Molecular Characterisation and Antibody Response to Bovine Respiratory Syncytial Virus in Vaccinated and Infected Cattle in Turkey

Bovine respiratory syncytial virus (BRSV) is one of the most important respiratory pathogens of cattle. In this study, frequency of infection, analysis of variants, and the immune status of vaccinated and non-vaccinated cattle were studied. Blood (n = 162) and nasal/oropharyngeal (n = 277) swabs were collected from 62 cattle herds in Turkey. Lung samples (n = 37) were also taken from dead animals and abattoirs. Antibodies to BRSV were detected in 76 (46%) out of 162 sera. The antibody levels in the vaccinated and non-vaccinated groups were statistically significant. Among 277 nasal/oropharyngeal swabs and 37 lungs, ten nasal/oropharyngeal and four lung samples were positive for BRSV-RNA. BRSV-G gene sequences of 5 out of 14 RT-PCR positive samples showed that all viruses clustered as Group-III in phylogenetic analysis with 88-100% homology. Similarity with previous Turkish BRSVs was 89-98%, and that with BRSVs detected in the USA and Czechia was 89.47-93.12%. BRSV continues to circulate in Turkish cattle, and vaccination seems beneficial in preventing BRSV. The diversity of the BRSVs found in this study needs be considered in vaccination strategies.

Molecular epidemiology and phylogenetic analysis of feline calicivirus in Kunshan, China

Feline calicivirus (FCV) is a highly contagious virus in cats, which typically causes respiratory tract and oral infections. Despite vaccination against FCV being a regular practice in China, new FCV cases still occur. Antigenic diversity of FCV hinders the effective control by vaccination. This is first report which aims to investigate the molecular epidemiology and molecular characteristics of FCV in Kunshan, China. The nasopharyngeal swabs were collected from cats showing variable clinical signs from different animal clinics in Kunshan from 2022 to 2023. Preliminary detection and sequencing of the FCV capsid gene were performed to study genetic diversity and evolutionary characteristics. FCV-RNA was identified in 52 (26%) of the samples using RT-PCR. A significant association was found between FCV-positive detection rate, age, gender, vaccination status and living environment, while a non-significant association was found with breed of cats. Nucleotide analysis revealed two genotypes, GI and GII. GII predominated in Kunshan, with diverse strains and amino acid variations potentially affecting vaccination efficacy and FCV detection. Notably, analysis pinpointed certain strains' association with FCV-virulent systemic disease pathotypes. This investigation sheds light on FCV dynamics, which may aid in developing better prevention strategies and future vaccine designs against circulating FCV genotypes.

An investigation on protection properties of Tantalum (V) oxide reinforced glass screens on unexposed breast tissue for mammography examinations

INTRODUCTION

The utilization of radiation shielding material positioned between the both breasts are crucial for the reduction of glandular dose and the safeguarding of the contralateral breast during mammographic procedures. This study proposes an alternative substance for shielding the contralateral breast from radiation exposure during mammography screening.

METHODS

In this study, we present an analysis of the shielding effectiveness of transparent glass that has been doped with Tantalum (V) oxide encoded as BTZT6. The evaluation of this shielding material was conducted using the MCNPX code, specifically for the ipsilateral and contralateral breasts. The design of the left and right breast phantoms involved the creation of three-layer heterogeneous breast phantoms, consisting of varying proportions of glandular tissue (25%, 50%, and 75%). The design of BTZT6 and lead-acrylic shielding screens is implemented using the MCNPX code. The comparative analysis of dose outcomes is conducted to assess the protective efficacy of BTZT6 and lead-acrylic shielding screens.

RESULTS

The utilization of BTZT6 shielding material resulted in a reduction in both breast dose and skin dose exposure when compared to the lead-acrylic shield.

CONCLUSION

Based on the findings acquired, the utilization of BTZT6 shielding material screens during mammography procedures involving X-rays with energy levels ranging from 26 to 30 keV is associated with a decrease in radiation dose.

IMPLICATIONS FOR PRACTICE

It can be inferred that the utilization of BTZT6 demonstrates potential efficacy in mitigating excessive radiation exposure to the breasts and facilitating the quantification of glandular doses in mammography procedures.

Intermittent systemic exposure to lipopolysaccharide-induced inflammation disrupts hippocampal long-term potentiation and impairs cognition in aging male mice

Age-related cognitive decline, a common component of the brain aging process, is associated with significant impairment in daily functioning and quality of life among geriatric adults. While the complexity of mechanisms underlying cognitive aging are still being elucidated, microbial exposure and the multifactorial inflammatory cascades associated with systemic infections are emerging as potential drivers of neurological senescence. The negative cognitive and neurobiological consequences of a single pathogen-associated inflammatory experience, such as that modeled through treatment with lipopolysaccharide (LPS), are well documented. Yet, the brain aging impacts of repeated, intermittent inflammatory challenges are less well studied. To extend the emerging literature assessing the impact of infection burden on cognitive function among normally aging mice, here, we repeatedly exposed adult mice to intermittent LPS challenges during the aging period. Male 10-month-old C57BL6 mice were systemically administered escalating doses of LPS once every two weeks for 2.5 months. We evaluated cognitive consequences using the non-spatial step-through inhibitory avoidance task, and both spatial working and reference memory versions of the Morris water maze. We also probed several potential mechanisms, including cortical and hippocampal cytokine/chemokine gene expression, as well as hippocampal neuronal function via extracellular field potential recordings. Though there was limited evidence for an ongoing inflammatory state in cortex and hippocampus, we observed impaired learning and memory and a disruption of hippocampal long-term potentiation. These data suggest that a history of intermittent exposure to LPS-induced inflammation is associated with subtle but significantly impaired cognition among normally aging mice. The broader impact of these findings may have important implications for standard of care involving infections in aging individuals or populations at-risk for dementia.

Radioprotective effects of dexmedetomidine on X-ray-induced testicular damage

OBJECTIVE

Approximately 70% of cancer patients require radiotherapy. However, despite its effectiveness in the treatment of cancer, radiotherapy can also affect and damage surrounding healthy tissues in addition to tumorous tissues. Since testicular tissues are highly radiosensitive, radiotherapy can cause impairments in spermatogenesis leading to infertility. The purpose of this study was to examine the potential radio-protective effect of dexmedetomidine (Dex), an α2-adrenoceptor agonist, on oxidative stress and apoptosis in testicular tissues caused by x-irradiation in rats.

MATERIALS AND METHODS

Thirty male Sprague-Dawley rats were allocated into three groups of ten (n=10): control, irradiation (IR), and IR + Dex groups. The IR group was exposed to a single dose of 2 Gy IR. The IR+Dex group was given a single intraperitoneal (i.p.) dose of 100 µg/kg Dex before IR. The control group received a single dose of saline solution i.p. Testicular tissues removed 24 hours after IR were subjected to histochemical, biochemical, and immunohistochemical analysis.

RESULTS

IR resulted in increased malondialdehyde (MDA) activity and significant changes in testis tissues. However, the application of Dex elevated glutathione levels by preventing MDA formation. In addition, Dex decreased tubular epithelial apoptosis via elevated Cleaved Caspase-3 expressions.

CONCLUSIONS

Dex exhibited a radio-protective effect against lipid peroxidation and apoptosis caused by IR.

Investigation of Obesity-Related HAdV-36 in NAFLD Patients: a Case-Control Study

BACKGROUND

HAdV-36 leads to adipocyte proliferation of adipose tissue through E4orf1 gene, leading to the development of obesity and related diseases. We aimed to investigate the presence and any association of HAdV-36 in non-alcoholic fatty liver disease (NAFLD) patients Methods: The patient group was composed of 116 patients; 30 obese patients with NAFLD (BMI > 30 kg/m2), 30 patients with Diabetes Mellitus (DM)+NAFLD (BMI > 30 kg/m2), 16 patients with NAFLD (BMI < 30 kg/m2), and operated obese group with NAFLD (BMI > 30 kg/m2). The control group comprised 81 non-obese healthy adults. Liver adipose tissue samples were obtained in 30 operated NAFLD patients. HAdV-36-DNA, HAdV-36 neutralizing antibodies, serum lipid, and adipokine levels were analyzed.

