Time Of Device Removal Research Articles

Implementation of Mandibular Distraction Osteogenesis for Patients With Pierre Robin Sequence in a Developing Country Through International Collaboration: A Paradigm for Success.

Though it has made significant strides, Vietnam remains a resource-constrained country of 98 million people. Vietnam National Children's Hospital (VNCH) provides tertiary care to a catchment of 40 million people and is the sole national children's hospital. As such, it is one of the few referral centers in the country equipped to take care of patients diagnosed with Pierre Robin sequence (PRS) as this requires pulmonary, critical care, otolaryngology, and plastic surgery expertise. Before 2015, the only surgical options were tongue lip adhesion or tracheostomy. Only 20% of patients successfully avoided tracheostomy, mechanical ventilation, or death. From 2015 to 2019, mandibular distraction osteogenesis (MDO) was introduced by visiting international surgeons on a short-term basis. Since 2020, local surgeons at VNCH have refined their technique and widely use MDO independently. This report seeks to capitulate their experience and identify factors leading to success. A retrospective review was conducted of patients diagnosed with PRS at VNCH from 2015 to 2022. Paper records were digitized, translated, and reviewed for inclusion criteria, including demographics, indications, hospital course, and postoperative outcomes. Complete records satisfying inclusion criteria were available for 53 patients with a diagnosis of PRS who underwent MDO from 2020 to 2022. From 2015 to 2019, there were 19 cases of MDO, though records were incomplete. The median age at the time of MDO was 50 ± 43 days. Forty patients (75.5%) had isolated PRS and 13 (24.5%) were syndromic. Forty-four patients (83%) had a cleft palate. Fifty-one (96.2%) of patients required preoperative supplemental oxygen or mechanical ventilation. The active distraction and consolidation phase was 4.8 ± 1.3 months. The median days to discharge after surgery was 19.0 ± 8.3 days. Median weight at birth, at the time of surgery, and at the time of device removal were 6.8 ± 1.2, 7.7 ± 1.9, and 14.8 ± 2.8 pounds, respectively. Fifty-two patients (98.1%) had obstructive sleep apnea preoperatively with an average Apnea Hypopnea Index of 25.0 ± 10.6. Post-MDO, only 4 (7.5%) had obstructive sleep apnea and the average Apnea Hypopnea Index was 5.2 ± 0.6. No patients (0) required a tracheostomy for a 100% success rate. The tremendous success of the implementation of MDO by local surgeons in Vietnam after its introduction by visiting international surgeons illustrates a paradigm for capacity-enhancing global surgical endeavors. Mandibular distraction osteogenesis has replaced tongue lip adhesion as the surgical treatment of choice for PRS patients at VNCH. Surgical techniques can be transferred to operating environments with basic infrastructure through collaboration and resource optimization. These results demonstrate that global surgical engagement may be scalable and repeatable with direct benefits for patients in lower-middle-income countries.

A single dose of FSH or hCG during a split-time AI program did not enhance follicular growth or pregnancy per artificial insemination in beef heifers

ABSTRACT The objective of this study was to evaluate the effect of a low dose of hCG or FSH on follicle growth and pregnancy per artificial insemination (AI) in crossbreed beef heifers subjected to a split-time AI program. All heifers (n = 386) were subjected to a 7-d Co-synch protocol and an intravaginal controlled internal drug release (CIDR) device (GnRH and CIDR insertion; 7 days later PGF2α, CIDR removal, and application of a tail head estrus detection patch; 36 hours later AI of heifers detected in estrus, 24 hours later timed AI of remaining heifers). At CIDR removal, heifers were randomly assigned to receive either 150 IU of hCG, 20 mg of FSH, or remained as untreated controls. The diameter of the preovulatory follicle and the pregnancy per AI did not differ among treatments. A smaller (P = 0.035) proportion of heifers in the hCG group were detected in estrus compared with control. Additionally, the incidence of premature ovulation was greater (P < 0.01) among heifers treated with hCG compared with control. In conclusion, using a low dosage of hCG or FSH at the time of device removal did not affect pre-ovulatory follicle growth or the proportion of pregnant heifers.

Role of Distraction Osteogenesis in the Management of Postankylotic Deformity.

Distraction osteogenesis (DO) has evolved in maxillofacial surgery and gained popularity due to the limitations of orthognathic surgery in gross asymmetry cases. The primary aim of the paper was to determine if the use of DO for the management of severe deformities of the mandible secondary to temporomandibular joint ankylosis can achieve optimal results, with or without genioplasty, based on cephalometric norms. The secondary aim of this study was to evaluate the complications associated with DO in this group of patients. Six patients with postankylotic deformity were included. Both internal and external devices were used for an average mandibular corpus lengthening of 15mm with adjunctive procedure genioplasty. All patients had excellent outcome in terms of profile, functional occlusion, and mouth opening without deviation. Two patients had primary genioplasty showed excellent compliance and 2 as secondary at the time of device removal. Complications noted were, difficulty in vector control during distraction, paresthesia, occlusal discrepancy, scarring, and relapse of 2 to 3mm. Preorthodontics and postorthodontics were done in all patients to settle the occlusion, which was stable after 2-year follow-up. Case series shows such gross deformities pose a greater challenge due to undergrowth, gross midline shift, and discrepancy between soft and hard tissue growth pattern and the desired results can be achieved by precise planning. Genioplasty at the time of device placement has definitive positive effect on patient compliance. Though orthognathic surgery has a definitive role in minor deformity, whereas in gross deformities DO with precise planning using 3-dimensional model and vector controlled technique offers excellent outcome.

