Prospects of toll-like receptors in dairy cattle breeding.

Toll-like receptors (TLRs) play an important role in mediating the immune response against various microbes, such as bacteria, viruses, parasites, and fungi, in innate and adaptive immunity. Ten functional TLRs (TLR1 to TLR10) have been identified and mapped in cattle, with each TLR recognising specific pathogen-associated molecular patterns. The variation in genes controlling the immune response contributes to susceptibility or resistance to various infectious diseases such as mastitis, bovine tuberculosis, and paratuberculosis. Identifying TLR SNPs shows promising results for future marker-assisted breeding strategies, screening for disease risks, and improving the genetic resistance of dairy cattle. This article aims not only to review the research into susceptibility or resistance to infectious diseases and milk production traits in dairy cattle but also to discuss the limitations in current studies and the prospects in dairy cattle breeding.

The Importance of Patellar Resurfacing in Total Knee Arthroplasty for Symptomatic Valgus Degenerative Deformity.

PURPOSE OF THE STUDY Patellar surface replacement during total knee arthroplasty is still a matter of discussion among orthopedic surgeons. The purpose of this study was to examine possible benefits of patellar surface replacement in selected patients with symptomatic degenerative valgus deformity. We have not found any studies in the literature that compare the results of patella management solely for valgus or varus knee deformity nor those that compare both. MATERIAL AND METHODS Patients were randomly assigned to a group that would receive patellar surface replacement during total knee arthroplasty and a group of patients in whom total knee arthroplasty was performed without patellar surface replacement. 60 patients were included in the study. Total knee arthroplasty with patellar resurfacing (TKAPR) was performed in 30, and without PR (TKA) in 30 of them. Results were prospectively gathered and compared at regular intervals. RESULTS There were no significant differences between groups for examined parameters except for Oxford Knee Score at 6 months which was in favor of patellar resurfacing group. DISCUSSION The decision whether to replace the patella or not is currently exclusively a matter of surgeon's choice. Establishing selection criteria for patients that would benefit from patella resurfacing could, therefore, be very useful for both patients and orthopaedic surgeons performing total knee replacement. CONCLUSIONS Although evidence in our study could not strongly suggest performing patella resurfacing in patients with valgus deformity, the results were slightly better in the patella resurfacing group and this trend could increase if larger series of patients would be employed. A longer follow-up period would be required for clear-cut decisions and more prospective studies are warranted. Key words: knee, arthroplasty, patella, replacement, valgus, deformity.

Seroepidemiology of Hepatitis E in Selected Population Groups in Croatia: A Prospective Pilot Study.

Hepatitis E has become an emerging infection in many European countries. We analysed the prevalence of hepatitis E virus (HEV) infection in selected population groups in Croatia. Overall HEV IgG seropositivity was 5.6%, while 1.9% participants showed IgM antibodies suggestive of recent infection. No IgM-positive sample was positive for HEV RNA. HEV IgG antibodies were most prevalent in alcohol abusers (8.9%) and war veterans (8.6%), compared with 6.1% among injecting drug users and 2.7% in healthcare professionals. No individual with high-risk sexual behaviour tested HEV seropositive. HEV IgG positivity increased significantly with age from 1.8% to 2.3% in individuals younger than 40 years to 11.3% in individuals older than 50 years (P = 0.023). The mean age of HEV-positive participants was significantly higher than that of HEV-negative participants (50.9 ± 11.8 years versus 41.2 ± 11.8 years, P = 0.008). Seroprevalence rates were significantly higher in residents of suburban and rural areas compared with residents of urban areas (14.5% versus 2.5%, P = 0.003). Additionally, an increasing prevalence of HEV IgG antibodies was observed from 1.8% in participants living in families with two household members to 12.1% in those living with more than four members (P = 0.046). Gender, marital status, educational level, sexual orientation, source of drinking water, history of blood transfusions, surgical procedures, tattooing and travelling were not associated with HEV seroprevalence. Logistic regression showed that living in suburban/rural areas was the main risk factor for HEV seropositivity (OR = 6.67; 95%CI = 1.89-25.0; AOR = 7.14, 95%CI = 1.89-25.0).

First evidence of simultaneous occurrence of West Nile virus and Usutu virus neuroinvasive disease in humans in Croatia during the 2013 outbreak.

