Clinical status and endoscopy of the upper respiratory tract of dairy calves infected with Bovine viral diarrhea virus 2 and Bovine herpes virus 1 after vaccination and trace minerals injection.

The objective was to compare clinical protection [evaluated through health scoring, endoscopy score of the upper respiratory tract (URT-ES), leukocyte count, viremia, and virus shedding in nasal secretions] following Bovine viral diarrhea virus 2 (BVDV2) and Bovine herpes virus 1 (BHV1) challenge among calves submitted to modified-live virus (MLV) booster vaccination (either intranasal or subcutaneous) concurrent with injectable trace minerals (ITM) or saline. Forty-eight dairy calves received an MLV intranasal (IN) vaccine containing BHV1, BRSV, and BPI3V and subcutaneous (SC) ITM (Se, Cu, Zn & Mn; ITM, n = 24) or saline (SAL, n = 24). Ten weeks later, calves received a second dose of ITM, or saline, according to previous groups and were randomly assigned to receive the same IN vaccine [ITM-IN (n = 12), SAL-IN (n = 12)] or a SC MLV vaccine containing BHV1, BRSV, BPI3V, BVDV1 & 2 [ITM-SC (n = 12), SAL-SC (n = 12)]. Additionally, 12 calves did not receive vaccine or treatment and served as a control group (UNVAC, n = 12). Forty-nine days after booster, calves were challenged with BVDV2; and seven days later with BHV1. Health scores indicated disease in UNVAC on days 6, 10 and 12 compared to the vaccinated groups. Unvaccinated calves had the highest URT-ES after BHV1 challenge. Calves that received SC booster had lower URT-ES after BHV1 challenge than UNVAC calves. Calves in ITM-IN had significantly lower URT-ES after BHV1 infection than SAL-IN and UNVAC calves. In conclusion, IN or SC MLV vaccination was similarly effective in protecting calves from BVDV2 + BHV1 challenges (reducing clinical and endoscopy scores, preventing leukopenia, and viremia), compared to unvaccinated calves. Endoscopic evaluation of the URT allowed visualization of the inflammation and damage at multiple depths in the URT caused by a serial BVDV2 + BHV1 challenge. Calves that received SC vaccination had significantly lower URT-ES after BHV1 challenge than the UNVAC calves. Administration of ITM concurrent with IN vaccination was associated with reduced URT inflammation after BVDV2 + BHV1 challenge.

Epidemiology and pathogenesis of stroke in preterm infants: A systematic review.

BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 -2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 -36 weeks gestational ages and birth weights between 450 -3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.

Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS).

BACKGROUND: There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. METHODS: Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. RESULTS: Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7-7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6-5.1). CONCLUSIONS: Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.

Does a dedicated hip fracture unit improve clinical outcomes? A five-year case series.

INTRODUCTION: The aim of the study was to establish whether a dedicated hip fracture unit, geographically separate from the local major trauma centre, could improve clinical outcomes for patients sustaining proximal femoral fragility fractures. MATERIALS AND METHODS: This study was a retrospective case series, using data collected from Brighton and Sussex University Hospitals NHS Trust's submissions to the National Hip Fracture Database between 1 April 2011 and 16 September 2016. The outcomes measured were mortality, length of hospital stay, time from admission to surgical intervention and return to premorbid residence. Patients were compared before and after reconfiguration of services into a separate dedicated hip fracture unit geographically distinct from the major trauma centre. RESULTS: A total of 2117 patients (2178 injuries) were managed before the existence of the hip fracture unit, while 660 patients (673 injuries) were treated within the hip fracture unit. During the five-year study period, the 30-day mortality rate (pre-hip fracture unit 5.47% vs hip fracture unit 3.13%, P = 0.014), variance in the length of hospital stay (P < 0.001), mean time to surgical intervention (P = 0.044) and return to premorbid residence were significantly improved. An immediate 12-month comparison demonstrated significantly improved variance in length of hospital stay (P = 0.020) and return to premorbid residence (P = 0.015). DISCUSSION: The reconfiguration of services significantly reduced variance in length of stay, enabling accurate resource planning in future. Multiple incremental improvements in service provision, in addition to the hip fracture unit, may explain the lower mortality observed. CONCLUSION: While further research is required, replication of the hip fracture unit service model may potentially afford significant clinical and financial gains.

