Remote Symptom Monitoring with Clinical Alerts Following Mastectomy: Do Early Symptoms Predict 30-Day Surgical Complications.

BACKGROUND: Electronic patient-reported outcome measures (ePROMs) for real-time remote symptom monitoring facilitate early recognition of postoperative complications. We sought to determine whether remote, electronic, patient-reported symptom-monitoring with Recovery Tracker predicts 30-day readmission or reoperation in outpatient mastectomy patients. METHODS: We conducted a retrospective review of breast cancer patients who underwent outpatient (< 24-h stay) mastectomy with or without reconstruction from April 2017 to January 2022 and who received the Recovery Tracker on Days 1-10 postoperatively. Of 5,130 patients, 3,888 met the inclusion criteria (2,880 mastectomy with immediate reconstruction and 1,008 mastectomy only). We focused on symptoms concerning for surgical complications and assessed if symptoms reaching prespecified alert levels-prompting a nursing call-predicted risk of 30-day readmission or reoperation. RESULTS: Daily Recovery Tracker response rates ranged from 45% to 70%. Overall, 1,461 of 3,888 patients (38%) triggered at least one alert. Most red (urgent) alerts were triggered by pain and fever; most yellow (less urgent) alerts were triggered by wound redness and pain severity. The 30-day readmission and reoperation rates were low at 3.8% and 2.4%, respectively. There was no statistically significant association between symptom alerts and 30-day reoperation or readmission, and a clinically relevant increase in risk can be excluded (odds ratio 1.08; 95% confidence interval 0.8-1.46; p = 0.6). CONCLUSIONS: Breast cancer patients undergoing mastectomy with or without reconstruction in the ambulatory setting have a low burden of concerning symptoms, even in the first few days after surgery. Patients can be reassured that symptoms that do present resolve quickly thereafter.

Reducing Disparities: Regional Anesthesia Blocks for Mastectomy with Reconstruction Within Standardized Regional Anesthesia Pathways.

BACKGROUND: Recent data suggest disparities in receipt of regional anesthesia prior to breast reconstruction. We aimed to understand factors associated with block receipt for mastectomy with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways. PATIENTS AND METHODS: Patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022 were included. All patients were considered eligible for and were offered preoperative nerve blocks as part of routine anesthesia care. Interpreters were used for non-English speaking patients. Patients who declined a block were compared with those who opted for the procedure. RESULTS: Of 4213 patients who underwent mastectomy with immediate TE reconstruction, 91% accepted and 9% declined a nerve block. On univariate analyses, patients with the lowest rate of block refusal were white, non-Hispanic, English speakers, patients with commercial insurance, and patients undergoing bilateral reconstruction. The rate of block refusal went down from 12 in 2017 to 6% in 2022. Multivariable logistic regression demonstrated that older age (p = 0.011), Hispanic ethnicity (versus non-Hispanic; p = 0.049), Medicaid status (versus commercial insurance; p < 0.001), unilateral surgery (versus bilateral; p = 0.045), and reconstruction in earlier study years (versus 2022; 2017, p < 0.001; 2018, p < 0.001; 2019, p = 0.001; 2020, p = 0.006) were associated with block refusal. CONCLUSIONS: An established preoperative regional anesthesia program with blocks offered to all patients undergoing mastectomy with TE reconstruction can result in decreased racial disparities. However, continued differences in age, ethnicity, and insurance status justify future efforts to enhance preoperative educational efforts that address patient hesitancies in these subpopulations.

Methods in regression analysis in surgical oncology research-best practice guidelines.

BACKGROUND: Using real working examples, we provide strategies and address challenges in linear and logistic regression to demonstrate best practice guidelines and pitfalls of regression modeling in surgical oncology research. METHODS: To demonstrate our best practices, we reviewed patients who underwent tissue expander breast reconstruction between 2019 and 2021. We assessed predictive factors that affect BREAST-Q Physical Well-Being of the Chest (PWB-C) scores at 2 weeks with linear regression modeling and overall complications and malrotation with logistic regression modeling. Model fit and performance were assessed. RESULTS: The 1986 patients were included in the analysis. In linear regression, age [ß = 0.18 (95% CI: 0.09, 0.28); p < 0.001], single marital status [ß = 2.6 (0.31, 5.0); p = 0.026], and prepectoral pocket dissection [ß = 4.6 (2.7, 6.5); p < 0.001] were significantly associated with PWB-C at 2 weeks. For logistic regression, BMI [OR = 1.06 (95% CI: 1.04, 1.08); p < 0.001], age [OR = 1.02 (1.01, 1.03); p = 0.002], bilateral reconstruction [OR = 1.39 (1.09, 1.79); p = 0.009], and prepectoral dissection [OR = 1.53 (1.21, 1.94); p < 0.001] were associated with increased likelihood of a complication. CONCLUSION: We provide focused directives for successful application of regression techniques in surgical oncology research. We encourage researchers to select variables with clinical judgment, confirm appropriate model fitting, and consider clinical plausibility for interpretation when utilizing regression models in their research.

