Is vertebral body stenting in combination with CaP cement superior to kyphoplasty?

PURPOSE: In the evolution of the minimally invasive treatment of vertebral compression fractures, vertebral body stenting (VBS) was developed to reduce intraoperative and secondary loss of vertebral height. Particularly in combination with the usage of biodegradable cement, the influence of VBS on the rate of intraoperative complications and long-term outcome is unclear. The purpose of this study was to investigate the differences between balloon kyphoplasty (BKP) and VBS regarding their long-term clinical and radiological outcome in combination with calcium phosphate (CaP) application instead of polymethyl methacrylate (PMMA). METHODS: This retrospective study included 49 patients with fresh mono-segmental thoracolumbar fractures without neurological signs treated with VBS or BKP and CaP cement (Calcibone). The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry disability score (ODI), and radiologically assessed. RESULTS: In the course of the radiological follow-up, the VBS group showed statistically significant less vertebral height loss than the BKP group. However, with respect to VAS and ODI scores there were no statistically significant differences between the VBS and BKP group in the clinical follow-up. The rate of cement leakage was comparable in both groups. CONCLUSIONS: Both techniques facilitated good clinical results in combination with absorbable cement augmentation. In particular, the VBS enabled us to benefit from the advantages of the resorbable isothermic CaP cement with an improved radiological outcome in the long term compared to BKP. However, there was a mentionable loss of reduction in the follow-up in both groups compared to previously published data with PMMA cement. These slides can be retrieved under Electronic Supplementary Material.

Evaluation of the optimal standardized ileal digestible tryptophan:lysine ratio in lactating sow diets.

Three hundred and fifteen primiparous and multiparous sows were evaluated in a study to determine the effect of standardized ileal digestible (SID) Trp:Lys ratio in lactating sow diets. Camborough sows (PIC USA, Hendersonville, TN) ranging from first parity to eighth parity were blocked by parity and randomly allotted to 1 of 4 experimental diets containing different levels of added L-Trp (0.006, 0.026, 0.045, and 0.064%, respectively) while soybean meal, 30% corn dried distiller's grain with solubles (DDGS), and L-Lys levels were held constant. The SID Lys level for the rations was 0.95% so that the SID Trp:Lys ratios were formulated to be 14, 16, 18, and 20%, respectively. All diets were formulated to have 3.2 Mcal ME/kg and to contain vitamins and minerals that exceeded NRC (1998) recommendations. Sows were fed twice a day with a Howema computerized feed system and were allowed a maximum intake (5.9 kg/d). Average daily feed intake had a tendency to be quadratically improved when the SID ratio was increased (5.11, 5.28, 5.24, 5.21 kg/d, P = 0.09). In addition, sow wean to estrus (6.71, 5.53, 5.58, 6.33, P < 0.02) was quadratically improved as SID Trp:Lys ratio increased. Percent of sows bred by 10 d (84.39, 90.82, 90.28, 90.61) was not linearly (P = 0.25) or quadratically (P = 0.40) improved. There was no difference in litter gain (2.44, 2.52, 2.60, 2.57 kg/d, P = 0.16). Based on a broken-line quadratic model, when sows are fed 30% DDGS, the SID Trp:Lys ratio of 17.6 is required for optimal sow average daily feed intake and 17.2 for wean to estrus interval.

Effect of timing of relocation of replacement gilts from group pens to individual stalls before breeding on fertility and well-being.

