Molecular detection of HEV in domestic pigs in Italy from Abruzzo and Molise regions

Background

Hepatitis E virus (HEV) is a zoonotic pathogen transmitted through the faecal-oral route and it is responsible of disease in humans with more than 21.000 cases reported in the European Union (EU) over the last decade. It is a non-enveloped single stranded RNA virus that includes 8 genotypes; among these, genotypes 3 and 4 (HEV-3 and HEV-4) are the most prevalent in developed countries and infect both humans and some animal species such as domestic pigs. In this study, we investigated the prevalence of HEV in domestic pigs bred in Italy, in Abruzzo and Molise regions.

Methods

During the period October 2020-March 2021, 327 liver samples from individual pigs were analysed. In particular, 211 were collected in 1 slaughterhouse and originated from animals bred in Abruzzo in 8 different farms and 116 were collected in 7 slaughterhouses and originated from animals bred in Molise in 47 farms. The real time retro-transcriptase (RT)-polymerase chain reaction (PCR) technique was used to detect HEV by targeting the open reading frame (ORF) 3 region of the viral ribonucleic acid (RNA).

Results

None of the samples deriving from pigs bred in Abruzzo tested positive for the detection of HEV RNA. Instead, 4 samples from pigs bred in 2 different farms in Molise tested positive, showing a prevalence of 3.45%.

Conclusions

Pigs are considered important reservoirs for HEV virus. For this reason, it is opportune to investigate the role of these animals for better understanding their involvement in the human infection through the consumption of contaminated raw or undercooked pork-meat products. These findings need to be further investigated with in depth genomic characterization of positive RNA samples to highlight the role of the specific strains circulating in this region and to draw conclusions about connections between animals, potential contaminated food and human disease.

Key messages

The study paved the way for defining the role of pigs in the transmission of HEV virus to humans through the consumption of pork meat products. This study reports the prevalence of HEV in domestic pigs of Abruzzo and Molise regions, two Italian regions.

Root internalization of Salmonella Typhimurium in basil plants

Background

Foodborne pathogens present in soil or irrigation water have the potential to internalize via root into edible parts of the plants and survive, representing a serious hazard for consumer's health (1). The present work assesses the ability of Salmonella Typhimurium (ST) to enter basil plants (Ocimum basilicum L., cultivar “Napoletano”) from roots. This situation may represent a risk in food safety since that vegetable is largely used raw/undercooked, in the Mediterranean diet.

Methods

Sixteen basil plants were cultivated in hydroponics, from the seeds. Roots from 14 plants at 4 leaves-stage were individually immersed in liquid media contaminated with a suspension of ST isolated from Aterno river in Abruzzo region, Italy (9 log10 cfu/mL final concentration). Two plants were used as negative controls (no ST challenge); surface swabs were taken from leaves and stems to exclude external contaminations. After 24 hours, plants were tested for detection (UNI EN ISO 6579-1:2017) and enumeration (in-house method) of ST in leaves and stems.

Results

ST detection gave positive results in 14/14 plants; in particular, ST was present in 14/14 plants in the leaves and for 9/14 plants also in the stems. The internalized ST strains were also enumerated in 10/14 plants. In particular, 3/14 plants gave positive results both in the leaves and stems, 2/14 only in the stems and other 5/14 only in the leaves. The average ST counts were of 4 log10 cfu/g in leaves and stems. All negative ctr/surface swabs were negative to ST.

Conclusions

Even though antimicrobial properties of basil plants have been described (2), this study demonstrated the potential of ST to internalize, survive and spread to edible parts. The findings highlight the risk of human infections by ST in plant following root uptake, suggesting the importance of applying appropriate preventive pre-harvest strategies.

Biblio

EFSA. E. Jour. (2014);12(3):3600 Tenore et al. (2017). Natural product research, 31(17), 2067-2071

Key messages

The ability of Salmonella Typhimurium to internalize, survive and spread to edible parts of basil plants. Pathogenic bacteria root uptake represents a potential risk for human health.

First report of HEV-3 subtypes e and f in the wild boar population in Abruzzo region, Italy

Background

Hepatitis E virus (HEV) is a zoonotic pathogen and wild boars are recognised as reservoirs. HEV is the most common cause of acute viral hepatitis worldwide and it is usually transmitted by faecal-oral route. EU reported more than 21.000 human cases over the last 10 years (1). At the present, HEV comprises 8 genotypes and several subtypes. HEV genotypes 3 and 4 (HEV-3 and HEV-4) are zoonotic. This is the first report of HEV-3 subtype e and f in the wild boar population in Abruzzo region.

