Association of estrous expression detected by an automated activity monitoring system within 40 days in milk and reproductive performance of lactating Holstein cows.

The objective of this observational study was to evaluate the association of estrous expression within 40 days in milk (DIM) using a neck-mounted automated activity monitor (Heatime Pro; SCR Engineers Ltd.) with reproductive performance in lactating Holstein cows. A total of 2,077 cows (614 primiparous cows and 1,463 multiparous cows) from 5 commercial dairy farms were included in the statistical analyses. Activity data from the first 7 d after calving were excluded. An estrus event was defined as an activity change index ≥35 for more than 2 h. Cows were classified according to the number of estrus events from d 7 until d 40 postpartum into 3 categories: (1) no estrus event (Estrus0); (2) one estrus event (Estrus1), and (3) 2 or more estrus events (Estrus2). Generalized linear mixed models were used to analyze continuous and categorical data. Shared frailty models were used for time to event data. Overall, 52.7% of cows had no estrus event detected by an automated activity monitor system from d 7 until d 40 postpartum. Herd level prevalence of Estrus0 ranged from 37.5 to 58.4%. Estrous expression from d 7 until d 40 postpartum affected estrous duration and estrous intensity at first artificial insemination (AI). Cows in Estrus0 had the shortest duration (13.2 ± 0.33 h) compared with cows in Estrus1 (13.8 ± 0.36 h) and Estrus2 (14.8 ± 0.41 h). Cows in Estrus2 had a longer estrous duration at first postpartum AI compared with cows in Estrus1. Among Estrus0 cows, 46.2% had an estrus event with high intensity at first postpartum AI. Among cows in Estrus1 and Estrus2, 50.8 and 53.8% had an estrus event with high intensity at first postpartum AI, respectively. There was a significant difference between Estrus2 and Estrus0 and a tendency between Estrus0 and Estrus1. There was no difference between Estrus1 and Estrus2. For Estrus0, Estrus1, and Estrus2 cows, pregnancy per AI was 29.4, 30.9, and 37.8%, respectively. There was a significant difference between Estrus0 and Estrus2 and Estrus1 and Estrus2. There was no difference between Estrus0 and Estrus1. Estrous expression from d 7 until d 40 postpartum affected time to first AI and time to pregnancy. Compared with Estrus0 cows, cows in Estrus1 [hazard risk (HR) = 1.74] and Estrus2 (HR = 1.77) had an increased hazard of being inseminated within 100 DIM. There was no difference between Estrus1 and Estrus2. Median DIM to first AI were 70, 59, and 58 for cows in Estrus0, Estrus1, and Estrus2, respectively. Compared with Estrus0 cows, cows in Estrus1 (HR = 1.28) and Estrus2 (HR = 1.33) had an increased hazard of becoming pregnant within 200 DIM. There was no difference between Estrus1 and Estrus2. Median DIM to pregnancy were 127, 112, and 103 for Estrus0 cows, Estrus1 and Estrus2, respectively. In conclusion, cows with no estrous expression from 7 to 40 DIM had reduced estrous expression at first AI and inferior reproductive performance compared with cows that displayed estrous activity.

Prevalence of disorders in preweaned dairy calves from 731 dairies in Germany: A cross-sectional study.

