectivity of streams for habitat maintenance. Although migration of brown trout from a PKD-positive river into a PKD-negative tributary, mainly for spawning, was confirmed, upstream spreading of PKD was not observed.

On the potential role of Mergus merganser as transport hosts for Tetracapsuloides bryosalmonae.

Transmission paths in the distribution of proliferative kidney disease (PKD) of salmonids are still largely unknown. In this study, the role of goosander (Mergus merganser) as possible transport host for Tetracapsuloides bryosalmonae through faeces was examined. Goosander fledglings were fed exclusively with diseased brown trout (Salmo trutta fario). In all trout used for feeding, intratubular sporogonic stage of the parasite was confirmed histologically. Between one to 10 hours post-feeding, the goosander faeces were sampled and tested for T. bryosalmonae DNA. In qPCR, only DNA fragments were found, and in conventional PCR, no amplification was confirmed. Therefore, we hypothesize that the role of goosander as transport hosts for T. bryosalmonae via their faeces can be neglected.

Comparative study of proliferative kidney disease in grayling Thymallus thymallus and brown trout Salmo trutta fario: an exposure experiment.

Proliferative kidney disease (PKD) is an emerging disease threatening wild salmonid populations, with the myxozoan parasite Tetracapsuloides bryosalmonae as the causative agent. Species differences in parasite susceptibility and disease-induced mortality seem to exist. The aim of the present study was to compare incidence, pathology and mortality of PKD in grayling Thymallus thymallus and brown trout Salmo trutta under identical semi-natural conditions. Young-of-the-year grayling and brown trout, free of T. bryosalmonae, were jointly exposed in cage compartments in a river in the northeast of Switzerland during 3 summer months. Wild brown trout were caught by electrofishing near the cage, and PKD status was compared with that of caged animals. Cage-exposed grayling showed a PKD incidence of 1%, regardless of whether parasite infection was determined by means of real-time PCR or histopathology/immunohistochemistry. In contrast, PKD incidence of caged brown trout was 77%. This value was not significantly different to PKD prevalence of wild brown trout caught above and below the cage (60 and 91%, respectively). Mortality in grayling was significantly higher compared with that of brown trout (40 versus 23%); however, grayling mortality was not considered to be associated with PKD. Mortality of caged and infected brown trout was significantly higher than mortality of non-infected caged trout. Histopathology indicated an ongoing mostly acute or chronic active infection in brown trout, which survived until the end of exposure. The results suggest that grayling are less susceptible to infection with T. bryosalmonae compared with brown trout under the tested field conditions.

Proliferative kidney disease in brown trout: infection level, pathology and mortality under field conditions.

Proliferative kidney disease (PKD) is an emerging disease threatening wild salmonid populations. In temperature-controlled aquaria, PKD can cause mortality rates of up to 85% in rainbow trout. So far, no data about PKD-related mortality in wild brown trout Salmo trutta fario are available. The aim of this study was to investigate mortality rates and pathology in brown trout kept in a cage within a natural river habitat known to harbor Tetracapsuloides bryosalmonae. Young-of-the-year (YOY) brown trout, free of T. bryosalmonae, were exposed in the River Wutach, in the northeast of Switzerland, during 3 summer months. Samples of wild brown trout caught by electrofishing near the cage location were examined in parallel. The incidence of PKD in cage-exposed animals (69%) was not significantly different to the disease prevalence of wild fish (82 and 80% in the upstream and downstream locations, respectively). The mortality in cage-exposed animals, however, was as low as 15%. At the termination of the exposure experiment, surviving fish showed histological lesions typical for PKD regression, suggesting that many YOY brown trout survive the initial infection. Our results at the River Wutach suggest that PKD in brown trout does not always result in high mortality under natural conditions.

Saúde nas empresas: um modelo gráfico para identificar oportunidades de gestão / Health in enterprises: a graphical model to identify management opportunities

A gestão de saúde nas empresas encontra fatores de resistência às propostas de melhoria e se caracteriza como um problema com vícios. Novas formas de abordar estes vícios podem ser úteis como ferramentas de reflexão estratégica. O presente trabalho parte do pressuposto dedutivo em que “a causa precede a consequência” e desenvolve estrutura gráfica simples em que desenha o fluxo de formação / concentração e dissolução / desconcentração de doentes em uma empresa. Essa abordagem gráfica permite novos olhares sobre essa dinâmica e facilita a identificação de alguns dos vícios existentes. A estrutura gráfica identifica 7 pontos de inflexão, que são apresentados como oportunidades de intervenção para reverter os vícios identificados na análise estratégica.

Health management in companies is facing resistance factors to proposed improvements and is characterized as a problem, as something having defects. New ways of approaching these defects may be useful as tools for strategic thinking.This paper is based on the deductive assumption that “cause precedes consequence” developing a simple graphical structure that draws the flow of formation / concentration and dissolution / deconcentration of sick people in a company. This graphical approach allows new perspectives on this dynamic and facilitates the identification of some existing defects.The graphical structure identifies seven turning points, which are presented as opportunities for intervention to reverse the defects identified in the strategic analysis.

Evaluation of polyphenol composition in red leaves from different varieties of Vitis vinifera.

