Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation.

OBJECTIVES: Proximal duodenal ulceration is often characterised by continuous bleeding, and treatment is challenging. The aims of this study were to investigate the role of vascularisation in proximal duodenal ulceration and describe clinical aspects, endoscopic features and treatment in dogs. MATERIAL AND METHODS: Polyurethane foam casts of gastroduodenal vessels were obtained from five dogs which had died from disorders unrelated to the digestive system. In addition, 12 dogs having proximal duodenal ulcers diagnosed by endoscopic examination were enrolled in a treatment trial. After the endoscopic diagnosis of a duodenal ulcer, all the dogs were treated medically and, in the absence of resolution, were subsequently treated by endoscopic electrocauterisation or by surgery. RESULTS: A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum. In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall. The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection of the proximal duodenal portion. All the dogs survived until discharge, and the median survival time following discharge was 107.5 days. CLINICAL SIGNIFICANCE: Based on the anatomical details highlighted in this study, the continuous bleeding observed in our patients may have been due to the prominent venous plexus evidenced at the level of the proximal duodenum. Surgical and endoscopic treatments in six patients resolved the ulcer bleeding with no recurrences noted during follow-up.

An overview of operations and processes for circular management of dredged sediments.

Dredging is an essential technique to maintain proper water depths in ports and bays. Many dredged sediments are considered as toxic waste due to their significant amounts of metals and other pollutants. In consequence, they need to be treated to reduce this toxicity and avoid pollutant resuspensions. Physical operations and chemical, thermal and biological processes have been conventionally used to this aim, but the traditional linear sediment approach is often unsustainable and economically and environmentally demanding. Considering the increasing people's awareness in environmental issues, more efficient dredged sediment management schemes are required. Some authors are making significant efforts to improve circularity in sediment management processes by taking advantage of the mineral composition of sediments to obtain products for the building and road construction sectors, therefore decreasing the need of raw materials while reducing the amounts of sediments wasted to landfills. However, information related to the characteristics of these products, their mechanical behaviour and their functionality is still scarce, being sediment-based by-products developed mainly at low Technological Readiness Level (TRL), showing low global impact in the market. To implement circular economy in the dredged sediment sector, some technical and socio-political barriers must be still overcome. To this aim, further research and technological applications must be developed, with the support of decision makers and stakeholders. This review aims at giving an overview of the circular trends applied to toxic dredged sediment management, pointing at current opportunities, barriers and constraints that hinder its wide development.

Water immersion vs. air insufflation in canine duodenal endoscopy: is the future underwater?

Endoscopy represents a commonly employed technique for canine enteropathies. Different trials in human intestinal endoscopy have suggested that the introduction of water for luminal distension, in place of air, improves the visualization of the mucosal texture and decreases pain. The aim of the study was to compare water immersion (WI) vs. air insufflation (AI) during duodenoscopy in anesthetized dogs in terms of mucosal visualization and nociception. Twenty-five dogs undergoing duodenoscopy were included. The same image of the descending duodenum was recorded applying WI and AI. Each pair of images was analyzed using morphological skeletonization, an image entropy evaluation, and a subjective blind evaluation by three experienced endoscopists. To evaluate differences in nociception related to the procedure applied, heart rate and arterial blood pressure were measured before, during and after WI/AI. To compare the two methods, a t-test for paired data was applied for the image analysis, Fleiss' Kappa evaluation for the subjective evaluation and a Friedman test for anesthetic parameters. No differences were found between WI and AI using morphological skeletonization and entropy. The subjective evaluation identified the WI images as qualitatively better than the AI images, indicating substantial agreement between the operators. No differences in nociception were found. The results of the study pointed out the absence of changes in pain response between WI and AI, likely due to the sufficient control of nociception by the anesthesia. Based on subjective evaluation, but not confirmed by the image analysis, WI provided better image quality than AI.

An innovative compact system for advanced treatment of combined sewer overflows (CSOs) discharged into large lakes: Pilot-scale validation.

Combined sewer overflows discharging into natural water bodies could potentially contaminate them in terms of conventional wastewater parameters and coliform bacteria. When green water infrastructures are not technically feasible or practically sustainable for stormwater management, innovative compact and effective end-of-pipe systems can be of interest. This study presents long-term and real-environment validated data of a compact and rapid treatment system specifically applicable to CSOs that consists of a dynamic rotating belt filter, adsorption on granular activated carbon and UV disinfection steps. The results of treatment for Lake Garda in Italy, showed great potential for TSS, COD and E. coli removal efficiencies with more than 90%, 69% and 99% respectively. Due to the short contact time of GAC adsorption, nutrients removals were not very high. TN and TP removal of around 41% and 19% were observed respectively that suggests further specific nutrients removal processes are required for achieving higher efficiencies. The treatment system, due to its compactness and rapidness could be a great asset for water utilities in different EU catchments that are dealing with the frequent CSO events. In addition, the possibility of using different combinations of treatment steps allows the choice of different treatment scenarios depending on the treatment goals for any specific catchment.