PURPOSE: We report on first evidence of simultaneous occurrence of West Nile virus (WNV) and Usutu virus (USUV) neuroinvasive infection in humans in Croatia during the transmission season 2013. METHODS: From June to December 2013, a total of 95 patients with clinically suspected WNV infection (WNV fever and neuroinvasive disease) were tested for WNV IgM/IgG antibodies using enzyme-linked immunosorbent assay. Twenty-six reactive samples were further tested by virus neutralization test for confirmation. RESULTS: WNV neuroinvasive infection was confirmed in 20 patients, while in three patients USUV neutralizing antibodies were detected. Cases occurred during the 11-week interval (from 24 July to 07 October 2013). Both WNV and USUV cases were distributed in three north-western Croatian counties. In addition to human cases, recent asymptomatic WNV infection (detection of IgM antibodies) was recorded in 9/3,460 (0.3 %) tested sentinel horses. Infected animals were recorded in two eastern and one north-western county. CONCLUSIONS: Our results indicate co-circulation of WNV and USUV in Croatia. WNV infection could be misdiagnosed with other emerging infectious diseases presenting with neurological symptoms such as USUV infection.

Two outbreaks of neuropathogenic equine herpesvirus type 1 with breed-dependent clinical signs.

Equine herpesvirus type 1 (EHV-1) is a worldwide spread pathogen of horses. It can cause abortion, respiratory and neurological disease and consequentially significant economic losses in equine industries. During 2009, two outbreaks of EHV-1 were confirmed in two stud farms in Eastern Croatia. The first outbreak occurred in February following the import of 12 horses from USA, serologically negative to EHV-1 before transport. Four mares aborted in the late stage of pregnancy and one perinatal death was recorded. Other six mares showed clinical signs of myeloencephalopathy with fatal end in four. One month later, the second EHV-1 outbreak was confirmed in stud farm about 100 km further with 17 abortions, three perinatal deaths and one mild neurological case. Epidemiological data showed that the disease was probably introduced in the first stud farm during international transport. The second outbreak started with the introduction of clinically healthy stallion from the first stud farm. Molecular characterisation and phylogenetic analysis confirmed that, despite different clinical signs, the identical virus caused both outbreaks. Both horse populations were free from EHV-1 infection before the outbreak and had not been vaccinated. Significant difference in clinical signs could be explained by different breed-related risk factors.

[Fixation of the tuberculum in multifragment fractures of the proximal humerus treated with hemiarthroplasty].

Hemiarthroplasty is an effective treatment for multifragmentary fractures of the proximal humerus. Purpose of this study was to compare 2 different methods of tuberosity dislocations,which is one of the primary reasons for successful posttraumatic arthroplasty. Between 2006 and 2008, 29 patients with multifragmentary fractures of the proximal humerus underwent hemiarthroplasty of the shoulder. Mean gae was 69y., while mean postoperative follow up was 27 months. We evaluated two different techiques of tuberosity fixation after anatomic reattachment on humeri: (A) intertuberosity suture stabilization around the prothesis, and their suture to the humeri and (B) direct intertuberosity suture and their suture to the humeri Postoperartive Constant score averaged 71 points. Reason for failure of the operative treatment was primary due to the postoperative tuberosity migration It was noted in all patients of group 2 and in 2 patients of group 1. Intertuberosity stabilization using sutures arpund the prothesis and tuberosity fixation to the humeri was proofed to be optimal method, because it decreased strain and mobility of tuberosities, maximize stability of the hemiarthroplasty and facilitate postoperative rehabilitation.

[Intramedullary fixation and proximal femoral fractures: diversity in use through case reports].

Proximal femoral fractures, including intertrochanetric and subtrochanteric with diaphiseal propagation represent a significant challenge in orthopedic surgery, especially in older population. Retrospective analysis of patients, after the application of "Bi Nail (Bioimpianti Inc.) intramedullary nail for fractures and pathological conditions of proximal femur, was done at the Department of Adult Orthopedics, Institute of Orthopedic surgery Banjica, during the three year period. We present patients with complex fractures and pathological conditions (metastasis and pseudoarthrosis) of proximal femur; most of the fractures were result of effects of low energy, and the most common pathological fracture is due to metastasis of breast cancer. The analysis included the technical characteristics and duration of surgery, intraoperative and postoperative complications as well as the coalescence time of fracture healing and postoperative quality of life after rehabilitation. We believe that the described surgical method, although technically demanding, with a variable length duration of surgery and treatment of high risk elderly patients, provides stable fracture fixation with early rehabilitation to improve the quality of life.

[Minimal-incision total hip arthoplasty: complications].

