Extra-Intestinal Fluoroquinolone-Resistant Escherichia coli Strains Isolated from Meat

Extra-intestinal E. coli are emerging as a global threat due to their diffusion as opportunistic pathogens and, above all, to their wide set of antibiotic resistance determinants. There are still many gaps in our knowledge of their origin and spread pathways, although food animals have been adjudicated vehicles for passing mult-drug resistant bacteria to humans. This study analyzed 46 samples of meat purchased from retail stores in Palermo in order to obtain quinolone-resistant E. coli isolates. Strains were screened for their phylogenetic groups, ST131-associated single nucleotide polymorphisms (SNPs), and then typed by ERIC-PCR. Their set of virulence factors, namely, kpsMII, papA, sfaS, focG, iutA, papC, hlyD, and afa genes, were investigated and their fluoroquinolone-resistance determinants evaluated. The data obtained show a dramatically high prevalence of multidrug resistance patterns in the Palermo area, with 28% of the isolates having virulence factor genes typical of ExPEC strains. No B2 group or ST131 strains were detected. Moreover, 20% of our isolates showed positivity to all the plasmid-mediated quinolone resistance (PMQR) determinants, showing a potential to transfer these genes among other bacteria. Therefore, these data underline the possibility that food animals and, specifically, poultry in particular may be a significant source of resistant bacterial strains, posing a potential zoonotic risk.

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Adding Handles to Optimize Manual Box Handling

The risk factors for developing musculoskeletal disorders in material handling tasks are well known. Among strategies for controlling risks, modifying boxes by adding handles is suggested. However, there are no clear recommendations regarding box modification as an approach to improve musculoskeletal health. In this study, we investigated the main literature databases to identify effects of box modification on reducing physical load. Electronic and manual searches were performed to identify studies that evaluated effects of boxes handles on physical exposure during handling tasks. The included studies were very heterogeneous (methods of assessment, types of handles used, and methodological quality), jeopardizing synthesis of evidence. Despite the mentioned limitations, we could suggest some features that could improve manual handling in practical settings, like the use of cylindrical handles forms with intermediate diameters (between 31 and 51 mm) and 30° inclination. Those characteristics demonstrated positive results on physical exposure. Regular cut-outs were indicated as a beneficial approach when boxes are handled in high surfaces. When handling occurs in medium heights or in the floor level, handles positioned on the top of the box might bring better results. Efforts to standardize methods are important to support both objective and subjective assessment of box handle design, as well to improve the internal validity of studies.

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Infections Caused by Extended-Spectrum β-Lactamase Producing Escherichia Coli in Systemic Lupus Erythematosus Patients: Prevalence, Risk Factors, and Predictive Model

Objective. To investigate the prevalence and risk factors of infections caused by Extended-Spectrum β-Lactamase (ESBL) producing Escherichia coli (E. coli) in systemic lupus erythematosus (SLE) patients and develop a predictive model. Methods. Three hundred and eighty-four consecutive SLE patients with E. coli infection were enrolled in this retrospective case control study from January 2012 to December 2017. Prevalence and antimicrobial susceptibility pattern of ESBL producing E. coli were analyzed. Multivariate analysis was performed to determine the risk factors. Sensitivity and specificity were obtained at various point cutoffs and area under the receiver operator characteristic curve (AuROC) was determined to confirm the prediction power of the model. Results. Of the total 384 E. coli strains tested, 212 (55.2%) produced ESBL. The majority of these isolates were from urine (44.3%). Carbapenems (>80%) and amikacin (89.6%) had good activity against ESBL producing E. coli. Eleven variables were identified as independent risk factors for ESBL producing E. coli infection including Enterobacteriaceae colonization or infection in preceding year (OR=8.15, 95%CI 5.12–21.71), daily prednisone dose > 30mg (OR=5.48, 95%CI 3.12–13.72), low C3 levels (OR=2.17, 95%CI 1.62–6.71), nosocomial acquired infection (OR=4.12, 95%CI 1.98–8.85), etc. The model developed to predict ESBL producing E. coli infection was effective, with the AuROC of 0.840 (95% CI 0.799-0.876). Conclusions. The prevalence of ESBL producing E. coli was increasing with high antibiotics resistance in patients with SLE. The model revealed excellent predictive performance and exhibited a good discrimination.

