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Bacterial community composition of biofilms in milking machines of two dairy farms assessed by a combination of culture-dependent and –independent methods
Authors: Mareike Weber aff001; Janine Liedtke aff001; Susanne Plattes aff002; André Lipski aff001
Authors place of work: Department of Food Microbiology and Hygiene, Institution of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University, Bonn, North-Rhine-Westfalia, Germany aff001; CIDRe, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, North-Rhine-Westfalia, Germany aff002
Published in the journal: PLoS ONE 14(9)
Category: Research Article
doi: https://doi.org/10.1371/journal.pone.0222238Summary
Dairy biofilms as a source of contamination of milk and its products are of great concern in the dairy industry. For a reliable risk assessment, knowledge about the microbial community composition of biofilms in the milking systems of dairy farms must be improved. In this work, swab samples of milking machine biofilms of two dairy farms were investigated by a combination of culture-dependent and -independent methods. Spots in the milking system with enhanced microbial colonization were identified by quantification on selective and non-selective media. In addition, stainless steel coupons were placed into the piping system of a milking machine, removed after several milking intervals, and investigated for colonization by cultivation and culture-independently. Isolates were differentiated and identified by a combination of chemotaxonomical methods and 16S rRNA sequencing. The culture-independent approach involved treatment of the samples with the viability dye propidium monoazide prior to direct DNA-extraction by enzymatic cell lysis and cloning to exclude bias from dead biomass. The milking equipment retainers and the outlet of the milk bulk tank were identified as highly colonized spots on both farms. A high bacterial diversity was detected covering the phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria. Presence of biofilms was demonstrated on several materials including stainless steel and plastic, which are frequently used in milking machines, but also in dairy processing plants. Growth of mainly Gram-positive bacteria with high percentages of the phylum Actinobacteria was detected on the stainless steel coupons after exposition in the milking system for two to three days. Knowledge about the heterogenic microbial load on different parts of the milking machines and the stainless steel coupons will help to identify primary colonizers of the milking system, to assess the risk potential of biofilms for raw milk, to improve sanitation processes and to identify parts of the milking machine, which should be improved by hygienic design.
Keywords:
Biology and life sciences – Organisms – Physical sciences – Engineering and technology – Anatomy – Medicine and health sciences – Microbiology – Medical microbiology – Microbial pathogens – Bacterial pathogens – Bacteria – Pathology and laboratory medicine – Pathogens – Materials science – Physiology – nutrition – Actinobacteria – Body fluids – Diet – Bacteriology – equipment – Bacterial biofilms – Biofilms – Bacillus – Beverages – Milk – Metallurgy – Alloys – Steel – Stainless steel
Introduction
Biofilms are accumulations of microbial cells attached to surfaces and embedded in self-produced matrices [1]. Attachment of cells and subsequent biofilm formation can be influenced by surface material, roughness, and hydrophobicity, which can in turn be affected by surface conditioning with food ingredients [2, 3].
Bacterial biofilms are a major problem in the food industry. Once attached, biofilm cells can withstand unfavorable environmental conditions, such as nutrient depletion or treatment with antimicrobial substances [4, 5]. Thus, it is difficult or impossible to remove mature biofilms by standard cleaning and sanitation processes [6].
For the dairy industry biofilm formation is a fundamental problem, because raw milk contains a wide variety of microorganisms and dairy products are susceptible to microbial spoilage. Even if primary biofilm formers are neither spoilage organisms nor pathogens, established biofilms can become a habitat for harmful organisms like Listeria monocytogenes [7]. Biofilms on surfaces with contact to pasteurized products pose a threat to human health and product quality [8, 9]. Additionally, the secretion of heat-resistant spoilage enzymes such as proteases and lipases by biofilm inhabitants into the raw milk can lead to reduced shelf-life of UHT milk [3, 10].
The bacterial community composition of raw milk has been described in detail by culture-dependent [11, 12] and–independent methods [13, 14], as well as by a combination of both [15–18]. For direct molecular methods, the effectiveness of DNA-extraction and the application of viable-PCR (vPCR) are crucial for the completeness and comparability of the depicted bacterial community composition [18].
The microbiota of udders and of the stable environment have already been described as sources for raw milk contamination [12, 17]. Dairy biofilms have been analyzed in sprinklers from dairy farm cooling systems [19], raw milk pipelines on dairy farms [20], raw milk cooling tanks [21], raw milk road tankers [10] and in dairy processing plants [8, 22, 23] so far. Many studies focus on the detection of pathogens, like Listeria monocytogenes [24], or on other prominent milk associated bacterial genera [25].
Biofilms in milking machines on dairy farms may affect udder health as well as the raw milk microbial load and microbiota. The spread of biofilm forming bacteria from raw milk to milk tankers and dairy processing plants affects the composition of biofilms in these areas.
To our knowledge, there are no data available about the microbial community composition of biofilms in milking systems detected by a combination of culture-dependent and -independent methods on different dairy farms. Those data are essential to assess the contribution of the milking system itself to raw milk contamination in addition to teat microbiota or other cow-associated microorganisms. The comparative investigation of different dairy farms can reveal typical bacterial genera present in milking machine biofilms and detect critical spots in the machine milking process with increased biofilm formation. Moreover, the recolonization dynamics of milking systems after cleaning and sanitation procedures are an important aspect for hygienic evaluation of the milking system operation. Therefore we included experiments with stainless steel coupons placed into the piping system of an operating milking system for several days to track the process of biofilm formation. Tracking biofilm formation on stainless steel coupons will help to identify bacterial genera initiating biofilm formation on stainless steel in the dairy environment under realistic conditions. The characterization of biofilms in milking machines as the starting point of dairy production can help to optimize cleaning and sanitation processes.
The aim of the present work was comparing the bacterial community composition of biofilms in the milking machines of two different dairy farms and tracking biofilm formation on stainless steel coupons placed into one milking machine during ongoing operation. To increase the detected bacterial diversity, a parallel approach of culture-dependent and -independent methods with viable-PCR (vPCR) was applied.
Materials & methods
Biofilm sampling
Characterization of the investigated dairy farms
Farm 1 (F1) is a research farm of the University of Bonn (Königswinter, Germany), where the raw milk of 60 German Holstein cows is collected twice daily. The milking machine and the bulk tank (Kryos 6BII, WestfaliaSurge Japy SAS, Saint Apollinaire, France) are cleaned in a cleaning in place (CIP) regime by alkaline (Circo Super AFM) or acidic treatment (Circo Super SFM) (GEA Farm Technologies, Bönen, Germany). The active compounds of the alkaline treatment are sodium hypochloride and sodium hydroxide, while the acidic treatment combines phosphoric acid and nitric acid. Alkaline and acidic treatments are applied alternating between each milking interval. The detergents are diluted automatically, resulting in final concentrations of 0.4%, as recommended by the manufacturer. Each treatment is preceded and followed by a water rinse.
Farm 2 (F2) is an owner-managed facility in Schlausenbach (Germany) with 18 cows milked twice daily. The milking machine and the bulk tank (Westfalia Systemat, WestfaliaSurge Japy SAS, Saint Apollinaire, France) are cleaned with an alkaline agent (Eifelrein A, Arla Foods Deutschland GmbH, Pronsfeld, Germany) with concentrations of 0.2% at 40°C for 30 min (milking machine) and 0.3% at 30°C for 15 min (bulk tank), respectively. Each cleaning cycle is preceded by a five-minute water rinse and followed by a 10 min water rinse.
We confirm that all authorities issued the permission for the field studies described. Owner of farm 1 is the Bau - und Liegenschaftsbetrieb (BLB) NRW (building and real estate management of the state North Rhine-Westphalia). The owner granted permission for this study. Owner of farm 2 is Susanne Plattes. She is a co-author of this study and permission was granted by her.
Swab sampling
Swab samples of biofilms were taken from the milking machines of the two dairy farms about 4 h after the cleaning and sanitation process. Samples were taken from the teat cups (TC), the milking equipment retainers (R), the stainless steel pipe containing the in-line milk filter (FP), a stainless steel pipe at the beginning of the pressure line (BP), a plastic pipe at the end of the pressure line (EP) and the outlet of the bulk tank (OB). Fig 1 shows a schematic diagram of the milking machine of farm 1.
Fig. 1. Schematic diagram of the milking machine of farm 1.
The proximity to the udders decreases from the teat cups to the outlet of the milk bulk tank.
Samples of farm 1 were taken in March and August 2014 and in June 2015. The 2014 samples were investigated by the culture-dependent method, while the 2015 samples of farm 1 and the samples of farm 2, taken in October 2014, were investigated culture-dependently and -independently in parallel approaches.
Stainless steel coupons
Stainless steel coupons (7.5 x 2.5 cm) (V2A, 1.4301, X5CrNi18-10) were cleaned by incubation in acetone for at least 3 h, rinsed with distilled water and sterilized by autoclaving. Sterilized and cleaned coupons were placed into the spiral holding the filter at the beginning of the pressure line in the milking machine of farm 1. They remained within the spiral during ongoing operation of the milking machine (including milking and CIP-processes) until they were removed for investigation. The removal took place at least 4 h after the last CIP-process so that surviving cells could recover in order to be detected by cultivation. During three samplings in November 2015, October 2016 and February 2017, the coupons remained in the milking machine for 48 h, which equals four milking intervals as well as CIP-procedures. In another sampling in December 2015, the coupons remained in the milking machine for 72 h (six milking intervals/CIP-procedures).