Variation in gilt fertility is associated with increased replacement and reduced longevity. Stress before breeding is hypothesized to be involved in reduced fertility. This study tested the timing of gilt relocation from pens to individual stalls before breeding on fertility and well-being. The experiment was performed in replicates on a commercial research farm. After detection of first estrus, gilts ( = 563) were assigned to treatment for relocation into stalls 3 wk (REL3wk), 2 wk (REL2wk), or 1 wk (REL1wk) before breeding at second estrus. Subsets of gilts from each treatment ( = 60) were selected for assessment of follicles at second estrus. Data included interestrus interval, number of services, conception, farrowing, total born, and wean to service interval. Piglet birth weight was obtained on subsets of litters ( = 42/treatment). Measures of well-being included BW, backfat, BCS, lesions, and lameness from wk 1 after first estrus until wk 16. Gilt BW at wk 5 (158.4 kg) was not affected ( > 0.10) by treatment. Measures of BCS, lameness, and lesions at breeding and throughout gestation did not differ ( > 0.10). Treatment did not affect ( > 0.10) gilts expressing a normal interestrus interval of 18 to 24 d (83.4%) but did influence ( < 0.05) the proportion expressing shorter ( < 0.001) and longer ( < 0.001) intervals. Gilts in REL3wk had a shorter ( < 0.001) interestrus interval (20.7 d) than those in REL2wk and REL1wk (22.6 d). Gilts with shorter intervals ( = 24) had fewer total born while gilts expressing longer cycles ( = 65) had reduced farrowing rates. The number of services (1.9) and number of follicles (19.7) at breeding were not affected ( > 0.10) by relocation. There was no effect of treatment on farrowing rate (85.2%), born alive (12.6), or any litter birth weight measures ( > 0.10). The percentage of sows bred within 7 d after weaning (94.4%) was also not affected by treatment ( > 0.10). These results suggest that the timing of relocation before breeding had no effect on well-being or on the majority of gilts with normal estrous cycles and their subsequent fertility. However, a smaller proportion of the gilts exhibited shorter and longer interestrus intervals in response to relocation 1 or 3 wk before breeding. In cases where gilt fertility may be less than optimal, producers that relocate gilts from pens to stalls before breeding should evaluate interestrus interval as a response criterion.

The feeding of dried distillers' grains with solubles to lactating sows.

Three experiments were conducted to evaluate the feeding of dried distillers' grains with solubles (DDGS) in sow lactation diets. In Exp. 1, 168 multiparous sows (PIC, Camborough 22) were fed a 10% DDGS diet throughout gestation. Sows were randomly allotted to 1 of 4 corn-soybean meal lactation diets formulated to contain different levels of DDGS (0, 10, 20, and 30%, respectively). All diets were formulated to be isocaloric (3.46 Mcal ME/kg) and all other nutrients exceeded NRC (1998) nutrient recommendations. Sow ADFI was not different ( > 0.10) as DDGS level increased. Increasing DDGS resulted in a linear ( < 0.03) increase in sow weight gain (7.5, 11.3, 20.3, and 17.2 kg, respectively) and a reduction in wean-to-first-service interval (7.1, 5.2, 5.0, and 4.9 d, respectively). Increasing DDGS did not affect subsequent total born per litter (13.7, 12.8, 13.3, and 12.3, respectively; > 0.10). In Exp. 2 and 3, lactation diets consisted of corn and 20, 30, 40, or 50% DDGS. Diets were formulated at 3.25 Mcal ME/kg, 1.05% standardized ileal digestible lysine, and all other nutrients to exceed NRC (1998) nutrient recommendations. In both experiments, sows (PIC, Camborough) were fed 40% DDGS in gestation and allocated to a randomized complete block based on the parity of the sow at the time of entry into the farrowing house. In Exp. 2, 256 gilts and multiparous sows were fed the randomly assigned diets. As DDGS inclusion increased, sow feed intake (6.2, 6.2, 6.0, and 5.9 kg/d, respectively) and sow weight gain (10.5, 10.3, 8.2, and 6.2 kg, respectively) tended to linearly decrease ( < 0.06). Sow wean to estrus differed between 20 and 30% DDGS inclusion (4.9 vs. 6.9 d; < 0.01). Litter gain was not different (2.55, 2.53, 2.51, and 2.59 kg/d, respectively; > 0.10) as DDGS inclusion increased. In Exp. 3, 98 multiparous sows were randomly allotted to 1 of the 4 experimental diets during the summer months. Sow feed intake, sow weight gain, and litter gain were not different ( > 0.10) between treatments. The data suggest that feeding high levels of DDGS of 40 to 50% may reduce sow feed intake and litter performance. These results demonstrate that feeding up to 30% DDGS in lactation diets can be done without adversely influencing sow or litter performance.

Influence of gonadotrophin-induced first oestrus on gilt fertility.

