Dairy calf transportation in the United States: Challenges and strategies to improve animal welfare.

The objectives of this symposium review are to summarize relevant research and key welfare issues relative to calf transportation and identify strategies to mitigate welfare challenges. An important animal welfare concern across the US dairy industry is the transportation of preweaning calves from the source dairy to a calf-raising facility (e.g., calf ranches, heifer raising facilities, veal operations), auction, livestock market, or directly to slaughter. Millions of calves are transported annually in the United States and calf transport has garnered increased attention. Transportation stressors include limited (if any) access to food and water, commingling, environmental temperature changes, and a variety of handling techniques. Calves in the United States are often transported at an average age of 3 d, and in many cases, less than 24 h of age. Neonates are particularly vulnerable to transportation stressors due to their decreased ability to thermoregulate, underdeveloped immune system, and immature physiologic stress responses. In addition to age, fitness for transport is a key welfare consideration; recent data from the United States demonstrate that some source dairies transport compromised calves (i.e., dehydration, diarrhea, navel inflammation, and so on), leading to important welfare challenges during transportation. Calves arriving at US veal facilities have been reported to be dehydrated, lethargic, hypoglycemic, and may also have poor body condition, navel inflammation, and diarrhea. Thus, there is ample opportunity to target decision-making and producer-focused education not only at the source dairy, but also at each stage of transportation to address critical welfare concerns. In addition, the supply chain and procurement model that influence calf transport practices should be evaluated to determine potential opportunities to improve calf welfare. Here, we provide 5 potential strategies to improve the welfare of transported calves: (1) provide excellent newborn care that "preconditions" calves for transport, (2) assess calves' fitness-for-transport to ensure they can withstand the journey, (3) handle calves with care, (4) wait until calves are older to transport, and (5) reduce transport duration.

Mitral annular disjunction in idiopathic ventricular fibrillation patients: just a bystander or a potential cause?

AIMS: Previously, we demonstrated that inferolateral mitral annular disjunction (MAD) is more prevalent in patients with idiopathic ventricular fibrillation (IVF) than in healthy controls. In the present study, we advanced the insights into the prevalence and ventricular arrhythmogenicity by inferolateral MAD in an even larger IVF cohort. METHODS AND RESULTS: This retrospective multi-centre study included 185 IVF patients [median age 39 (27, 52) years, 40% female]. Cardiac magnetic resonance images were analyzed for mitral valve and annular abnormalities and late gadolinium enhancement. Clinical characteristics were compared between patients with and without MAD. MAD in any of the 4 locations was present in 112 (61%) IVF patients and inferolateral MAD was identified in 24 (13%) IVF patients. Mitral valve prolapse (MVP) was found in 13 (7%) IVF patients. MVP was more prevalent in patients with inferolateral MAD compared with patients without inferolateral MAD (42 vs. 2%, P < 0.001). Pro-arrhythmic characteristics in terms of a high burden of premature ventricular complexes (PVCs) and non-sustained ventricular tachycardia (VT) were more prevalent in patients with inferolateral MAD compared to patients without inferolateral MAD (67 vs. 23%, P < 0.001 and 63 vs. 41%, P = 0.046, respectively). Appropriate implantable cardioverter defibrillator therapy during follow-up was comparable for IVF patients with or without inferolateral MAD (13 vs. 18%, P = 0.579). CONCLUSION: A high prevalence of inferolateral MAD and MVP is a consistent finding in this large IVF cohort. The presence of inferolateral MAD is associated with a higher PVC burden and non-sustained VTs. Further research is needed to explain this potential interplay.

Preliminary exploration of the health and behavior around the time of transportation of beef × dairy calves and Holstein bull calves 3 days of age or younger in the western United States.

