Surgical Treatment of Chest Wall Tumors

peer reviewedThe observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps

Arterial Revascularization with Free Tissue Transfer for Salvage of Ischemic Limbs with Extensive Tissue Loss: An Alternative to Amputation

peer reviewedSevere limb ischemia is a common problem encountered in medical practice. Aggressive attempts at revascularization have extended the limits of limb salvage. However, in certain cases, extended tissue loss compromises the healing process. It often results in amputation despite bypass graft patency. Microvascular free tissue transfer combined with arterial revascularization allows healing of these wounds and limb preservation. This combined approach is the ultimate alternative to amputation

Pain trajectories and possible predictors of a favourable course of low back pain in patients consulting musculoskeletal physicians in The Netherlands

BACKGROUND: In The Netherlands, low back pain patients can consult physicians specialized in musculoskeletal (MSK) medicine. Previous studies have reported on the characteristics of patients consulting MSK physicians, and the treatment options used. There are no studies yet reporting on the course of Low Back Pain (LBP) after treatment by musculoskeletal (MSK) physicians in The Netherlands. METHODS: In an observational cohort study MSK physicians recorded data about all low back pain patients presenting for a first consultation. At baseline they recorded age, gender, type and duration of the main complaint, and concomitant complaints. At the end of treatment they recorded the type of treatment and the number of treatment sessions. Patients were recruited to answer questionnaires at baseline, and at 6-weekly intervals during a follow-up period of six months. Patient questionnaires included information about previous medical consumption, together with PROMs measuring the level of pain and functional status. Latent Class Growth Analysis (LCGA) was used to classify patients into different groups according to their pain trajectories. Baseline variables were evaluated as predictors of a favourable trajectory using logistic regression analyses, and treatment variables were evaluated as possible confounders. RESULTS: A total of 1377 patients were recruited, of whom 1117 patients (81%) answered at least one follow-up measurement. LCGA identified three groups of patients with distinct pain trajectories. A first group (N = 226) with high pain levels showed no improvement, a second group (N = 578) with high pain levels showed strong improvement, and a third group (N = 313) with mild pain levels showed moderate improvement. The two groups of patients presenting with high baseline pain scores were compared, and a multivariable model was constructed with possible predictors of a favourable course. Male gender, previous specialist visit, previous pain clinic visit, having work, a shorter duration of the current episode, and a longer time since the complaints first started were predictors of a favourable course. The multivariable model showed a moderate area under the curve (0.68) and a low explained variance (0.09). CONCLUSIONS: In low back pain patients treated by musculoskeletal physicians in The Netherlands three different pain trajectories were identified. Baseline variables were of limited value in predicting a favourable course. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12998-021-00392-3

Clonally Related Neisseria gonorrhoeae Isolates with Decreased Susceptibility to the Extended-Spectrum Cephalosporin Cefotaxime in Amsterdam, the Netherlands

From 2006 to 2008, Neisseria gonorrhoeae isolates were identified with decreased susceptibility to the extended-spectrum cephalosporin (ESC) cefotaxime among visitors of the Amsterdam sexually transmitted infections (STI) clinic, the Netherlands. Spread, clonality, and characteristics of 202 isolates were examined using antibiograms, conventional penA mosaic gene PCR, and N. gonorrhoeae multiple-locus variable-number tandem repeat analysis (NG-MLVA). A strictly defined subset was further characterized by N. gonorrhoeae multiantigen sequence typing (NG-MAST) and sequencing of ESC resistance determinants (penA, mtrR, and porB1b). Seventy-four N. gonorrhoeae isolates with a cefotaxime MIC of >0.125 mu g/ml (group A), 54 with a cefotaxime MIC of 0.125 mu g/ml (group B), and a control group of 74 with a cefotaxime MIC of <0.125 mu g/ml (group C) were included. Fifty-three clonally related penA mosaic-positive isolates (penicillin-binding protein 2 type XXXIV) were identified in group A (n = 47 isolates; 64%) and B (n = 6 isolates; 11%). The 53 penA mosaic-positive isolates were predominantly NG-MAST ST1407 (87%) and contained an mtrR promoter A deletion (98%) and porB1b alterations G101K/A102N. All were assigned to the same NG-MLVA cluster that comprised in total 56 isolates. A correlation was found between decreased cefotaxime susceptibility and ST1407 that was highly prevalent among visitors of the Amsterdam STI clinic. The rapid spread of this strain, which also has been identified in many other countries, might be facilitated by high-risk sexual behavior and should be monitored closely to identify potential treatment failure. Quality-assured surveillance of ESC susceptibility on the national and international levels and exploration of new drugs and/or strategies for treatment of gonorrhea are crucia

