Aims The objectives of this study were to estimate the prevalence of digital dermatitis (DD) in Victoria, Australia, and to investigate which organisms are consistent with typical DD lesions. The prevalence and causative pathogens of DD are not clear yet in Australia and this paper is one of the first to explore these questions in this country.Methods Examination and sampling of limbs was undertaken at three knackeries in Victoria, Australia. Limbs were classified as normal (N), active DD-lesion (A), dried or chronic DD-lesion (D) or suspected case of DD (S). A total of 823 cows were examined. Six skin biopsies were taken at each knackery, from which DNA was extracted for diversity profiling. Histochemical staining of samples was performed on eight of the skin biopsies.Results DD was detected in 29.8% of all cows. The prevalence of DD was significantly higher in dairy cows (32.2%) than in beef cows (10.8%). The differential abundance of Treponema-species was significantly increased in dried lesions, compared with the normal skin biopsies. Actinobacteria, Proteobacteria, Firmicutes and Tenericutes were found to be significantly different in abundance in the DD lesions compared with normal skin biopsies. Silver staining of samples showed only mild inflammation and in two samples organisms with morphology consistent with Spirochaetes were detected. ConclusionsThe calculated prevalence indicates that DD is present in Victoria, Australia. The results of diversity profiling showed that the presence of Treponema-species was significantly different between the samples of DD lesions and normal skin.
and the Cochrane Library through Wiley (ending December 15, 2017). Key findings: Of 160 patients with carotid webs, 135 (84%) were symptomatic and 24 (15%) were asymptomatic (1 could not be classified). Twenty-six patients (22%) had bilateral carotid webs. Regarding symptomatic patients, the median age was 46 years, 70% were black, 67% were women, and the majority (84%) had <50% internal carotid artery stenosis. Forty-seven (28%) symptomatic patients were managed medically (91% with antiplatelet agents); more than half of these patients (56%) suffered recurrent strokes distal to the carotid web during follow-up (median, 12 months; range, 0-97 months). Treatment of the other 70 (72%) symptomatic patients was equally divided between carotid endarterectomy and carotid stenting (CAS), and there were no complications.Conclusion: Carotid webs lead to ischemic stroke in younger patients with a high stroke recurrence rate in medically managed symptomatic patients, whereas carotid endarterectomy and CAS effectively prevented recurrent stroke.Commentary: A carotid web is also known as atypical focal carotid bulb fibromuscular dysplasia (FMD). It is defined as an intraluminal filling defect of the posterolateral wall of the most proximal part of the internal carotid artery. This atypical pathologic process is different from the classic "string of beads" seen in medial FMD. The underlying mechanism of stroke in carotid web patients is thought to be due to turbulent flow and stasis just distal to the web, resulting in thrombus and embolus.This study reported that more than half of patients with symptomatic carotid webs who were treated medically (primarily antiplatelet agents) had recurrent strokes. I find three aspects of this report intriguing (or defying belief, in other words). First, the large majority of symptomatic carotid web patients had only mild stenosis, which does not make a lot of sense. Why should lesser degrees of stenosis be associated with more thrombus beyond the web? Second, why did these patients undergo CAS and not plain old carotid balloon angioplasty, which is the recommended treatment for most patients with classic symptomatic FMD despite antiplatelet administration? Third, the authors recommend that patients with carotid web who had a stroke should be treated with CAS because antiplatelet agents did not prevent future strokes in half the patients. However, currently, antiplatelet agents are recommended as first-line treatment of patients with symptomatic carotid FMD, not carotid balloon angioplasty or CAS. Again, it does not make sense why a single web should be treated more aggressively than multiple "webs" or defects found in classic carotid FMD.The law of natural selection: Complex open aortic aneurysm repairs will more commonly be performed at high-volume centersdwithout the need for regulation Hospital Volume Matters: The Volume-Outcome Relationship in Open Juxtarenal AAA Repair O'Donnell TF, Boitano LT, Deery SE, Lancaster RT, Siracuse JJ, Schermerhorn ML, et al. Ann Surg 2018 Nov 29. [Epub ahe...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.