The aim of this study was to determine the association between the oestrous response of pre-pubertal gilts to gonadotrophin injection or boar exposure and their subsequent farrowing rate and litter size. At 154 days of age, randomly selected pre-pubertal gilts received an intramuscular injection of 400 IU equine chorionic gonadotrophin plus 200 IU human chorionic gonadotrophin (PG600(®) ; Merck Animal Health; n = 181). From the remaining pool of animals not treated with hormones, the first gilts showing signs of oestrus were selected to act as controls (n = 201). Boar exposure began at 155 days of age for both groups, and gilts were bred at a weight of approximately 130 kg. Comparisons were made between PG600(®) -treated gilts exhibiting oestrus or not within 7 days post-injection (early and late responders, respectively) and control gilts exhibiting oestrus or not within 30 days after beginning of boar exposure (select and non-select control gilts, respectively). By 162 days, oestrus was detected in 67.5% of PG600(®) -treated gilts compared with 5.7% of control gilts (p < 0.0001). The proportion of animals observed in oestrus at least three times before breeding was greater for select control gilts compared with early and late responder PG600(®) -treated gilts (p ≤ 0.001). There were no significant differences in farrowing rate and litter size between the four treatment groups. These data indicate that PG600(®) is an effective tool to induce an earlier oestrus in gilts, that subsequent farrowing rate and born alive litter size compare favourably to that of select gilts and that gilts failing to respond promptly to hormonal stimulation do not exhibit compromised fertility.

Influence of lactation length and gonadotrophins administered at weaning on fertility of primiparous sows.

The aim of this study was to determine the effect of lactation length and treatment with gonadotrophins at weaning on reproductive performance of primiparous sows. After 3 wk of lactation, primiparous sows were either weaned (W3; n=273) or received a 7-d-old foster litter for a further 14 d of suckling (W5; n=199). At final weaning (3 wk or 5 wk lactation) sows were randomly assigned to receive an injection of 400 IU equine chorionic gonadotrophin plus 200 IU human chorionic gonadotrophin (PG600(®); W3 + P; n=108 and W5 + P; n=96) or no injection (W3; n=165 and W5; n=103). Sows were inseminated at first observed estrus after final weaning and 24h later. The proportion of sows showing estrus by 6 d post-weaning was greater (P<0.01) for W3+P (86%) compared to W3 (64%), however, there was not a difference (P=0.13) for W5 + P (79.4%) compared to W5 (69.1%). There was no effect of either lactation length or gonadotrophin treatment on farrowing rates or on the proportion of sows culled before breeding. Total born litter size was smaller (P=0.05) for W3 + P (11.7 ± 0.4) compared to W3 (12.6 ± 0.3). However, sows that lactated for 35 d had larger litters than sows that lactated for 21 d regardless of gonadotrophin treatment (14 ± 0.5 and 14.5 ± 0.4 for W5+P and W5, respectively; P<0.001). These data indicate that for primiparous sows, a longer lactation improves total born litter size at their next farrowing. Gonadotrophin treatment is useful in shortening the weaning to estrus interval but subsequent total born litter size may be negatively affected.

Effect of day of mixing gestating sows on measures of reproductive performance and animal welfare.

