Genetic relationships between detailed reproductive traits and performance traits in Holstein-Friesian dairy cattle.

The objective of the study was to estimate the genetic relationships between detailed reproductive traits derived from ultrasound examination of the reproductive tract and a range of performance traits in Holstein-Friesian dairy cows. The performance traits investigated included calving performance, milk production, somatic cell score (i.e., logarithm transformation of somatic cell count), carcass traits, and body-related linear type traits. Detailed reproductive traits included (1) resumed cyclicity at the time of examination, (2) multiple ovulations, (3) early ovulation, (4) heat detection, (5) ovarian cystic structures, (6) embryo loss, and (7) uterine score, measured on a 1 (little or no fluid with normal tone) to 4 (large quantity of fluid with a flaccid tone) scale, based on the tone of the uterine wall and the quantity of fluid present in the uterus. (Co)variance components were estimated using a repeatability animal linear mixed model. Genetic merit for greater milk, fat, and protein yield was associated with a reduced ability to resume cyclicity postpartum (genetic correlations ranged from -0.25 to -0.15). Higher genetic merit for milk yield was also associated with a greater genetic susceptibility to multiple ovulations. Genetic predisposition to elevated somatic cell score was associated with a decreased likelihood of cyclicity postpartum (genetic correlation of -0.32) and a greater risk of both multiple ovulations (genetic correlation of 0.25) and embryo loss (genetic correlation of 0.32). Greater body condition score was genetically associated with an increased likelihood of resumption of cyclicity postpartum (genetic correlation of 0.52). Genetically heavier, fatter carcasses with better conformation were also associated with an increased likelihood of resumed cyclicity by the time of examination (genetic correlations ranged from 0.24 to 0.41). Genetically heavier carcasses were associated with an inferior uterine score as well as a greater predisposition to embryo loss. Despite the overall antagonistic relationship between reproductive performance and both milk and carcass traits, not all detailed aspects of reproduction performance exhibited an antagonistic relationship.

Factors associated with the differential in actual gestational age and gestational age predicted from transrectal ultrasonography in pregnant dairy cows.

The objective of the study was to determine (1) how gestational age predicted using transrectal ultrasonography related to actual gestational age derived as the number of days from the most recent artificial insemination date, (2) what factors, if any, were associated with the differential between the two measures, and (3) the association between this differential in gestational age and the likelihood of subsequent pregnancy loss, stillbirth, or calving dystocia. The data set contained 7340 ultrasound records from 6805 Holstein Friesian dairy cows in 175 herds. Ultrasonography assessment underestimated gestational age relative to days since last service by 0.51 days (standard error [SE]: 0.040), although the differential was less during embryonic development phase (i.e., ≤42 days of gestation; mean overestimation of 0.31 days) versus fetal development phase (i.e., >42 days of gestation; mean underestimation of 0.81 days). Predicted calving date calculated from ultrasonography was 1.41 days (SE: 0.040) later than the actual subsequent calving date and was, on average, 0.52 days later than predicted calving date, assuming a gestation length of 282 days. Parity of the dam (P < 0.05), stage of pregnancy (P < 0.001), and sex of the calf born (P < 0.001) were all associated with the differential in gestational age based on ultrasonography versus days since last service. No obvious trend among parities was evident in the difference between the methods in predicting gestational age. Ultrasonography underestimated gestational age by 0.83 (SE: 0.15) days in parity 5+ cows and underestimated gestational age by 0.41 (SE: 0.14) days in the first-parity cows. Relative to gestational age predicted from the most recent service, ultrasonography underestimated gestational age by 0.75 (SE: 0.13) days for heifer fetuses and underestimated gestational age by 0.36 (SE: 0.13) days for bull fetuses. The heritability of the differential in gestational age between the methods of prediction was low 0.05 (SE: 0.022), corroborating heritability estimates for most cow reproductive traits. Overestimation of gestational age using ultrasonography was associated with an increased likelihood of pregnancy loss (P < 0.001). Gender of calf born (P < 0.001), sire breed of calf (P < 0.001), and parity (P < 0.001) were all associated with gestation length. Gestation length was 1.27 days longer (SE: 0.01) for bull calves compared to heifer calves. Calves from beef sires had a longer gestation length than calves from dairy sires, and older parity cows had a longer gestation length than younger cows. The results highlight factors associated with differences in gestational age obtained from ultrasonography and insemination data and illustrate the value of ultrasonography for the prediction of calving date and pregnancy loss.

