EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis.

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

Poster - Thur Eve - 04: Online review of beam output and profile constancy using statistical process control.

The objective of this work was to create a comprehensive online tool to evaluate and review the performance of quality assurance measurements that assess beam output and profile constancy as soon as they are acquired using statistical process control. As part of routine quality assurance: output, flatness and symmetry measurements are acquired daily and weekly with DQA3 and the Matrix and symmetry and flatness are acquired on a monthly basis with Profiler2. An individuals control chart and a moving range control chart was plotted for each set of data. Upper and lower control limits were calculated using measurements acquired during a several month period when the linear accelerators were operating optimally. The existing action levels, established according to TG142 and CAPCA guidelines were compared with the calculated statistical control limits. Tighter tolerance limits were recommended for output, symmetry and flatness Matrix measurements and DQA3 flatness measurements.

A predictive model for heat inactivation of Listeria monocytogenes biofilm on stainless steel.

Heat treatment of potential biofilm-forming sites is sometimes used for control of Listeria monocytogenes in food processing plants. However, little information is available on the heat treatment required to kill L. monocytogenes present in biofilms. The purpose of this study was to develop a predictive model for the heat inactivation of L. monocytogenes in monoculture biofilms (strains Scott A and 3990) and in biofilms with competing bacteria (Pseudomonas sp. and Pantoea agglomerans) formed on stainless steel in the presence of food-derived soil. Biofilms were produced on stainless steel coupons with diluted tryptic soy broth incubated for 48 h at 25 degrees C. Duplicate biofilm samples were heat treated for 1, 3, 5, and 15 min at 70, 72, 75, 77, and 80 degrees C and tested for survivors using enrichment culture. The experiment was repeated six times. A predictive model was developed using logistic regression analysis of the fraction negative data. Plots showing the probability of L. monocytogenes inactivation in biofilms after heat treatment were generated from the predictive equation. The predictive model revealed that hot water sanitation of stainless steel can be effective for inactivating L. monocytogenes in a biofilm on stainless steel if time and temperature are controlled. For example, to obtain a 75% probability of total inactivation of L. monocytogenes 3990 biofilm, a heat treatment of 80 degrees C for 11.7 min is required. The model provides processors with a risk management tool that provides predicted probabilities of L. monocytogenes inactivation and allows a choice of three heat resistance assumptions. The predictive model was validated using a five-strain cocktail of L. monocytogenes in the presence of food soil.

Biofilm Formation and Control in Food Processing Facilities.

Microorganisms on wet surfaces have the ability to aggregate, grow into microcolonies, and produce biofilm. Growth of biofilms in food processing environments leads to increased opportunity for microbial contamination of the processed product. These biofilms may contain spoilage and pathogenic microorganisms. Microorganisms within biofilms are protected from sanitizers increasing the likelihood of survival and subsequent contamination of food. This increases the risk of reduced shelf life and disease transmission. Extracellular polymeric substances associated with biofilm that are not removed by cleaning provide attachment sites for microorganisms newly arrived to the cleaned system. Biofilm formation can also cause the impairment of heat transfer and corrosion to metal surfaces. Some of the methods used to control biofilm formation include mechanical and manual cleaning, chemical cleaning and sanitation, and application of hot water.

Comparison of ITS profiling, REP- and ERIC-PCR of Salmonella Enteritidis isolates from Poland.

Thirty-one Salmonella Enteritidis strains isolated from chickens, broilers and hens were analysed by genotypic typing including REP-PCR. ERIC-PCR and ITS profiling (PCR-ribotyping). Analysis of DNA banding patterns generated by REP-PCR revealed the presence of 22 different genotypes, which were grouped by dendrogram analysis into three distinct lineages (maximum similarity approx. 50%). Each isolate of S. Enteritidis analysed by ERIC-PCR generated an individual DNA pattern. Again, these isolates could be divided into three distinct genomic groups (maximum similarity approx. 60%) by their ERIC-PCR fingerprints. REP- and ERIC-PCR were found to be more discriminatory for typing of S. Enteritidis than ITS profiling. Amplification of the 16S-23S rDNA spacer region gave nine different profiles of DNA, subdivided into two closely related groups by dendrogram analysis. In summary, data obtained by genotyping methods for S. Enteritidis isolates from regions located in the south-west and the central parts of Poland revealed an enormous heterogeneity among analysed samples, and proved that REP- and ERIC-PCR are highly discriminatory techniques, which can be used, in addition to conventional methods, in epidemiological studies of S. Enteritidis infections.

