Tuberculosis, Brucellosis and Leucosis in Cattle: A Cost Description of Eradication Programmes in the Region of Lazio, Italy.

The eradication of tuberculosis, brucellosis and leucosis in cattle has not yet been achieved in the entire Italian territory. The region of Lazio, Central Italy, represents an interesting case study to evaluate the evolution of costs for these eradication programmes, as in some provinces the eradication has been officially achieved, in some others the prevalence has been close to zero for years, and in still others disease outbreaks have been continuously reported. The objectives of this study were i) to describe the costs for the eradication programmes for tuberculosis, brucellosis and leucosis in cattle carried out in Lazio between 2007 and 2011, ii) to calculate the ratio between the financial contribution of the European Union (EU) for the eradication programmes and the estimated total costs and iii) to estimate the potential savings that can be made when a province gains the certification of freedom from disease. For the i) and ii) objectives, data were collected from official sources and a costing procedure was applied from the perspective of the Regional Health Service. For the iii) objective, a Bayesian AR(1) regression was used to evaluate the average percentage reduction in costs for a province that gained the certification. The total cost for the eradication programmes adjusted for inflation to 1 January 2016 was estimated at 18 919 797 euro (5th and 95th percentiles of the distribution: 18 325 050-19 552 080 euro). When a province gained the certification of freedom from disease, costs decreased on average by (median of the posterior distribution) 47.5%, 54.5% and 54.9% for the eradication programmes of tuberculosis, brucellosis and leucosis, respectively. Information on possible savings from the reduction of control costs can help policy makers operating under budget constraints to justify the use of additional resources for the final phase of eradication.

Control and eradication of tuberculosis in cattle: a systematic review of economic evidence.

Bovine tuberculosis (TB) is a disease of zoonotic importance for which control and eradication programmes have been carried out in many countries for decades. While the impact of these programmes on public health is still uncertain, the impact on trade is significant because of movement restrictions for animals, costs of testing and culling. The objective of this systematic review was to provide a contribution to the general debate over costs against benefits for the control and eradication of bovine TB in cattle. The search strategy was performed on four electronic databases following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The selection process, data abstraction and quality appraisal were carried out according to the Cochrane Collaboration guidelines. The search identified 66 articles out of which eight fulfilled the inclusion criteria. The evidence gathered in this review by combining the conclusions of the most methodologically sound articles supports the idea that, when multiple cost and benefit components are taken into account, efforts to control or eradicate bovine TB may be effective in reducing disease prevalence, economically viable and worth doing.

Short communication: comparing real-time PCR and bacteriological cultures for Streptococcus agalactiae and Staphylococcus aureus in bulk-tank milk samples.

For more than 30 yr, a control plan for Streptococcus agalactiae and Staphylococcus aureus has been carried out in more than 1,500 dairy herds of the province of Brescia (northern Italy). From 2010 to 2011, the apparent prevalence of Strep. agalactiae has been relatively stable around 10%, but the apparent prevalence of Staph. aureus has been greater than 40% with an increasing trend. The aim of this paper was to estimate and compare the diagnostic accuracy of 3 assays for the detection of Strep. agalactiae and Staph. aureus in bulk-tank milk samples (BTMS) in field conditions. The assays were a qualitative and a quantitative bacteriological culture (BC) for each pathogen and a homemade multiplex real-time PCR (rt-PCR). Because a gold standard was not available, the sensitivities (Se) and specificities (Sp) were evaluated using a Bayesian latent class approach. In 2012 we collected one BTMS from 165 dairy herds that were found positive for Strep. agalactiae in the previous 2-yr campaigns of eradication plan. In most cases, BTMS collected in these herds were positive for Staph. aureus as well, confirming the wide spread of this pathogen. At the same time we also collected composite milk samples from all the 8,624 lactating cows to evaluate the within-herd prevalence of Strep. agalactiae. Streptococcus agalactiae samples were cultured using a selective medium Tallium Kristalviolette Tossin, whereas for Staph. aureus, we used Baird Parker modified medium with added Rabbit Plasma Fibrinogen ISO-Formulation. In parallel, BTMS were tested using the rt-PCR. Regarding Strep. agalactiae, the posterior median of Se and Sp of the 2 BC was similar [qualitative BC: Se=98%, posterior credible interval (95%PCI): 94-100%, and Sp=99%, 95%PCI: 96-100%; quantitative BC: Se=99%, 95%PCI: 96-100%, and Sp=99%, 95%PCI: 95-100%] and higher than those of the rt-PCR (at 40 cycle threshold, Se=92%, 95%PCI: 85-97%; Sp=94%, 95%PCI: 88-98%). Also in case of Staph. aureus, the posterior medians of BC were generally higher than those of rt-PCR. In fact, although the Se of BC was slightly lower (rt-PCR at 40 cycle threshold, median Se=99%, 95%PCI: 97-100%, and qualitative BC, median Se=94%, 95%PCI: 87-99%), the Sp was much higher (rt-PCR at 40 cycle threshold, median Sp=67%, 95%PCI: 38-97%; qualitative BC, median Sp=95%; 95%PCI: 76-100%). Our study confirms that BC and rt-PCR are reliable diagnostic tools to detect Strep. agalactiae and Staph. aureus, and rt-PCR results should be confirmed by BC carried out on BTMS and possibly on composite milk samples.

Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone.

AIM: The incidence of postoperative nausea and vomiting (PONV) is high after laparoscopic surgery. A number of drugs have been used for prevention; in some studies a single dexamethasone dose before induction of anaesthesia has been effective. METHODS: To test the effectiveness of this therapy, we recruited 80 patients in a double-blind placebo-controlled study (dexamethasone 8 mg or placebo) scheduled for laparoscopic cholecystectomy. We measured nausea, vomiting, postoperative pain and length of stay. RESULTS: Patients who received preoperative dexamethasone had a reduction of PONV, but experienced the same degree of postoperative pain and remained in the hospital for the same duration. No apparent side effects were observed. CONCLUSION: Although only a small number of patients were tested, we confirm the efficacy of dexamethasone therapy for reduction of PONV. We suggest routine use of a single dose of dexamethasone for the prevention of PONV in laparoscopic cholecystectomy.

Intraspinal therapy for the treatment of chronic pain: a review of the literature between 1990 and 2005 and suggested protocol for its rational and safe use.

The administration of intrathecal drugs has been shown to be efficacious in the treatment of both cancer pain and noncancer pain in patients who do not respond well to conventional treatment, in those who are unable to tolerate side-effects of opioids, and in those who constantly require significant increases in drug dosing. Although morphine represents the "drug of choice" for intrathecal administration, the use of alternative drugs (e.g., bupivacaine, clonidine, and hydromorphone) appears promising for intrathecal therapy of pain in patients who are unresponsive to morphine, those who cannot tolerate its side-effects, and those patients with neuropathic pain. This study analyzes results of studies published from 1990 to 2005 in order to evaluate the efficacy of intraspinal therapy.

Endoluminal repair of a Dardik prosthesis pseudoaneurysm using the wallgraft endoprosthesis.

A 58-year-old man with a history of severe invalidating claudicatio intermittens underwent femoropopliteal bypass with a human umbilical vein graft. Seven years later he presented with a painful enlarging mass in the middle portion of his right thigh. The duplex scan showed a pseudoaneurysm of the body of the prosthesis, which was confirmed by angiography. As an alternative to surgical management, Wallgraft endoprosthesis was used for endoluminal exclusion of the pseudoaneurysm. To our knowledge, this technique has never been used before in such a case.

Metabolic fate of exogenous sphingosine in neuroblastoma neuro2A cells. Dose-dependence and biological effects.

The possible relationship between metabolism and biological effects of sphingosine was investigated in Neuro2a cells. [C3-3H]-sphingosine, administered at different doses (80 pmol-80 nmol/mg cell protein). Amounts up to hundredfold were rapidly taken up and metabolized, the intracellular content of sphingosine being processed within 2 h. At low doses, [3H]-sphingosine represented a minor portion of the cellular radiolabel, and N-acylated metabolites, particularly ceramide, prevailed over degradation products. Neuro2a cell differentiation took place in conjunction with ceramide increase. At increasing exogenous sphingosine/cell ratio, the acylation process became saturated while sphingosine degradation increased proportionally. From this point on [3H]-sphingosine accumulated and cell toxicity occurred. In conclusion, in Neuro2a cells the biological effects exerted by exogenous sphingosine are strictly connected to the exogenous sphingosine/cell ratio and to the capacity of the cell to metabolize sphingosine.

A mediator role of ceramide in the regulation of neuroblastoma Neuro2a cell differentiation.

Current studies indicate that ceramide is involved in the regulation of important cell functions, namely cell growth, differentiation, and apoptosis. In the present study, the possible role of ceramide in the differentiation of neuroblastoma Neuro2a cells was investigated. The following results were obtained. (a) Ceramide content of Neuro2a cells, induced to differentiate by retinoic acid (RA) treatment rapidly increased after addition of RA, was maintained at high levels in RA-differentiated cells and returned to the starting levels with removal of RA and reversal of differentiation; under the same conditions, the sphingosine content remained unchanged. (b) After a short pulse with [3H]sphingomyelin or [3H]sphingosine or L-[3H]serine, the metabolic formation of ceramide was markedly higher and more rapid in RA-differentiated than undifferentiated cells. (c) Inhibitors of ceramide biosynthesis (Fumonisin B1, beta-chloroalanine and L-cycloserine) diminished the extent of the differentiating effect of RA and concomitantly Cer content decreased. (d) The activity of neutral sphingomyelinase increased after addition of RA, maintained high levels in RA-differentiated cells, and returned to the initial levels with removal of RA. (e) Experimental conditions that cause an elevation of ceramide content (treatment with sphingosine or ceramide or C2-ceramide or bacterial sphingomyelinase) inhibited cell proliferation and stimulated neurite outgrowth; dihydro-analogues of sphingosine, ceramide, and C2-ceramide had no effect on differentiation. (f) treatment with Fumonisin B1 completely inhibited sphingosine-induced differentiation. These data suggest a specific bioregulatory function of ceramide in the control of Neuro2a cell growth and differentiation and pose the general hypothesis of a mediator role of ceramide in the differentiation of cells of neural origin.

