[Objective assessment of udder filling degree in diary cattle during shows]. / Objektive Beurteilung des Euterfüllungsgrades bei Ausstellungskühen.

INTRODUCTION: Overbagged udders are commonly seen at dairy cow shows in Switzerland and abroad due to prolonged milking intervals. In recent years various studies documented the negative effects of prolonged milking intervals and examined the objectivity of an ultrasound-based assessment scheme for determining udder filling. In addition, risk factors were calculated which lead to udder edema outside the puerperal phase. For example, the effects of a sudden increased 24-hour milking interval were altered behavior (reduced feeding time, increased rumination time) and a significantly increased cell count in experimental cows. Edema formation was observed sonographically in the subcutaneous udder tissue at the sites of predilection known from previous studies. No evidence of edema was observed in cows milked at 12 hour intervals. Based on these results, a new scoring system was defined using ultrasound images of show cows (grade 0 = no edema, grade 1 = slight, grade 2 = moderate, grade 3 = severe edema). Results documented that experienced clinicians were able to score ultrasound images reliable (interobserver reliability κ = 0.815, three different clinicians; intraobserver reliability κ = 0.90 and κ = 0.85, two clinicians) and little variability existed between the clinicians. A prolonged milking interval was identified as the main risk factor. Modified Swiss Dairy Show Regulations were implemented by January 1st, 2018 and ultrasonographic examinations proofed to be reliable in practice. Since January 1st, 2019 visual scoring of the udder filling is evaluated as part of a pre-show inspection. The sonographic evaluation can be used as a reliable diagnostic addition.

INTRODUCTION: Des vaches avec des mamelles très remplies en raison d'un intervalle de traite prolongé (appelée overbaging) sont régulièrement observées dans les grandes expositions d'élevage de vaches laitières en Suisse et à l'étranger. Ces dernières années, plusieurs études ont été menées en Suisse. Elles ont montré d'une part les effets négatifs d'un intervalle de traite prolongé et d'autre part, recherché l'objectivité d'un système d'évaluation basé sur l'examen échographique pour la détermination du remplissage de la mamelle. De plus, les facteurs de risque qui conduisent à un œdème du pis en dehors de la phase puerpérale ont été calculés. Un intervalle de traite soudain, porté à 24 heures sur des vaches expérimentales, a par exemple provoqué un comportement considérablement altéré (réduction de la durée d'alimentation, période de rumination prolongée, etc.) et un nombre de cellules somatiques considérablement plus élevé. De plus, un œdème a été observé dans les tissus de la mamelle, ce qui a pu être démontré par échographie aux sites de prédilection connus dans le cadre d'études antérieures. Si les vaches étaient traites toutes les 12 heures, il n'y avait aucune trace d'œdème. Sur la base de cette constatation, l'imagerie par ultrasons des vaches de démonstration a été utilisée pour définir un nouveau système de classement permettant une classification du degré de gravité (degré 0 = pas d'œdème, degré 1 = faible degré, degré 2 = moyen, degré 3 = œdème élevé). Les évaluations ont montré que des observateurs expérimentés étaient capables de donner des notes aux images échographiques avec une forte concordance (fiabilité inter-observateur κ = 0,815 chez trois observateurs différents, fiabilité intra-observateur κ = 0,90 et κ = 0,85 chez deux observateurs différents), de sorte que le résultat de l'évaluation montrait peu de variabilité entre les examinateurs. Les calculs des facteurs de risque ont clairement montré que l'intervalle de traite était le principal facteur de risque. Les examens par échographie de certaines vaches après les classements, introduits dans le cadre d'une modification du règlement sur les expositions à compter du 1er janvier 2018, se sont révélés praticables. Depuis le 1er janvier 2019, l'évaluation du remplissage de la mamelle est effectuée visuellement dans le cadre d'une inspection avant présentation. En complément, l'échographie peut être utilisée à ce moment-là.

Sensing between reactions - how the metabolic microenvironment shapes immunity.

Perception of potential threat is key for survival. The immune system constantly patrols the organism scanning for potential pathogenic or malignant danger. Recent evidence suggests that immunosurveillance not only relies on classic receptors [e.g. Toll-like receptors (TLRs) or antibodies] but is also based on sensing of the metabolic environment. Metabolites interact in numerous ways with immune cells, and are therefore more than just reaction intermediates. This new perspective opens the door for potential, future therapeutic strategies. Here we describe how immune functionality during infections, cancer or autoimmunity, as exemplified by short-chain fatty acids, lactate and reactive oxygen species (ROS), can be shaped by metabolic intermediates.