Clinical outcomes of knee joint distraction combined with marrow stimulation procedures for patients with advanced knee osteoarthritis

BackgroundKnee joint distraction (KJD) has received much attention as a joint preserving surgery, especially in young patients with advanced knee osteoarthritis (OA). MethodsThis study included 16 patients with advanced knee OA who underwent KJD combined with marrow stimulating techniques and were followed up for more than 2 years. The patients’ clinical scores, including the Japanese Orthopaedic Association (JOA) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, ROM, joint space width, and semiquantitative MRI were evaluated. The factors affecting clinical outcomes were analyzed. ResultsPostoperatively, the JOA score and the individual scores of the KOOS subscales improved significantly (JOA score: P = 0.0028, KOOS-symptoms: P = 0.0016, -pain: P = 0.0011, -ADL: P = 0.0009, -sports/recreation: P = 0.0144, and -QOL: P = 0.0034). Although the extension of the knee joint did not change throughout the follow-up period, flexion of the joint deteriorated at the time of device removal but recovered to the preoperative level at the final follow-up. Preoperative joint space width was 2.4 ± 2.0 mm and at the final follow-up, it increased to 3.3 ± 1.5 mm, showing statistically significant improvement (P = 0.034). The postoperative semiquantitative MRI score also improved significantly (from 6.0 ± 3.0 to 42.1 ± 28.7, P = 0.0001). A high BMI was associated with a poor clinical outcome. ConclusionAlthough the effect of marrow stimulating techniques for cartilage repair was not well clarified and the complication rate was high, the clinical and radiographic outcomes showed significant improvement after KJD combined with marrow stimulating techniques in patients with advanced knee OA. However, we should be careful about suggesting this procedure in obese patients.

Risk Factors and Treatment of Postpartum Anestrus in Cattle: The Case of Zebu

This literature review reports on risk factors for postpartum anoestrus in zebus and their potential treatments. Prolonged postpartum anestrus is one of the major factors limiting reproductive efficiency in cattle, particularly in Bos indicus cows in tropical regions, as it prevents a calving interval of 365 days from being achieved. During anestrus, ovulation does not occur despite ovarian follicular development, as the growing follicles do not reach maturity. This period is very variable and depends on various factors whose importance is relative or, on the contrary, essential. Some are specific to the animal (breastfeeding or food); others relate more to its social environment, season sanitary conditions. Several hormonal treatments have been used to induce ovulation and cyclicity in postpartum cows. Generally speaking, given the inconsistency of the effects or even their lack of practicability, treatments using a single or repeated injection of a gonadotropin-releasing hormone (GnRH) have been gradually abandoned in favour of progestagens. These are administered for 8 to 12 days on a continuous basis in the form of a subcutaneous implant (Crestar®), a vaginal coil (PRID®) or a CIDR. A prostaglandin injection is given two days before the implant is removed. The addition of an ECG treatment at the time of device removal, which increased plasma progesterone concentrations and pregnancy rates in anestrous postpartum suckled Bos indicus cows, may be useful to improve reproductive performance. This improvement requires a better understanding of the effect of different risk factors on the recovery of postpartum cyclicity.

An intrauterine device with potential to control fertility in feral equids

Fertility control of feral equids is difficult. A 4-month pilot study was conducted with a hormone-free intrauterine device (iUPOD). There was evaluation of i) device retention; ii) contraceptive efficacy; iii) fertility following device removal; iv) effects of device on estrous cycle periodicity and; v) abundance of biofilm on devices after removal from the uterus. The iUPODs were inserted trans-cervically in eight mares at random stages of the estrous cycle. Mares were confined in a paddock with a stallion the following day and remained with the stallion for 120 days. Transabdominal detection of the iUPOD, using a non-invasive handheld magnetic detector wand, was performed weekly. Mares were examined using transrectal ultrasonography on days 0 (Time at insertion = day 0), 14, and 30, and subsequently every third week to assess number and size of follicles, corpora lutea, and whether there was intrauterine fluid (IUF) present. The mares and stallion were observed daily for mating behavior. Weekly samples were assayed for progesterone (P4) at day 0 and until 3 weeks subsequent to stallion removal. None of the mares became pregnant while fitted with the iUPOD. Two of four mares conceived within 30 days subsequent to iUPOD removal. Three of eight mares fitted with the device had periods greater than 14 days with P4 concentrations <1 ng/mL, and seven of eight mares had periods greater than 14 days with P4 concentrations>1 ng/mL. There was a marked abundance of biofilm on devices of two mares at the time of device removal.

