Lactoferrin gene polymorphisms associated with clinical mastitis in Honduran Holstein inheritance cows.

BACKGROUND: Lactoferrin (LTF) is an iron-binding glycoprotein found in milk and other exocrine secretion with antibacterial activity proposed as an alternative to mastitis treatment or prevention. LTF has been proposed as a candidate gene for mastitis resistance selection. The aim of this paper was to assess LTF promotor to explore variations with potential association to mastitis resistance in dairy cows from Honduras. METHODS: A resequencing of promotor and Exon I of LTF gene in extreme mastitis susceptibility cows (126 Holstein and Holstein crossbred) was performed. RESULTS: Eight polymorphisms were found in promotor region, four of them were novel variations. Two were important by frequency among extreme groups, but a polymorphism in - 421 A/T position was significantly (P = 0.0188) associated to mastitis susceptibility. CONCLUSION: Results support the key role of regulatory region of LTF gene. Some candidate genes are proposed in association with mastitis traits and implications are discussed.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

European Academy of Neurology guideline on the management of medication-overuse headache.

BACKGROUND: The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication-overuse headache (MOH). METHODS: Based on the available literature in this guideline, the first step in patient management is education and counselling. RESULTS: Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long-lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpatient setting.

Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables / Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions

La presente revisión tiene como objetivo brindar una visión actualizada en diferentes campos de la cirugía radioguiada. En lo que se refiere a la biopsia del ganglio centinela en el carcinoma escamoso oral, se exponen los resultados del debate interactivo llevado a cabo en el reciente Congreso de nuestra especialidad sobre los aspectos más relevantes del Consenso de Londres. En los tumores ginecológicos, cáncer de endometrio y cérvix, se detallan las particularidades del drenaje, las indicaciones establecidas según las guías actuales y se presentan nuevos escenarios para el médico nuclear, como pueden ser la cirugía robótica y los trazadores híbridos. Por otra parte, la notable expansión de las indicaciones de la cirugía radioguiada de lesiones no palpables, ampliamente utilizada en patología mamaria, hace conveniente la puesta al día en dos procedimientos que han demostrado resultados satisfactorios, como son el nódulo pulmonar solitario y el osteoma osteoide

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma

Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions. / Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables.

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.

The headache under-response to treatment (HURT) questionnaire, an outcome measure to guide follow-up in primary care: development, psychometric evaluation and assessment of utility.

BACKGROUND: Headache disorders are both common and burdensome but, given the many people affected, provision of health care to all is challenging. Structured headache services based in primary care are the most efficient, equitable and cost-effective solution but place responsibility for managing most patients on health-care providers with limited training in headache care. The development of practical management aids for primary care is therefore a purpose of the Global Campaign against Headache. This manuscript presents an outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire, describing its purpose, development, psychometric evaluation and assessment for clinical utility. The objective was a simple-to-use instrument that would both assess outcome and provide guidance to improving outcome, having utility across the range of headache disorders, across clinical settings and across countries and cultures. METHODS: After literature review, an expert consensus group drawn from all six world regions formulated HURT through item development and item reduction using item-response theory. Using the American Migraine Prevalence and Prevention Study's general-population respondent panel, two mailed surveys assessed the psychometric properties of HURT, comparing it with other instruments as external validators. Reliability was assessed in patients in two culturally-contrasting clinical settings: headache specialist centres in Europe (n = 159) and primary-care centres in Saudi Arabia (n = 40). Clinical utility was assessed in similar settings (Europe n = 201; Saudi Arabia n = 342). RESULTS: The final instrument, an 8-item self-administered questionnaire, addressed headache frequency, disability, medication use and effect, patients' perceptions of headache "control" and their understanding of their diagnoses. Psychometric evaluation revealed a two-factor model (headache frequency, disability and medication use; and medication efficacy and headache control), with scale properties apparently stable across disorders and correlating well and in the expected directions with external validators. The literature review found few instruments linking assessment to clinical advice or suggested actions: HURT appeared to fill this gap. In European specialist care, it showed utility as an outcome measure across headache disorders. In Saudi Arabian primary care, HURT (translated into Arabic) was reliable and responsive to clinical change. CONCLUSIONS: With demonstrated validity and clinical utility across disorders, cultures and settings, HURT is available for clinical and research purposes.

The role of positron emission tomography/computed tomography imaging with radiolabeled choline analogues in prostate cancer.

