Phylogeny of Culex theileri virus flavivirus in Spain, Myanmar, Portugal and Turkey

Objective: To study the genetic diversity of Culex theileri flavivirus and the spread of this virus among Spain, Portugal and Turkey.Methods: A database consisting of 55 sequences of the NS5/3'UTR region of Culex theileri flavivirus group downloaded from GenBank were aligned and manual edited with Bioedit.ModelT est v.3.7 was used to select the simplest evolutionary model that adequately fitted the sequence data.Maximum likelihood analysis was performed using MEGA7.The phylogenetic signal of the dataset was investigated by the likelihood mapping analysis.Results: The phylogenetic tree showed three clusters.Myanmar sequences clusterd together with Turkish sequences, Spain and Portugal strains grouped together and two Turkish sequences grouped separately.Selective pressure analysis showed a moderate percentage of sites(22.5%) under pervasive negative selection and only 1% under pervasive positive selection.The sites subject to selective pressure in CTFV RdRp NS5 fragments have been located onto the predicted three-dimensional structure.Conclusions: Phylogenetic and evolutionary analysis can be an important tool for understanding the evolutionary impact of the probable contemporary existence between nonpathogenic and pathogenic flaviviruses among these vectors.

Validations of new cut-offs for surgical drains management and use of computerized tomography scan after pancreatoduodenectomy:The DALCUT trial

BACKGROUND Postoperative pancreatic fistula(POPF)is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections,sepsis and bleeding.A previous study which identified cut-offs of drains amylase levels(DALs)determined on postoperative day(POD)1 and POD3,was able to significantly predict POPF,abdominal collections and biliary fistulas,when related to specific findings detected at the abdominal computerized tomography(CT)scan routinely performed on POD3.AIM To validate the cut-offs of DALs in POD1 and POD3,established during the previous study,to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection.METHODS The DALCUT trial is an interventional prospective study.All patients who will undergo pancreatoduodenectomy(PD)for periampullary neoplasms will be considered eligible.All patients will receive clinical staging and,if eligible for surgery,will undergo routine preoperative evaluation.After the PD,daily DALs will be evaluated from POD1.Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days.RESULTS This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD.Drains could be removed in POD3 in case of POD1 DALs<666 U/L and POD3 DALs<207 U/L.In case of POD3 DALs≥252,abdominal CT scan will be performed in POD3 to identify abdominal collections≥5 cm.In this latter category of patients,drains could be maintained beyond POD3.CONCLUSION The results of this trial will contribute to a better knowledge of POPF and management of surgical drains.