Stomal Stenosis After Continent Urinary Diversion in Bladder Exstrophy: Risk Factors and Management.

OBJECTIVE: To identify risk factors for stenosis and compare management strategies for stenosis etiology and to examine the efficacy of each approach. Patients with classic bladder exstrophy (CBE), a rare genitourinary malformation, may require construction of a continent urinary stoma (CUS) if incontinence persists. Stomal stenosis is a challenging complication as it is common, progressive and recurrent. METHODS: CBE patients who underwent CUS were retrospectively reviewed for risk factors for stenosis including stoma type, prior midline laparotomy number, and umbilicoplasty suture material. Stenosis etiology and management strategies were further reviewed. RESULTS: A total of 260 CBE patients underwent CUS creation. Stenosis developed in 65 patients (25.0%) at a median interval of 1.9 years. Etiology included scar contracture (n=41), keloid (n=17), and hypertrophic scar (n=7). Multifilament suture was the only variable associated with an increased risk of stenosis compared to monofilament suture (p=0.009). Almost all patients required surgical intervention. Most scar contractures underwent stomal incision with success in 100%. Hypertrophic scars and keloids responded best to excision with local tissue rearrangement (66.7%). At last follow-up, all patients achieved success. CONCLUSION: Stomal stenosis is common and challenging for the reconstructive surgeon. Strategies to prevent and effectively manage this are greatly desired. Use of multifilament suture for the umbilicoplasty increased stenosis perhaps from a greater inflammatory response and scarring, while monofilament suture may reduce its incidence. Stomal incision for treating scar contractures, and excision with local tissue rearrangement for hypertrophic scars and keloids may improve successful primary surgical intervention.

Effects of clinical covariates on serum miRNA expression among women without ovarian cancer.

BACKGROUND: Serum microRNAs (miRNAs) are potential biomarkers for ovarian cancer; however, many factors may influence miRNA expression. To understand potential confounders in miRNA analysis, we examined how sociodemographic factors and comorbidities, including known ovarian cancer risk factors, influence serum miRNA levels in women without ovarian cancer. METHODS: Data from 1,576 women from the Mass General Brigham Biobank collected between 2012 and 2019, excluding subjects previously or subsequently diagnosed with ovarian cancer, were examined. Using a focused panel of 179 miRNA probes optimized for serum profiling, miRNA expression was measured by flow cytometry using the Abcam Fireplex® assay and correlated with subjects' electronic medical records. RESULTS: The study population broadly reflected the New England population. The median age of subjects was 49 years, 34% were current or prior smokers, 33% were obese (BMI >30kg/m2), 49% were postmenopausal, and 11% had undergone prior bilateral oophorectomy. Significant differences in miRNA expression were observed among ovarian risk factors such as age, obesity, menopause, BRCA1 or BRCA2 germline mutations or breast cancer in family history. Additionally, miRNA expression was significantly altered by prior bilateral oophorectomy, hypertension, and hypercholesterolemia. Other variables, such as smoking, parity, age at menarche, hormonal replacement therapy, oral contraception, breast, endometrial, or colon cancer, and diabetes were not associated with significant changes in the panel when corrected for multiple testing. CONCLUSIONS: Serum miRNA expression patterns are significantly affected by patient demographics, exposure history, and medical comorbidities. IMPACT: Understanding confounders in serum miRNA expression is important for refining clinical assays for cancer screening.

Pelleting and particle size reduction of corn increase net energy and digestibility of fiber, protein, and fat in corn-soybean meal diets fed to group-housed pigs.

