3D detection of colonic polyps by CT colonography: accuracy, pitfalls, and solutions by adjunct 2D workup

Computed tomography colonography (CTC) enables evaluation of the colon with minimal invasiveness. In spite of advances in multidetector CT (MDCT) technology and advanced software features, including electronic bowel cleansing (digital removal and tagging of fluid and debris), a number of potential pitfalls in the evaluation of the 3D volumetric dataset persist. The purpose of this article is to illustrate the strengths and potential pitfalls in the detection of colorectal polyps using CTC via a primary three-dimensional (3D) approach for evaluation.

Experimental Evaluation of Faecal Escherichia coli and Hepatitis E Virus as Biological Indicators of Contacts Between Domestic Pigs and Eurasian Wild Boar

Domestic pigs and Eurasian wild boar (Sus scrofa) share several important viral and bacterial pathogens. Therefore, direct and indirect contacts between domestic pigs and wild boar present a risk of pathogen spillover and can lead to long-term perpetuation of infection. Biological indicators could be a powerful tool to understand and characterize contacts between wild boar and domestic pigs. Here, faecal Escherichia coli and Hepatitis E virus (HEV) were explored as potential biological indicators under experimental conditions. The data gained in our pilot study suggest that faecal E. coli can be used as biological indicator of contact between wild boar and domestic pig. For HEV, faecal transmission was also confirmed. However, molecular studies on full-genome basis did not reveal markers that would allow tracing of transmission direction. Based on these promising results, future field studies will especially target the practicability of E. coli microbiome molecular typing as surrogate of contacts at the wildlife-livestock interface.

Association of type and location of BRCA1 and BRCA2 mutations with risk of breast and ovarian cancer

IMPORTANCE

Limited information about the relationship between specific mutations in BRCA1 or BRCA2 (BRCA1/2) and cancer risk exists.

OBJECTIVE

To identify mutation-specific cancer risks for carriers of BRCA1/2.

DESIGN, SETTING, AND PARTICIPANTS

Observational study of women who were ascertained between 1937 and 2011 (median, 1999) and found to carry disease-associated BRCA1 or BRCA2 mutations. The international sample comprised 19,581 carriers of BRCA1 mutations and 11,900 carriers of BRCA2 mutations from 55 centers in 33 countries on 6 continents. We estimated hazard ratios for breast and ovarian cancer based on mutation type, function, and nucleotide position. We also estimated RHR, the ratio of breast vs ovarian cancer hazard ratios. A value of RHR greater than 1 indicated elevated breast cancer risk; a value of RHR less than 1 indicated elevated ovarian cancer risk.

EXPOSURES

Mutations of BRCA1 or BRCA2.

MAIN OUTCOMES AND MEASURES

Breast and ovarian cancer risks.

RESULTS

Among BRCA1 mutation carriers, 9052 women (46%) were diagnosed with breast cancer, 2317 (12%) with ovarian cancer, 1041 (5%) with breast and ovarian cancer, and 7171 (37%) without cancer. Among BRCA2 mutation carriers, 6180 women (52%) were diagnosed with breast cancer, 682 (6%) with ovarian cancer, 272 (2%) with breast and ovarian cancer, and 4766 (40%) without cancer. In BRCA1, we identified 3 breast cancer cluster regions (BCCRs) located at c.179 to c.505 (BCCR1; RHR = 1.46; 95% CI, 1.22-1.74; P = 2 × 10(-6)), c.4328 to c.4945 (BCCR2; RHR = 1.34; 95% CI, 1.01-1.78; P = .04), and c. 5261 to c.5563 (BCCR2', RHR = 1.38; 95% CI, 1.22-1.55; P = 6 × 10(-9)). We also identified an ovarian cancer cluster region (OCCR) from c.1380 to c.4062 (approximately exon 11) with RHR = 0.62 (95% CI, 0.56-0.70; P = 9 × 10(-17)). In BRCA2, we observed multiple BCCRs spanning c.1 to c.596 (BCCR1; RHR = 1.71; 95% CI, 1.06-2.78; P = .03), c.772 to c.1806 (BCCR1'; RHR = 1.63; 95% CI, 1.10-2.40; P = .01), and c.7394 to c.8904 (BCCR2; RHR = 2.31; 95% CI, 1.69-3.16; P = .00002). We also identified 3 OCCRs: the first (OCCR1) spanned c.3249 to c.5681 that was adjacent to c.5946delT (6174delT; RHR = 0.51; 95% CI, 0.44-0.60; P = 6 × 10(-17)). The second OCCR spanned c.6645 to c.7471 (OCCR2; RHR = 0.57; 95% CI, 0.41-0.80; P = .001). Mutations conferring nonsense-mediated decay were associated with differential breast or ovarian cancer risks and an earlier age of breast cancer diagnosis for both BRCA1 and BRCA2 mutation carriers.