Development of a managed clinical network in oral medicine.

Oral medicine is concerned with the oral health care of patients with chronic, recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management. For historical reasons care for conditions falling within the scope of oral medicine practice has been inconsistent with limited planning of clinical services. Managed Clinical Networks (MCNs) bring advantages to all stakeholders with a positive impact on patient pathways and access to equitable and quality care across a network of providers working in a coordinated way to make best use of NHS resources. MCNs provide a framework to address the limitations of legacy arrangements and are very relevant to dentistry. Here we describe oral medicine MCN development in Yorkshire and the Humber within the framework of the Five year forward view NHS policy. A step-wise approach is being taken across the region to introduce an MCN model that reflects cooperative working between oral medicine, oral surgery, oral & maxillofacial surgery and other stakeholders. Preliminary data are already informing how a regional oral medicine MCN can be further developed with the potential for translation of the lessons learned to other regions.

Survival analysis and functional outcome of the Oxford unicompartmental knee replacement up to 11 years follow up at a District General Hospital.

BACKGROUND: There have been several large originator studies reporting excellent results with this prosthesis but far fewer large independent studies. We present, to our knowledge, the largest independent series documenting excellent survivorship rates and good functional outcomes at a mean follow up of 5.5 years post implantation of the Oxford unicompartmental knee replacement. METHODS: Our prospective study looks at the survivorship and the functional outcome of 364 Oxford UKRs performed in a district general hospital at a mean follow up of 5.5 years (range 5-11 years). Post operatively knees were assessed in a research clinic using the Oxford knees score (as well as the American Knee Society Score and the Hospital for Special Surgery Score). Maximal flexion was also measured. RESULTS: There were 26 revisions of 364 knees giving a survivorship, with revision as the end point, of 93% at a mean of 5.5 years post op (range 5-11 years). We achieved an Oxford score of 37.5, a mean AKSS of 161 (divided as American knee functional score 75.75/American knee objective score 85.4 (excellent)). The mean HSS score was 84.5. We achieved 'Excellent' Oxford knee scores in 137 knees (48%), 'Good' in 75 (26%), 'Moderate' in 51 (17%) and 'Poor' in only 27 (9%) of knees. Mean improvement in functional scores were: Oxford score (14.4), AKSS (71) and HSS (26.3). Mean maximal flexion was 123° range (110-140). CONCLUSIONS: We have confirmed that good medium to long-term function and survival can be obtained following Oxford medial knee replacement for treating anteromedial osteoarthritis, in our large independent series.

Vancomycin iontophoresis of allograft bone.

OBJECTIVES: The most concerning infection of allografts and operative procedures is methicillin resistant Staphylococcus aureus (MRSA) and no current iontophoresed antibiotics effectively combat this microbe. It was initially hypothesised that iontophoresis of vancomycin through bone would not be effective due to its large molecular size and lack of charge. The aim of this study was to determine whether this was a viable procedure and to find the optimum conditions for its use. METHODS: An iontophoresis cell was set up with varying concentrations of Vancomycin within the medulla of a section of sheep tibia, sealed from an external saline solution. The cell was run for varying times, Vancomycin concentrations and voltages, to gain information on optimisation of conditions for impregnating the graft. Each graft was then sectioned and dust ground from the exposed surface. The dust was serially washed to extract the Vancomycin and concentrations measured and plotted for all variables tested. RESULTS: Vancomycin was successfully delivered and impregnated to the graft using the iontophoresis technique. The first order fit to the whole data set gave a significant result (p = 0.0233), with a significant concentration (p = 0.02774) component. The time component was the next most significant (p = 0.0597), but did not exceed the 95% confidence level. CONCLUSIONS: Iontophoresis is an effective method for delivering Vancomycin to allograft bone. The concentrations of the vancomycin solution affected the bone concentration, but results were highly variable. Further study should be done on the effectiveness of delivering different antibiotics using this method. Cite this article: Bone Joint Res 2014;3:101-7.