Short communication: Risk factors for sonographically detectable udder edema in overbagged cows at dairy shows.

At dairy cow shows, the appearance of the udder is very important. To show cows at their best, udders are often presented in an overbagged state by extending milking intervals before the show. This practice represents an animal welfare issue because it is associated with behavior changes (e.g., excessive abduction and decreased eating time) and may affect the health of the animal. The aim of the current study was to determine the association between various parameters (e.g., milk yield, days in milk, milking procedures, or administration of nonsteroidal anti-inflammatory drugs, steroids, or diuretics) and the sonographically detectable udder edema score. Data were collected from the show catalogs, by interviewing the exhibitors, by analyzing official veterinary treatment protocols and official milking data, via laboratory analysis of blood samples, and by sonographic examinations of the udders at the show. For sonographically detectable udder edema scoring, 3 scans were taken, 1 on each fore quarter and 1 incorporating both rear quarters at the level of the median suspensory ligament. For grading the scans, a scoring system of 4 grades (score 0 = no edema, 1 = slight edema, 2 = moderate edema, 3 = severe edema) was used. Data from 321 cows of different breeds were collected at 4 highly competitive Swiss dairy shows (shows A-D) between January and September 2017. To determine risk factors for sonographically detectable udder edema, data were analyzed with 2 different logistic regression models. In model 1, the odds ratios were 3.33 (milking intervals of ≥16 h vs. <14 h), 3.84 (show A vs. show C), and 7.39 (dairy breeds vs. dual-purpose breeds). Milking intervals of dairy breeds were significantly higher than those of dual-purpose breeds. In model 2, milking interval was the only significant risk factor with an odds ratio of 9.00 for milking intervals of ≥16 h. Only the milking intervals represented a relevant risk factor in both models; therefore, we concluded that the previously described sonographic udder edema scoring is a useful technique for detecting overbagged udders at dairy shows. Its routine implementation may improve cow welfare at dairy shows.

Technical note: Evaluation of a sonographic overbagging edema scoring system for show cows: Comparison with visual inspection.

Overbagged udders are commonly seen at dairy cow shows due to prolonged milking intervals. The aims of this study were to describe the prevalence of udder edema in dairy cows at shows as determined by sonography and to suggest a sonographic scoring system, which was evaluated for reproducibility and repeatability. At 4 highly competitive Swiss dairy cow shows, 319 cows of various breeds were examined. Sonographic scans-1 from each fore quarter and 1 from the rear, representing both hind quarters-were collected by 3 experienced veterinarians at defined positions predisposed to overbagging edema. Sonographic scans were scored with the aid of a newly suggested scoring system (score 0 = no edema, grade 1 = slight edema, grade 2 = moderate edema, grade 3 = severe edema). Further, 139 video sequences from behind while the cows were walking and the same number of photographs of the udder each from the left, right, and behind were selected. The photographs and video sequences were visually scored for different parameters as 0 = not present or 1 = present except for abduction, which was scored on a visual analog scale (0 = no abduction; 100 = maximal imaginable abduction). Visual scores were then compared with the sonographic scoring (Pearson's chi-squared). The prevalence of udder edema scores 1, 2, and 3 was 14.0, 6.5, and 2.3%, respectively. Interobserver reliability for objective sonographic scoring (κ = 0.815) and intraobserver agreement (κ = 0.90 and 0.85 for 2 different observers) was estimated as "almost perfect." Interobserver agreements for visual parameters were κ = 0.40 or less except for teat shape (κ = 0.52). Classification of the videos resulted in better interobserver agreement; when rating hind limb abduction, Spearman correlation coefficient was 0.61, whereas κ = 0.61 for absence of udder movement. Udder movement and teat shape were significantly associated with the edema score. The higher inter- and intraobserver reliability of the sonographic edema scoring compared with the visual scoring system indicates that the newly suggested scoring system might be used in the future to objectively identify udder edema in cows at dairy shows.

Clinical and Patient-reported Outcomes of a Zirconia Oral Implant: Three-year Results of a Prospective Cohort Investigation.