Enumeration and isolation of bacteria
The swabs were transferred into sterile test tubes containing 10 ml of Ringer’s solution (Merck KGaA, Darmstadt, Germany) and stirred on a vortex mixer for 25 s. Serial dilutions were spread on the following media (all by Merck KGaA, Darmstadt, Germany): trypticase soy agar (TSA) for total microbial count (TMC), violet red bile dextrose agar (VRBD) for the detection of Enterobacterales, cetrimide agar (CFC) for Pseudomonas spp., Baird Parker agar (BP) for Staphylococci and de Man, Rogosa, and Sharpe agar (MRS) for lactic acid bacteria (LAB). The stainless steel coupons were pressed on the surface of the agar media described above for several seconds. Plates were incubated at 30°C for 72 h. MRS agar was only used for swab samples and stainless steel coupons of farm 1 and was incubated anaerobically. The main colonizers, defined by uniform colony morphology, were selected for isolation from each medium and purified on TSA for subsequent identification.
Differentiation and identification of isolates
Isolates were characterized according to their colony and cell morphology and differentiated by Gram-staining [26] and KOH lysis test. Fatty acid analysis was conducted for each isolate after growth on TSA for 48 h at 30°C. Fatty acid methyl esters were prepared according to the method of Sasser (1990) [27] and analyzed by GC-MS with a model 7890A (Agilent, Waldbronn, Germany) gas chromatograph equipped with a 5% phenylmethylsilicone capillary column and a model 5975C (Agilent, Waldbronn, Germany) mass spectrometer, as described by Lipski and Altendorf (1997) [28].
The isolates were grouped according to their fatty acid profiles and representative isolates of each group were identified by 16S rRNA gene sequencing, as described previously [18]. They were assigned to a species at ≥ 98.7% sequence similarity [29] with type strain sequences taken from the databases EzTaxon server [30] and GenBank using the Basic local alignment search tool (BLASTN) [31] at the NCBI-website.
Biofilm formation assays
The biofilm forming potential of the farm 1 isolates was tested in 96-well polystyrene microplates in tryptic soy bouillon (TSB, Merck KGaA, Darmstadt, Germany) according to the method of Kolari et al. (2003) [32] with minor modifications. The cell density per well was adjusted to 1 x 106 cfu/ml in 200 μl TSB. After incubation (30°C, 24 h), the wells were emptied and filled with 250 μl of crystal violet solution (4 g/l in 20% methanol). After 5 min of incubation, the plates were emptied, washed three times with distilled water (Nunc ImmunoTM Washer, Thermo Scientific, Waltham, USA) and the dye was extracted by addition of 300 μl of ethanol. After 60 min, the absorbance at 550 nm was measured by a microplate reader (Epoch Reader, BioTek, USA). The mean absorption of the blank was subtracted from the absorption of the isolates. The biofilm forming ability of the isolates was propotional to their mean absorption (n = 4) and classified as strong (Abs 550 nm ≥ 2.0), moderate (2.0 > Abs 550 nm ≥ 0.5), weak (0.5 > Abs 550 nm ≥ 0.1) or no biofilm formation (Abs 550 nm < 0.1).
Spoilage potential
Lipolytic activity was analyzed on tributyrin agar (TSA supplemented with 1.0% v/v tributyrin) and proteolytic activity was analyzed on TSA containing 5% (w/v) skim milk powder [33]. Plates were incubated at 30°C for 72 h.
PMA treatment, DNA extraction and cloning of the 16S rRNA genes
Both sides of a stainless steel coupon were rubbed with swabs wetted in Ringer’s solution. The swabs were transferred into sterile test tubes containing 10 ml of Ringer’s solution and the cells were removed by stirring. 2 ml of the suspensions were treated with propidium monoazide (PMA) [stock solution: 20 mM PMA (Biotium Inc., Hayward, CA) in 20% dimethyl sulfoxide (AppliChem GmbH, Darmstadt, Germany)] at a final concentration of 75 μM. Incubation in the dark and PMA activation by light exposure were conducted as described previously [18].
After centrifugation at 13,000 x g for 10 min, the cell pellet was resuspended in 180 μl of lysis buffer [20 mM Tris HCl (pH 8.2), 2 mM EDTA, and 1.2% Triton X-100] containing lysozyme (20 mg/ml) and lysostaphin (0.15 mg/ml), and 9 μl of mutanolysin was added (stock solution: ≥ 4,000 U in 0.1 M potassium phosphate buffer, pH 6.2) (all chemicals by Sigma Aldrich, Munich, Germany). The mixture was incubated at 37°C for 30 min, then 25 μl of Proteinase K and 200 μl of buffer AL (both Qiagen GmbH, Hilden, Germany) were added. Another incubation step at 70°C for 30 min was followed by addition of 200 μl of ethanol (Merck KGaA, Darmstadt, Germany). Further DNA extraction was performed using the DNeasy Blood & Tissue kit (Qiagen GmbH, Hilden, Germany) according to the manufacturer’s instructions.
The 16S rRNA genes were amplified using the primer pair GM3F and GM4R [34] and the PCR products were purified using the QIaquick PCR purification kit (Qiagen, Hilden, Germany).
The purified PCR products were used to construct clone libraries with the pGEM-T vector system and were transferred into competent E. coli JM109 cells as specified by the manufacturer (Promega Corp., Madison, WI). Inserts of randomly selected clones were amplified using the primer pair M13F and M13R [35]. PCR products that were confirmed to have the correct length by gel electrophoresis were purified and sequenced as described previously [18]. Prior to identification, all sequences were checked for chimeras by using the Pintail program [36] and chimeric sequences were excluded from further analysis.
Statistical analysis and construction of phylogenetic trees
Coverage according to Good (1953) [37] was calculated to assess the completeness of the depicted bacterial diversity by the number of sequenced clone inserts. Sequences were assigned to the same operational taxonomic unit (OTU) at ≥ 99% sequence similarity [38]. Shannon-Index (H) and Equitability (E) were calculated for each sample [39].
Representative sequences of each OTU obtained in this study were deposited in the European Nucleotide Archive (ENA) or GenBank under the accession numbers LN717247, LN997865 to LN998002, MK547258 to MK547271, MK547287 to MK547293, LT222224, and LT222225.
Results
Bacterial counts
The total microbial count as well as the bacterial counts for presumptive Enterobacterales, Pseudomonas spp., Staphylococcus spp. and lactic acid bacteria are presented in Table 1. The bacterial counts of the teat cups of both farms were lower than the detection limit of 0.4 log10 cfu/cm2.
Tab. 1. Biofilm bacterial counts on different parts of the milking machines of farm 1 (F1) and farm 2 (F2) and on stainless steel coupons placed into the milking machine of farm 1 for different time intervals.
The highest mean TMC of 6.3 log10 cfu/cm2 was detected on the milking equipment retainers of farm 1, followed by the plastic pipe at the end of the pressure line and the outlet of the milk bulk tank with TMCs about 2 log levels lower. On farm 2, the TMC for the outlet of the milk bulk tank was one log level higher than the mean TMC of the milking equipment retainers. While the TMCs for the filter tubes of both farms were similar, the TMC of the plastic pipe at the end of the pressure line on farm 2 was 2.4 log levels lower than on farm 1.
The high standard deviations on the stainless steel pipe at the beginning of the pressure line and the outlet of the milk bulk tank of farm 1 indicate that the population density ranged from TMCs close to the detection limit to higher TMCs on different sampling occasions. In contrast to this, the standard deviations of all other sampling spots of farm 1 were considerably lower, indicating constant population densities between different samplings within a period of 15 months.
The TMC on the stainless steel coupon exposed in the milking machine for 48 h in October 2016 was lower than the detection limit of 1 cfu/18.8 cm2, while the TMCs were 5 and 3 cfu/cm2 in November 2015 and February 2017, respectively, resulting in a mean log10 cfu/cm2 of 0.4. The TMC more than doubled on the coupon with extended exposition time in the milking machine for 72 h.
On both farms, presumptive Enterobacterales and Pseudomonas spp. were only detected on the milking equipment retainers and the outlet of the milk bulk tank, which were the spots with the highest TMCs. However, no Pseudomonas spp. could be detected on the milking equipment retainers of farm 2, and presumptive Enterobacterales were only detected on one of the two sampled retainers.
The bacterial counts of presumptive lactic acid bacteria increased from 1.7 ± 1.0 at the filter tube to 3.3 ± 0.6 log10 cfu/cm2 at the plastic pipe at the end of the pressure line of farm 1. LAB dominated in the pipe system of farm 1 together with presumptive Staphylococcus spp. In contrast to this, Staphylococci were not detected in the biofilm samples of the milking machine of farm 2.
Bacterial community composition
The length of the 16S rRNA gene sequences used for isolate and clone identification ranged from 647 bp to 1475 bp, respectively. Clone libraries were successfully generated from swab sampling spots with high microbial counts (> 2.8 log10 cfu/cm2). No clone libraries could be generated from spots with low microbial counts (< 2.6 log10 cfu/cm2). Despite of the low TMC on the stainless steel coupons, clone libraries were successfully constructed for the coupons from December 2015 that were exposed in the milking machine for 72 h, as well as for the coupons from October 2016 and February 2017 that remained there for 48 h.
Overall, 120 isolates and 59 clone sequences from the swab samples of farm 1 and 24 isolates and 61 clone sequences from farm 2 were identified by 16S rRNA gene sequencing. Moreover, 55 isolates and 28 clone sequences from the stainless steel coupons placed in the milking machine of farm 1 were identified.
Table 2 shows the percentage distribution of the detected phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria within clone and isolate sequences of both farms. Swab samples and stainless steel coupons of farm 1 are depicted separately. Regarding the swab samples, the majority of isolate and clone sequences belonged to the phylum Proteobacteria, with 38% of all isolate sequences and 56% of all clone sequences of farm 1, and 42% of all isolates and 37% of all clone sequences of farm 2.
Tab. 2. Percentage distribution of phyla within isolate and clone sequences from swab samples of both farms and stainless steel coupons from farm 1.
