Severe rigid hip flexion-abduction contracture in cerebral palsy: a case report and review of the literature.

INTRODUCTION: severe, rigid hip abduction deformity in individuals with cerebral palsy (CP) is an exceptionally uncommon condition. This posture hinders the positioning in the wheelchair and the completion of basic activities of daily living (ADL). Addressing such severe deformities can be quite challenging. MATERIAL AND METHODS: a 14-year-old male, with spastic-dystonic quadriplegic CP, developed rigid and severe flexion-abduction contractures in both hips, characterized by 90 degrees of flexion and 100 degrees of abduction. These contractures severely impeded his ability to comfortably use a wheelchair and even pass through doorways. Performing basic ADLs became a significant challenge for both the patient and his caregivers. RESULTS: the treatment approach involved a two-stage surgical procedure, one for each hip, with a two-month interval between them. An extensive release of the fascia latae, gluteus maximus, external rotators, and hip flexors; in combination with a proximal femur osteotomy were performed. To maintain the corrections achieved, long-leg casts connected with two bars were employed, followed by orthotic support and physiotherapy. Following the procedure, lower limb adduction was achieved, and the patient and caregivers were highly satisfied, as ADLs and basic caregiving had been greatly facilitated. CONCLUSIONS: while the available literature on the management of severe rigid abduction hip contractures in non-ambulatory CP patients is limited, and treatment options are often complex, the present case underscores the effectiveness of a comprehensive approach involving soft tissue release and bone surgery. Achieving a more favorable wheelchair positioning and facilitating basic ADLs and care represents a significant success for patients and families.

INTRODUCCIÓN: la deformidad severa y rígida en abducción de cadera en individuos con parálisis cerebral (PC) es una condición infrecuente. Esta postura dificulta el posicionamiento en la silla de ruedas y la realización de actividades básicas de la vida diaria (AVD). El tratamiento de estas deformidades tan severas puede ser todo un reto. MATERIAL Y MÉTODOS: varón de 14 años, con PC tetrapléjica espástica-distónica, que desarrolló contracturas rígidas y severas de flexión-abducción en ambas caderas, caracterizadas por 90 grados de flexión y 100 grados de abducción. Estas contracturas impedían gravemente su capacidad para utilizar cómodamente una silla de ruedas e incluso pasar por las puertas. La realización de actividades básicas de la vida diaria se convirtió en un reto importante tanto para el paciente como para sus cuidadores. RESULTADOS: el tratamiento consistió en una intervención quirúrgica en dos fases, una para cada cadera, con un intervalo de dos meses entre ellas. Se realizó una amplia liberación de la fascia lata, el glúteo mayor, los rotadores externos y los flexores de la cadera; en combinación con una osteotomía proximal del fémur. Para mantener las correcciones conseguidas, se emplearon escayolas de pierna larga conectadas con dos barras, seguidas de soporte ortésico y fisioterapia. Tras la intervención, se consiguió la aducción de los miembros inferiores y el paciente y los cuidadores se mostraron muy satisfechos, ya que se habían facilitado en gran medida las AVD y los cuidados básicos. CONCLUSIONES: aunque la bibliografía disponible sobre el tratamiento de las contracturas rígidas graves de la cadera en abducción en pacientes no deambulantes con PC es limitada, y las opciones de tratamiento suelen ser complejas, el presente caso subraya la eficacia de un enfoque integral que incluye la liberación de los tejidos blandos y la cirugía ósea. Conseguir una posición más favorable en la silla de ruedas y facilitar las AVD básicas y los cuidados representa un éxito significativo para los pacientes y sus familias.

Exploring vaginal discharge scoring to assess clinical metritis severity: Comparison between intrauterine dextrose and systemic antibiotics treatments.