118 A comparison of intravaginal progesterone devices for fixed-time artificial insemination in beef cattle

Intravaginal progesterone (P4) devices used for ovarian synchronization before fixed-time AI (FTAI) differ in drug release, which may influence fertility outcome. A 2×2 study was designed to determine the effects of different intravaginal devices (PRID Delta, 1.55g of P4 vs. CIDR, 1.38g of P4) and parity (heifers vs. cows) on follicular dynamics, expression of oestrus, and pregnancy per AI (P/AI). At random stages of the oestrous cycle, nulliparous beef heifers and lactating cows were given 100µg of gonadorelin (gonadotrophin-releasing hormone, GnRH) intramuscularly (IM) and assigned randomly to either the PRID (n=76 heifers, 76 multiparous, 27 primiparous) or CIDR (n=76 heifers, 73 multiparous, 32 primiparous) group. Devices were removed 5 days later, an oestrus-detection patch was applied just cranial to the tail head, and 500µg of cloprostenol was given IM at the time of device removal and again 24h later. At 72h after device removal, cattle were inseminated and given 100µg of GnRH IM. Transrectal ultrasonography was used to determine the diameter of the largest follicle on the day of device removal and at FTAI, ovulation time, and pregnancy status 30 days after FTAI. A colour change of ≥50% of the oestrus-detection patch at FTAI was taken as expression of oestrus. Data were compared among groups by 2-way ANOVA using MIXED and GLIMMIX procedures. There were no interactions between P4 device and parity for any endpoint. The diameter of the largest follicle (mean±s.e.m.) was not different between PRID and CIDR groups on either the day of device removal (10.6±0.1 vs. 10.9±0.1mm) or the day of FTAI (13.7±0.1 vs. 13.9±0.1mm). The proportion displaying oestrus did not differ between P4 device groups, but was greater in heifers than in cows [121/152 (79.6%) vs. 135/207 (65.2%); P&amp;lt;0.01], and the interval from FTAI to ovulation was shorter in heifers than in cows (27.8±1.2 vs. 32.0±1.1 h; P=0.01). The P/AI was not different between P4 device groups or parity groups (overall 67.0%, 238/355). However, among lactating cows, the P/AI tended to be greater in the PRID vs. CIDR group [75/102 (73.5%) vs. 64/105 (61.0%); P=0.10], and was greater in multiparous vs. primiparous cows [106/148 (71.6%) vs. 33/59 (55.9%); P=0.04]. Among cattle that displayed oestrus, the P/AI tended to be greater in the PRID vs. CIDR group [92/123 (74.8%) vs. 85/131 (64.9%); P=0.09]. Among lactating cows that displayed oestrus, the P/AI was greater in multiparous vs. primiparous cows [74/94 (78.2%) vs. 24/42 (57.1%); P&amp;lt;0.01]. In summary, follicular dynamics and expression of oestrus did not differ between PRID and CIDR groups, but the P/AI tended to be greater in PRID-treated lactating cows and in cattle that displayed oestrus. This research was supported by CEVA Animal Health, Saskatchewan ADF, Agriculture and Agri-Foods Canada, and Rockway Inc.

Le Fort III Distraction Osteogenesis: Early Experience With an Internal Bilevel Midface Distraction System

Internal distraction devices for severe midface hypoplasia are often criticized for their distraction at a single pivot point, resulting in “mid-face tipping,” a phenomenon which is in part related to the differential resistance of the soft tissues at orbital and maxillary levels. To address this deficiency, we present our early experience with an internal bi-level midface distraction system. Four patients underwent midface advancement with an internal bi-level distraction system. The specifics of design, application, distraction, and removal are detailed. Hospital records were reviewed to capture patient demographics, length of stay, OR times, and complications. Relevant cephalometry was performed pre- and post-operatively, and compared. In 2015, 4 patients with severe mid-face hypoplasia were treated with an internal bi-level mid-face distraction system. The mean age was 13.5 ± 1.7 years. The mean operative time was 269.7 ± 67.4 min. The mean LOS was 10 ± 7.4 days. The on-table distraction was 5 mm. Distraction subsequently proceeded at a variable rate of 0.5 to 1.0 mm daily with a maximal distraction of 20 and 30 mm at orbital and maxillary levels, respectively. Mean time to distractor removal was 11.2 ± 1.1 weeks. Device design allowed facile removal through minimally invasive incisions. Cephalometry was seen to progress towards age-matched norms. There were no major complications. Minor complications included breakage of the vertical component of the maxillary arm at the time of device removal in 1 patient. By allowing real-time adjustment at the orbital and maxillary levels to combat differential resistance, early experience with our device maximizes occlusal advancement without overcompensating orbital translation.