Effects of day of mixing sows after breeding were measured for reproduction and welfare on a commercial research farm. Sows (n = 1,436) were weaned into stalls for breeding, and groups of sows were assigned to 1) no mixing and housed in individual stalls (STL), 2) mixed on d 3 to 7 after breeding (D3), 3) mixed on d 13 to 17 after breeding (D14), or 4) mixed 35 d after breeding (D35). Mixed sows were moved into pens (n = 58 sows/pen) with an electronic sow feeding station and maintained as a static group. In the first 12 d after mixing or movement into STL (period 1), sows were assessed for lameness and lesions every 3 d and then every 2 wk until farrowing (period 2). Cortisol and fights were measured in period 1. Conception rates were reduced (P < 0.005) in D3 (87.1%) and D14 (89.2%) compared to D35 (92.2%) and STL (96.2%). Farrowing rates were lower (P < 0.0001) in D3 (82.8%) compared to D35 (90.5%) and STL (96.2%), but litter size was not (P ≥ 0.20) affected by mixing. The proportion of sows bred within 10 d of weaning was reduced (P < 0.05) for D14 compared to STL, but D3 and D35 did not differ among treatments. Number of fights 24 h after mixing was less (P < 0.0001) for D14 compared to D3 and D35 groups, and serum cortisol was greater (P < 0.05) for D35 compared to STL and D3. From period 1 to 2, lameness increased in D3 and decreased in D35 but did not change for D14 and STL (treatment × period, P < 0.05), whereas leg inflammation did not differ (P > 0.10) among treatments. Head and body lesion scores declined from period 1 to 2 in all mix groups, whereas vulva lesions increased in the D3 and D35 but did not change in D14 and STL (treatment × period, P < 0.0001). These results suggest STL can improve most measures of welfare compared to mixing in groups. However, when mixing sows, assessments for reproductive performance and welfare may change from gestation to farrowing. The poorest reproductive performance and welfare was observed when sows were mixed 3 to 7 d after breeding. There were few differences between the D14 and D35 treatments in reproduction or welfare, but D14--not D35--differed from STL in weaned sows rebred. Overall, results of this trial suggest that, even though any of the mixing days can result in acceptable measures of reproduction, there are clear effects of day of mixing on fertility and welfare, and special attention should be focused on the long-term reproductive and welfare consequences.

[Short version of the updated S3 (level 3) guidelines for diagnosis and treatment of gallstones of the German Society for Digestive and Metabolic Diseases and the German Society for the Surgery of the Alimentary Tract]. / Kurzfassung der aktualisierten S3-Leitlinie der DGVS und DGVC zur Diagnostik und Behandlung von Gallensteinen.

This short version of the guidelines summarizes the evidence-based key recommendations for the diagnosis and treatment of gallstones. The guidelines were developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, and patient support groups, under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. It used structural level 3 consensus-based methodology and includes statements on clinical practice, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone disease.

Endosonographic elastography in the diagnosis of mediastinal lymph nodes.

BACKGROUND AND STUDY AIMS: Ultrasonographic elastography is a new technique for describing the mechanical properties of tissue during real-time ultrasonography. The aim of this study was to test the feasibility of this method in endosonography (EUS) of the dorsal mediastinum, and to compare the elastographic patterns of lymph nodes with results from EUS-guided fine-needle aspiration biopsy (FNAB). PATIENTS AND METHODS: 50 consecutive patients undergoing EUS-guided FNAB of at least one paraesophageal lymph node were included. Each of these targeted lymph nodes was examined also elastographically. The elastographic patterns were described and compared with the histologic results by a first examiner. The elastographic classification was subsequently further tested by two blinded reviewers. RESULTS: In total, 66 lymph nodes were examined; 37 lymph nodes revealed benign and 29 malignant tissue at the histologic evaluation. Good elastographic records were obtained for all lymph nodes. Of the 37 benign lymph nodes, 31 showed a homogeneous pattern of intermediate elasticity, whereas a dominance of hard tissue with variable patterns was found in 23 of 29 malignant lymph nodes. Applying these criteria, the accuracy range among the three examiners was between 81.8 % and 87.9 % for benign lymph nodes and between 84.6 % and 86.4 % for malignant ones. The interobserver agreement was excellent (kappa = 0.84). CONCLUSION: EUS elastography of mediastinal lymph nodes can be performed reliably. The results are good for a noninvasive technique, but they remain inferior to the success rate of EUS-guided FNAB. The method might occasionally be useful for targeting the most suitable lymph nodes for FNAB.

[S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract]. / S3-Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen.

This guideline provides evidence-based key recommendations for diagnosis and therapy of gallstones and upgrades version 2000. It was developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, external comparative quality assurance and patient support groups under the auspices of the German Society for Digestive and Metabolic Diseases and the German Society for Surgery of the Alimentary Tract. The guideline used structural S3 consensus-based methodology and includes statements on clinical practice, prevention, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone diseases.

Biofilm Formation by Neisseria gonorrhoeae.