The objectives of this study were to assess: 1) differences in the metabolic status, systemic inflammation, daily milk yield, and daily rumination time between Holstein dairy cows with different vaginal discharge scores (VDS) in the first 7±3 DIM, and 2) effects of intrauterine dextrose infusion on metabolic status, systemic inflammation, daily milk yield and daily rumination time in dairy cows with VDS4 and VDS5. Cows (n=641) from a farm located in central Pennsylvania were screened at 7±3 DIM (study d 0) to assess vaginal discharge scores. Vaginal discharge was scored using a five-point scale (i.e., 1- clear fluid, 2- <50% white purulent fluid, 3- >50% white purulent fluid, 4- red-brownish fluid without fetid smell, and 5- fetid red-brownish watery fluid). Cows with VDS4 and VDS5 were blocked by parity and randomly assigned to one of two treatment groups: 1) CONV (VDS4 n=15; VDS5 n= 23): two injections of ceftiofur (per label; 6.6 mg/Kg) 72 h apart; and 2) DEX (VDS4 n=15; VDS5 n=22): three intrauterine infusions of a 50% dextrose solution (1 L/cow) every 24 h. Cows that presented a VDS 1, 2, and 3 were categorized as normal vaginal discharge animals (NOMVDS; n=35) and were randomly selected and matched by parity to CONV and DEX cows. Daily milk yield and rumination time for the first 150 DIM were collected from on-farm computer records. Blood samples were collected to assess haptoglobin (HP) and ß-hydroxybutyrate (BHB) concentrations at study d 0, d 7, and d 14 relative to enrollment. Subclinical ketosis was defined as having a BHB concentration >1.2 mmol/dL at any of the sampling points. The data were analyzed using the MIXED and GLIMMIX procedures of SAS as a randomized complete block design. When comparing cows with different VDS (i.e., NOMVDS, VDS4, VDS5) separately, cows with VDS5 had the highest concentration of HP at enrollment compared to cows with VDS4 and NOMVDS; however, cows with VDS4 had higher concentrations of HP compared to cows with NOMVDS. Cows with VDS4 or VDS5 had a higher incidence of subclinical ketosis compared to cows with NOMVDS (p=0.005; VDS4= 62.08±9.16%; VDS5=74.44±6.74%; NOMVDS=34.36±8.53%). Similarly, daily milk yield (p<.0001; VDS4=30.17±1.32 kg/d; VDS5=27.40±1.27 kg/d; NOMVDS=35.14±1.35 kg/d) and daily rumination time (p=0.001; VDS4=490.77±19.44 min; VDS5=465±16.67 min; NOMVDS=558.29±18.80 min) was lower for cows with VDS4 and VDS5 compared to cows with NOMVDS at 7±3 days in milk. When analyzing HP concentration between treatment groups in cows with VDS4 (p=0.70), VDS5 (p=0.25), or VDS4 and VDS5 combined (p=0.31), there was no difference in HP concentration by study d 14 between treatment groups. Interestingly, when only cows with VDS4 were considered for treatment, both treatments, DEX and CONV, increased the daily milk yield to the levels of NOMVDS cows by 14 days in milk. On the other hand, when only cows with VDS5 were considered for treatment, cows treated with DEX produced, on average, 4.48 kg/d less milk in the first 150 days in milk compared to cows treated with CONV or cows that had NOMVDS. Similarly, when cows with either VDS4 or VDS5 were considered for treatment, DEX treatment also impaired milk yield. These results suggest that cows with either VDS 4 or 5 have an altered inflammatory status, and decreased milk yield and rumination compared to cows with NOMVDS. Furthermore, DEX treatment may have similar effects on daily milk yield and metabolic status compared to CONV in cows with VDS4, while DEX is not recommended for cows with VDS5.

Assessment of the effects of prepartum anti-inflammatory therapies on type 1/type 2 immunity ratio using a rapid blood test.

The objective of this study was to assess (1) the effects of prepartum administration of anti-inflammatory therapies on type 1/type 2 immunity ratio using a rapid blood test (D2Dx immunity test; Nano Discovery Inc.), and (2) correlations between rapid blood test scores and daily milk yield in Holstein dairy cows. At 14 d before the expected calving date, cows (n = 64) and heifers (n = 23) were blocked by body condition score (optimal = 3.25-3.5; high ≥3.75) and parity (nulliparous, parous), and randomly allocated to one of 3 treatment groups (1) ASA (n = 29) = receive one oral treatment with administration of acetylsalicylic acid (4 boluses; 480 grain/bolus); (2) MEL (n = 31) = receive one oral administration with meloxicam (1 mg/kg of body weight), or (3) PLC (n = 27) = receive one oral treatment with 4 gelatin capsules filled with water. Blood samples were collected weekly starting 1 wk before treatment until 3 wk after calving for assessment of type 1/type 2 immunity ratio using a rapid blood test (i.e., D2Dx immunity test). A higher D2Dx score corresponds to a higher type 1/type 2 ratio. Furthermore, blood samples were collected within 72 h before and after calving by farm personnel. Daily milk yield for the first 60 d in milk (DIM) was collected from on-farm computer records. The data were analyzed using MIXED procedure of SAS (SAS Institute Inc.) as a randomized complete block design. On average enrolled cows received treatment administration 10 d before the actual calving date (standard deviation = 5.10 d). There was a tendency for a treatment by day interaction. Cows treated with ASA had higher type 1/type 2 ratio within 3 d after calving compared with MEL and PLC cows (ASA = 0.065 ± 0.002; MEL = 0.059 ± 0.002; PLC = 0.053 ± 0.002). Similarly, ASA and MEL cows had a higher type 1/type 2 ratio at 7 ± 3 DIM compared with PLC cows (ASA = 0.062 ± 0.002; MEL = 0.064 ± 0.002; PLC = 0.056 ± 0.002). Regardless of treatment, there was an interaction between parity and day. Parous cows had higher type 1/type 2 ratios compared with nulliparous cows at 14 ± 3 d before calving and at 7 ± 3, 14 ± 3, and 21 ± 3 d after calving. Furthermore, there was a positive correlation between D2Dx scores at 14 ± 3 DIM and average daily milk yield in the first 60 DIM. These results suggest that prepartum anti-inflammatory therapies may cause an increased shift in type 1 immunity around calving. Similarly, parous cows may have an increased shift in type 1 immunity after calving. Interestingly, higher type 1/type 2 ratios may be associated with higher milk yields in the first 60 DIM. Larger studies are needed to identify associations between the D2Dx immunity test and cow health and performance, as well as to assess the applicability of these types of tests in a conventional farm setting.

The impact of beef sire breed on dystocia, stillbirth, gestation length, health, and lactation performance of cows that carry beef × dairy calves.

