A decline in the occurrence of extended-spectrum ß-lactamase-producing Escherichia coli in retail chicken meat in the UK between 2013 and 2018.

AIMS: The aim of this study was to report on the occurrence of antimicrobial resistant (AMR) Escherichia coli from retail chicken meat samples in the UK, with particular focus on AmpC and extended spectrum beta-lactamase (ESBL) production and carbapenem resistance. METHODS AND RESULTS: Methods from EU protocols were used for selective isolation of AmpC-/ESBL-producing E. coli, carbapenem-resistant E. coli and for performing minimum inhibitory concentrations. Additional work not part of EU protocols included viable counts, detection by PCR of blaCTX-M , blaOXA, blaSHV and blaTEM genes in ESBL-phenotype E. coli and screening for mcr plasmid-mediated colistin resistance. From the 313/309 retail chicken meat samples tested in 2016/2018, carbapenem or mcr plasmid-mediated colistin-resistant E. coli were not detected. For 2016/2018 chicken samples, 141/42 (45·0%/13·6%), 90/23 (28·8%/7·4%), 48/16 (15·3%/5·2%) and 3/3 (1·0%/1·0%) were positive for ESBL- and/or AmpC-, ESBL- alone AmpC- alone and AmpC+ESBL-phenotype E. coli respectively. ESBL-producing E. coli were predominantly blaCTX-M-1 . All AmpC and/or ESBL-phenotype E. coli were sensitive to colistin, ertapenem, imipenem, meropenem, temocillin and tigecycline, applying epidemiological cut-off values. CONCLUSIONS: A previous study in 2013/14 showed that 65·4% of retail chicken meat samples tested in the UK were positive for ESBL-producing (mainly CTX-M) E. coli. Since then the proportion of samples positive in the UK has dropped significantly to 7·4% in 2018. SIGNIFICANCE AND IMPACT OF THE STUDY: Significant reductions in antimicrobials used in the UK poultry meat sector between 2012 and 2016 may be linked to significant reductions in AmpC/ESBL-phenotype E. coli in retail chicken between 2013/14 and 2018.

Detection of extended-spectrum ß-lactam, AmpC and carbapenem resistance in Enterobacteriaceae in beef cattle in Great Britain in 2015.

AIMS: This study investigated the occurrence and genetic diversity of Enterobacteriaceae with extended-spectrum ß-lactamase (ESBL)-, AmpC- and carbapenemase-mediated resistance in British beef cattle, and related risk factors. METHODS AND RESULTS: Faecal samples (n = 776) were obtained from farms in England and Wales (n = 20) and Scotland (n = 20) in 2015. Isolates from selective agars were identified by MALDI ToF mass spectrometry. Selected isolates were characterized by multiplex PCR (blaCTX -M, blaOXA , blaSHV and blaTEM genes), whole-genome sequencing (WGS), minimum inhibitory concentrations and pulsed-field gel electrophoresis. None of the faecal samples yielded carbapenem-resistant Escherichia coli. Ten (25%) of the farms tested positive for ESBL-producing CTX-M Enterobacteriaceae, 15 (37·5%) of the farms were positive for AmpC phenotype E. coli and none were positive for carbapenem-resistant E. coli. WGS showed a total of 30 different resistance genes associated with E. coli, Citrobacter and Serratia from ESBL agars, and colocation of resistance genes with blaCTX -M1 . Buying bulls and bringing in fattening cattle from another farm were identified as significant risk factors for positive samples harbouring CTX-M Enterobacteriaceae or AmpC phenotype E. coli respectively. CONCLUSIONS: Beef cattle on a proportion of farms in GB carry ESBL-producing Enterobacteriaceae. Factors, such as operating as a closed herd, may have an important role in reducing introduction and transmission of resistant Enterobacteriaceae. The results indicate management factors may play an important role in impacting ESBL prevalence. In particular, further study would be valuable to understand the impact of maintaining a closed herd on reducing the introduction of resistant Enterobacteriaceae. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study showing the presence of ESBL-producing Enterobacteriaceae in British beef cattle.

Longitudinal study on the occurrence in pigs of colistin-resistant Escherichia coli carrying mcr-1 following the cessation of use of colistin.