In the western United States, it is common practice for dairy and beef × dairy calves to be sold and shipped within the first few days of life, making transportation one of the first challenges that a calf will experience. To date, no published research has examined the effects of calf transport within the western United States. The objectives of this observational study were to describe the health status of calves leaving the source dairy, characterize transportation conditions and calf behavior during transportation, and determine if age at transportation and transportation duration are associated with dehydration, blood glucose and lactate, and behavior. An observational study was performed on 2 source dairies in the western United States. Initial enrollment consisted of dairy bull calves and beef × dairy calves (n = 126 total) across 16 transport cohorts which were sold and transported to separate calf-raising facilities approximately 80 km from the source dairy. Health exams and measurements were performed on all study participants 2 to 3 h before transport and ≤2 h after transport. Two researchers performed health exams using the Wisconsin calf health score, which included clinical respiratory scores, lung ultrasound, and fecal, navel, and joint scores. Hydration status was assessed using skin tent duration. Blood samples were collected and immediately analyzed for blood glucose and lactate using glucose and lactate meters. Accelerometers were attached at the source dairy on ≤10 calves in each of the 16 transport groups to record movement and behavior during transport (n = 90 had accelerometers attached). Results showed that about half of calves (49%) were identified with at least one health abnormality before transport. Researchers found an association between age and dehydration status in which calves <24 h of age were more likely to be dehydrated compared with calves 1 d of age. Additionally over half of the calves (56%) were identified as dehydrated after transport. To the authors' knowledge, this is the first observational study that investigates the effects of transportation on dairy bull and beef × dairy calf health and welfare in the western United States. Our findings support the need for improved management and decision making before transporting calves to reduce the negative effects of transport.

Oral meloxicam given as an ancillary treatment at respiratory disease diagnosis was not associated with growth, clinical scores, or ultrasound scores in preweaned dairy calves.

Objective: To assess the efficacy of a single dose of oral meloxicam as an ancillary therapy to an antibiotic given at the time of respiratory disease identification on average daily gain (ADG), behavioral attitude, clinical respiratory, and lung ultrasound scores in preweaned dairy calves. Animals: 215 male and female Holstein, Jersey, and crossbred preweaned calves enrolled between 1 and 14 days of age at study enrollment on a single commercial dairy in the western US. Methods: The study took place from March 4, 2021, to November 21, 2021. In this double-blind placebo-controlled study, calves were given an antibiotic (1.1 mL of tulathromycin/kg, SC, once) and either a placebo (1 mg of lactose monohydrate/kg, in a gelatin capsule) or oral meloxicam (1 mg/kg) at the time of respiratory disease identification. Behavioral attitude, clinical respiratory, and lung ultrasound scores and ADG were assessed in preweaned dairy calves at different time points including the next health examination, 1 week later, or at weaning. Results: There was no association between treatment (placebo vs meloxicam) on ADG or respiratory disease status at weaning (P > .05). There was no effect of treatment on behavioral attitude, clinical respiratory, or lung ultrasound scores at the next health examination or 1 week later (P > .05). Clinical Relevance: The present study did not provide evidence that oral meloxicam given once is beneficial for growth, behavioral attitude, or clinical or lung ultrasound scores.

Veterinarians' perspectives of pain, treatment, and diagnostics for bovine respiratory disease in preweaned dairy calves.