In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to determine if dystocia risk, stillbirth (SB) risk, gestation length (GL), probability of early-lactation clinical disease events, early-lactation culling risk, or subsequent milk production differ between cows that carried calves sired by different beef breeds and those that carried Holstein-sired calves. Records from 10 herds contained 75,256 lactations from 39,249 cows that had calves with known Holstein or beef breed sires from the years 2010 to 2023. Calf sire breeds with ≥150 records included in analyses were Holstein, Angus, Simmental, Limousin, crossbred beef, and Charolais. Additional beef sire breeds that existed in lower frequency (n < 150 records) were condensed together and classified as "other." Because GL is a continuous variable, sire breed inclusion criteria were reduced to n ≥ 100 records; thus, Wagyu sires were included as their own breed group. Some records did not contain all variables of interest, thus models included fewer lactations depending on variable. Binomial generalized mixed models evaluated dystocia risk (defined as calving ease score ≥4 or calving ease score ≥3), SB risk, clinical health event risk (defined as lameness, mastitis, metabolic, reproductive, other, or any health events occurring within 60 d in milk [DIM]), and early culling risk (defined as death or culling within 60 DIM). Gestation length and test-date milk, fat, and protein yields were evaluated with mixed models. Calves sired by crossbred beef bulls had a greater probability of being stillborn (5%; 95% confidence interval lower = 2.9% upper = 9.0%) than those sired by Holstein bulls (2%; 95% confidence interval lower = 1.5%, upper = 2.7%). All beef-sired calves increased GL from that of Holstein-sired calves (277 ± 0.15 d) with Limousin (282 ± 0.81 d) and Wagyu-sired calves (285 d ± 0.79) resulting in the longest GL. The risk of dystocia, clinical health events, and early-lactation culling did not differ by calf sire breed nor did subsequent milk and component yield. Generally, carrying a calf sired by the beef breeds included in this study did not negatively affect the dairy cow.

Deleterious phenotypes in wild Arabidopsis arenosa populations are common and linked to runs of homozygosity.

In this study, we aimed to systematically assess the frequency at which potentially deleterious phenotypes appear in natural populations of the outcrossing model plant Arabidopsis arenosa, and to establish their underlying genetics. For this purpose, we collected seeds from wild A. arenosa populations and screened over 2,500 plants for unusual phenotypes in the greenhouse. We repeatedly found plants with obvious phenotypic defects, such as small stature and necrotic or chlorotic leaves, among first-generation progeny of wild A. arenosa plants. Such abnormal plants were present in about 10% of maternal sibships, with multiple plants with similar phenotypes in each of these sibships, pointing to a genetic basis of the observed defects. A combination of transcriptome profiling, linkage mapping and genome-wide runs of homozygosity patterns using a newly assembled reference genome indicated a range of underlying genetic architectures associated with phenotypic abnormalities. This included evidence for homozygosity of certain genomic regions, consistent with alleles that are identical by descent being responsible for these defects. Our observations suggest that deleterious alleles with different genetic architectures are segregating at appreciable frequencies in wild A. arenosa populations.

Small proteins modulate ion-channel-like ACD6 to regulate immunity in Arabidopsis thaliana.

The multi-pass transmembrane protein ACCELERATED CELL DEATH 6 (ACD6) is an immune regulator in Arabidopsis thaliana with an unclear biochemical mode of action. We have identified two loci, MODULATOR OF HYPERACTIVE ACD6 1 (MHA1) and its paralog MHA1-LIKE (MHA1L), that code for ∼7 kDa proteins, which differentially interact with specific ACD6 variants. MHA1L enhances the accumulation of an ACD6 complex, thereby increasing the activity of the ACD6 standard allele for regulating plant growth and defenses. The intracellular ankyrin repeats of ACD6 are structurally similar to those found in mammalian ion channels. Several lines of evidence link increased ACD6 activity to enhanced calcium influx, with MHA1L as a direct regulator of ACD6, indicating that peptide-regulated ion channels are not restricted to animals.

Gender differences in workplace violence against physicians and nurses in Latin America: a survey from the Interamerican Society of Cardiology.

OBJECTIVES: To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS: Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS: Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.

Immune dysregulation and pathophysiology of alcohol consumption and alcoholic liver disease.

Alcoholic liver disease (ALD) is a clinical-pathologic entity caused by the chronic excessive consumption of alcohol. The disease includes a broad spectrum of anomalies at the cellular and tissual level that can cause acute-on-chronic (alcoholic hepatitis) or chronic (fibrosis, cirrhosis, hepatocellular cancer) injury, having a great impact on morbidity and mortality worldwide. Alcohol is metabolized mainly in the liver. During alcohol metabolism, toxic metabolites, such as acetaldehyde and oxygen reactive species, are produced. At the intestinal level, alcohol consumption can cause dysbiosis and alter intestinal permeability, promoting the translocation of bacterial products and causing the production of inflammatory cytokines in the liver, perpetuating local inflammation during the progression of ALD. Different study groups have reported systemic inflammatory response disturbances, but reports containing a compendium of the cytokines and cells involved in the pathophysiology of the disease, from the early stages, are difficult to find. In the present review article, the role of the inflammatory mediators involved in ALD progression are described, from risky patterns of alcohol consumption to advanced stages of the disease, with the aim of understanding the involvement of immune dysregulation in the pathophysiology of ALD.