AIMS: In 2015, colistin-resistant Escherichia coli and Salmonella with the mcr-1 gene were isolated from a pig farm in Great Britain. Pigs were subsequently monitored over a ~20-month period for the occurrence of mcr-1-mediated colistin resistance and the risk of mcr-1 E. coli entering the food chain was assessed. METHODS AND RESULTS: Pig faeces and slurry were cultured for colistin-resistant E. coli and Salmonella, tested for the mcr-1 gene by PCR and selected isolates were further analysed. Seventy-eight per cent of faecal samples (n = 275) from pigs yielded mcr-1 E. coli after selective culture, but in positive samples only 0·2-1·3% of the total E. coli carried mcr-1. Twenty months after the initial sampling, faecal samples (n = 59) were negative for E. coli carrying mcr-1. CONCLUSIONS: The risk to public health from porcine E. coli carrying mcr-1 was assessed as very low. Twenty months after cessation of colistin use, E. coli carrying mcr-1 was not detected in pig faeces on a farm where it was previously present. SIGNIFICANCE AND IMPACT OF THE STUDY: The results suggest that cessation of colistin use may help over time to reduce or possibly eliminate mcr-1 E. coli on pig farms where it occurs.

Evaluation of meat, fruit and vegetables from retail stores in five United Kingdom regions as sources of extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Escherichia coli.

We determined the prevalence and types of extended-spectrum ß-lactamase (ESBL)-producing and carbapenem-resistant Escherichia coli in raw retail beef, chicken, pork, fruit and vegetables in five UK regions in 2013-14. Raw meat (n=397), and fruit and vegetable samples (n=400) were purchased from retail stores in London, East Anglia, North West England, Scotland and Wales. Samples were tested for the presence of ESBL-producing E. coli by plating enriched samples on CHROMagar CTX and CHROMagar ESBL, for AmpC-type E. coli by plating on "CHROMagar FOX" (CHROMagar ECC+16mg/L cefoxitin), and for carbapenem-resistant E. coli by plating on CHROMagar KPC. Additionally, pre-enrichment counts were performed on the above agars, and on CHROMagar ECC. Isolates of interest were characterised by MALDI-ToF to confirm identification, by PCR for blaCIT,blaCTX-M,blaOXA, blaSHV and blaTEM genes; ESBL or blaCIT genes were sequenced. Only 1.9% and 2.5% of beef and pork samples, respectively were positive for ESBL-producing E. coli after enrichment compared with 65.4% of chicken samples. 85.6% positive samples from chicken meat carried blaCTX-M-1; blaCTX-M-15 was not detected. None of the fruits or vegetables yielded ESBL-producing E. coli and none of the meat, fruit or vegetable samples yielded carbapenem-resistant E. coli. Retail chicken was more frequently a source of ESBL-producing E. coli than were beef, pork, fruit or vegetables. None of the foodstuffs yielded E. coli with CTX-M-15 ESBL, which dominates in human clinical isolates in the UK, and none yielded carbapenem-resistant E. coli.

Joint Raman spectroscopic and quantum chemical analysis of the vibrational features of Cs2RuO4.

The Raman spectroscopic characterization of the orthorhombic phase of Cs2RuO4 was carried out by means of group theory and quantum chemical analysis. Multiple models based on ruthenate (VI+) tetrahedra were tested, and characterization of all the active Raman modes was achieved. A comparison of Raman spectra of Cs2RuO4, Cs2MoO4, and Cs2WO4 was also performed. Raman laser heating induced a phase transition from an ordered to a disordered structure. The temperature-phase transition was calculated from the anti-Stokes/Stokes ratio and compared with the ones measured at macroscopic scale. The phase transition is connected with tilting and/or rotations of RuO4 tetrahedra, which lead to a disorder at the RuO4 sites. © 2015 The Authors. Journal of Raman Spectroscopy published by John Wiley & Sons Ltd.

Prevalence of extended-spectrum-ß-lactamase-producing Escherichia coli from pigs at slaughter in the UK in 2013.