The objective of this cross-sectional study was to determine the prevalence of disorders in preweaned calves in 3 regions in Germany, exemplary for structural diversity in dairy farming. A farm visit was performed on a single occasion on 731 dairy farms in the northern, eastern, and southern regions of Germany between December 2016 and July 2019. Farms differed in herd size, geographical location, and management. In the northern region, the farms had a median of 90 milking cows and were often run as full-time family businesses, partly with external workers. The eastern region tended to have larger farms (a median of 251 milking cows), which were often large-scale agricultural enterprises with employees. In the southern region, the farms had a median of 39 milking cows and were often traditional family businesses, some of these being part-time businesses. Clinical examinations were performed on 14,164 preweaned dairy calves (median 12 calves per farm) by trained veterinarians. A complete data set was available for 13,656 calves. Almost half (42.0%) of the evaluated calves were classified as being affected by at least 1 of the common calf disorders. Omphalitis (O, 20.9%; n = 2,876) and diarrhea (D, 18.5%; n = 2,670) were the most frequently recorded diagnoses, whereas respiratory diseases (RD) were observed to a lesser extent (8.7%; n = 1,100). A striking feature was the fact that 7.1% (n = 987) of the calves were affected by more than 1 disorder at the same time (multimorbidity, M). The following combinations of disorders were frequently observed: O and D (n = 596), O and RD (n = 164), and D and RD (n = 140). Disorders such as O and D, as well as M, were predominantly observed in calves aged 2 wk. A gradual increase in the frequency of RD was observed with age. For all disorders except RD, male calves were more often affected than females. Omphalitis was predominantly diagnosed in the summer months, whereas RD, D, and M were more common in the fall. We detected several statistically significant differences in the prevalence of clinical signs and disorders in preweaned dairy calves between the 3 exemplary regions. The prevalence of RD was higher in the south (10.8%) than in the north (8.2%) and east (7.4%). In the north (33.2%), O was observed more frequently than in the other regions (east: 18.9%; south: 10.5%), whereas D was found less frequently in the north (13.8%) than in the east (21.6%) and south (20.0%).

Sensitivity and specificity of a tail-activity measuring device for calving prediction in dairy cattle.

Efficient calving surveillance is essential for avoiding stillbirth due to unattended dystocia. Calving sensors can help detect the onset of parturition and thus ensure timely calving assistance if necessary. Tail-raising is an indicator of imminent calving. The objective of this study was to evaluate a tail-mounted inclinometer sensor (Moocall Ltd., Dublin, Ireland) and to monitor skin integrity after sensor attachment. Cows (n = 157) and heifers (n = 23) were enrolled at 275 d post insemination, and a sensor was attached to each cow's tail. Investigators checked for signs indicating the onset of stage II of parturition, verified the position of the sensor, and evaluated the skin integrity of the tail above and below the sensor hourly for 24 h/d. We used 5 different intervals (i.e., 1, 2, 4, 12, and 24 h until calving) to calculate sensitivity and specificity. Sensors continuously remained on the tail (i.e., within 3 cm of the initial attachment position) after initial attachment until the onset of calving in only 13.9% of animals (n = 25). Sensors were reattached until a calving event occurred (51.6%) or the animal was excluded for other reasons (34.4%). In 31 animals the sensor was removed because the tail was swollen or painful. Heifers were significantly less likely than cows to lose a sensor but more likely to experience tail swelling or pain. Depending on the interval preceding the onset of parturition, sensitivity varied from 19 to 75% and specificity from 63 to 96%.

Validated low-volume aldosterone immunoassay tailored to GCLP-compliant investigations in small sample volumes.

INTRODUCTION: Heart failure is well investigated in adults, but data in children is lacking. To overcome this shortage of reliable data, appropriate bioanalytical assays are required. OBJECTIVES: Development and validation of a bioanalytical assay for the determination of aldosterone concentrations in small sample volumes applicable to clinical studies under Good Clinical Laboratory Practice. METHODS: An immunoassay was developed based on a commercially available enzyme-linked immunosorbent assay and validated according to current bioanalytical guidelines of the EMA and FDA. RESULTS: The assay (range 31.3-1000 pg/mL [86.9-2775 pmol/L]) is characterized by a between-run accuracy from - 3.8% to - 0.8% and a between-run imprecision ranging from 4.9% to 8.9% (coefficient of variation). For within-run accuracy, the relative error was between - 11.1% and + 9.0%, while within-run imprecision ranged from 1.2% to 11.8% (CV). For parallelism and dilutional linearity, the relative error of back-calculated concentrations varied from - 14.1% to + 8.4% and from - 7.4% to + 10.5%, respectively. CONCLUSIONS: The immunoassay is compliant with the bioanalytical guidelines of the EMA and FDA and allows accurate and precise aldosterone determinations. As the assay can run low-volume samples, it is especially valuable for pediatric investigations.