Postpartum intrauterine dextrose infusion: Effects on uterine health, metabolic stress, systemic inflammation, and daily milk yield in clinically healthy dairy cows.

The objective of this study was to assess the effect of intrauterine dextrose infusion at 4 ± 1 d in milk (DIM) on the incidence of clinical metritis (CM), metabolic stress [i.e., body condition score (BCS), ß-hydroxybutyrate (BHB) concentration, and subclinical ketosis incidence], systemic inflammation (i.e., haptoglobin concentration), and daily milk yield in clinically healthy postpartum dairy cows. Cows (n = 245) from a dairy farm located in southwest Pennsylvania were screened at 4 ± 1 DIM using a Metricheck (Simcro Tech Ltd.) device to assess vaginal discharge. In addition, overall cow health (e.g., lameness, abnormal breathing) and rectal temperature were assessed at this time. Cows (n = 134) that presented a clear dense vaginal discharge, were in clinically good health status, and had a normal rectal temperature (i.e., <39.7°C) were blocked by parity (primiparous = 64; multiparous = 70) and randomly assigned to 1 of 3 groups: (1) SAL (n = 45): 1 intrauterine infusion of isotonic saline solution (1 L/cow); (2) DEX (n = 44): 1 intrauterine infusion of a 50% dextrose solution (1 L/cow), or (3) CON (n = 45): cows remained untreated. Cows were re-screened at 7 d after enrollment (11 ± 1 DIM) using the Metricheck device to assess CM incidence (research clinical metritis incidence; RCMI). On-farm computer records (i.e., Dairycomp 305) were also used to collect clinical metritis incidence (farm clinical metritis incidence; FCMI). In addition, BCS was assessed and blood samples were collected at enrollment and at study d 7, 14, and 21. Furthermore, daily milk yield and clinical disease events for the first 60 DIM were collected from on-farm computer records. The data were analyzed using the MIXED and GLIMMIX procedures of SAS (SAS Institute Inc.) as a randomized complete block design. Although not significant, the RCMI and FCMI in DEX and SAL cows were on average 14.5 and 18.1 percentage points higher, respectively, compared with CON cows. The SAL cows had higher BHB and haptoglobin concentrations and higher incidence of subclinical ketosis compared with CON cows on study d 7. With regard to daily milk yield, there was a day by treatment interaction, where CON cows produced more milk on certain days compared with DEX and SAL cows. Based on these findings, authors conclude that intrauterine dextrose infusion in clinically healthy postpartum cows with normal vaginal discharge may be prejudicial for cow health and performance.

Corticosteroid safety in COVID-19 patients: a pharmacovigilance study / Seguridad de corticoesteroides en pacientes con COVID-19: un estudio de farmacovigilancia

The use of oral and intravenous corticosteroids as a treatment for SARS-CoV-2 infection has been shown to inhibit the exaggerated inflammatory response, reducing symptoms and days of hospitalization of patients. However, its use is controversial because not enough clinical studies have been made to verify the safety of the drugs. Objective: To assess the safety profile of corticosteroids treatment, at high and low doses, in suspected or confirmed patients with COVID-19, determining the most frequent side effects in patients, and assessing whether the administration of the drugs represents a greater benefit than the risk of presenting these effects. Methods: Ambispective study of active pharmacovigilance at a cohort of confirmed or suspected COVID-19 patients, treated with intravenous and oral corticosteroids. 366 patients were evaluated and divided into 3 groups: use of methylprednisolone (155 mg average) every 24 hours for 3 days, dexamethasone (6 mg) every 24 hours for 10 days, and a control group. Results: The distribution of the cases with hyperglycemia was 33 in high doses and 82 with low doses of corticosteroids and both high and low doses have a similar distribution in cases of infections. When evaluating the harshness and severity of hyperglycemia in the two groups with corticosteroids, it is observed that patients with high doses present more harsh (48%). In case of harshness and severity of infections it is observed that patients with high doses present more harsh (62%) and more severe (79%) cases than those who were administered low doses. (AU)

El uso de corticoides orales e intravenosos como tratamiento para la infección por SARS-CoV-2 ha demostrado inhibir la respuesta inflamatoria exagerada, reduciendo los síntomas y los días de hospitalización de los pacientes. Sin embargo, su uso es controvertido porque no se han realizado suficientes estudios clínicos para verificar la seguridad de los medicamentos. Objetivo: Evaluar el perfil de seguridad del tratamiento con corticoides, a dosis altas y bajas, en pacientes con sospecha o confirmación de COVID-19, determinando los efectos secundarios más frecuentes en los pacientes, y valorando si la administración de los fármacos representa un mayor beneficio que el riesgo de presentar estos efectos. Métodos: Estudio ambispectivo de farmacovigilancia activa en una cohorte de pacientes confirmados o sospechosos de COVID-19, tratados con corticoides intravenosos y orales. Se evaluaron 366 pacientes y se dividieron en 3 grupos: uso de metilprednisolona (155 mg promedio) cada 24 horas por 3 días, dexametasona (6 mg) cada 24 horas por 10 días y un grupo control. Resultados: La distribución de los casos con hiperglucemia fue de 33 casos usando dosis altas y 82 con dosis bajas de corticoides, tanto las dosis altas como las bajas tienen la misma distribución en los casos de infecciones. Al evaluar la severidad y gravedad de la hiperglucemia en los dos grupos con corticoides, se observa que los pacientes con dosis altas presentan mayor gravedad (48%). En caso de severidad y gravedad de las infecciones se observa que los pacientes con dosis altas presentan casos más graves (62%) y más severos (79%) que los que recibieron dosis bajas. (AU)

Plant NLR diversity: the known unknowns of pan-NLRomes.