Prepectoral Versus Subpectoral Implant-Based Reconstruction: How Do We Choose?

Aspects of a patient's lifestyle, their state of health, breast size, and mastectomy skin flap quality are factors that influence the suggested plane of dissection in implant-based breast reconstruction. This article aims to review developments in prosthetic breast reconstruction and provide recommendations to help providers choose whether prepectoral or subpectoral reconstruction in the best approach for each of their patients.

A Cohort Analysis of Early Outcomes After AlloDerm, FlexHD, and SurgiMend Use in Two-Stage Prepectoral Breast Reconstruction.

BACKGROUND: Acellular dermal matrix (ADM) is frequently utilized in prepectoral breast reconstruction, but few studies have examined the role of ADM type in complication risk. OBJECTIVES: This study was performed to determine the impact of ADM type on early complication rates in 2-stage alloplastic prepectoral breast reconstruction. METHODS: We performed a cohort examination of all patients who underwent mastectomy with immediate 2-stage alloplastic prepectoral breast reconstruction with ADM support at Memorial Sloan Kettering Cancer Center from 2018 to 2021. ADM types utilized included AlloDerm (LifeCell Corporation, Branchburg, NJ), FlexHD (MTF Biologics, Edison, NJ), and SurgiMend (Integra LifeSciences Corporation, Princeton, NJ). Complication rates based on the number of tissue expanders (TEs) were determined for each ADM type. Performance of multivariate logistic regression determined the impact of ADM type on complication risk after accounting for confounders. RESULTS: Overall, 726 patients (1054 TEs: 194 AlloDerm, 93 FlexHD, 767 SurgiMend) were included. The 3 cohorts differed in terms of mastectomy type (nipple-sparing: 23.5% of AlloDerm, 33.3% of FlexHD, 19.1% of SurgiMend, P = .038); ADM perforation (perforated: 94.8% of AlloDerm, 98.2% of FlexHD, 100% of SurgiMend, P < .001); and ADM size (AlloDerm: 153.2 cm2 [37.6], SurgiMend: 198.7 cm2 [10.4], FlexHD: 223.7 cm2 [37.9], P < .001). On univariate examination, no differences existed between ADM types for seroma, infection, exposure, malposition, or TE loss. Additionally, after adjustment for confounders with multivariate regression, no ADM type had higher odds of TE loss. CONCLUSIONS: In this large cohort of prepectoral reconstruction patients, ADM type did not significantly affect the risk of complications. Additional prospective studies are warranted to better evaluate ADM choice for prepectoral breast reconstruction.

Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes.

BACKGROUND: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma. Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) is limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants. METHODS: Complication rates and BREAST-Q scores were compared between (i) asymptomatic patients who underwent conversion from textured to smooth implants (n=224), (ii) symptomatic patients who underwent conversion from textured to smooth implants (n=83), (iii) patients who underwent explantation without replacement (n=44), and (iv) patients who underwent replacement with autologous reconstruction (n=33). Linear regression examined PROs controlling for clinical and surgical variables. RESULTS: Overall complication rates in 384 patients (637 implants) differed across groups (p=0.034) with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in satisfaction with breasts (<0.05). Autologous reconstruction patients had significant improvements in satisfaction with breasts sustained after 3 months postoperative (p<0.01) and sexual well-being sustained after 6-months postoperative (p<0.05). Patients who underwent removal without replacement had lower physical well-being of the chest scores at ≥1 year than the other groups. CONCLUSIONS: Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications.

