Prevalence, Treatment, and Prognosis of Tumor Thrombi in Renal Cell Carcinoma.

Background: Renal cell carcinoma (RCC) can be complicated by a venous tumor thrombus (TT), of which the optimal management is unknown. Objectives: This study sought to assess the prevalence of TT in RCC, its current management, and its association with venous thromboembolism (VTE), arterial thromboembolism (ATE), major bleeding (MB), and mortality. Methods: Patients diagnosed with RCC between 2010 and 2019 in our hospital were included and followed from RCC diagnosis until 2 years after, or until an outcome of interest (VTE, ATE, and MB) or death occurred, depending on the analysis. Cumulative incidences were estimated with death as a competing risk. Cause-specific hazard models were used to identify predictors and the prognostic impact. Results: Of the 647 patients, 86 had a TT (prevalence 13.3%) at RCC diagnosis, of which 34 were limited to the renal vein, 37 were limited to the inferior vena cava below the diaphragm, and 15 extended above the diaphragm; 20 patients started therapeutic anticoagulation and 45 underwent thrombectomy with/without anticoagulation. During follow-up (median 24.0 [IQR: 7.0-24.0] months), 17 TT patients developed a VTE, 0 developed an ATE, and 11 developed MB. TT patients were more often diagnosed with VTE (adjusted HR: 6.61; 95% CI: 3.18-13.73) than non-TT patients, with increasing VTE risks in more proximal TT levels. TT patients receiving anticoagulation still developed VTE (HR: 0.56; 95% CI: 0.13-2.48), at the cost of more MB events (HR: 3.44; 95% CI: 0.95-12.42) compared with those without anticoagulation. Conclusions: Patients with RCC-associated TT were at high risk of developing VTE. Future studies should establish which of these patients benefit from anticoagulation therapy.

Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study.

Background Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies. Results Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and "CTPA only" in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04-7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3-16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6-7.0). Conclusion Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.

Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients.

Background: Whereas accumulating studies on patients with coronavirus disease 2019 (COVID-19) report high incidences of thrombotic complications, large studies on clinically relevant thrombosis in patients with other respiratory tract infections are lacking. How this high risk in COVID-19 patients compares to those observed in hospitalized patients with other viral pneumonias such as influenza is unknown. Objectives: To assess the incidence of venous and arterial thrombotic complications in hospitalized patients with influenza as opposed to that observed in hospitalized patients with COVID-19. Methods: This was a retrospective cohort study; we used data from Statistics Netherlands (study period: 2018) on thrombotic complications in hospitalized patients with influenza. In parallel, we assessed the cumulative incidence of thrombotic complications-adjusted for competing risk of death-in patients with COVID-19 in three Dutch hospitals (February 24 to April 26, 2020). Results: Of the 13 217 hospitalized patients with influenza, 437 (3.3%) were diagnosed with thrombotic complications, versus 66 (11%) of the 579 hospitalized patients with COVID-19. The 30-day cumulative incidence of any thrombotic complication in influenza was 11% (95% confidence interval [CI], 9.4-12) versus 25% (95% CI, 18-32) in COVID-19. For venous thrombotic (VTC) complications and arterial thrombotic complications alone, these numbers were, respectively, 3.6% (95% CI, 2.7-4.6) and 7.5% (95% CI, 6.3-8.8) in influenza versus 23% (95% CI, 16-29) and 4.4% (95% CI, 1.9-8.8) in COVID-19. Conclusions: The incidence of thrombotic complications in hospitalized patients with influenza was lower than in hospitalized patients with COVID-19. This difference was mainly driven by a high risk of VTC complications in the patients with COVID-19 admitted to the Intensive Care Unit. Remarkably, patients with influenza were more often diagnosed with arterial thrombotic complications.

Effect of BioSentry 904 and ethylenediaminetetraacetic acid-tris disinfecting during incubation of chicken eggs on microbial levels and productivity of poultry.