Plants and pathogens constantly adapt to each other. As a consequence, many members of the plant immune system, and especially the intracellular nucleotide-binding site leucine-rich repeat receptors, also known as NOD-like receptors (NLRs), are highly diversified, both among family members in the same genome, and between individuals in the same species. While this diversity has long been appreciated, its true extent has remained unknown. With pan-genome and pan-NLRome studies becoming more and more comprehensive, our knowledge of NLR sequence diversity is growing rapidly, and pan-NLRomes provide powerful platforms for assigning function to NLRs. These efforts are an important step toward the goal of comprehensively predicting from sequence alone whether an NLR provides disease resistance, and if so, to which pathogens.

Intramuscular psoas lengthening at the pelvic brim plus proximal lengthening of the rectus femoris as a treatment for fixed knee flexion deformity in cerebral palsy. / Tenotomía intrapélvica del psoas y alargamiento proximal del recto anterior como tratamiento del flexo fijo de rodilla en parálisis cerebral infantil.

Although the correction of knee flexion by lengthening the hamstring musculature is traditionally contemplated in cerebral palsy, literature suggests that treatment of hip flexion also improves knee extension. The aim of the study was to first show the efficacy of the sequence of intrapelvic tenotomy of the psoas followed by intramuscular lengthening of the proximal rectus anterior and, later, that of both surgical soft tissue surgeries separately. For this, a prospective study was carried out in 10 patients with a mean age of 14 years, which presented 16 fixed knee flexes with a mean of deformity of 22°. The data was analyzed through means of an ANOVA of repeated measures and to determine the effect separately of each one of the techniques, the improvements obtained with respect to the previous level were contrasted. The mean extension achieved was 12°, 7° corresponding to the intrapelvic tenotomy of the psoas and, on the remaining knee flexion, a correction of 5° after intramuscular lengthening of the anterior rectus at the proximal level. Both the sequence of proposed gestures and those that form separately, showed statistically significant differences (P <0.001) in the correction of the deformity. In conclusion, the proposed techniques applied sequentially or separately are effective in reducing knee flexion in predominantly spastic cerebral palsy, facilitating or even being able to avoid the treatment that is directly needed.

Effects of postpartum acetylsalicylic acid on uterine diseases and reproductive performance in dairy cattle.

Uterine diseases are some of the most prevalent and costly diseases for the dairy industry. It has been reported that an exacerbated and prolonged inflammatory response around calving can increase the risk of developing metritis, which subsequently can impair production and fertility in dairy cows. The objective of this study was to assess the effects of 2 oral administrations of acetylsalicylic acid 24 h apart on the incidence of uterine diseases [i.e., retained fetal membranes, clinical metritis, clinical endometritis) and reproductive performance [i.e., days in milk to conception, number of services to conception, proportion of cows pregnant at first service, proportion of abortion at first service (ABRT)] in dairy cows after calving. Cows from one dairy farm (n = 246) located in central Pennsylvania were included in this study. Animals were blocked by parity and randomly assigned to 1 of 2 groups: (1) ASA (n = 121): within ~12 h after parturition, cows received 2 treatments with acetylsalicylic acid (ASA; 200 mg/kg, 4 boluses) 24 h apart; or (2) UNT (n = 125): cows remained untreated. Clinical metritis was assessed at 7 ± 3 and 14 ± 3 d in milk (DIM) using a Metricheck device (Simcro Tech Ltd., Hamilton, New Zealand). Cows that presented a fetid, red-brownish, watery vaginal discharge were classified as having clinical metritis. Clinical endometritis was assessed through ultrasonography and defined as presence of hyperechoic fluid (>3 mm) in the uterus lumen at 50 ± 10 DIM. The incidence of retained fetal membranes was defined as the failure of expulsion of the placenta within 24 h after calving and recorded by farm personnel. The data were analyzed using the MIXED and GLIMMIX procedures of SAS (SAS Institute Inc., Cary, NC) as a randomized complete block design. A lower proportion of cows treated with acetylsalicylic acid developed clinical metritis at 7 ± 3 DIM (ASA = 34.97 ± 5.57%; UNT = 57.21 ± 5.80%) and tended to develop clinical endometritis at 50 ± 10 DIM (ASA = 3.84 ± 2.67%; UNT = 13.61 ± 5.23%) compared with cows that remained untreated. Cows treated with acetylsalicylic acid tended to require 18 d less to conceive compared with UNT cows (ASA = 125.63 ± 8.21 d; UNT = 143.44 ± 6.28 d). Furthermore, there was a tendency for a treatment × ABRT interaction, whereby ASA cows that aborted at first service tended to conceive 35 d sooner compared with UNT cows that aborted at first service (ASA = 151.42 ± 15.90 d; UNT = 186.38 ± 11.84 d). Although there was no difference in pregnancy per AI at first service between treatment groups (ASA = 23.88 ± 7.92%; UNT = 17.93 ± 6.31%), the proportion of cows aborting at first service in the ASA group tended to be lower than that in the UNT group (ASA = 1.03 ± 1.06%; UNT = 6.04 ± 2.62%). Results from this study suggest that a short-duration acetylsalicylic acid treatment after calving may decrease the incidence of uterine diseases and improve reproductive success in cows that aborted at first service in dairy cattle.

