Multistate outbreak of listeriosis caused by imported cheese and evidence of cross-contamination of other cheeses, USA, 2012

Listeria monocytogenes is a foodborne pathogen that can cause bacteraemia, meningitis, and complications during pregnancy. In July 2012, molecular subtyping identified indistinguishable L. monocytogenes isolates from six patients and two samples of different cut and repackaged cheeses. A multistate outbreak investigation was initiated. Initial analyses identified an association between eating soft cheese and outbreak-related illness (odds ratio 17·3, 95% confidence interval 2·0-825·7) but no common brand. Cheese inventory data from locations where patients bought cheese and an additional location where repackaged cheese yielded the outbreak strain were compared to identify cheeses for microbiological sampling. Intact packages of imported ricotta salata yielded the outbreak strain. Fourteen jurisdictions reported 22 cases from March-October 2012, including four deaths and a fetal loss. Six patients ultimately reported eating ricotta salata; another reported eating cheese likely cut with equipment also used for contaminated ricotta salata, and nine more reported eating other cheeses that might also have been cross-contaminated. An FDA import alert and US and international recalls followed. Epidemiology-directed microbiological testing of suspect cheeses helped identify the outbreak source. Cross-contamination of cheese highlights the importance of using validated disinfectant protocols and routine cleaning and sanitizing after cutting each block or wheel.

Neuronal activity and stress differentially regulate hippocampal and hypothalamic corticotropin-releasing hormone expression in the immature rat

Corticotropin-releasing hormone, a major neuromodulator of the neuroendocrine stress response, is expressed in the immature hippocampus, where it enhances glutamate receptor-mediated excitation of principal cells. Since the peptide influences hippocampal synaptic efficacy, its secretion from peptidergic interneuronal terminals may augment hippocampal-mediated functions such as learning and memory. However, whereas information regarding the regulation of corticotropin-releasing hormone's abundance in CNS regions involved with the neuroendocrine responses to stress has been forthcoming, the mechanisms regulating the peptide's levels in the hippocampus have not yet been determined. Here we tested the hypothesis that, in the immature rat hippocampus, neuronal stimulation, rather than neuroendocrine challenge, influences the peptide's expression. Messenger RNA levels of corticotropin-releasing hormone in hippocampal CA1, CA3 and the dentate gyrus, as well as in the hypothalamic paraventricular nucleus, were determined after cold, a physiological challenge that activates the hypothalamic pituitary adrenal system in immature rats, and after activation of hippocampal neurons by hyperthermia. These studies demonstrated that, while cold challenge enhanced corticotropin-releasing hormone messenger RNA levels in the hypothalamus, hippocampal expression of this neuropeptide was unchanged. Secondly, hyperthermia stimulated expression of hippocampal immediate-early genes, as well as of corticotropin-releasing hormone. Finally, the mechanism of hippocampal corticotropin-releasing hormone induction required neuronal stimulation and was abolished by barbiturate administration. Taken together, these results indicate that neuronal stimulation may regulate hippocampal corticotropin-releasing hormone expression in the immature rat, whereas the peptide's expression in the hypothalamus is influenced by neuroendocrine challenges.

SEGMENTATION OF BREAST THERMOGRAM: IMPROVED BOUNDARY DETECTION WITH MODIFIED SNAKE ALGORITHM

Background: Breast cancer is a common and dreadful disease in women. One in five cancers in Singaporean women is due to breast cancer. Breast health is every woman's right and responsibility. In average, every $100 spent on breast mammogram screening, an additional $33 was spent on evaluating possible false-positive results. Thermography, with its non-radiation, non-contact and low-cost basis has been demonstrated to be a valuable and safe early risk marker of breast pathology, and an excellent case management tool available today in the ongoing monitoring and treatment of breast disease. The surface temperature and the vascularization pattern of the breast could indicate breast diseases and early detection saves lives. To establish the surface isotherm pattern of the breast and the normal range of cyclic variations of temperature distribution can assist in identifying the abnormal infrared images of diseased breasts. Before these thermograms can be analyzed objectively via computer algorithm, they must be digitized and segmented. The authors present a method to segment thermograms and extract useful region from the background. Thermography could detect the presence of tumors much earlier and of much smaller size than mammography. This paper thus aims to develop an intelligent diagnostic system based on thermography for the detection of tumors in breast. Methods: We have examined about 50 normal, healthy female volunteers in Nanyang Technological University and 130 patients in Singapore General Hospital. We did the examinations for some of them continuously for two months. From these examinations, we obtained about 1000 thermograms for contact and 800 thermograms for non-contact approaches. Standard ambient conditions were observed for all examinations. The thermograms obtained were analyzed. The first step in processing these thermograms is image segmentation. Its aim is to discern the useful region from the background. In general, autonomous segmentation is one of the most difficult tasks in image processing. This step in the process determines the eventual success or failure of the analysis. In this work, two different techniques have been presented to extract the objects from the background. Results: After analyzing these thermograms and with reference to some relevant well-documented papers, we were able to classify the thermograms. The step is very useful in identifying the normal or suspected (abnormal) thermograms. A series of thermograms was studied with the help of the in-house developed computer software. On the basis of the anatomic and vascular symmetry, the surface temperature distributions of both left and right breasts were compared. The surface isotherm pattern of breasts can indicate the local metabolism and vascularity of the underlying tissues, and the change in local blood or glandular activities can be reflected in the surface temperature of breast. We evaluated the temperature distribution pattern and the menstrual cyclic variation of temperature with time. All these results can be used to detect breast cancer. Conclusion: Automatic identification of object and surface boundary of breast thermal images is a difficult and challenging task. Both the traditional snake and gradient vector flow snake failed to detect the boundary of these images successfully. In this work, a new method is proposed in conjunction with image pre-processing, image transition, image derivative, filtering and gradient vector flow snake. This novel method can easily detect the boundary of the breast thermal image with good agreement.

Incidence of acute respiratory infections in Australia

We used a national survey of 7578 randomly selected respondents in 2008-2009 to identify the period prevalence of acute respiratory infection (ARI) by season and state, and to estimate the incidence of ARI in the Australian community. A case was defined as any episode of cold or flu with at least one of the following symptoms: fever, chills, sore throat, running nose, or cough in the past 4 weeks. Frequency data were weighted to the Australian population. The response rate to the survey was 49%, and 19·9% (1505/7578) of respondents reported an ARI in the previous 4 weeks, which extrapolated to 68·9 million cases [95% confidence interval (CI) 65·1-72·7] of ARI in Australia annually. The incidence was 3·2 (95% CI 3·0-3·4) cases of ARI/person per year, and was highest in young children and lowest in older people. ARI imposes a significant burden on Australian society.