[A several-week history of inflammatory changes in the right foot and right hand of a 57-year-old male patient]. / Seit mehreren Wochen bestehende entzündliche Veränderungen an rechtem Fuß und rechter Hand bei einem 57-jährigen Patienten.

Metastatic fat necrosis due to inflammatory or neoplastic pancreatic diseases is rare. This phenomenon is attributed to systemic effects of pancreatic enzymes. Depending on the sites of fat necrosis, a number of different diseases may be mimicked, leading to incorrect diagnosis and therapies. Many case reports describe the phenomenon of skin, joint and bone manifestations of fat necrosis under the acronym PPP (pancreatic, panniculits, polyarthritis) syndrome. The management of "autodigestion" primarily consists of treating the underlying pancreatic disease.

Using geospatial methods to measure the risk of environmental persistence of avian influenza virus in South Carolina.

Avian influenza (AIV) is a highly contagious virus that can infect both wild birds and domestic poultry. This study aimed to define areas within the state of South Carolina (SC) at heightened risk for environmental persistence of AIV using geospatial methods. Environmental factors known to influence AIV survival were identified through the published literature and using a multi-criteria decision analysis with GIS was performed. Risk was defined using five categories following the World Organization for Animal Health Risk Assessment Guidelines. Less than 1% of 1km grid cells in SC showed a high risk of AIV persistence. Approximately 2% - 17% of counties with high or very high environmental risk also had medium to very high numbers of commercial poultry operations. Results can be used to improve surveillance activities and to inform biosecurity practices and emergency preparedness efforts.

Preweaned heifer management on US dairy operations: Part IV. Factors associated with the presence of Escherichia coli O157 in preweaned dairy heifers.

Dairy calves shed pathogenic Escherichia coli O157 (O157) in feces and are a potential route of exposure for human infections. As part of the National Animal Health Monitoring System's (NAHMS) Dairy 2014 study, we evaluated farm, animal, and environmental factors associated with O157 presence in dairy heifer calves. For this O157 study, calves were enrolled from 100 dairy operations in 13 states. Each operation collected data from calves from birth to weaning over an 18-mo period. A single fecal sample was collected from 487 calves in western states and from 871 calves in eastern states (n = 1,358 total), and O157 was detected in 2.5% (n = 34) of fecal samples. Descriptive statistics and univariable screening were used to determine which farm practices, environmental factors, and calf health measures were associated with O157 detection. Multilevel logistic models, controlling for dairy operation, were created using backward elimination of screened variables. The final O157 main effects model included variables for source of colostrum, temperature-humidity index (THI), and serum IgG concentration. Higher serum IgG was associated with lower odds of O157 shedding, whereas calves fed colostrum from their own dam had higher odds of O157 shedding than calves fed colostrum from pooled sources. Interaction models showed that THI level modified the effect of colostrum source on O157 shedding; calves with a THI indicative of heat stress had a significantly increased presence of O157 when fed colostrum from a first-lactation dam. The THI level also modified the effects of serum IgG. Calves with thermoneutral or heat stress THI values had increased presence of O157 with poor (<10 g/L) or adequate (10-15 g/L) serum IgG levels compared with those having excellent (≥15 g/L) serum IgG levels. These results highlight factors that influence the presence of O157 in preweaned dairy heifer calves and may be used to guide practices that mitigate shedding through improved animal husbandry.

Associations between Escherichia coli O157 shedding and the faecal microbiota of dairy cows.

AIMS: Dairy cattle shed pathogenic Escherichia coli O157 (O157) in faeces, playing a role in human exposure. We aimed to measure faecal microbial communities in early lactation dairy cattle, and model outcomes with O157 shedding metrics. METHODS AND RESULTS: Daily faecal samples were collected from 40 cattle on two Colorado dairies for five consecutive days, and characterized for O157. 16S rRNA gene sequencing was used to measure sample-level microbial communities. Alpha-diversity metrics were associated with O157 outcomes via regression modelling, adjusting for confounders. Differential abundance of taxa were identified between O157(+) and O157(-) samples and between shedding days of individuals, using matched Wilcoxon rank-sum tests, zero-inflated Gaussian (ZIG) regression and negative binomial regression. After removing an outlier, multi-day and intermittently shedding cows had lower average richness compared to those that never shed. ZIG modelling revealed Bacillus coagulans to be more abundant in O157(-) samples, while Moryella were more abundant in O157(+) samples. Negative binomial models and Wilcoxon tests revealed no differentially abundant taxa between O157(+) vs O157(-) samples, or between shedding days of individuals. CONCLUSIONS: Microbial diversity and some taxa may be influenced by or affect O157 shedding by dairy cattle. SIGNIFICANCE AND IMPACT OF THE STUDY: If future work corroborates these findings, dairy cow microbial community changes may be used to guide on-farm strategies that mitigate O157 dissemination, protecting the human food chain.

