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Fei-Fei Chang, Chang-Chieh Chen, Shao-Hung Wang and Chiou-Lin Chen


Introduction: Laryngeal swab samples collected from three waterfowl slaughterhouses in central Taiwan were cultured and suspected isolates of Riemerella anatipestifer were identified by API 20NE and 16S rDNA PCR.

Material and Methods: Serum agglutination was used for serotyping, and antimicrobial susceptibility was tested.

Results: Seventy-six R. anatipestifer isolates were detected, and the prevalences in the ducks and geese were 12.3% (46/375) and 8.0% (30/375), respectively. The positive isolation rates were 65.6% for all arriving waterfowl, 76.0% for birds in the holding area, 1.6% for defeathered carcasses, but zero for degummed carcasses. A PCR examination detected R. anatipestifer in the slaughtering area frequently. Serotype B was dominant in both duck (34.8%) and goose (46.7%) isolates, but the wide serotype distribution may very well impede vaccination development. All isolates were resistant to colistin, and 79.7% were resistant to more than three common antibiotics.

Conclusion: The results proved that most ducks had encountered antibiotic-resistant R. anatipestifer in rearing, which suggests that the bacterium circulates in asymptomatic waterfowl. It is worth noting that most waterfowl farms were found to harbour R. anatipestifer, and contaminated slaughterhouses are a major risk factor in its spread. Effective prevention and containment measures should be established there to interrupt the transmission chain of R. anatipestifer.

Open access

Yi Chih Chang, Tien Hsing Chen, Pyng Jing Lin, Kuo Chun Hung, Fen Chiung Lin, Chun Chieh Wang, I Chang Hsieh, Jian Liang Wang, Hung Ta Wo and Chien Chia Wu


Background: Maintaining continuity between the mitral valve and the subvalvular apparatus during mitral valve replacement (MVR) maximizes the left ventricular (LV) function and increases the survival rate. However, MVR potentially cause rupture of the papillary muscles, systemic embolization, or dehiscence of the mitral annulus from the transposed position.

Objective: We presented a case with severe rheumatic mitral valve disease treated with MVR and partial preservation of the posterior and anterior chordae tendineae.

Methods: Retrospectively review of medical records.

Results: Transthoracic echocardiography performed two weeks after surgery revealed a floating mass in the posterior inferior aspect of the left atrium and a lobulated mass joining the tip of the posterior papillary muscle in the left ventricle. Perioperative examination confirmed a large thrombus in the left atrium and the stump of the preserved posterior papillary muscle of the mitral valve.

Conclusion: Thus, the papillary muscle could present itself as an abnormal mass on echocardiography, resulting in misdiagnosing.

Open access

Wei-Chieh Wu, Yi-Ru Chang, Yo-Liang Lai, An-Cheng Shiau, Ji-An Liang, Chun-Ru Chien, Yu-Cheng Kuo and Shang-Wen Chen



The aim of the study was investigate the impact of body-mass factors (BMF) on setup displacement during pelvic radiotherapy in patients with lower abdominal cancers.

Patients and methods

The clinical data of a training cohort composed of 60 patients with gynecological, rectal, or prostate cancer were analyzed. The daily alignment data from image-guided radiotherapy (IGRT) were retrieved. Setup errors for were assessed by systematic error (SE) and random error (RE) through the superior-inferior (SI), anterior-posterior (AP), and medial-lateral (ML) directions. Several BMFs and patient-related parameters were analyzed with binary logistic regression and receiver-operating characteristic curves. A scoring system was proposed to identify those with greater setup displacement during daily treatment. The results were validated by another cohort.


A large hip lateral diameter correlated with a greater SI-SE and AP-SE, whereas a large umbilical AP diameter correlated with a greater ML-SE and ML-RE. A higher SI-RE was associated with a large hip circumference. The positive predictors for setup uncertainty were chosen to dichotomize patients into groups at high risk and low risk for setup displacement. Based on the scoring system, the adequate treatment margins for the SI direction in the high-and low-risk groups were 5.4 mm and 3.8 mm, whereas those for the ML direction were 8.2 mm and 4.2 mm, respectively. The validated cohort showed a similar trend.


Large BMFs including hip lateral diameter, hip circumference, and umbilical AP diameter are associated with greater setup uncertainty. Based on the scores, IGRT or required treatment margins can be adapted for patients with high risk features.