Correction: Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors.

Correction for 'Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors' by S. Teracciano et al., Chem. Commun., 2016, 52, 12857-12860.

Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors.

Hsp90 C-terminal modulation represents an attractive strategy for the development of potent and safer antitumor compounds. Continuing our investigation on DHPM type inhibitors here we report a new set of potent C-terminal ligands which allowed us to identify the key structural features crucial for the biological activity.

Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete.

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.

Two different approaches for novel extracapsular cranial cruciate ligament reconstruction: an in vitro kinematics study.

OBJECTIVE: To analyse the best combination of isometric points with the best kinematic results between two different approaches of TightRope® cranial cruciate ligament reconstruction. MATERIALS AND METHODS: Cranial drawer, cranial tibial thrust, internal/external, range of motion and varus/valgus tests were passively performed in different stifle conditions: cranial cruciate ligament-intact/deficient, after F2-T2/F2-T3 TR reconstruction at 22-44-99 N of tension. Data were acquired by a custom-made navigation system. RESULTS: The cranial drawer test showed recovery of laxity only at 99 N in both approaches. Significant laxity reduction (cranial tibial thrust) was present at only the F2-T2 point. Differences were noted in internal/external and varus/valgus rotation between the cranial cruciate ligament-intact and TightRope® stifles at all of the implant tensions. The range of motion underlined significantly lower laxity values following the F2-T2/F2-T3 reconstruction at all of the evaluated implant tensions. CLINICAL SIGNIFICANCE: The best isometric site was at the F2-T2 point, however significant differences in the amount of laxity between the two techniques were limited to the cranial tibial thrust and internal/external test. The F2-T2 technique was the best consideration for clinical application because it is relatively easy to perform, repeatable and results in good stifle stability with low morbidity and complications.

Gas chromatographic analysis of polyhydroxybutyrate in activated sludge: a round-robin test.

Polyhydroxyalkanoates (PHA) and poly-beta-hydroxybutyrate (PHB) in particular have become compounds which is routinely investigated in wastewater research. The PHB analysis method has only recently been applied to activated sludge samples where PHA contents might be relatively low. This urges the need to investigate the reproducibility of the gas chromatographic method for PHB analysis. This was evaluated in a round-robin test in 5 European laboratories with samples from lab-scale and full-scale enhanced biological phosphorus removal systems. It was shown that the standard deviation of measurements in each lab and the reproducibility between the labs was very good. Experimental results obtained by different laboratories using this analysis method can be compared. Sludge samples with PHB contents varying between 0.3 and 22.5 mg PHB/mg sludge were analysed. The gas chromatographic method allows for PHV, PH2MB and PH2MV analysis as well.

Cutaneous microenvironment of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative individuals, with special reference to Staphylococcus aureus colonization.

A cross-sectional quantitative study of cutaneous bacterial and yeast flora at seven body sites in 99 human immunodeficiency virus-seropositive and 50 seronegative military personnel was performed. Statistically significant differences in carriage rates were only observed for Staphylococcus aureus on the foreheads of seropositive individuals. Seronegative individuals demonstrated staphylococcal carriage rates 1.3 to 2 times as great as those of historical controls (defined as healthy individuals not receiving any medications) at five of six body sites. We conclude that seropositive military personnel do not exhibit statistically significant elevations in densities and carriage rates of the microorganisms examined (except Staphylococcus aureus), relative to seronegative individuals. Seropositive individuals may be predisposed to staphylococcal carriage. The elevated staphylococcal carriage rates of military personnel undergoing basic training warrants a formal evaluation of the impact of training exercises on cutaneous flora. The information gained may serve to limit the spread of infection during training exercises and battlefield conditions.

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora.