Genetic parameters of ovarian and uterine reproductive traits in dairy cows.

The objective of the study was to estimate genetic parameters of detailed reproductive traits derived from ultrasound examination of the reproductive tract as well as their genetic correlations with traditional reproductive traits. A total of 226,141 calving and insemination records as well as 74,134 ultrasound records from Irish dairy cows were used. Traditional reproductive traits included postpartum interval to first service, conception, and next calving, as well as the interval from first to last service; number of inseminations, pregnancy rate to first service, pregnant within 42 d of the herd breeding season, and submission in the first 21 d of the herd breeding season were also available. Detailed reproductive traits included resumed cyclicity at the time of ultrasound examination, incidence of multiple ovulations, incidence of early postpartum ovulation, heat detection, ovarian cystic structures, embryo loss, and uterine score; the latter was a subjectively assessed on a scale of 1 (little fluid with normal uterine tone) to 4 (large quantity of fluid with a flaccid uterine tone). Variance (and covariance) components were estimated using repeatability animal linear mixed models. Heritability for all reproductive traits were generally low (0.001-0.05), with the exception of traits related to cyclicity postpartum, regardless if defined traditionally (0.07; calving to first service) or from ultrasound examination [resumed cyclicity at the time of examination (0.07) or early postpartum ovulation (0.10)]. The genetic correlations among the detailed reproductive traits were generally favorable. The exception was the genetic correlation (0.29) between resumed cyclicity and uterine score; superior genetic merit for cyclicity postpartum was associated with inferior uterine score. Superior genetic merit for most traditional reproductive traits was associated with superior genetic merit for resumed cyclicity (genetic correlations ranged from -0.59 to -0.36 and from 0.56 to 0.70) and uterine score (genetic correlations ranged from -0.47 to 0.32 and from 0.25 to 0.52). Genetic predisposition to an increased incidence of embryo loss was associated with both an inferior uterine score (0.24) and inferior genetic merit for traditional reproductive traits (genetic correlations ranged from -0.52 to -0.42 and from 0.33 to 0.80). The results from the present study indicate that selection based on traditional reproductive traits, such as calving interval or days open, resulted in improved genetic merit of all the detailed reproductive traits evaluated in this study. Additionally, greater accuracy of selection for calving interval is expected for a relatively small progeny group size when detailed reproductive traits are included in a multitrait genetic evaluation.

Ovarian structures and uterine environment are associated with phenotypic and genetic merit for performance in lactating dairy cows.

The objective of this study was to estimate the association between detailed reproductive phenotypes for cows categorized as divergent for phenotypic and genetic performance. The hypothesis was that higher yielding animals, either phenotypically or genetically, would have compromised ovarian and uterine reproductive performance. Detailed reproductive traits including multiple ovulations, cystic ovarian structures, corpus luteum (CL) presence, and uterine environment were available on 9675 ultrasound records from 8174 dairy lactating cows, calved between 10 and 70 days. Cows were categorized, within parity, into low, average, or high for each of the performance traits. There was a greater likelihood of multiple ovulations in cows with greater phenotypic yields (odds ratio: 1.53-1.81) and greater genetic merit for yield (odds ratio: 1.31-1.59) relative to lower performing contemporaries. After adjustment for genetic merit, a similar trend of increased odds (odds ratio: 1.29-1.87) of multiple ovulations in higher yielding cows was observed compared with the lowest yielding category. There was no association between either phenotypic milk composition or genetic merit for milk composition with the likelihood of multiple ovulations. The likelihood of cystic ovarian structures was highest in cows with greatest phenotypic milk yields (odds ratio: 2.75-3.24), greater genetic merit for milk yield (odds ratio: 1.30-1.51), and even after adjustment for genetic merit there was a greater likelihood of cystic ovarian structures in cows with the highest milk yields (odds ratio: 2.71-2.95), compared with cows in the lowest category for each of the milk traits. Cows with average phenotypic milk yields were more likely to have a CL, compared with the lowest yielding category (odds ratio: 1.20-1.23), and these associations remained after adjustment for genetic merit of the trait. The likelihood of CL presence was highest in cows with the lowest genetic merit for milk. Lower fat:protein ratio was associated with an increased likelihood of CL presence compared with cows with greater fat:protein ratio and cows with the highest phenotypic milk composition were more likely to have a CL compared with cows in the lowest composition category. Genetic predisposition to higher somatic cell score was associated with a reduced risk of multiple ovulations (odds ratio: 0.69; 95% CI: 0.55-0.87) but an increased likelihood of CL presence (odds ratio: 2.66; 95% CI: 2.09-3.37) and poorer uterine health score (odds ratio: 1.36; 95% CI: 1.20-1.55). There was a lower likelihood of multiple ovulations, cystic ovarian structures, and poorer uterine health and an increased likelihood of CL presence in cows with superior genetic merit for reproductive performance and survival.