Phylogenetic similarity of the canine parvovirus wild-type isolates on the basis of VP1/VP2 gene fragment sequence analysis.

Biological material was taken from dogs with diarrhoea. Faecal samples were taken from within live animals and intestinal tract fragments (i.e. small intestine, and stomach) were taken from dead animals. In total, 18 specimens were investigated from dogs housed alone or in large groups. To test for the presence of the virus, latex (On Site Biotech, Uppsala, Sweden) and direct immunofluorescence tests were performed. At the same time, polymerase chain reaction (PCR) with primers complementary to a conservative region of VP1/VP2 was carried out. The products of amplification were analysed on 2% agarose gel. The purified products were cloned with the Template Generation System (Finnzymes, Espoo, Finland) using a transposition reaction and positive clones were searched using the 'colony screening by PCR' method. The sequencing gave 12 sequences of VP1/VP2 gene fragments that were of high similarity. Among the 12 analysed sequences, six exhibited 88% similarity, four exhibited 100% similarity and two exhibited 71% similarity.

Influence of surface finish on the cleanability of stainless steel.

Stainless steel for fabricating food processing equipment is available with various surface finishes. The objective of this research was to determine the effect of surface finish on cleanability. Nine samples of stainless steel, type 304, from various manufacturers including no finish (hot rolled and pickled), #4 finish, 2B mechanical polished, and electropolished were tested. Cleanability was assessed by using coupon samples soiled with either cultured milk inoculated with spores of Bacillus stearothermophilus or by growth of a Pseudomonas sp. biofilm. Samples were cleaned by immersion in a turbulent bath of 1.28% sodium hydroxide at 66 degrees C for 3 min followed by a sterile water rinse, neutralizing in 0.1% phosphoric acid for 30 s, rinsing in phosphate buffer, sanitizing in 100 ppm hypochlorite, neutralizing in sodium thiosulfate, and drying. To determine residual milk soil, coupon samples were covered with PM indicator agar and incubated for 25 h at 58 degrees C. Other coupons were subjected to an additional 10 soiling or cleaning cycles, and the residual protein was measured by using epifluorescent microscopy and image analysis. Results indicate that the spore count was more precise for measuring initial cleanability of the finished samples, and the protein residue determination was useful for determining the effect of repeated cleaning. Data on the removal of milk soil suggest that stainless steel should be purchased based on measures of surface defects rather than finish type. Surface defects, as determined using a surface roughness gauge, produced a correlation of 0.82 with spore counts. Data also indicated that biofilm was more difficult to remove than milk-based soil.

[REP and ERIC repetitive DNA sequences in bacteria--diagnostic significance]. / Powtórzone sekwencje DNA typu REP i ERIC u bakterii--znaczenie diagnostyczne.

Main part of eukaryotic genomes is build of unique sequences coding proteins and RNAs, but they contain as well numerous repeats interspersed with single-copy fragments. Existence of repetitive sequences were also demonstrated in prokaryotic genomes. They are found in different species of Gram-negative and Gram-positive bacteria. Interspersed repetitive sequence elements called REP and ERIC sequences are present in different species of Enterobacteriaceae family, including Escherichia coli and Salmonella typhimurium. Their functions are not completely clear, probably they play important role in regulation of gene expression. Nevertheless, REP and ERIC elements are widely use in identification and genetic analysis of bacteria. For example, using rep-PCR technique it is possible to discriminate between closely related serovars of the same species, which enables to analyze phylogenetic and epidemiological relations among them.

Inactivation of aflatoxigenic aspergilli by treatment with ozone.

The D-values of conidia of aflatoxigenic Aspergillus flavus and Aspergillus parasiticus exposed to 1.74 ppm. ozone in 1 mM potassium phosphate buffer (pH 7.0 and 5.5) at 25 degrees C were determined. D-values of A. flavus conidia were 1.72 and 1.54 min at pH 5.5 and 7.0, respectively; D-values of A. parasiticus were 2.08 and 1.71 min, respectively. None of these D-values was significantly (P < or = 0.05) different from each other.

