The diagnostic accuracy of transabdominal ultrasonography needs to be considered when managing gallbladder polyps.

BACKGROUND: Transabdominal ultrasonography (TAUS) is the most commonly used modality to diagnose gallbladder (GB) disease. GB polyps are reported in 1-5.6 % of TAUS studies. Histopathologic studies suggest that there is a relationship between GB polyps and GB cancer. Previous literature suggests GB polyps reported on TAUS do not correlate well with histological findings. There have been recent advances in TAUS technology. We hypothesize the recent advances in TAUS technology have improved the accuracy of TAUS for diagnosing GB polyps. METHODS: Radiology and pathology databases at our tertiary care center were retrospectively searched between January 1, 2000, and December 31, 2010. Ultrasound reports that suggested a GB polyp was present on TAUS were correlated to histopathology in cases where a cholecystectomy was performed. The pathology reports where a GB polyp was found were correlated with preoperative TAUS reports. RESULTS: There were 102,740 TAUS reports referring to the GB, of which 6,612 (6.4 %) contained search terms suggesting a GB polyp was present. There were 13,278 cholecystectomy pathology reports, of which 159 (1.2 %) included a diagnosis of GB polyp. TAUS detected only 50 % of the polyps identified on histopathology. The sensitivity and specificity of TAUS for diagnosing GB polyps were 50.0 and 98.3 %, respectively. The positive and negative predictive values were 10.5 and 99.8 %. CONCLUSIONS: Despite improvement in TAUS technology, the accuracy for GB polyps remains poor. This needs to be considered when managing patients with TAUS-detected GB polyps. We recommend that the decision to operate on TAUS-detected GB polyps be largely based on symptoms, and following GB polyps with TAUS should be discouraged.

Identification of a ribosomal L10-like protein from Flavobacterium psychrophilum as a recombinant vaccine candidate for rainbow trout fry syndrome.

The psychrophilic bacterium Flavobacterium psychrophilum is a rapidly emerging, virulent pathogen of a variety of commercially important finfish species, including salmonids. No vaccines against F. psychrophilum are currently available, partly due to its recalcitrant growth in vitro. Consequently, we explored the possibility of constructing recombinant vaccines in Escherichia coli as a prophylactic biotechnological strategy to counter F. psychrophilum infections. An immunoreactive clone from a F. psychrophilum expression library was found to express a approximately 16 kDa protein antigen. A proteomics approach was taken to identify the ORF encoding the approximately 16 kDa protein. Tryptic fragments of the approximately 16 kDa protein were analyzed by MALDI-TOF mass spectrometry and compared to theoretical (in silico) tryptic fragments of translated ORFs predicted within the cloned DNA. The target protein was identified as a 166 amino acid protein (named 7-166) with homology to rplJ which encodes bacterial ribosomal protein L10. Whenhighly expressed in E. coli as an N-terminal fusion protein, this chimera reacted with convalescent rainbow trout serum. When adjuvanted and administered intraperitoneally to immature rainbow trout a high level of protection (82% RPS) was afforded against virulent F. psychrophilum challenge; thus establishing F. psychrophilumrplJ homologue 7-166 as a promising vaccine candidate for RTFS.

Identification and expression of a host-recognized antigen, FspA, from Flavobacterium psychrophilum.

Flavobacterium psychrophilum is the aetiological agent of rainbow trout fry syndrome, an economically important disease of immature salmonid fish for which there is no vaccine. Convalescent serum from the host, rainbow trout (Oncorhynchus mykiss), reacted strongly with a approximately 20 kDa, Flavobacterium-specific protein antigen (subsequently named FspA) from F. psychrophilum. Protein-enriched, detergent-partitioned samples were separated by two-dimensional gel electrophoresis and the protein target was excised, proteolytically cleaved and the resulting peptides analysed by MS. Quadrupole-time-of-flight MS was used to generate a fragmented peptide spectrum. The resulting peptide sequences were then used to design degenerate PCR primers to amplify the gene (fspA) of interest: 612 bp encoding 203 aa, including a putative 19 aa N-terminal signal sequence which predicted a processed 19 303.6 Da protein. FspA proved to be unique and only homologous to two unspecified sequences reported from Flavobacterium johnsoniae, although weakly homologous to a Yersinia pseudotuberculosis adhesin. An amplified gene fragment (537 bp, encoding 179 aa) was further cloned into an expression vector, expressed as a approximately 30 kDa N-terminal fusion protein and found to retain its strong reactivity with host serum antibodies. These results suggest that the surface-localized FspA may be an important subunit vaccine candidate antigen against F. psychrophilum.