The second and third most abundant phyla were different for the culture-dependent compared to the culture-independent approach. In the isolation approach, about one third of the swab isolates of farm 1 were members of the phyla Actinobacteria and Firmicutes, respectively. However, the phylum Actinobacteria was not represented within the clone sequences, while the phylum Firmicutes was represented by only five clone sequences (9%). On farm 2, the phylum Actinobacteria was also the second most abundant phylum in the isolation approach with similar percentages to farm 1, followed by the phylum Firmicutes, to which 17% of the isolate sequences were assigned. In contrast to farm 1, 15% of the clone sequences of farm 2 belonged to the phylum Actinobacteria, while no clone sequence was assigned to the phylum Firmicutes. The phylum Bacteroidetes, which was represented by less than 10% of all isolate sequences of both farms, made up considerably larger percentages (35% and 48%) of the clone sequences.
The percentage distribution of phyla detected on the stainless steel coupons, which remained in the milking machine of farm 1, clearly differed from the swab samples. Most of the coupon isolates were assigned to Gram-positive phyla. The percentage of the phylum Actinobacteria (69%) was more than twice as high as within the swab samples, while the proportion of the phylum Firmicutes was similar to the swab samples. Less than 10% of the isolates from coupons were assigned to the phyla Bacteroidetes and Proteobacteria, respectively. However, more than half of the clone sequences represented the phylum Proteobacteria, while no Bacteroidetes clone sequence was obtained. In contrast to the swab samples of farm 1, about one third of the clone sequences from coupons were assigned to the phylum Actinobacteria, while five clone sequences from coupons (18%) represented the phylum Firmicutes.
Species identification as well as the number of clone and isolate sequences per sampling spot of the detected phyla Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria are presented in Table 3. Their biofilm formation, mastitis pathogenic potential described in literature, and spoilage potential is also indicated. Multiple sequences from the same farm obtained by the same approach (culture-dependent or -independent) with ≥ 99% sequence similarity were assigned to the same operational taxonomic unit (OTU). Sequences which were assigned to the same type strain or genus but with < 99% sequence similarity among each other are labelled with consecutive numbers. The Accession numbers of representative sequences for each OTU, as well as for sequences of single strains or single clones are given in Table 3.
Tab. 3. Species and genera detected in biofilm samples of farm 1 (F1) and farm 2 (F2) as determined by culture-dependent methods (isolate sequences, I) and clone libraries (C).
Biofilm formation (B), mastitis pathogenic (M) and/or spoilage (S) potential are highlighted.
Species affiliation was determined as ≥ 98.7% sequence similarity to type strains obtained from the databases “BLAST” and “EzTaxon-e server”. One representative sequence for each species was deposited in the European Nucleotide Archive (ENA) or GenBank with the given Accession-Numbers. The number of sequences is given for the different isolation sources: teat cups (TC), milking equipment retainers (R), filter pipe (FP), stainless steel pipe at the beginning of the pressure line (BP), plastic pipe at the end of the pressure line (EP), outlet of the raw milk bulk tank (OB), and stainless steel coupon (SC). Sequences of the same farm and approach with ≥ 99% sequence similarity were assigned to the same operational taxonomic unit (OTU); sequences which were assigned to the same type strain or genus but with < 99% sequence similarity among each other are labelled with consecutive numbers. Origin of sequence: strain number, clone or representative sequence for OTU. Extent of biofilm forming ability is subdivided into weak (+), moderate (++), strong (+++), or no biofilm formation (−). Spoilage potential is subdivided in lipolysis (L) and proteolysis (P), or no spoilage potential (−). * indicates that strain specific differences of the trait were detected; “M”, considered as potential mastitis pathogen; nd, not determined; “/”, not applicable for clone sequences.
The majority of 82 isolate sequences were assigned to the phylum Actinobacteria. A high species richness of the genus Microbacterium and high numbers of isolates of the genus Kocuria were detected on both farms. The species Kocuria salsicia was isolated from different parts of the milking machine of both farms. A large proportion of the isolates assigned to the genera Arthrobacter, Gordonia, Dermacoccus, Rhodococcus, Kocuria and Microbacterium originated from the stainless steel coupons that remained in the milking machine of farm 1 for several days during ongoing operation. Except for the ladder two genera, they were not that abundant in the swab samples of the same milking machine. While nine clone sequences of farm 2 were assigned to the genera Microbacterium, Plantibacter, Renibacterium and Propioniciclava, all sequences from the coupon DNA-extracts of farm 1 were assigned to the species Microbacterium foliorum/phyllosphaerae.
Of the phylum Bacteroidetes, a high species richness of the genus Chryseobacterium was detected for both farms. While seven clone sequences and one isolate of farm 2 were assigned to five different OTUs of the genus Sphingobacterium, only two isolates of farm 1 were identified as Sphingobacterium spiritivorum and Sphingobacterium multivorum.
Only four isolates from farm 2 were designated to the genera Bacillus, Staphylococcus and Lactococcus of the phylum Firmicutes. In contrast to this, twelve isolates of farm 1 were assigned to seven different species of the genus Bacillus, and eight isolates and three clone sequences were assigned to seven different Staphylococcus species. The species Enterococcus faecalis and Lactobacillus casei were represented by clone and isolate sequences of farm 1. Three clone sequences originating from different stainless steel coupons were assigned to the species Listeria monocytogenes. This species was neither isolated from the swab samples nor from the stainless steel coupons of farm 1.
A high diversity of isolates and clone sequences of both farms was assigned to the phylum Proteobacteria. Many isolate and clone sequences belonged to different species of the genus Acinetobacter. Representatives of the species Acinetobacter guillouiae were detected on the milking equipment retainers of both farms. Different species of the genus Pseudomonas were isolated preferentially from the outlet of the milk bulk tank of both farms. In contrast to the genus Acinetobacter, to which 18 clone sequences of both farms were assigned, only one coupon clone sequence of farm 1 was assigned to the genus Pseudomonas. Eight isolates of different genera from the order Enterobacterales derived predominantly from the milking equipment retainers and the outlet of the milk bulk tank of farm 1. 24 clone sequences from various swab sampled areas as well as from the stainless steel coupons of farm 1 were designated to the species Rhodanobacter glycinis. This species was not represented within the isolates.
In conclusion, the culture-dependent approach led to the identification of 176 isolates from farm 1, which could be designated to 86 different species. In the parallel culture-independent approach, the identification of 85 clone sequences led to the detection of 20 different species. Six of them were also detected by the isolation approach. From the swab samples of farm 2, 24 isolates were assigned to 17 different species, while 61 clone sequences were assigned to 31 different species. Six species were detected by both approaches. In total, eight out of 135 species were detected on both farms, either by isolation or by the cloning approach.
Most of the isolates belonging to the dominating genera in the milking machine biofilms of farm 1 were classified as strong biofilm formers in microplate tests. These were the genera Kocuria, Bacillus, Acinetobacter, Pseudomonas as well as different isolates of the order Enterobacterales (e. g. Serratia marcescens and Escherichia coli). A high proportion of isolates with strong biofilm forming potential was found in the phylum Proteobacteria. While many isolates of the phylum Actinobacteria showed lipolytic activity, lactic acid bacteria showed proteolytic activity. Many strains of the genera Bacillus, Pseudomonas, Serratia and Stenotrophomonas were lipolytic and proteolytic.
Statistics
The coverages of the cloning approach for the swab samples of farm 1 were 86.2% for the milking equipment retainers, 90.9% for the filter tube, and 100% for the plastic pipe at the end of the pressure line and the outlet of the milk bulk tank, respectively. The coverages for farm 2 were 84.2% for the milking equipment retainers, and 64.3% for the outlet of the bulk tank. The coverage for the stainless steel coupons placed in the milking machine of farm 1 was 85.1%. This demonstrates that most of the microbial diversity of these habitats was recovered by this analysis.
The Shannon diversity indices and Equitability values for the culture-dependent and culture-independent approaches of both farms are depicted in Table 4. The microbial diversity described by the Shannon indices was generally higher for the cultivation approaches than for the molecular approaches. As an exception, the Shannon index of the milking equipment retainers of farm 2 was higher in the cloning approach than in the cultivation approach. The highest Shannon index depicting the highest microbial diversity was detected on the stainless steel coupons and the milking equipment retainers of farm 1, while the highest diversity for farm 2 was detected on the outlet of the raw milk bulk tank.
Tab. 4. Shannon diversity index (H) and Equitability (E) values of the different sampling spots calculated for the culture-dependent isolation approach and the molecular cloning approach of farm 1 and farm 2.
The equal distribution of the detected diversity across the identified taxa is presented as Equitability values. These values were higher for the cultivation approaches than for the culture-independent approaches, except for the bulk tank outlets of both farms, as well as the plastic pipe at the end of the pressure line and the stainless steel coupons of farm 1, where no or only minor differences were observed. Equitability values close to 1.0 indicate a uniform distribution of taxa, whereas lower equitability values indicate the dominance of particular taxa. The latter was observed for the milking equipment retainers in the culture-independent approach of both farms as well as for the molecular approach of the filter tube of farm 1.
Discussion
Bacterial loads on different parts of the milking machine
The milking equipment retainers and the outlets of the milk bulk tank of both farms were spots with high microbial loads with TMCs between 3.8 and 6.3 log10 cfu/cm2. These findings were in accordance with the findings of Flach et al. (2014) [21], who found the highest bacterial counts on the milk drain valves of raw milk cooling tanks on dairy farms by cultivation techniques. These spots are in close contact with the cows during milking on the one hand and with the consumer and the dairy industry on the other hand. High TMCs on the milking equipment retainers could be an essential source of contamination of the milking system with biofilm formers, pathogenic bacteria and/or spoilage organisms, while high TMCs on the outlet of the bulk tank could lead to the transfer of these organisms to the dairy industry.