Risk factors associated with multiple ovulation and twin birth rate in Irish dairy and beef cattle.

The objective of this study was to quantify the phenotypic and genetic risk factors associated with multiple ovulations and twin births in cattle. Prevalence and cow- and herd-level risk factors associated with ovulation rate were determined using 40,617 ultrasonographic records of the reproductive tract from 27,907 dairy and beef cows from 738 commercial herds. Prevalence of twin births was estimated from the Irish national database containing 23,658,351 calving events from 8,546,695 cows from 125,251 dairy and beef herds; factors associated with twin births were determined using a random subsample of 505,200 calving events from 280,638 cows in 81,329 herds. The mean prevalence of multiple ovulations was 6.83% while the prevalence of twin births was 1.74%. Occurrence of both multiple ovulations and twin births was associated with the month of scan (P < 0.0001) and month of calving (P < 0.0001), respectively, and peaked in November for multiple ovulations and October for twin births. The likelihood of multiple ovulations increased with interval postpartum and peaked between 45 to 185 d postcalving, after which the likelihood declined. The likelihood of both multiple ovulations (P < 0.0001) and twin births (P < 0.0001) increased with increasing cow parity. A greater proportion of Holstein, Friesian, Simmental, Hereford, and Charolais breed fractions were associated with a greater likelihood of multiple ovulations. There was no difference between breed proportion of the cow and incidence of twin births, where all breed proportions examined, litter difference existed among breeds in their association with risk of twin births. Although multiple ovulations were lowly heritable (0.028 ± 0.003), their occurrence was repeatable (0.326 ± 0.342) while twin birth rate in cattle was lowly heritable (0.017 ± 0.004) and repeatable (0.018 ± 0.011). The genetic SD of the presence of multiple ovulations and twin births was 0.04 and 0.02, respectively, indicating considerable genetic variation, especially for multiple ovulations. A moderate genetic correlation (0.66 ± 0.16) existed between multiple ovulations and twin births.

A study of the personal use of digital photography within plastic surgery.

The advent of digital photography has greatly increased the use of medical illustration within specialties dealing with visible pathologies. It offers improved communication between medical professionals, education and counselling of their patients and forms an important aspect of their medical records. With the increased availability of digital cameras there is an increased tendency for clinicians to take digital photographs of patients themselves. In doing so, clinicians take on the responsibility to act in accordance with the regulations governing this practice issued by the UK Department of Health. This study sought to investigate the prevalence of this practice by way of an anonymous questionnaire distributed to three representative plastic surgery units within the UK. It looked at the awareness of and compliance with the present governing regulations. The results showed that of the 60 distributed questionnaires, 30 of 42 respondents took digital photographs of patients themselves. Photographs were taken for the purposes of inclusion in the medical records, education, development of personal libraries and publication. Consent was usually taken but was often only in a verbal form. Processing, storage and security measures highlighted potential risks for breaches in confidentiality. Knowledge relating to the NHS Confidentiality Code of Practice, the Data Protection Act and the need for registration with the Data Commissioner when acting in a private capacity were often not known. This small study highlights a number of important points surgeons need to be aware of when taking photographs of patients themselves and makes recommendations for its practice within a plastic surgery department.

Long-term sequelae of fasciotomy wounds.

A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

Volar metacarpophalangeal joint dislocation.

Volar dislocation of the metacarpophalangeal joint is a very rare clinical finding. A volar dislocation of the metacarpophalangeal joint of the left index finger in a 44 year old man is reported. Closed reduction proved unsuccessful requiring subsequent open reduction and internal fixation via a combined dorsal and volar approach. The presentation, mechanism of injury and treatment of this case and other previously reported cases are discussed.