Methods

During the hunting season 2018-2019, liver samples from wild boars were analysed using Real Time RT-PCR for the detection of HEV RNA. Among these, positive sample were subjected to Whole Genome Sequencing for genotyping. After the quality check, reads were mapped using the nearest identified ref. sequence (KU176129) and the resulting HEV RNA sequences have been analysed using HEV net (open source software).

Results

Overall, 40 samples were tested positive for the detection of HEV RNA. Among these, 19 samples, with a Ct value ≤ 38, were selected for phylogenetic analysis. All RNA viral samples belonged to HEV-3. In particular, 2 RNA viral samples belonged to subtype e and 1 to subtype f. The others, instead, belonged to HEV-3 subtype c.

Conclusions

Up to now, only HEV-3 subtype c has been reported among wild boars in Abruzzo, an Italian region officially recognized as an HEV hot spot because of the high number of human cases and for the strong sero-prevalence among blood donors. In this study, we report for the first time the presence of HEV-3 subtypes e and f in the wild boar population of this area. Since HEV-3 subtypes e and f are commonly associated to human disease from consumption of raw/undercooked pork meats, these findings suggest the potential risk also associated with the consumption of wild boar meat. Nevertheless, this speculation needs further investigations.

1.EFSA (2017). Public health risks associated with HEV as a food-borne pathogen. E. Jou., 15(7)

Key messages

First report of the presence of HEV-3 subtypes e and f among wild boar population in Abruzzo region. Potential risk for human health of HEV transmission associated with raw/undercooked wild boar meat consumption.

Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis

Minimally invasive Heller myotomy is considered the gold standard surgical approach for symptomatic achalasia because it is a safe and effective procedure. Over the last years, several studies comparing the laparoscopic and robotic approach for Heller myotomy have been published. Although the robotic approach appears to have some advantages over standard laparoscopy, data on this topic are still controversial and no definite conclusions have been drawn. This metanalysis has been designed to systematically evaluate and compare the effectiveness and safety of the robot-assisted Heller myotomy as compared to the standard laparoscopic approach. According to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic search on both laparoscopic and robotic Heller myotomy was performed in all the major electronic databases (PubMed, Web of Science, Scopus, EMBASE), using the following search string: (achalasia OR Dor) AND robotic. Six articles were included in the final analysis. A metaregression analysis was performed to assess the possible effects of demographic variables (age, gender, body mass indes (BMI)) and previous abdominal surgery or endoscopic intervention on the analyzed outcomes. No statistical difference was observed in operative times (mean difference (MD) = 20.79, P = 0.19, 95% confidence interval (CI) -10.05,51,62), estimated blood loss (MD = -17.10, P = 0.13, 95% CI -40.48,5.08), conversion rate to open surgery (risk difference (RD) = -0.01, P = 0.33, 95% CI -0.05,0.02), length of hospital stay (MD = -0.73, P = 0.15, 95% CI -1.71,0.25) and long-term recurrence (odds ratio (OR) = 0.59, P = 0.45, 95% CI 0.15,2.33). On the contrary, the robotic approach was found to be associated with a significantly significant lower rate of intraoperative esophageal perforations (OR = 0.13, P < 0.001, 95% CI 0.04, 0.45). Our results suggest that the robotic approach is safer than the laparoscopic Heller myotomy, encouraging the use of robot-assisted surgery. However, our analysis is limited because of the exiguous number of comparative studies and because most of the included studies were statistically underpowered, given the small sample size. Moreover, a high degree of heterogeneity was observed in most of published studies. Taking in consideration the additional costs of robot-assisted procedures, larger Randomized Controlled Trials (RCTs) are advocated to confirm the safety and effectiveness of the robotic approach, and its advantages over standard laparoscopic surgery. In conclusion, well-designed prospective trials and RCTs with homogeneous parameters are needed to draw definitive conclusions about the best surgical approach to pursue in treating symptomatic achalasia.

Sterile carbon particle suspension vs India ink for endoscopic tattooing of colonic lesions: a randomized controlled trial

BACKGROUND

Different markers have been used preoperatively to mark colonic lesions, especially India ink. In recent years, another kind of marker has been developed: sterile carbon particle suspension (SCPS). No comparison between these two markers has yet been made. The aim of the present study was to compare the pyrogenic, inflammatory and intraperitoneal effect of these two markers.

METHODS

From September 2015 to December 2018, adult patients who were candidates for elective laparoscopic colon resection were randomized to the SCPS or conventional India ink injection group using computer-based randomization. The primary endpoint of the study was the presence of intraoperative adhesions related to the endoscopic tattoo. Secondary endpoints were differences in white blood cell, C-reactive protein, and fibrinogen levels as well as, abdominal pain and body temperature at baseline (before endoscopic tattooing) and 6 and 24 h after colonoscopy. Finally, the visibility of the tattoo during the minimally invasive intervention was assessed.