Background: Bovine Respiratory Disease (BRD) is a leading cause of morbidity and mortality in preweaned dairy calves. Early detection and therefore treatment are essential to minimize animal welfare concerns, particularly given that recent research also demonstrates that BRD is painful. Veterinarians are essential to ensuring calves with BRD receive appropriate treatment, but little to no research exists regarding veterinarians' perspectives about BRD detection and treatment in dairy calves. This is a critical step to determine education and outreach needs that can target BRD treatment to improve calf welfare. Thus, the objectives of the current study were to describe US veterinarians' current detection methods and treatment practices for BRD in preweaned dairy calves, understand veterinarians' rationale for treatment decisions, and identify gaps in knowledge regarding treatment and management of calf BRD. Methods: An online survey was sent to two veterinarian-focused list-serves and newsletter. Final responses (n = 47) were analyzed using qualitative and quantitative analyses. Results: On-farm necropsy was the diagnostic tool most considered "extremely important" (26, 55.3%). All veterinarians indicated that BRD was at least mildly painful. However, only 53% of veterinarians (n = 25) assess pain in preweaned calves with BRD in order to make treatment decisions. Furthermore, of the veterinarians that assessed pain, 40% (n = 10) reported that their knowledge of pain assessment and treatment was adequate, but most (n = 24) considered a calf's pain-level at least "moderately important" to make BRD treatment decisions. The most important ancillary therapy for antimicrobials were NSAIDs (21, 44.7%). The ancillary therapy most often considered "extremely important" for treating BRD was NSAIDs. Qualitative analysis identified the following as factors that influenced veterinarians' willingness to provide analgesia: the farm's willingness to administer drugs, clinical signs, perceived severity of pain, the need for anti-inflammatories, and the presence of fever and comorbidities. Discussion: This study included a small sample size and an extremely low response rate; results should therefore be interpreted with caution. Despite this limitation, important gaps in knowledge were identified, including pain assessment and consideration when making treatment decisions, and diagnostic tools. Addressing these needs in future research and outreach efforts could help ensure appropriate and timely treatment of calf BRD, including pain mitigation.

Addition of FFRct in the diagnostic pathway of patients with stable chest pain to reduce unnecessary invasive coronary angiography (FUSION) : Rationale and design for the multicentre, randomised, controlled FUSION trial.

BACKGROUND: Coronary computed tomography angiography (CCTA) is widely used in the diagnostic work-up of patients with stable chest pain. CCTA has an excellent negative predictive value, but a moderate positive predictive value for detecting coronary stenosis. Computed tomography-derived fractional flow reserve (FFRct) is a non-invasive, well-validated technique that provides functional assessment of coronary stenosis, improving the positive predictive value of CCTA. However, to determine the value of FFRct in routine clinical practice, a pragmatic randomised, controlled trial (RCT) is required. We will conduct an RCT to investigate the impact of adding FFRct analysis in the diagnostic pathway of patients with a coronary stenosis on CCTA on the rate of unnecessary invasive coronary angiography, cost-effectiveness, quality of life and clinical outcome. METHODS: The FUSION trial is a prospective, multicentre RCT that will randomise 528 patients with stable chest pain and anatomical stenosis of ≥ 50% but < 90% in at least one coronary artery of ≥ 2 mm on CCTA, to FFRct-guided care or usual care in a 1:1 ratio. Follow-up will be 1 year. The primary endpoint is the rate of unnecessary invasive coronary angiography within 90 days. CONCLUSION: The FUSION trial will evaluate the use of FFRct in stable chest pain patients from the Dutch perspective. The trial is funded by the Dutch National Health Care Institute as part of the research programme 'Potentially Promising Care' and the results will be used to assess if FFRct reimbursement should be included in the standard health care package.

Characterizing heat mitigation strategies utilized by beef processors in the United States.

During lairage at slaughter plants, cattle can be exposed to extreme heat conditions from pen densities and holding pen microclimates. While research outlining heat mitigation strategies used in other sectors of the beef supply chain is available, there is no published data on the use of heat mitigation strategies at slaughter plants. The objective of this study was to characterize short-term heat mitigation strategies used by commercial beef slaughter plants in the United States. Twenty-one beef slaughter plants, representing an estimated 60% of beef slaughter in the United States, were included in the study. All plants indicated use of at least one heat mitigation strategy, and five of them used more than one type. Sprinklers/misters were the most commonly used heat mitigation type (n = 17, 81%), and fans were the least common type (n = 4, 19%). Shade usage was present in several plants (n = 7, 33%), ranging from barn style roofs to shade cloths. Respondents indicated that they believed heat mitigation strategies provide benefits both to cattle well-being and meat quality outcomes. Future research should focus on the effectiveness of these techniques in improving animal well-being and quality outcomes in the slaughter plant environment and protocols for optimum implementation.

Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes.

BACKGROUND: Type 2 diabetes is a condition associated with a state of low-grade inflammation caused by adipose tissue dysfunction and insulin resistance. High sensitive-CRP (hs-CRP) is a marker for systemic low-grade inflammation and higher plasma levels have been associated with cardiovascular events in various populations. The aim of the current study is to evaluate the relation between hs-CRP and incident cardiovascular events and all-cause mortality in high-risk type 2 diabetes patients. METHODS: Prospective cohort study of 1679 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART). Cox proportional hazard models were used to evaluate the risk of hs-CRP on cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality. Hs-CRP was log-transformed for continuous analyses. Findings were adjusted for age, sex, BMI, current smoking and alcohol use, non-HDL-cholesterol and micro-albuminuria. RESULTS: 307 new cardiovascular events and 343 deaths occurred during a median follow-up of 7.8 years (IQR 4.2-11.1). A one unit increase in log(hs-CRP) was related to an increased vascular- and all-cause mortality risk (HR 1.21, 95% CI 1.01-1.46 and HR 1.26, 95% CI 1.10-1.45 respectively). No relation was found between log(hs-CRP) and myocardial infarction or stroke. The relations were similar in patients with and without previous vascular disease. CONCLUSION: Low grade inflammation, as measured by hs-CRP, is an independent risk factor for vascular- and all-cause mortality but not for cardiovascular events in high-risk type 2 diabetes patients. Chronic low-grade inflammation may be a treatment target to lower residual cardiovascular risk in type 2 diabetes patients.

Novel advances in cardiac rehabilitation : Position paper from the Working Group on Preventive Cardiology and Cardiac Rehabilitation of the Netherlands Society of Cardiology.

Cardiac rehabilitation (CR) has evolved as an important part of the treatment of patients with cardiovascular disease. However, to date, its full potential is fairly underutilised. This review discusses new developments in CR aimed at improving participation rates and long-term effectiveness in the general cardiac population. It consecutively highlights new or challenging target groups, new delivery modes and new care pathways for CR programmes. These new or challenging target groups include patients with atrial fibrillation, obesity and cardiovascular disease, chronic coronary syndromes, (advanced) chronic heart failure with or without intracardiac devices, women and frail elderly patients. Also, the current evidence regarding cardiac telerehabilitation and loyalty programmes is discussed as new delivery modes for CR. Finally, this paper discusses novel care pathways with the integration of CR in residual risk management and transmural care pathways. These new developments can help to make optimal use of the benefits of CR. Therefore we should seize the opportunities to reshape current CR programmes, broaden their applicability and incorporate them into or combine them with other cardiovascular care programmes/pathways.

Fire and herbivory drive fungal and bacterial communities through distinct above- and belowground mechanisms.

Fire and herbivory are important natural disturbances in grassy biomes. Both drivers are likely to influence belowground microbial communities but no studies have unravelled the long-term impact of both fire and herbivory on bacterial and fungal communities. We hypothesized that soil bacterial communities change through disturbance-induced shifts in soil properties (e.g. pH, nutrients) while soil fungal communities change through vegetation modification (biomass and species composition). To test these ideas, we characterised soil physico-chemical properties (pH, acidity, C, N, P and exchangeable cations content, texture, bulk density, moisture), plant species richness and biomass, microbial biomass and bacterial and fungal community composition and diversity (using 16S and ITS rRNA amplicon sequencing, respectively) in six long-term (18 to 70 years) ecological research sites in South African savanna and grassland ecosystems. We found that fire and herbivory regimes profoundly modified soil physico-chemical properties, plant species richness and standing biomass. In all sites, an increase in woody biomass (ranging from 12 to 50%) was observed when natural disturbances were excluded. The intensity and direction of changes in soil properties were highly dependent on the topo-pedo-climatic context. Overall, fire and herbivory shaped bacterial and fungal communities through distinct driving forces: edaphic properties (including Mg, pH, Ca) for bacteria, and vegetation (herbaceous biomass and woody cover) for fungi. Fire and herbivory explained on average 7.5 and 9.8% of the fungal community variability, respectively, compared to 6.0 and 5.6% for bacteria. The relatively small changes in microbial communities due to natural disturbance is in stark contrast to dramatic vegetation and edaphic changes and suggests that soil microbial communities, having evolved with disturbance, are resistant to change. This represents both a buffer to short-term anthropogenic-induced changes and a restoration challenge in the face of long-term changes.