Proper sanitation practices and the use of efficacious disinfectants in a hatchery have an effect on chick quality. Aerosol bacterial counts, egg moisture loss, hatchability, chick quality, and broiler productivity were evaluated when egg surfaces were contaminated by immersion of each egg into a broth medium containing a field isolate of Pseudomonas aeruginosa and incubated with exposure to one of three disinfectant treatments administered by fine spray: distilled water, BioSentry 904 (904), and a 1:1 ratio of 904 and ethylenediaminetetraacetic acid (EDTA)-Tris. The aerosol bacteria levels were statistically greater on day 21 of incubation in the group treated with distilled water than in those receiving disinfectants. Overall hatch of fertile eggs and egg moisture loss were comparable among all three treatments. At 1 day of age, the chicks incubated with 904 had a statistically lower yolk sac contamination rate than those incubated with 904+EDTA-Tris or distilled water. The 2-wk mortality rates, body weights, feed conversion ratios, yolk sac weights, and yolk sac contamination rates were all similar among the three treatments.

Isolation and characterization of a 6/85-like Mycoplasma gallisepticum from commercial laying hens.

Eighty-three-week-old table egg layers with swollen sinuses were presented with a history of increased mortality. Serology revealed positive titers to Mycoplasma gallisepticum (MG). The birds were part of a flock in which some birds had been vaccinated with 6/85 live MG vaccine at 18 wk of age. Tracheal cultures were obtained from both vaccinated and unvaccinated birds within the flock. The cultures were indistinguishable from 6/85 vaccine by both random amplified polymorphic DNA analysis and DNA sequence analysis. Challenge studies were performed to compare the field isolates with 6/85 vaccine and the R strain of MG. The field isolates produced a greater antibody response by serum plate agglutination than did the 6/85 vaccine. The isolates effectively colonized the trachea without increasing the tracheal mucosal thickness; however, they did not extensively colonize the air sacs or cause airsacculitis in the experimental birds.

The effect of dietary lysine deficiency on the immune response to Newcastle disease vaccination in chickens.

The effect of lysine deficiency on chicken immune function was evaluated using broiler chickens fed a diet with lysine at 67% of the control diet (1.24% lysine). The evaluation of humoral immune function was conducted by measuring the antibody production to a live Newcastle disease virus (NDV) vaccination using the hemagglutination inhibition (HI) test and enzyme-linked immunosorbent assay (ELISA). The cellular immune function was evaluated through the use of cutaneous basophil hypersensitivity test. The antibody response to NDV vaccination was reduced in broiler chickens fed a lysine-deficient diet when measured by ELISA but not when measured by HI. The cell-mediated immune response was also reduced by lysine deficiency.

The in vitro efficacy of a quaternary ammonia disinfectant and/or ethylenediaminetetraacetic acid-tris against commercial broiler hatchery isolates of Pseudomonas aeruginosa.

Studies have indicated variations in the degree of efficacy of certain commercial disinfectants used in poultry production facilities. We used an adequate method of in vitro testing to compare the efficacy of disinfectants while testing them in conditions similar to those of the poultry facilities. BioSentry 904, ethylenediaminetetracetic acid (EDTA)-Tris, and a combination of the two were tested by this method against five field isolates of Pseudomonas aeruginosa at 10(3), 10(6), and 10(9) colony-forming units (CFU)/ml. At the 10(9) CFU/ml concentration, most compounds failed to achieve a total kill with a contact time of 15 min. When tested at bacterial concentrations of 10(3) CFU/ml, the combination of EDTA-Tris mixed at a 1:1 ratio with BioSentry 904 killed the bacteria upon initial contact (< or = 0.05 min). This disinfectant mixture exhibited antagonistic, indifferent, or synergetic effects when exposed to different bacterial isolates at a concentration of 10(6) CFU/ml.

Characterization of Pseudomonas aeruginosa isolates associated with mortality in broiler chicks.

