Infectious Necrosis Research Articles

In field use of water samples for genomic surveillance of infectious spleen and kidney necrosis virus (ISKNV) infecting tilapia fish in Lake Volta, Ghana.

Viral outbreaks are a constant threat to aquaculture, limiting production for better global food security. A lack of diagnostic testing and monitoring in resource-limited areas hinders the capacity to respond rapidly to disease outbreaks and to prevent viral pathogens becoming endemic in fisheries productive waters. Recent developments in diagnostic testing for emerging viruses, however, offers a solution for rapid in situ monitoring of viral outbreaks. Genomic epidemiology has furthermore proven highly effective in detecting viral mutations involved in pathogenesis and assisting in resolving chains of transmission. Here, we demonstrate the application of an in-field epidemiological tool kit to track viral outbreaks in aquaculture on farms with reduced access to diagnostic labs, and with non-destructive sampling. Inspired by the "lab in a suitcase" approach used for genomic surveillance of human viral pathogens and wastewater monitoring of COVID19, we evaluated the feasibility of real-time genome sequencing surveillance of the fish pathogen, Infectious spleen and kidney necrosis virus (ISKNV) in Lake Volta. Viral fractions from water samples collected from cages holding Nile tilapia (Oreochromis niloticus) with suspected ongoing ISKNV infections were concentrated and used as a template for whole genome sequencing, using a previously developed tiled PCR method for ISKNV. Mutations in ISKNV in samples collected from the water surrounding the cages matched those collected from infected caged fish, illustrating that water samples can be used for detecting predominant ISKNV variants in an ongoing outbreak. This approach allows for the detection of ISKNV and tracking of the dynamics of variant frequencies, and may thus assist in guiding control measures for the rapid isolation and quarantine of infected farms and facilities.

Influence of Cyp3A4, Cyp3A5 and ABCB1 Polymorphisms on Tacrolimus Concentrations and Rejection Risk in Indian Kidney Transplant Recipients

Background: Tacrolimus metabolism is known to be determined by gene polymorphisms. Cyp3A5 genotype has most widely been seen to be associated with tacrolimus metabolism. Studies on other genes have produced mixed results. Objective: We studied the association of three polymorphisms CYP3A4*1B (-392 G>A), CYP3A5 (6986 A>G), and ABCB1 (3435 T>C) on tacrolimus levels and their association with either rejection or nephrotoxicity (infection or tacrolimus toxicity) in renal transplant recipients from India. Materials and Methods: In this prospective cohort study, patients who underwent kidney transplantation between July 2018 and July 2023 were studied. Inclusion criteria: Patients who underwent Kidney Transplantation and were (i) on tacrolimus-based immunosuppression and (ii) not on medications known to interact with calcineurin inhibitors, such as ketoconazole, phenytoin, and diltiazem, were studied. Tacrolimus levels, tacrolimus concentration/dose (C/D) and tacrolimus C/D per kg body weight, at monthly time points posttransplant for 6 months and biopsy-proven rejection, infection, tacrolimus toxicity, and acute tubular necrosis data were collected. Results: Three hundred and twenty-seven patients were included in the study. Two hundred and fifty-seven were male and 70 were female. A total of 1402 tacrolimus samples were collected, with an average of 3.2 ± 2.1 samples per patient. Tacrolimus levels were significantly lower in the Cyp3A5 AG and AA GG genotypes versus GG (5.27 ± 2.95 and 6.22 ± 2.79 vs. 8.05 ± 4.83, P < 0.001) as were C/D (3.45 ± 2.29 and 3.37 ± 1.91 vs. 6.47 ± 4.44, P < 0.001) and C/D/W (52.45 ± 33.98 and 52.19 ± 32.61 vs. 98.09 ± 73.80, P < 0.001). Cyp3A5 AA and AG had higher rejection rates than GG (20% vs. 13 vs. 8%, P = 0.03). The relative risk of rejection with A versus G polymorphism was 1.9 (confidence interval: 1.03–3.58), P = 0.03. Cyp3A4 and ABCB1 polymorphism studies did not show any association with the parameters studied. Conclusion: Our study showed that Cyp3A5 gene polymorphisms were significantly associated with tacrolimus metabolism, rejection episodes, and rejection risk. Cyp3A4 and ABCB1 were not significantly associated with the parameters studied.