CONCLUSIONS AND RELEVANCE

Breast and ovarian cancer risks varied by type and location of BRCA1/2 mutations. With appropriate validation, these data may have implications for risk assessment and cancer prevention decision making for carriers of BRCA1 and BRCA2 mutations.

Emergence of a novel cluster of influenza A(H5N1) virus clade 2.2.1.2 with putative human health impact in Egypt, 2014/15

A distinct cluster of highly pathogenic avian influenzaviruses of subtype A(H5N1) has been found to emergewithin clade 2.2.1.2 in poultry in Egypt since summer2014 and appears to have quickly become predominant.Viruses of this cluster may be associated withincreased incidence of human influenza A(H5N1) infectionsin Egypt over the last months.

Vaccines against influenza A viruses in poultry and swine: Status and future developments

Influenza A viruses are important pathogens with a very broad host spectrum including domestic poultry and swine. For preventing clinical disease and controlling the spread, vaccination is one of the most efficient tools. Classical influenza vaccines for domestic poultry and swine are conventional inactivated preparations. However, a very broad range of novel vaccine types ranging from (i) nucleic acid-based vaccines, (ii) replicon particles, (iii) subunits and virus-like particles, (iv) vectored vaccines, or (v) live-attenuated vaccines has been described, and some of them are now also used in the field. The different novel approaches for vaccines against avian and swine influenza virus infections are reviewed, and additional features like universal vaccines, novel application approaches and the "differentiating infected from vaccinated animals" (DIVA)-strategy are summarized.

Field study on swine influenza virus (SIV) infection in weaner pigs and sows

OBJECTIVE

The aim of this field study was to explore the occurrence of and factors associated with the detection of swine influenza virus (SIV) by RTqPCR in weaner pigs and sows from herds with a history of respiratory or reproductive disorders.

MATERIAL AND METHODS

The sample set was based on nasal swabs from 823 sows (123 submissions) and 562 weaner pigs (80 submissions). Nasal swab samples were taken and submitted by 51 veterinary practices from all over Germany. Corresponding to the pig density most of the submissions originated from the north-western part of Germany. The nasal swabs were used to detect SIV RNA by real-time RT-PCR (RTqPCR). Subtyping of SIV RNA by conventional RT-PCR and sequencing was attempted directly from clinical samples or from isolates when available. The herd characteristics, management and housing conditions of the pig herd as well as the course of the disease were collected by a telephone questionnaire with the herd attending veterinarian.

RESULTS

SIV was detected by RTqPCR in 53.8% of the submissions from weaner pigs with a history of respiratory disease. Moreover SIV was detected in 10.6% of the submissions from sows. The predominant endemic subtype found in nasal swabs from sows and weaner pigs was H1N1 (60.5%) whereas subtypes H1N2 (14.0%) and H3N2 (14.0%) were detected less frequently. In addition, human pandemic H1N1 virus or reassortants thereof were found in 11.5%.

CONCLUSION AND CLINICAL RELEVANCE

The results underline the significance of a SIV infection in young pigs. A significant lower detection of SIV in wea- ner pigs was associated with the vaccination of piglets against por- cine circovirus type 2 (PCV2), possibly indicating an interaction of SIV and PCV2. Most of the positive samples from sows originated from gilts, whereas only two originated from sows. An association between reproductive disorders and the detection of SIV could not be confirmed.

Biochemical cartilage alteration and unexpected signal recovery in T2* mapping observed in ankle joints with mobile MRI during a transcontinental multistage footrace over 4486 km

OBJECTIVE

The effect of ultra-long distance running on the ankle cartilage with regard to biochemical changes, thickness and lesions is examined in the progress of a transcontinental ultramarathon over 4486 km.