RESULTS

Ninety-four patients were included in the study, 47 for each arm. There were 45/94 females (47.9%) and 49/94 males (52.1%), with a median age of 67.85 ± 9.22 years. No differences were found between groups in WBC, fibrinogen levels, body temperature or VAS scores, but we documented significantly higher CRP values at 6 and 24 h after endoscopic tattooing with India ink injection. There were significantly fewer adhesions in the SCPS Endoscopic Marker group. All the endoscopic tattoos were clearly visible.

CONCLUSIONS

SCPS is an effective method for tattooing colonic lesions and has a better safety profile than traditional India ink in terms of post-procedure inflammatory response and intraoperative bowel adhesions.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov (ID: NCT03637933).

Occurrence of G-banding in metaphase chromosomes of Encarsia berlesei (Hymenoptera: Aphelinidae)

Well-defined G-bands were obtained on somatic metaphase chromosomes of Encarsia berlesei using trypsin and warm 2x SCC in sequence. The G-banded pattern allowed rapid identification of all five metacentric chromosomes, which appeared uniformly lighted when stained with DAPI fluorochrome dye. It is stressed that ageing affects G-banding in this insect species; in fact, good banded chromosomes were obtained on 1-month air-stored chromosomes. Evidence for asynchronous condensation on the chromosomes of this species is also provided.

Prokinetic effect of a standardized yarrow (Achillea millefolium) extract and its constituent choline: studies in the mouse and human stomach

BACKGROUND

Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder characterized by alterations in gastric motility. Yarrow (Achillea millefolium L., Fam Asteraceae) preparations are traditional remedies used to treat dyspeptic complaints. Herein, we investigated the effect of a standardized dry water extract obtained from A. millefolium flowering tops (AME) on gastric motility.

METHODS

The effect of AME on motility was evaluated on the resting tone of the isolated gastric antrum and on gastric emptying in vivo (phenol red meal method) both in control mice and in the model of cancer chemotherapy (cisplatin)-induced gastric abnormalities.

KEY RESULTS

The AME contracted mouse and human gastric strips and this action was unaffected by hexamethonium and tetrodotoxin, but strongly reduced by atropine. Among various chemical ingredients in yarrow, choline, but not the flavonoids rutin and apigenin, mimicked the action of AME. Furthermore, AME deprived of choline did not exert a contractile effect. In vivo, AME stimulated gastric emptying both in control and in cisplatin-treated mice, being more active in pathological states.

CONCLUSIONS & INFERENCES

It is concluded that (i) AME exerts a direct spasmogenic effect on gastric antrum; (ii) choline is the chemical ingredient responsible of such effect; (iii) the prokinetic effect of AME observed in vivo could provide the pharmacological basis underlying its traditional use in the treatment of dyspepsia.

Proinflammatory stimuli activates human-derived enteroglial cells and induces autocrine nitric oxide production

BACKGROUND

Enteric glial cells (EGCs) have been recently indicated as key regulators of intestinal inflammation in animals. Whether or not this is true and how these cells participate to inflammatory responses in humans is unknown.

METHODS

We isolated primary EGCs from human small bowel and then, we purified and characterized those using specific glial markers, such as S100B and glial fibrillary acidic protein (GFAP). To mimic an inflammatory scenario, we exposed EGCs to exogenous stimuli, such as lipopolysaccharide and interferon-gamma (LPS and IFN-γ), alone or in combination, to evaluate glial activation [measuring GFAP, S100B level together with c-fos, major histocompatibility complex (MHC) class II, inducible nitric oxide (iNOS) proteins expression and nitric oxide (NO) production] and proliferation, respectively.

KEY RESULTS

We showed that, when challenged with a combination of LPS and IFN-γ, EGCs are significantly activated, as indicated by their positivity to c-fos and MHC class II. Similarly, pro-inflammatory stimuli significantly increase the cell proliferation rate, the expression of both S100B and GFAP, and the NO production consequent to the induction of EGCs-derived iNOS protein, with the last being dependent on S100B-RAGE (receptor for advanced glycation endproducts) interaction.

CONCLUSIONS & INFERENCES

Our data provide the first evidence that human EGCs directly respond to pro-inflammatory stimuli by changing their expression profile and by proliferating. The finding that stimulated EGCs are able to produce NO points to a role of this cell population in the scenario of intestinal inflammation.