PSXII-36 Use of FSH or hCG to enhance follicular growth and pregnancy per artificial insemination during a split-AI program in crossbreed beef heifers

Abstract The objective of the study was to compare follicle growth and pregnancy per artificial insemination (P/AI) in crossbreed heifers receiving either a low dose of hCG (150 IU) or a low dose of FSH (20 mg) vs. a control group during the final stage of a split-AI protocol. A total of 387 heifers were enrolled in the trial and were randomly assigned in three treatments (Control n = 134, FSH n = 125, and hCG n =128) within reproductive tract score (RTS; 1 to 5 scale), body condition score (BCS; 1 to 9 scale) and pubertal status. All groups were synchronized with a 7-day CO-Synch + CIDR protocol, at CIDR removal the two treatments were injected, an Estrotect patch was placed, and the diameter of the dominant follicle was assessed through transrectal ultrasonography, at day 9 heifers that presented estrus (&amp;gt; 50% of the Estrotect patch rubbed off) were AI, and those that did not were TAI at day 10. An ultrasound was carried out along with the AI to measure the diameter of the preovulatory follicle and 30 days after for pregnancy check. The data was analyzed using the GLIMMIX procedure (SAS). The diameter of the preovulatory follicle was different among treatments (Control: 11.48 ± 0.21; FSH: 11.48 ± 0.25; hCG; 10.73 ± 0.28; P = 0.01). However, the rate of follicular growth (Control: 4.96 ± 0.37; FSH: 4.59 ± 0.39; hCG: 5.12 ± 0.38; P = 0.64) and P/AI (control: 41.35%; FSH: 35.77%; and hCG: 34.38%; P = 0.47) were not different among groups. There was a significant difference (P &amp;lt; .0001) in P/AI when comparing animals that presented estrous (48.99%) or not (29.27%). In conclusion, the use of low dosed of hCG or FSH at the time of device removal did not increase the proportion of pregnant heifers.

Effect of a 12-h increment in the short-term treatment regimen on ovarian status, estrus synchrony, and pregnancy rate in artificially inseminated dairy goats

This study was conducted to assess effects of two hormonal treatments on ovarian follicular status, estrous synchrony and fertility in dairy goats during the non-breeding season when duration of progestogen device use varied by 12 h. In both experiments, does were administered 60 mg of medroxyprogesterone acetate via intravaginal devices, respectively, for 6 and 6.5 d (G6 and G6.5). At 24 or 36 h before device removal, 200 IU of eCG im and 30 μg d-cloprostenol im were administered. In Experiment 1 (n = 24), data related to sexual behavior and that were collected using ovarian ultrasonography were recorded, and in Experiment 2 (n = 83) fertility was assessed after Flexible Time Artificial Insemination (FxTAI). The interval from device removal to estrus was shorter (P < 0.05) after imposing the G6.5 treatment regimen. Diameter of largest and second-largest ovarian follicles and interval from device removal to ovulation were similar (P> 0.05) between groups. The does treated with the G6.5 hormonal regimen had greater estrous synchrony, associated with greater development of largest follicles at the time of device removal, which might have led to a lesser fertility rate (P > 0.05). Conversely, treatment with the G6 hormonal regimen resulted in a greater conception rate. In conclusion, increasing time the intravaginal device is inserted from 6 to 6.5 d resulted in greater estrous synchrony, advanced ovarian follicular development, abnormal CL function and lesser pregnancy rates in artificially inseminated dairy goats when there were treatments during the non-breeding season.

172 Effect of period of insertion of a progesterone-releasing device and pro-oestrus length on follicular and luteal characteristics and pregnancy rates to fixed-time AI in Bos indicus heifers

An experiment was designed to evaluate the effect of the length of insertion of a progesterone (P4)-releasing device and the length of pro-oestrus on follicular and luteal characteristics and pregnancy rates to AI (P/AI) in Bos indicus heifers treated with oestradiol/P4-based treatments. Bos indicus beef heifers (n=374), 22-26 months of age, with a corpus luteum (CL) or at least one follicle ≥8mm in diameter and with a body condition score between 2.5 and 3.5 (1-to-5 scale) were synchronised using three treatments for fixed-time AI (FTAI). On Day 0, all heifers received 2mg of oestradiol benzoate (Sincrodiol, Ourofino) and an intravaginal device with 1g of P4 (Sincrogest, Ourofino). The P4 device was removed on Day 6 in heifers in the J-Synch 6 group (n=120) and on Day 7 in heifers in the J-Synch 7 group (n=105) and conventional group (n=165). All heifers received 500μg of cloprostenol (Sincrocio, Ourofino) and 300IU of equine chorionic gonadotrophin (SincroeCG 6000UI, Ourofino) at the time of P4 device removal. Furthermore, heifers in the conventional treatment group received 0.5mg of oestradiol cypionate (SincroCP, Ourofino) at the same time. In addition, all heifers were tail-painted for oestrus detection (CeloTest, Biotay). Heifers that had lost ≥50% of the tail paint by 70-74h (J-Synch groups) or 48-52h (conventional group) after device removal were FTAI at that time. Heifers not showing oestrus by 70-74h (J-Synch groups) or 48-52h (conventional group) received 10μg of gonadotrophin-releasing hormone (Sincroforte, Ourofino) at the same time and were FTAI 8h later. All heifers were also examined using ultrasonography (Mindray DP50 Vet) every 12h from the time of device removal to determine the time of ovulation, 6 days after ovulation to determine the diameter of the CL, and 28 days after FTAI for P/AI determination. Data were analysed using the MLGM procedure (InfoStat) for normal data families (follicular dynamics) and binary data family (P/AI). The results are shown in Table 1. The diameter of the dominant preovulatory follicle and the CL did not differ among groups (P&amp;gt;0.12). However, the interval from device removal to ovulation was longer in heifers in the J-Synch groups than in heifers in the conventional group (P&amp;lt;0.05). Furthermore, P/AI was not different among groups. In conclusion, although the J-Synch protocols delayed the interval from P4 device removal to ovulation, the three protocols evaluated in the present study were equally effective in Bos indicus heifers. Table 1.Mean (±s.e.m.) diameter of the preovulatory follicle (P/Foll) and corpus luteum (CL), interval from progesterone (P4) device removal to ovulation, and pregnancy rates to AI (P/AI) in Bos indicus heifers Treatment P/Foll, mm Interval to ovulation, h CL diameter, mm P/AI,% (n) J-Synch 6 10.5±0.7 101.4±2.3a 18.6±1.0 52.0 (62/120) J-Synch 7 10.6±0.7 96.0±2.2a 16.5±0.9 39.0 (41/105) Conventional 9.4±0.7 73.0±1.9b 16.8±0.9 45.0 (74/165) a,bDifferent superscripts denote differences between groups in the interval from P4 device removal to ovulation.