Transferrina como marcador de maturação pulmonar em cordeiros nascidos a termo ou prematuros / Transferrin as a marker of pulmonary maturation in lambs born at term or premature

O objetivo do estudo foi procurar proteínas de fase aguda que possam indicar sinais de maturação no neonato prematuro, por meio da quantificação sérica delas. Identificou-se a imunoglobulina A, a ceruloplasmina, a haptoglobina, a glicoproteína ácida, a transferrina, a albumina e as imunoglobulinas G de cadeias leve e pesada, pela comparação do perfil dos proteinogramas de cordeiros nascidos a termo com os prematuros submetidos a diferentes protocolos terapêuticos, a fim de estimular a atividade respiratória. Constituíram-se seis grupos: PN (n= 9): nascidos de parto normal; CN (n= 7): nascidos de cesariana em tempo normal de gestação; CP (n= 6): nascidos de cesariana prematura sem nenhum tipo de tratamento; DEX (n= 9): prematuros cujas mães receberam dexametasona pré-parto; SURF (n= 6): prematuros tratados com surfactante; e DEXSURF (n= 6): prematuros tratados com surfactante cujas mães receberam dexametasona pré-parto. As avaliações foram realizadas nos momentos imediatamente após o nascimento (M0), após 24 (M24) e após 48 horas (M48). As amostras foram processadas por meio de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE). A albumina, as imunoglobulinas e a proteína total dos cordeiros tiveram elevação após a ingestão de colostro. Maiores valores séricos de transferrina são referentes a maior período gestacional, podendo essa proteína ser utilizada como marcador de maturação neonatal.(AU)

The aim of this study was to search for acute phase proteins that could indicate signs of maturation in the premature neonate by quantifying them in serum. Immunoglobulin A, ceruloplasmin, haptoglobin, acid glycoprotein, tranferrin, albumin, light and heavy chain immunoglobulin G were quantified, comparing the profile of proteinograms from term to preterm lambs submitted to different protocols that stimulate respiratory activity. Six groups were used: PN (n= 9): born from normal birth; CN (n= 7): born from caesarean section at normal time of gestation; CP (n= 6): born from premature cesarean without any type of treatment; DEX (n= 9) preterm whose mothers received prepartum dexamethasone; SURF (n= 6) preterm treated with surfactant; DEXSURF (n= 6): preterm treated with surfactant whose mothers received prepartum dexamethasone. The evaluations were performed immediately after birth (M 0), after 24 and 48 hours (M 24 and M 48). Samples were processed with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Albumin, immunoglobulins, and serum total protein of the lambs were elevated, after colostrum ingestion. Higher serum transferrin values refer to a longer gestational period, and this protein may be used as a marker of neonatal maturation.(AU)

Does sperm quality and DNA integrity differ in cryopreserved semen samples from young, adult, and aged Nellore bulls?

BACKGROUND: In humans, it is now well documented that rising paternal age is correlated with decreased sperm DNA integrity and embryonic developmental failures. On the other side of the coin, it is also reported that very young fathers such as teenagers carry an increased risk of adverse birth outcomes. These observations suggest that, at least in humans, there is an age window for optimal sperm DNA integrity. In bovine, little is known about sperm DNA quality in young bulls and how it evolves with age. This study aimed to fill in this gap as it may be of importance for the bovine industry to know when exactly a bull is an optimal performer for reproductive programs. METHODS: Forty Nellore bulls were divided into three age groups: 1.8 to 2 years - young bulls; 3.5 to 7 years - adult bulls; and 8 to 14.3 years - aged bulls. Three ejaculates were collected from each bull, cryopreserved and evaluated for various parameters including: computer-assisted sperm analysis (CASA), plasma membrane and acrosome integrity, mitochondrial potential, sperm nuclear protamination, DNA oxidative damage, and Sperm Chromatin Structure Assay (SCSA). RESULTS: We report here that young bulls presented superior values for motility, plasma and acrosomal membrane integrity, and high mitochondrial potential. However, they also presented higher values for sperm morphological abnormalities compared to adult and aged animal groups (p < 0.05). In addition, young bulls exhibited more defective protamination than older animals did. The oldest bulls showed more nuclear oxidative damage than the younger groups of bulls while both the young and aged groups were found more susceptible to DNA denaturation as revealed with the SCSA test (p < 0.05). CONCLUSION: These results indicate that young bulls spermatozoa best survived the freezing procedure, followed by adult and aged bulls. However, young and aged bulls were found to be more susceptible to DNA damage, respectively caused by protamine deficiency and oxidation. Therefore, although young bulls have correct semen parameters according to classical evaluation, our results indicate that they may show some structural nuclear immaturity.