Retrospective analysis of endocarditis patients to investigate the eligibility for oral antibiotic treatment in routine daily practice.

BACKGROUND: According to the current guidelines of the European Society of Cardiology, patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4-6 weeks, leading to extensive hospital stay and high costs. Recently, the Partial Oral Treatment of Endocarditis (POET) trial suggested that partial oral treatment is effective and safe in selected patients. Here, we investigated if such patients are seen in our daily clinical practice. METHODS: We enrolled 119 adult patients diagnosed with left-sided infective endocarditis in a retrospective, observational study. We identified those that would be eligible for switching to partial oral antibiotic treatment as defined in the POET trial (e.g. stable clinical condition without signs of infection). Secondary objectives were to provide insight into the time until each patient was eligible for partial oral treatment, and to determine parameters of longer hospital stay and/or need for extended intravenous antibiotic treatment. RESULTS: Applying the POET selection criteria, the condition of 38 patients (32%) was stable enough to switch them to partial oral treatment, of which 18 (47.3%), 8 (21.1%), 9 (23.7%) and 3 patients (7.9%) were eligible for switching after 10, 14, 21 days or 28 days of intravenous treatment, respectively. CONCLUSION: One-third of patients who presented with left-sided endocarditis in routine clinical practice were possible candidates for switching to partial oral treatment. This could have major implications for both the patient's quality of life and healthcare costs. These results offer an interesting perspective for implementation of such a strategy, which should be accompanied by a prospective cost-effectiveness analysis.

Impacts of shade on cattle well-being in the beef supply chain.

Shade is a mechanism to reduce heat load providing cattle with an environment supportive of their welfare needs. Although heat stress has been extensively reviewed, researched, and addressed in dairy production systems, it has not been investigated in the same manner in the beef cattle supply chain. Like all animals, beef cattle are susceptible to heat stress if they are unable to dissipate heat during times of elevated ambient temperatures. There are many factors that impact heat stress susceptibility in beef cattle throughout the different supply chain sectors, many of which relate to the production system, that is, availability of shade, microclimate of environment, and nutrition management. The results from studies evaluating the effects of shade on production and welfare are difficult to compare due to variation in structural design, construction materials used, height, shape, and area of shade provided. Additionally, depending on operation location, shade may or may not be beneficial during all times of the year, which can influence the decision to make shade a permanent part of management systems. Shade has been shown to lessen the physiologic response of cattle to heat stress. Shaded cattle exhibit lower respiration rates, body temperatures, and panting scores compared with unshaded cattle in weather that increases the risk of heat stress. Results from studies investigating the provision of shade indicate that cattle seek shade in hot weather. The impact of shade on behavioral patterns is inconsistent in the current body of research, with some studies indicating that shade provision impacts behavior and other studies reporting no difference between shaded and unshaded groups. Analysis of performance and carcass characteristics across feedlot studies demonstrated that shaded cattle had increased ADG, improved feed efficiency, HCW, and dressing percentage when compared with cattle without shade. Despite the documented benefits of shade, current industry statistics, although severely limited in scope, indicate low shade implementation rates in feedlots and data in other supply chain sectors do not exist. Industry guidelines and third-party on-farm certification programs articulate the critical need for protection from extreme weather but are not consistent in providing specific recommendations and requirements. Future efforts should include: updated economic analyses of cost vs. benefit of shade implementation, exploration of producer perspectives and needs relative to shade, consideration of shade impacts in the cow-calf and slaughter plant segments of the supply chain, and integration of indicators of affective (mental) state and preference in research studies to enhance the holistic assessment of cattle welfare.