171 Follicular and luteal characteristics and pregnancy rates in Bos indicus suckled cows treated with two oestradiol/progesterone-based protocols with a prolonged pro-oestrus

An experiment was designed to evaluate the effect of the length of insertion of a progesterone (P4)-releasing device on follicular and luteal characteristics and pregnancy rates to fixed-time AI (P/FTAI) in Bos indicus cows treated with oestradiol/P4-based treatments with a prolonged pro-oestrus. Multiparous Bos indicus suckled beef cows (n=659), 60-90 days postpartum, with a corpus luteum (CL) or at least one follicle ≥8mm in diameter and with a body condition score between 2 and 3.5 (1-to-5 scale) were synchronised using three treatments. On Day 0, all cows received 2mg of oestradiol benzoate (Sincrodiol, Ourofino) and an intravaginal device with 1g of P4 (Sincrogest, Ourofino). The P4 device was removed on Day 6 in cows in the J-Synch 6 group (n=195) and on Day 7 in cows in the J-Synch 7 group (n=262) and conventional group (n=202). All cows received 500μg of cloprostenol (Sincrocio, Ourofino) and 400IU of equine chorionic gonadotrophin (SincroeCG 6000UI, Ourofino) at the time of P4 device removal. Cows in the conventional treatment group also received 0.5mg of oestradiol cypionate (SincroCP, Ourofino) at the same time. In addition, all cows were tail-painted for oestrous detection (CeloTest, Biotay). Cows that had lost ≥50% of the tail paint 62-66h (J-Synch groups) or 48-52h (conventional group) after device removal were FTAI at that time. Cows not showing oestrus by 62-66h (J-Synch groups) or 48-52h (conventional group) received 10μg of GnRH (Sincroforte, Ourofino) at the same time and were FTAI 8h later. A subset of 20 cows per group was also examined using ultrasonography (Mindray DP50 Vet) every 12h from the time of device removal to determine the time of ovulation, 6 days after ovulation to determine CL diameter, and 30 days after FTAI to determine P/AI. Data were analysed using the GLM Mixed procedure (InfoStat). The results are shown in Table 1. The diameter of the dominant preovulatory follicle was larger and the interval from device removal to ovulation was longer in cows in the J-Synch groups compared with those in the conventional group (P&amp;lt;0.05). Furthermore, the diameter of the CL was larger and P/FTAI was higher in cows in the J-Synch 7 group compared with those in the J-Synch 6 and conventional groups. In conclusion, delaying the removal of the P4 device by 1 day (i.e. Day 7 vs. Day 6) in the J-Synch groups and prolonging the pro-oestrus period by not giving oestradiol cypionate at P4 device removal (i.e. J-Synch 7 vs. conventional) resulted in a larger preovulatory follicle and CL and higher P/FTAI in Bos indicus suckled cows. Table 1.Mean (±s.e.m.) diameter of the preovulatory follicle (P/Foll) and corpus luteum (CL), interval from progesterone (P4) device removal to ovulation, and pregnancy rates to fixed-time AI (P/FTAI) in Bos indicus suckled cows Treatment P/Foll diameter, mm CL diameter, mm Interval to ovulation, h P/FTAI,% (n) J-Synch 6 15.5±0.3a 18.7±0.8a 83.0±4.0b 41.0 (80/195)a J-Synch 7 16.4±0.2b 21.9±0.8b 86.0±3.0b 52.0 (136/262)b Conventional 13.8±0.2a 16.8±0.9a 64.0±3.0a 37.1 (75/202)a a,bDifferent superscripts denote differences between means or P/FTAI.