Evaluation of methods to improve the diagnosis of systemic inflammation in alpacas.

BACKGROUND: The stoic nature of alpacas and limitations of current diagnostic tests make early recognition of inflammatory diseases in this species challenging. OBJECTIVES: In a model of mild systemic inflammation, this study evaluated the utility of different clinical and clinicopathologic variables as accurate predictors of inflammation in alpacas. ANIMALS: Twelve clinically healthy alpacas were randomly assigned to equal-sized treatment (TG) and control (CG) groups. After collection of initial blood samples (0 hour), lipopolysaccharide (LPS; 20 µg/kg/24 h) or saline was administered by SC osmotic mini-pumps (OMP) for 96 hours. Additional blood samples were collected at 12, 18, 24, 36, 48, 72, 96, 120, 144, and 240 hours and differential leukocyte counts and concentrations of globulin, albumin, iron, haptoglobin, and serum amyloid A were measured. RESULTS: Mild swelling was observed at OMP implantation sites in both groups. Other clinical signs of systemic inflammation were not observed. Total leukocytes, neutrophils, albumin, and globulin concentrations were not significantly different between groups. Compared with CG-alpacas, TG-alpacas had fewer lymphocytes (P = .0322), more band neutrophils (P = .0087), and higher neutrophil/lymphocyte ratios (P = .0295) during the first 96 hours of the study. During LPS administration, serum iron concentrations were significantly decreased in TG-alpacas (P < .0001). Haptoglobin concentrations of TG-animals exceeded those of CG-animals after removal of OMP (P = .0056). Serum amyloid A was not detectable in alpacas in this study. CONCLUSION AND CLINICAL IMPORTANCE: These results indicated that neutrophil/lymphocyte ratios and serum iron concentrations are early indicators of inflammation in alpacas. Additional research is needed to evaluate the acute phase protein responses of alpacas.

Pharmacokinetics of tramadol and its major metabolites in alpacas following intravenous and oral administration.

Tramadol, a centrally acting opioid analgesic with monamine reuptake inhibition, was administered to six alpacas (43-71 kg) randomly assigned to two treatment groups, using an open, single-dose, two-period, randomized cross-over design at a dose of 3.4-4.4 mg/kg intravenously (i.v.) and, after a washout period, 11 mg/kg orally. Serum samples were collected and stored at -80°C until assayed by HPLC. Pharmacokinetic parameters were calculated. The mean half-lives (t(1/2)) i.v. were 0.85±0.463 and 0.520±0.256 h orally. The Cp(0) i.v. was 2467±540 ng/mL, and the C(max) was 1202±1319 ng/mL orally. T(max) occurred at 0.111±0.068 h orally. The area under the curve (AUC(0-∞)) i.v. was 895±189 and 373±217 ng*h/mL orally. The volume of distribution (V(d[area])) i.v. was 5.50±2.66 L/kg. Total body clearance (Cl) i.v. was 4.62±1.09 h; Cl/F for oral administration was 39.5±23 L/h/kg. The i.v. mean residence time (MRT) was 0.720±0.264. Oral adsorption (F) was low (5.9-19.1%) at almost three times the i.v. dosage with a large inter-subject variation. This may be due to binding with the rumen contents or enzymatic destruction. Assuming linear nonsaturable pharmacokinetics and absorption processes, a dosage of 6.7 times orally would be needed to achieve the same i.v. serum concentration of tramadol. The t(1/2) of all three metabolites was longer than the parent drug; however, O-DMT, N-DMT, and Di-DMT metabolites were not detectable in all of the alpacas. Because of the poor bioavailability and adverse effects noted in this study, the oral administration of tramadol in alpacas cannot be recommended without further research.

Segmented interlocking nail: an in vivo evaluation of a novel humeral osteotomy fixation device in a caprine model.