The high TMCs can be explained by inadequate cleaning and sanitation processes. Both spots are not covered by the CIP-procedures used to clean the milking machine after each milking. In addition, after water rinsing of the teat cups, they are placed on their retainers under wet conditions, which favors bacterial growth. Since the milking equipment retainers themselves are not cleaned at regular intervals, residues can accumulate on the retainer surface. This was confirmed by visibly loaded swabs after sampling.
The bulk tanks and their outlets are cleaned by CIP-procedures only after pickup of the raw milk by the purchaser. In case of farm 1, this takes place every three days. Within this period, farm staff frequently takes milk samples from the outlet. Additionally, during milking the bulk tank outlet is connected to the piping system of the milking machine acting as tank inlet. Despite of water rinses afterwards, milk residues may favor bacterial growth. Flach et al. (2014) [21] also found that the milk drain valve is difficult to clean and they observed milk residues on the swabs used for sampling.
On most sampling spots of the piping system of both farms, TMCs were lower than on the milking equipment retainers and the outlet of the bulk tank. Only the plastic pipe at the end of the pressure line of farm 1 had a TMC in the range of the bulk tank outlet. An explanation can be oxygen-limitation that might appear within the piping system and limit bacterial growth. An evidence for limited oxygen availability is the increasing abundance of lactic acid bacteria in the piping system of farm 1. Lactic acid bacteria are aerotolerant anaerobes and might have a growth advantage over obligate aerobes at low oxygen concentrations.
Except for the outlet of the milk bulk tank, the plastic surfaces of farm 1 appeared to have higher bacterial counts than the stainless steel surfaces. This could be due to the slightly higher surface hydrophobicity of plastic compared to stainless steel. Although the original surface hydrophobicity of the material plays only a minor role for bacterial adhesion, it may impact surface conditioning by milk components during milking. Modification of the physicochemical properties of the original surface may then favor bacterial adhesion and subsequent biofilm formation [40, 41]. However, such tendency was not observed on farm 2, where the plastic pipe at the end of the pressure line had a lower TMC than the stainless steel filter pipe.
Another reason for the high TMC of the plastic pipe at the end of the pressure line of farm 1 could be a higher surface roughness of the material, which could favor biofilm formation and protect bacteria from shear stress during the CIP-procedures. The plastic pipe had an operating time of several years at the moment of sampling. This contrasts with the teat cups, which are replaced at regular intervals and would argue for a higher surface roughness due to material stress. Although the effect of surface roughness on biofilm formation is adversely discussed in the literature [41], Latorre et al. (2010) [9] also observed that biofilms on milk meters were mainly associated with surface scratches by applying scanning electron microscopy.
The exposition of stainless steel coupons in the milking machine of farm 1 demonstrated that bacterial adhesion already took place after 48 h. The number of adhering microorganisms increased with exposition time in the milking machine.
From the relevant bacterial groups in the dairy environment, Enterobacteria and Pseudomonads were only detected on the swab sampled spots with high TMCs, i.e. the milking equipment retainers and the outlet of the milk bulk tank of both farms. In contrast to this, Gram-positive Staphylococci and LAB were the dominating groups in the piping system of farm 1, while Staphylococci were not detected in the milking machine of farm 2. These findings lead to the assumption that the usual dairy-associated microbiota dominated on spots of the milking machine with low biofilm cell density, while those taxa often associated with contamination and product spoilage predominated in biofilms with higher bacterial densities.
All swab samples were taken a few hours after the milking machines were cleaned by CIP processes. This indicates that either the procedures applied are inefficient in removing already established biofilms, or that a recontamination took place after cleaning and sanitation. This may occur, for example, if the tap water used to rinse the milking machine after the CIP procedures was contaminated with potential biofilm formers, as already discussed by Flach et al. (2014) [21]. However, the transfer of biofilm formers from the tap water used for rinsing the system does not account for the high diversity and cell density detected in the milking machine biofilms alone. Instead, biofilm formers can be transferred to the milking machine from various routes.
Bacterial community composition
Both farms investigated by swab sampling had similar community compositions with respect to the detected phyla and their percentages. They also showed the same tendency towards overrepresentation of clone sequences assigned to the phylum Bacteroidetes and no or little representation of the phyla Firmicutes and Actinobacteria. Both approaches, cultivation and cultivation-independent, identified the phylum Proteobacteria as dominating part of the biofilm microbiota of swab sampled areas. In contrast to this, most bacteria (about 90%) isolated from stainless steel coupons were Gram-positive, with more than two thirds belonging to the phylum Actinobacteria.
Most genera of all four phyla detected in this study are frequently isolated from raw milk [18, 42] and the dairy environment [12], including biofilms in milk tankers and on dairy processing plants [8, 10, 22]. They can be considered as typical milk-associated genera.
The majority of isolates of the phylum Actinobacteria originated from swab samples of non-stainless steel surfaces of the milking machine of farm 1, such as the textile filter in the filter tube as well as the plastic milking equipment retainers. However, most of the stainless steel coupon isolates were assigned to this phylum. This could be a hint that early colonizers of stainless steel surfaces may differ from the bacterial community composition of mature biofilms found on this material and that the primary colonizers of the phylum Actinobacteria may only be present in low numbers in mature biofilms.
The detection of a high species richness of coryneform genera in milking machine biofilms and that many isolates were classified at least as weak biofilm formers in the present study confirms previous suggestions that smear cheese ripening bacteria are transferred to cheese manufacturing plants via raw milk [43, 44].
Only few isolates of the genus Chryseobacterium formed biofilms in microplate assays. This leads to the conclusion that members of this genus rather integrate into already established biofilms, or they may need other bacteria for biofilm formation. However, in vitro assays do not reflect realistic conditions in the milking machine, so that the results can only give a hint to the biofilm forming potential under in vivo conditions. Species of the genus Chryseobacterium have been isolated in the past from raw milk [45–47] as well as from beverage plant surfaces [48], which confirms their role as biofilm-associated bacteria in food production.
The detection of seven species of the genus Bacillus demonstrates a high species richness of this genus for farm 1. Members of this genus are known to produce heat resistant endospores, which are able to survive the pasteurization process. This favors biofilm formation on post-pasteurization pipelines in the milk-processing industry, which are then sources of recurrent contamination of the pasteurized product. Sharma & Anand (2002) [8] sampled biofilms in dairy processing plants and found that isolates of the genus Bacillus dominated in pre - and post-pasteurization pipelines; a similar finding was made by Malek et al. (2012) [49]. Not only the production of spoilage enzymes limiting shelf life and quality of milk products is of importance, but also the ability of B. cereus and relatives to produce enterotoxins, which threatens consumer health by causing food poisoning [50]. Isolates of the B. cereus group were detected on farm 1. Many of the isolates were potent biofilm, lipase and protease producers, which favors the hypothesis of transfer of biofilm formers via raw milk to the dairy industry. Although many studies have focused on B. cereus so far, other endospore forming Bacilli might also threaten the milk processing industry. This was confirmed by Teh et al. (2011) [10] who found that a Bacillus licheniformis isolate from a milk tanker was able to produce a heat-resistant protease and attached to stainless steel. Two isolates from the milking equipment retainers of farm 1 in this study were assigned to the closely related species B. paralicheniformis.
Seven different species of the genus Staphylococcus were detected on farm 1. They included the coagulase-negative species S. chromogenes and S. haemolyticus, which can cause mainly subclinical but persistent intramammary infections [51, 52]. Since they are colonizers of udder and teat skin [53], their biofilm forming ability is regarded as a potential virulence factor for causing mastitis as skin opportunists [54, 55]. In our study, Staphylocci were frequently isolated from the milking equipment retainers, which are in close contact to the udder during milking. This illustrates the potential role of the milking equipment for the transmission of mastitis pathogens within the herd.
Most of the LAB species isolated in this study have been frequently isolated from raw milk cheese, where they appear as non-starter lactic acid bacteria (NSLAB), which can be used as adjunct cultures in cheese-manufacture. NSLAB are important for the flavor-development during the ripening process of cheeses, but they are also suspected to lower product quality by producing off-flavors and other manufacturing defects [56, 57]. Since certain NSLAB species have already been detected in biofilms on dairy plants [58, 59], their detection in milking machine biofilms in this study argues for the carryover of biofilm forming organisms from dairy farms to dairy plants.
Three Listeria monocytogenes clone sequences originated from two different coupon DNA extracts of farm 1, which is a hint for the permanent presence of this pathogen in the milking system of farm 1. However, the presence of this organism was not confirmed by the cultivation method. Latorre et al. [9, 24] detected L. monocytogenes in biofilms in in-line milk filters, on milking equipment, the bulk tank outlet, and the parlor environment after selective enrichment, which was not within the scope of our study. This indicates that this pathogen is only present in low numbers in milking machine biofilms, if at all, and is unlikely to be detected by cultivation without prior enrichment.
The detection of isolates and clone sequences genetically related to the species Acinetobacter guillouiae and Pseudomonas gessardii in milking machine biofilms of both farms underlines the relevance of the genera Acinetobacter and Pseudomonas in the dairy environment. Representatives of these genera have already been described as psychrotolerant spoilage enzyme producing bacteria in the dairy environment [3, 11]. Their detection indicates that milking machine biofilms are a potential source of recurrent contamination of bulk tank raw milk with milk spoilage bacteria. Pseudomonads may also act as primary colonizers facilitating adherence and proliferation of weak or non-biofilm-formers, for example pathogens. This might also be true for the isolates detected in the milking machine biofilms of farm 1, since most of them were strong biofilm and spoilage enzyme producers.
Different species of the order Enterobacterales were found on both farms. Escherichia coli was isolated from several sampling sites of the milking machine of farm 1. Coliforms like E. coli are considered equipment hygiene indicators [60]. Their detection on the milking equipment retainers and the outlet of the milk bulk tank in combination with high bacterial counts on VRBD agar indicate insufficient sanitation efficiencies of these spots. Moreover, the detection of E. coli as a potential mastitis pathogen on the milking equipment retainers is of concern for animal health.