RESULTS

HAdV-36 neutralizing antibodies (HAdV-36 Ab-positive) were detected in 10/116 and 2/81 participants in the study and control groups, respectively; the difference was statistically significant (p < 0.005). LDL, total cholesterol but not adipokine levels were found to be significantly higher in HadV-36 Ab-positive patients (p < 0.05). While HAdV-36 was identified as a risk factor with OR = 4.11 in univariate analyses, there was no significant difference in binary logistic regression analysis. HAdV-36-DNA was detected in the adipose tissue samples of two patients.

CONCLUSIONS

We suggest that the presence of HAdV-36 may lead to the development of obesity with the increase in adipose tissue, and diseases such as hyperlipidemia, NAFLD, DM, and metabolic syndrome may develop on the basis of chronic inflammation caused by obesity. Thus, HAdV-36 may be a plausible risk factor for the development of NAFLD.

Development of in House ELISAs to Detect Antibodies to SARS-CoV-2 in Infected and Vaccinated Humans by Using Recombinant S, S1 and RBD Proteins

(1) Background: The aim of this study was to produce in-house ELISAs which can be used to determine SARS-CoV-2-specific antibody levels directed against the spike protein (S), the S1 subunit of S and the receptor binding domain (RBD) of S in SARS-CoV-2 vaccinated and infected humans. (2) Methods: Three in-house ELISAs were developed by using recombinant proteins of SARS-CoV-2, namely the S, S1 and RBD proteins. Specificity and sensitivity evaluations of these tests were performed using sera from SARS-CoV-2-infected (n = 70) and SARS-CoV-2-vaccinated (n = 222; CoronaVac vaccine) humans in Istanbul, Turkey. The analyses for the presence of SARS-CoV-2-specific antibodies were performed using the in-house ELISAs, a commercial ELISA (Abbott) and a commercial surrogate virus neutralization test (sVNT). We also analyzed archival human sera (n = 50) collected before the emergence of COVID-19 cases in Turkey. (3) Results: The sensitivity of the in-house S, S1 and RBD ELISAs was found to be 88.44, 90.17 and 95.38%, while the specificity was 72.27, 89.08 and 89.92%, respectively, when compared to the commercial SARS-CoV-2 antibody test kit. The area under curve (AUC) values were 0.777 for the in-house S ELISA, 0.926 for the S1 ELISA, and 0.959 for the RBD ELISA. The kappa values were 0.62, 0.79 and 0.86 for the S, S1 and RBD ELISAs, respectively. (4) Conclusions: The in-house S1 and RBD ELISAs developed in this study have acceptable performance characteristics in terms of sensitivity, specificity, AUC and kappa values. In particular, the RBD ELISA seems viable to determine SARS-CoV-2-specific antibody levels, both in infected and vaccinated people, and help mitigate SARS-CoV-2 outbreaks and spread.

Feasibility and image quality of myocardial perfusion imaging by CMR in patients with conditional and non-conditional cardiac devices

Purpose

First, to determine image quality using different cardiovascular magnetic resonance (CMR) perfusion protocols in patients with all available active device types in a real-world setting, including non-conditional devices.

Second, to demonstrate feasibility of high-quality perfusion imaging using spoiled gradient echo (sGE) protocols for non-invasive stress-testing.

Methods

From August 2020 to March 2022, N=222 patients with active cardiac implantable electronic devices (CIED) were scanned on a 1.5-T MR scanner (Philips Ingenia and Ambition). Our CMR scanning protocol was tailored to the clinical indication, and whenever myocardial perfusion imaging was possible, both a conventional steady-state-free-precession (SSFP)-based and a modified sGE-perfusion protocol were applied. Such a tailored perfusion protocol was performed in N=119 patients (70% men) with exclusively left-sided devices (pacemaker (PM), n=45; implantable cardioverter-defibrillator (ICD), n=46; subcutaneous ICD (S-ICD), n=15 and cardiac resynchronization therapy-pacemaker (CRT-P, n=5) or -defibrillator (CRT-D, n=8) with a percentage of 10% non-conditional devices. For assessment of image quality, a semi-quantitative 4-point grading scale was used based on a standard 16-segment model.

Results

A total of N=33 stress-tests with either regadenosone, adenosine or dobutamine and N=86 rest perfusion protocols were performed. Asynchronous pacing was required in 34% of the patients due to a heart rate of &lt;40bpm. Device interrogation before and after CMR scanning showed no significant changes. Image quality was substantially better in sGE-based perfusion protocols compared to conventional SSFP-based perfusion in ICD, CRT-D and S-ICD patients (p&lt;0.001). In patients with PM/ CRT-P image quality was neither significantly impaired in SSFP- nor in sGE-based protocols. Most device artefacts were located primarily in the anterior myocardial segments (1, 7, 13) in transvenous implanted devices and lateral in SICD-patients. A significant relationship between the extent of device artefacts and the parameters LVEDV (p=0.03), LVESV (p=0.005) and non-conditional devices (p=0.029) in SSFP-perfusion protocols were found in patients with PM/CRT-P. In contrast, there was no correlation between clinical and CMR-parameters in patients with ICD/ CRT-D. In S-ICD-patients, there was an inverse relationship between the extent of device artefact and age (p=0.006), BMI (p=0.001) in sGE-perfusion.

Conclusion

Myocardial perfusion imaging by CMR is safe and feasible with high image-quality in patients with all kinds of CIEDs – including MR-conditional as well as non-conditional devices. When performing CMR-based myocardial perfusion imaging in patients with left-sided ICD/CRT-D/S-ICD, a sGE-based perfusion-protocol should be preferred compared to conventional SSFP-based perfusion protocols in order to achieve artefact-free and well interpretable images.

Funding Acknowledgement

Type of funding sources: None.

Therapeutic value of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) with cardiomyopathy based on cardiovascular magnetic resonance (CMR) imaging

Background

Tafamidis was approved in Europe for the treatment of cardiomyopathy (CM) in patients with transthyretin amyloidosis (ATTR) in April 2020. So far, real-world data addressing the therapeutic value of tafamidis for the treatment of ATTR-CM are scarce. The purpose of this study was to carefully analyse the therapeutic benefit of tafamidis in patients with wild-type ATTR (ATTRwt) and CM (ATTRwt-CM) after one year of therapy based on serial multi-parametric cardiovascular magnetic resonance (CMR) imaging.

Purpose

The purpose of this study was to carefully analyse the therapeutic benefit of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) and cardiomyopathy (ATTRwt-CM) after one year of therapy based on serial multi-parametric cardiovascular magnetic resonance (CMR) imaging.

Methods

The present study comprised N=40 patients with ATTRwt-CM who underwent two serial multi-parametric CMR studies within a follow-up period of 12±3 months. Baseline (BL) clinical parameters, serum biomarkers and CMR findings were compared to follow-up (FU) values in patients with treated “with” tafamidis 61mg daily (n=20, group A) and those “without” tafamidis therapy (n=16, group B). CMR studies were performed on a 1.5-T system and comprised (amongst others) cine-imaging for assessment of cardiac anatomy and function including 3D longitudinal strain assessment. In addition, a modified Look-Locker inversion recovery (MOLLI) T1-mapping sequence was performed for measurement of pre- and post-contrast myocardial T1-values with additional calculation of extracellular volume fraction (ECV)-values.

Results

While left ventricular ejection fraction (LV-EF), left ventricular mass index (LVMi), left ventricular wall thickness (LVWT), native T1- and ECV-values remained unchanged in the tafamidis group A, a slight reduction in LV-EF (p=0.003) as well as a subtle increase in LVMi (p=0.034), in LVWT (p=0.001), in native T1- (p=0.038) and ECV-values (p=0.017) were observed in the untreated group B. Serum NT-proBNP levels showed an overall increase in both groups, however, with the untreated group B showing a relatively higher increase compared to the treated group A. Assessment of NYHA class did not result in significant intra-group differences when BL were compared with FU, but a trend to improvement in the treated group A compared to a worsening trend in the untreated group B (Δp=0.005).

Conclusion

Tafamidis does not improve cardiac phenotype in patients with ATTRwt-CM after one year of therapy. However, tafamidis seems to slow down cardiac disease progression in patients with ATTRwt-CM compared to those without tafamidis therapy based on multi-parametric CMR data already after one year of therapy.

Funding Acknowledgement

Type of funding sources: None.