BACKGROUND: Reduction of the particle size of corn increases energy digestibility and concentrations of digestible and metabolizable energy. Pelleting may also reduce particle size of grain, but it is not known if there are interactions between particle size reduction and pelleting. The objective of this experiment was to test the hypothesis that particle size reduction and pelleting, separately or in combination, increase N balance, apparent total tract digestibility (ATTD) of fiber and fat, and net energy (NE) in corn-soybean meal diets fed to group-housed pigs. METHODS: Six corn-soybean meal-based diets were used in a 3 × 2 factorial design with 3 particle sizes of corn (i.e., 700, 500, or 300 µm) and 2 diet forms (i.e., meal or pelleted). Pigs were allowed ad libitum access to feed and water. Twenty-four castrated male pigs (initial weight: 29.52 kg; standard diviation: 1.40) were allotted to the 6 diets using a 6 × 6 Latin square design with 6 calorimeter chambers (i.e., 4 pigs/chamber) and 6 periods. Oxygen consumption and CO2 and CH4 productions were measured during fed and fasting states and fecal and urine samples were collected. RESULTS: Regardless of particle size of corn, the ATTD of gross energy (GE), N, and acid-hydrolyzed ether extract (AEE), and the concentration of NE were greater (P < 0.05) in pelleted diets than in meal diets. Regardless of diet form, the ATTD of GE, N, and AEE, and the concentration of NE were increased (linear; P < 0.05) by reducing the particle size of corn, but the increase was greater in meal diets than in pelleted diets (interaction; P < 0.05). CONCLUSIONS: Both pelleting and reduction of corn particle size increased nutrient digestibility and NE, but increases were greater in meal diets than in pelleted diets.

Almond hulls and shells as an alternative fiber source in limit-fed growing beef cattle diets.

Almond hulls and shells are a by-product of almond production that can be incorporated as a feed ingredient in beef cattle diets. Three experiments were conducted to determine the effects of hammermill screen size on almond hull and shell bulk density and inclusion of ground or non-ground almond hulls and shells in limit-fed growing diets on growth performance, diet digestibility, and ruminal fermentation characteristics of beef cattle. In experiment 1, almond hulls and shells were ground with a laboratory-scale hammermill using no screen, a 11.1-mm screen, a 19.1-mm screen, or a 25.4-mm screen. Each screen-size treatment was ground at three separate time points (n= 3 replications/treatment). Grinding almond hulls and shells with no screen increased bulk density by 111% and minimized proportions of fine particles; therefore, almond hulls and shells ground using no screen were included as a treatment in the following experiments. In experiment 2, 364 steers (initial body weight [BW]: 257±â€…20.7 kg) were blocked by truckload (n = 4), stratified by BW, and assigned to pen within block. Pens were randomly assigned to 1 of 4 experimental diets (n= 10 pens/treatment). The control diet (CON) contained (DM basis) 39.5% dry-rolled corn, 7.5% supplement, 40% wet-corn gluten feed, and 13% prairie hay. Non-ground (13AH) or ground (13GAH) almond hulls and shells replaced prairie hay and were fed at 13% of diet DM or non-ground almond hulls and shells were fed at 26% of diet DM and replaced 13% prairie hay and 13% dry-rolled corn (26AH). Diets were limit-fed at 2.2% of BW daily (DM basis) for 56 d. Overall average daily gains (ADG) were greater (P ≤ 0.05) for CON, 13AH, and 13GAH compared with 26AH. In addition, ADG from days 14 to 56 were greater (P= 0.03) for 13GAH and tended to be greater (P = 0.09) for 13AH compared with CON. Experiment 3 was a 4 × 4 replicated Latin square in which 8 ruminally cannulated heifers (initial BW = 378 ±â€…44.0 kg) were fed diets from experiment 2. Apparent dry matter digestibility did not differ (P = 0.21) among treatments. Total ruminal volatile fatty acid concentrations were greater (P ≤ 0.03) for 13GAH and 13AH compared with 26AH and tended (P = 0.06) to be greater for 13GAH compared with CON. Overall, almond hulls and shells can be utilized as an alternative to prairie hay in limit-fed growing diets without negatively influencing rates of gain or diet digestibility.

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis During the COVID-19 Pandemic - United States, 2019-2021.

Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis.

Differences in Serum miRNA Profiles by Race, Ethnicity, and Socioeconomic Status: Implications for Developing an Equitable Ovarian Cancer Screening Test.