OBJECTIVES: To determine the prevalence and types of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli occurring in pigs at slaughter in the UK in 2013. METHODS: Caecal samples from 637 pigs, sampled via a UK-wide monitoring programme in 2013, were enriched overnight in buffered peptone water, before plating to CHROMagar CTX and Oxoid Brilliance ESBL agar. Presumptive ESBL-producing E. coli from both media were tested for ESBL phenotype using MAST ESßL ID discs. Isolates with an ESBL phenotype were examined for the presence of blaCTX-M, blaOXA, blaSHV and blaTEM genes using a multiplex PCR. All blaCTX-M and blaSHV genes identified by PCR were sequenced. RESULTS: A total of 23.4% (95% CI 19.2-27.6) of pigs were positive for ESBL-producing E. coli; 22% (95% CI 17.8-26.1) of the pigs carried E. coli producing CTX-M enzymes [comprising enzyme types 1 (18.7% of pigs), 3 (0.2%), 14 (0.5%), 15 (1.4%), 27 (0.5%), 32 (0.5%) and 55 (0.3%)] and 2.2% (95% CI 0.8-3.6) of the pigs carried E. coli producing SHV-12. Five pigs carried both CTX-M- and SHV-12-producing E. coli as different isolates. There were no statistically significant differences observed between the two medium types in terms of the proportions of each CTX-M enzyme type isolated. CONCLUSIONS: In this UK study, 23.4% of pigs were found to be positive for ESBL-producing E. coli using selective culture media. The use of two different commercially available ESBL isolation media was found to improve the detection of ESBL-producing E. coli.

Isolation and detection of extended spectrum ß-lactamase (ESBL)-producing enterobacteriaceae from meat using chromogenic agars and isothermal loop-mediated amplification (LAMP) assays.

The aim of this work was to develop a molecular method using loop-mediated isothermal amplification (LAMP) for detection of extended spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae from meat, and to compare it with different isolation agars and microarrays. LAMP assays were developed for CTX-M groups 1, 2, and 9 and OXA-10-like genes. Chicken, lamb, beef, pork, and turkey samples were spiked with 10, 100, and 1,000 cfu/gram using 8 strains of ESBL-producing Enterobacteriaceae (CTX-M sequence types 1, 2, 3, 14, 15, OXA-11, SHV-2, TEM-52) +/- a mix of competitor organisms. Samples were enriched overnight in buffered peptone water (BPW) +/- antibacterials before plating to CHROMagar CTX, OXOID ESBL Brilliance agar, and MacConkey agar with 1 mg/L cefotaxime. Selected BPW broths were also tested using LAMP assays, microarrays and using cefpodoxime discs on agar. For isolation/detection of ESBL producers from beef, pork, lamb, and turkey spiked with 10 or 100 cfu/gram ESBL (natural flora only), all agars and the LAMP assays showed 100% sensitivity and specificity for ESBL spike strains. For chicken samples, both LAMP and chromogenic agars showed improved sensitivity and specificity for isolation of ESBLs compared with MacConkey agar, particularly with competitor bacteria added. In comparison, the cefpodoxime disc method and microarray showed reduced sensitivity.

Characteristics of ciprofloxacin and cephalosporin resistant Escherichia coli isolated from turkeys in Great Britain.

1. A field study was performed to investigate the presence and characteristics of ciprofloxacin-resistant, extended spectrum ß-lactamase (ESBL) and AmpC Escherichia coli from turkeys in Great Britain. E. coli were isolated from ~9000 boot swab samples from 27 different farms owned by four different companies. Between 1 and 14 visits were made to each farm (mean 3) at between 0 and 15 m intervals (mean ~5 m). 2. CHROMagar ECC with and without ciprofloxacin or cephalosporin antibiotics was used as selective isolation media. Representative isolates with different phenotypes were tested for mutations in gyrA and for: qnrA, B, S, qepA and aac(6')-Ib genes, for ESBL phenotype, the presence of bla genes and plasmid type, and for ampC genes Representative ciprofloxacin-resistant and CTX-M isolates were further tested for serotype and PFGE type. On ciprofloxacin selective media 55% of samples yielded ciprofloxacin resistant E. coli and of those further analysed, most had ciprofloxacin MICs >4 mg/l and mutations in gyrA. 3. For the different companies, the mean number of samples per farm with cefoxitin- or cefotaxime-resistant isolates ranged from 1·0% to 61·9% and 4·7% to 31·7% respectively. Cefotaxime-resistance was most commonly associated with an ESBL phenotype, a CTX-M-1 or CTX-M-14 sequence type and an I1-γ or K plasmid inc type. The mechanism of cefoxitin resistance was not determined for most isolates, but where determined it was bla . 4. PFGE and serotyping showed clonally-related isolates persisting over multiple visits suggesting both more prudent use of antibiotics and improved farm hygiene are needed to address the issue of antimicrobial resistance in isolates from turkeys.

[Acute neoplastic colic obstructions: therapy and postoperative complications. Our experience]. / Le occlusioni acute neoplastiche del colon: terapia e risoluzione di complicanze postoperatorie. Nostra esperienza.