Colonization of the gastrointestinal microbiota with Enterococcus and Staphylococcus predicts infected necrosis in patients with acute pancreatitis (POEMA): a prospective multicenter study

Colonization of the gastrointestinal microbiota with Enterococcus and Staphylococcus predicts infected necrosis in patients with acute pancreatitis (POEMA): a prospective multicenter study

Development of a spotted sea bass (Lateolabrax maculatus) bulbus arteriosus cell line and its application to fish virology and immunology

The bulbus arteriosus tissue of teleosts, which is located at the forefront of the heart, is used to reduce the pulse pressure. In this study, we constructed a permanent cell line (LmAB) for the first time using bulbus arteriosus tissue from spotted sea bass (Lateolabrax maculatus). This cell line has been passaged more than 80 times. Currently, it can be subcultured in L-15 medium with 8 % fetal bovine serum added. The optimal fetal bovine serum concentration and culture temperature for LmAB cells at 62 passages are 20 % and 28 °C, respectively. This cell line consists predominantly of epithelial-like cells. We used 18S rRNA gene sequencing to confirm that LmAB cells originated from spotted sea bass. Karyotype analysis revealed that 43 % of LmAB cells in passage 63 had 48 chromosomes. Exogenous plasmid transfection revealed that LmAB cells can express the green fluorescent protein gene with a transfection efficiency of up to 40 %, indicating that these cells can be used for in vitro genetic research. LmAB cells showed susceptibility to nervous necrosis virus, largemouth bass ulcer syndrome virus, and infectious spleen and kidney necrosis virus, which results in severe cytopathic effects. PCR analysis verified that these viruses can replicate in LmAB cells, and analysis of cytoskeletal F-actin patterns verified that infected cells exhibit serious changes in their actin cytoskeleton. LmAB cells infected with these three viruses showed increased expressions of interferon signaling pathway genes (IFNd, IFNγ-rel, and ISG15), indicating that the host interferon signaling pathway participates in the antiviral immune response. These findings indicate that our newly developed LmAB cell line is a valuable resource for future research in genetics, virology, and immunology.

BACH1 promotes tissue necrosis and Mycobacterium tuberculosis susceptibility

Oxidative stress triggers ferroptosis, a form of cellular necrosis characterized by iron-dependent lipid peroxidation, and has been implicated in Mycobacterium tuberculosis (Mtb) pathogenesis. We investigated whether Bach1, a transcription factor that represses multiple antioxidant genes, regulates host resistance to Mtb. We found that BACH1 expression is associated clinically with active pulmonary tuberculosis. Bach1 deletion in Mtb-infected mice increased glutathione levels and Gpx4 expression that inhibit lipid peroxidation. Bach1−/− macrophages exhibited increased resistance to Mtb-induced cell death, while Mtb-infected Bach1-deficient mice displayed reduced bacterial loads, pulmonary necrosis and lipid peroxidation concurrent with increased survival. Single-cell RNA-seq analysis of lungs from Mtb-infected Bach1−/− mice revealed an enrichment of genes associated with ferroptosis suppression. Bach1 depletion in Mtb-infected B6.Sst1S mice that display human-like necrotic lung pathology also markedly reduced necrosis and increased host resistance. These findings identify Bach1 as a key regulator of cellular and tissue necrosis and host resistance in Mtb infection.

Combined effect of persistent cytomegalovirus infection and Tumor Necrosis Factor‐α Polymorphism on age‐related cognitive decline