Serum miRNAs are promising biomarkers for several clinical conditions, including ovarian cancer. To inform equitable implementation of these tests, we investigated the effects of race, ethnicity, and socioeconomic status on serum miRNA profiles. Serum samples from a large institutional biobank were analyzed using a custom panel of 179 miRNA species highly expressed in human serum, measured using the Abcam Fireplex assay via flow cytometry. Data were log-transformed prior to analysis. Differences in miRNA by race and ethnicity were assessed using logistic regression. Pairwise t tests analyzed racial and ethnic differences among eight miRNAs previously associated with ovarian cancer risk. Pearson correlations determined the relationship between mean miRNA expression and the social deprivation index (SDI) for Massachusetts residents. Of 1,586 patients (76.9% white, non-Hispanic), compared with white, non-Hispanic patients, those from other racial and ethnic groups were younger (41.9 years ± 13.2 vs. 51.3 ± 15.1, P < 0.01) and had fewer comorbidities (3.5 comorbidities ± 2.7 vs. 4.6 ± 2.8, P < 0.01). On logistic regression, miRNAs predicted race and ethnicity at an AUC of 0.69 (95% confidence interval, 0.66-0.72), which remained consistent when stratified by most comorbidities. Among eight miRNAs previously associated with ovarian cancer risk, seven significantly varied by race and ethnicity (all P < 0.01). There were no significant differences in SDI for any of these eight miRNAs. miRNA expression is significantly influenced by race and ethnicity, which remained consistent after controlling for confounders. Understanding baseline differences in biomarker test characteristics prior to clinical implementation is essential to ensure instruments perform comparably across diverse populations. PREVENTION RELEVANCE: This study aimed to understand factors affecting miRNA expression, to ensure we create equitable screening tests for ovarian cancer that perform well in diverse populations. The goal is to ensure that we are detecting ovarian cancer cases earlier (secondary prevention) in women of all races, ethnic backgrounds, and socioeconomic means.

Postmanufacturing techniques for mitigation of viral pathogens in porcine-derived feed ingredients: a review.

African swine fever virus (ASFV) is a highly infectious virus known to cause substantial mortality and morbidity in pigs. The transmissibility and severity of disease within pigs, as well as the potentially resultant catastrophic trade ramifications, warrant its status as a foreign animal disease of substantial concern to the United States. The ASFV virus can survive for extended periods of time outside its host, and its greatest concentration is often observed in blood and organs, products that are frequently used as raw materials to manufacture porcine-derived ingredients fed to animals in the United States. Unlike ruminant-based proteins that cannot be fed to ruminant animals, it is permissible to feed porcine-derived ingredients to pigs in the United States. However, the increased threat of ASFV entry into the United States and our evolving understanding of viral transmission by feedstuffs warrant further investigation into this practice. The objectives of this review are to describe the current knowledge of ASFV survival in raw materials used to produce porcine-based ingredients, identify priorities for future research, and summarize potential options for managing risk until additional knowledge can be gained. While limited data is available for ASFV-specific mitigation, the temperatures used in both spray-drying and rendering have proven to effectively reduce viral concentrations of multiple swine viruses below detectable limits. However, some of these procedures may not eliminate the risk of recontamination, which necessitates the need for additional prevention or mitigation measures. Most published research in this area relies on direct inoculation of raw ingredient, not the finished porcine-derived ingredient. Currently, three published studies report ASFV mitigation in either thermally processed conditions (>40 °C) or ingredient quarantine (<40 °C). Virus inactivation, or the reduction of viral concentrations below detectable levels, was observed in the thermally processed study and one of the two ingredient quarantine studies. In conclusion, there is little knowledge to eliminate the risk of recontamination in porcine-derived ingredients; therefore, future research should aim to support and validate the currently available literature for the continued and safe production of porcine-derived ingredients in the event of a foreign animal disease outbreak.

Interposing Rectus and Gracilis Muscle Flaps For Pelvic Reconstruction in Bladder Exstrophy After Bladder Neck Closure.