METHOD

In an observational field study, repeated follow-up scanning of 22 participants of the TransEurope FootRace (TEFR) with a 1.5 T MRI mounted on a mobile unit was performed. For quantitative biochemical and structural evaluation of cartilage a fast low angle shot (FLASH) T2* weighted gradient-echo (GRE)-, a turbo-inversion-recovery-magnitude (TIRM)- and a fat-saturated proton density (PD)-weighted sequence were utilized. Statistical analysis of cartilage T2* and thickness changes was obtained on the 13 finishers (12 male, mean age 45.4 years, BMI 23.5 kg/m²). None of the nine non-finisher (eight male, mean age 53.8 years, BMI 23.4 kg/m²) stopped the race due to ankle problems.

RESULTS

From a mean of 17.0 ms for tibial plafond and 18.0 ms for talar dome articular cartilage at baseline, nearly all observed regions of interest (ROIs) of the ankle joint cartilage showed a significant T2*-signal increase (25.6% in mean), with standard error ranging from 19% to 33% within the first 2500 km of the ultra-marathon. This initial signal behavior was followed by a signal decrease. This signal recovery (30.6% of initial increase) showed a large effect size. No significant morphological or cartilage thickness changes (at baseline 2.9 mm) were observed.

CONCLUSION

After initial T2*-increase during the first 2000-2500 km, a subsequent T2*-decrease indicates the ability of the normal cartilage matrix to partially regenerate under ongoing multistage ultramarathon burden in the ankle joints.

No virological evidence for an influenza A - like virus in European bats

New members of the influenza A virus genus have been detected recently in bats from South America. By molecular investigations, using a generic real-time RT-PCR (RT-qPCR) that detects all previously known influenza A virus subtypes (H1-H16) and a newly developed RT-qPCR specific for the South American bat influenza-like virus of subtype H17, a total of 1571 samples obtained from 1369 individual bats of 26 species from Central Europe were examined. No evidence for the occurrence of such influenza viruses was found. Further attempts towards a more comprehensive evaluation of the role of bats in the ecology and epidemiology of influenza viruses should be based on more intense monitoring efforts. However, given the protected status of bats, not only in Europe, such activities need to be embedded into existing pathogen-monitoring programs.

Quantitative pixelwise myocardial perfusion maps from first-pass perfusion MRI

OBJECTIVE

To calculate and evaluate absolute quantitative myocardial perfusion maps from rest first-pass perfusion MRI.

METHODS

10 patients after revascularization of myocardial infarction underwent cardiac rest first-pass perfusion MRI. Additionally, perfusion examinations were performed in 12 healthy volunteers. Quantitative myocardial perfusion maps were calculated by using a deconvolution technique, and results were compared were the findings of a sector-based quantification.

RESULTS

Maps were typically calculated within 3 min per slice. For the volunteers, myocardial blood flow values of the maps were 0.51 ± 0.16 ml g(-1) per minute, whereas sector-based evaluation delivered 0.52 ± 0.15 ml g(-1) per minute. A t-test revealed no statistical difference between the two sets of values. For the patients, all perfusion defects visually detected in the dynamic perfusion series could be correctly reproduced in the maps.

CONCLUSION

Calculation of quantitative perfusion maps from myocardial perfusion MRI examinations is feasible. The absolute quantitative maps provide additional information on the transmurality of perfusion defects compared with the visual evaluation of the perfusion series and offer a convenient way to present perfusion MRI findings.

ADVANCES IN KNOWLEDGE

Voxelwise analysis of myocardial perfusion helps clinicians to assess the degree of tissue damage, and the resulting maps are a good tool to present findings to patients.