Cytological evidence for population-specific sex chromosome heteromorphism in Palaearctic green toads (Amphibia, Anura)

A chromosome study was carried out on a number of European and Central Asiatic diploid green toad populations by means of standard and various other chromosome banding and staining methods (Ag-NOR-, Q-, CMA3-, late replicating [LR] banding pattern, C-and sequential C-banding + CMA3 + DAPI). This study revealed the remarkable karyological uniformity of specimens from all populations, with the only exception being specimens from a Moldavian population, where one chromosome pair was heteromorphic. Though similar in shape, size and with an identical heterochromatin distribution,the difference in the heteromorphic pair was due to a large inverted segment on its long arms. This heteromorphism was restricted to females, suggesting a female heterogametic sex chromosome system of ZZ/ZW type at a very early step of differentiation.

[Surgical treatment and prognostic factors in colorectal cancer]

AIM

The aim of this study was to make a contribution to improve the care of patients with colorectal cancer by optimizing times and methods of the follow-up; particular attention is given to factors which may be important for the prognosis and for the quality of life in the immediate postoperative period.

METHODS

The study includes all the patients with colorectal cancer who underwent laparotomic surgical treatment from 1996 to 2003. The total number of patients was 226 with an average age of 65 years; male to female ratio was 1.57:1. According to the stage of tumor, an adjuvant radiotherapeutic and/or chemiotherapeutic treatment was associated to surgery.

RESULTS

On the basis of the preoperative staging and tumor localization, our patients underwent: 3 total colectomies, 57 right hemicolectomies, 137 left hemicolectomies, 6 Hartmann resections, 19 Miles resections, 4 transverse resections.

CONCLUSION

The results obtained show that the 5-year overall survival is particularly influenced by the stage and the factors which directly or indirectly affect the primary tumor; thus the prognostic factors which should be considered for the survival and in the follow-up of these patients are: stage, grading and nodal involvement of the tumor.

Karyology of the Antarctic scallop Adamussium colbecki, with some comments on the karyological evolution of pectinids

Karyotype, location of the nucleolar organiser region (NOR) and heterochromatin presence and composition were studied in the Antarctic scallop Adamussium colbecki Smith, 1902. The karyotype exhibits 2n = 38 chromosomes with 11 pairs of metacentrics, 5 of submetacentrics, one subtelocentric and two telocentrics. Ag-NOR, CMA(3), DA/MM and NOR-FISH evidenced paracentromeric NORs on the short arm of 2nd pair chromosomes. Digestion with three restriction endonucleases followed by sequential staining with Giemsa, CMA(3) and DAPI evidenced on all chromosomes centromeric heterochromatin positive for both DAPI and CMA(3). In situ hybridisation analysis showed the presence of an AT-rich satellite DNA in the centromeric heterochromatin of several chromosomes. A mosaicism was detected in the germinal cell lines of one specimen, as in six of the 20 plates examined the set had 37 chromosomes with a missing pair of telocentrics and an unpaired metacentric. Comparison of the chromosome sets of all the pectinids studied to date and comparison with a phyletic tree obtained from molecular mitochondrial genes studies yielded good agreement between karyotype morphology and taxonomic classification.

[Ultrasound-guided endoscopic drainage, without radiological examination, in patients with neoplastic biliary obstruction. Preliminary results]

AIM

Endoscopic stent insertion has become the preferred method for palliation of malignant biliary obstruction. Currently, endoscopic stent placement involves the use of contrast media and radiological equipment to achieve direct opacification of the biliary duct systems, and to determine the location and the extension of biliary obstruction. This report proposes a new combination of ultrasonography and biliary endoscopy, with endoscopic stent placement entirely performed under US-guidance.

METHODS

US-guided stent placement was carried out in 8 patients. A guide-wire and a guiding-catheter were endoscopically introduced and identified, by US, the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10F) were finally inserted over the guide-wire/guiding-catheter by a pusher tube system.

RESULTS

Successful stent insertion was achieved in all patients. There were no complications. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2+/-9.5 vs 4.2+/-2.9 mg/dl at 1 week).

CONCLUSION

Endoscopic stent placement performed under US-guidance, is safe and effective. Further studies in a larger series, including more proximal strictures are suggested.