BACKGROUND: The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy (CBE) and cloacal exstrophy (CE). Patients undergo multiple soft-tissues procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterwards for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed. METHODS: A retrospective cohort study of exstrophy-epispadias complex patients who underwent BNC and had a muscle fap was performed. Indication for flap use, surgical technique, risks for BNC failure including mucosal violations (MVs) were reviewed. MVs were prior bladder mucosa manipulation for exstrophy closure, repeat closure(s) and bladder neck reconstruction. Success was defined as BNC without fistula development. RESULTS: Thirty-four patients underwent reconstruction. Indications included during BNC (n=13), fistula closure after BNC (n=17), following BNC during open cystolithotomy (n=1) or fistula closure after open cystolithotomy (n=3). A vesicourethral fistula developed most frequently in CBE (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flap were used with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success and 2 CE patients required a second flap. CONCLUSION: The rectus flap is preferred as it covers the antero-inferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs, increase the risk of fistula formation and may influence the need for prophylactic flaps.

Evaluation of Truck Cab Decontamination Procedures following Inoculation with Porcine Epidemic Diarrhea Virus and Porcine Reproductive and Respiratory Syndrome Virus.

This experiment aimed to evaluate commercially available disinfectants and their application methods against porcine epidemic diarrhea virus (PEDV) and porcine reproductive and respiratory syndrome virus (PRRSV) on truck cab surfaces. Plastic, fabric, and rubber surfaces inoculated with PEDV or PRRSV were placed in a full-scale truck cab and then treated with one of eight randomly assigned disinfectant treatments. After application, surfaces were environmentally sampled with cotton gauze and tested for PEDV and PRRSV using qPCR duplex analysis. There was a disinfectant × surface interaction (p < 0.0001), indicating a detectable amount of PEDV or PRRSV RNA was impacted by disinfectant treatment and surface material. For rubber surfaces, 10% bleach application had lower detectable amounts of RNA compared to all other treatments (p < 0.05) except Intervention via misting fumigation, which was intermediate. In both fabric and plastic surfaces, there was no evidence (p > 0.05) of a difference in detectable RNA between disinfectant treatments. For disinfectant treatments, fabric surfaces with no chemical treatment had less detectable viral RNA compared to the corresponding plastic and rubber (p < 0.05). Intervention applied via pump sprayer to fabric surfaces had less detectable viral RNA than plastic (p < 0.05). Furthermore, 10% bleach applied via pump sprayer to fabric and rubber surfaces had less detectable viral RNA than plastic (p < 0.05). Also, a 10 h downtime, with no chemical application or gaseous fumigation for 10 h, applied to fabric surfaces had less detectable viral RNA than other surfaces (p < 0.05). Sixteen treatments were evaluated via swine bioassay, but all samples failed to produce infectivity. In summary, commercially available disinfectants successfully reduced detectable viral RNA on surfaces but did not eliminate viral genetic material, highlighting the importance of bioexclusion of pathogens of interest.

Effect of the pelleting process on diet formulations with varying levels of crystalline amino acids and reducing sugars on digestibility in growing pigs.

The objective of this experiment was to determine the effects of pelleting on the standardized ileal digestibility (SID) of amino acids (AA) and crude protein (CP) in diets with or without increased concentrations of free AA and reducing sugars (RS). Eight individually housed, ileal cannulated barrows (initially 31.4 kg) were allotted to an 8 × 8 Latin square with eight diets and eight 7-d periods with ileal digesta collected on days 6 and 7. Treatments were arranged in a 2 × 2 × 2 factorial with the main effects of diet form (mash or pellet), crystalline AA (low or high), or RS (low or high), provided by distillers dried grains with solubles and bakery meal. Diets were pelleted to achieve a hot pellet temperature of 85 to 88 °C. Data were analyzed as a Latin square design using the GLIMMIX procedure of SAS 9.4. A feed form × RS interaction (P < 0.026) for SID of tryptophan was observed. Feeding pelleted low RS diets increased SID of tryptophan compared with mash high and low RS diets, and pelleted high RS diets. For the main effects of feed form, the SID of total AA, CP, and indispensable AA was greater (P < 0.042) in pelleted diets compared with mash diets. For the main effects of crystalline AA, pigs fed high crystalline AA had increased (P = 0.007) SID of tryptophan and decreased (P = 0.050) SID of histidine compared with those fed low crystalline AA diets. For the main effects of RS, high RS diets had decreased (P < 0.05) SID of total AA, CP, and indispensable AA compared with low RS diets. In conclusion, pelleting diets increased AA digestibility, and pelleting diets with increased crystalline AA or RS did not affect the improvement in AA digestibility from pelleting. Diets formulated with high crystalline AA had increased SID of tryptophan. Formulating diets with high RS resulted in decreased AA digestibility compared with corn-soybean meal-based diets.