Effectiveness of sanitation with quaternary ammonium compound or chlorine on stainless steel and other domestic food-preparation surfaces.

The relative ability of various materials used for domestic and/or food-service sinks and countertops to be sanitized was determined. Both smooth (unused) and abraded surfaces were tested by exposure to 200 mg of quaternary ammonium compound per liter or 200 mg of sodium hypochlorite per liter. Surface materials tested included mechanically polished (type 304, #4 finish) and electropolished stainless steel, polycarbonate, and mineral resin. Surfaces were prepared for testing by allowing attachment of a Staphylococcus aureus culture for 4 h to achieve an initial attached population of 10(4) to 10(5) CFU/cm2. The test procedure involved immersion of the surface in sanitizer solution followed by wiping with a sanitizer-saturated cloth. Residual staphylococci were detected by overlaying agar directly on the treated surface. Results indicated that the stainless steels and the smooth polycarbonate, which had 0.5 log CFU/cm2 or fewer of residual staphylococci, were more readily sanitized by quaternary ammonium compound than were either the mineral resin surfaces, which had nearly 2.0 log CFU/cm2 of residual staphylococci, or the abraded polycarbonate which had nearly 1.0 log CFU/cm2 of residual staphylococci. Chlorine was most effective on the mechanically polished stainless steel, the unabraded electropolished stainless steel, and the polycarbonate surfaces, reducing cell populations to less than 1.0 log CFU/cm2. Chlorine was less effective on abraded electropolished stainless steel and mineral resin surfaces, where populations remained greater than 1.0 log CFU/cm2. Sanitation with quaternary ammonium compound or chlorine reduced S. aureus populations more than 1,000-fold on all surfaces except unabraded mineral resin.

Formation of viable but nonculturable Salmonella during starvation in chemically defined solutions.

Salmonella enteritidis enters a viable-but-nonculturable state when exposed to starvation in aquatic environments. This study determined starvation survival of this pathogen in chemically defined solutions and tested the ability of nonselective enrichment to detect viable-but-nonculturable cells. Starvation of Salm. enteritidis at 7 degrees C in 7.35 mmol l-1 potassium phosphate buffer resulted in complete loss of culturability after 5 weeks with maintenance of a substrate-responsive population of over 10,000 cell ml-1. Starvation at 21 degrees C and starvation in saline solutions or lower concentrations of phosphate buffer resulted in prolonged survival of a culturable population although this population was lower than the total viable population. Enrichment using lactose broth did not allow resuscitation of viable-but-nonculturable cells even after 5 d of incubation at 35 degrees C.

C1q enhancement of antibody-dependent granulocyte-mediated killing of nonphagocytosable targets in vitro.

A possible role for C1q in antibody-dependent granulocyte-mediated killing of nonphagocytosable targets was investigated utilizing IgG-dependent granulocyte cytotoxicity directed against microfilariae of Dirofilaria immitis. Granulocyte-mediated killing of microfilariae is enhanced by addition of fresh serum. Lack of C4 did not significantly reduce the observed increase in cytotoxicity. The addition of highly purified monomeric human Clq (0.2 microgram/ml) in the presence of immune IgG resulted in a two- to fivefold enhancement of killing (P less than 0.025). C1q enhancement of killing occurred in the absence of fluid-phase IgG, but killing was significantly less than when both fluid-phase IgG and C1q were present. The effect of C1q was inhibited by the addition of solubilized type I collagen (44-92% inhibition of killing, P less than 0.05). Significant 125I-Clq binding to microfilariae occurred only in the presence of immune IgG. In addition, C1q in concentrations ranging from 0.5 to 2.0 micrograms/ml resulted in a dose-dependent increase in binding of 125I-immune IgG to microfilariae. Finally, when purified C1q was added to preopsonized, washed microfilariae, granulocyte production of superoxide was increased from 0.25 +/- 0.07 to 0.68 +/- 0.07 nm/10(6) cells.10 min (P less than 0.01). These results describe a novel functional role for C1q in enhancement of antibody-dependent cellular cytotoxicity towards nonphagocytosable targets.

Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients.