Nucleic acid-based detection of influenza A virus subtypes H7 and N9 with a special emphasis on the avian H7N9 virus

In 2013, a novel influenza A virus of subtype H7N9 was transmitted from avian sources to humans in China, causing severe illness and substantial mortality. Rapid and sensitive diagnostic approaches are the basis of epidemiological studies and of utmost importance for the detection of infected humans and animals. We developed various quantitative reverse transcriptase PCR (RT-qPCR) assays for (i) the generic detection of the haemagglutinin (HA) gene of H7 viruses or the neuraminidase (NA) gene of N9 viruses, and (ii) the specific detection of HA and NA of the novel avian H7N9/2013 virus. The sensitivity of the newly developed assays was compared with previously published PCRs, and the specificity of all RT-qPCRs was examined using a panel of 42 different H7 and 16 different N9 isolates. Furthermore, we analysed the performance of the RT-qPCR assays with dilution series and diagnostic samples obtained from animal experiments. Our study provides a comprehensive set of RT-qPCR assays for the reliable detection of the novel avian H7N9 virus, with high sensitivity and improved and tailored specificity values compared with published assays. Finally, we also present data about the robustness of a duplex assay for the simultaneous detection of HA and NA of the avian influenza H7N9/2013 virus.

Limited interlaboratory comparison of Schmallenberg virus antibody detection in serum samples

Eight veterinary institutes in seven different countries in Europe participated in a limited interlaboratory comparison trial to evaluate laboratory performances of Schmallenberg virus (SBV) antibody detection in serum. Seven different sheep sera and three different cattle sera were circulated, and all participating institutes were asked to test these sera using SBV antibody detection assay(s) in place in their laboratories. All laboratories within the trial performed a virus neutralisation test (VNT) as well as one or two ELISAs on all samples, and swiftly detected SBV antibodies using these assays. VNT was more sensitive in detecting SBV antibodies than several of the used ELISA assays. Based on the test results, one cattle and one sheep SBV antibody-positive serum were selected to serve as reference sera, which now can be supplied to other laboratories on request.

[Cowpox virus infection in an alpaca (Vicugna pacos) - clinical symptoms, laboratory diagnostic findings and pathological changes]

Orthopoxvirus infections appear to be rare in South American Camelids, because only a few cases have been reported in the literature. Based on a generalized infection with cowpox virus in an alpaca, the clinical symptoms, laboratory diagnostic findings and the pathological changes are described. The case history showed a long treatment because of chronic skin lesions. The main clinical symptom was miliary papules over the entire skin. Furthermore, a bilateral mucopurulent conjunctivitis occurred as well as excessive salivation due to a severe erosive-ulcerative stomatitis. Although the animal received intensive treatment, it died 8 days after admission to the clinic. During necropsy, an erosive-ulcerative laryngitis as well as a necrotising pneumonia and lymphadenitis were observed. Histopathological examination of representative organ samples led to the diagnosis of a suspected orthopoxvirus infection. Electron microscopy and quantitative polymerase chain reaction (qPCR) of tissue samples confirmed this diagnosis. The virus could be isolated in tissue culture and a PCR with subsequent nucleotide sequencing identified cowpox virus as the causative agent for this generalised infection.

Kuhpockenvirusinfektion bei einem Alpaka (Vicugna pacos) – klinische Symptomatik, Diagnostik und pathologische Befunde

Beschreibungen von Infektionen mit Orthopockenviren bei Neuweltkameliden beschränken sich in der Literatur auf einzelne Fallberichte. Ausgehend von einer generalisierten Kuhpockenvirusinfektion eines Alpakas werden klinische Symptomatik, Diagnostik und pathologische Befunde dargestellt. Laut Vorbericht wurde das Tier bereits über einen längeren Zeitraum aufgrund von Hautveränderungen behandelt. Bei der klinischen Untersuchung fielen papulöse Veränderungen auf der gesamten Hautoberfläche auf. Außerdem lagen eine beidseitige mukopurulente Konjunktivitis sowie starke Salivation infolge einer hochgradigen erosiv-ulzerativen Stomatitis vor. Trotz intensivmedizinischer Versorgung verstarb das Alpaka 8 Tage nach Einweisung in die Klinik. Bei der Sektion fanden sich weiterhin eine erosiv-ulzerative Laryngitis sowie eine nekrotisierende Pneumonie und Lymphadenitis. Histologisch wurde der Verdacht auf eine Orthopockenvirusinfektion gestellt. Diese ließ sich in der elektronenmikroskopischen Untersuchung und mittels quantitativer Polymerasekettenreaktion (qPCR) von Organmaterial bestätigen. Das Virus konnte isoliert werden und eine PCR mit anschließender Sequenzierung verifizierte Kuhpockenvirus als ursächlich für die generalisierte Infektion.