AbstractBackgroundHuman cytomegalovirus (HCMV) is a ubiquitous infectious agent, widely distributed in human populations. Its infection has been correlated with a number of age‐related disorders but associations with neurocognitive decline are not seen consistently. The Tumor Necrosis Factor‐α (TNF) is a cytokinine playing a key role in inflammation and TNF polymorphisms have been associated with various autoimmune diseases. In this study, we investigated the impact of TNF genotype and HCMV on age‐related cognitive decline.MethodThe study cohort consisted of 200 Caucasian Australians (aged 59‐89 years) drawn from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study. We used linear regression models to assess the effect of TNF genotype, HCMV and their interaction on a series of domain‐specific composite scores (Preclinical Alzheimer Cognitive Composite; PACC, Recognition, Attention Processing, Language). The models accounted for the potential effect of age, education level and Apolipoprotein E genotype.ResultThe interaction between HCMV and TNF genotype significantly predicted PACC (b = 5.3; SE = 2.56; p = 0.04) and Recognition scores (b = 1.9; SE = 0.78; p = 0.01). Interactions were not significant in the other domains investigated (attention processing & language).ConclusionThe results suggest that the presence of TNF polymorphism, combined with HCMV infection have a protective effect against cognitive loss. Further research is needed to understand the underpinning mechanisms.

Development and validation of a multiplex quantitative polymerase chain reaction assay for detecting and genotyping red sea bream iridoviral disease

Megalocytiviruses are responsible for severe mortality in various marine and freshwater fish species worldwide. Specifically, the red sea bream iridovirus (RSIV) and infectious spleen and kidney necrosis virus (ISKNV) genotypes are known to cause the red sea bream iridoviral disease (RSIVD). Although several quantitative polymerase chain reaction (qPCR) assays have been developed for diagnosing RSIVD, these methods fail to differentiate between viral genotypes within Megalocytivirus. The present study introduces an innovative multiplex qPCR assay for the precise detection of RSIVD. This diagnostic method targets the histidine triad motif (HIT)-like protein and ORF080L genes, which are unique markers for the RSIV and ISKNV genotypes. The assay exhibited high analytical sensitivity, expressed as the 95% limit of detection (LoD95%), of 8.69 copies/5 μL for RSIV and 19.07 copies/5 μL for ISKNV. Notably, the assay exhibited no cross-reactivity and was unaffected by common inhibitory substances. The diagnostic sensitivity and specificity were 100% for both RSIV and ISKNV, demonstrating the reliability of the assay. The multiplex qPCR assay was 100–1000 times more sensitive than conventional PCR methods, emphasizing its importance in early-stage infection detection. The repeatability and reproducibility of the assay were confirmed through extensive testing, showing low variation and high correlation across different technicians and laboratory settings. Furthermore, the ability of the assay to selectively detect and differentiate between RSIVD genotypes represents a significant advancement in aquatic animal disease diagnostics. This multiplex qPCR assay offers a rapid, specific, sensitive, and quantitative diagnostic tool for global RSIVD surveillance efforts and contributes to the prevention and understanding of disease progression in the aquaculture industry.

Molecular epidemiology and current management of Infectious Spleen and Kidney Necrosis Virus (ISKNV) infection in Ghanaian cultured tilapia

Infectious Spleen and Kidney Necrosis Virus (ISKNV) is globally gaining more attention, due to its highly significant economic impact on the aquaculture industry. In late 2018, unusually high levels of mortality (60–90%) was reported in some intensive tilapia cage culture systems on the Eastern bank of Lake Volta in Ghana. This resulted in the fold-up of several small and medium scale farms. Preliminary investigations confirmed the involvement of ISKNV, a viral pathogen noted for fatal systemic infections in many fish species. As a follow-up on the outbreak situation, and post-mass vaccination of affected fish farms, the need to investigate further the molecular epidemiology and phylogeography of the virus across Lake Volta became paramount. A multiplexed PCR assay to detect the virus and MinION™ nanopore sequencing of the Major Capsid Protein (MCP) were performed to investigate the presence and genotype of ISKNV in tilapia collected from 30 randomly selected farms at various geographical locations. ISKNV was found to be widely distributed across the lake and detected in 80% of farms with a reported average daily mortality of 40%. Fry and juvenile fish were the most affected, and approximately 50% of fish that tested positive were asymptomatic. These apparently healthy fish are likely contributors of virus transmission across farms. Phylogenetic analysis of the MCP revealed that all 35 isolates from 14 different farms distributed across the lake clustered with ISKNV clade I with 100% homology to isolates from the 2019 outbreak strain. Vaccination and heat-shock treatment; the two main specific interventions currently employed to control the viral pathogen have not achieved much success, and ISKNV remains a threat to the growth of the aquaculture industry in Ghana. The outcome of this study can be useful in improving fish health management and biosecurity policies in the aquaculture industry.