Climate, lactation, and treatment factors influence faecal shedding of Escherichia coli O157 pathotypes in dairy cows.

Among pathogens shed by cattle, Escherichia coli O157 ranks highest in those causing human illness. To date, prevalence and risk factors for O157 shedding have been assessed in feedlot, but not dairy cattle. The study aimed to determine prevalence levels and risk factors for O157 atypical enteropathogenic E. coli (aEPEC) and enterohaemorrhagic E. coli (EHEC) shedding in dairy cattle. Dairy cattle (n = 899) within the first 21 days of lactation were sampled monthly over the course of 1 year, on three dry lot dairies surrounding Fort Collins, CO. During visits multiple factors were measured (disease history, pharmaceutical use, climate measures, etc.), and cattle faeces were collected and assessed for presence of O157 and virulence genes. Logistic regression analysis was performed using O157 outcomes and measured factors. Prevalence of O157 aEPEC was 3·7%, while EHEC was 3·0%. Many potential risk factors were highly correlated, and used to build separate multivariable models. An increase in humidity was positively associated with aEPEC, while fluid faeces and history of disease showed a negative association. Meanwhile, an increase in temperature and antibiotic treatment was positively associated with EHEC, while more days in milk, higher hygiene score and cow contact were negatively associated. These results may guide mitigation strategies that reduce O157 shedding, and contamination of the human food chain.

A dangerous hobby? Erysipelothrix rhusiopathiae bacteremia most probably acquired from freshwater aquarium fish handling.

Erysipelothrix rhusiopathiae is a facultative anaerobic Gram-positive rod that occurs widely in nature and is best known in veterinary medicine for causing swine erysipelas. In humans, infections are rare and mainly considered as occupationally acquired zoonosis. A case of E. rhusiopathiae bacteremia most likely associated with home freshwater aquarium handling is reported. The route of transmission was probably a cut with the dorsal fin of a dead pet fish. A short review of clinical presentations, therapeutic considerations and pitfalls of E. rhusiopathiae infections in humans is presented.

Meningitis and Bacteremia Due to Neisseria cinerea following a Percutaneous Rhizotomy of the Trigeminal Ganglion.

Neisseria cinerea is a human commensal. The first known case of meningitis and bacteremia due to Neisseria cinerea following percutaneous glycerol instillation of the trigeminal ganglion is reported. Conventional phenotypic methods and complete 16S RNA gene sequencing accurately identified the pathogen. Difficulties in differentiation from pathogenic neisseriae are discussed.

A case of Capnocytophaga canimorsus sacral abscess in an immunocompetent patient.

We report a unique case of sacral Capnocytophaga canimorsus abscess successfully treated with surgery and antibiotics. Close contact to a dog was assumed to be the most likely source of infection. Established risk factors for invasive C. canimorsus infection such as splenectomy, alcoholism or overt immunosuppression could not be identified. The role of cigarette smoking, portal of entry and the possible relevance of altered skin microbiota as well as the diagnostic value of polymerase chain reaction are discussed in the light of the scarce literature of spinal C. canimorsus infections.

5-HT(3) and 5-HT(4) receptors contribute to the anti-motility effects of Garcinia buchananii bark extract in the guinea-pig distal colon.

BACKGROUND: Garcinia buchananii bark extract is an anti-motility diarrhea remedy. We investigated whether G. buchananii bark extract has components that reduce gastrointestinal peristaltic activity via 5-HT(3) and 5-HT(4) receptors. METHODS: Aqueous G. buchananii extract was separated into fractions using preparative thin layer chromatography (PTLC), and major chemical components were identified using standard tests. The anti-motility effects of the extract and its fractions (PTLC1-5) were studied through pellet propulsion assays using isolated guinea-pig distal colons. KEY RESULTS: Anti-motility (PTLC1 & PTLC5) and pro-motility (PTLC2) fractions were isolated from the extract. Flavonoids, steroids, alkaloids, tannins, and phenols were identified in the extract and PTLC1&5. The potency of the extract applied via the mucosal surface was reduced by 5-HT, 5-HT(3) receptor agonist RS-56812, 5-HT(4) receptor agonists cisapride and CJ-033466, 5-HT(3) receptor antagonist granisetron, and 5-HT(4) receptor antagonist GR-113808. The anti-motility effects of the aqueous extract and PTLC1&5 when applied serosally were reversed by RS-56812, cisapride, and CJ-033466. The 5-HT(3) receptor antagonists, granisetron and ondansetron, reduced the effects of the extract to an extent and completely reversed the anti-motility effects of PTLC1&5. GR-113808 inhibited the actions of the extract during the initial 10 min, but enhanced the extracts' anti-motility effects after 15 min. GR-113808 augmented the anti-motility activities of PTLC1 and PTLC5 by 30%. CONCLUSIONS & INFERENCES: These results indicate that the anti-motility effects of G. buchananii aqueous extract are potentially mediated by compounds that affect 5-HT(3) and 5-HT(4) receptors. Identification and characterization of the bioactive compounds within G. buchananii could lead to the discovery of new non-opiate anti-diarrhea formulations.