We have demonstrated previously that application of topical erythromycin, an antibiotic commonly used for the treatment of acne, results in an increased density of cutaneous erythromycin-resistant (Emr) coagulase-negative staphylococci; however, it is unknown if this increase results in an overall higher density of total cutaneous staphylococci or if upon cessation of erythromycin use, Emr coagulase-negative staphylococci remain at an increased density compared with the pretreatment density. To investigate this, 2% erythromycin or vehicle was applied to each subject's forehead (n = 225) twice a day by laboratory personnel for a period of 6 weeks. Samples were obtained for culture from the forehead, anterior nares, and back of the subjects at baseline and at weeks 6, 9, and 12 of the study. Cultures were performed on differential media. Plates into which erythromycin was incorporated (8 micrograms/ml) were used to identify Emr coagulase-negative staphylococci. The species of all Emr coagulase-negative staphylococci were determined, and an antibiogram for 16 antibiotics was obtained. The baseline prevalence of Emr coagulase-negative staphylococci on the forehead and nose was about 80% at the two study sites, whereas that on the back was 50%. The baseline density of Emr coagulase-negative staphylococci on the forehead, nose, and back was approximately 20% of the total flora. Following 6 weeks of erythromycin treatment, the prevalence of Emr coagulase-negative staphylococci on the forehead and nose was nearly 100% and the densities were 73 and 62%, respectively; the prevalence and density for the back were 78 and 42%, respectively. The most prevalent erythromycin resistance gene expressed by the Emr coagulase-negative staphylococci was ermC. There was no increase in the numbers of Staphylococcus aureus, gram-negative rods, or yeasts, nor was there increased resistance to any other antibiotic except clindamycin. The density of total aerobic organisms also remained static. There were no changes in the prevalence or density of Emr coagulase-negative staphylococci in the vehicle group. A statistically significant decrease in the prevalence and density of Emr coagulase-negative staphylococci in the erythromycin group was observed within 3 weeks posttreatment and by 6 weeks posttreatment, the prevalence and density returned to baseline values. These data demonstrate that the increased prevalence and density of Emr coagulase-negative staphylococci as a result of topical 2% erythromycin use are transient on both population and individual levels.

Replicate plating: does it increase reliability?

As a part of a clinical study to evaluate the antibacterial effect of a topically applied erythromycin gel, microbiological specimens were taken from two groups of patients: one group using 2% erythromycin gel and the other group using a placebo gel. These specimens were plated in triplicate using a common source on bacteriological media using standard procedures. After the appropriate incubation times, the numbers of aerobic and anaerobic organisms were counted separately from each of three plates. A comparison of the bacterial colony counts from the replicate plates showed a high degree of similarity for each type of organism. Tests for treatment differences in organism counts were performed based on single, double and triplicate plating. The results obtained were almost identical, suggesting that replicate plating from a common source is no more accurate than single plating. The only apparent advantage of this type of replicate plating is heightened confidence in the reliability of bacterial counts from single plates.

A new method for in vivo evaluation of antimicrobial agents by translocation of complex dense populations of cutaneous bacteria.

Previously, we described methods for measuring in vivo antimicrobial activity in which the resident bacterial flora of the forearm is expanded by occlusion with an impermeable plastic film, test agents are applied and quantitative cultures are obtained at varying time points. This methodology allows for an in vivo quantitative assessment of antimicrobial effects directed against a dense flora comprised primarily of staphylococci. This method may not be applicable to situations in which there is a high density of multiple species of bacteria. We describe herein new methods which permit in vivo determination of antimicrobial activity against a dense, mixed flora. Swabs moistened with a dilute nonionic detergent are used to remove bacteria from the subject's axilla or groin which are then translocated to the subject's forearm. Occlusion of the forearm with a large, sterile plastic chamber provides the necessary humid environment to yield a dense flora (10(5)-10(6) CFU) consisting of gram-positive cocci, gram-positive coryneforms and gram-negative rods. In this manner, multiple test sites are created on each forearm allowing for the simultaneous evaluation of multiple antimicrobial agents in a single subject. This method allows for the evaluation of the immediate, as well as sustained, in vivo bactericidal effect of an antimicrobial agent against a dense mixed flora with quantitative cultures obtained at varying time points after application of the test agent. Furthermore, ecological pressures which select for resistant organisms or allow for an overgrowth of nonsensitive bacteria can be evaluated by determining the composition of the flora after single or repeated applications of a test agent. The testing methodologies described herein can provide relevant information regarding the antimicrobial effectiveness of an agent in a variety of situations such as use against the axillary flora (including its utility as a deodorant), use as a perineal cleanser for critically ill, hospitalized patients and use in situations where a dense mixed flora exists, e.g. stasis ulcers and infected intertriginous dermatoses.

The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria.

BACKGROUND: Previous studies have indicated that cutaneous bacteria, particularly coagulase-negative staphylococci, play a role in the pathogenesis of miliaria. An accumulation of periodic acid-Schiff (PAS)-positive material has been described as blocking the sweat duct in miliaria. Furthermore, a PAS-positive extracellular polysaccharide substance (EPS) has been identified as a product of some strains of Staphylococcus epidermidis. OBJECTIVE: We evaluated the relative ability of various species of coagulase-negative staphylococci to induce miliaria with particular reference to the potential role of EPS. METHODS: We inoculated various strains of coagulase-negative staphylococci on the volar forearms of subjects under an occlusive dressing coupled with thermal stimulation. Ability to induce miliaria as well as microbiologic, histologic, and immunostaining features were evaluated. RESULTS: Miliaria was induced only with strains of S. epidermidis; other species including S. haemolyticus, S. hominis, S. cohnii, S. saprophyticus, and S. simulans were not capable of inducing miliaria. Moreover, only S. epidermidis strains capable of producing EPS were capable of inducing miliaria. CONCLUSION: Our data indicate that EPS is the PAS-positive material that obstructs the delivery of sweat to the skin surface in miliaria and therefore demonstrate that the EPS produced by S. epidermidis plays a central role in the pathogenesis of miliaria. Furthermore, in a survey of staphylococcal flora isolated from 68 subjects, EPS-producing strains were found to be common.

