Infection and Recurrence Rates in Rural Inguinal Hernia Repair.

Introduction: Inguinal hernia repair (IHR) is a common procedure performed by general surgeons in rural community hospitals. Infection and recurrence rates for three types of IHR over two years at a rural Kansas hospital were analyzed. Previous research has shown outcomes regarding pain at six weeks were typically no different, and neither were long-term results, between open and laparoscopic techniques. However, there were fewer data showing the outcomes of these three hernia repair approaches in rural settings. Methods: This was a retrospective, cross-sectional study using data collected from the electronic medical record (EMR) of a small hospital in central Kansas. Data from adult patients who had undergone IHRs over a two-year period (2018-2019) were deidentified and described using frequencies and percentages. This study used multi-variate logistic regression to examine the association of patient, surgeon, and surgical procedure characteristics on the occurrence of post-operative complications. Results: Of the patients who received IHR, 46 were male and 5 were female. Mean age was 66 years, with a minimum of 34 and maximum ≥ 89 years. There were 14 total post-operative complications; two were superficial infections. There were no recurrences. Conclusions: The sample size for each procedure type was too small to allow for statistical testing. However, the hospital had no recurrences. Future research should follow-up with this and other rural hospitals and perform a direct comparison of hernia surgery outcomes with those at a larger, more urban hospital, to understand potential differences by hospital size.

Expression of pentraxin 3 in equine lungs and neutrophils.

Endotoxin-induced diseases cause significant mortality and morbidity in the horse, leading to enormous economic damage to the equine industry. Neutrophils play a critical role in initiating the immune response in the lung. Pattern recognition receptors (PRRs) are programmed to recognize microbial structures unique to pathogens and mount an immune response. Pentraxin 3 (PTX3) is a PRR that is produced at sites of inflammation by many cell types upon stimulation by pro-inflammatory cytokines and agonists, such as endotoxins [also known as lipopolysaccharides (LPS)]. Pentraxin 3 recognizes and binds to many pathogens, activates the complement cascade, and has a role in the clearance of apoptotic and necrotic cells. Recently, PTX3 has been reported to be localized in the specific granules in human and mouse neutrophils, but no reports exist on the in-situ localization of PTX3 in neutrophils and the lungs of horses. Therefore, the objective of this study was to localize the PTX3 protein in normal and LPS-exposed neutrophils and in normal equine lungs. Immunohistochemical data showed PTX3 staining in the bronchial epithelial cells and the vascular endothelium of normal lungs. Immunogold electron microscopy localized PTX3 in the nuclei, cytoplasm, and vesicular organelles of alveolar macrophages, endothelial cells, and pulmonary intravascular macrophages. Immunohistochemical staining for PTX3 in isolated horse neutrophils showed an altered staining pattern in neutrophils stimulated with LPS. These data suggest that neutrophils may be a mobile form of PTX3 that is readily shuttled to the site of inflammation, where it can be released to fine tune a host defense response.