Current scenario of viral diseases and vaccination strategies of cattle in Turkey

The dairy and meat industry has rapidly developed in the last decade in Turkey and is playing a key role in supplying animal proteins for human consumption. Viral pathogens continue to threaten the dairy and meat industry leading to serious economic losses worldwide, including Turkey. The Turkish cattle industry has been vulnerable to the spread of viral diseases within the country in the continent. Combating animal diseases is crucial for the economy of Turkey. A good cattle health management policy may reduce the direct losses associated with viral diseases and thereby lead to increase in export of animals and animal products. Countries that are unable to combat animal diseases remain excluded from international trade. Control and eradication of cattle diseases require the availability of effective and practical interventions including vaccination and biosecurity measures. This review summarises the currently available information about viral diseases in cattle in Turkey and emphasizes the need for disease monitoring and research, along with implementation of disease control measures to mitigate economic losses to farmers and the country. The information presented here can be of great value in the research, prevention, and control of cattle diseases.

POS1216 POTENTIAL PREDICTORS OF OUTCOME FOR ANAKINRA TREATMENT IN COVID-19 PATIENTS WITH MACROPHAGE ACTIVATION SYNDROME

Background

A hyperinflammatory response compatible with features of macrophage activation syndrome (MAS) contributes to this worse outcome in patients with Coronavirus Disease 2019 (COVID-19). Glucocorticoids have become the standard of care for those requiring oxygen support or mechanical ventilation. More targeted anti-inflammatory treatments with tocilizumab and anakinra have also been shown to be effective.

Objectives

More studies are being awaited to clarify the features of patients who would benefit more, and we investigated the characteristics of the surviving and dead patients who received anakinra.

Methods

The records of hospitalized adult patients between March 2020 and May 2021 in a tertiary referral center were evaluated. Diagnosis of COVID-19-related MAS was based on the expert opinion and preliminary criteria developed by our group that patients with a score of ≥45 were accepted COVID-19-related MAS.1 Patients who received anakinra constituted the study group. Anakinra dose was determined according to the clinical and inflammatory parameters; and doses varied between daily 100-300 mg SC to 400-800 mg IV.

Laboratory data of surviving and died patients were comparatively analyzed by using the ANCOVA method on the relevant days (baseline, anakinra-onset day, first response to anakinra treatment, and discharge or death). The temporal variation (drug onset day-first response day, drug onset day-discharge, or death day) was evaluated using the ANOVA method. A 50% reduction of CRP compared to the anakinra start day was accepted as the first response to the treatment.

Results

Out of 1080 hospitalized patients, 218 (151 male, 67 female, mean age 60.0±14.1) who received anakinra were identified. Among them, 125 (57.3%) patients were followed in the ward, 21 (9.6%) did not need oxygen treatment during the hospitalization; 69 (31.6%) patients were followed at ICU, 40 of them were intubated, 30 (13.7%) died in ICU. Anakinra had been started in a mean of 4.8 days of hospitalization. Twenty had tocilizumab initially and then received anakinra because of ongoing inflammatory parameters. The majority (83.5%) received steroid treatment (79.5% methylprednisolone, 5% of dexamethasone), and 6 received one IV pulse 250 mg of methylprednisolone; 36 (16.5%) were followed before September 2020 and received anakinra without steroids because of the standard of care at that period. Only CRP was different between the alive and dead patients for the baseline parameters (p=0.05). On the first day of drug treatment, CRP and procalcitonin values were significantly higher in dead patients (Table 1). A 50% decrease in CRP level was achieved in 3.1 days in survivors and 4.7 days in dead patients. D-dimer (p=0.018), CRP (p=0.006), LDH (p=0.003), procalcitonin (p=0.005), creatinine kinase (p=0.001), and fibrinogen levels (p=0.05) were significantly different between the surviving and dead patients when the measurements between the first drug administration day and response day were compared. Neutrophil, lymphocyte count, ferritin, D-dimer, CRP, LDH, AST, procalcitonin, creatinine kinase, and fibrinogen levels were significantly different between the patients when the parameters between the first drug administration day and discharge/death day were compared. Dead patients had higher CRP values and they did not show a continuing CRP decrease with the steroids and anakinra (Figure 1).

Conclusion

Retrospective analysis of 218 patients suggests that starting anakinra earlier in hospitalized patients may provide better results, and a decrease in CRP, ferritin, D-dimer values, as well as an increase in lymphocyte count, are associated with favorable outcomes. Increasing values of D-dimer and troponin during treatment are associated with worse outcomes, possibly indicating cardiovascular and thrombotic pathologies not responding to anakinra. Changes in the CRP values are found to help monitor the response to anakinra. Other inflammatory pathways could be targeted in those who are not responding to appropriate doses of anakinra within 5 days.

Disclosure of Interests

None declared

Thoracoscopic Management of Iatrogenic Cardiac Perforations

AIMS

Iatrogenic cardiac perforation is an uncommon but potentially fatal complication of invasive cardiac procedures. When non-surgical management fails, urgent cardiac surgery is required. Standard surgical approach is usually through full sternotomy. However, we propose a less invasive and equally effective technique with video-assisted thoracoscopic surgery (VATS).

METHODS

This single-centre retrospective study in a tertiary hospital identified all patients requiring surgical intervention due to iatrogenic cardiac perforation over a period of 5 years. Patients were grouped by surgical approach, being either sternotomy or VATS. Primary endpoints were operating time, length of ICU stay, hospital stay, 30-day mortality and all round mortality.

RESULTS

25 patients were identified: 11 in the sternotomy-group and 14 in the VATS-group. Preoperative baseline characteristics were equal. Significant difference was found for 30-day mortality (p < 0.05). There was no difference for the other endpoints.

CONCLUSIONS

Video-assisted thoracoscopic surgery is a promising alternative to standard sternotomy for iatrogenic cardiac perforations after invasive cardiac procedures. This article is protected by copyright. All rights reserved.

Clinical, virological, imaging and pathological findings in a SARS CoV-2 antibody positive cat

This paper reports a presumptive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a cat. A cat with respiratory disease living with three individuals with coronavirus disease 2019 showed bilateral ground-glass opacities in the lung on X-ray and computed tomography. The clinical swabs were negative for SARS-CoV-2 RNA, but the serum was positive for SARS-CoV-2 antibodies. Interstitial pneumonia and prominent type 2 pneumocyte hyperplasia were noted on histopathology. Respiratory tissues were negative for SARS-CoV-2 RNA or antigen, but the cat was positive for feline parvovirus DNA. In conclusion, the respiratory disease and associated pathology in this cat could have been due to exposure to SARS-CoV-2.

Surgical adrenalectomy during rescue Extracorporeal Life Support for pheochromocytoma induced cardiogenic shock: a case report

Introduction : Pheochromocytoma, a rare catecholamine-producing tumor, has been described to provoke stress-induced Takotsubo-like cardiomyopathy and even severe refractory cardiogenic shock. In this case report, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used for hemodynamic stabilization and was continued during the resection of a large neuroendocrine tumor. Description : A 69-year old male, recently diagnosed with a pheochromocytoma, was referred to our center because of severe cardiogenic shock after induction of anesthesia for resection of the mass. Despite adequate alpha-and beta-adrenergic blockade for one month, he developed malignant hypertension with subsequently hemodynamic collapse. After successful cardiopulmonary resusci-tation he developed pulmonary oedema with severe hypoxemia and persistent hemodynamic lability. On arrival in our hospital, echocardiography revealed significant left ventricular impairment. Decision was made to commence him on VA-ECMO for a refractory cardiogenic shock with severe pulmonary oedema. Because of persistent blood pressure swings despite VA-ECMO and beta-adrenergic blockade, we decided to remove the tumor on mechanical circulatory support by an open surgical approach the next day. After clamping of the adrenal circulation, the patient experienced profound hypotension requiring high doses of epinephrine and a methylene blue infusion. Surgical resection was successful but complicated by a postoperative bleeding for which the patient underwent an emergent endovascular embolization of an adrenal artery. Over the next days, there was progressive cardiac recovery and the patient was weaned off VA-ECMO on the fourth postoperative day. The patient was discharged from the intensive care 27 days after admission and left the hospital on day 30. Discussion: VA-ECMO seems to be a feasible last resort therapy in refractory cardiogenic shock induced by pheochromocytoma crisis as suggested by a high survival rate in literature. Despite its support benefit during this type of shock, surgical removal of the tumor is rarely done with mechanical circulatory support and heparinization.