Comparison of estradiol benzoate and cypionate in Girolando cows submitted to a timed artificial insemination

The various studies on the manipulation of the estrous cycle culminated in the development of estrous and ovulation synchronization protocols, to the point of defining an optimum moment for artificial insemination. The induction of ovulation is a primordial part for the determination of the moment of the TAI, so to study which hormones and how they behave allows a better understanding of this physiological process and, to manipulate it efficiently. The aim of the present study was to compare the use of estradiol benzoate (EB) and cypionate (ECP) as ovulation inducer in Girolando cows submitted to Timed Artificial Insemination (TAI). Ovulations of 108 Girolando cows were synchronized and the initial day of treatment, recorded as D0, which was when the animals received an intravaginal device containing 1g of progestogen and an intramuscular application (im) of 2mg of EB. After 8 days (D8), the device was removed and 500μg of cloprostenol (im) was administered to all females. Then, the animals were randomly divided into two treatments: BG Group (n = 52) and CG Group (n = 56). The CG animals received 1mg of ECP (im) as the ovulation inducer at the time of device removal, while BG Group cows received 1mg of EB (im) 24 h later (D9). TAI occurred at D10. After device removal, ultrasound evaluations were performed every 12 h up to ovulation. The following reproductive parameters were evaluated: interval from intravaginal device removal to ovulation - IDO (hours); interval from ovulation to TAI-IOT (hours); diameter of the largest follicle at intravaginal device removal (mm); maximum diameter of the DF (mm) at D10; the dominant follicle growth rate (mm/day); synchronization rate - SR (%); ovulation rate - OR (%) and PR - pregnancy rate (%). Only the ovulation rate presented a statistical difference (p&lt;0.05). In conclusion, despite the ovulation rate difference, both estradiol esters administered were effective and presented similar pregnancy rates in Girolando cows submitted to TAI.

Is prostaglandin F2α administration at the beginning of a progesterone and estradiol-based treatment for FTAI an effective strategy in Bos taurus heifers?

The objective was to evaluate effects of prostaglandin (PG) F2α administration at the beginning of a progesterone and estradiol-based treatment period on ovarian response and pregnancy rate (P/AI) in Bos taurus beef heifers. Heifers were treated with 500 μg of cloprostenol administered: a) in two half-doses (250 μg) at the time of progesterone device insertion and removal (two-PG), or b) in a single dose at the time of device removal (one-PG). In the two-PG group, administration of PG at device insertion resulted in lesser serum progesterone concentrations during the 7-d treatment period (P < 0.05). Additionally, diameter of the follicle from which ovulation occurred was greater, and ovulation occurred earlier in the two-PG compared with one-PG group (P < 0.05). Fixed-time artificial insemination (FTAI) was performed in 3479 heifers with two times for FTAI (48 compared with 54 h from device removal). There was no effect on P/AI percentage for the PG treatment or the time of FTAI. The FTAI at 54 h resulted in a greater P/AI percentage in the one-PG than two-PG group (70.5%, 253/359 and 63.5%, 254/400, respectively; P < 0.05). There were no differences between PG treatments when FTAI was performed at 48 h after device removal. In conclusion, the administration of PG at the time of intravaginal progesterone device insertion results in lesser progesterone concentrations, and an increased size of the follicle from which ovulation occurs, and the time of ovulation is earlier after device removal. The pregnancy rate was not affected by the PG administration at the time of device insertion.

Removing the magnetic sphincter augmentation device: operative management and outcomes.

Recurrent or persistent symptoms of reflux, dysphagia, or device erosion can lead to removal of the magnetic sphincter augmentation (MSA aka Linx) device. Device removal has been previously reported, and outcomes of various surgical management strategies at the time of removal have not been well described. This is a retrospective review of patients undergoing MSA removal from March 2009 to September 2017 in a single institution. Reason for removal, operative management, and short-term outcomes are reported. During the study, 435 MSA devices were implanted, 24 of which required removal (5.5%). Removal was due to refractory dysphagia in 1.8% (8/435), for recurrent or persistent GERD in 2.9% (13/435), and secondary to erosion in 0.5% (2/435). Mean time from implant to removal was 863days (range 119-1762 days). The most common reasons for removal were recurrent GERD (54%), dysphagia (38%), or erosion (8%). Significant operative findings included recurrent or progressive hiatal hernia (38%), erosion (8%), and normal anatomy (46%). Hiatal hernia was found and repaired at the time of device removal in 38% of patients (9/24). The MSA device was removed through laparotomy (4%), laparoscopically (88%), or through a combination of endoscopy and laparoscopy (8%). After removal patients underwent repeat MSA (33%), fundoplication (21%), gastrectomy (4%), or no additional procedure (42%). Symptoms prompting removal of the MSA device had resolved in 52% of patients and improved in an additional 35% at last contact. Of the 10 patients having no anti-reflux procedure after removal, 9 were available for follow-up at a mean of 97 (106) days of whom 22.2% (2/9) had symptoms of GERD or required any anti-reflux medication. No major complications occurred after removal. MSA removal when necessary can be accomplished through minimally invasive means. Repeat Linx or fundoplication can be performed after removal, however may not be necessary in patients with removal for dysphagia.

Detection of Biofilm-associated Implant Pathogens in Cardiac Device Infections: High Sensitivity of Sonication Fluid Culture Even in the Presence of Antimicrobials.