Colonic perforation following prolonged hypovolaemia in a major burns injury.

Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.

Dupuytren's disease. The way forward?

Histologically, Dupuytren's disease has been compared to the process of neoplasia because of fibroblast proliferation, recurrence, chromosomal abnormalities and antigenic profiles. However, a comparison of Dupuytren's tissue with the granulation tissue formed in wound healing could be more valid. Histology reveals similarities in cell types, proliferation, vascularity and collagen morphology. Pharmacologically, both tissues have a similar range of agonist and antagonist responses. Biochemical analysis reveals new collagen synthesis, an increased ratio of type III to type I collagen, and similar changes of the ground substance in both processes. Considering such similarities perhaps it is possible to regard some of the models used for the investigation of wound healing and granulation tissue as the missing experimental "model" for the study of Dupuytren's disease. Recently great strides have been made in the basic understanding of wound biology, and such a comparison might well provide novel therapeutic options for Dupuytren's disease.

Use of Western-based HIV risk-reduction interventions targeting adolescents in an African setting.

PURPOSE: To evaluate an intervention (based on one which had previously been successful in reducing adolescent human immunodeficiency virus (HIV) risk behaviors in the United States) among adolescents residing in Namibia, a country located in sub-Saharan Africa. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sex was conducted among 515 youth (median age 17 years; median grade 11) attending 10 secondary schools located in two districts in Namibia. Knowledge, attitudes, intentions, and HIV risk behaviors were assessed at baseline and in the immediate postintervention period. RESULTS: Knowledge increased significantly among intervention compared to control youth (88% vs. 82%; correct responses, p < .0001). At postintervention follow-up, more intervention than control youth believed that they could be intimate without having sex, could have a girlfriend or boyfriend for a long time without having sex, could explain the process of impregnation, knew how to use a condom, and could ask for condoms in a clinic. Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her, and that condoms took away a boy's pleasure. More intervention than control youth anticipated using a condom when they did have sex, and fewer expected to drink alcohol. Finally, after intervention, there was a trend for increased condom use. There were significant gender-related differences at baseline, although intervention impact was generally equivalent. CONCLUSIONS: These findings provide support for the judicious adaptation of successful Western HIV prevention programs in other cultural settings. A single intervention approach appears to be effective in short-term follow-up with both genders.

HIV risk behaviors, intentions, and perceptions among Namibian youth as assessed by a theory-based questionnaire.

Considerable progress has been made in the United States and Europe regarding HIV risk prevention efforts targeting adolescents. However, in Africa less progress has been made to date. This article address three questions: Can risk assessment questionnaires developed in Western countries be modified so as to be appropriate for use in African countries? Are social cognitive models appropriate in African settings? Does covariation among risk behaviors occur among youth residing in African countries? The data was obtained from a cross-sectional survey conducted among 922 youth ages 12 to 18 years living in school-based hostels in Namibia. Data were collected using a theory-based risk assessment questionnaire. One third of the youth were sexually experienced, three quarters of whom had engaged in sexual intercourse in the previous 6 months. Over one third of these youth had had more that one sexual partner in the previous 6 months and over one half had not used a condom at last episode of intercourse. The psychometric properties of the questionnaire and the relationship between perceptions and behaviors provide evidence that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. The data also provide strong evidence of covariation between risk behaviors among Namibian youth.

PIP: Findings are presented from an investigation into whether risk assessment questionnaires developed in Western countries can be modified to be used appropriately in African countries. The authors also explored whether covariation among risk behaviors occurs among youth living in African countries. Data were obtained from a cross-sectional survey conducted among 922 individuals aged 12-18 years, of median age 15 years, living in school-based hostels in Namibia. 49% of the subjects were male. 37% overall and 56% of the boys had ever had sexual intercourse, of whom 70% had experienced such intercourse during the preceding 6 months. 29% of those who were sexually experienced reported having more than 1 sex partner in the previous 6 months and 50% used a condom during their most recent intercourse. Study findings suggest that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. Study data also provide strong evidence of covariation between risk behaviors among Namibian youth.

Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction intervention: a randomized, longitudinal study.