Studies were performed in continuous-flow chambers to determine whether Neisseria gonorrhoeae could form a biofilm. Under these growth conditions, N. gonorrhoeae formed a biofilm with or without the addition of 10 microM sodium nitrite to the perfusion medium. Microscopic analysis of a 4-day growth of N. gonorrhoeae strain 1291 revealed evidence of a biofilm with organisms embedded in matrix, which was interlaced with water channels. N. gonorrhoeae strains MS11 and FA1090 were found to also form biofilms under the same growth conditions. Cryofield emission scanning electron microscopy and transmission electron microscopy confirmed that organisms were embedded in a continuous matrix with membranous structures spanning the biofilm. These studies also demonstrated that N. gonorrhoeae has the capability to form a matrix in the presence and absence of CMP-N-acetylneuraminic acid (CMP-Neu5Ac). Studies with monoclonal antibody 6B4 and the lectins soy bean agglutinin and Maackia amurensis indicated that the predominate terminal sugars in the biofilm matrix formed a lactosamine when the biofilm was grown in the absence of CMP-Neu5Ac and sialyllactosamine in the presence of CMP-Neu5Ac. N. gonorrhoeae strain 1291 formed a biofilm on primary urethral epithelial cells and cervical cells in culture without loss of viability of the epithelial cell layer. Our studies demonstrated that N. gonorrhoeae can form biofilms in continuous-flow chambers and on living cells. Studies of these biofilms may have implications for understanding asymptomatic gonococcal infection.

Nontypeable Haemophilus influenzae strain 2019 produces a biofilm containing N-acetylneuraminic acid that may mimic sialylated O-linked glycans.

Previous studies suggested that nontypeable Haemophilus influenzae (NTHI) can form biofilms during human and chinchilla middle ear infections. Microscopic analysis of a 5-day biofilm of NTHI strain 2019 grown in a continuous-flow chamber revealed that the biofilm had a diffuse matrix interlaced with multiple water channels. Our studies showed that biofilm production was significantly decreased when a chemically defined medium lacking N-acetylneuraminic acid (sialic acid) was used. Based on these observations, we examined mutations in seven NTHI strain 2019 genes involved in carbohydrate and lipooligosaccharide biosynthesis. NTHI strain 2019 with mutations in the genes encoding CMP-N-acetylneuraminic acid synthetase (siaB), one of the three NTHI sialyltransferases (siaA), and the undecaprenyl-phosphate alpha-N-acetylglucosaminyltransferase homolog (wecA) produced significantly smaller amounts of biofilm. NTHI strain 2019 with mutations in genes encoding phosphoglucomutase (pgm), UDP-galactose-4-epimerase, and two other NTHI sialyltransferases (lic3A and lsgB) produced biofilms that were equivalent to or larger than the biofilms produced by the parent strain. The biofilm formed by the NTHI strain 2019pgm mutant was studied with Maackia amurensis fluorescein isothiocyanate (FITC)-conjugated and Sambucus nigra tetramethyl rhodamine isocyanate (TRITC)-conjugated lectins. S. nigra TRITC-conjugated lectin bound to this biofilm, while M. amurensis FITC-conjugated lectin did not. S. nigra TRITC-conjugated lectin binding was inhibited by incubation with alpha2,6-neuraminyllactose and by pretreatment of the biofilm with Vibrio cholerae neuraminidase. Matrix-assisted laser desorption ionization-time of flight mass spectometry analysis of lipooligosaccharides isolated from a biofilm, the planktonic phase, and plate-grown organisms showed that the levels of most sialylated glycoforms were two- to fourfold greater when the lipooligosaccharide was derived from planktonic or biofilm organisms. Our data indicate that NTHI strain 2019 produces a biofilm containing alpha2,6-linked sialic acid and that the sialic acid content of the lipooligosaccharides increases concomitant with the transition of organisms to a biofilm form.

Lambda spectra in 11.6A GeV/c Au-Au collisions.