Emergence of West Nile Virus Lineage-2 in Resident Corvids in Istanbul, Turkey

West Nile fever is a vector-borne viral disease affecting animals and humans causing significant health and economic problems globally. This study was aimed at investigating circulating West Nile virus (WNV) strains in free-ranging corvids in Istanbul, Turkey. Brain, liver, and kidney were collected from corvids (n = 34) between June 2019 and April 2020 and analyzed for the presence of WNV-specific RNA by quantitative RT-PCR. In addition, histopathologic and immunohistochemical examinations were also performed. Samples found to be positive by qRT-PCR were partially sequenced. WNV-specific RNA was detected in 8 of 34 corvids analyzed, which included 7 hooded crows (Corvus cornix) and 1 Eurasian magpie (Pica pica). Phylogenetic analysis based on partial WNV sequences from the 8 WNV-positive corvids identified in this study revealed that all sequences clustered within the WNV lineage-2; they were at least 97% homologues to WNV lineage-2 sequences from Slovakia, Italy, Czechia, Hungary, Senegal, Austria, Serbia, Greece, Bulgaria, and Germany. WNV sequences showed a divergence (87.94-94.46%) from sequences reported from Romania, Central African Republic, South Africa, Madagascar, Israel, and Cyprus, which clustered into a different clade of WNV lineage-2. Common histopathologic findings of WNV-positive corvids included lymphoplasmacytic hepatitis, myocarditis, and splenitis. The liver and heart were found to be the tissues most consistently positive for WNV-specific antigen by immunohistochemistry, followed by the kidney and brain. This study demonstrates for the first time the existence of WNV virus belonging to the genetic lineage-2 in resident corvids in Istanbul, Turkey. We hypothesize that the WNV strains circulating in Istanbul are possibly the result of a spillover event from Europe. Since WNV is a zoonotic pathogen transmitted by mosquito vectors, the emergence of WNV in Istanbul also poses a risk to humans and other susceptible animals in this densely populated city and needs to be addressed by animal and public health authorities.

Presence of Antibodies to SARS-CoV-2 in Domestic Cats in Istanbul, Turkey, Before and After COVID-19 Pandemic

Recent studies demonstrated that domestic cats can be naturally and experimentally infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study was performed to investigate the presence of SARS-CoV-2-specific antibodies within the domestic cat population in Istanbul, Turkey, before the coronavirus disease 2019 (COVID-19) and during the COVID-19 pandemic. Overall, from 155 cat sera analyzed, 26.45% (41/155) tested positive in the spike protein-ELISA (S-ELISA), 28.38% (44/155) in the receptor-binding domain-ELISA (RBD-ELISA), and 21.9% (34/155) in both, the S- and RBD-ELISAs. Twenty-seven of those were also positive for the presence of antibodies to feline coronavirus (FCoV). Among the 34 SARS-CoV-2-positive sera, three of those were positive on serum neutralization assay. Six of the 30 cats before COVID-19 and 28 of the 125 cats during COVID-19 were found to be seropositive. About 20% of ELISA-positive cats exhibited mainly respiratory, gastrointestinal, and renal signs and skin lesions. Hematocrit, hemoglobin, white blood cells, lymphocyte, and platelet numbers were low in about 30% of ELISA-positive cats. The number of neutrophils and monocytes were above normal values in about 20% of ELISA-positive cats. The liver enzyme alanine aminotransferase levels were high in 23.5% ELISA-positive cats. In conclusion, this is the first report describing antibodies specific to SARS-CoV-2 antigens (S and RBD) in cats in Istanbul, Turkey, indicating the risk for domestic cats to contract SARS-CoV-2 from owners and/or household members with COVID-19. This study and others show that COVID-19-positive pet owners should limit their contact with companion animals and that pets with respiratory signs should be monitored for SARS-CoV-2 infections.

Wide QRS complex tachycardia due to typical atrial flutter with accessory pathway conduction

A 62-year-old male patient was admitted with regular wide QRS complex tachycardia. After ajmaline administration, the heart rate slowed down disclosing atrial flutter with variable QRS morphologies. Electrocardiography after conversion to sinus rhythm showed narrow QRS complexes. Decremental atrial stimulation during electrophysiological study caused progressive pre-excitation. Spontaneously, typical atrial flutter occurred with pre-excited QRS complexes. Both accessory pathway and atrial flutter were ablated in the same session.

Resveratrol prevents acute renal injury in a model of ruptured abdominal aortic aneurysm

OBJECTIVE

To examine the biochemical and histopathological effects of ischemia/reperfusion (I/R) injury in a ruptured abdominal aortic aneurysm (RAAA) model in rats, and to investigate the potential protective role of resveratrol.

METHODS

Thirty-two male Sprague-Dawley rats were randomly assigned into four groups-control, I/R, sham (I/R + solvent/dimethyl sulfoxide), and I/R + resveratrol. The control group underwent midline laparotomy only. In the other groups, infrarenal vascular clamps were attached following 60-min shock to the abdominal aorta. Ischemia was applied for 60 min followed by reperfusion for 120 min. In the I/R + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min prior to ischemia and immediately before reperfusion. The I/R + dimethyl sulfoxide group received dimethyl sulfoxide, and the I/R group was given saline solution. All animals were sacrificed by exsanguination from the carotid artery at the end of the experiment. In addition to histopathological examination of the rat kidney tissues, malondialdehyde, glutathione, catalase, and nitric oxide levels were also investigated.

RESULTS

A decrease in glutathione, catalase and nitric oxide levels, together with increases in malondialdehyde levels, numbers of apoptotic renal tubular cells, caspase-3 levels, and tubular necrosis scores, were observed in the IR and I/R + dimethyl sulfoxide groups. In contrast, resveratrol increased glutathione, catalase and nitric oxide levels in renal tissues exposed to I/R, while reducing malondialdehyde levels, apoptotic renal tubular cell numbers, caspase-3 levels, and tubular necrosis scores.

CONCLUSION

Our findings suggest that resveratrol can be effective against I/R-related acute kidney damage developing during RAAA surgery by reducing oxidative stress and apoptosis.

Diagnosis and treatment of cardiac amyloidosis: position statement of the German Cardiac Society (DGK)

Systemic forms of amyloidosis affecting the heart are mostly light-chain (AL) and transthyretin (ATTR) amyloidoses. The latter is caused by deposition of misfolded transthyretin, either in wild-type (ATTRwt) or mutant (ATTRv) conformation. For diagnostics, specific serum biomarkers and modern non-invasive imaging techniques, such as cardiovascular magnetic resonance imaging (CMR) and scintigraphic methods, are available today. These imaging techniques do not only complement conventional echocardiography, but also allow for accurate assessment of the extent of cardiac involvement, in addition to diagnosing cardiac amyloidosis. Endomyocardial biopsy still plays a major role in the histopathological diagnosis and subtyping of cardiac amyloidosis. The main objective of the diagnostic algorithm outlined in this position statement is to detect cardiac amyloidosis as reliably and early as possible, to accurately determine its extent, and to reliably identify the underlying subtype of amyloidosis, thereby enabling subsequent targeted treatment.

COSMIC RADIATION EXPOSURE CALCULATIONS FOR INTERNATIONAL AND DOMESTIC FLIGHTS DEPARTS FROM ISTANBUL AND ANKARA

In this study, cosmic radiation doses were calculated for domestic and international flights departing from Istanbul and furthermore for domestic flights departing from Ankara using a software program called CARI-7A and also a mathematical method approach. Main parameters for calculating cosmic radiation are vertical cut-off rigidity, flight duration, latitude-longitude and altitude of the flight. Our calculation results agree with the measurements for domestic and international flights departing from Istanbul and Ankara.

The initial detection of Toscana virus in phlebotomine sandflies from Turkey

Toscana virus (TOSV) is a prominent arthropod-borne viral agent of human central nervous system infections occurring in the Mediterranean region. The main transmission route to susceptible individuals involves sandflies as vectors. Despite several reports revealing widespread TOSV activity in Turkey, vectors remained unidentified. A sandfly field survey was carried out in five provinces in Central, Southeast and Mediterranean Anatolia in 2017 to identify TOSV and related sandfly-borne phleboviruses and Leishmania parasites, with evidence for circulation in the region. A total of 7136 sandfly specimens, collected via standard methods, were evaluated in 163 pools. TOSV was detected in 11 pools (6.7%), comprising Phlebotomus major sensu lato, Sergentomyia dentata and Phlebotomus papatasi species. TOSV partial L and S segment sequences were characterized, that phylogenetically clustered with local and global genotype A strains. An amino acid substitution outside the conserved motifs of the viral polymerase, also present in previous TOSV sequences in endemic regions, was observed. Leishmania tropica was detected in a single pool of Ph. sergentii (0.6%). This is the first report of TOSV in sandflies from Turkey, and this study further provides evidence for additional sandfly species with the potential to transmit TOSV.