OBJECTIVE: To evaluate an HIV risk-reduction intervention among Namibian adolescents. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sexual practices conducted among 515 youths (median age 17 years and median grade 11) attending 10 secondary schools located in two districts in Namibia. Youths were randomly assigned to the intervention or control condition at the level of the individual. HIV risk behaviours, intentions and perceptions were assessed at baseline, immediately post-intervention and at 6 and 12 months post-intervention. RESULTS: Among all 515 youths who enrolled in the programme, rates of either abstinence or sex with a condom were not different between control and intervention youths at baseline or in the follow-up period. However, analyses conducted among the subset of youths who were sexually inexperienced at baseline (n = 255) revealed that a higher percentage of intervention youths (17%) than control youths (9%, P<0.05) remained sexually inexperienced one year later. Moreover, in the immediate post-intervention period, among baseline virgins who subsequently initiated sex, intervention youths were more likely than control youths to use a condom (18 versus 10%, P<0.05). Additional HIV-related risk behaviours (failure to discuss previous HIV risk exposure with one's sexual partner and alcohol use), intentions to use condoms, and perceptions of the ability to use condoms were positively affected by the intervention. CONCLUSIONS: There is evidence that the 'My Future is My Choice' (MFMC) intervention is reducing HIV risk behaviours among sexually inexperienced participants aged 15-18. Related risk behaviours and perceptions are also positively impacted by the intervention.

Human skin histology as demonstrated by Herovici's stain: a guide for the improvement of dermal substitutes for use with cultured keratinocytes?

The potential for the widespread use of cultured keratinocytes for burns treatment is handicapped by practical problems such as fragility, poor take and, often, unsatisfactory cosmesis. Although dermal equivalents reduce these problems there remains a lack of consensus on what is the best structure of such equivalents. At present the commonest support is type I collagen. This histological study, however, using Herovici's stain, clearly shows that in human skin from a variety of anatomical sites the epidermis is not in direct contact with type I collagen but rather with a distinct layer of type III collagen. We suggest that dermal equivalents may have to be constructed so as to include a layer of type III collagen at the interface between the keratinocytes and a type I collagen neo-dermis, so mimicking normal skin structure more closely.

A modern translation and interpretation of the treatise on burns of Fabricius Hildanus (1560-1634).

At the beginning of the seventeenth century, some surgeons were as interested in the classification, prognosis and treatment of burns as their successors are at the close of the twentieth century. We present extracts from our translation of the visionary treatise on Burns by Fabricius Hildanus (Wilhelm Fabry), the "Father of German surgery", and show how some of the present day approaches to burns have their origins almost 400 years ago.

A picropolychrome staining technique applied to Dupuytren's tissue.

Although the histology of Duputyren's tissue is well-documented, conventional stains do not distinguish between the different types of collagen which biochemistry and immunochemistry suggest are present. Duputyren's specimens [nodules (n = 26), cords (n = 15) and dermofasciectomies (n = 6)] were stained with haematoxylin and eosin, Van Gieson's Mallory's, Masson's, and Herovici's picropolychrome stain, and examined for both cellularity and collagen staining characteristics. All stains illustrated the marked cellularity of the nodules, contrasting with a paucity of cells within the cords. The first four stains demonstrated uniformity of the collagen staining within the tissues. Herovici's picropolychrome, however, showed distinct staining patterns for the dermis, nodules and cords, with both purple/red and blue areas. Other studies suggest that those fibres stained purple/red and blue are types I and III collagens respectively. These findings may shed further light on the tissue of origin of Duputyren's disease.

Newborn transport in South Australia, 1978-80: experience of the Queen Victoria Hospital, Adelaide.

389 infants were transported to the Queen Victoria Hospital, Adelaide between 1978 and 1980. Twenty-three percent (99) of the infants were ventilated, and 49% (189) received intravenous or intra-arterial therapy. Fifty-six percent (217) of the infants required transport because of prematurity; 11% (46) because of perinatal asphyxia in babies weighing more than 2,500 g. Only one baby died during transport, while 14% of the babies died subsequently. A core temperature of less than 36 degrees C in either hospital is important; a cold baby is 3.5 times more likely to die (X2=25.46, P less than 0.001). The transport of babies over distances greater than 300 kilometres is peculiar to Australia. Significantly more of these babies were cold than those retrieved from hospitals near Adelaide (X2=4.7, P less than 0.05), and significantly more died. Difficulty in transferring mothers in preterm labour may be another reason these babies did relatively badly. Better education and facilities will be important if we are to improve their survival chances.