OBJECTIVES: To describe a novel humeral fixation device, the insertion technique, healing of humeral osteotomies, and clinical outcomes in a caprine model over a six month period. METHODS: Fourteen mature female Boer/Nubian cross goats with a mean body weight of 50.7 kg were implanted with a proprietary segmented interlocking nail (SILN) in both humeri. Each goat had one humerus randomly selected for mid-diaphyseal osteotomy. RESULTS: Immediately after surgery all but one goat was able to stand, although none of the goats were weight bearing on the osteotomy limb. During the six month study, clinical lameness was always associated with the osteotomy limb. One month after surgery, lameness for twelve of the goats was grade 2/5 or better. At three months, 11 of the 14 did not exhibit any signs of lameness. On radiographic images, notable malalignment of the osteotomy was observed, although all osteotomies went to bone union. CLINICAL SIGNIFICANCE: The results of this study suggest that despite misalignment, the SILN maintained adequate osteotomy fixation to achieve bone union in the research model studied, with reduced morbidity and early return to function with bilateral implantation. The SILN used in this study allowed intramedullary fixation of humeral diaphyseal osteotomies with a limited and safe surgical approach.

Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre- and post-operatively.

BACKGROUND: Treatment for metatarsal head avascular necrosis is largely conservative. For severe or refractory cases there are various surgical options. METHODS: We have performed a 'modified Weil's osteotomy' of the distal metatarsal in order to manage this problem. We present the largest case series, to our knowledge, with 17 such cases. The patients were scored pre- and post-operatively using the AOFAS Forefoot scoring system. RESULTS: We found that this procedure provided a mean score improvement of 36 points, with a complication rate of 5.9%. CONCLUSION: We would advocate this modified osteotomy as an effective, reliable and safe treatment option.

Intrauterine inoculation of seronegative heifers with bovine viral diarrhea virus concurrent with transfer of in vivo-derived bovine embryos.

Bovine viral diarrhea virus (BVDV) has been shown to be associated with single transferable in vivo-derived bovine embryos despite washing and trypsin treatment. Hence, the primary objective was to evaluate the potential of BVDV to be transmitted via the intrauterine route at the time of embryo transfer. In vivo-derived bovine embryos (n=10) were nonsurgically collected from a single Bos tarus donor cow negative for BVDV. After collection and washing, embryos were placed into transfer media containing BVDV (SD-1; Type 1a). Each of the 10 embryos was individually loaded into an 0.25-mL straw, which was then nonsurgically transferred into the uterus of 1 of the 10 seronegative recipients on Day 0. The total quantity of virus transferred into the uterus of each of the 10 Bos tarus recipients was 878 cell culture infective doses to the 50% end point (CCID(50))/mL. Additionally, control heifers received 1.5 x 10(6) CCID(50) BVDV/.5 mL without an embryo (positive) or heat-inactivated BVDV (negative). The positive control heifer and all 10 recipients of virus-exposed embryos exhibited viremia by Day 6 and seroconverted by Day 15 after transfer. The negative control heifer did not exhibit a viremia or seroconvert. At 30 d after embryo transfer, 6 of 10 heifers in the treatment group were pregnant; however, 30 d later, only one was still pregnant. This fetus was nonviable and was positive for BVDV. In conclusion, the quantity of BVDV associated with bovine embryos after in vitro exposure can result in viremia and seroconversion of seronegative recipients after transfer into the uterus during diestrus.

Bovine viral diarrhea virus (BVDV) associated with single in vivo-derived and in vitro-produced preimplantation bovine embryos following artificial exposure.

The objective was to determine the average amount of bovine viral diarrhea virus (BVDV) associated with single in vivo-derived and in vitro-produced bovine embryos following recommended processing procedures for embryos. In vivo-derived and in vitro-produced bovine embryos at 7d post-fertilization were exposed (for 2h) to 2 x 10(5-7) cell culture infective dose (CCID(50))/mL of SD-1 (a noncytopathic, Type 1a strain of BVDV), and then washed according to International Embryo Transfer Society (IETS) guidelines prior to testing. Of the 87 in vivo-derived embryos tested, 27% were positive for virus by quantitative polymerase chain reaction (qPCR). The range in amount of virus associated with 99% of the contaminated embryos was

Telemedicine in oral surgery and maxillofacial trauma: a descriptive account.