Comparability of direct molecular and cultivation approaches
Most of the spots analyzed showed a lower diversity and a lower equitability for the direct cloning procedure than for the isolation approach. This means that fewer taxa were detected by the direct methods and that the detected microbiota was more frequently dominated by single taxa compared to the isolation approach. This demonstrates that results from both approaches are not congruent. The lower diversity and lower equitability of the direct method can be attributed to selecting effects of the cell lysis and PCR reactions which may lower the detection rates for cells with robust cell walls and select for 16S rRNA sequences with higher amplification efficiencies. On the other hand, some genera like Propionibacterium, Epilithonimonas and the pathogen Listeria monocytogenes were exclusively detected by the direct approach. This indicates that the cultivation conditions used were not appropriate for all organisms present in the samples, or that their abundance was too low to be detected without prior enrichment.
The absence of clone sequences of the phylum Actinobacteria in the swab samples from farm 1 and their low percentage in the coupon clone libraries cannot be explained by the low incidence of these bacteria on the sampled surfaces, since 28% of the swab isolates and 69% of the coupon isolates were assigned to this phylum in the cultivation approach. This was in accord with a similar observation during a previous analysis of the raw milk microbiota of farm 1 [18]. The high GC-content of the DNA of this phylum may lower PCR-amplification efficiency of their 16S rRNA-genes, especially in DNA-extracts of mixed bacterial communities [61, 62].
The highest Shannon indices and thus high bacterial diversities were observed for the milking equipment retainers and the stainless steel coupons of farm 1 and the outlet of the milk bulk tank of farm 2. The coverage rates of these spots indicate that the actual diversity has not yet been completely covered by analyzing the clone libraries. A tendency towards higher diversities on sampling spots with high TMCs could be observed for the swab samples of both farms. Low Equitability values were often associated with spots with low Shannon indices. This indicates a low microbial diversity accompanied by the dominance of one or few species. This was the case for the molecular approach of the milking equipment retainers of both farms as well as the filter tube of farm 1. The presented data demonstrate that the diversity of the milking system biofilm microbiota is best characterized based on a combination of isolation and cultivation-independent methods.
Conclusions
In conclusion, the detected microbial counts and diversities reflect farm-specific differences and may have been influenced by seasonal variations. However, different genera of the order Enterobacterales, as well as the genera Acinetobacter, Bacillus, Chryseobacterium, Kocuria, Microbacterium, Pseudomonas, and Staphylococcus were detected on both farms. Most of them have already been found in raw milk, biofilms on dairy processing plants [8], and in raw milk tankers [10]. This study confirms biofilms in milking machines of dairy farms as potential source of raw milk contamination with biofilm forming bacteria. The incidence of adhering bacteria on stainless steel coupons after short time exposition in the milking machine demonstrates the speed of adherence and subsequent biofilm formation. This study is the first to describe the relevance of members of the phylum Actinobacteria as potential primary colonizers of stainless steel surfaces in milking machines. The difference between microbial community composition of the coupons and swab samples may reflect the shift between primary surface colonizers and the microbiota of mature biofilms.
Biofilm organisms transferred into raw milk tankers and dairy processing plants can establish new biofilms and possibly survive the pasteurization process. The secretion of spoilage enzymes from biofilms as well as the inhabitation of pathogens is a risk for milk quality and consumer health. The risk of pathogen transmission was demonstrated by the detection of L. monocytogenes sequences on the stainless steel coupon DNA extracts on different sampling occasions. This clearly indicates that the establishment of effective CIP procedures as well as a hygienically optimized plant design are essential to prevent or at least limit biofilm formation and proliferation in dairy farms. This prevention is of crucial importance to maintain a high quality of milk and its products.
Zdroje
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- Structural equation modeling for hypertension and type 2 diabetes based on multiple SNPs and multiple phenotypes
- Correction: Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study
- Short-term exercise training improves cardiac function associated to a better antioxidant response and lower type 3 iodothyronine deiodinase activity after myocardial infarction
- Unexpected low genetic variation in the South American hystricognath rodent Lagostomus maximus (Rodentia: Chinchillidae)
- PRC2 activates interferon-stimulated genes indirectly by repressing miRNAs in glioblastoma
- Surgical resection is sufficient for incidentally discovered solitary pulmonary nodule caused by nontuberculous mycobacteria in asymptomatic patients
- “I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi
- Impact of major illnesses and geographic regions on do-not-resuscitate rate and its potential cost savings in Taiwan
- Implementation of intermittent theta burst stimulation compared to conventional repetitive transcranial magnetic stimulation in patients with treatment resistant depression: A cost analysis
- Genome-wide analysis of DNA methylation profile identifies differentially methylated loci associated with human intervertebral disc degeneration
- Correction: Artificial neural networks reveal individual differences in metacognitive monitoring of memory
- Combining fish and environmental PCR for diagnostics of diseased laboratory zebrafish in recirculating systems
- Reading skill modulates the effect of parafoveal distractors on foveal lexical decision in deaf students
- Association between the posterior part of the circle of Willis and the vertebral artery hypoplasia
- Exposure to marital conflict: Gender differences in internalizing and externalizing problems among children
- Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials
- The effect of age and perturbation time on online control during rapid pointing
- Oilseed rape (Brassica napus) resistance to growth of Leptosphaeria maculans in leaves of young plants contributes to quantitative resistance in stems of adult plants
- Lymphocyte proliferation induced by high-affinity peptides for HLA-B*51:01 in Behçet’s uveitis
- Sensitization of avian pathogenic Escherichia coli to amoxicillin in vitro and in vivo in the presence of surfactin
- Genomic characterization of the complete terpene synthase gene family from Cannabis sativa
- Inhibition of gap junctional intercellular communication by an anti-migraine agent, flunarizine
- Levels of serum eosinophil cationic protein are associated with hookworm infection and intensity in endemic communities in Ghana
- Plant growth promoting rhizobacterium Stenotrophomonas maltophilia BJ01 augments endurance against N2 starvation by modulating physiology and biochemical activities of Arachis hypogea
- Hierarchical integrated and segregated processing in the functional brain default mode network within attention-deficit/hyperactivity disorder
- Rising co-payments coincide with unwanted effects on continuity of healthcare for patients with schizophrenia in the Netherlands
- Analysis of Zobellella denitrificans ZD1 draft genome: Genes and gene clusters responsible for high polyhydroxybutyrate (PHB) production from glycerol under saline conditions and its CRISPR-Cas system
- False-negative errors in next-generation sequencing contribute substantially to inconsistency of mutation databases
- Identification of potassium phosphite responsive miRNAs and their targets in potato
- Quantification of bell-shaped size selectivity in shrimp trawl fisheries using square mesh panels and a sorting cone after a Nordmøre grid
- Deactivation of somatosensory and visual cortices during vestibular stimulation is associated with older age and poorer balance
- Combined immunization with attenuated live influenza vaccine and chimeric pneumococcal recombinant protein improves the outcome of virus-bacterial infection in mice
- Flooding performance evaluation of alkyl aryl sulfonate in various alkaline environments
- An artificial intelligent diagnostic system on mobile Android terminals for cholelithiasis by lightweight convolutional neural network
- Enhanced detection of prion infectivity from blood by preanalytical enrichment with peptoid-conjugated beads
- COI metabarcoding primer choice affects richness and recovery of indicator taxa in freshwater systems
- Retraction: APRIL Induces Tumorigenesis and Metastasis of Colorectal Cancer Cells via Activation of the PI3K/Akt Pathway
- The intake pattern and feed preference of layer hens selected for high or low feed conversion ratio
- Individualized pattern recognition for detecting mind wandering from EEG during live lectures
- Ontogenetic expression of thyroid hormone signaling genes: An in vitro and in vivo species comparison
- Post-activation potentiation effect of eccentric overload and traditional weightlifting exercise on jumping and sprinting performance in male athletes
- Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study
- Quantitative detection of ALK fusion breakpoints in plasma cell-free DNA from patients with non-small cell lung cancer using PCR-based target sequencing with a tiling primer set and two-step mapping/alignment
- Nuclei deformation reveals pressure distributions in 3D cell clusters
- Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study
- Rapid evolution of Mexican H7N3 highly pathogenic avian influenza viruses in poultry
- Certified service dogs – A cost-effectiveness analysis appraisal
- Endothelial dysfunction and low-grade inflammation in the transition to renal replacement therapy
- Assessing the impact of a research funder’s recommendation to consider core outcome sets
- Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure
- Detection of deceptive motions in rugby from visual motion cues
- The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis
- Epidemiological investigation and management of bloody diarrhea among children in India
- Irisin promotes C2C12 myoblast proliferation via ERK-dependent CCL7 upregulation
- Bacteria isolated from Bengal cat (Felis catus × Prionailurus bengalensis) anal sac secretions produce volatile compounds potentially associated with animal signaling
- Petri net–based model of the human DNA base excision repair pathway
- Complexation and conformation of lead ion with poly-γ-glutamic acid in soluble state
- The effects of sympathetic activity induced by ice water on blood flow and brachial artery flow-mediated dilatation response in healthy volunteers
- The Youth-Physical Activity Towards Health (Y-PATH) intervention: Results of a 24 month cluster randomised controlled trial
- The COPD multi-dimensional phenotype: A new classification from the STORICO Italian observational study
- Morphological identification of Amphitetranychus species (Acari: Tetranychidae) with crossbreeding, esterase zymograms and DNA barcode data
- Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients’ experiences, views, information needs and approaches towards making treatment decisions
- Cultural differences in the use of acoustic cues for musical emotion experience
- Effects of a rifampicin pre-treatment on linezolid pharmacokinetics
- High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands
- Infection/inflammation-associated preterm delivery within 14 days of presentation with symptoms of preterm labour: A multivariate predictive model
- Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis
- Correction: Early life predictors of midlife allostatic load: A prospective cohort study
- PCR-free whole exome sequencing: Cost-effective and efficient in detecting rare mutations
- Epstein-Barr virus genome packaging factors accumulate in BMRF1-cores within viral replication compartments
- Symbiotic incompatibility between soybean and Bradyrhizobium arises from one amino acid determinant in soybean Rj2 protein
- Does anticoagulation needed for distally located incidental pulmonary thromboembolism in patients with active cancer?