INTRODUCTION: prostate cancer is the most frequent solid malignant tumor in Western Countries. Positron emission tomography/x-ray computed tomography imaging with radiolabeled choline analogues is a useful tool for restaging prostate cancer in patients with rising prostate-specific antigen after radical treatment (in whom conventional imaging techniques have important limitations) as well as in the initial assessment of a selected group of prostate cancer patients. For this reason a literature review is necessary in order to evaluate the usefulness of this imaging test for the diagnosis and treatment of prostate cancer. EVIDENCE ACQUISITION: a MEDLINE (PubMed way) literature search was performed using the search parameters: «Prostate cancer¼ and «Choline-PET/CT¼. Other search terms were «Biochemical failure¼ and/or «Staging¼ and/or «PSA kinetics¼. English and Spanish papers were selected; original articles, reviews, systematic reviews and clinical guidelines were included. CONCLUSIONS: according to available data, radiolabeled choline analogues plays an important role in the management of prostate cancer, especially in biochemical relapse because technique accuracy is properly correlated with prostate-specific antigen values and kinetics. Although is an emerging diagnostic technique useful in treatment planning of prostate cancer, final recommendations have not been submitted.

A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study.

INTRODUCTION: The management of medication-overuse headache (MOH) is often difficult and no specific guidelines are available as regards the most practical and effective approaches. In this study we defined and tested a consensus protocol for the management of MOH on a large population of patients distributed in different countries. SUBJECTS AND METHODS: The protocol was based on evidence from the literature and on consolidated expertise of the members of the consensus group. The study was conducted according to a multicentric interventional design with the enrolment of 376 MOH subjects in four centres from Europe and two centres in Latin America. The majority of patients were treated according to an outpatient detoxification programme. The post-detoxification follow-up lasted six months. RESULTS: At the final evaluation, two-thirds of the subjects were no longer overusers and in 46.5% of subjects headache had reverted back to an episodic pattern of headache. When comparing the subjects who underwent out-patient detoxification vs those treated with in-patient detoxification, both regimens proved effective, although the drop-out rate was higher in the out-patient approach. CONCLUSIONS: The present findings support the effectiveness and usability of the proposed consensus protocol in different countries with different health care modalities.

Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project).

OBJECTIVE: The objective of this article is to investigate whether headache-related disability, depression and anxiety can be reduced by detoxification and prophylactic treatment in patients with medication-overuse headache (MOH). METHODS: Patients with MOH were included from six centres in Europe and Latin America in a seven-month cohort study. Before and six months after treatment, the degree of disability was measured by the Migraine Disability Assessment (MIDAS) questionnaire, while anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 694 patients with MOH were included, of whom 492 completed the study. Headache days were reduced by 58.4% from 23.6 to 9.8 days per month at six months ( P < 0.001). The MIDAS score was reduced by 57.1% from baseline 59.9 to 25.7 ( P < 0.001). Number of patients with depression was reduced by 50.7% from 195 to 96 and number of those with anxiety was reduced by 27.1% from 284 to 207 (both P < 0.001). CONCLUSIONS: Disability, depression and anxiety were considerably reduced in patients with MOH by detoxification and prophylactic treatment. This emphasises the urgent need for increased awareness about avoiding overuse of headache medications and demonstrates that not only headache frequency but also disability are remarkably improved by adequate intervention.

Increasing energy and lysine in diets for growing-finishing pigs in hot environmental conditions: consequences on performance, digestibility, slurry composition, and gas emission.

The influence of dietary nutrient concentration on growth performance, manure composition, and gas emission was studied in pigs in hot environmental conditions. A total of 64 intact males and 64 females [(Landrace × Large White) × Pietrain] weighing 63.1 ± 9.7 kg were divided into 2 dietary treatments: high (HD: 14.39 MJ of DE/kg and 1.11% Lys) and low (LD: 13.97 MJ of DE/kg and 1.01% Lys) in energy and Lys contents. Pigs were allocated to 32 split-sex pens with 4 pigs/pen and 16 pens/treatment. Average productive performance was recorded for 41 d (phase 1). After phase 1, 12 females of 103.3 ± 3.15 kg (6 per treatment) were selected and housed individually, and feces and slurry were collected during 3 and 4 consecutive days, respectively, to calculate nutrient digestibility and measure gas emissions (phase 2). For gas emission measurements, slurry was pooled by treatment and stored for 76 d. Initial composition of slurry and pH were analyzed. Maximum and minimum temperatures registered in the barn throughout the growing period were 35.1 and 18.1°C, respectively. Animals fed the HD diet grew more efficiently than pigs fed the LD diet (G:F, 0.43 vs. 0.40; SEM = 0.01; P < 0.05). Fat digestibility was greater in HD compared with LD pigs (88.0 vs. 84.9%; SEM = 0.9; P < 0.05). Slurry from pigs fed the LD diet showed greater DM, OM, total N, and VFA contents than slurry from pigs fed the HD diet. Cumulative NH(3), CO(2), and especially CH(4) emissions were greater in the HD slurry compared with the LD slurry (192.4 vs. 210.g of NH(3)/m(3); 2,712 vs. 3,210 g of CO(2)/m(3); 1,502 vs. 2,647 mL of CH(4)/kg of OM). Increasing feed density in the present study led to a more efficient growth, a decreased nutrient concentration in the slurry, and a greater gas emission.