E896 has measured Lambda production in 11.6A GeV/c Au-Au collisions over virtually the whole rapidity phase space. The midrapidity p(t) distributions have been measured for the first time at this energy and appear to indicate that the Lambda hyperons have different freeze-out conditions than protons. A comparison with the relativistic quantum molecular dynamics model shows that while there is good shape agreement at high rapidity the model predicts significantly different slopes of the m(t) spectra at midrapidity. The data, where overlap occurs, are consistent with previously reported measurements.

Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients.

BACKGROUND AND STUDY AIMS: The main complication associated with biliary stenting is stent occlusion. This study tested the hypothesis that bilioduodenal reflux may play a crucial role in stent clogging. PATIENTS AND METHODS: Plastic stents in 100 consecutive patients with various biliary disorders were investigated macroscopically and cytologically. RESULTS: In 37 patients with elective stent extraction, the only risk factor for stent occlusion was the duration of stenting. Plant material was found as a consequence of duodenobiliary reflux in 38 of the 89 stents with any stent content. In patients who had two stents, the stent content was identical in eight of 14 cases. CONCLUSIONS: In addition to other mechanisms of biliary stent occlusion, duodenobiliary reflux appears to play an important role. A stent design capable of at least partly preventing this type of reflux might be of clinical benefit.

Language decline across the life span: findings from the Nun Study.

The present study examines language samples from the Nun Study. Measures of grammatical complexity and idea density were obtained from autobiographies written over a 60-year span. Participants who had met criteria for dementia were contrasted with those who did not. Grammatical complexity initially averaged 4.78 (on a 0-to-7-point scale) for participants who did not meet criteria for dementia and declined .04 units per year; grammatical complexity for participants who met criteria for dementia initially averaged 3.86 and declined .03 units per year. Idea density averaged 5.35 propositions per 10 words initially for participants who did not meet criteria for dementia and declined an average of .03 units per year, whereas idea density averaged 4.34 propositions per 10 words initially for participants who met criteria for dementia and declined .02 units per year. Adult experiences, in general, did not moderate these declines.

The effect of dietary soy genistein on pig growth and viral replication during a viral challenge.

Twelve replications of four littermate pigs from a herd naive for porcine reproductive and respiratory syndrome (PRRS) were weaned (10 +/- 2 d of age) and penned individually in isolation rooms. Pigs were randomly allotted within litter to one of four dietary soy genistein concentrations (0, 200, 400, and 800 ppm) to quantify the effect of soy genistein on pig growth and virus replication during a viral challenge. Genistein was provided as the soy glycoside, genistin. At 29 +/- 2 d of age (4.9 +/- 1.4 kg BW), pigs were oronasally inoculated with 10(4.3) PRRS virus/mL from strain JA142 in a 2-mL dose. Blood was collected every 4 d from d 0 to 24 postinoculation and analyzed for serum PPRS virus, interferon activity, and alpha1-acylglycoprotein (AGP) concentrations. Serum virus and interferon peaked at 10(5) virus/mL and 57% protection, respectively, at 4 d postinoculation and then declined steadily. Serum AGP concentration peaked at 12 d postinoculation. Each log increase in serum virus was associated with a reduction of daily gain of 0.034 kg in 5.3-kg pigs and 0.004 kg in 11-kg pigs. As dietary genistein concentration increased, serum concentrations of PRRS virus decreased linearly (10(2.46), 10(2.26), 10(2.05), and 10(2.14) virus per milliliter of serum, P < 0.07) and interferon responded quadratically (28.4, 25.7, 22.8, and 30.9% protection, P < 0.06) independent of days postinoculation. The AGP concentrations increased (P < 0.01) quadratically with the magnitude of the response to dietary genistein maximized at 12 to 16 d postinoculation. Effects of dietary genistein on daily pig gain and feed intake were dependent on dietary genistein concentration and stage of viremia. Daily pig gains from d 0 to 24 postinoculation were improved as dietary genistein increased, but the magnitude of the response to dietary genistein concentration lessened as the serum virus concentrations were minimized resulting in a linear genistein x period interaction (P < 0.07). Daily feed intakes also were increased quadratically as genistein concentration increased. These data indicate that soy genistein at dietary concentrations of 200 to 400 ppm is an orally active immune modulator that enhances systemic serum virus elimination and body growth in virally challenged pigs.