CONTEXTE: Chez l'homme, de nombreuses données indiquent maintenant que l'avancée de l'âge du père est associée à une réduction de l'intégrité de l'ADN des spermatozoïdes et aux échecs de développement embryonnaire. D'un autre côté, il est aussi rapporté que les jeunes pères, tels les adolescents, sont porteurs d'un risque accru d'issue défavorable de la grossesse. Ces observations suggèrent que, au moins chez l'humain, il existe une tranche d'âge dans laquelle l'intégrité de l'ADN des spermatozoïdes est optimale. Chez les bovins, on dispose de peu de connaissances sur la qualité de l'ADN des spermatozoïdes des jeunes taureaux et sur son mode d'évolution avec l'âge. La présente étude a pour but de combler ce manque car il peut être important, pour l'industrie bovine, de savoir à quelle période précise un taureau est un reproducteur optimal pour les programmes de reproduction. MATÉRIEL ET MÉTHODES: Quarante taureaux Nellore ont été répartis en trois groupes d'âge: 1, 8 à 2 ans ­ jeunes taureaux; 3,5 à 7 ans ­ taureaux adultes; et 8 à 14,3 ans ­ taureaux âgés. Trois éjaculats ont été collectés par taureau, cryopréservés et évalués pour différents paramètres incluant l'analyse assistée du sperme par ordinateur (CASA), l'intégrité des membranes plasmique et acrosomique, le potentiel mitochondrial, la protamination du noyau, l'altération oxydative de l'ADN et l'évaluation de la structure de la chromatine du noyau du spermatozoïde (SCSA). RÉSULTATS: Nous rapportons ici que les jeunes taureaux présentent des valeurs supérieures de la mobilité des spermatozoïdes et de l'intégrité des membranes plasmique et acrosomique, ainsi qu'un potentiel mitochondrial élevé. Cependant, les jeunes taureaux présentent aussi des valeurs plus élevées d'anomalies morphologiques des spermatozoïdes que celles des groupes adulte et âgé (p < 0.05). De plus, les jeunes taureaux ont une protamination plus défectueuse que celle des taureaux plus âgés. Les taureaux les plus âgés présentent plus d'altérations oxydatives du noyau que les jeunes taureaux alors que les deux groupes -jeunes et âgés- sont plus susceptibles d'avoir une dénaturation de l'ADN nucléaire comme indiqué par le SCSA (p < 0.05). CONCLUSIONS: Ces résultats indiquent que les spermatozoïdes des jeunes taureaux survivent le mieux au processus de congélation, suivis par les adultes puis les âgés. Toutefois, les jeunes taureaux et les âgés sont plus susceptibles d'avoir une altération de l'ADN, causée respectivement par une protamination déficiente et une oxydation. Par conséquent, bien que les jeunes taureaux aient des paramètres spermatiques corrects à l'évaluation classique, nos résultats indiquent que leurs spermatozoïdes peuvent présenter un certain degré d'immaturité structurale nucléaire.

Parâmetros hematológicos e perfil bioquímico renal de cordeiros nascidos a termo e prematuros / Hematologic parameters and renal biochemical profile in full-term and premature lambs

O objetivo do presente estudo foi avaliar as variáveis hematológicas e o perfil bioquímico renal sérico de cordeiros nascidos a termo e prematuros do nascimento às 48 horas de vida, bem como verificar a influência da dexametasona sobre tais variáveis. Foram constituídos quatros grupos experimentais: PN (cordeiros nascidos de parto normal, n=15, média de 146 dias); PNDEX (cordeiros nascidos de parto normal cujas mães receberam 16mg de dexametasona aos 141 de gestação, n=8, média de 143 dias); PRE (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, n=10) e PREDEX (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação cujas mães receberam 16mg de dexametasona dois dias antes, n=9). Os valores médios do volume globular e de hemoglobina diminuíram ao longo das 48 horas de observação, nos quatro grupos experimentais, porém dentro dos limites fisiológicos para a espécie. Houve variação da concentração plasmática de proteínas totais em todos os momentos, sendo os menores valores no grupo PRE. A contagem leucocitária foi mais alta no grupo PN apenas no M24h. Ao longo do período, apenas o grupo PN mostrou diferença entre o M24h e os demais momentos, e o grupo PRE apresentou os menores valores de neutrófilos no M0h, M15min e M60min. As concentrações séricas de creatinina foram mais altas no grupo PRE no M60min, M24h e M48h. Em todos os grupos, houve diminuição no M24h e M48h. Os parâmetros avaliados foram afetados pela prematuridade na espécie ovina e a dexametasona teve influência positiva sobre a taxa de sobrevivência dos animais prematuros.(AU)