In order to evaluate sustainable sources of high-quality pharmaceutical starting material, a comparative study of 135 samples of red vine leaves of different origin was conducted to determine flavonol, anthocyanin and polyphenol contents. Total flavonol content was found to be between 0.6 % and 3.5 %, anthocyanin content between 0.2 % and 1.45 % and polyphenol content between 4.6 % and 18.9 %. The results are discussed in view of published data on red vine leaf components. In order to define the optimum timeframe for collecting leaves without damaging their grape-bearing vines the ontogenetic development of red vine leaves constituents was studied. High-performance liquid chromatography (HPLC) methods used for determining anthocyanins and flavonols in red vine leaves were validated and findings were compared to results produced by assays described in the French Pharmacopoeia. Whereas the correlation between conventional photometric and HPLC methods was satisfactory for anthocyanins, the correlation between the pharmacopoeia assay for total polyphenols and the HPLC analysis for flavonols was poor. As flavonol compounds are considered relevant for the vasoprotective effect of red vine leaves, their content in starting material used in the production of herbal medicines needs to be quantified.

Effects of probucol versus aspirin and versus brachytherapy on restenosis after femoropopliteal angioplasty: the PAB randomized multicenter trial.

PURPOSE: To evaluate the effect of probucol and/or of endovascular brachytherapy (EVBT) on restenosis after percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries. METHODS: A total of 335 patients (206 men; mean age 72+/-9 years) with intermittent claudication were randomized according to a 2x2 factorial design to 1 of the 4 groups: probucol, placebo, EVBT, and EVBT+probucol. Probucol (1 g/d) or placebo were given in double-blinded fashion 1 month before and for 6 months after PTA. Gamma irradiation (192Iridium, 14 Gy, 5-mm reference depth) was randomly applied in an unblinded manner from a noncentered endoluminal catheter. All patients received aspirin (100 mg/d). Primary endpoint was restenosis (>50% diameter reduction) detected by duplex ultrasound 6 months after PTA. Secondary endpoints included clinical and hemodynamic assessment. RESULTS: Restenosis in patients undergoing EVBT was 17% (23/133) versus 35% (50/142) in patients without EVBT (p<0.001); in patients treated with probucol versus placebo, the rates were 23% (31/135) and 30% (43/140, p<0.001). Three quarters (77%, 102/133) of patients were free of claudication after EVBT therapy versus 61% (87/142) without EVBT (p<0.05). Need for target vessel revascularization was 6% (8/133) with EVBT versus 14% (20/142) without EVBT (p<0.01). Late thrombotic occlusions occurred in 4% (6/133), exclusively in patients treated with EVBT after stent implantation. CONCLUSIONS: Endovascular brachytherapy significantly reduces restenosis, improves symptoms, and reduces reinterventions after PTA of femoropopliteal arteries. Probucol reduces restenosis but has no additive effect when combined with brachytherapy.

Immediate and long-term outcome of upper extremity balloon angioplasty in giant cell arteritis.

PURPOSE: To review the immediate and long-term results of subclavian, axillary, and brachial artery balloon angioplasty (PTA) in giant cell arteritis (GCA). CASE REPORTS: Four patients (3 men; mean age 65+/-8.9 years) with upper limb claudication due to GCA underwent PTA for 2 stenoses and 1 occlusion of the subclavian artery, 6 stenoses and 2 occlusions of the axillary artery, and 2 stenoses of the brachial artery. Patients received steroids prior to the intervention, and steroid treatment was continued for at least 2 years. All procedures were performed successfully with no residual stenosis. At follow-up after 2 years (n=2), 5 years (n=1), and 10 years (n=1), no significant recurrent stenoses were detected by duplex scanning. CONCLUSIONS: PTA is a safe and effective therapy for stenotic lesions and occlusions of the upper limb arteries due to GCA. The long-term results seem to benefit from postprocedural therapy with steroids and aspirin.

Late acute thrombotic occlusion after endovascular brachytherapy and stenting of femoropopliteal arteries.

OBJECTIVES: The aim of this article is to underline the importance of this complication after endovascular brachytherapy (EVBT) and intravascular stenting of the femoropopliteal arteries occurring in a running randomized trial. BACKGROUND: Endovascular brachytherapy has been proposed as a promising treatment modality to reduce restenosis after angioplasty. However, the phenomenon of late acute thrombotic occlusion (LATO) in patients receiving EVBT after stenting is of major concern. METHODS: In an ongoing prospective multicenter trial, patients were randomized to undergo EVBT (iridium 192; 14 Gy at a depth of the radius of the vessel +2 mm) after percutaneous recanalization of femoropopliteal obstructions. Of the 204 patients who completed the six months follow-up, 94 were randomized to EVBT. RESULTS: Late acute thrombotic occlusion occurred exclusively in 6 of 22 patients (27%) receiving EVBT after intravascular stenting and always in concomitance with reduction of antithrombotic drug prevention (clopidogrel). Conversely, none of the 13 patients with stents and without EVBT (0%; p < 0.05) and none of the 72 patients (0%; p < 0.01) undergoing EVBT after simple balloon angioplasty presented LATO. CONCLUSIONS: Late thrombotic occlusion occurs not only in patients undergoing EVBT after percutaneous coronary recanalization but also after stenting of the femoropopliteal arteries and may compromise the benefits of endovascular radiation. The fact that all our cases with LATO occurred concomitantly with stopping clopidogrel may indicate a possible rebound mechanism. An intensive and prolonged antithrombotic prevention is probably indicated in these patients.

La salud por la naturaleza

Principios básicos y metodologías operativas y prácticas de la Medicina Naturista. Es un valioso texto para los profesionales de la salud que quieran ampliar sus conocimientos de la etiología de ciertas enfermedades, y el tratamiento de muchos malestares y motivos de consulta de la práctica médica general

La salud por la naturaleza

Principios básicos y metodologías operativas y prácticas de la Medicina Naturista. Es un valioso texto para los profesionales de la salud que quieran ampliar sus conocimientos de la etiología de ciertas enfermedades, y el tratamiento de muchos malestares y motivos de consulta de la práctica médica general