Introduction:Sonication showed more sensitivity than traditional culture in the diagnosis of device infections. Aims of the study were to assess the role of sonication in the microbiological diagnosis and management of cardiac device infections (CDIs), to evaluate the sensitivity of sonication in patients on antimicrobial therapy at the time of device removal, and to analyze biofilm formation of the isolated strains.Materials and Methods:A total of 90 devices (31 generators and 59 electrodes) collected from 31 patients with infection underwent sonication before culture. Devices were sonicated for 5 min and centrifuged at 3200 rpm for 15 min. Intraoperative traditional cultures were performed in 26 patients. Microorganisms were identified using conventional methods. Staphylococcal strains were tested for slime production.Results:Microbiological diagnosis was achieved in 28 patients (90%). Sonicate fluid was positive in 68/90 (76%) of devices (27/31 [87%] generators and 41/59 [69%] electrodes), whereas intraoperative pocket swabs grew bacteria in 10/26 patients (38%, P = 0.0007). Among leads, 37/59 (62.7%) yielded bacteria even in the absence of vegetation. Coagulase-negative Staphylococci accounted for 83.8% (57/68) of the total; Staphylococcus aureus and Gram-negative bacilli were found in 4.4% (3/68) and 5.8% (4/68), respectively. Biofilm production was present in 15/22 (69%) staphylococcal strains. Overall, patients on therapy (n = 23) had a microbiological diagnosis in 20/23 (86.9%) and 7/22 (30.4%) through sonication and intraoperative cultures, respectively (P = 0.0002).Discussion:Our data showed the high sensitivity of sonication in the diagnosis of CDIs, even in patients under antimicrobial therapy.Conclusion:Sonication represents an essential tool for both diagnosis and management of CDIs.

Equine chorionic gonadotropin administration after insemination affects luteal function and pregnancy establishment in postpartum anestrous beef cows

Two experiments were conducted with the aim of determining the effect of equine chorionic gonadotropin (eCG) administration on day 14 after insemination on ovarian response and pregnancy establishment in postpartum anestrous beef cows. In both experiments, cows were subjected to a progesterone- and estradiol-based treatment for fixed-time artificial insemination (FTAI) and were randomly allocated into 4 groups to receive or not receive eCG (400 IU) at the time of device removal and/or at 14 d after FTAI. In experiment 1, from day 14 to 22, daily ultrasonographic determinations were performed to monitor ovarian dynamics, and blood was collected to determine hormone concentrations in 60 cows. In experiment 2, confirmation of pregnancy was performed at 30 and 60 d after FTAI in 1,060 anestrous cows assigned to the same experimental design. Cows that received eCG on day 14 after FTAI showed increases in corpus luteum area (P < 0.01), follicle diameter (P < 0.05), serum progesterone concentrations (P < 0.01), and estradiol-17β concentrations (P < 0.01), compared with cows that did not receive eCG on day 14. Pregnancy rate on day 30 was greater in those cows that received both eCG treatments (ie, at device removal and 14 d after insemination) than in those that did not receive eCG treatment (P < 0.05). In conclusion, eCG administered on day 14 after FTAI increases serum progesterone concentrations during the critical period of pregnancy in anestrous cows, and this second eCG treatment seems to have a positive effect on achieving pregnancy.

Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial.

This trial evaluated the safety and effectiveness of the Orbera Intragastric Balloon as an adjunct to lifestyle intervention. In this multicenter, randomized, open-label clinical trial, 255 adults with a body mass index of 30-40 kg m-2 were treated and outcomes were assessed up to 12 months. Participants were randomized to endoscopic placement of an intragastric balloon plus lifestyle or lifestyle intervention alone. Balloons were removed at 6 months and lifestyle intervention continued for both groups through 12 months. At 9 months, coprimary end points were two measures of weight loss. At 6 months, weight loss was -3.3% of total body weight (-3.2 kg) in the lifestyle arm vs -10.2% (-9.9 kg) in the balloon plus lifestyle arm (P<0.001); at 9 months (3 months postballoon removal), weight loss was -3.4% (-3.2 kg) vs -9.1% (-8.8 kg, P⩽0.001); and at 12 months, -3.1% (-2.9 kg) vs -7.6% (-7.4 kg, P⩽0.001). For the primary end points, at 9 months, mean percent loss of weight in excess of ideal body weight (s.d.) at 9 months was 26.5% (20.7) (P=0.32) and 9.7% (15.1) in the balloon and control groups, respectively. Also, 45.6% (36.7, 54.8) of the subjects randomized to the balloon achieved at least 15% loss of weight in excess of ideal body weight greater than the control group (P<0.001). The majority of balloon subjects experienced adverse events; 86.9% nausea, 75.6% vomiting, 57.5% abdominal pain and 18.8% had their device removed before 6 months because of an adverse event or subject request. Five subjects (3.1%) in the balloon group had a gastric abnormality at the time of device removal, and no ulcers were found. Intragastric balloon achieved greater short-term weight loss at 3 and 6 months postballoon removal than lifestyle intervention alone. Adverse gastrointestinal events were common.