ONCOR: design of the Dutch cardio-oncology registry.

BACKGROUND: The relative new subspecialty 'cardio-oncology' was established to meet the growing demand for an interdisciplinary approach to the management of cancer therapy-related cardiovascular adverse events. In recent years, specialised cardio-oncology services have been implemented worldwide, which all strive to improve the cardiovascular health of cancer patients. However, limited data are currently available on the outcomes and experiences of these specialised services, and optimal strategies for cardio-oncological care have not been established. AIM: The ONCOR registry has been created for prospective data collection and evaluation of cardio-oncological care in daily practice. METHODS: Dutch hospitals using a standardised cardio-oncology care pathway are included in this national, multicentre, observational cohort study. All patients visiting these cardio-oncology services are eligible for study inclusion. Data collection at baseline consists of the (planned) cancer treatment and the cardiovascular risk profile, which are used to estimate the cardiotoxic risk. Information regarding invasive and noninvasive tests is collected during the time patients receive cardio-oncological care. Outcome data consist of the incidence of cardiovascular complications and major adverse cardiac events, and the impact of these events on the oncological treatment. DISCUSSION: Outcomes of the ONCOR registry may aid in gaining more insight into the incidence of cancer therapy-related cardiovascular complications. The registry facilitates research on mechanisms of cardiovascular complications and on diagnostic, prognostic and therapeutic strategies. In addition, it provides a platform for future (interventional) studies. Centres with cardio-oncology services that are interested in contributing to the ONCOR registry are hereby invited to participate.

Recommendations on how to provide cardiac rehabilitation services during the COVID-19 pandemic.

The ongoing coronavirus disease 2019 (COVID-19) crisis is having a large impact on acute and chronic cardiac care. Due to public health measures and the reorganisation of outpatient cardiac care, traditional centre-based cardiac rehabilitation is currently almost impossible. In addition, public health measures are having a potentially negative impact on lifestyle behaviour and general well-being. Therefore, the Working Group of Cardiovascular Prevention and Rehabilitation of the Dutch Society of Cardiology has formulated practical recommendations for the provision of cardiac rehabilitation during the COVID-19 pandemic, by using telerehabilitation programmes without face-to-face contact based on current guidelines supplemented with new insights and experiences.

Feasibility and potential benefit of pre-procedural CMR imaging in patients with ischaemic cardiomyopathy undergoing cardiac resynchronisation therapy.

AIM: To determine the feasibility and potential benefit of a full cardiac magnetic resonance (CMR) work-up for assessing the location of scarred myocardium and the region of latest contraction (LCR) in patients with ischaemic cardiomyopathy (ICM) undergoing cardiac resynchronisation therapy (CRT). METHODS: In 30 patients, scar identification and contraction timing analysis was retrospectively performed on CMR images. Fluoroscopic left ventricular (LV) lead positions were scored with respect to scar location, and when placed outside scar, with respect to the LCR. The association between the lead position with respect to scar, the LCR and echocardiographic LV end-systolic volume (LVESV) reduction was subsequently evaluated. RESULTS: The CMR work-up was feasible in all but one patient, in whom image quality was poor. Scar and contraction timing data were succesfully displayed on 36-segment cardiac bullseye plots. Patients with leads placed outside scar had larger LVESV reduction (-21 ± 21%, n = 19) compared to patients with leads within scar (1 ± 25%, n = 11), yet total scar burden was higher in the latter group. There was a trend towards larger LVESV reduction in patients with leads in the scar-free LCR, compared to leads situated in scar-free segments but not in the LCR (-34 ± 14% vs -15 ± 21%, p = 0.06). CONCLUSIONS: The degree of reverse remodelling was larger in patients with leads situated in a scar-free LCR. In patients with leads situated within scar there was a neutral effect on reverse remodelling, which can be caused both by higher scar burden or lead position. These findings demonstrate the feasibility of a CMR work-up and potential benefit in ICM patients undergoing CRT.