Low-temperature immunization attenuates the residual virulence of orf074r gene-deleted infectious spleen and kidney necrosis virus: a candidate immersion vaccine.

Global aquaculture production yielded a record of 122.9 million tons in 2022. However, ~10% of farmed aquatic animal production is lost each year due to various infectious diseases, resulting in substantial economic waste. Therefore, the development of vaccines is important for the prevention and control of aquatic infectious diseases. Gene-deletion live attenuated vaccines are efficacious because they mimic natural pathogen infection and generate a strong antibody response, thus showing good potential for administration via immersion. However, most gene-deletion viruses still have residual virulence, and thus, gene-deletion immersion vaccines for aquatic viruses are rarely developed. In this study, an orf074r deletion strain (Δorf074r) of ISKNV with residual virulence was constructed, and an immunization process was developed to reduce its residual virulence at 22°C, thereby making it a potential immersion vaccine against ISKNV. Our work will aid in the development of an aquatic gene-deletion live-attenuated immersion vaccine.

Does the dominant hand’s use affect the complication rates in prosthetic breast reconstruction?

Background Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction.Methods We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method.Results During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024).Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

Arthrodesis of the interphalangeal joints of the hand by two-dimensional intraosseous wiring

BackgroundNumerous techniques for arthrodesis have been described to fix interphalangeal (IP) joints, and the fixation method should be considered on a case-by-case basis. This study aimed to investigate the availability of IP joint arthrodesis of the hand, using a two-dimensional intraosseous wiring (two-DIOW) method.MethodsA total of 43 joints (19 thumb IP joints, 9 proximal finger interphalangeal (PIP) joints and 15 distal interphalangeal (DIP) joints in 29 patients with a mean age of 66 years (range, 24–85 y) were retrospectively analyzed. All operations were performed with two-DIOW method. We evaluated the bone union rate, correction loss, presence of any surgical complications, and oral steroid use in cases of joint fixation using the two-DIOW method.ResultsOf these 43 digits, 42 achieved bone union (97.7%). Non-union was seen in a thumb IP joint of mutilans rheumatoid arthritis. Mean correction loss of deviation was 1.0°, and flexion or extension angulation was 1.6° in the direction of extension. Surgical complications included mild nail deformity in 2 digits and wire irritation necessitating wire removal in 2 digits. Oral steroids were used for 18 of the 43 digits, including 2 digits complicated by nail deformities. There was no infection and skin necrosis in all digits with or without steroid use.ConclusionsThe two-DIOW method appears to offer an effective method of IP joint fixation, but caution should be exercised in digits of severe joint destruction and in the treatment of wire knot.

Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature.

To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. Systematic review conducted by 2 independent reviewers following PRISMA guidelines. Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". Use of BFP in primary and secondary cleft palatoplasty. Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.

External pancreatic fistula as a risk factor for erosive complications in patients with infected walled-off necrosis

External pancreatic fistula as a risk factor for erosive complications in patients with infected walled-off necrosis

Early Experience of Direct-to-Implant Breast Reconstruction Using Acellular Dermal Matrix after Robot-Assisted Nipple-Sparing Mastectomy.

The authors performed a retrospective review to analyze operative outcomes of breast mound reconstruction after robot-assisted mastectomy. Patients who underwent nipple-sparing mastectomy (NSM) with a robotic device (Da Vinci Xi) and immediate prepectoral prosthetic reconstruction by lateral incision from June of 2018 to July of 2019 were enrolled. Patient characteristics, complications, and satisfaction rates as assessed by BREAST-Q were analyzed. The surgical technique was described in detail. Thirty-nine cases, including 7 bilateral cases (total 46 breasts), underwent robot-assisted NSM followed by immediate prepectoral prosthetic implant reconstruction. The median patient age was 46.63 years (range, 21 to 63 years). The mean operation time for each prepectoral breast mound reconstruction using the direct-to-implant technique was 126.55 minutes. Robot-assisted reconstruction resulted in superior BREAST-Q scores compared with the conventional reconstruction method. Major infection occurred in 7 cases (15.2%), and complete nipple loss occurred in 3 cases (6.6%). Severe complications requiring breast implant removal occurred in 4 breasts (8.7%). Two cases were due to the coexistence of infection and skin necrosis; in 1 case, the skin flap became congested on postoperative day 3 and required additional surgery to change the expander. Other complications were resolved with conservative care or minor revision. This report is the first concerning robot-assisted NSM followed by prepectoral acellular dermal matrix-wrapped prosthetic reconstruction. This procedure was not inferior to other methods. Further prospective research to evaluate oncologic outcomes is warranted. Therapeutic, IV.