Multiple-Locus Variable-Number Tandem Repeat Analysis of Neisseria gonorrhoeae▿

The prevalence of Neisseria gonorrhoeae in the Netherlands has increased in recent years. A multiple-locus variable-number tandem repeat analysis (MLVA) was developed to assess the molecular epidemiology of N. gonorrhoeae and to elucidate transmission networks in high-risk groups in Amsterdam. The MLVA was evaluated using 5 variable-number tandem repeat (VNTR) loci with various degrees of polymorphism that were amplified in 2 multiplex PCRs and were then separated and sized on an automated sequencer. The assessed number of repeats was used to create MLVA profiles that consisted of strings of 5 integers. The stability of the VNTR loci was assessed using isolates obtained from multiple anatomical locations from the same patient (n = 118) and from patients and their sexual partners (n = 55). When isolates with a single locus variant were considered to belong to the same MLVA type, 87% of samples from multiple anatomical locations and 88% of samples from sexual partners shared an MLVA type. MLVA was ultimately performed on 880 isolates that were previously genotyped by restriction fragment length polymorphism (RFLP) analysis of the por-opa genes. Hierarchical cluster analysis of the MLVA profiles from 716 patient visits (one anatomical location per visit) classified 430 patient visits into 14 larger clusters (≥10 patient visits). In 7 clusters, 81% to 100% of isolates came from men who have sex with men (MSM); in 5 clusters, 79% to 100% of isolates came from heterosexuals; and 2 clusters contained isolates from fully mixed populations. Clusters also differed in characteristics such as ethnic background and coinfections. MLVA provided accurate identification of genetically related N. gonorrhoeae strains and revealed clusters of MSM and heterosexuals reflecting distinct transmission networks

Characterization and whole genome sequencing of closely related multidrug-resistant Salmonella enterica serovar Heidelberg isolates from imported poultry meat in the Netherlands.

Multidrug-resistant Salmonella enterica serovar Heidelberg isolates are frequently recovered in the Netherlands from poultry meat imported from South America. Our aim was to retrospectively assess the characteristics of the antimicrobial determinants, gene content and the clonal relatedness of 122 unique S. Heidelberg isolates from chicken meat from Brazil (n = 119) and Argentina (n = 3) that were imported between 2010 and 2015. These isolates were subjected to antimicrobial susceptibility testing, PCR and Illumina HiSeq2500 whole genome sequencing. Draft genomes were assembled to assess the gene content, and the phylogenetic relationships between isolates were determined using single nucleotide polymorphisms. Ciprofloxacin-resistance was identified in 98.4% of the isolates and 83.7% isolates showed resistance to the extended-spectrum cephalosporins cefotaxime and ceftazidime (83.6% and 82.8% respectively). Of the latter, 97.1% exhibited an AmpC phenotype and contained blaCMY-2, whereas the remaining three isolates contained an extended spectrum beta-lactamase. Of the 99 extended-spectrum cephalosporins-resistant isolates harboring CMY-2 plasmids, 56.6% contained the incompatibility group I1 replicon. Phylogenetic cluster analysis showed that all isolates from Brazil clustered together, with 49% occurring in clusters larger than 5 isolates that revealed intra-cluster similarities based on geographical location and/or resistance profiles. The remaining isolates were classified in smaller clusters or as singletons, highlighting the large diversity of S. Heidelberg in the poultry chain in Brazil that was revealed by this study. Considering the potential public health risk associated with multidrug-resistant S. Heidelberg in imported poultry, collaborative whole genome sequencing-based surveillance is needed to monitor the spread, pathogenic properties and epidemiological distribution of these isolates