The aim of the study was to evaluate hematologic parameters and renal biochemical profile of full-term and premature lambs from birth to 48 hours of life, and assess the effect of dexamethasone on such variables. Four experimental groups were formed: NDG (normal delivery group - lambs vaginally delivered, n=15, average of 146-day gestation); NDEXG (normal delivery with dexamethasone group - lambs vaginally delivered whose mothers received 16 mg of dexamethasone at 141 days of gestation, n=8, average of 143-day gestation); PRE (premature lambs born by cesarean section at 138 days of gestation, n=10) and PREDEX (premature lambs born by cesarean section at 138 days gestation, whose mothers received 16 mg of dexamethasone two days before, n=9). Mean values of cell volume and hemoglobin content decreased during the observation period of 48 hours in all groups, but within the physiologic limits for ovine species. There was significant variation in plasma concentration of total protein in all periods evaluated, with the lowest mean values in PRE group. The leukocyte count was significantly higher in PN group only in M24h. Throughout the observation period, only PN group showed differences between M24h and the other moments and PRE group showed the lowest values of neutrophils in M0h, M15min and M60min. Serum creatinine concentration was significantly higher in group PRE in M60min, M24h and M48h. In all groups, there was a decrease in M24 and M48. The evaluated parameters were affected by prematurity in sheep and dexamethasone had a positive effect on the survival rate of premature animals.(AU)

Sperm morphometry and chromatin condensation in Nelore bulls of different ages and their effects on IVF.

The aim of this study was to evaluate the chromatin packing and sperm head morphometry of cryopreserved semen of Nelore bulls (Bos taurus indicus) of different ages. Furthermore, the influence of the degree of chromatin compaction on in vitro embryo production (IVP) was investigated. Forty bulls were divided into three groups: young (1.8-2 years), adult (3.5-7 years), and senile (8-14.3 years). The ejaculates were frozen according to standards established by the Artificial Insemination Center located in the Southeast of Brazil. Toluidine blue staining was used for simultaneous evaluation of the sperm chromatin and sperm head morphometry. Chromomycin A3 (CMA3) was applied to analyze sperm protamination and IVP for embryonic development. Spermatozoa of young bulls presented higher values for area (A, pixels), perimeter (P, pixels), and width (W, pixels) compared to adults and senile (young: A = 1848.5 ± 119.79, P = 10.23 ± 0.29, and W = 1.95 ± 0.1; adults: A = 1672.9 ± 104.46, P = 9.86 ± 0.33, and W = 1.81 ± 0.06; senile: A = 1723.1 ± 124.41, P = 9.97 ± 0.33, and W = 1.83 ± 0.09; P < 0.0001) and showed higher protamination deficiency when analyzed by CMA3 (young: 1.57 ± 0.76; adults: 1.09 ± 0.63, and senile: 0.90 ± 0.59; P < 0.05). Likewise, variables of sperm head size (A, P, and W) and protamination assessed by CMA3 showed negative correlation with age and positive correlation with ellipticity, evaluated by toluidine blue method (P < 0.05). Sperm head area was larger in spermatozoa presenting chromatin instabilities than spermatozoa without chromatin alteration (P < 0.0001). There was no difference in IVP when using semen with larger or smaller portions of spermatozoa with chromatin instabilities, indicating that the proportion of sperm with abnormal chromatin compaction (4%-16.15%) did not interfere with early embryonic development. From our results, it can be concluded that sperm of young Nelore bulls have larger heads compared to adults and senile due to reduced protamine content when evaluated by CMA3 and higher proportion of major sperm defects assessed by differential interference contrast microscopy.

Kinetic scale turbulence and dissipation in the solar wind: key observational results and future outlook.

Turbulence is ubiquitous in the solar wind. Turbulence causes kinetic and magnetic energy to cascade to small scales where they are eventually dissipated, adding heat to the plasma. The details of how this occurs are not well understood. This article reviews the evidence for turbulent dissipation and examines various diagnostics for identifying solar wind regions where dissipation is occurring. We also discuss how future missions will further enhance our understanding of the importance of turbulence to solar wind dynamics.

Impaired protamination and sperm DNA damage in a Nellore bull with high percentages of morphological sperm defects in comparison to normospermic bulls / Deficiências de protaminação e danos de DNA no sêmen de um touro Nelore com elevada porcentagem de patologias espermáticas em comparação a touros normospérmicos