The degradative pathway of gangliosides GM1 and GM2 in Neuro2a cells by sialidase.

Gangliosides GM1 [3H-labeled at the sphingosine (Sph) moiety] and GM2 [3H-labeled at the Sph or N-acetylgalactosamine (GalNAc) moiety] were administered to cultured Neuro2a cells for varying pulse (1-4 h) and chase (up to 4 h) periods, and their metabolic processing was followed. The main and earliest formed 3H-metabolites of [Sph-3H]GM1 were GM2, asialo-GM1 asialo-GM2, and lactose-ceramide, and those of [Sph-3H]GM2 were asialo-GM2 and lactose-ceramide. The asialo-GM1 and asialo-GM2 formed were isolated and chemically characterized. [3H]Asialo-GM2 was produced in identical amounts after treatment with equimolar [Sph-3H]GM2 and [GalNAc-3H]GM2. At low temperature or in the presence of chloroquine, the formation of all 3H-metabolites, including asialo-GM2 and asialo-GM1, was undetectable, indicating that ganglioside metabolic processing was an endocytosis- and lysosome-dependent process. These results demonstrate that in Neuro2a cells exogenous GM1 (and GM2) is mainly degraded through the pathway GM1-->GM2-->asialo-GM2-->-->Sph, with a minor fraction of GM1 undergoing degradation with the sequence GM1-->asialo-GM-1-->asialo-GM2-->-->Sph. These findings are consistent with the hypothesis that Neuro2a cells contain a sialidase (likely of lysosomal nature) affecting ganglioside GM1 and GM2. The sialidase-mediated degradative pathway of GM1 and GM2 in Neuro2a cells might be related to the tumoral nature of these cells.

[Leiomyoma of the esophagus]. / I leiomiomi dell'esofago.

In this paper the Authors report a review of the clinical records from 1972 to 1985 of the Institut of IV Clinica Chirurgica of Rome of esophageal leiomyoma. We report on 7 cases: three males and four females. Their ages ranged from 37 to 78 years (mean 54 years). The most frequent symptoms were dysphagia (71.4%), loss weight (57.1%) and slight epigastralgia (42.8%). Barium meal, esophagoscopy, esophageal manometry, TAC are the most sensitive procedures for a correct preoperative diagnosis. The therapy of choice is surgical treatment. However surgery is conservative: extramucosal enucleation of the leiomyoma is the procedures of choice. The postoperative course was free of complications, the long-term results were excellent.

[Staplers and pulmonary surgery]. / Staplers e chirurgia polmonare.

The Authors report their experience with staplers (model T.A. 30) in lung surgery: 152 stapled sutures were, in fact, performed in the IV Surgical Department of the University "La Sapienza" of Rome, during the period 1980/90. The use of staplers assures a perfect closure and prevents granulomas due to suture materials in typical as well as atypical lung resections.

[Current clinico-therapeutic trends in essential varicocele]. / Attuali orientamenti clinico-terapeutici in tema di varicocele essenziale.

The authors report their experience with the diagnosis and surgical correction of varicoceles in 20 patients. They stress the usefulness of the Doppler Ultrasound for the diagnosis of subclinical varicocele.

[100 cases of bronchial mechanical sutures]. / 100 casi di suture meccaniche bronchiali.

The Authors report their experience with stapler model T.A. 30 in lung resections; 100 stapled sutures were carried out in the IV Surgical Department of the University "La Sapienza" of Rome, during the period 1980-88. The use of stapler with two rows of staples allows a secure closure of the bronchial stump. Moreover, it prevents granulomas caused by suture material. The bronchopleural fistulas, serious complications of manual suturing, did not occur. Finally, this method is simpler and rapidly feasible in comparison with classic ones.

[Echocardiographic and polycardiographic findings in multiple-transfused patients with thalassemia major]. / Indagine ecocardiografica e policardiografica in soggetti affetti da talassemia mayor politrasfusi.

Echocardiographic and policardiographic measurements were carried out in 11 thalassemic major patients between 2 and 24 years of age, kept at on average Hb level of 9,77 gr.% (+/- 1,13) and who underwent chelation therapy with Deferoxamine subcutaneous and Vit. C. The echocardiographic examination gave normal values in 7 patients. In 4 patients underwent enlargement of the left ventricle: only in the telediastolic diameter in one case, with progressive involvement of the aorta and the left atrium in another 3 cases. Such alterations, as have already been recorded by various researchers, are probably the result of a condition due to the anemia state of the younger patients, whereas in older and polytransfused patients may be attributed to iron overload. No parameters surveyed by the polycardiographic examination indicated significant alterations in cardiac efficiency, except of one patient. The importance of echocardiography should be stressed; it is a simple, non invasive way of recording early cardiac alterations in thalassemic major patients and enables long-term monitoring of cardiac function in the assessment of the effectiveness of the chelation therapy.