Ruling in or out the presence of cardiac amyloidosis based on cut-off values using T1-mapping – caution is required regarding the control group

Background

Cardiac amyloidosis (CA) is an infiltrative disease that is characterized by accumulation of amyloid deposits in the interstitium of the myocardium. In contrast, hypertrophic cardiomyopathy (HCM) is caused by a disorganized arrangement of myocyte hypertrophy as well as expanded extracellular matrix, composed of interstitial and replacement fibrosis.

Purpose

A diagnostic algorithm based on (native) T1-mapping using cardiovascular magnetic resonance (CMR) was suggested in a recent study for the diagnosis of CA: A native T1 &lt;1,036ms was mentioned to have a 98% negative predictive value (NPV) for ruling out CA whereas a native T1 &gt;1,164ms showed a 98% positive predictive value (PPV) for the presence of CA. In the present study, we critically addressed the calculation of such cut-off values considering possible differences in the composition of the control group.

Methods

N=30 patients with CA, N=20 patients with HCM and N=15 healthy controls without relevant cardiac disease underwent dedicated CMR studies on a 1.5-T MR scanner. The CMR protocol comprised standard sequences for cine-imaging, native and post-contrast MOLLI-based T1-mapping and late-gadolinium-enhancement (LGE). ECV measurements were based on pre- and post-contrast T1-mapping images.

Results

Native T1 and ECV were significantly increased in CA compared to HCM and receiver operating characteristic (ROC) analyses revealed an area-under-the-curve (AUC) = 0.984 for native T1 (p&lt;0.001) and AUC = 0.985 for ECV (p&lt;0.001) regarding the diagnosis of CA). When CA patients were compared to HCM patients (excluding healthy controls), a native T1 &lt;1,036ms or an ECV &lt;33% were associated with a 99% NPV for ruling out CA whereas a native T1 ≥1,082ms or an ECV ≥41% were associated with a 99% PPV for diagnosis of CA. However, when CA patients were compared to healthy controls (excluding HCM patients), a native T1 &lt;1,025ms or an ECV &lt;34% were associated with a 99% NPV for ruling out CA whereas a native T1 ≥1,025ms or an ECV ≥34% were associated with a 99% PPV for diagnosis of CA since there was no overlap in native T1 and ECV values between CA patients and healthy controls.

Conclusion

Cut-off values for native T1 or ECV derived from ROC analyses (in a specific group of study patients) for ruling in or out the presence of CA are – amongst others - determined by the native T1 and ECV values of the respective “control group”. A different composition of the control group (e.g. HCM patients vs. healthy volunteers) will result in different cut-off values. Hence, previously suggested cut-off values obtained in single center studies need to be considered carefully – with a special attention to the control group of the underlying study – and should not be transferred to other centers carelessly.

Funding Acknowledgement

Type of funding source: None

Totally endoscopic aortic valve replacement: technique and first experience

Background

Cardiac surgery is still looking for new minimally invasive techniques with less trauma and better cosmetic results. In the field of aortic valve replacement, several types of less invasive procedures were introduced, allowing a reduction in blood loss, infections, ventilation times, morbidity and mortality. The most common technique for minimally invasive aortic valve replacement is the mini-sternotomy approach. In this report, the initial experience with a non-sternotomy approach for aortic valve replacement by means of a totally endoscopic surgical technique is presented.

Methods

The totally endoscopic aortic valve replacement was carried out in 201 patients (59,7% males, mean age: 71.6±11.7 years) from October 2017 until October 2019. Severe aortic valve stenosis was the surgical indication for all patients, who had a mean EuroSCORE II of 2.35±3.82. The surgery was carried out with the patient in supine position and a standard zero-degree optics was used. A 20 mm working port in the 2nd right intercostal space and two 5 mm trocars gained access to the aorta. After groin cannulation, cardiopulmonary bypass was initiated. Transthoracic aortic cross-clamping followed by antegrade administration of a single shot cold mixed-blood cardioplegia was assessed. The aortotomy was followed by the excision of the stenotic aortic valve and the aortic valve prosthesis was implanted in supra-annular position. After the closure of the aorta, an external pacemaker wire was placed.

Results

Mean cross-clamp and cardiopulmonary bypass times were 62±14 and 94±25 minutes, respectively. No conversion to a sternotomy was needed. The mean length of stay at the intensive care unit was 69.4±149.6 hours while patients spend 9.6±10 days at the hospital. Due to our new fast track protocol, the mean hospital stay in the last two months was 6.1 days (26 patients, 12.9%). The average postoperative blood loss (24h) was 251±298 mL and the patients were ventilated for 6.9±9 hours. In 10 patients (4.9%), re-exploration in an endoscopic way was needed. None of them had a surgical bleeding focus. No paravalvular leakages were detected at discharge. 69 patients (34.7%) developed atrial fibrillation after surgery. In addition, 10 patients (4.9%) underwent a pacemaker implantation postoperatively whereas 4 patients (1.9%) suffered from a CVA. Finally, the 30-day mortality was 2.0%.

Conclusion

These results concerning the feasibility and safety of totally endoscopic aortic valve replacement are promising. The aortic cross clamping times are acceptable, and the morbidity and mortality rates are low. Long term results are needed to confirm these initial findings.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

Hybrid CMR- and FDG-PET-imaging gives new insights into the relationship of myocardial metabolic activity and fibrosis in patients with Becker muscular dystrophy

Background

Cardiac involvement in patients with Becker muscular dystrophy (BMD) is an important predictor of mortality. The cardiac phenotype of BMD patients is characterized by slowly progressive myocardial fibrosis that starts in the left ventricular (LV) free wall segments and extends into the septal wall during the disease course.

Purpose

Since the reason for this characteristic cardiac phenotype is unknown and comprehensive approaches using e.g. hybrid imaging combining cardiovascular magnetic resonance (CMR) with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) are limited, the present study addressed this issue by a comprehensive non-invasive imaging approach.

Methods

Hybrid CMR- and FDG-PET-imaging was performed in N=14 patients with BMD on a whole-body Biograph mMR system. The CMR protocol comprised cine- and late-gadolinium-enhancement (LGE)-imaging. Metabolism was assessed with FDG-PET after oral glucose loading to effect myocardial carbohydrate uptake. PET was acquired for 65 minutes starting with tracer injection. Uptake values from 60 to 65 minutes p.i. were divided by the area under the blood activity curve and reported as percentages relative to the segment with maximal myocardial FDG uptake.

Results

In the total study group, mean left ventricular (LV) ejection fraction (EF) was 55±5% and there were 6/14 patients with a reduced LV-EF &lt;55%. A characteristic pattern of LGE in LV lateral wall was observed in 13/14 patients whereas an additional septal LGE pattern was documented in 6/14 patients only. Segmental FDG uptake was 88±6% in the LV lateral wall vs. 77±10% in the septal wall (p&lt;0.001). There was a rather inverse relationship between segmental FDG activity compared to segmental LGE extent (r=−0.33, p=0.089). There were N=6 patients (= ΔFDG-high) with a segmental difference in FDG uptake of &gt;15% in the LV lateral wall compared to the septal wall (lateral FDG = 91±3% vs. septal FDG = 69±8%; p&lt;0.001) while the remaining N=8 patients (= ΔFDG-low) showed a segmental difference in FDG uptake of ≤15% (lateral FDG = 85±7% vs. septal FDG = 83±5%; p=0.37). Patients in the ΔFDG-high group showed a similar LV lateral wall vs. septal wall LGE extent of 12±6% vs. 7±15%, respectively, while those patients in the ΔFDG-low group demonstrated a large difference in LV lateral wall vs. septal wall LGE extent of 33±24% vs. 4±6%, respectively.