Authors report their experience about neoplastic large bowel obstructions and present two cases of anastomotic leakage resolution by means of transtomy wash-out. They observe that the most important problem in this surgery is anastomotic leakage which, if small, can be solved in a non operative way. According with literature, they also point out anastomotic leakage is commonly due to the impossibility of a correct preparation of colon to operation in emergency. They conclude it is possible, in case of little leakages, to perform trans-stomy wash out which permits a good toilette and sterilization of the colon.

Seasonal variations in the relationship between mid-upper arm circumference and maximum voluntary contraction among Ethiopian farmers.

OBJECTIVES: To determine the nature of the relationship between mid-upper arm circumference (MUAC) and maximum voluntary contraction (MVC) in pre- and post-harvest seasons among adult Ethiopian farmers. SUBJECTS/METHODS: A total of 491 healthy adult men aged 18-60 years were recruited at pre-harvest season and followed up at post-harvest season. Anthropometric measurements (weight, MUAC, biceps/triceps skinfold thickness and forearm circumference) were obtained using standard techniques and arm muscle circumference (AMC)/arm muscle area (AMA) was calculated. MVC of both arms was measured using a handgrip dynamometer. Paired t-test was used to compare means, and linear regression to investigate the relationship between MUAC and MVC. RESULTS: Maximum voluntary contraction showed statistically significant correlation with MUAC. Grip strength (MVC) demonstrated a linear increase from under-nourished to normal subjects across MUAC classes. Paradoxically, mean MVC of both arms declined significantly during the post-harvest season. However, the relationship between MUAC and MVC held tight in the post-harvest season as seen in the pre-harvest period. CONCLUSIONS: This study has highlighted that under-nourished adult men have reduced functional ability (strength) in all seasons. In addition, strength increases in a linear fashion as MUAC increases during both seasons. More work examining the relationship between functional ability and anthropometric indices in adults from different developing countries is needed to address use and cutoffs for grip strength.

[Etiopathogenic hypothesis on carcinoma of the gallbladder: our study]. / Un'ipotesi eziopatogenetica in tema di carcinoma della colecisti: il nostro studio.

The authors are interested in determining causes of gallbladder cancer (GBC). By this intention, they theorize a correlation between genetic modifications (which are responsible of malignant transformation of biliary epithelium) and some intestinal infections. From 1999 to 2004 they observed 15 GBC and all 15 gallbladder have been analyzed histologically and from microbiological aspect; by these means from 1999 till 2004 they have studied also 30 persons with colelithiasis. The authors noticed that bile of both groups contained, in three cases in the first and in 8 cases in the second, a germ named Escherichia Coli which normally lives in intestine, while in 10 operated gallbladders of the first group and 12 of the second there was a positive for k-ras. They are studying to confirm their theories.

[Treatment of skin neoplasms with polidocanol infiltrations. Our experience]. / Trattamento delle neoplasie cutanee con infiltrazioni di polidocanolo. Nostra esperienza.

The authors try to explain the importance of day surgery today. They report their 5 years experience in treatment of face and neck skin neoplasms by injections of a sclerosant product as hydropolyethoxydodecan, in case of a difficult good esthetic result with surgery or other therapies because of patients general conditions, such as diabetic ones, or because of their viral nature. Then they affirm to have treated 350 benign and malign tumors with this method. All subjects presented a complete resolution of disease in few weeks and none between them controlled has actually complications or recruitment of neoplasm. They conclude by saying that this result is probably due to local ischemic reaction caused by the substance used.

[A case of intestinal obstructions caused by a gossypiboma]. / Su un caso di occlusione intestinale da garzoma.

The Authors explain a case of intestinal obstruction due to a gossypiboma. They stress the great importance of the prevention in surgical operations (count of surgical towels, exploration of the surgical site) and the role of the differential diagnosis.

[Merkel cell tumor: a case report and literature review]. / Tumore a cellule di Merkel: presentazione di un caso clinico e revisione della letteratura.

Merkel cell tumor (MCT) is extremely rare, being discovered so far about 400 cases in literature. It is classified among neuroendocrine tumors. We report a case of MCT in the subclavicular region in a 93 years old woman. We confirm the efficacy of radiotherapy associated with octreotide, which these tumours express specific receptors for.

The use of armspan measurement to assess the nutritional status of adults in four Ethiopian ethnic groups.