Falso negativo de la gammagrafía con 99mTc-sestamibi en un carcinoma paratiroideo con tumores pardos asociados. Aportaciones de la PET/TAC-18F-FDG / False negative of the scintigraphy with 99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the 18F-FDG-PET/CT

El carcinoma paratiroideo (CPT) es un tumor poco frecuente que suele ser hiperfuncionante, produciendo un exceso de hormona paratiroidea. El hiperparatiroidismo produce trastornos del metabolismo óseo, como osteopenia y en ocasiones tumores pardos. Los tumores pardos son lesiones óseas benignas, pero localmente destructivas, cuyo diagnóstico diferencial con metástasis u otros tipos de tumores primarios puede ser complicado. La técnica habitual para la detección de patología paratiroidea es la gammagrafía con 99mTc-sestamibi, con una sensibilidad del 85–100% y una especificidad cercana al 100% en adenomas paratiroideos, presentando cifras muy similares en la detección del CPT. Presentamos el caso de un paciente diagnosticado de hiperparatiroidismo de origen tumoral con lesiones óseas asociadas en el que la gammagrafía con 99mTc-sestamibi presentó un falso negativo en la detección de patología paratiroidea. Sin embargo, la PET/TAC-18F-FDG detectó el CPT y ayudó en el diagnóstico diferencial de las lesiones óseas asociadas, que fueron finalmente tumores pardos(AU)

Parathyroid carcinoma (PTC) is a rare malignant disease that is usually hyperfunctioning, which produces an excess of parathyroid hormone. Hyperparathyroidism causes bone metabolism disorders, as osteopenia and sometimes brown tumors. Brown tumors are benign but locally aggressive bone lesions, whose differential diagnosis with metastases or other primary malignancies may be complicated. 99mTc-Sestamibi scan is the usual procedure for the detection of parathyroid pathology, with a sensitivity of 85–100% and specificity close to 100% in parathyroid adenomas, it having similar percentages in the detection of PTC. We present the case of a patient diagnosed of a malignant hyperparathyroidism associated with bone lesions in which the 99mTc-Sestamibi scan showed a false negative result in the detection of parathyroid condition. However, 18F-FDG-PET/CT detected the PTC and helped in the differential diagnosis of associated bone lesions, which were finally confirmed as brown tumors(AU)

Evaluation of sludge from paper recycling as bedding material for broilers.

Several materials have been used as bedding substrates in broiler production. In this work, the sludge from paper recycling was tested for its potential use as litter material and was compared with wood shavings. Moisture content, apparent density, and water-holding capacity were measured and characterized in both materials. Later, 192 male broiler chickens were distributed among 16 experimental pens, 8 of which contained wood shavings as bedding material and 8 of which contained the sludge. Growth rate, consumption, tonic immobility, gait score, breast lesions, foot pad dermatitis, hock burn, tibial dyschondroplasia, and metatarsal thickness were determined in the birds. Although the moisture content of the sludge was high, it decreased strongly after 7 d of drying, reaching lower values than those of wood shavings. In general, few differences were found between the materials in terms of bird performance and welfare and only the incidence of hock burn was higher in the sludge than in the wood shavings. Although further research is needed, sludge from paper recycling is a possible alternative to traditional bedding materials because it achieves most of the requirements for broiler bedding materials and does not show negative effects on the birds.

Recommendations for headache service organisation and delivery in Europe.

Headache disorders are a major public-health priority, and there is pressing need for effective solutions to them. Better health care for headache-and ready access to it-are central to these solutions; therefore, the organisation of headache-related services within the health systems of Europe becomes an important focus. These recommendations are the result of collaboration between the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. The process of development included wide consultation. To meet the very high level of need for headache care both effectively and efficiently, the recommendations formulate a basic three-level model of health-care organisation rationally spread across primary and secondary health-care sectors, taking account of the different skills and expertise in these sectors. They recognise that health services are differently structured in countries throughout Europe, and not always adequately resourced. Therefore, they aim to be adaptable to suit these differences. They are set out in five sections: needs assessment, description of the model, adaptation, standards and educational implications.

[False negative of the scintigraphy with 99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the 18F-FDG-PET/CT]. / Falso negativo de la gammagrafía con 99mTc-sestamibi en un carcinoma paratiroideo con tumores pardos asociados. Aportaciones de la PET/TAC-18F-FDG.