- Control of human testis-specific gene expression
- Speaking up culture of medical students within an academic teaching hospital: Need of faculty working in patient safety
- Appraisal on the wound healing potential of Melaleuca alternifolia and Rosmarinus officinalis L. essential oil-loaded chitosan topical preparations
- Understanding parental perspectives on outcomes following paediatric encephalitis: A qualitative study
- Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017
- Native seed, soil and atmosphere respond to boreal forest topsoil (LFH) storage
- Development of a quantitative polymerase chain reaction assay and environmental DNA sampling methods for Giant Gartersnake (Thamnophis gigas)
- Genetic diversity and population structure of four Chinese rabbit breeds
- Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study
- Correction: An impact evaluation of two rounds of mass drug administration on the prevalence of active trachoma: A clustered cross sectional survey
- Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital
- Graph convolutional network approach applied to predict hourly bike-sharing demands considering spatial, temporal, and global effects
- Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh
- Feeling the heat: Elevated temperature affects male display activity of a lekking grassland bird
- Constructing a comprehensive disaster resilience index: The case of Italy
- Intraocular pressure according to different types of tonometry (non-contact and Goldmann applanation) in patients with different degrees of bilateral tearing
- Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus
- Silent volumetric multi-contrast 7 Tesla MRI of ocular tumors using Zero Echo Time imaging
- Nonverbal synchrony in virtual reality
- Do speed cameras reduce road traffic collisions?
- A zero-shot learning approach to the development of brain-computer interfaces for image retrieval
- Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d’Ivoire, West Africa: A cross-sectional study
- DNA barcoding of southern African crustaceans reveals a mix of invasive species and potential cryptic diversity
- Development of an international external quality assurance program for HIV-1 incidence using the Limiting Antigen Avidity assay
- Correction: The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs
- Structural characteristics of lipocalin allergens: Crystal structure of the immunogenic dog allergen Can f 6
- Transport oil product consumption and GHG emission reduction potential in China: An electric vehicle-based scenario analysis
- Ontogenetic shift in the energy allocation strategy and physiological condition of larval plaice (Pleuronectes platessa)
- Increased proliferation and altered cell cycle regulation in pancreatic stem cells derived from patients with congenital hyperinsulinism
- Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis
- Assessment of glucose-6-phosphate dehydrogenase activity using CareStart G6PD rapid diagnostic test and associated genetic variants in Plasmodium vivax malaria endemic setting in Mauritania
- Spatial distribution of breast cancer in Sudan 2010-2016
- Human-induced fire regime shifts during 19th century industrialization: A robust fire regime reconstruction using northern Polish lake sediments
- Enhanced effectiveness of oil dispersants in destabilizing water-in-oil emulsions
- Development of UV spectrophotometry methods for concurrent quantification of amlodipine and celecoxib by manipulation of ratio spectra in pure and pharmaceutical formulation
- Iron and manganese co-limit growth of the Southern Ocean diatom Chaetoceros debilis
- Bilateral and unilateral load-velocity profiling in a machine-based, single-joint, lower body exercise
- Veterans Health Administration nurses’ training and beliefs related to care of patients with traumatic brain injury
- Supplementation strategies affect the feed intake and performance of grazing replacement heifers
- Active transcutaneous bone conduction hearing implants: Systematic review and meta-analysis
- Parameterization-induced uncertainties and impacts of crop management harmonization in a global gridded crop model ensemble
- Acidification effects on isolation of extracellular vesicles from bovine milk
- GPR40 full agonism exerts feeding suppression and weight loss through afferent vagal nerve
- Mining version history to predict the class instability
- Humpback whale song occurrence reflects ecosystem variability in feeding and migratory habitat of the northeast Pacific
- A phase 2 study of an oral mTORC1/mTORC2 kinase inhibitor (CC-223) for non-pancreatic neuroendocrine tumors with or without carcinoid symptoms
- Asprosin response in hypoglycemia is not related to hypoglycemia unawareness but rather to insulin resistance in type 1 diabetes
- Muscle oxygenation maintained during repeated-sprints despite inspiratory muscle loading
- Reconstructing systematic persistent impacts of promotional marketing with empirical nonlinear dynamics
- Trans-national conservation and infrastructure development in the Heart of Borneo
- Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study
- Data in question: A survey of European biobank professionals on ethical, legal and societal challenges of biobank research
- Hypertensive APOL1 risk allele carriers demonstrate greater blood pressure reduction with angiotensin receptor blockade compared to low risk carriers
- Reconstructing birth in Australopithecus sediba
- Value of contrast-enhanced ultrasound for preoperative assessment of liver reserve function in patients with liver tumors
- Correction: Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians’ weight screening practice in outpatient clinics, Saudi Arabia
- Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program
- Changes in intracellular folate metabolism during high-dose methotrexate and Leucovorin rescue therapy in children with acute lymphoblastic leukemia
- Functional role and evolutionary contributions of floral gland morphoanatomy in the Paleotropical genus Acridocarpus (Malpighiaceae)
- On the efficiency of HIV transmission: Insights through discrete time HIV models
- Metabolic cost calculations of gait using musculoskeletal energy models, a comparison study
- Comparison of molecular profile in triple-negative inflammatory and non-inflammatory breast cancer not of mesenchymal stem-like subtype
- Evolutionary analysis of six chloroplast genomes from three Persea americana ecological races: Insights into sequence divergences and phylogenetic relationships
- Cultural transmission in a food preparation task: The role of interactivity, innovation and storytelling
- Correction: Effects of affective priming through music on the use of emotion words
- Safety and immunogenicity of investigational seasonal influenza hemagglutinin DNA vaccine followed by trivalent inactivated vaccine administered intradermally or intramuscularly in healthy adults: An open-label randomized phase 1 clinical trial
- Estimation of vaccination coverage from electronic healthcare records; methods performance evaluation – A contribution of the ADVANCE-project
- Dietary phytogenics and galactomannan oligosaccharides in low fish meal and fish oil-based diets for European sea bass (Dicentrarchus labrax) juveniles: Effects on gut health and implications on in vivo gut bacterial translocation
- Suicide by hanging: Results from a national survey in Switzerland and its implications for suicide prevention
- Gene dysregulation in peripheral blood of moyamoya disease and comparison with other vascular disorders
- Genome wide genetic dissection of wheat quality and yield related traits and their relationship with grain shape and size traits in an elite × non-adapted bread wheat cross
- Safety and tolerability of artesunate-amodiaquine, artemether-lumefantrine and quinine plus clindamycin in the treatment of uncomplicated Plasmodium falciparum malaria in Kinshasa, the Democratic Republic of the Congo
- Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach
- Comparison of post-traumatic changes in circulating and bone marrow leukocytes between BALB/c and CD-1 mouse strains
- Physiological stress reactivity and recovery related to behavioral traits in dogs (Canis familiaris)
- Associations between birth order with mental wellbeing and psychological distress in midlife: Findings from the 1970 British Cohort Study (BCS70)
- Non-steroidal anti-inflammatory drugs use in older adults decreases risk of Alzheimer’s disease mortality
- The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis
- Ancient technology and punctuated change: Detecting the emergence of the Edomite Kingdom in the Southern Levant
- Flowers as viral hot spots: Honey bees (Apis mellifera) unevenly deposit viruses across plant species
- Randomized control trial of Tools of the Mind: Marked benefits to kindergarten children and their teachers
- Preserving cultural heritage: Analyzing the antifungal potential of ionic liquids tested in paper restoration
- PNPLA3 rs738409 G allele carriers with genotype 1b HCV cirrhosis have lower viral load but develop liver failure at younger age
- Correction: Unraveling the genetic complexity underlying sorghum response to water availability
- Impact of tear metrics on the reliability of perimetry in patients with dry eye
- Using DNA barcoding to improve invasive pest identification at U.S. ports-of-entry
- Correction: Effects of Lactobacillus plantarum 15-1 and fructooligosaccharides on the response of broilers to pathogenic Escherichia coli O78 challenge
- Physico-chemical characterization and transcriptome analysis of 5-methyltryptophan resistant lines in rice
- Patient factors affecting successful linkage to treatment in a cervical cancer prevention program in Kenya: A prospective cohort study
- Is this a man’s world? The effect of gender diversity and gender equality on firm innovativeness
- Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study
- Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock
- Quantitation of free glycation compounds in saliva
- Resolving an 87-year-old taxonomical curiosity with the description of Psylla frodobagginsi sp. nov. (Hemiptera: Sternorrhyncha: Psyllidae), a second distinct Psylla species on the New Zealand endemic plant kōwhai
- The effect of cathodal tDCS on fear extinction: A cross-measures study
- Physiological responses to affiliation during conversation: Comparing neurotypical males and males with Asperger syndrome
- Human cord blood (hCB)-CD34+ humanized mice fail to reject human acute myeloid leukemia cells
- Investigating the dispersal of antibiotic resistance associated genes from manure application to soil and drainage waters in simulated agricultural farmland systems
- Continuous norming of psychometric tests: A simulation study of parametric and semi-parametric approaches
- Phylogenetic microbiota profiling in fecal samples depends on combination of sequencing depth and choice of NGS analysis method
- Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings
- Biochemical profile and in vitro biological activities of extracts from seven folk medicinal plants growing wild in southern Tunisia
- Low genetic differentiation yet high phenotypic variation in the invasive populations of Spartina alterniflora in Guangxi, China
- A mathematical model for designing networks of C-Reactive Protein point of care testing
- Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis
- Femtosecond laser induced step-like structures inside transparent hydrogel due to laser induced threshold reduction
- From In Situ to satellite observations of pelagic Sargassum distribution and aggregation in the Tropical North Atlantic Ocean
- The polyether ionophore salinomycin targets multiple cellular pathways to block proliferative vitreoretinopathy pathology
- BRAF V600E and Pten deletion in mice produces a histiocytic disorder with features of Langerhans cell histiocytosis
- HIV prevalence and risk behavior among male and female adults screened for enrolment into a vaccine preparedness study in Maputo, Mozambique
- Sputum microbiota and inflammation at stable state and during exacerbations in a cohort of chronic obstructive pulmonary disease (COPD) patients
- Direct estimation of the parameters of a delayed, intermittent activation feedback model of postural sway during quiet standing
- Occurrence mechanism and coping paths of accidents of highly aggregated tourist crowds based on system dynamics
- Correction: Low Dose Aerosol Fitness at the Innate Phase of Murine Infection Better Predicts Virulence amongst Clinical Strains of Mycobacterium tuberculosis
- Effects of enalapril and paricalcitol treatment on diabetic nephropathy and renal expressions of TNF-α, p53, caspase-3 and Bcl-2 in STZ-induced diabetic rats
- Correction: Public reaction to Chikungunya outbreaks in Italy—Insights from an extensive novel data streams-based structural equation modeling analysis
- Correction: Comparison of neurodegenerative types using different brain MRI analysis metrics in older adults with normal cognition, mild cognitive impairment, and Alzheimer’s dementia
- Intra-individual variability of sleep and nocturnal cardiac autonomic activity in elite female soccer players during an international tournament
- Therapeutic efficacy of equine botulism heptavalent antitoxin against all seven botulinum neurotoxins in symptomatic guinea pigs
- Interleukin 10 knock-down in bovine monocyte-derived macrophages has distinct effects during infection with two divergent strains of Mycobacterium bovis
- Clinical outcomes of bortezomib-based therapy in Taiwanese patients with multiple myeloma: A nationwide population-based study and a single-institute analysis
- Scope and efficacy of the broad-spectrum topical antiseptic choline geranate
- Hematological and biochemical parameters for Chinese rhesus macaque
- Veterinary peer study groups as a method of continuous education—A new approach to identify and address factors associated with antimicrobial prescribing
- Correction: The prognosis of heart failure patients: Does sodium level play a significant role?
- Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin
- Systematic identification of facility-based stillbirths and neonatal deaths through the piloted use of an adapted RAPID tool in Liberia and Nepal
- Effects of salbutamol and phlorizin on acute pulmonary inflammation and disease severity in experimental sepsis
- Correction: Age, sex and storage time influence hair cortisol levels in a wild mammal population
- Reasons to care: Personal motivation as a key factor in the practice of the professional foster carer in Romania
- Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: A cross-sectional analysis
- Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff
- EGF receptor stimulation shifts breast cancer cell glucose metabolism toward glycolytic flux through PI3 kinase signaling
- The Better Management of Patients with Osteoarthritis Program: Outcomes after evidence-based education and exercise delivered nationwide in Sweden
- The negative effects of short-term extreme thermal events on the seagrass Posidonia oceanica are exacerbated by ammonium additions
- Pathogen invasion history elucidates contemporary host pathogen dynamics
- Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis
- Healthcare resource utilization and costs for multiple sclerosis management in the Campania region of Italy: Comparison between centre-based and local service healthcare delivery
- Deconstruction of central line insertion guidelines based on the positive deviance approach—Reducing gaps between guidelines and implementation: A qualitative ethnographic research
- PBMCs transcriptome profiles identified breed-specific transcriptome signatures for PRRSV vaccination in German Landrace and Pietrain pigs
- The impact of admission serum lactate on children with moderate to severe traumatic brain injury
- Hypervirulent Klebsiella pneumoniae serotype K1 clinical isolates form robust biofilms at the air-liquid interface
- Determination of the bruise degree for cherry using Vis-NIR reflection spectroscopy coupled with multivariate analysis
- Genome-wide identification and expression profile analysis of nuclear factor Y family genes in Sorghum bicolor L. (Moench)
- Trends in maternal prepregnancy body mass index (BMI) and its association with birth and maternal outcomes in California, 2007–2016: A retrospective cohort study
- Distribution of the Duffy genotypes in Malaysian Borneo and its relation to Plasmodium knowlesi malaria susceptibility
- Hippocampal connectivity with sensorimotor cortex during volitional finger movements: Laterality and relationship to motor learning
- A self-adaptive deep learning method for automated eye laterality detection based on color fundus photography
- The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016
- Identification of QTLs for powdery mildew (Podosphaera aphanis; syn. Sphaerotheca macularis f. sp. fragariae) susceptibility in cultivated strawberry (Fragaria ×ananassa)
- Chemical volatiles present in cotton gin trash: A by-product of cotton processing
- PTP1B negatively regulates nitric oxide-mediated Pseudomonas aeruginosa killing by neutrophils
- Differential metabolomics networks analysis of menopausal status
- Experimental study of the temporal profile of breath alcohol concentration in a Chinese population after a light meal
- Association between regional brain volumes and BMI z-score change over one year in children
- Relationships between Potentially Toxic Elements in intertidal sediments and their bioaccumulation by benthic invertebrates
- Long-term outcomes of dialysis in patients with chronic kidney disease and new-onset atrial fibrillation: A population-based cohort study
- Hospital burden of pulmonary arterial hypertension in France
- Understanding the variability of Australian fire weather between 1973 and 2017
- Photon-counting cine-cardiac CT in the mouse
- Ecophysiological impacts of Esca, a devastating grapevine trunk disease, on Vitis vinifera L.
- Black “Reading the Mind in the Eyes” task: The development of a task assessing mentalizing from black faces
- Osmolytes ameliorate the effects of stress in the absence of the heat shock protein Hsp104 in Saccharomyces cerevisiae
- Reliable and robust method for abdominal muscle mass quantification using CT/MRI: An explorative study in healthy subjects
- Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers
- Multiple origins and the population genetic structure of Rubus takesimensis (Rosaceae) on Ulleung Island: Implications for the genetic consequences of anagenetic speciation
- Genetic profiling of fatty acid desaturase polymorphisms identifies patients who may benefit from high-dose omega-3 fatty acids in cardiac remodeling after acute myocardial infarction—Post-hoc analysis from the OMEGA-REMODEL randomized controlled trial
- A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders
- Optimising outputs from a validated online instrument to measure health-related quality of life (HRQL) in dogs
- Young adults’ perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study
- Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research
- Genetic characterization of fall armyworm (Spodoptera frugiperda) in Ecuador and comparisons with regional populations identify likely migratory relationships
- Correction: Lkb1 Deficiency Alters Goblet and Paneth Cell Differentiation in the Small Intestine
- Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care
- Synteny and phylogenetic analysis of paralogous thyrostimulin beta subunits (GpB5) in vertebrates
- Dual-Subpopulation as reciprocal optional external archives for differential evolution
- NGS analysis in Marfan syndrome spectrum: Combination of rare and common genetic variants to improve genotype-phenotype correlation analysis
- Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one
- Silymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial
- Clinical evaluation of General Electric new Swiftscan solution in bone scintigraphy on NaI-camera: A head to head comparison with Siemens Symbia
- Pharmacist-led academic detailing improves statin therapy prescribing for Malaysian patients with type 2 diabetes: Quasi-experimental design
- Proton pump inhibitors attenuate myofibroblast formation associated with thyroid eye disease through the aryl hydrocarbon receptor
- Clinical outcomes with neoadjuvant versus adjuvant chemotherapy for triple negative breast cancer: A report from the National Cancer Database
- Identification and characterization of a novel heparan sulfate-binding domain in Activin A longest variants and implications for function
- Wikipedia network analysis of cancer interactions and world influence
- Using path signatures to predict a diagnosis of Alzheimer’s disease
- Development and verification of prediction models for preventing cardiovascular diseases
- Additive and heterozygous (dis)advantage GWAS models reveal candidate genes involved in the genotypic variation of maize hybrids to Azospirillum brasilense
- Fish tank granuloma: An emerging skin disease in Iran mimicking Cutaneous Leishmaniasis
- Transience effect in capture-recapture studies: The importance of its biological meaning
- Detailed global modelling of soil organic carbon in cropland, grassland and forest soils
- Oral dosing for antenatal corticosteroids in the Rhesus macaque
- Retraction: Modulation of the Pentose Phosphate Pathway Induces Endodermal Differentiation in Embryonic Stem Cells
- An analysis on HBsAg, Anti-HCV, Anti-HIV½ and VDRL test results in blood donors according to gender, age range and years
- Clinical factors associated with bacterial translocation in Japanese patients with type 2 diabetes: A retrospective study
- Meaningful work and resilience among teachers: The mediating role of work engagement and job crafting
- The conditional Fama-French model and endogenous illiquidity: A robust instrumental variables test
- Breast cancers utilize hypoxic glycogen stores via PYGB, the brain isoform of glycogen phosphorylase, to promote metastatic phenotypes
- Characterization of sequentially-staged cancer cells using electrorotation
- Vancomycin-laden calcium phosphate-calcium sulfate composite allows bone formation in a rat infection model
- Genetic evidence for plural introduction pathways of the invasive weed Paterson’s curse (Echium plantagineum L.) to southern Australia
- Risk of major autoimmune diseases in female breast cancer patients: A nationwide, population-based cohort study
- Real-time three-dimensional MRI for the assessment of dynamic carpal instability
- Interim report on the effective intraperitoneal therapy of insulin-dependent diabetes mellitus in pet dogs using “Neo-Islets,” aggregates of adipose stem and pancreatic islet cells (INAD 012-776)
- The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience
- Retraction: Analysis of Mycobacterium tuberculosis-Specific CD8 T-Cells in Patients with Active Tuberculosis and in Individuals with Latent Infection
- The association between role model presence and self-regulation in early adolescence: A cross-sectional study
- Correction: A controlled-release oral opioid supports S. aureus survival in injection drug preparation equipment and may increase bacteremia and endocarditis risk
- Methamphetamine regulation of activity and topology of ventral midbrain networks
- Evaluation and treatment of latent tuberculosis infection among healthcare workers in Korea: A multicentre cohort analysis
- Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA
- TCF4 induces enzalutamide resistance via neuroendocrine differentiation in prostate cancer
- Structural characterization of EGFR exon 19 deletion mutation using molecular dynamics simulation
- Comparing infiltration rates in soils managed with conventional and alternative farming methods: A meta-analysis
- Correction: Permissivity of Primary Human Hepatocytes and Different Hepatoma Cell Lines to Cell Culture Adapted Hepatitis C Virus
- Radiomics features of the primary tumor fail to improve prediction of overall survival in large cohorts of CT- and PET-imaged head and neck cancer patients
- The complete mitochondrial genome of Calyptogena marissinica (Heterodonta: Veneroida: Vesicomyidae): Insight into the deep-sea adaptive evolution of vesicomyids
- Correction: In vitro larval rearing protocol for the stingless bee species Melipona scutellaris for toxicological studies
- Correction: Morphological and molecular identification of the dioecious “African species Volvox rousseletii (Chlorophyceae) in the water column of a Japanese lake based on field-collected and cultured materials
- Upper versus lower airway microbiome and metagenome in children with cystic fibrosis and their correlation with lung inflammation
- “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study
- Does a spinal implant alter dual energy X-ray absorptiometry body composition measurements?