Ossifying myositis in the infant. About a case. / Miositis osificante en el lactante. A propósito de un caso.

Myositis ossificans is a benign disorder characterized by the formation of heterotopic bone in skeletal muscle or soft tissues. It is extremely rare in children, <1% of cases occur in children under 10 years. We present a 17-day-old boy that, after 10 days of Intermediate Care Unit stay, was referred to our hospital for a developmental dysplasia of the hip. On clinical examination, he had swelling on the left thigh and increase in size compared to the contralateral one, therefore was admitted for studying. Imaging findings including plain radiographs, CT, MRI and bone scintigraphy, as well as treatment performed, are described. To the best of our knowledge, is the youngest case reported in the literature.

Association of prepartum lying time with nonesterified fatty acids and stillbirth in prepartum dairy heifers and cows.

The objective of the present study was to assess the association of prepartum lying time (LT) and the coefficient of variation (CV) of LT within 7 d before calving with prepartum serum nonesterified fatty acid (NEFA) concentration at 7 ± 3 d prepartum (dpp) and stillbirth. Prepartum pregnant Holstein heifers and cows from 3 dairy herds were used (n = 1,044). Animals were housed in freestall barns using a prepartum pen 21 d before the expected calving date and were moved into a contiguous maternity pen at parturition. Monthly, cohorts of 20 to 36 animals (heifers and cows combined) were enrolled at each farm and electronic data loggers (IceQube, IceRobotics, Edinburgh, UK) were fitted to the hind leg of individual animals to assess their behavioral activity. Stillbirth was defined as a calf born dead or died during the first 24 h after parturition in dams with normal gestation length. The LT was recorded for the last 7 dpp to assess differences among dams with stillbirth versus those with a calf born alive. Mean LT within 7 d before blood NEFA collection was assessed to determine the association with prepartum serum NEFA at 7 ± 3 dpp. Blood samples for the assessment of serum NEFA concentration were collected from prepartum animals at 14 ± 3 and at 7 ± 3 dpp. Blood samples for total serum calcium concentration were collected from postpartum cows within 48 h after parturition to assess differences among cows with stillbirth versus those with a calf born alive. Data were analyzed using CORR, MIXED, or GLIMMIX procedures of SAS (SAS Institute Inc., Cary, NC). Dams experiencing dystocic births had a greater proportion of stillbirth, but herd, parity, and season did not have an effect. Dams with a stillborn calf had reduced LT and increased CV of LT within the last 7 dpp compared with dams with a calf born alive, regardless of parity. Multiparous cows with a stillborn calf had higher prepartum serum NEFA concentration compared with multiparous cows with a calf born alive, but this did not differ for first-calf heifers. Regardless of parity, the proportion of postpartum cows with hypocalcemia was higher for dams with a stillborn calf compared with those with a calf born alive. Regardless of parity, LT of prepartum dams was strongly correlated with the CV of LT (as LT increased, the CV decreased), and prepartum dams with a mean LT between 11 and 15 h/d had the lowest serum NEFA concentration compared with dams with LT of 8 to 10 or >16 h/d. Serum NEFA concentrations at 7 ± 3 dpp was positively correlated with the CV of LT within 7 d before blood sample. These results show that the dam's prepartum LT and its consistency over time are associated with prepartum serum NEFA and calf survival at calving.

Administration of acetylsalicylic acid after parturition in lactating dairy cows under certified organic management: Part I. Milk yield, milk components, activity patterns, fertility, and health.

Parturition is a natural process that gradually progresses from one stage to the next. However, around 5% of dairy cows will experience dystocia, which is considered to be a painful and stressful event. Studies have reported positive effects on cow performance and welfare after treatment with nonsteroidal anti-inflammatory drugs during the first postpartum days. The objectives were to assess the effects of acetylsalicylic acid administration after calving on (1) milk yield and components, (2) daily activity patterns, (3) reproductive performance, and (4) health in lactating dairy cows under certified organic management. Cows from 3 organic herds were enrolled. Within 12 h after parturition, cows were blocked by parity and calving ease and randomly assigned to 2 treatments: (1) aspirin (ASP; n = 278), in which cows received 4 consecutive treatments every 12 h with acetylsalicylic acid (100 mg/kg; 2 boluses) or (2) placebo (PLC, n = 285), in which cows received 4 treatments every 12 h with gelatin capsules (2 capsules) filled with water. Daily milk yield for the first 30 d in milk (DIM) and monthly milk yield, fat, protein, and somatic cell count (SCC) data from the first 5 Dairy Herd Improvement Association tests were collected. Activity patterns were measured using activity data loggers in the first 7 DIM. Clinical disease events (60 DIM) and fertility data were collected from on-farm computer records. Statistical analysis was performed using the MIXED (milk yield, components, and activity), LIFETEST (fertility), and GLIMMIX (health) procedures of SAS (SAS Institute Inc., Cary, NC). Overall, ASP cows produced 1.82 kg/d more milk than PLC cows during the first 30 DIM. Interestingly, cows that experienced dystocia and received ASP produced 4.48 kg/d more milk compared with cows in the PLC group that experienced dystocia. Cows treated with ASP had lower somatic cell count during the first 5 Dairy Herd Improvement Association tests. There were no differences in daily lying time, lying bouts, and lying bout duration between the ASP and PLC groups. However, cows in the ASP group had 587,64 steps/d more compared with PLC cows. In addition, ASP cows tended to require fewer days (ASP = 113.76 ± 4.99 d; PLC = 125.36 ± 4.74 d) and needed fewer services (ASP = 1.86 ± 0.21 services; PLC = 2.19 ± 0.24 services) to become pregnant compared with PLC cows. There were no differences in clinical disease events between treatments. Results from this study suggest that treating cows with ASP after calving may help improve milk yields and udder health, increase activity, and enhance fertility in dairy cattle under certified organic management.