Cytological and molecular analysis in the rare discoglossid species, Alytes muletensis (Sanchiz & Adrover 1977) and its bearing on archaeobatrachian phylogeny

Cytogenetic and molecular data on Alytes muletensis (Amphibia: Discoglossidae) are compared with other representatives of archaeobatrachian frogs: Bombina variegata pachypus, Pelobates cultripes, Pelodytes punctatus, Xenopus laevis, and Discoglossus. A. muletensis has the karyotype typical for the genus Alytes, 38 elements with either one or two arms, some of which can be considered as 'microchromosomes'. The NORs are located on the telomeres of the tenth chromosome pair which agrees with the state in A. obstetricians but differs from A. cisternasii reflecting phylogenetic affinities. C-banding and staining with DAPI and chromomycin A3 revealed important blocks of telomeric CMA-positive heterochromatin on the smaller chromosomes of Alytes, similar to the state found in Discoglossus. Phylogenetic analysis of 750 bp of fragments of the mitochondrial 16S and 12S rRNA genes corroborated that Discoglossus and Alytes are sister taxa which together probably form the sister group of the Bombinatorinae. Centromeric heterochromatin in Alytes may be responsible for the retention of a plesiomorphic asymmetric karyotype which independently has evolved into a symmetric karyotype through centric fusions in Bombina and Discoglossus. The HindIII satellite DNA family was present in all archaeobatrachians studied but absent in hyloid and ranoid neobatrachians.

Role of surgery in thymic disorders

Thymomas are relatively slow-growing neoplasms that should be considered malignant tumours. When treated in the early stages, however, they have an excellent prognosis for long-term survival. Surgery, radiation therapy and chemotherapy all play a role in the management of these neoplasms. Surgery is the treatment of choice in thymoma patients and has become an increasingly accepted procedure in the treatment of myasthenia gravis (MG) since 1936, when thymectomy was performed for this disease for the first time. Improvement in myasthenic symptoms is nearly always observed following thymectomy, but the rates of complete remission vary from 7% to 63%. We have studied the potential preoperative factors predicting the evolution of MG.

[Aneurysms of the splanchnic arteries]

Although visceral aneurysms usually have an asymptomatic course, ruptures associated with high mortality do occur. When an asymptomatic lesion is found, the physician must decide whether it should be treated surgically and which surgical technique should be used. Because this type of aneurysm is relatively rare, the answer to these questions have not been determined previously. The outcome in 16 patients treated by surgical or embolization procedures was evaluated. A group of 16 patients with visceral aneurysms were observed in our institution between 1987 and 1993. Localization of aneurysms was on the splenic artery in 8 cases, renal artery in 4 cases, hepatic artery in 3 patients and superior mesenteric artery in one patient. Hypertension was related to renal aneurysms and angina abdominis to the patient with superior mesenteric artery aneurysm. Of the 16 patients, 8 (6 splenic and 2 hepatic aneurysms) were asymptomatic, 3 (2 splenic and 1 hepatic) were treated as an emergency because they presented with shock. In the splenic group (8 cases), 2 patients underwent embolization procedures with Gianturco's coils, and 6 surgical procedures; in the hepatic group 1 embolization and 1 surgical procedure were performed; and finally in the renal and mesenteric group surgical reconstruction was performed during aortic prosthetic surgery. Because of well documented natural history of progressive enlargement and eventual rupture, the aneurysms of visceral arteries should be corrected surgically when the diagnosis is confirmed by vascular imaging (ultrasounds, CT, RM, angiography). Ruptures are treated with emergency operations, when possible. In high-risk patients, non operative management by selective embolization (in case of splenic and hepatic aneurysms) may be suitable alternative.

[Endoscopic surgery of the digestive system: state of the art. Opinion of an endoscopic surgeon]

The Authors review the possible applications of surgical endoscopy in oesophageal, gastric, biliary, pancreatic and colic diseases. This critical assessment, performed under the abdominal endoscopic surgeon's point of view, is based on the overall experience of about 20 years of surgery, with particular regard to the sclerosis of oesophageal varices, neoplastic obstructions of oesophagus, biliary tract, colon and localized Laser treatment of neoplasms. Based on the results achieved, thanks to selective indications and monitoring by conventional surgical experience, the Authors conclude by staging a better reliability of the surgeon who performs surgical endoscopy to obtain good results after an accurate selection of those cases which can really benefit from endoscopic management.

[Recent developments in the medical treatment of emergency cirrhotic hemorrhage. Vasopressin and glipressin, prostaglandins, somatostatin, propranolol, cimetidine and ranitidine]

Haemorrhages in the course of cirrhosis and portal hypertension are surgical emergencies. Nevertheless medical treatment may be necessary both to revive the patient and temporarily to check the haemorrhaging itself. Some views are presented on the use of drugs, both those already in clinical use and others at the experimental stage, which appear to be effective in the treatment of haemorrhaging in portal hypertension (Vasopressin, glypressin, prostaglandin, somatostatin, propranolol, cimetidine and ranitidine).