Parathyroid carcinoma (PTC) is a rare malignant disease that is usually hyperfunctioning, which produces an excess of parathyroid hormone. Hyperparathyroidism causes bone metabolism disorders, as osteopenia and sometimes brown tumors. Brown tumors are benign but locally aggressive bone lesions, whose differential diagnosis with metastases or other primary malignancies may be complicated. (99m)Tc-Sestamibi scan is the usual procedure for the detection of parathyroid pathology, with a sensitivity of 85-100% and specificity close to 100% in parathyroid adenomas, it having similar percentages in the detection of PTC. We present the case of a patient diagnosed of a malignant hyperparathyroidism associated with bone lesions in which the (99m)Tc-Sestamibi scan showed a false negative result in the detection of parathyroid condition. However, (18)F-FDG-PET/CT detected the PTC and helped in the differential diagnosis of associated bone lesions, which were finally confirmed as brown tumors.

Sources of Salmonella contamination during broiler production in Eastern Spain.

Prevention of Salmonella contamination of poultry products requires detailed knowledge of the main sources associated with its presence in the production system. The aims of this study were to determine the main sources of Salmonella contamination in broiler production during growing, to assess the risk factors for Salmonella contamination at the end of the rearing period and to determine the main serovars involved in broiler production systems in Eastern Spain. A total of 65 different broiler houses from different farms were sampled. Each house was sampled at different times during the rearing period. First, when the previous flock was taken to the slaughterhouse, samples of dust, surfaces and previous flock faeces were collected. After cleaning and disinfection (C&D), samples of dust and surfaces were also taken. On the first day of rearing, samples of water, bedding, farming boots, meconiums, delivery-box liners and feed were collected. During rearing, feed samples were taken directly from the truck and from feeders. On slaughter day, samples of dust, surfaces, water, feed and faeces were also collected. Finally, two days after slaughter, carriers (rodents, flies and beetles) were trapped. All samples collected were analysed according to ISO 6579:2002 (Annex D) and positive samples were serotyped in accordance with Kauffman-White-Le-Minor technique. Our results showed that all different types of samples collected were contaminated with Salmonella (prevalence ranged between 1.5% and 38.6%). The most contaminated samples related with poultry production were: delivery-box liners (32.0%), faeces samples (31.2%), dust samples (25.0%), farming boots (19.7%) and feed from feeders (16.0%). However, the most important risk factors for Salmonella contamination of the flocks at the end of the rearing period were Salmonella status of the house after cleaning and disinfection, Salmonella status of day-old chick flocks and feed from feeders. Twenty-one different serovars were isolated from the samples analysed. The most prevalent were in decreasing order: Salmonella Enteritidis (52.9%), S. Hadar (17.8%), S. Virchow (8.9%) and S. Ohio (5.4%). The study suggested that there are many sources for Salmonella contamination and persistence in broiler production. Hence, the whole production chain needs to be controlled to eradicate the bacteria from primary production.

Displasia fibrosa ósea. Aportación de la Medicina Nuclear al diagnóstico de sospecha de degeneración sarcomatosa / Fibrous dysplasia of the bone. Contribution of Nuclear Medicine in the diagnosis of suspicion of sarcomatous degeneration

La displasia fibrosa (DF) es una enfermedad benigna del hueso relativamente frecuente, en la que existe un trastorno de la maduración del mesénquima óseo con sustitución del tejido lamelar de la cavidad medular de los huesos por un tejido fibroso anómalo. Su diagnóstico a menudo es un hallazgo casual al realizar estudios radiológicos o gammagráficos óseos por otros motivos ya que normalmente es asintomática. En ocasiones puede presentar complicaciones como deformidades, fracturas patológicas y excepcionalmente transformación maligna. El diagnóstico diferencial entre DF y neoplasia maligna puede ser complicado y llevar a un diagnóstico tardío de cuando ya existe degeneración sarcomatosa. En este contexto, la tomografía de positrones con 18F-fluorodesoxiglucosa (PET-FDG) puede ser de utilidad en el seguimiento de esta patología. Presentamos 2 casos de pacientes diagnosticadas de DF con sospecha de malignización de sus lesiones y a las que se les solicitaron estudios complementarios de medicina nuclear(AU)

Fibrous dysplasia (FD) is a relatively frequent benign disease of the bone in which there is a maturation disorder of the bone-forming mesenchyme where the lamellar bone marrow is replaced with abnormal fibrous tissue. Its diagnosis is often an accidental finding when X-ray studies or bone scans are performed for other reasons since it is usually asymptomatic. There may be complications such as deformities, pathological fractures and exceptionally malignant transformation. The differential diagnosis between malignancy and FD can be complicated and lead to late diagnosis when sarcomatous degeneration already exists. In this context, the positron tomography with 18F-fluorodeoxyglucose (FDG-PET) may be useful in the monitoring of this condition. We present two cases of patients diagnosed of FD with suspicion of malignization of their bone lesions who were referred to Nuclear Medicin(AU)