Conclusions

Segmental FDG uptake – reflecting myocardial metabolic activity – is in principal higher in the LV free wall of BMD patients – possibly due to a higher segmental work load. However, segmental metabolic activity seems to be dependent on and limited by the respective segmental extent of myocardial fibrosis as depicted by LGE-imaging.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsche Gesellschaft für Kardiologie (DGK)

Hybrid coronary revascularization with endoscopic closed-chest arterial coronary bypass technique (endo-CABG)

Introduction

Treatment of three-vessel coronary disease in minimally invasive manner could be complex in some cases. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) gives good patency rates which outlive vein grafts. The hybrid approach, combination of PCI with minimally invasive endoscopic coronary artery bypass graft (endo-CABG), might be a valuable option for treatment of multivessel coronary disease. Hereby we describe our series of patients undergoing arterial revascularization of the anterior and/or lateral wall combined with PCI of the right coronary artery or a marginal branch.

Methods

From March 2013 until December 2019, 208 patients (82.2% males, mean age: 66.69±10.44 years) underwent hybrid coronary revascularization for multivessel disease. Patients with multivessel disease suitable for hybrid approach were accepted at the heart team. All patients received total arterial revascularisation by endo-CABG. The PCI was prior or after the endo-CABG. There was no discontinuation of dual platelet therapy. Uni or bilateral internal mammary artery (IMA) harvesting was performed through three 5mm endoscopic ports in the 2nd, 3rd and 4th intercostal space. Cardiopulmonary bypass was established using a minimally invasive extracorporeal circulation (MiECC) with groin cannulation. Transthoracic aortic cross-clamping was followed by antegrade administration of a single shot cold mixed blood cardioplegia. A utility port of three centimeter was used for direct vision anastomosis.

Results

The procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 44.38±28.33 and 91.75±37.97 minutes, respectively, with a mean of 2.1±0.91 bypasses for each patient. All patients received total arterial revascularization. The mean ICU and hospital length of stay were 62.5±39.74 hours and 8.80±4.64 days, respectively. Average postoperative blood loss over 24 hours was 555.20±859.19 mL. There were 8 re-interventions on the target vessels (3.8%) and 2 patients suffered from a stroke (1%). The 30-day mortality rate was 0.5%.

Conclusion

Minimally invasive hybrid arterial coronary revascularization is a safe and valuable alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. The endo-CABG is a safe and feasible technique without compromising operative morbidity and providing good postoperative results.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

Identification of Newcastle disease virus subgenotype VII.2 in wild birds in Turkey

BACKGROUND

Newcastle disease viruses (NDVs) can spread across continents via migratory birds. Hence, we investigated the frequency of NDV in both non-migratory and birds migrating on the Black Sea-Mediterranean flyway, in Istanbul, Turkey. Birds were trapped using nets placed around the Kucukcekmece lake Avcilar, Istanbul, in spring seasons of 2016 and 2018. In total, 297 birds belonging to 42 different species were trapped, categorized according to species and sex, and flocked oropharyngeal swabs were collected. In addition, flocked swabs were also collected from 115 mallards caught by hunters around Edirne and from 207 birds which had been treated in the Veterinary Faculty of Istanbul university-Cerrahpasa. Tissue samples were taken from dead wild birds brought by public to Veterinary Faculty. A total of 619 flocked oropharyngeal swabs were pooled into 206 samples. RNA was extracted from swabs and tissue samples. Real-time RT-PCR prob. assay was used to detect NDV-RNA in samples.

RESULTS

There was no amplification in real time RT-PCR in samples taken from wild birds caught by traps. However, amplification of NDV-F gene was observed in oropharyngeal swabs taken from 2 waterfowls (Common Moorhen and Mallard), and in tissue samples taken from 2 little owls and 1 common kestrel. Sequencing and phylogenetic analyses of these 5 samples for NDV-F gene showed great similarity with NDV subgenotype VII.2 viruses. Analysis also showed that there is a high similarity with the F gene sequences previously reported from Turkey in 2012 and as well as the sequences from neighbouring countries Bulgaria and Georgia and geographically close country such as Pakistan. Although the strains found in this study are closely related, there is a relatively small degree of molecular divergence within 543 bp of F gene of the Turkish NDV isolate and strains detected in Israel, Pakistan, Iran, United Arab Emirates and Belgium.

CONCLUSIONS

Our findings revealed the presence of subgenotype VII.2 of NDVs in wild birds in north west of Turkey and demonstrated some degree of molecular evolution when compared to the earlier NDV-VII.2 isolate in Turkey.

Effects of Complement Regulators and Chemokine Receptors in Type 2 Diabetes

CD55 and CD59 are complement regulatory proteins suggested to be related with progression of diabetes and its complications. The stromal cell-derived factor 1 (SDF-1) and C-X-C chemokine receptor type 4 (CXCR-4) are chemokine proteins. We aimed to investigate the relation of CD55 and CD59 expression levels and polymorphisms of SDF-1 and CXCR-4 with type 2 diabetes mellitus (T2DM) and its complications. Seventy-five T2DM patients and 73 controls were enrolled. Expression levels of CD55 and CD59 were measured by FACS Calibur; qRT-PCR was used to determine SDF-1 and CXCR-4 gene polymorphisms. CD55 and CD59 expressions in patients with nephropathy, retinopathy and cardiovascular disease were significantly lower than controls. Frequency of CXCR-4 T allele carrying was high in patients and created 1.6 fold risk for the disease (p = .07). CXCR-4 a allele carriers had decreased nephropathy; although there was no statistical significance in carrying CXCR-4 T allele, presence of nephropathy was approximately 2 times higher (p = .254). The nephropathy risk increased 10-fold in CXCR-4 TT genotype carriers (p = .02). All SDF-1 CC genotype carriers had retinopathy, so, it was considered that the CC genotype was effective in retinopathy development (p = .031). For the presence of cardiovascular disease, significant difference was observed for SDF-1 genotypes. Increased cardiovascular risk of 5- and 1.9-fold in SDF-1 T (p = .007) and CXCR-4 T (p = .216) allele carriers, respectively, was observed. We suggest that CD55 and CD59 protein levels and SDF-1 and CXCR-4 have predictive importance in process, complications and tendency of T2DM.

Molecular characterisation and phylogenetic analysis of Marek's disease virus in Turkish layer chickens

1. There is no current data about the genotypes of Marek's disease virus (MDV) in Turkish poultry flocks; hence, this study was performed to analyse CVI988/Rispens, turkey herpesvirus (HVT) vaccine viruses and MDV field viruses as well as to perform phylogenetic analysis of MDV in Turkish layer chickens. 2. In 2017 and 2018, a total of 602 spleen samples from 49 layer flocks were collected from the Marmara, West Black Sea and Aegean regions. DNA was extracted from the spleen samples and the samples were analysed by real-time PCR probe assay to detect CVI988/Rispens and HVT vaccine viruses and MDV field strains. Samples found positive for MDV by real-time PCR were subjected to PCR using the Meq gene primers for phylogenetic analysis. 3. Amongst 49 flocks, virulent MDV was detected in nine flocks. CVI988/Rispens and HVT vaccine strains were detected in 47 flocks and HVT in all 49 flocks. Splenomegaly, hepatomegaly and tumours in the oviduct were observed in chickens of affected flocks. Virulent MDV was detected in 120 out of 602 spleen samples. Sequencing and phylogenetic analyses showed that MDVs detected in this study were closely related to MDV strains from Italy, Poland, Saudi Arabia, Iraq, India and China but showed diversity with MDV strains from Egypt and Hungary. Multiple sequence analysis of the Meq protein revealed several point mutations in deduced amino acid sequences. Interestingly, CVI988/Rispens vaccine virus from China (AF493555) showed mutations at position 66 (G66R) and 71 (S66A) along with two other vaccine strains from China (GU354326.1) and Russia (EU032468.1), in comparison with the other vaccine strain CVI988/Rispens (DQ534538). The molecular analyses of the Meq gene suggested that Turkish field strains of MDV are in the class of virulent or very virulent pathotypes. 4. The results have shown that MDV still affects poultry health, and the phylogenetic and amino acid variation data obtained will help in vaccination and control strategies.