Comparison between conventional and oncoplastic breast surgeries regarding resection margins and local recurrences in breast cancer: Retrospective study

Background Breast cancer is the most common cancer in women and the second-leading cause of cancer-related fatalities globally. Breast-conserving surgery (BCS) is the primary surgical treatment for early-stage breast cancer, with oncoplastic BCS techniques expanding its possibilities. BCS offers a higher quality of life compared to mastectomy. However, it has two absolute contraindications: the inability to produce negative margins without deforming the breast and inflammatory breast cancer. Oncoplastic displacement and replacement BCS allow resections of up to 50% of breast volume without creating deformity. Positive surgical margins often require a second procedure, which can increase pain, complications, and medical expenses. Patient and methods This retrospective cohort study analyzed 310 patients with primary invasive breast cancer or DCIS who underwent conventional or oncoplastic breast cancer surgery. Most patients underwent lateral and therapeutic reduction mammoplasties. Other techniques included LD flap, TDAP flap, mini-LD muscle flap, ICAP flap, grisotti flap, LICAP flap, and modified round block technique. Oncoplastic techniques were tailored based on breast cup size, tumor size, tumor location, and patient preference. Wide local excision of the tumor with free margins was confirmed through intraoperative frozen sections. Result The mean weight of the specimen was 55.89 gm in the conventional group and 101.55 gm in the oncoplastic group. The mean operative time was 65.9 min in the conventional group, while the oncoplastic group had 72.58 min Complications included seroma, hematoma, wound infection, wound dehiscence, lymphedema, and partial nipple necrosis. The aesthetic outcome was excellent, with 132 patients satisfied with their results in the oncoplastic group compared to 90 in the conventional group. Conclusion Oncoplastic breast surgeries are safe, feasible and became the standard of care in breast cancer. Oncoplastic breast surgeries are of choice in cases of multifocal cancer. People who performed oncoplastic breast surgeries had wider free margins, much more aesthetic outcome, better psychological status, less redo surgery, less late deformities, more time consuming, more wound complications improved with frequent dressing, and did not causea delay in the adjuvant therapy, more requirement for contralateral symmetrizing surgery.

Incidence of Postoperative Rerupture of Achilles Tendon and Associated Risk Factors in South Korea: A National Population-Based Study

Category: Sports; Ankle Introduction/Purpose: Achilles tendon rerupture (ATRR) is a frequently occurring complication following the treatment of an Achilles tendon rupture (ATR) that can lead to disability; however, comprehensive risk factors for the development of postoperative ATRR remain unclear. We aimed to determine the incidence rate of postoperative ATRR and its associated risk factors, including comorbidities and medication, among the South Korean population. Methods: This study was performed based on Health Insurance Review and Assessment claims data, which covers 98% of the overall Korean population. Patients with ATR were identified according to the disease code S86.0 (Achilles tendon injury) of the Korean classification of disease between 2007 and 2020, and a washout period of 1 year was set. Instances of reoperation on the Achilles tendon between 42 and 365 days after the initial surgery, in the absence of infection or skin necrosis, were classified as cases of Achilles tendon rerupture (ATRR). Data on age, sex, comorbidities, and medications were collected and statistically analyzed. Results: Between 2009 and 2018, the incidence of surgical treatment for primary ATR was 9.91 per 100,000 person-years, showing a significant annual increase. The postoperative rerupture rate was 2.14% and did not show a significant increase. Male sex, young age, preexisting Achilles tendinopathy, osteoarthritis, and preoperative exposure to non-steroidal anti-inflammatory drugs and opioids were risk factors for postoperative ATRR. Conclusion: This information needs to be considered when determining the surgical treatment for patients with Achilles tendon rupture. The study results provoke further biological and clinical research on the risk factors for postoperative ATRR.