Trauma patients presenting to emergency rooms (ER) in rural or remote locations have significantly less access to oral and maxillo-facial surgery (OMFS) specialists. In this case, OMFS services at four hospitals were rearranged to concentrate expertise, inpatients, and 24/7 cover on a single site. A Federation (managed clinical network) model was used that improved the management of inpatients and made better use of a small team of junior medical staff. New government standards limiting the on-call burden for U.K. junior doctors (The New deal) were met under this service model. Despite the success of the Federation, the loss of on-site OMFS support to the three peripheral ER departments was problematic. Sites that do not have OMFS support used a simple telephone referral to transfer patients to the OMFS center. The degree to which referrals were considered inappropriate led to operational and patient satisfaction difficulties. The introduction of an OMFS telemedicine system linking the three peripheral/"spoke" ER departments to the OMFS center/"hub" succeeded in increasing the appropriateness of patient transfers, developed the skills of the ER medical staff, and was believed to have led to an overall improvement in the early-stage management of this group of patients. The telemedicine system augmented the overall success of the Federation model. New uses for telemedicine within the OMFS service soon developed.

Accuracy of diagnosis of fractures by maxillofacial and accident and emergency doctors using plain radiography compared with a telemedicine system: a prospective study.

Ten facial radiographs with fractures and 10 without fractures were viewed by eight oral and maxillofacial surgery (OMFS) and eight accident and emergency (A&E) doctors who were each asked questions about the presence and site of any fractures as well as the quality of the images and diagnostic confidence. Each radiograph was then transmitted over a teleradiology link and viewed by the same OMFS doctors who answered the same questions. The position of the fracture was more accurately assessed using plain radiography. Diagnosis by OMFS doctors using telemedicine was broadly comparable with fracture diagnosis by A&E doctors using plain radiography. Poor quality radiographs and frontozygomatic and infraorbital rim fractures were poorly diagnosed by telemedicine. This telemedicine system was a useful tool to aid diagnosis of most facial fractures. The need for appropriate clinical information is vital. Diagnosis of frontozygomatic and infraorbital rim disruption using telemedicine is less reliable than plain radiography.

Impact of dedicated trauma lists on a maxillofacial surgical service.

In 1995, the maxillofacial surgical inpatient services in East Lancashire were centralized in Blackburn Royal Infirmary, and twice-weekly operating lists dedicated to maxillofacial trauma were established. We examined the non-elective workload for three-month periods before and after trauma lists became available to find out the proportion of non-elective operations done out of normal working hours. Although there was an increase in the total number of non-elective patients after centralization, day-time trauma lists allowed a reduction in the proportion of operations performed out of normal working hours. Fewer trauma cases were added to elective lists. Trauma lists allow the unit to comply with the recommendations of both NCEPOD and the Calman report, in that they maximize training opportunities for all staff and facilitate both audit and research.

Environmental health education for health professionals and communities. Using a train the trainer approach.

1. AAOHN is implementing a 3 year environmental health education grant to enhance the environmental health knowledge of nursing faculty and nurses practicing in community health settings, as well as the citizens in their communities. 2. The process for implementation of the cooperative agreement with ASTDR involves collaboration with ATSDR, EPA, and other agencies who have responsibilities for informing, educating, and encouraging participation of community members in the agencies' work at hazardous waste sites. 3. Through a train the trainer approach, nurses serving populations near selected hazardous waste sites will receive education and technical support. In turn, they will act as resources for community education and health promotion. 4. AAOHN will evaluate the impact of the education on the communities and on the practice of the nurses who participate in the education, disseminating the results of the project at a future American Occupational Health conference and through other means, such as the Internet.

Day surgery: handling patients' complaints.

The number of surgical procedures being performed as day cases is increasing. In an attempt to ensure that patients are given the chance to present their views of this developing service, one unit has set up an innovative project to allow patients to voice any dissatisfactions directly to the staff. The project has led to several changes being made and increased satisfaction for both staff and patients.