The traditional antidiarrheal remedy, Garcinia buchananii stem bark extract, inhibits propulsive motility and fast synaptic potentials in the guinea pig distal colon.

BACKGROUND: Garcinia buchananii bark extract is a traditional African remedy for diarrhea, dysentery, abdominal discomfort, and pain. We investigated the mechanisms and efficacy of this extract using the guinea pig distal colon model of gastrointestinal motility. METHODS: Stem bark was collected from G. buchananii trees in their natural habitat of Karagwe, Tanzania. Bark was sun dried and ground into fine powder, and suspended in Krebs to obtain an aqueous extract. Isolated guinea pig distal colon was used to determine the effect of the G. buchananii bark extract on fecal pellet propulsion. Intracellular recording was used to evaluate the extract action on evoked fast excitatory postsynaptic potentials (fEPSPs) in S-neurons of the myenteric plexus. KEY RESULTS: Garcinia buchananii bark extract inhibited pellet propulsion in a concentration-dependent manner, with an optimal concentration of ∼10 mg powder per mL Krebs. Interestingly, washout of the extract resulted in an increase in pellet propulsion to a level above basal activity. The extract reversibly reduced the amplitude of evoked fEPSPs in myenteric neurons. The extract's inhibitory action on propulsive motility and fEPSPs was not affected by the opioid receptor antagonist, naloxone, or the alpha- 2 adrenoceptor antagonist, yohimbine. The extract inhibited pellet motility in the presence of gamma-aminobutyric acid (GABA), GABA(A) and GABA(B) receptor antagonists picrotoxin and phaclofen, respectively. However, phaclofen and picrotoxin inhibited recovery rebound of motility during washout. CONCLUSIONS & INFERENCES: Garcinia buchananii extract has the potential to provide an effective, non-opiate antidiarrheal drug. Further studies are required to characterize bioactive components and elucidate the mechanisms of action, efficacy, and safety.

Reliability of perioperative SSEP recordings in spine surgery.

OBJECTIVE: The reproducibility and clinical reliability of perioperative somatosensory-evoked potentials (SSEP) were prospectively evaluated in uneventful scoliosis surgery. The influence of anesthesia owing to induction of total intravenous anesthesia (TIVA) upon preoperative SSEP and the variability of intraoperative SSEP were calculated. The potential effect of spine surgery was assessed by comparing pre- to postoperative SSEP. METHODS: A total of 2,143 pre-, intra- and postoperative tibial and median SSEP recorded in 25 patients undergoing spine surgery owing to idiopathic scoliosis were analyzed. The anesthesia protocol consisted of a computerized target controlled infusion (TCI) device for propofol and intravenous application of an opioid. RESULTS: Anesthesia induced a significant and comparable prolongation of the tibial SSEP onset, P40 and P60 latencies, while the N50 latency was less changed. Throughout anesthesia, latencies of median (onset, N20, P25 and N35) and tibial (onset, P40, N50 and P60) SSEP showed mean variations of less than 6%. The intraoperative SSEP amplitudes were less stable with a relative standard deviation of 30-40%. In uneventful spine surgery, the postoperative tibial SSEP were not significantly changed in comparison to preoperative recordings. CONCLUSIONS: By using a standardized anesthesia protocol, the impact of anesthesia on preoperative SSEP can be predicted. Furthermore, the controlled application of sedatives and analgesics allows recording of stable SSEP parameters for intraoperative monitoring purposes. As in uneventful spine surgery pre- to postoperative SSEP are unchanged the latter comparison can be applied as an additional perioperative neuromonitoring procedure to assess the influence of spine surgery or other invasive interventions on spinal cord function.

Light maxillary expansion forces with the magnetic expansion device. A preliminary investigation.

An active maxillary magnetic expansion device (MED) was developed to be used clinically. The aim was to show the effects of light and continuous forces producing less traumatic stimulation of maxillary sutural growth than a conventional rapid maxillary expansion device. In this study, two different types of appliances were used on six patients between 7 years 4 months and 16 years 2 months: the first type was bonded, the other one used bands. For better appreciation, four implants were placed on each patient: two apically between central and lateral incisors, and two between second premolars and molars. A standardized radiographic technique was used to take occlusal radiographs, and postero-anterior and lateral headplates. The results varied according to the age and the appliance used. The skeletal effect with the banded MED was between 16 and 77 per cent, and for the bonded MED 0 and 25 per cent in comparison to the overall expansion. It seems that 250-500 g of continuous magnetic forces can produce dental and skeletal movements in a light force expansion concept, but further studies with larger samples are needed to make firm conclusions.