Molecular epidemiology of Megalocytivirus in freshwater angelfish (Pterophyllum scalare) from Johor, Malaysia.

Malaysia has more than 630 culturists who are involved in the ornamental fish industry and culture 250 species, including local and exotic species. Among these viruses, megalocytiviruses have been associated with severe systemic diseases and economic losses in ornamental fish. The intensity of Megalocytivirus infection in Pterophyllum scalare in Malaysia remains unknown. Thus, this study aimed to investigate the occurrence of Megalocytivirus while discovering its associated risk factors and the genotypes of its causative agents in an ornamental fish farm in Malaysia. Seven broodstock pairs of P. scalare were used in this study to follow the life stages of fish, from egg to market size. Water samples and other samples, such as mucus swabs, gill swabs, P. scalare eggs, fries, juveniles, snails, snail eggs, live feed (Tubifex worms and Moina spp.), sediment samples, and wild fish, were collected periodically for initial environmental sampling from day 0 to day 60. Nested polymerase chain reaction amplifications were performed for megalocytivirus-related sequences. The phylogenetic tree, including the sampled causative agents of megalocytiviruses, was inferred from the major capsid protein genes of all known Iridoviridae species. Pearson's correlation coefficients were calculated to determine the strength of the correlation between the presence of megalocytiviruses in P. scalare samples and the associated risk factors. A total of 312 out of 935 pooled and individual samples tested positive for the presence of Megalocytivirus-related sequences, except snail eggs and wild fish (Poecilia reticulata). No clinical symptoms were observed in any fish samples. Megalocytivirus-associated viruses detected in water samples indicate horizontal transmission of the virus. All the nucleotide sequences found in this study had high nucleotide identities of 95%-99 % and were closely related to Megalocytivirus genotype I infectious spleen and kidney necrosis virus. Risk factors associated with Megalocytivirus include water temperature, dissolved oxygen (DO), pH, ammonia, nitrate, nitrite, and the life stages of P. scalare. High Megalocytivirus infection was detected when the water temperature, DO, and pH were high in P. scalare, high water temperature and nitrate in the water samples, and the same rate of Megalocytivirus infection in P. scalare fry and juveniles. This is the first study to confirm the existence of different possible routes of megalocytivirus distribution in ornamental fish farms in Malaysia. Nevertheless, the connection between the mode of transmission and the risk factors for this virus needs to be explored further to recognize the evolution and potential new host species.

Fungating Soft Tissue Sarcoma: A Complex Treatment Dilemma.

Fungating soft tissue sarcoma (STS) occurs in up to 3.7% of STS cases, ulcerate or protrude directly from the skin. Several studies have examined past treatments and outcomes of patients with such tumors and suggest that management can be especially challenging. Considering this, it is plausible that fungating extremity tumors may warrant an individualized treatment approach that differs from standard treatment for non-fungating STS. We sought to examine treatment and outcome trends for fungating extremity STS to guide future treatment considerations. A comprehensive literature review of the PubMed database identified 1515 articles. Inclusion criteria included human subjects, adult population, extremity tumors and fungating tumors. Studies published prior to 1982 were excluded. 10 articles were relevant and met all criteria. Outcomes compare fungating STS with non-fungating STS. Patients with fungating STS are more likely to receive amputations as primary or secondary treatment (23-35 vs. 7.8-12%). Metastatic disease is more common among patients with fungating STS (20-33% vs. 9-15%). Patients with fungating STS have been found to have a higher likelihood of local recurrence (LR) (20.0% vs. 16.5%). 5-year overall survival (OS) is significantly decreased in patients with fungating STS (18.0-26.0% vs. 56.8-71.3%).Patients with fungating STS who receive limb sparing surgery (LSS) are more likely to require plastic surgical intervention (65% vs. 25%). Fungating STS is strongly associated with decreased mean time to death (13.8-16.2 months vs 29.0-30.4 months). Complication rates following surgical treatment of fungating STS are as high at 75% following amputation and 43% following LSS with up to 17% of those requiring reoperation. Infection and flap necrosis are the most common complications described. Though limited, current literature persistently reveals fungation as a poor prognostic factor for patients with soft tissue sarcoma. Expedient primarysurgical treatment may be appropriate given the higher metastatic potential and increased rate of complications associated with fungating STS. Limb salvage surgery is appropriate for primary, non-metastatic surgical treatment, though fungating tumors are treated with primary amputation more often than non-fungating STS, which may reduce postoperative complications in high-risk patients. Fungation is well established as an indication for palliative amputation. Increased rates of primary amputation in fungating STS may correspond to higher rates of metastatic disease at time of initial presentation for fungating STS. Timing of XRT should be carefully considered, as neoadjuvant XRTcoupled with a fungating tumor may result in a higher incidence of pre and postoperative complications and increased need for plastic surgical closure techniques. Adjuvant XRT is appropriate though used less often in patients with fungating STS.