Administration of acetylsalicylic acid after parturition in lactating dairy cows under certified organic management: Part II. Biomarkers of nociception, inflammation, and stress.

The objective was to assess the effect of oral administration of acetylsalicylic acid after calving on the concentrations of substance P (SP), haptoglobin (HP), and cortisol in lactating dairy cows. Holstein dairy cows (n = 152) from 3 organic herds were included. At parturition, cows were blocked by parity [multiparous (MULT) and primiparous (PRIM)] and calving ease [eutocia (EUT) and dystocia (DYS)] and were randomly assigned to 1 of 2 treatment groups: aspirin (ASP; n = 76), in which within 12 h after parturition cows received 4 treatments with acetylsalicylic acid (100 mg/kg; 2 boluses) at 12-h intervals, or placebo (PLC; n = 76), in which within 12 h after parturition cows received 4 consecutive treatments with gelatin capsules (2 capsules) containing water 12 h apart. Blood samples were collected immediately before treatment and at 12, 24, 36, 48, and 168 h (7 DIM) for assessment of circulating concentration of SP, HP, and cortisol. Based on farm records, cows were classified in the following clinical disease categories: no clinical disease event (NO-EVT), a single clinical disease event (SI-EVT), and more than 1 clinical disease event (MU-EVT). The study data were analyzed as a randomized complete block design using mixed multiple linear and logistic regression models. With regard to HP, there was a tendency for an interaction between treatment and parity, where MULT cows treated with ASP had lower concentration of HP compared with MULT cows treated with PLC (ASP = 124.33 ± 6.83 µg/mL; PLC = 143.9 ± 7.24 µg/mL). Analysis by calving ease showed that cows with DYS had higher concentrations of HP (DYS = 159.17 ± 5.97 µg/mL; EUT = 138.72 ± 6.22 µg/mL) and SP (only at 168 h; DYS = 64.99 pg/mL, 95% confidence interval, CI: 2.68-2.81; EUT = 60.33 pg/mL, 95% CI: 2.91-3.06) after calving compared with EUT cows. Regardless of treatment, PRIM cows had higher concentrations of SP (MULT = 55.11 pg/mL, 95% CI: 1.27-1.30; PRIM = 57.62 pg/mL, 95% CI: 1.99-2.06), HP (MULT = 134.14 ± 4.96 µg/mL; PRIM = 163.75 ± 7.76 µg/mL), and cortisol (MULT = 18.65 µg/mL, 95% CI: 1.02-1.05; PRIM = 21.92 µg/mL, 95% CI: 1.67-1.74) compared with MULT cows. In addition, cows that experienced SI-EVT or MU-EVT had higher concentrations of HP (NO-EVT = 134.13 ± 5.95 µg/mL; SI-EVT = 142.68 ± 7.32 µg/mL; MU-EVT = 170.03 ± 9.42 µg/mL) and cortisol (NO-EVT = 17.86 µg/mL, 95% CI: 1.20-1.24; SI-EVT = 21.01 µg/mL, 95% CI: 1.61-1.67; MU-EVT = 22.01 µg/mL, 95% CI: 2.08-2.18) compared with cows with NO-EVT recorded. Results from this study suggest that a short-duration anti-inflammatory therapy after calving reduced HP in MULT cows but may not have effects on SP and cortisol concentrations. Calving ease and parity affected the concentrations of markers of inflammation, nociception, and stress regardless of treatment. Further research is warranted to assess anti-inflammatory strategies aimed at decreasing inflammation and stress in DYS and PRIM cows and therefore improve welfare and performance of these high-priority groups.

[Evaluation of function and limiting factors of gait disorder treatment in cerebral palsy: development of the Walking Abilities Levels Classification System]. / Evaluación funcional y de factores limitantes del tratamiento de los trastornos de la marcha en la parálisis cerebral infantil: desarrollo del sistema de clasificación de niveles de deambulación funcional.