OBJECTIVES: To investigate the use of armspan as a proxy for height in the assessment of nutritional status using body mass index (BMI) for four ethnic groups in Ethiopia. DESIGN: Cross-sectional study. SETTING: Four regions in Ethiopia, namely Oromia, Amhara, Tigre and Somali Region. SUBJECTS: A total of 1706 (884 males and 822 females) Ethiopians aged 18-50 y from four different ethnic groups. METHODS: Anthropometric measurements (weight, height and armspan) were obtained using standard techniques. BMI using height (BMI-ht) and using armspan (BMI-as) were calculated, t-tests were used to compare means, and linear regression to investigate the relationship between BMI-ht and BMI-as. RESULTS: Ethnic and sex differences in the relationship between height and armspan, and their derived variables (BMI-ht and BMI-as), were found. Armspan and height (r=0.83-0.9), and BMI-ht and BMI-as (r=0.89-0.97), were highly correlated in all ethnic groups. BMI-as cut-offs equivalent to the conventional BMI-ht classification of chronic energy deficiency were similar in the Oromo, Amhara and Tigre, but substantially higher in the Somalis. CONCLUSION: Armspan can be used as a proxy for height to estimate BMI, but the relationship between the two measures varies considerably with ethnicity and sex. Unless sex- and ethnicity-specific cut-offs are applied, the use of BMI-as using conventional cut-offs will overestimate the prevalence of underweight in these populations. SPONSORSHIP: HelpAge International.

[Pseudo-thrombophlebitic syndrome of the leg caused by cyst in the inner popliteal hamstrings. A case report]. / Sindrome pseudo-tromboflebitica dell'arto inferiore da cisti del cavo popliteo. Presentazione di un caso clinico.

The Authors present a clinical case of pseudo-thrombophlebitic syndrome caused by a cyst of the inner popliteal hamstrings. Pointing out anatomic characteristics of the area involved together with the physiopathology and etiology of the formation that fill the space of the inner popliteal hamstrings, in agreement with the observations reported in literature, and intervene in determining a great number of venous blockage observed in the leg. In conclusion, they observe how a correct clinical-anamnestic approach is important in the diagnosis and consequent prompt and aimed therapy, and how this approach should use the modern instruments available today for a definite diagnosis in the presence of a syndrome of venous stasis of the lower limbs.

[Treatment of single hepatic metastasis from surgically treated breast carcinoma. (Report of a clinical case and review of the literature)]. / Trattamento di metastasi epatica singola da carcinoma mammario operato. (Presentazione di un caso clinico e revisione della letteratura).

In the natural history of the breast cancer, the liver metastatic location represents a clear element of an advanced stage of the disease, because it is often accompanied to multiple locations in the same organ and/or in different organs and tissues. The finding into two years after the primary intervention, during the ordinary follow-up, of an insulated metastasis in the 3rd hepatic segment in a patient operated for breast carcinoma, and the following surgical treatment of the metastasis, have suggested us to draft this note. The finding of a single metastasis in the liver in patients operated for breast carcinoma imposes a revaluation of the stage of sickness to highlight the contemporary presence of subsequent distance metastatic location; the negativity of the instrumental investigations performed has triggered the question about the type of therapeutic treatment to do to the patient. The range of therapeutic hypothesis spaces from the ultrasound guided mini-invasive techniques (alcoholization, infusion of LAK cells, use of radio frequencies), to the chemotherapy, so general that local one, by means of super selective catheterization of the hepatic artery, up to the, finally, minus usual (in these cases) surgical therapy. In the patient observed we have chosen the surgical treatment, consisting of a segmentary resection, we haven't any complication, neither intra- nor post-operative, and the patient was discharged in 8th day. Our choice of the surgical approach has bean consequence of an attentive evaluation so of the clinical indicators of the patient (good general conditions, bulk of the injury and surgical treatableness) that of the biological parameters of the neoplasm. The results of our experience, in line with whet indicated from the other AA., encourage the choice of the surgical treatment of the insulated hepatic metastasis from breast carcinoma, with the awareness of the concept of "adjuvant" that it necessarily engages in such circumstances, and, however, after an accurate selection of the patients.

[Treatment of rectal carcinoma: our experience]. / Trattamento del carcinoma del retto: nostra esperienza.

Authors' experience with 53 patient operated on for adenocarcinoma of the rectum in Oncologic Surgery Department--University of Messina (Italy) was analysed. The development of mechanical devices has allowed surgeons to perform sphincter-saving in patients with medium-lower tumors of the rectum. In this experience abdominoperineal amputation was performed in cases of distal rectal tumors, local transanal excision was performed in 6 cases. There were no statistically significant differences between low anterior resection and abdomino-perineal resection with respect to local (17% vs 16.6%) and distant (16% vs 16%) recurrence.