Investigation of Vector-Borne Viruses in Ticks, Mosquitos, and Ruminants in the Thrace District of Turkey

There is a considerable increase in vector-borne zoonotic diseases around the world, including Turkey, such as Crimean-Congo hemorrhagic fever (CCHF), tick borne encephalitis (TBE), Rift Valley fever (RVF), and West Nile fever (WNF), causing disease and death in humans and animals and significant economical losses. Hence, the aim of this study was to investigate the presence of CCHF virus (CCHFV) and TBE virus (TBEV) in ticks and RVF virus (RVFV) and WNF virus (WNV) in mosquitos, as well as in sheep and cattle, in the Thrace district of the Marmara region, which borders Bulgaria and Greece. Buffy-coat samples from 86 cattle and 81 sheep, as well as 563 ticks and 7390 mosquitos, were collected and examined by quantitative real-time RT-PCR for the presence of CCHFV, TBEV, RVFV, and WNV. All buffy-coat samples from cattle and sheep were negative for these viruses. Similarly, all tick samples were negative for CCHFV-RNA and TBEV-RNA. Among 245 pools representing 7390 mosquitos, only 1 pool sample was found to be positive for WNV-RNA and was confirmed by sequencing. Phylogenetic analysis revealed that it was WNV lineage-2. No RVFV-RNA was detected in the 245 mosquito pools. In conclusion, results of this study indicate that CCHFV, TBEV, and RVFV are not present in livestock and respective vectors in the Thrace district of Marmara region of Turkey, whereas WNV-RNA was found in mosquitos from this region.

First report of influenza D virus infection in Turkish cattle with respiratory disease

Bovine respiratory infections are the most economically important diseases affecting the cattle industry worldwide including Turkey. Influenza D virus (IDV) could play an important role to trigger bovine respiratory disease (BRD) complex. Since, there is no data about the presence and genotypes of IDV in Turkish cattle herds; this study was performed to investigate IDV in cattle in Turkey. Animals analyzed in this study were from commercial cattle farms having respiratory disease in calves with significant mortality. Nasal swabs and tissue samples from cattle in Marmara, Inner Anatolia and Aegean region of Turkey were analyzed by real-time RT-PCR assay to detect IDV. Among 76 samples form 12 cattle herds, IDV was detected in 3 cattle in a herd. Sequencing and phylogenetic analysis of partial hemagglutinin esterase fusion (HEF) gene showed that the Turkish strain is 95% identical to its European and US counterparts, which suggest intercontinental spread of the virus. These findings highlight the need for future continuous surveillance on larger scale to determine the distribution pattern and evolution of this novel emerging pathogen in Turkish cattle industry.

[Diagnostics and Treatment of Cardiac Sarcoidosis - Consensus Paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)]

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.

Carcass and meat quality of Karacabey Merino and Kivircik lambs under an intensive finishing system

Carcass and meat quality traits of male and female lambs are important considerations in planning gender-based production and developing a marketing strategy for the product. Thus, the aim of this study was to determine the effects of sex on carcass and meat quality of Kivircik and Karacabey Merino lambs. Twenty male and 17 female lambs were used. Lambs were weaned at 45 days old and then fed ad libitum with concentrates and roughage until slaughter at 120 days. The study was carried out in two experiments at three-month intervals. Kivircik lambs had greater dressing percentage (47.96% vs 46.49%, P <0.05) and omental-mesenteric fat proportion (1.71% vs 1.10%, P <0.01), while Karacabey Merino lambs had a greater proportion of skin (11.14% vs 9.42%, P =0.001). Breed had no influence on water-holding capacity, shear force, L* and hue values (P >0.05). The meat of Karacabey Merino lambs had greater a*, b* and chroma values after blooming for 24 hours than meat from Kivircik lambs. Male lambs had greater proportions of head (5.39% vs 4.62%, P <0.001), feet (2.65% vs 2.46%, P <0.01) and visceral organs (4.53% vs 4.15%, P <0.05), while females had a greater proportion of visceral fat (1.76% vs 1.05%, P =0.001). Meat from female lambs was darker than meat from male lambs. In conclusion, under intensive conditions, the indigenous Kivircik breed had similar carcass and meat quality characteristics to the Karacabey Merino, a wool and meat breed. Keywords: breed effect; carcass quality; sex; lamb; meat quality

Sampling Hazelnuts for Aflatoxin: Uncertainty Associated with Sampling, Sample Preparation, and Analysis

The variability associated with the aflatoxin test procedure used to estimate aflatoxin levels in bulk shipments of hazelnuts was investigated. Sixteen 10 kg samples of shelled hazelnuts were taken from each of 20 lots that were suspected of aflatoxin contamination. The total variance associated with testing shelled hazelnuts was estimated and partitioned into sampling, sample preparation, and analytical variance components. Each variance component increased as aflatoxin concentration (either B1 or total) increased. With the use of regression analysis, mathematical expressions were developed to model the relationship between aflatoxin concentration and the total, sampling, sample preparation, and analytical variances. The expressions for these relationships were used to estimate the variance for any sample size, subsample size, and number of analyses for a specific aflatoxin concentration. The sampling, sample preparation, and analytical variances associated with estimating aflatoxin in a hazelnut lot at a total aflatoxin level of 10 ng/g and using a 10 kg sample, a 50 g subsample, dry comminution with a Robot Coupe mill, and a highperformance liquid chromatographic analytical method are 174.40, 0.74, and 0.27, respectively. The sampling, sample preparation, and analytical steps of the aflatoxin test procedure accounted for 99.4, 0.4, and 0.2% of the total variability, respectively.

Sampling Hazelnuts for Aflatoxin: Effect of Sample Size and Accept/Reject Limit on Reducing the Risk of Misclassifying Lots

About 100 countries have established regulatory limits for aflatoxin in food and feeds. Because these limits vary widely among regulating countries, the Codex Committee on Food Additives and Contaminants began work in 2004 to harmonize aflatoxin limits and sampling plans for aflatoxin in almonds, pistachios, hazelnuts, and Brazil nuts. Studies were developed to measure the uncertainty and distribution among replicated sample aflatoxin test results taken from aflatoxin-contaminated treenut lots. The uncertainty and distribution information is used to develop a model that can evaluate the performance (risk of misclassifying lots) of aflatoxin sampling plan designs for treenuts. Once the performance of aflatoxin sampling plans can be predicted, they can be designed to reduce the risks of misclassifying lots traded in either the domestic or export markets. A method was developed to evaluate the performance of sampling plans designed to detect aflatoxin in hazelnuts lots. Twenty hazelnut lots with varying levels of contamination were sampled according to an experimental protocol where 16 test samples were taken from each lot. The observed aflatoxin distribution among the 16 aflatoxin sample test results was compared to lognormal, compound gamma, and negative binomial distributions. The negative binomial distribution was selected to model aflatoxin distribution among sample test results because it gave acceptable fits to observed distributions among sample test results taken from a wide range of lot concentrations. Using the negative binomial distribution, computer models were developed to calculate operating characteristic curves for specific aflatoxin sampling plan designs. The effect of sample size and accept/reject limits on the chances of rejecting good lots (sellers' risk) and accepting bad lots (buyers' risk) was demonstrated for various sampling plan designs.

P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction

Background

Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown.

Objective

In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF).

Methods

In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent.

Results

sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above.

Analysis of sST2 in heart failure

Conclusions

We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.

P5274Characterization of cardiac involvement in patients with MELAS syndrome in comparison to HCM patients by conventional LGE imaging and novel T1-mapping

Background

MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) is a rare clinical subtype of mitochondrial myopathy. Cardiovascular magnetic resonance (CMR) images of MELAS-patients at an advanced state of the disease often show characteristic patterns: septal pronounced left ventricular (LV) hypertrophy and distinct focal myocardial scars in late-gadolinium-enhancement (LGE) images. This specific pattern is different from those seen in patients with hypertrophic cardiomyopathy (HCM) due to sarcomere protein mutations. Besides LGE imaging another method for the assessment of myocardial integrity, T1-mapping, has been established recently. This is the first study comparing native and enhanced T1-mapping (T1-na/en) as well as extracellular volume (ECV) values in HCM and MELAS.

Methods

12 patients with confirmed MELAS syndrome at different states of the disease, 13 HCM patients and 15 controls were included. All CMR studies were performed on a 1.5T MR scanner (Ingenia, Philips) using bSSFP cine sequences for the assessment of LV-function and MOLLI sequences for T1-na/en mapping. 15min after IV injection of 0.1mmol/kg BW Gadobutrol for LGE imaging, T1-en maps were acquired. For comparison of groups T1-na/en and ECV values in a basal short axis slice were used.