- Economic and livestock health impacts of birds on dairies: Evidence from a survey of Washington dairy operators
- Repair of subtotal tympanic membrane perforations: A temporal bone study of several tympanoplasty materials
- Shifts in temperature influence how Batrachochytrium dendrobatidis infects amphibian larvae
- Sequential two-step chromatographic purification of infectious poliovirus using ceramic fluoroapatite and ceramic hydroxyapatite columns
- Frequency and distribution of corneal astigmatism and keratometry features in adult life: Methodology and findings of the UK Biobank study
- Differences in the impedance of cochlear implant devices within 24 hours of their implantation
- Suppressive impact of metronomic chemotherapy using UFT and/or cyclophosphamide on mediators of breast cancer dissemination and invasion
- Expression of Concern: miRNA 17 Family Regulates Cisplatin-Resistant and Metastasis by Targeting TGFbetaR2 in NSCLC
- Group leaders establish cooperative norms that persist in subsequent interactions
- Addis Ababa population-based pattern of cancer therapy, Ethiopia
- Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: A meta-epidemiological study of randomized controlled trials of physical therapy interventions
- Oxidoreductase disulfide bond proteins DsbA and DsbB form an active redox pair in Chlamydia trachomatis, a bacterium with disulfide dependent infection and development
- DNA barcoding of coastal ray-finned fishes in Vietnam
- Comparison of climbing-specific strength and endurance between lead and boulder climbers
- The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011–2015
- Analgesic drug use in elderly persons: A population-based study in Southern Italy
- RCER: Reliable Cluster-based Energy-aware Routing protocol for heterogeneous Wireless Sensor Networks
- Beta-defensins and analogs in Helicobacter pylori infections: mRNA expression levels, DNA methylation, and antibacterial activity
- Changing educational gradient in long-term care-free life expectancy among German men, 1997-2012
- A non-parametric significance test to compare corpora
- Evaluating the impact of policies recommending PrEP to subpopulations of men and transgender women who have sex with men based on demographic and behavioral risk factors
- Different levels of statistical learning - Hidden potentials of sequence learning tasks
- Dry period heat stress induces microstructural changes in the lactating mammary gland
- Organic resolution function and effects of platinum nanoparticles on bacteria and organic matter
- High levels of fasting glucose and glycosylated hemoglobin values are associated with hyperfiltration in a Spanish prediabetes cohort. The PREDAPS Study
- Genetically distinct Group B Streptococcus strains induce varying macrophage cytokine responses
- Dynamic up- and down-regulation of the default (DMN) and extrinsic (EMN) mode networks during alternating task-on and task-off periods
- ERK1/ATF-2 signaling axis contributes to interleukin-1β-induced MMP-3 expression in dermal fibroblasts
- Cytokine profiles of umbilical cord blood mononuclear cells upon in vitro stimulation with lipopolysaccharides of different vaginal gram-negative bacteria
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- Correction: Recombinant rabbit beta nerve growth factor production and its biological effects on sperm and ovulation in rabbits
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- Repeated transspinal stimulation decreases soleus H-reflex excitability and restores spinal inhibition in human spinal cord injury
- Expression of Concern: Resveratrol Enhances Antitumor Activity of TRAIL in Prostate Cancer Xenografts through Activation of FOXO Transcription Factor
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- Retraction: Autophagy in Muscle of Glucose-Infusion Hyperglycemia Rats and Streptozotocin-Induced Hyperglycemia Rats via Selective Activation of m-TOR or FoxO3
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- Correction: Development of a high-throughput assay to measure measles neutralizing antibodies
- Correction: Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana
- Correction: Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis
- Potential impact of efflux pump genes in mediating rifampicin resistance in clinical isolates of Mycobacterium tuberculosis from India
- Feed-forward visual processing suffices for coarse localization but fine-grained localization in an attention-demanding context needs feedback processing
- Level Set method-based two-dimensional numerical model for simulation of nonuniform open-channel flow
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- Effect of poor glycaemic control on plasma levels and activity of protein C, protein S, and antithrombin III in type 2 diabetes mellitus
- Retraction: IL-21 Regulates the Differentiation of a Human γδ T Cell Subset Equipped with B Cell Helper Activity
- Sugar transporters in Fabaceae, featuring SUT MST and SWEET families of the model plant Medicago truncatula and the agricultural crop Pisum sativum
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- Research on multi-agent genetic algorithm based on tabu search for the job shop scheduling problem
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- Acute ex vivo changes in brain white matter diffusion tensor metrics
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- Sodium alginate potentiates antioxidant defense and PR proteins against early blight disease caused by Alternaria solani in Solanum lycopersicum Linn.
- Ground reaction forces and muscle activity while walking on sand versus stable ground in individuals with pronated feet compared with healthy controls
- Correction: Roadway traffic crash prediction using a state-space model based support vector regression approach
- MET as resistance factor for afatinib therapy and motility driver in gastric cancer cells
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- Clinical features of pulmonary embolism in patients with lung cancer: A meta-analysis
- Cinobufacini ameliorates experimental colitis via modulating the composition of gut microbiota
- Factors restraining the population growth of Varroa destructor in Ethiopian honey bees (Apis mellifera simensis)
- Coastal proximity of populations in 22 Pacific Island Countries and Territories
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- Genetic characterization of Angiostrongylus larvae and their intermediate host, Achatina fulica, in Thailand
- Targeted in-vitro-stimulation reveals highly proliferative multi-virus-specific human central memory T cells as candidates for prophylactic T cell therapy
- Influence of ocean circulation and the Kuroshio large meander on the 2018 Japanese eel recruitment season
- Growth response of the ichthyotoxic haptophyte, Prymnesium parvum Carter, to changes in sulfate and fluoride concentrations
- Letrozole treatment of pubertal female mice results in activational effects on reproduction, metabolism and the gut microbiome
- Prognostic nomogram predicts overall survival in pulmonary large cell neuroendocrine carcinoma
- Microbiome profiling of the onion thrips, Thrips tabaci Lindeman (Thysanoptera: Thripidae)
- Characteristics of proximal early gastric cancer differentiating distal early gastric cancer
- Retraction: Impacts of rock properties on Danxia landform formation based on lithological experiments at Kongtongshan National Geopark, northwest China
- Correction: SVR12 rates higher than 99% after sofosbuvir/velpatasvir combination in HCV infected patients with F0-F1 fibrosis stage: A real world experience
- Retraction: Plexin-B1 Activates NF-κB and IL-8 to Promote a Pro-Angiogenic Response in Endothelial Cells
- Relationship between cognitive behavioral variables and mental health status among university students: A meta-analysis
- Association between temperature, sunlight hours and alcohol consumption
- Using graph learning to understand adverse pregnancy outcomes and stress pathways
- Correction: The step-to-step transition mode: A potential indicator of first-fall risk in elderly adults?
- Surgical referral systems in low- and middle-income countries: A review of the evidence
- In vivo clearance of nanoparticles by transcytosis across alveolar epithelial cells
- Correction: The Economic Impact of Malignant Catarrhal Fever on Pastoralist Livelihoods
- Correction: Identification of miRNAs involved in fruit ripening by deep sequencing of Olea europaea L. transcriptome
- Correction: Characterization of ecto- and endoparasite communities of wild Mediterranean teleosts by a metabarcoding approach
- Correction: Vascular Endothelial Growth Factor Receptor-2 Couples Cyclo-Oxygenase-2 with Pro-Angiogenic Actions of Leptin on Human Endothelial Cells
- Correction: Plant traits linked to field-scale flammability metrics in prescribed burns in Eucalyptus forest
- Correction: Maturation of three-dimensional, hiPSC-derived cardiomyocyte spheroids utilizing cyclic, uniaxial stretch and electrical stimulation
- Correction: To keep or not to keep? Decision making in adolescent pregnancies in Jamestown, Ghana
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