The objective of this study was to determine the clinical, radiographic, and patient-reported outcomes of a 1-piece alumina-toughened zirconia implant restored with single crowns (SCs) or 3-unit fixed dental prostheses (FDPs) after 3 y of observation. Forty patients received 53 implants, placed in a 1-stage operation with immediate temporization. Finally, 50 implants were restored with 24 SCs and 13 FDPs. To evaluate peri-implant bone loss, standardized radiographs were taken at implant insertion, at final restoration delivery, and after 1 and 3 y. Additionally, several soft tissue parameters and patient-reported outcome measures were evaluated. Linear mixed models with random intercept for each patient and patients as clusters were used to compare subgroups. Three patients did not receive a SC due to early implant loss, and 1 patient died. As a result, 36 patients with 49 implants were followed-up for 3 y, giving a cumulative survival rate of 94.2%. The average marginal bone loss amounted to 0.79 mm (SCs, 0.47 mm; FDPs, 1.07 mm; P < 0.001). After the delivery of the final prosthetic restoration, further bone loss was not statistically significant (0.09 mm; P = 0.700). Probing depth, clinical attachment level, and modified bleeding index increased significantly at the implant sites, whereas gingival recession decreased significantly. Compared with the pretreatment questionnaires, the patient-reported outcome measures showed a permanently improved perception of function, aesthetics, sense, speech and self-esteem. The survival rate of the investigated ceramic implant system seems to be comparable to reported survival rates of titanium implants when immediately restored. The recorded parameters suggest its potential for clinical utilization.

A national evaluation of workplace-based assessment tools (WPBAs) in foundation dental training: a UK study. Effective and useful but do they provide an equitable training experience?

A questionnaire study was undertaken with trainers and trainees from 12 deaneries in England and Northern Ireland in June 2010 to evaluate workplace-based assessments (WPBAs) in foundation training. From the sample consisting of 741 trainers and 643 foundation trainees, experience of WPBAs was positive overall, playing an important role in trainees' learning during foundation training and building confidence. However, there is a need for comprehensive training in the WPBA tools used to ensure their efficacy.

Evaluation of workplace based assessment tools in dental foundation training.

OBJECTIVE: The aims of this survey were to evaluate the effectiveness of workplace based assessments (WPAs) in dental foundation training (formerly vocational training [VT]). METHODS: Two online questionnaire surveys were sent to 53 foundation dental practitioners (FDPs) and their 51 trainers in the Mersey Deanery at month four and month nine of the one year of dental foundation training. The questionnaires investigated the effectiveness of and trainers' and trainees' satisfaction with the WPAs used in foundation training, namely dental evaluation of performance (D-EPs), case-based discussions (DcBD) and patients' assessment questionnaires (PAQs). The questionnaires also investigated the perceived impact of reflection and feedback associated with WPAs on clinical practise and improving patient care. RESULTS: A total of 41 (7.4%) FDPs and 44 (86.3%) trainers responded. Of the 41 FDPs, the majority found that feedback from WPAs had a positive effect on their training, giving them insight into their development needs. Overall 84.1% of the FDPs felt the WPAs helped them improve patient care and 82.5% of trainers agreed with that outcome. CONCLUSIONS: The findings from this study demonstrate the value of WPAs in dental foundation training by the use of feedback and reflection in directing the learning of foundation dental practitioners and that this can lead to improved clinical practise and patient care.

A dental undergraduate course for the management of medical emergencies in dental practice.

There is a specific requirement for undergraduate dental students to be trained in the management of medical emergencies that may arise in dental practice. This paper describes a practical skills course that has been developed specifically to fulfil this requirement. The rationale, course structure, methodology of delivery and assessment methods are discussed in detail.

A practical skill one day medical emergencies course for dentists and DCPs.

This paper describes a practical skills one day course in the 'management of medical emergencies' which is aimed at fulfilling the requirements for training for dentists and DCPs as defined by the Resuscitation Council UK and prefaced by the GDC.

[Nasal polyps and osteolyses]. / Nasenpolypen und Osteolysen.

A 38-year-old man presented with a 2-month history of progressive leg pain. An x-ray film of both tibial bones showed multiple osteolysis. At the same time, nasal polyps were present. A biopsy of the tibial bone remained unclear. A carcinoma was not found. A biopsy of the nasal polyps revealed a Rosai-Dorfman-Destombes disease.

Constrictive tuberculous pericarditis in a HIV-positive patient.

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomy was performed. The therapeutical approach is discussed and the literature is reviewed.

Left recurrent laryngeal nerve palsy associated with silicosis.

Left recurrent laryngeal nerve palsy usually results from invasion or compression of the nerve caused by diseases localized within the aortopulmonary window. This study reports the case of a 76-yr-old male with vocal cord paralysis due to lymph node involvement by silicosis. This rare entity was identified by video-mediastinoscopy, which revealed a granulomatous and fibrosed recurrent lymph node encasing the nerve. The nerve was dissected and released from scar tissues. Progressive clinical improvement was observed followed by total and durable recovery of the voice after 15 weeks follow-up.