Molecular genetic analysis of the Rhizobium meliloti fixK promoter: identification of sequences involved in positive and negative regulation.

Transcription of the Rhizobium meliloti fixK gene is induced in symbiotic and microaerobic growth conditions by the FixL/FixJ modulator/effector pair. Transcription of fixK is also negatively autoregulated. By 5' deletion analysis, the involvement in negative regulation of a DNA region between -514 and -450 with respect to the transcription start was demonstrated. Site-directed mutagenesis allowed us to show that a sequence homologous to the binding site of the Escherichia coli Fnr protein, centred at position -487, participates in this effect. However, deletion or mutagenesis of this Fnr-like sequence does not completely eliminate FixK-dependent repression, which suggests that either an additional DNA region is involved in negative regulation or that it is mediated at the level of fixLJ transcription. Deletion analysis also allowed the definition of a DNA region involved in FixJ-mediated activation of the fixK promoter, between -79 and -42. Different point mutations in the -60, -45 and -35 regions were shown to affect promoter activity. In some cases, the activity of mutant promoters could be partly or fully restored by increasing the expression of the fixLJ regulatory genes, in an E. coli strain harbouring a plasmid with fixLJ under the control of an inducible (p-tac) promoter.

Antibiotic resistance patterns in coagulase-negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy.

Antibiotic resistance of the resident cutaneous bacterial flora is a well recognized consequence of systemic antibiotic therapy. In this study, we followed the development of antibiotic resistance of coagulase-negative staphylococci (CNS), the most numerous aerobic bacteria found on the skin surface, during treatment with three topical antimicrobial agents used to treat acne vulgaris. Groups of 20 subjects received either topical erythromycin, benzoyl peroxide or a combination of the two for 16 weeks. After 12 weeks of treatment with erythromycin, the aerobic flora was dominated by S. epidermidis which was completely resistant to erythromycin. In addition there was an increase in resistance to clindamycin and tetracycline. Treatment with benzoyl peroxide and the combination of erythromycin and benzoyl peroxide resulted in a significant reduction in the number of aerobic bacteria without any change in the resistance pattern to erythromycin or other antibiotics.

Reduced response to hepatitis B virus vaccination in boys with steroid-sensitive nephrotic syndrome.

Vaccination against hepatitis B virus (HBV) was performed in 18 boys (aged 5.7 +/- 2.4 years) suffering from steroid-sensitive nephrotic syndrome (SSNS) and in a control group of 21 healthy boys (aged 5.6 +/- 3.8 years). The percentage of patients who responded to vaccination was significantly lower than the control group 1, 6, 8, 12, 18 and 24 months after the start of vaccination. The titre of antibodies to HBV surface antigen produced by responders at 6 and 24 months was significantly lower in patients than in the control group. Boys with SSNS have an impaired response to HBV vaccination.

Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru.

The handwashing practices and bacterial hand flora of 62 pediatric staff members of a teaching hospital in Lima, Peru, were studied. Handwashing followed patient contact 29.3% of the time (204/697 contacts). Mean duration was 14.5 seconds, and significant differences in practices were found by unit (rehydration or neonatal intensive care), type of staff member (nurses or physicians), and type and duration of patient contact. Mean count of colony-forming units was log10 5.87 +/- 0.41, with significant differences in density of flora found between patient care and kitchen staffs. There was no significant effect of handwashing on counts of colony-forming units. Significant differences were also found by unit and by staff position with regard to species isolated and antimicrobial resistance of isolates. A more efficacious and cost-effective form of hand hygiene and a more prudent use of antimicrobial agents are indicated.

Normal response to anti-HBV vaccination in children with chronic renal insufficiency.

Anti-HBV vaccination was performed in 17 children with chronic renal insufficiency on conservative treatment and in 29 control children. The response to vaccination was satisfactory in patients as well as in the control group and no significant difference was found between the two groups as to percentage of responders and to the titre of HBsAb produced. It appears reasonable to vaccinate all patients with chronic renal insufficiency before they reach end-stage renal disease in areas with high prevalence of HBV infection.