The keystone island perforator flaps: a new option in soft tissue management of plastic surgery

ABSTRACT Background: The keystone flap is an effective technique for reconstructive surgery that restores the natural contour of the affected area and provides superior aesthetic results. This technique involves taking healthy skin and subcutaneous tissue from a nearby area and transplanting it to the site of the defect, creating a new skin area that meets the patient’s ideal outcome. We conducted a research project to objectively examine and evaluate the effectiveness and practicality of keystone flaps in clinical settings. Our two objectives were to analyze the characteristics of skin abnormalities on the body and to assess the surgical outcomes of using keystone flaps to repair defects. Methods: 40 patients with soft tissue defects throughout the body who underwent surgical treatment using keystone flap coverage at the Orthopedic and Plastic Surgery Center, Hue Central Hospital - Viet Nam. Results: The most common causes of soft tissue defects are infectious necrosis (35.0%), chronic ulcerative lesions (32.5%), trauma (17.5%), scar excision (12.5%), and other factors (2.5%). Flaps are primarily designed in Type I and Type III fashion. Our follow-up evaluation of the flaps after 3 - 6 months showed that the majority of cases achieved good results, with 37 out of 40 cases (92.5%) and 3 out of 40 cases (7.5%) categorized as fair. No significant complications were reported. Conclusion: The keystone island perforator flap is a modern method in plastic surgery that has proven to be a useful tool. The authors strongly recommend the use of the keystone technique as a safe, reliable, and feasible approach to covering soft tissue defects that vary in clinical characteristics.

Understanding tilapia mortalities and fish health management in Lake Volta: a systematic approach

Unusual fish mortalities in aquaculture threaten global food security and carry significant socio-economic burdens. In 2018, Nile tilapia (Oreochromis niloticus) suffered unusual patterns of mortalities, attributed to disease-causing agents in Lake Volta cage aquaculture. In recent times, disease investigations have shifted from single to consideration of multiple factors to understand the puzzling range of causal risk factors. This study therefore aimed at expanding on tilapia mortality risk factors, while documenting fish health and Lake Volta management practices for sustainable aquaculture. We interviewed relevant aquaculture stakeholders operating on Lake Volta and conducted thematic analysis on their responses to map out mortality risk factors and management practices. The identified risk factors were conceptualized in established models of causation web and Social-Ecological System to explain the practical significance of the findings. The results showed that the risk factors of tilapia mortalities are a combination of pathogens and non-infectious factors mediated by weak law enforcement. The results further suggested mortality reinforcing mechanisms through the horizontal transmission of pathogens, namely, Streptococcus agalactiae and Infectious Spleen and Kidney Necrosis Virus. Moreover, the recognition of weak enforcement as a possible factor reinforcing human activities is a non-infectious route that can be deleterious to fish health. Health management practices comprised phytotherapy, vaccination, heat shock treatment, biological controls, and best husbandry practices. Lake management involves creating a waterfront buffer of 85.34 m, surveillance, and executing the framework guiding aquaculture development on the Lake. The findings are suggestive of complementary quantitative studies that augment the qualitative evidence herein. Such follow up studies can disclose precise mortality risk factors to inform policy directives and effective remedial strategies that can secure fish and lake health.