The objective of this study was to determine the effects of pelleting on the standardized ileal digestibility (SID) of amino acids (AA) in diets with or without increased concentrations of free AA and reducing sugars (RS). Treatments were arranged in a 2 × 2 × 2 factorial with the main effects of diet form (mash or pellet), crystalline AA (low or high), or RS (low or high), provided by dried distillers grains with solubles and bakery meal. A total of 8 illeal cannulated barrows were fed treatments in an 8 × 8 Latin square design. Results indicated that there was no evidence of interactions between diet types and diet form, indicating that increasing amounts of crystalline AA and RS did not reduce amino acid digestibility when pelleting diets. Additionally, pelleting diets resulted in increased amino acid digestibility compared to mash diets. Diets formulated with 20% dried distillers grains with solubles and 15% bakery resulted in decreased amino acid digestibility compared with the corn­soybean meal-based diets. Crystalline amino acid concentration did not influence amino acid digestibility of indispensable AA, except for SID of tryptophan which was increased in diets with higher concentrations of crystalline AA.

Strategic restoration planning for land birds in the Colorado River Delta, Mexico.

Ecological restoration is an essential strategy for mitigating the current biodiversity crisis, yet restoration actions are costly. We used systematic conservation planning principles to design an approach that prioritizes restoration sites for birds and tested it in a riparian forest restoration program in the Colorado River Delta. Restoration goals were to maximize the abundance and diversity of 15 priority birds with a variety of habitat preferences. We built abundance models for priority birds based on the current landscape, and predicted bird distributions and relative abundances under a scenario of complete riparian forest restoration throughout our study area. Then, we used Zonation conservation planning software to rank this restored landscape based on core areas for all priority birds. The locations with the highest ranks represented the highest priorities for restoration and were located throughout the river reach. We optimized how much of the available landscape to restore by simulating restoration of the top 10-90% of ranked sites in 10% intervals. We found that total diversity was maximized when 40% of the landscape was restored, and mean relative abundance was maximized when 80% of the landscape was restored. The results suggest that complete restoration is not optimal for this community of priority birds and restoration of approximately 60% of the landscape would provide a balance between maximum relative abundance and diversity. Subsequent planning efforts will combine our results with an assessment of restoration costs to provide further decision support for the restoration-siting process. Our approach can be applied to any landscape-scale restoration program to improve the return on investment of limited economic resources for restoration.

National Postoperative Opioid Prescribing Rates Following Pediatric Urology Procedures Before and After the 2018 American Academy of Pediatrics Challenge to Reduce Opioid Prescribing: A Claims Database Analysis.

OBJECTIVE: To evaluate trends in opioid prescribing rates following pediatric urologic surgery. METHODS: We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge. RESULTS: Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts. CONCLUSION: Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation.

Nocardia farcinica abortion in a goat.

A female goat fetus was received by the Colorado State University-Veterinary Diagnostic Laboratory following an isolated abortion of twins by a reportedly healthy doe. Postmortem examination did not reveal any gross abnormalities. Histologic evaluation revealed pyogranulomatous and necrotizing bronchopneumonia with intracellular and extracellular gram-positive and non-acid-fast filamentous bacilli. Aerobic culture of the stomach contents and pooled lung and liver tissue yielded light growth of Nocardia sp., which was identified by MALDI-TOF MS and 16s rDNA sequencing as Nocardia farcinica.

Postoperative Opioid Prescribing in Adolescents and Young Adults After Urologic Procedures Is Associated With New Persistent Opioid Use Disorder: A Large Claims Database Analysis.