In mid-2000, a broiler chicken company in Alabama experienced high early mortality rates in chicks from two different hatcheries. Five isolates of Pseudomonas aeruginosa, obtained from these contaminated hatcheries and resulting broiler chicks with omphalitis, were selected to determine virulence of the bacteria. One-day-old specific-pathogen-free white leghorn chicks were placed into positive pressure isolation units (10 chicks per unit); feed and water were provided ad libitum. The five isolates of P. aeruginosa (1 x 10(1) or 1 x 10(1) colony-forming units/bird) were used to challenge two replicates of 10 chicks via yolk sac inoculation. Two control groups were injected with 0.1 ml of phosphate-buffered saline, and two groups received no treatment. Mortality was recorded daily, and the chicks that died were necropsied and liver and yolk sacs were cultured. After 14 days, the remaining chickens were euthanatized and necropsied. Bacterial isolates retrieved from liver and yolk sacs were identified by the API 20 NE typing system to confirm that they were the same as the challenge isolate. Virulence varied greatly among the isolates, resulting in mortality rates from 0 to 90%. The challenge isolates produced different and often distinctive postmortem lesion patterns. Antibiotic sensitivity tests showed that all five isolates were resistant to sulfisoxazole, ceftiofur, penicillin, lincomycin, bacitracin, oxytetracycline, erythromycin, naladixic acid, and tetracycline. The isolates varied in sensitivity to other antibiotics, but all isolates were sensitive to gentamicin.

In vitro effect of ethylenediaminetetraacetic acid-Tris on the efficacy of hatchery disinfectants.

Solutions of ethylenediaminetetraacetic acid (EDTA)-Tris showed synergistic or additive effects on gram-negative bacteria when combined with hatchery disinfectants consisting of phenol and detergent (Magnaphen-100), quaternary ammonium compound (QAC) and glutaraldehyde (Synergize), QAC (BioSentry 904), and hydrogen peroxide. The gram-positive bacteria reacted less favorably, with reaction mixtures showing all three levels of potentiation (synergistie, additive, and antagonistic). Combinations of EDTA-Tris and a commercial glutaraldehyde solution (Glutracide), when mixed with the test organisms, showed mostly antagonistic effects. Solutions of EDTA-Tris decreased the concentration of hatchery disinfectants required for bacterial killing by 75% in those situations in which synergistic potentiation occurred. EDTA-Tris is nontoxic to 12-day-old embryos. Serial passage of the test organisms in solutions of EDTA-Tris did not result in the development of resistant forms.

Pathogenic effects on domestic poultry of a mycoplasma gallisepticum strain isolated from a wild house finch.

Mycoplasma gallisepticum (MG) has been isolated from wild house finches. The pathogenic effects of MG finch strain (K4058) and MG R-strain were compared after exposure of chickens and turkeys. Gross and histologic lesions, reisolation of the organism, serology, and clinical disease were evaluated. Milder histologic and gross lesions, in addition to lower serologic titers, occurred in birds inoculated with the finch strain. Mortality, concurrent with clinical and gross respiratory signs and lesions, was observed only in chickens challenged with R-strain. Both the MG finch strain and MG R-strain were recovered from the respective challenge groups at 14 and 28 days postexposure. The results show that MG isolated from wild house finches may infect domestic poultry species but causes only mild disease and is less virulent than MG R-strain. Commercial enzyme-linked immunosorbent assay kits best detected the serologic response of chickens and turkeys to the MG finch strain.

Effect of hydrogen peroxide disinfection during incubation of chicken eggs on microbial levels and productivity.

Hatchery sanitation has a significant impact on chick quality. The proper use of disinfectants is essential. Aerosol bacterial counts, egg moisture loss, hatchability, chick quality, and broiler productivity were measured in eggs exposed to hydrogen peroxide fogging and compared with eggs not exposed to disinfectant during the incubation period. Hydrogen peroxide was also evaluated in the presence of a severe challenge with Staphylococcus aureus-contaminated eggs. A significant reduction was found in aerosol bacterial counts within the hatcher when incubators were fogged with 3% hydrogen peroxide when compared with water-fogged machines even in the face of high bacterial challenge. Eggs exposed to hydrogen peroxide lost a significantly greater amount of moisture during incubation, but hatchability was not affected. The use of hydrogen peroxide as a hatchery sanitizer did not affect broiler livability, body weight, or feed conversion but did reduce the incidence of retained yolk sacs in 42-day-old chickens.

The effect of inoculating Enterococcus faecalis into the yolk sac on chick quality and maternal antibody absorption.