The routine semen evaluation assessing sperm concentration, motility and morphology, does not identify subtle defects in sperm chromatin architecture. Bulls appear to have stable chromatin, with low levels of DNA fragmentation. However, the nature of fragmentation and its impact on fertility remain unclear and there are no detailed reports characterizing the DNA organization and damage in this species. The intensive genetic selection, the use of artificial insemination and in vitro embryo production associated to the cryopreservation process can contribute to the chromatin damage and highlights the importance of sperm DNA integrity for the success of these technologies. Frozen-thawed semen samples from three ejaculates from a Nellore bull showed high levels of morphological sperm abnormalities (55.8±5.1%), and were selected for complementary tests. Damage of acrosomal (76.9±8.9%) and plasma membranes (75.7±9.3%) as well as sperm DNA strand breaks (13.8±9.5%) and protamination deficiency (3.7±0.6%) were significantly higher compared to the values measured in the semen of five Nellore bulls with normospermia (24.3±3.3%; 24.5±6.1%; 0.6±0.5%; 0.4±0.6% for acrosome, plasma membrane, DNA breaks and protamine deficiency, respectively) (P<0.05). Motility and percentage of spermatozoa with low mitochondrial potential showed no differences between groups. This study shows how routine semen analyses (in this case morphology) may point to the length and complexity of sperm cell damage emphasizing the importance of sperm function testing.(AU)

O exame de rotina de sêmen, o qual avalia a concentração de espermatozoides, a motilidade e a morfologia, pode não identificar defeitos sutis na arquitetura da cromatina de espermatozoides. Os touros parecem ter cromatina estável com baixos níveis de fragmentação do DNA. No entanto, a natureza da fragmentação e o seu impacto sobre a fertilidade ainda não estão claros e não há relatos que caracterizam a organização do DNA e os danos nessa espécie com mais detalhes. A seleção genética intensiva e o uso da inseminação artificial e da produção in vitro de embriões, além do processo de criopreservação, podem contribuir para o dano da cromatina, e sabe-se a importância da integridade do DNA espermático para o sucesso dessas tecnologias. Amostras de sêmen de três ejaculados de um touro Nelore com altos níveis de alterações morfológicas (55,8±5,1%) foram selecionadas para realização de exames complementares. Os danos de acrossoma (76,9±8,9%) e das membranas plasmáticas (75,7±9,3%), bem como quebras de fita de DNA de espermatozoides (13,8±9,5) e deficiência de protamina (3,7±0,6) foram significativamente maiores em comparação aos valores avaliados no sêmen de cinco touros Nelore com normospermia (24,3±3,3%; 24,5±6,1%; 0,6±0,5%; 0,4±0,6% para acrossoma, membrana plasmática, quebras de DNA e deficiência de protamina, respectivamente) (p<0,05). Motilidade e porcentagem de espermatozoides com baixo potencial mitocondrial não diferiram estatisticamente. Essas avaliações mostram que análises de sêmen de rotina (neste caso, morfologia) podem apontar para a extensão e a complexidade dos danos na célula espermática, o que indica que a deficiência de protamina e os danos no DNA podem ocorrer simultaneamente a defeitos morfológicos. Tal ocorrência enfatiza a importância das análises de sêmen clássicas e dos testes complementares.(AU)

Molecular characterisation of Cryptosporidium spp. in lambs in the South Central region of the State of São Paulo / Caracterização molecular de Cryptosporidium spp. em cordeiros na região centro sul do Estado de São Paulo

Considering the proximity of sheep farmers to animals that are possibly diseased or releasing fecal oocysts into the environment and the marked pathogenicity in lambs, the aim of this study was to determine the occurrence and to molecularly characterize the infection by Cryptosporidium spp. in lambs in the South Central region of the state of São Paulo, Brazil. A total of 193 fecal samples were collected from sheep of several breeds, males and females, aged up to one year. Polymerase chain reaction (nested-PCR) was used to amplify DNA fragments from the subunit 18S rRNA gene and indicated 15% positivity; sequencing of amplified fragments was possible for 19 samples. Analysis of the obtained sequences showed that the identified species were Cryptosporidium xiaoi for 15 samples, constituting thus the first molecular characterization study of this Cryptosporidium species in Brazil. Cryptosporidium ubiquitum was identified for three samples and Cryptosporidium meleagridis for one sample; the latter two are considered zoonotic species.(AU)

Devido à proximidade de criadores de ovinos com animais possivelmente doentes e/ou eliminando oocistos fecais no ambiente e pela acentuada patogenicidade em cordeiros o objetivo foi, determinar a ocorrência e caracterizar molecularmente a infecção por Cryptosporidium spp. em cordeiros na região Centro Sul do Estado de São Paulo, Brasil. Num total de 193 amostras de fezes foram coletadas de ovinos de diversas raças, machos e fêmeas, com idade de até um ano. Por meio da reação em cadeia da polimerase (nested PCR) para a amplificação de fragmentos de DNA a partir do gene da subunidade 18S do rRNA houve positividade de 15% e o sequenciamento dos fragmentos amplificados foi possível em 19 amostras. A análise das sequências obtidas mostraram que as espécies identificadas nesses animais foram Cryptosporidium xiaoi em 15 amostras, sendo o primeiro estudo de caracterização molecular desta espécie de Cryptosporidium no Brasil. Cryptosporidium ubiquitum em três amostras, e Cryptosporidium meleagridis em uma amostra, sendo estas duas últimas consideradas espécies zoonóticas.(AU)