The clinical distinction between bacterial colonization of the tracheobronchial tree and nosocomial pneumonia is difficult, especially in intubated patients. We studied 51 intubated, intensive care unit patients prospectively by serial examinations of tracheal aspirates for elastin fibers, graded Gram's stains, and quantitative bacterial cultures in conjunction with clinical and radiologic observations in an attempt to develop criteria for the early detection of pulmonary infection. Patients with infection had new or progressive pulmonary infiltrates plus 1 of the following: positive blood culture results, radiographic evidence of cavitation, or histologic evidence of pneumonia, or 2 or more of the following: new fever, new leukocytosis, or grossly purulent tracheal aspirates. Twenty-one patients developed infection, 22 remained colonized, and 8 had an uncertain status. Infiltrates developed in 34 patients (21 infected, 8 colonized, 5 uncertain status). Gram-negative bacilli were most commonly isolated and were more frequent in infected patients (81 versus 47%, p less than 0.05); Pseudomonas aeruginosa and Serratia marcescens were most often associated with infection. No differences were observed between infected and colonized patients in demographic features, smoking history, underlying disease, previous antibiotic therapy, days in hospital before intubation, preexisting pneumonia upon intubation, or highest temperature or leukocyte count during course. By univariate analysis, infected patients had a longer duration of intubation (p less than 0.05), higher Gram's stain grading for neutrophils (p less than 0.05) or bacteria (p less than 0.005), higher bacterial colony counts (p less than 0.05), and more frequent detection of elastin fibers in tracheal aspirates (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Left-sided endocarditis due to Pseudomonas aeruginosa. A report of 10 cases and review of the literature.

Ten confirmed cases of left-sided endocarditis due to Pseudomonas aeruginosa were reported in detail and the English literature was reviewed. In recent years, venous access (usually illicit) has been the major predisposing factor to this infection and abuse of pentazocine and tripelennamine has been particularly associated with endocarditis due to this organism. This infection involves previously damaged as well as normal valves. The development of congestive heart failure did not adversely affect the prognosis of this infection. However, the development of azotemia was associated with a greater likelihood of a fatal outcome. In the current series, deaths were due to uncontrolled infection. This often occurred despite inhibitory and bactericidal activity in serum generally considered adequate for treatment of endocarditis. Medical treatment alone rarely produced cure of infection. Our experience with a high frequency of major vessel embolization (4/10) and the improved survival after medical/surgical treatment suggests that prompt valve replacement combined with high doses of an aminoglycoside plus carbenicillin or ticarcillin provide the best opportunity for successful outcome in patients with left-sided endocarditis due to P. aeruginosa.

Sputum elastin fibers and the diagnosis of necrotizing pneumonia.

Potassium hydroxide (KOH) preparations for elastin fibers on sputum obtained from 80 patients seen over a four-month period at two Cleveland hospitals were performed. The results were compared with roentgenographic evidence of necrosis and case diagnosis. Sixty-one patients had neither elastin in sputum nor roentgenographic evidence of cavitation; 11 had positive results using both methods. Two patients had no elastin fibers in sputum but had parenchymal pulmonary cavities on chest x-ray film. Six patients had elastin observed in KOH preparations of sputum, but no cavitation roentgenographically. The presence of elastin in sputum was strongly correlated with roentgenographic evidence of pulmonary necrosis (p = 5.7 X 10(-8]. Including patients seen before, after, and during the prospective study, we have observed a total of nine with positive sputum preparations for elastin and no cavitation on chest x-ray film for whom tissue was available for study. All had pulmonary necrosis histologically. Our observations suggest that the KOH preparation of sputum for elastin fibers may be more sensitive than the chest roentgenogram in the detection of pulmonary necrosis and may be a useful adjunct in the diagnosis of necrotizing disease.

Elastin fibers in the sputum of patients with necrotizing pneumonia.

We have observed five patients for whom the presence of fibers of elastin in potassium hydroxide (KOH) preparations of sputum represented the first evidence of necrotizing pulmonary disease. In four cases, the discovery of elastin fibers in sputum provided additional evidence supporting initiation or modification of antibiotic therapy. Necrotizing disease was confirmed in all cases by autopsy or by the development of cavitation on chest x-ray film. Cytochemical staining, electron microscopy, and elastase digestion all suggest that the refractile fibers seen on KOH wet mount of sputum are elastin. The test, first described in 1846, is simple to perform, requires little experience to read, and may be a valuable adjunct to the chest roentgenogram in the diagnosis of pulmonary parenchymal destruction.