Four hundred thirty-two 1-day-old specific-pathogen-free chicks were randomly divided into 36 groups of 12. All chicks were given 0.2 ml of Newcastle disease antiserum (hemagglutination-inhibition [HI] titer 1:5120) by injection into the yolk sac at hatch. Half of the groups received 0.2 ml of Enterococcus faecalis (4.0 x 10(8) colony-forming units/ml) by injection into the yolk sac at hatch (treatment). The remaining 18 groups received no bacteria (control). Two treatment groups and two control groups were weighed, bled, killed, and yolk sac weighed daily for the first 9 days of life. Feed was weighed at placement and at the end of the trial. Blood was tested for packed cell volume (PCV), total plasma protein, and Newcastle disease HI titer. No significant difference was observed between treatment and control groups for chick body weight, PCV, and feed consumption. Total plasma protein and retained yolk weight were significantly higher for treatment groups over control (P < 0.01 and P < 0.0001, respectively). Also, the geometric mean serum HI titer (log2) for Newcastle disease antibody was significantly higher in the control chicks vs. the treatment chicks (P < 0.01).

Sodium sesquicarbonate toxicity in broiler chickens.

A case of feed misformulation resulted in the addition of sodium sesquicarbonate (SSC) into broiler chicken feed. SSC is a buffering agent used in the manufacture of high urea ruminant feeds that were also produced in this feed mill. Within 2 days of receipt of the tainted broiler feed on the farm, chickens were exhibiting polydypsia and wet droppings and had increased levels of mortality. The postmortem lesions were dehydration, fluid-filled intestines, swollen, pale kidneys, and visceral urate deposits. Histopathology of the kidneys revealed dilated tubules with a giant cell response, loss of tubular epithelium, and a few needlelike crystals. The mortality within 4 days of exposure in three severely affected houses reached 17%. An analysis of the feed revealed sodium levels ranging from 2.59% to 4.88%, with chloride levels of 0.24%-0.40%. Ten percent of the ration was thought to be SSC that contains 36% sodium. To determine if the presence of the SSC caused the problems observed, a controlled study was undertaken. One hundred fifty 3-wk-old broilers were evenly distributed into three floor pens. One group was fed a normal grower ration, a second group was fed a ration containing 5% SSC, and a third group received a ration with 10% SSC. Mortality, packed cell volumes (PCV), total serum proteins, and histopathology of the kidneys were determined. The 10% SSC group had a 6% mortality. Dehydration was evident by elevated PCV within 1 day of ingestion of either ration containing SSC. Microscopic lesions in the kidney were more severe in chickens ingesting SSC when compared with control groups.

Pasteurella challenge and ELISA serology evaluation of broiler breeders vaccinated with live cholera vaccine.

Broiler breeder pullets were vaccinated against fowl cholera at 10 and 20 wk of age using a live PM-1 Pasteurella multocida vaccine administered by wing web stick. Antibody production for P. multocida was measured at vaccination and at 1-4-wk intervals following vaccination by enzyme-linked immunosorbent assay. Groups of vaccinated birds were challenged at 23 and 32 wk of age. Two doses of a live PM-1 P. multocida vaccine protected broiler breeder hens against virulent challenge up to 32 wk of age when measured antibody levels had a range of 1951-4346 and a geometric titer of 3000.

Evaluation of ELISA titers to infectious laryngotracheitis.

Infectious laryngotracheitis (ILT), a highly infectious upper respiratory disease of chickens, can cause serious economic loss in areas where the poultry industry is concentrated. To determine the antibody levels associated with vaccine administration, field challenge, and protection, six groups of 20 specific-pathogen-free leghorn chickens were housed in biosecured isolation units. Individual groups served as either negative controls, vaccinated (one full dose per bird of chicken embryo origin [CEO] administered by the eyedrop method) and challenged (intratracheal administration with USDA strain ILT virus at 10(4.1) 50% embryo infective dose [EID50]), or unvaccinated and challenged with USDA strain ILT virus at various dose levels (10(2.1), 10(5.1), or 10(4.1) EID50). Chickens in each group were bled weekly, and their sera were tested for antibody using a commercially available enzyme-linked immunosorbent assay test kit. The antibody response using CEO vaccine resulted in a 400-600 geometric mean titer that appeared to be protective against severe field challenge. Negative controls had no titers, whereas vaccinated and/or challenged chickens had detectable titers within 2 wk of exposure, and these titers remained high for the next 4-7 wk. Mortality in nonvaccinated controls began at 3 days post-challenge and continued for up to 10 days.