Validation of alternative behavioral observation methods in young broiler chickens.

Continuous sampling provides the most complete data set for behavioral research; however, it often requires a prohibitive investment of time and labor. The objectives of this study were to validate behavioral observation methods of young broiler chickens using 1) 7 scan sampling intervals (0.5, 1, 3, 5, 10, 15, and 30 min) and 2) an automated tracking software program (EthoVision XT 14) compared to continuous behavioral observation, considered the gold standard for behavior observation. Ten 19-day-old Ross 708 broiler cockerels were included in this study. All behavior was video recorded over an 8-h period, and data were collected using a continuous sampling methodology. The same video files were utilized for analysis for scan sampling and automated tracking software analysis. For both analyses, the following criteria were used to identify which method accurately reflected the true duration and frequency for each behavior, as determined by continuous observation: R2 ≥ 0.9, slope was not different from 1 (P > 0.05), and intercept was not different from 0 (P > 0.05). Active, eating, drinking, and maintenance behaviors were accurately estimated with 0.5-min scan sample intervals. Active, inactive, eating, and maintenance behaviors were accurately estimated with 1-min scan sample intervals. Inactive behavior was accurately estimated with 5-min scan sample intervals. The remainder of sampling intervals examined did not provide accurate estimates, and no scan sampling interval accurately estimated the number of behavior bouts. The automated tracking software was able to accurately detect true duration of inactive behavior but was unable to accurately detect activity. The results of this study suggest that high-frequency behaviors can be accurately observed with instantaneous scan sampling up to 1-min intervals. Automated tracking software can accurately identify inactivity in young broiler chickens, but further behavior identification will require refinement.

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country.

INTRODUCTION: Rheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS). METHODS: This study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group. RESULTS: The results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376-1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months. CONCLUSIONS: In this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.

Short communication: Behavioral attitude scores associated with bovine respiratory disease identified using calf lung ultrasound and clinical respiratory scoring.

The objective of this study was to determine whether calves exhibit differences in behavioral attitude when diagnosed with their first bovine respiratory disease (BRD) event and whether fever (≥39°C) at the time of BRD diagnosis affected attitude. Preweaned dairy calves (n = 280; 21 ± 6 d) were examined twice weekly until weaning using a clinical respiratory score (CRS; CRS+: 2 respiratory categories with scores of 2 or greater; CRS-: 1 respiratory category with a score of 2 or greater or all respiratory categories scoring less than 2), lung ultrasound, and attitude score (normal = bright, alert, responsive; depressed = dull but responds to stimulation, slow to stand, or reluctant to lie down). Bovine respiratory disease was categorized as subclinical BRD (SBRD; CRS- and lung consolidation ≥1 cm2; n = 164) or clinical BRD (CBRD; CRS+, with or without lung consolidation; n = 79). Calves without BRD (NOBRD; n = 37) remained CRS- with lung consolidation <1 cm2 for the study. Depressed attitudes were found in 23, 6, and 0% of CBRD, SBRD, and NOBRD calves, respectively. In calves with CBRD, the odds of having a depressed attitude were 5.2 (95% confidence interval, confidence interval: 1.1-23.7) and 4.5 (95% confidence interval: 2.0-10.4) times higher compared with the odds of NOBRD and SBRD calves having a depressed attitude, respectively. The odds of having a depressed attitude did not differ between SBRD and NOBRD calves. Fever was associated with the odds of having a depressed attitude score, whereby calves with a fever had 6.2 (95% confidence interval: 2.8-14) times higher odds of having a depressed attitude score compared with calves without a fever. Sensitivity and specificity of the attitude score for identifying CBRD were 23% (95% confidence interval: 14-33) and 95% (95% confidence interval: 82-99), respectively. Producers should be cautious when using this attitude score as the primary means of detecting calves affected by BRD.