Avaliação do efeito trombogênico da perfusão regional intravenosa com gentamicina em equinos / Evaluation of intravenous regional perfusion thrombogenic effect with gentamicin in equine

A extremidade distal dos equinos é frequentemente afetada por processos sépticos de difícil tratamento. A perfusão regional intravenosa de antimicrobianos é uma opção de tratamento para esses processos, pois aumenta a concentração do fármaco no local mediante pequenas doses. Entretanto, apesar de ser muito utilizada recentemente, ainda apresenta várias questões. O objetivo deste trabalho foi avaliar as possíveis complicações da técnica, com o uso da gentamicina na dose de 2,2mg/kg na veia cefálica de equinos. Utilizaram-se 15 equinos hígidos divididos aleatoriamente em três grupos de cinco animais: grupo somente com torniquete (GT), grupo que recebeu 40mL de solução fisiológica (GSF) e grupo que recebeu gentamicina na dose de 2,2mg/kg, acrescida de solução fisiológica até completar o volume de 40mL (GSG). O membro perfundido foi avaliado por termografia e ultrassonografia duplex em cores ao longo do tempo. Os dados foram submetidos à análise pelos testes de Tukey e de Dunnett, e o nível de significância adotado foi de P<0,05. Todos os grupos apresentaram escore trombótico zero, e não houve diferença significativa entre os grupos quanto ao diâmetro médio da veia e da temperatura dos membros. A antibiose intravenosa regional com 2,2mg/kg de gentamicina, em dose única, não acarretou o desenvolvimento de trombose na veia cefálica...

The distal end of the horse is often affected by septic processes that are difficult to treat. The intravenous regional perfusion of antimicrobials is a treatment option for these processes, increasing the local concentration of the drug using small doses, and is currently widely used, but still presenting various issues. The aim of this study was to evaluate the possible complications of the technique, using gentamicin at a dose of 2.2mg/kg in the cephalic vein of horses. Fifteen healthy horses were assigned to three groups of 5 animals. Group 1, tourniquet group (TG), group 2, tourniquet and 40mL of physiologic saline solution (SPG) and group 3, tourniquet and 2.2mg/kg gentamicin completed to 40mL by the addition of physiologic saline solution (ASG). The perfused limb was evaluated by thermography and ultrasound Duplex color over time. The data were analyzed by Tukey's and Dunnett's method, and the accepted significance level was P<0.05. All groups showed thrombotic score zero and there was no significant difference between groups in the average diameter of the vein and member temperatures. The intravenous regional antibiosis with 2.2mg/kg of gentamicin as a single dose did not affect the development of thrombosis in the cephalic vein...

Heparin and penicillamine-hypotaurine-epinephrine (PHE) solution during bovine in vitro fertilization procedures impair the quality of spermatozoa but improve normal oocyte fecundation and early embryonic development.

The presence of heparin and a mixture of penicillamine, hypotaurine, and epinephrine (PHE) solution in the in vitro fertilization (IVF) media seem to be a prerequisite when bovine spermatozoa are capacitated in vitro, in order to stimulate sperm motility and acrosome reaction. The present study was designed to determine the effect of the addition of heparin and PHE during IVF on the quality and penetrability of spermatozoa into bovine oocytes and on subsequent embryo development. Sperm quality, evaluated by the integrity of plasma and acrosomal membranes and mitochondrial function, was diminished (P<0.05) in the presence of heparin and PHE. Oocyte penetration and normal pronuclear formation rates, as well as the percentage of zygotes presenting more than two pronuclei, was higher (P<0.05) in the presence of heparin and PHE. No differences were observed in cleavage rates between treatment and control (P>0.05). However, the developmental rate to the blastocyst stage was increased in the presence of heparin and PHE (P>0.05). The quality of embryos that reached the blastocyst stage was evaluated by counting the inner cell mass (ICM) and trophectoderm (TE) cell numbers and total number of cells; the percentage of ICM and TE cells was unaffected (P>0.05) in the presence of heparin and PHE (P<0.05). In conclusion, this study demonstrated that while the supplementation of IVF media with heparin and PHE solution impairs spermatozoa quality, it plays an important role in sperm capacitation, improving pronuclear formation, and early embryonic development.