[Blunt thoracic trauma with hemorrhage into a mediastinal lymphangioma--case report]. / Stumpfes Thoraxtrauma mit Einblutung in ein mediastinales Lymphangiom--Fallbeschreibung.

We describe a young snowboarder suffering from dyspnea, chest pain and dysphagia following a blunt chest injury. These symptoms were caused by an accident-related hemorrhage within a preexisting lymphangioma of the right posterior mediastinum. At the same time a lymphangioma of the left anterior mediastinum was found. The lymphangioma of the posterior mediastinum was resected through a right posterolateral thoracotomy after thoracoscopy had demonstrated that a complete resection could not be performed on this way. The lymphangioma of the left side was resected 4 month later by a left-sided hemiclamshell approach due to its size and localisation. Complications arising from mediastinal lymphangioma are described as compression, infection, spontaneous bleeding, rupture and chylothorax. This is the first description of a posttraumatic, symptomatic hemorrhage within a mediastinal lymphangioma.

Developmental toxicity of sodium fluoride in rats.

Despite the chronic exposure of the US population to fluoridated drinking water since the 1940s, existing studies have been judged inadequate to determine any potential reproductive or developmental hazard. This study was conducted to determine the effects of sodium fluoride (NaF) on foetal development. Sperm-positive female rats were given 0, 10, 25, 100, 175 or 250 ppm NaF daily throughout gestation. They were dosed by drinking water to mimic human exposure to fluoridated water. No dose-related behavioural changes or maternal clinical signs were noted. Fluid consumption by females in the 175- and 250-ppm groups was significantly less than that of the control females. Because of this decreased fluid consumption, the daily amount of NaF ingested (0, 1.4, 3.9, 15.6, 24.7 and 25.1 mg/kg body weight) was less than expected at the two high levels. Feed consumption decreased significantly at 250 ppm, and body weights of pregnant females reflected feed consumption trends. The mean number of viable foetuses per female in all treated groups was similar to that of the control group. The significant decrease in the mean number of implants per litter in the 250-ppm group is probably linked to the lower mean number of corpora lutea in this group. The occurrence of in utero deaths was similar in the control and treated groups. Foetal growth (in terms of foetal body weight and crown-rump length) was not affected by NaF, despite the fact that the dams in the 250-ppm group ate significantly less feed and drank significantly less fluid. There was no dose-related increase in the number of external anomalies in foetuses due to NaF ingestion. At the doses given, NaF had no effect on the development of specific bones, including sternebrae. A significant increase was seen in the average number of foetuses with three or more skeletal variations in the 250-ppm group; the number of litters with foetuses with three or more skeletal variations was increased in the 250-ppm group also, but the increase was not significant. There was no dose-related effect of NaF on the incidence of soft tissue variations.

One-year toxicity of orally administered acrolein to the beagle dog.

Forty-eight dogs were separated into four groups of six males and six females. Acrolein (0.1% aqueous) was administered in gelatin capsules to three of these groups at dosing levels of 0.1, 0.5 and 1.5 mg kg-1 day-1 based on results of a range-finding study. After 4 weeks, the high dose was increased to 2 mg kg-1 day-1. The fourth group received deionized water in the same number of gelatin capsules as the high-dose group. Dosing was 7 days per week for 53 weeks. Blood and biochemical measurements were made pretest and at 3-month intervals thereafter. At termination, all dogs were subjected to full necropsy and histological examination. The major test effect noted was frequent vomiting after dosing. This was observed to be dose-dependent and the frequency decreased with time, indicating an adaptive effect. One mid-dose female died during the test and was diagnosed as having died of severe bronchial pneumonia, probably a result of vomitus aspiration. Serum albumin, calcium and total protein values were depressed in high-dose animals throughout the study. Some variability in red blood cell parameters and coagulation times were noted but the significance of these effects was not obvious.

Subchronic oral administration of acemannan in the rat and dog.

Acemannan is the USAN-accepted name for long-chain polydispersed beta-(1,4)-acetylated polymannose with interspersed O-acetyl groups, with a mannose monomer/acetyl ratio of approximately 1:1. This complex polysaccharide is extracted from Aloe vera (barbadensis Miller); the technical material contains approximately 78% acemannan. Technical grade acemannan was administered po to rats for 14 d at 5% of the diet and for 6 mo at up to 2,000 mg/kg/d, and to beagle dogs for 90 d at up to 1,500 mg/kg/d without significant effect on any parameter measured in either species.