Minimally invasive hip surgery techniques have been proposed as an alternative to conventional soft tissue exposure total hip arthroplasty. Purposed advantages of the technique included less blood loss, faster recovery, shoter stay in hospital and better cosmetical result. During the years good results have been presented by many authors, and serious complications have been found only in a few articles. But, some papers reported a catastrofic complications of the MIS procedures. Our intention is to present complication which had occured in our experience with MIS total hip replacement. Retrospective study involved 215 patients (230 hips). All patients, of mean age 55.7 years, obtained fiber metal midcoated or fiber metal taper femoral stem and identical fiber metal coated acetabular shell with polyethylene or ceramic insert. The goal of the study was to evaluate intraoperative and early postoperative complications: bone fractures and/or implant, blood loss, dislocations, prolonged bleeding, loss of component position in 6 week postop. period, infections, and thromboembolism. The complications we had may occure with any type of operating technique. The purpose of the study was not either to condone or condemn MIS techniques but to shaw the complications that had occurred in our experience.

Unusual position of bone tunnels in failed ACL reconstruction.

INTRODUCTION: Surgery of ACL deficient knees is very frequent nowadays due to advanced surgical techniques, sophisticated implants and large number of surgeons. Therefore, the number of revisions for various reasons is growing up. There are several well known reasons for failed surgery This paper reported a case of revision surgery in a patient with previously done and failed reconstruction of ACL. CASE OUTLINE: Reviewing the clinical findings and X rays we found out peculiar position of the transplant and tunnels as a cause of the failure. We haven't found such complication reported in literature therefore we decided to report the case. CONCLUSION: Variety of implants and instruments can ease the surgery but basic anatomical knowledge of position and relations of the knee ligaments are essential for good surgical outcome.

Wegener's granulomatosis in New Zealand: evidence for a latitude-dependent incidence gradient.

BACKGROUND: The aim of the study was to determine whether there was evidence for a geographic gradient in the incidence of Wegener's granulomatosis (WG) and WG-like disease in New Zealand (NZ). METHODS: The National Minimum Dataset of the Ministry of Health, NZ was searched for individual patient discharges coded by the International Classification of Diseases 10th Revision, Australian Modification as either M301 (polyarteritis with lung involvement, including Churg Strauss and allergic granulomatous angiitis) or M313 (WG, necrotizing respiratory granulomatosis) for the period 1 January 1999 to 31 December 2003. Data were standardized using the 2001 NZ census. RESULTS: One hundred and ninety-five patients (95 men) were given a first-time discharge code of either M301 (40 patients) or M313 (155 patients). No gender bias was seen. The rate among Europeans was twice that of NZ Maoris or Asians. The rate of disease peaked in the age band 70-79 years and during winter months. A significant positive north-south geographic gradient was present for M313. No difference in the rate of readmission or time to relapse between geographic regions was found for M313. CONCLUSION: A north-south gradient in the rate of patient discharges given a diagnostic code of M313 (WG, necrotizing respiratory granulomatosis) was present in NZ. This finding supports the hypothesis that there is a latitude-dependent risk factor(s) for WG possibly common to both global hemispheres.

[Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs ligamentum patellae].

In this study we have analyzed outcome during the early rehabilitation period phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendonosus/gracilis tendon (SG) based reconstruction. This study included 40 patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant differences were observed in LP group in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrated advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.

[Anterior cruciate ligament reconstruction: comparison of male and female athletes using the patellar tendon and hamstring autografts].

Few authors have studied the effects of gender on the outcome of ACL reconstruction in athletes. This retrospective-prospective study compared the treating results using the patellar tendon (LP) and hamstring (StG) techniques in men and women. We followed 40 athletes (23 males, 17 females) from population of 120 patients operated at Institute for Orthopaedic Surgery Banjica. There were 13 males and 7 females in the LP group and 11 males and 9 females in the StG group. Patients were operated by the same surgeons within 6 month from injury and underwent the same rehabilitation program. After an average of 24 months they were assesed by clinical evaluation, knee laxity analysis and standard knee scores. Among LP patients there were no significant differences between males and females regarding knee evaluation form, laxity or functional tests. Females in the hamstring group had significantly grater laxity and significantly higher deficit in flexion and extension. We suggest further studies on the clinical significance of these findings, particularly on their ramifications of return to sports and rehabilitation of female athletes.

[Treatment of unreduced posterior dislocations of the shoulder].

Unreduced posterior dislocations of the shoulder are rare and difficult to treat. Treatment depends of defect of the humeral head. Since 1997 to 2002 eleven patients were referred to us for treatment unreduced posterior dislocations of shoulder with impressed fracture of the humeral head. Dislocations have lasted between two to eight months. All patients were treated with open reduction. Allograft reconstruction of the defect was used in six and hemiarthroplasty in two cases. As assessed with the scoring system of Constant, patients were rated excellent (9), satisfactory (1), unsatisfactory (1). Allograft reconstruction is the optimal choice for defects involving 20% to 45% of the humeral head. Prosthetic replacement is preferred for larger defects. Reconstruction of the defects involving less than 20% of the humeral head is not necessary. The observation is only ment to serve as a guide during decision making. The surgeon must make his own surgical choice based on the individual patient factors and on the intraoperative findings.