INTRODUCTION: The Gross Motor Function Classification System has allowed us to stratificate cerebral palsy patients, according to their walking abilities. The lack of sensitivity about detecting changes and the absence of a global patient evaluation, justify the search of new pre-operative evaluation tools. AIMS: To present the Walking Abilities Levels Classification System (WALCS) and to show the first inter-observer agreement study that has been carried out. This system uses first a different pattern for ordering gait functional skills, and after that, evaluates the reversibility of the contextual factors that may limit the result of a gait disorder treatment. SUBJECTS AND METHODS: A new evaluation frame was built by an interdisciplinary team with an average professional experience of more than 15 years, initially focused as part of the pre-surgical patient evaluation. An inter-observer agreement study was held to gain the first insight of it. 14 participants studied the medical reports and gait lab video images of 10 cases. RESULTS: The kappa index was 0.76 for the walking ability level, 0.79 for the biological type, 0.69 psychological type and 0.64 social type of limiting factors. CONCLUSIONS: The WALCS offers a new evaluation frame gathering patient walking skills and limiting factors treatment. The initial inter-observer agreement rate endorsed more intra- and inter-studies in order to achieve a more robust validation.

TITLE: Evaluación funcional y de factores limitantes del tratamiento de los trastornos de la marcha en la parálisis cerebral infantil: desarrollo del sistema de clasificación de niveles de deambulación funcional.Introducción. El Gross Motor Function Classification System ha permitido estratificar, según su habilidad para caminar, a los pacientes que padecen parálisis cerebral infantil. La falta de sensibilidad en la detección de cambios y la ausencia de una evaluación del paciente en el contexto en el que se encuentra justifican la búsqueda de alternativas de evaluación pretratamiento. Objetivos. Presentar y mostrar la concordancia interobservador inicial del sistema de clasificación de niveles de deambulación funcional. Con él se evalúa la destreza para caminar y la necesidad de asistencia para realizar transferencias desde la silla de ruedas, y, posteriormente se analiza el escenario que la salud y el entorno del paciente ofrecen como condicionantes en la corrección de la marcha o la bipedestación asistida. Sujetos y métodos. Se describe un nuevo marco de evaluación, elaborado por un grupo interdisciplinar con más de 15 años de experiencia media, enfocado inicialmente a la toma de decisiones antes de un tratamiento quirúrgico. Como control interno, 14 participantes evaluaron la historia clínica y los vídeos de marcha de 10 casos. Resultados. Se alcanzó un índice kappa de acuerdo de 0,76 en niveles funcionales y de 0,79 en el tipo de escenario biológico, de 0,69 en el psicológico y de 0,64 en el social. Conclusiones. El sistema de clasificación de niveles de deambulación funcional ofrece un marco para la evaluación conjunta de la deambulación y de los factores limitantes en la eficacia de un tratamiento. La concordancia interobservador avala iniciar su validación.

Effects of postpartum acetylsalicylic acid on metabolic status, health, and production in lactating dairy cattle.

The transition period is one of the most challenging times for dairy cattle. Previous research suggests that treatment of postpartum cows with anti-inflammatory drugs may decrease pain and inflammation, enhancing cow welfare and performance during this challenging period. However, these strategies involve numerous time-consuming interventions, which require extra labor and do not fit modern farm logistics. The objective of this experiment was to assess the effects of acetylsalicylic acid (ASA) every 24 h for 2 d after calving on (1) daily milk yield, daily milk conductivity, and daily rumination during the first 60 days in milk (DIM), and 305-d mature-equivalent milk, milk fat, and milk protein yields, (2) body condition score, ß-hydroxybutyrate (BHB), and haptoglobin, and (3) incidence of clinical diseases during the first 60 DIM. Dairy cows (n = 246) from a dairy farm located in Pennsylvania were enrolled in this experiment. Cows were blocked by parity and assigned randomly to 1 of 2 treatments: (1) ASA (n = 121), in which cows received 2 treatments with ASA (200 mg/kg; 4 boluses), the first within 12 h after parturition and the second 24 h later; or (2) untreated (UNT; n = 125), in which cows remained untreated. Blood samples were collected at 30 ± 6 h, 7 ± 3 d, and 14 ± 3 d after calving to measure BHB and haptoglobin concentrations. Body condition score was assessed at enrollment, 7 ± 3 DIM, 14 ± 3 DIM, and 50 ± 10 DIM. Furthermore, incidences of diseases, daily rumination, daily milk yield, and daily milk conductivity during the first 60 DIM and 305-d mature-equivalent milk, milk fat, and milk protein yields were collected from on-farm computer records. The data were analyzed using mixed multiple linear and logistic regression models as a randomized complete block design. Multiparous cows treated with ASA produced 1.64 kg/d more milk compared with multiparous cows that remained untreated (ASA = 41.66 ± 0.88 kg/d; UNT = 40.02 ± 0.81 kg/d) during the first 60 DIM. There was no difference in daily milk conductivity and rumination between treatments. Cows treated with ASA had lower concentration of BHB (ASA = 1.16 ± 0.64 mmol/L; UNT = 1.23 ± 0.80 mmol/L) during the first 14 ± 3 DIM and had higher body condition score within the first 50 ± 10 DIM compared with cows that remained UNT. There were no differences in circulating concentrations of haptoglobin between treatments. These results support previous findings showing that the use of anti-inflammatory drugs after calving may increase milk production and affect the metabolic status of dairy cows.