OBJECTIVE: To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults. MATERIALS AND METHODS: The TriNetX LLC Diamond Network was queried for patients aged 13-21years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9months after index procedure without another surgery requiring anesthesia during the postoperative timeframe. RESULTS: Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After propensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiopexy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who received postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiopexy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98). CONCLUSION: The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use.

Summary of methodology used in enterotoxigenic Escherichia coli (ETEC) challenge experiments in weanling pigs and quantitative assessment of observed variability.

Postweaning diarrhea in pigs is often caused by the F4 or F18 strains of enterotoxigenic Escherichia coli (ETEC). To evaluate interventions for ETEC, experimental infection via a challenge model is critical. Others have reviewed ETEC challenge studies, but there is a lack of explanation for the variability in responses observed. Our objective was to quantitatively summarize the responses and variability among ETEC challenge studies and develop a tool for sample size calculation. The most widely evaluated response criteria across ETEC challenge studies consist of growth performance, fecal consistency, immunoglobulins, pro-inflammatory cytokines, and small intestinal morphology. However, there is variation in the responses seen following ETEC infection as well as the variability within each response criteria. Contributing factors include the type of ETEC studied, dose and timing of inoculation, and the number of replications. Generally, a reduction in average daily gain and average daily feed intake are seen following ETEC challenge as well as a rapid increase in diarrhea. The magnitude of response in growth performance varies, and methodologies used to characterize fecal consistency are not standardized. Likewise, fecal bacterial shedding is a common indicator of ETEC infection, but the responses seen across the literature are not consistent due to differences in bacterial enumeration procedures. Emphasis should also be placed on the piglet's immune response to ETEC, which is commonly assessed by quantifying levels of immunoglobulins and pro-inflammatory cytokines. Again, there is variability in these responses across published work due to differences in the timing of sample collection, dose of ETEC pigs are challenged with, and laboratory practices. Small intestinal morphology is drastically altered following infection with ETEC and appears to be a less variable response criterion to evaluate. For each of these outcome variables, we have provided quantitative estimates of the responses seen across the literature as well as the variability within them. While there is a large degree of variability across ETEC challenge experiments, we have provided a quantitative summary of these studies and a Microsoft Excel-based tool was created to calculate sample sizes for future studies that can aid researchers in designing future work.

Multi-staged vs Single-staged Pelvic Osteotomy in the Modern Treatment of Cloacal Exstrophy: Bridging the Gap.

PURPOSE: Staged pelvic osteotomy has been shown in the past to be an effective tool in the closure of the extreme pubic diastasis of cloacal exstrophy. The authors sought to compare orthopedic complications between non-staged pelvic osteotomies and staged pelvic osteotomies in cloacal exstrophy. METHODS: A prospectively maintained exstrophy-epispadias complex database of 1510 patients was reviewed for cloacal exstrophy bladder closure events performed with osteotomy at the authors' institution. Bladder closure failure was defined as any fascial dehiscence, bladder prolapse, or vesicocutaneous fistula within one year of closure. There was a total of 172 cloacal exstrophy and cloacal exstrophy variant patients within the database and only closures at the authors' institution were included. RESULTS: 64 closure events fitting the inclusion criteria were identified in 61 unique patients. Staged osteotomy was performed in 42 closure events and non-staged in 22 closures. Complications occurred in 46/64 closure events, with 16 grade III/IV complications. There were no associations between staged osteotomy and overall complication or grade III/IV complications (p = 0.6344 and p = 0.1286, respectively). Of the 46 total complications, 12 were orthopedic complications with 6 complications being grade III/IV. Staged osteotomy closure events experienced 10/42 orthopedic complications while non-staged osteotomy closures experienced 2/22 orthopedic complications, however this did not reach significance (p = 0.1519). Of the 64 closure events, 57 resulted in successful closure with 6 failures and one closure with planned cystectomy. CONCLUSION: This study confirms, in a larger series, superior outcomes when using staged pelvic osteotomy in cloacal exstrophy bladder closure. Staged osteotomy was shown to be a safe alternative to non-staged osteotomy that can decrease the risk of closure failure in this group. Staged pelvic osteotomy should be considered in all patients undergoing cloacal exstrophy bladder closure. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.