[Arthroscopy of the hip--surgical treatment of synovial osteochondromatosis].

The hip arthroscopy is an efficient procedure in treatment of synovial chondromatosis in selected patients. The advantages compared to open procedures are lesser operative moribidity and faster postoperative recovery.

[Rigid-fix pins fixation and LCA reconstruction with semitendinosus/gracilis autograft].

ACL reconstruction techniques highly developed during the decades and biomechanical tests for hamstrings graft showed much in advance loading and stiffness comparing BPTB grafting. We have made joint analysis of 30 patients with semitendinosus / gracilis ACL reconstruction. Choice for proximal fixation was Mitek Rigid-fix Pins technique and bioactive screws for distal fixation; in 18 cases bioactive screws were used for femoral and tibial graft fixation. Lysholm score and knee clinical tests were parameters used for outcome evaluation. Follow up averaged 6 months with assessment after 1, 3, 6 and 12 months. Our results showed excellent postoperative Lysholm score in 85% and very good in 15% of cases. Postoperative Lachman was 1+ in 15% and postoperative pivot shift was 0%. Full rehabilitation achieved 85% and with modifications in everyday activities 15% of patients. Donor localization morbidity was markedly reduced and we have no complications. On the basis of the improved results in graft compression as well as stability with this technique, applied method is highly recommended for the reconstruction in ACL deficient knees.

[ACL reconstruction with BTB graft--unusual evolution of knee arthrofibrosis case report].

Knee arthrofibrosis, which usually occurs after trauma or surgery, can inhibit joint biomechanics. An elaborated interaction of growth factors and other inflammatory mediators initiates and coordinates this deleterious tissue proliferation. Knowledge of risk factors can aid clinicians in helping patients avoid knee arthrofibrosis. Once the condition is present, a history and examination are imperative to institute the most appropriate treatment regimen. Nonoperative measures can be used as therapy, though surgery is often necessary for optimal results. We have analyzed problems in patient with uncommon evolution of knee arthrofibrosis following ACL recontruction with BTB autograft.

[Choice of anesthesia in microsurgical procedures on peripheral nerves]. / Izbor anestezije kod mikrohirurskih operacija na perifernim nervima.

Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transfer; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.); for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgeons and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

[Supplementary feeding--additional food in daily infant nutrition]. / Prihranjivanje--dodatna hrana u dnevnoj formuli ishrane odojceta.

A group of 707 children aged 1 to 24 months from the territory of Vojvodina (10 rural and urban settlements) was examined regarding additional food (nonmilk and milk food), time of introduction, infant's age and frequency of consumption. It has been concluded that supplementary feeding, including all food, starts early. Fruit and vegetable are introduced at the age of 34 months. As for the introduction of yolk (first given at about 4 months) it differs from the modern attitudes regarding the intake of this food. Milk formulae, meat and chicken liver are usually introduced about the fifth month. Analyses of the type of food and the way of preparation point to some extremities. Special emphasis is given to the environmental specificities which determine the recommendations.

[Hematologic parameter of red blood cells in children up to 2 years of age]. / Hematoloski parametri crvene loze u dece uzrasta do dve godine.

The authors investigated the hematologic parameters in 592 children up to two years of age. By analyzing hemoglobin and hematocrit values, the specific criterions were established for diagnosis of anemia. Iron deficient anemia was found in 12.8% children, which suggest that anemia is still a great health and socioeconomic problem. By examination of every single case, the authors found out that anemia is not a specific entity, but a result of basic aspects of iron metabolism and nutrition.

[Acute alcoholic intoxication in children in Vojvodina]. / Akutna trovanja etanolom u dece u SAP Vojvodini.

The aim of this work was to investigate the frequency and characteristics of acute ethanol poisoning in children in the territory of the Socialist Autonomous Province of Voivodina. In a retrospective study histories of poisoned children aged 0-15 years, who were hospitalized in all eleven stationary centres in Voivodina during 1985/86, were analysed. From 795 children, 52 were poisoned with ethanol (6.54%). With the exception of Novi Knezevac, where only eight cases of poisoning were recorded during the two-year period, the frequency of ethanol poisoning showed major regional differences varying from 3.03% in Zrenjanin to 11.45% in Subotica. Poisoning among boys was significantly more frequent than among girls, especially with ethanol. The average age of children poisoned with ethanol was 8.4 years i.e. almost twice that of children poisoned with other substances. The children's age and circumstances of ethanol poisoning point to the absence and failure of preventive measures.