Results

Median and interquartile ranges of LV function, T1 and ECV are shown in the table. There was no difference in LV ejection fraction (LVEF) between the groups, but end-diastolic LV-mass was increased in HCM- and MELAS-patients vs. controls (p<0.001, p=0.028). In MELAS-patients, myocardial fibrosis was detected in focal spots clearly defined in both septum and free lateral wall. In HCM patients there was a rather diffuse LGE pattern in the hypertrophic septum and the RV insertion points. Here T1-na/en and ECV significantly differed from those measured in healthy controls (p<0.001, p<0.001, p=0.002). In the MELAS group T1-na values were significantly higher compared to controls (p=0.004) and significantly lower compared to HCM patients (p=0.003).

LV-function and mapping parameters of compared groups LV-EF, % LV-EDV, ml/m2 LV-mass, g/m2 T1-na, ms T1-en, ms ECV, % MELAS 57 (44–63) 86 (81–122) 80 (50–131) 969 (940–1033) 409 (381–465) 27 (24–35) HCM 60 (57–65) 50 (73–94) 94 (72–102) 1041 (1021–1074) 362 (346–430) 31 (28–36) Controls 61 (58–65) 72 (67–89) 53 (42–60) 937 (894–951) 464 (446–513) 26 (24–27)

Conclusion

Compared to healthy controls and HCM-patients, cardiac involvement in MELAS-patients is not only reliably visualized by conventional LGE imaging but also detected without the use of contrast agent by native T1-mapping. MELAS vs. HCM-patients show a different pattern of LGE and higher native T1 values, respectively.

P608Exercise testing and multi-parametric CMR assessment in patients with Ebstein anomaly

Background

Ebstein anomaly (EA) is a rare congenital heart disease characterized by an apically displaced tricuspid valve. It is associated with tricuspid valve regurgitation and right heart dilatation leading to significant morbidity. While echocardiography remains the mainstay of routine outpatient cardiac imaging, assessment of right ventricular (RV) anatomy and function is still challenging. Cardiovascular magnetic resonance imaging (CMR) has been shown to be of advantage in these patients being free from acoustic window limitations and offering superior volume quantification. In the present study, parameters obtained from cardiopulmonary exercise testing (CPET) were compared to conventional and novel CMR parameters in patients with EA.

Methods

In this prospective single centre study, N=17 patients with EA (mean age = 33.8±12.7yrs; N=10 females) underwent clinical assessment, CPET and multi-parametric CMR. Maximal work load (maxWL) and peak oxygen uptake (maxO2) were derived from CPET. CMR studies were performed on a 1.5-T Philips scanner and respective CMR parameters comprised a) anatomical, b) functional and c) myocardial deformation values of both ventricles.

Results

The majority of patients presented in NYHA class I or II (mean NYHA = 1.6±0.7) and with normal or mildly elevated NT-proBNP values (mean NT-proBNP = 189±158pg/ml). CPET-based maxWL was 147.14±55 watts and maxO2 19.32±5 ml/kg/min. CMR-based mean LVEF was 57.1±6.4% and RVEF was 46.5±11.1%, respectively. Deformation imaging revealed (amongst others) a LV global longitudinal strain (LV-gLS) of −13.7±3.0 and a RV global longitudinal strain (RV-gLS) of −14.7±5.0. Non-ischemic presence of late-gadolinium-enhancement was documented in 36% of our patients. Comprehensive correlation analysis revealed a substantial correlation a) between LV-gLS and NYHA class (r=0.64, p=0.01), but not between RV-gLS and NYHA class (r=0.19, p=0.46), b) between serum NT-proBNP levels and maxO2 (r=−0.53, p=0.03) as well as maxWL (r=−0.63, p=0.02), and c) between LV-EF and LV-gLS (r=−0.64, p=0.01).

Conclusion

Our preliminary data suggest that serum markers such as NT-proBNP and novel CMR parameters such as LV-gLS – but not RV-gLS - correlate with CPET-derived exercise parameters in patients with EA. The predictive value of these parameters regarding cardiac disease progression in EA has to be evaluated in future follow-up studies.

Effects of infliximab against carbon tetrachloride-induced intestinal injury via lipid peroxidation and apoptosis

Carbon tetrachloride (CCL₄) is often employed in the production of chlorofluorocarbons, petroleum refining, oil and rubber processing, and laboratory applications. Oral, subcutaneous, and inhalation exposure to CCL₄ in animal studies have been shown to be capable of leading to various types of cancer (benign and malignant, liver, breast, and adrenal gland tumors). The present study also evaluated the protective role of infliximab (INF) against the deleterious effects of CCL₄ on the intestinal system. Twenty-four male Sprague-Dawley rats were randomly assigned into three groups, control (n = 8), CCL₄ (n = 8), and CCL₄ + INF (n = 8). The control group received 1 mL isotonic saline solution only via intraperitoneal (i.p.) injection. The CCL₄ group received a single i.p. dose of 2 mL/kg CCL₄. The CCL₄ + INF group received a single i.p. dose of 7 mg/kg INF followed 24 h later by a single dose of 2 mL/kg CCL₄. All rats were euthanized 2 days following drug administration. CCL₄ group samples also exhibited diffuse loss of enterocytes, vascular congestion, neutrophil infiltration, an extension of the subepithelial space and significant epithelial lifting along the length of the villi with a few denuded villous tips. In addition, CCL₄ treatment increased intestinal malondialdehyde (MDA) level and caspase-3 positivity. On the other hand, INF decreased MDA levels, caspase-3 positivity, and loss of villous. Our findings suggest that CCL₄ appears to exert a highly deleterious effect on the intestinal mucosa. On the other hand, INF is effective in preventing this CCL₄-induced intestinal injury by reducing oxidative stress and apoptosis.

Artificial intelligence and amniotic fluid multiomics: prediction of perinatal outcome in asymptomatic women with short cervix

OBJECTIVE

To evaluate the application of artificial intelligence (AI), i.e. deep learning and other machine-learning techniques, to amniotic fluid (AF) metabolomics and proteomics, alone and in combination with sonographic, clinical and demographic factors, in the prediction of perinatal outcome in asymptomatic pregnant women with short cervical length (CL).

METHODS

AF samples, which had been obtained in the second trimester from asymptomatic women with short CL (< 15 mm) identified on transvaginal ultrasound, were analyzed. CL, funneling and the presence of AF 'sludge' were assessed in all cases close to the time of amniocentesis. A combination of liquid chromatography coupled with mass spectrometry and proton nuclear magnetic resonance spectroscopy-based metabolomics, as well as targeted proteomics analysis, including chemokines, cytokines and growth factors, was performed on the AF samples. To determine the robustness of the markers, we used six different machine-learning techniques, including deep learning, to predict preterm delivery < 34 weeks, latency period prior to delivery < 28 days after amniocentesis and requirement for admission to a neonatal intensive care unit (NICU). Omics biomarkers were evaluated alone and in combination with standard sonographic, clinical and demographic factors to predict outcome. Predictive accuracy was assessed using the area under the receiver-operating characteristics curve (AUC) with 95% CI, sensitivity and specificity.

RESULTS

Of the 32 patients included in the study, complete omics, demographic and clinical data and outcome information were available for 26. Of these, 11 (42.3%) patients delivered ≥ 34 weeks, while 15 (57.7%) delivered < 34 weeks. There was no statistically significant difference in CL between these two groups (mean ± SD, 11.2 ± 4.4 mm vs 8.9 ± 5.3 mm, P = 0.31). Using combined omics, demographic and clinical data, deep learning displayed good to excellent performance, with an AUC (95% CI) of 0.890 (0.810-0.970) for delivery < 34 weeks' gestation, 0.890 (0.790-0.990) for delivery < 28 days post-amniocentesis and 0.792 (0.689-0.894) for NICU admission. These values were higher overall than for the other five machine-learning methods, although each individual machine-learning technique yielded statistically significant prediction of the different perinatal outcomes.

CONCLUSIONS

This is the first study to report use of AI with AF proteomics and metabolomics and ultrasound assessment in pregnancy. Machine learning, particularly deep learning, achieved good to excellent prediction of perinatal outcome in asymptomatic pregnant women with short CL in the second trimester. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.