Growth of preweaned, group-housed dairy calves diagnosed with respiratory disease using clinical respiratory scoring and thoracic ultrasound-A cohort study.

The objectives of this cohort study were to identify a cut point on a previously described 6-level ultrasound score (USS6) at which average daily gain (ADG) is affected and to determine whether there is any additional benefit of using a clinical respiratory score. Calves from a commercial herd in Ohio were enrolled at entry to an automated calf feeder barn at (mean ± standard deviation) 21 ± 6 d of age (n = 308). Calves that survived until 50 d (n = 233) were included in the analyses. Twice-weekly health exams included a clinical respiratory score (CRS), USS6 (0-5, based on lung mass involved), and body weight. For the CRS, the nose, eyes, ears, cough, and rectal temperature were assigned a score (0-3), and calves were considered positive (CRS+) when at least 2 areas scored ≥2. For analysis, USS6 and CRS status were based on a calf's first bovine respiratory disease event identified during the study period. The first multivariable linear model was fit to determine whether USS6 was associated with ADG and controlled for CRS. We detected no difference in ADG among calves with USS6 scores of 2, 3, 4, and 5. Based on this finding, we proposed a simplified 2-level ultrasound score (USS2; without lung consolidation or with lung consolidation ≥1 cm2). A second multivariable model was fit to assess the association between USS2 and ADG; this model controlled for CRS, birth weight category, breed, and cohort. Calves with lung consolidation (n = 169) had lower ADG than calves without lung consolidation (n = 64; 0.73 vs. 0.85 kg/d, respectively). Calves that were CRS+ (n = 61) had lower ADG than calves that were CRS- (n = 172; 0.74 vs. 0.84 kg/d, respectively). Although CRS did not affect the relationship between USS2 and ADG, both CRS and USS2 are necessary to explain variation in ADG. We simplified USS6 and proposed USS2 based on how lung consolidation affected ADG. A simplified 2-level ultrasound score may be more practical for veterinarians to identify calves that may be at risk for poor growth. The effect on ADG was similar between calves with lung consolidation and calves identified as CRS+. Therefore, both thoracic ultrasonography and CRS should be used to identify calves with all types of respiratory disease that affect growth. However, this study represents calves in group housing from 21 to 50 d of age on 1 farm with high disease incidence. We encourage studies that investigate the effects of lung consolidation and CRS on ADG in different management systems.

Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair.

BACKGROUND: In patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery. However, long-term results are conflicting. Here, we sought to determine the clinical outcome of this cohort, the rate of TR progression after MV surgery and the role of MV aetiology. METHODS: Patients for elective MV surgery without concomitant TV repair were retrospectively analysed with longitudinal echocardiographic and clinical follow-up, focusing on TR progression and MV aetiology. Linear regression analysis was performed for change in TR at follow-up, using pre-determined variables and confounders. RESULTS: In total 204 patients without TV repair were analysed. Development of more than moderate TR after a median of 3.1 [1.6-4.6] years was rarely seen: only in 2 out of 161 patients (1.2%) with known TR grade at follow-up. Overall, median preoperative and late postoperative TR grade were equal (p = 0.116). Subanalysis showed no significant difference in MV aetiology subgroups. Preoperative TR grade and male gender were inversely correlated to change in TR. Mortality was not influenced by the 1­year postoperative TR severity. CONCLUSION: Our data showed that in a study population of patients with mild to moderate TR undergoing MV surgery without concomitant TV repair, significant late TR was rarely seen. Based on our study, it is safe to waive concomitant TV repair in this specific patient cohort.