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The Role of Endothelium in Physiological and Pathological States: New Data

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Endoscopic submucosal dissection of superficial esophageal cancer expanding into the diverticulum

Abstract

Endoscopic submucosal dissection (ESD) is standard treatment for early esophageal cancer (EEC). Cancer located within the diverticulum, which has a thin or nonexistent muscular coating, is extremely rare. We describe successful ESD of esophageal diverticular cancer with a high risk of perforation. A 20‐mm EEC lesion expanding into the diverticulum was detected in the middle thoracic esophagus of a 73‐year‐old man. Positive‐pressure ventilation under general anesthesia and carbon dioxide insufflation were performed.

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EUS‐guided coil and cyanoacrylate embolization for gastric varices and the roles of endoscopic Doppler and Endosonographic varicealography in vascular targeting

Abstract

Objectives

To report the results of endoscopic‐ultrasound guided injection of coils with cyanoacrylate using a less‐expensive coil, with an emphasis on the roles of Doppler and Endosonographic varicealography in identifying the feeder vessel in gastric varix treatment.

Methods

An observational, descriptive study with prospectively collected data. Patients with gastric varices were included and were treated by the endoscopic‐ultrasound guided injection of cyanoacrylate and a less‐expensive coil. Technical success, complete and immediate variceal obliteration, rebleeding, complication and survival rates were evaluated.

Results

Thirty patients with gastric varices, with a mean age of 62 years (range 44‐76 years), were treated. The median number of coils used was 2 (range 1‐3), and the median volume of cyanoacrylate was 1.8 ml (1.2‐2.4 ml). The technical success rate was 100%. Endosonographic varicealography technical success was observed in 26/30 patients. Complete variceal obliteration was observed in 96.6%of patients, and the immediate disappearance of the varix was observed in 24 (80%) patients. The complication rate was 6.7%.

Conclusions

Endoscopic‐ultrasound guidance for gastric varix treatment with the addition of endosonographic varicealography and the use of a less‐expensive coil is a safe and effective technique that results in the immediate disappearance of gastric varices after targeting the feeding vessel.

This article is protected by copyright. All rights reserved.

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Deferoxamine but Not Dimethyloxalylglycine, L-Mimosine, or Cobalt Dichloride Can Interfere with the MTT Assay

Hypoxia mimetic agents (HMAs) have been shown to have a positive influence on cellular functions in a multitude of tissue regenerative strategies. Novel experimental approaches use biomaterials as carriers for controlled delivery of these HMAs. Here, the cytotoxic aspects of biocompatibility are of key relevance. The MTT assay is widely used to evaluate cytotoxicity and proliferation. Based on the implications from the proceeding research we hypothesized that specific HMAs such as deferoxamine at high concentrations can interfere with the MTT assay. Thus, the aim of this study was to test the repercussions of the HMAs dimethyloxalylglycine, deferoxamine, L-mimosine, and CoCl2 on the validity of the MTT assay. Murine MC3T3-E1 cells were cultured in serum-free alphaMEM and in alphaMEM supplemented with 10 % fetal bovine serum with the HMAs dimethyloxalylglycine, deferoxamine, L-mimosine, and CoCl2, respectively, at 3 mM-0.3 mM for 24 h (experimental groups). Cells without HMAs served as control (control groups). The same experiments were performed with medium and phosphate buffered saline (PBS) without cells. In all settings MTT solution was added to PBS-washed or unwashed culture plates for the last two hours of the incubation period. Then MTT solution was removed and dimethyl sulfoxide was added to dissolve the formazan crystals and absorption was measured. Our data show that the presence of deferoxamine can interfere with the MTT assay if not removed before the addition of MTT. This is particularly important when evaluating cell viability in setups where deferoxamine-loaded biomaterials are used.

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