Les maladies induites par les endotoxines provoquent une mortalité et une morbidité importantes chez le cheval, entraînant d'énormes dommages économiques pour l'industrie équine. Les neutrophiles jouent un rôle essentiel dans le déclenchement de la réponse immunitaire dans les poumons. Les récepteurs de reconnaissance de formes (PRR) sont programmés pour reconnaître les structures microbiennes propres aux agents pathogènes et déclencher une réponse immunitaire. La pentraxine 3 (PTX3) est un PRR qui est produit sur les sites d'inflammation par de nombreux types de cellules lors de la stimulation par des cytokines pro-inflammatoires et des agonistes, tels que les endotoxines [également appelées lipopolysaccharides (LPS)]. La pentraxine 3 reconnaît et se lie à de nombreux agents pathogènes, active la cascade du complément et joue un rôle dans la clairance des cellules apoptotiques et nécrotiques. Récemment, il a été rapporté que PTX3 était localisé dans les granules spécifiques des neutrophiles humains et de souris, mais aucun rapport n'existe sur la localisation in situ de PTX3 dans les neutrophiles et les poumons des chevaux. Par conséquent, l'objectif de cette étude était de localiser la protéine PTX3 dans les neutrophiles normaux et exposés au LPS et dans les poumons équins normaux. Les données immunohistochimiques ont montré une coloration PTX3 dans les cellules épithéliales bronchiques et l'endothélium vasculaire des poumons normaux. La microscopie électronique d'immunomarquage à l'or colloïdal a localisé PTX3 dans les noyaux, le cytoplasme et les organites vésiculaires des macrophages alvéolaires, des cellules endothéliales et des macrophages intravasculaires pulmonaires. La coloration immunohistochimique de PTX3 dans des neutrophiles de cheval isolés a montré un schéma de coloration altéré dans les neutrophiles stimulés avec du LPS. Ces données suggèrent que les neutrophiles peuvent être une forme mobile de PTX3 qui est facilement acheminée vers le site de l'inflammation, où elle peut être libérée pour affiner une réponse de défense de l'hôte.(Traduit par Docteur Serge Messier).

Prospective evaluation of flow cytometric characteristics, histopathologic diagnosis and clinical outcome in dogs with naïve B-cell lymphoma treated with a 19-week CHOP protocol.

Canine B-cell lymphoma is a clinically heterogenous disease; however, it is generally treated as a single disease entity. The purpose of this clinical trial was to prospectively evaluate naïve canine B-cell lymphoma patients using histopathology, flow cytometry (FC) and a standardized chemotherapy protocol to better define subsets of this disease that may respond differently to treatment. Sixty-four dogs with naïve multicentric B-cell lymphoma were treated with a standardized 19-week CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy protocol. Most of the dogs (84.3%) were diagnosed with diffuse large B-cell lymphoma (DLBCL), followed by nodal marginal zone (7.8%), small B-cell (4.7%), Burkitt-like (1.6%) and follicular lymphoma (1.6%). FC confirmed the diagnosis of B-cell lymphoma in all cases. There were no clear phenotyping differences between the subtypes of B-cell lymphoma detectable by our FC panel. The histologic subtypes in this study exhibited a range of forward scatter values on flow cytometry, but all of the DLBCL cases were higher than a value of 469, while the only cases with a lower forward scatter value were follicular lymphoma and diffuse small B-cell lymphoma. Dogs with DLBCL had a significantly better objective response rate to the CHOP protocol (96.3%) than the non-DLBCL subtypes (70%, P = .024). The median progression-free survival time for patients with DLBCL (233 days) was significantly longer than that of all other histopathologic subgroups combined (163 days, P = .0005).

Blunted pathogen-associated molecular pattern motif induced TNF, IL-6 and IL-10 production from whole blood in dogs with lymphoma.

Lymphoma is associated with a higher risk of sepsis as compared to other forms of neoplasia in people and dogs which might be due to alterations in cytokine production. The objective of this study was to compare bacterial pathogen associated molecular pattern (PAMP) motif-induced TNF, IL-6, and IL-10 response of whole blood from dogs with naïve lymphoma and healthy dogs. We hypothesized that whole blood from dogs with lymphoma would exhibit an impaired cytokine response to LPS, lipoteichoic acid (LTA), and peptidoglycan (PG) stimulation compared to whole blood from healthy dogs. Whole blood was collected from dogs with lymphoma (n=20) and healthy dogs (n=15) and stimulated with PAMPs or phosphate buffered saline. Whole blood production of TNF, IL-6 and IL-10 was measured. Whole blood from dogs with lymphoma had reduced TNF, IL-6 and IL-10 production capacity after LPS, LTA and PG stimulation compared to whole blood from healthy dogs. These data could partially explain why dogs with lymphoma have a higher risk for infection compared to dogs with other forms of neoplasia.