Protection by a commercial Arkansas-type infectious bronchitis virus vaccine against a field isolate of the same serotype.

A late-breaking infectious bronchitis virus (IBV)-associated respiratory disease was a chronic problem in Georgia broilers in 1995. The predominant virus isolated from diseased birds was the Arkansas (Ark) type of IBV. Because broilers in Georgia are currently vaccinated with the Arkansas serotype, there was concern that a phenotypic and/or genotypic change had occurred in the field virus so it could break through immunity conferred by commercial vaccines. The purpose of this study was to determine if a commercially available vaccine for IBV as currently used in the field still protected broilers against those viruses. We obtained 108 1-day-old broilers from a commercial source and assigned them randomly to 12 groups. One-half of the groups of birds were vaccinated at 1 day of age and again at 18 days of age with commercially available B1/Mass/Ark vaccine. One-half of both vaccinated and nonvaccinated groups of birds were challenged at 35 and 42 days of age with a recent IBV Ark field isolate. Serologic titers were evaluated by enzyme-linked immunosorbent assay at time of challenge and at the end of the trial. A necropsy was performed on birds at 56 days and pathogenicity was assessed. Seroconversion was statistically significant in all birds exposed to vaccine or challenge by 56 days of age. Gross airsacculitis was significantly more severe in broilers challenged without prior exposure to vaccine.

Transmission electron microscopic demonstration of abnormalities on the tracheal cilia of chicks exposed to formaldehyde during hatching.

Formaldehyde gas used to fumigate hatcheries for control of microbial contamination has an adverse effect on tracheal cilia function and morphology. Evaluation of the changes revealed alterations in the ultrastructure of the axoneme with the absence of B subfibers and the production of additional A subfibers. Spikes and vesicular blebs in the cilia walls were evident in formaldehyde-exposed cilia. These changes could result in ciliastasis and cilia loss.

Investigation of bacterial resistance to hatchery disinfectants.

Three commercial chicken hatcheries were sampled for environmental bacteria. Isolated bacteria were tested for resistance to commercial preparations of quaternary ammonia, phenolic, and glutaraldehyde liquid disinfectants. Bacterial isolates were exposed to several disinfectant dilutions bracketing the dilutions recommended by the manufacturer for 5-, 10-, and 15-min exposure periods before subculturing to broth medium. Approximately 8% of the isolates from two of three hatcheries were resistant to disinfectant concentrations at and above the manufacturers recommended dilution and time of exposure. Resistant bacteria included Serratia marcescens, Bacillus cereus, Bacillus thuringiensis, Bacillus badius, Enterococcus faecalis, Enterococcus faecium, Pseudomonas stutzeri, and Enterobacter agglomerans.

Copper sulfate toxicosis in commercial laying hens.

A flock of 51-week-old leghorn hens experienced a 16% drop in egg production in a single week. The layer ration contained 1477 ppm copper from the addition of copper sulfate. Severe oral ulcers were present in the pharynx. Oral ulcers, reduced feed intake, and a drop in egg production occurred when a ration containing 1437 ppm copper was evaluated experimentally.

Effect of formaldehyde exposure in the hatcher and of ventilation in confinement facilities on broiler performance.

Broiler embryos and chicks were exposed to formaldehyde vapors (up to 130 ppm) during the final 3 days of incubation. Bacterial load was significantly lower in a formaldehyde-fumigated hatcher than in an unfumigated hatcher. Hatchability was not affected. To determine if exposure to formaldehyde vapors in the hatcher would affect broilers' ability to tolerate variations in air quality, chicks were placed in either adequately or poorly ventilated confinement facilities for 45 days. Total and respirable dust particles (< or = 5 microns in diameter) increased to a greater extent between 5 and 6 weeks of broiler age in the poorly ventilated facility than in the facility with adequate ventilation. Mortality at 6 weeks of age was significantly higher in broilers exposed to formaldehyde in the hatcher and housed with poor ventilation than in broilers exposed to formaldehyde and raised with adequate ventilation. Six-week body weight, feed conversion, and septicemia/toxemia condemnations were adversely affected by poor ventilation. This study found that the quality of air in the confinement facility had a greater influence on broiler productivity than did exposure to formaldehyde vapors in the hatcher.