Validated low-volume immunoassay for the reliable determination of direct renin especially valuable for pediatric investigations.

INTRODUCTION: The pharmacotherapy of pediatric patients suffering from heart failure is extrapolated from adults due to missing data in children. OBJECTIVES: Development and validation of a low-volume immunoassay for the reliable determination of renin. EXPERIMENTAL: The immunoassay was validated according to international guidelines. RESULTS: The assay allows the reliable determination of renin in 40 µL plasma within a calibration range of 4-128 pg/mL. Between-run accuracy varied from -3.3 to +3.0% (relative error), while between-run precision ranged from 4.9 to 11.3% (coefficient of variation). CONCLUSION: The low-volume immunoassay facilitates the reliable collection of pharmacodynamic data in children.

Rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios nasales / Clinical assessment in the diagnosis of bone fractures in patients with nasal trauma

Introduction: The aim of this study was to evaluate the performance of clinical assessment in the diagnosis of bone fractures in patients with nasal trauma. Methods: Retrospective review of medical records of 220 patients with nasal trauma treated at the Maxillofacial Surgery Department of Hospital Workers in Santiago was performed. Eight clinical criteria were evaluated: epistaxis, ecchymosis, swelling, nasal injury, airway obstruction, nasal deviation, irregular nasal dorsum, and acute septal injury. The gold standard for diagnosis of nasal fracture was the radiological evaluation. The sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each separate clinical criteria (8), for all possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). Results: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture was very low (< 35 percent). However, the specificity and positive predictive values were relatively high (> 90 percent) and increased, respectively, when at least one criterion was present (92 percent and 94 percent respectively), when 2 clinical criteria were present (98 percent and 96 percent, respectively), and when at least 3 clinical criteria were present (100 percent for both). Conclusion: The presentation of the clinical criteria can be a valuable method for diagnosis of nasal fracture, however, when these clinical criteria are absent, the possibility of nasal fracture cannot be excluded, although the possibility is remote.

Introducción: El objetivo del presente trabajo fue conocer el rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios en pacientes con trauma nasal. Material y Método: Revisión retrospectiva de fichas clínicas de 220 pacientes con trauma nasal atendidos en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador de Santiago. Ocho criterios clínicos fueron evaluados: epistaxis, equimosis, inflamación, herida nasal, obstrucción de vía aérea, laterorrinia, dorso nasal irregular, y lesión aguda del tabique nasal. El estándar de oro para el diagnóstico de fractura nasal fue el estudio radiológico. La sensibilidad, especificidad, y positivo/valor predictivo negativo (VPP/VPN) se calcularon para cada criterio clínico por separado (8), para todas las combinaciones posibles de 2 criterios clínicos (28) y 3 criterios clínicos (56). Resultados: Para cualquiera de los 8 criterios, el promedio de sensibilidad y valor predictivo negativo para la fractura nasal fue muy baja (< 35 por ciento). Sin embargo, la especificidad y valores predictivos positivos fueron relativamente altas (> 90 por ciento) y aumentó, respectivamente, cuando al menos un criterio estuvo presente (92 por ciento y 94 por ciento, respectivamente), cuando 2 criterios clínicos estaban presentes (98 por ciento y 96 por ciento, respectivamente), y cuando al menos 3 criterios clínicos estaban presentes (100 por ciento para ambos). Conclusiones: La presentación de los criterios clínicos puede ser un método valioso para el diagnóstico de fractura nasal, sin embargo, cuando estos criterios clínicos están ausentes, la posibilidad de la fractura nasal no se puede descartar, aunque la posibilidad es remota.

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador / Management of intractable bleeding facial trauma

Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.

Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.

[Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix]. / Tödliche Lungenarterienembolie nach endoskopischer Embolisation einer "Downhill-Varize" des Osophagus.

HISTORY AND CLINICAL FINDINGS: A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism. INVESTIGATIONS: He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix. TREATMENT AND COURSE: The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein. CONCLUSION: Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.

Resuscitation from cardiogenic shock by direct angioplasty and 23-hour balloon inflation using a coronary perfusion balloon.

Direct angioplasty is an accepted treatment for acute myocardial infarction and has resulted in stabilization and improvement in the clinical, electrocardiographic, and hemodynamic consequences of acute myocardial infarction. This case demonstrates the effectiveness of coronary perfusion as a method of resuscitation during cardiogenic shock and asystole in a patient with massive acute diaphragmatic and right ventricular infarction. Utilization of prolonged balloon inflation in this case obviated the need for emergency coronary bypass surgery and provided the patient with remarkable and almost complete recovery of left and right ventricular function.

Lipid management program: results of applying national guidelines in a private practice.

In our large single-specialty cardiology practice, we implemented a lipid management program based on the recommendations of the Expert Panel of the National Cholesterol Education Program and the Helsinki Heart Study. This program used allied health professionals and customized computer software to deliver efficient, comprehensive care to the 1214 patients enrolled in the program after 33 months. Data are reported for the 543 patients enrolled for more than 1 year. Cholesterol data were analyzed for all patients whose initial triglyceride values were less than 400 mg/dL. For this group of patients, the mean cholesterol level decreased from 242.7 to 217.4 mg/dL, triglycerides fell from 170.0 to 144.7 mg/dL, HDL cholesterol increased from 41.6 to 42.9 mg/dL, and LDL cholesterol fell from 167.2 to 145.7 mg/dL. Using guidelines modified from the National Cholesterol Education Program, a significant number of patients were able to achieve desirable LDL and HDL goals. Modified national guidelines can be used effectively in a private practice setting.

Where do the new U.S. immigrants live?

"Analyzing the location choices of the post-1964 U.S. immigrants results in three main findings: (1) these immigrants are more geographically concentrated than natives of the same age and ethnicity and reside in cities with large ethnic populations; (2) education plays a key role in location choice, reducing geographic concentration and the likelihood of being in cities with a high concentration of fellow countrymen and increasing the probability of changing locations after arrival in the United States; (3) internal migration within the United States occurs more frequently among immigrants than natives and facilitates the process of assimilation for the more educated individuals."

[Alpha interferon in the therapy of hairy cell leukemia. Results of 3 prospective multicenter studies in West Germany]. / Interferon alpha für die Therapie der HCL. Ergebnisse von drei Prospektiven multizentrischer Studien in der Bundesrepublik.

Within 19 months of recruitment 51 centers enrolled 84 patients in our prospective multicenter trial for low-dose IFN alpha-2c for HCL (1.2 x 10 IU/m x 28 days s.c.- or lower). Induction therapy of 84 days was followed by maintenance with 2 weekly doses. Patients who reached stage Jansen I or A were then randomized to 2 arms either to receive further IFN or to stop treatment. Reinduction was reinstituted whenever any patient lost Jansen stage A or I. Only 3 patients failed. But enrollment was discontinued when it became apparent that fatalities in splenectomized (SX) patients due to septicemia outnumbered deaths given in the literature. Low-dose IFN administered daily might compromise host defense. Our next study aimed at improving the safety of IFN for SX patients. Pulsatile IFN on 7 consecutive days within a 28-day period was given to all SX patients. A randomization of non-SX patients either to receive daily or pulsatile IFN should provide proof of the efficiency. The intermissions ought to be as suitable for in-vitro investigations as for observations concerning the capacity of IFN to produce 'induction of inducers'. Pulsatile treatment has so far been safe in 13 splenectomized patients. Central diagnostic procedures remained the same during both studies. It seems important to us to use an intermittent schedule for the injection of IFN in SX patients and to restrict splenectomy to selected patients.