Abstract: The Use of Distraction Osteogenesis in the Treatment of Rickets-Associated Craniosynostosis

INTRODUCTION: There is a known increased incidence of craniosynostosis in patients affected by the metabolic condition of rickets.1–3 Due to abnormal bone development, and a tendency toward presentation at an older age than most craniosynostosis patients, cranial remodeling surgery in rickets patients may be complicated by inadequate post-operative cranial growth and a greater risk of sutural re-fusion. We present two cases of 3-year old boys with rickets-associated sagittal craniosynostosis, and demonstrate the effectiveness of distraction osteogenesis in the surgical management of this condition. METHODS: Two 3-year-old boys with rickets presented with sagittal synostosis and marked scaphocephalic deformity as an indication for surgical intervention. A single midline sagittal osteotomy extending from the bregma to the lambda was made. A sagittal suturectomy was not performed in order to ensure bone edge proximity across the sagittal osteotomy site at the commencement of the distraction phase. Transverse osteotomies were made bilaterally behind the coronal suture to the pterion, and just anterior to the lambdoid sutures to the asterion to allow for biparietal distraction of the bilateral parietal region. Transverse wedge ostectomies were performed anterior to the lambdoid sutures, and the occipital bone was barrel-staved to encourage anterior occipital movement resulting from scalp tension during the ensuing transverse distraction. The devices were activated for 30 days. Consolidation phase lasted 12 weeks. Breadth of distraction and quality of regenerate were confirmed clinically at the time of device removal. Head shape was documented photographically. RESULTS: In both cases: Distraction breadth was verified intraoperatively as 30mm. Clinical exam confirmed that the regenerate was solid bone, without palpable areas of incomplete osteogenesis. A significant improvement in cranial proportion was achieved in both patients, as assessed clinically. Estimated blood loss was high in both cases, presumably related to the hyperemic nature of rickets bone, rather than the surgical distraction approach employed. CONCLUSIONS: Distraction osteogenesis promotes bone growth and cranial remodeling in patients with craniosynostosis due to rickets. The technique allows for continuous, incremental expansion of both bone and scalp tissue to overcome the limitations of abnormal bone healing due to rickets, as well as inadequate scalp compliance due to older age.4 We recommend consideration of distraction osteogenesis specifically for the treatment of craniosynostosis in older children with severe deformity, including those with rickets. REFERENCES: 1. Carlsen NL, Krasilnikoff PA, Eiken M. Premature cranial synostosis in X-linked hypophosphatemic rickets: possible precipitation by 1-alpha-OH-cholecalciferol intoxication. Acta Paediatr Scand 73(1):149–54, 1984 2. Currarino G. Sagittal synostosis in X-linked hypophosphatemic rickets and related diseases. Pediatr Radiol 37(8):805–12, 2007 3. Freudlsperger C, Hoffmann J, Castrillon-Oberndorfer G, Engel M. Bilateral coronal and sagittal synostosis in X-linked hypophosphatemic rickets: a case report. J Craniomaxillofac Surg 41(8):842–4, 2013 4. Gough J, Walker DG, Theile R, Tomlinson FH. The role of cranial expansion for craniocephalic disproportion. Pediatr Neurosurg 41(2):61–9, 2005

Synchronization of ovulation in cattle with an aromatase inhibitor–based protocol

A study was designed to determine the effect of stage of the estrous cycle on the proportion of animals that ovulated and the synchrony of ovulation of heifers treated with an aromatase inhibitor–based protocol. Forty-eight heifers were treated intramuscularly with 500 μg of cloprostenol (PGF) followed by 100 μg of GnRH 24 hours later to serve as control data for comparison of the ovulatory response to a subsequent aromatase inhibitor protocol. Daily ultrasound examinations were done to determine the incidence of and interval to ovulation. At the time of ovulation (Day 0), heifers were assigned randomly to five day-groups (n = 8-11/group) and given an intravaginal device containing 3 g of letrozole for 4 days starting on Day 0, 4, 8, 12, or 16. At the time of device removal, heifers were given PGF followed by GnRH 24 hours later. Ultrasound examinations were done daily from 2 days before device insertion to 9 days after the posttreatment ovulation. The preovulatory follicle diameter after letrozole treatment was larger in the Day 4 group compared to the Day 0 and 16 groups and intermediate in the Day 8 and 12 groups (P < 0.001). Compared to control data, the percentage of heifers that ovulated after letrozole treatment was greater (87.1% vs. 69.4%, respectively; P < 0.05) as was the synchrony of ovulation (residuals: 0.24 ± 0.07 vs. 0.68 ± 0.13; P < 0.01). The day on which letrozole treatment was initiated did not affect the proportion of heifers that ovulated or the interval to ovulation. Plasma estradiol concentrations at the time of removal of the letrozole device in the Day 0 and 4 groups was lower (P < 0.05) than in the corresponding controls. Estradiol concentrations in the Day 8 and 12 groups did not differ from already low concentrations in the respective controls. Corpus luteum diameter profiles and progesterone production were not affected by day-group although reduced luteal lifespan after letrozole treatment was observed and requires further investigation. In summary, a protocol involving a letrozole-impregnated intravaginal device for 4 days, PGF treatment at device removal, and GnRH 24 later resulted in a greater ovulation rate and greater synchrony of ovulation than in heifers not given letrozole. Results suggest that the protocol may be initiated effectively at random stages of the estrous cycle and may provide impetus for further studies to assess the efficacy of a letrozole-based synchronization protocol for fixed-time insemination.