Anestesia local por tumescência com lidocaína em cadelas submetidas a mastectomia / Tumescent local anesthesia with lidocaine in dogs undergoing mastectomy

O presente estudo investigou os benefícios da anestesia por tumescência com lidocaína em cadelas submetidas à mastectomia, visando ao conforto do paciente e à sua recuperação pós-operatória. Foram utilizados sete animais, de peso e raças variadas, que apresentavam neoplasia em região de cadeia mamária e que foram submetidos à cirurgia de mastectomia. Todos os animais receberam o mesmo protocolo anestésico, sendo utilizado como MPA a associação entre acepromazina e morfina, nas doses de 0,04mg/kg e 0,4mg/kg (IM), respectivamente. Após 15 minutos, foi alocado um cateter em veia cefálica e realizou-se a indução com propofol 4mg/kg e midazolam 0,2mg/kg, seguida de manutenção anestésica com isofluorano. Posteriormente à instrumentação, procedeu-se à técnica de anestesia por tumescência com solução gelada composta por ringer lactato, lidocaína 2% sem vasoconstritor e adrenalina, em um volume total de 15mL/kg. Em média, o tempo de duração do procedimento foi de 74±18 minutos. O pico plasmático de lidocaína deu-se entre 30 e 60 minutos após a infiltração da solução. O resgate analgésico foi realizado após sete horas, aproximadamente, da infiltração. Pode-se concluir que a anestesia por tumescência com lidocaína deve ser considerada como constituinte do protocolo anestésico e analgésico de cadelas a serem submetidas à cirurgia de mastectomia, proporcionando estabilidade de parâmetros, segurança e recuperação pós-operatória de boa qualidade.

The present study investigated the benefits of tumescent anesthesia with lidocaine in dogs undergoing mastectomy, seeking the patients' comfort and their postoperative recovery. Seven animals, with different weight and breed, who had cancer in the region of mammary chain underwent mastectomy surgery. All animals received the same anesthetic protocol being used as the association between acepromazine and morphine doses of 0.04mg.kg-1 and 0.4mg.kg-1 (IM), respectively. After 15 minutes a catheter was placed in the cephalic vein and induction with propofol 4mg.kg-1 and 0.2mg.kg-1 followed by maintenance with isoflurane anesthesia was done. After instrumentation, we proceeded to the tumescent anesthesia technique with ice-cold solution consisting of Ringer's lactate, lidocaine 2% without epinephrine and adrenaline in a total volume of 15mL.kg-1. The average duration of the procedure was 74±18 minutes. The plasmatic peak of lidocaine was between 30 and 60 minutes after infiltration. The rescue analgesic was performed after approximately seven hours of infiltration. It can be concluded that the tumescent anesthesia with lidocaine should be considered as a constituent of anesthetic and analgesic protocol in dogs undergoing mastectomy surgery providing parameter stability, safety and good quality postoperative recovery.

Preterm birth and neurodevelopment: a review of outcomes and recommendations for early identification and cost-effective interventions.

This review summarizes research findings to date on neurological and health outcomes following preterm birth, tools to identify children at risk for neurodevelopmental impairment and interventions to prevent preterm birth and improve outcomes. We bring together findings from research in high- and low-income countries, with an aim to provide a global perspective on the issues. Around the world, preterm birth is rising in importance as a cause of under-five morbidity and mortality, and we project that this trend will continue over time, particularly given the lack of interventions to prevent the condition. With the development of improved screening instruments, further identification and scale up of cost-effective interventions to optimize early childhood development and accelerated research on the underlying biological mechanisms, we have an opportunity to reduce rates of neurodevelopmental impairment, particularly in countries with the highest burden.

Detection of small-scale structures in the dissipation regime of solar-wind turbulence.

Recent observations of the solar wind have pointed out the existence of a cascade of magnetic energy from the scale of the proton Larmor radius ρ(p) down to the electron Larmor radius ρ(e) scale. In this Letter we study the spatial properties of magnetic field fluctuations in the solar wind and find that at small scales the magnetic field does not resemble a sea of homogeneous fluctuations, but rather a two-dimensional plane containing thin current sheets and discontinuities with spatial sizes ranging from l >/~ ρ(p) down to ρ(e) and below. These isolated structures may be manifestations of intermittency that localize sites of turbulent dissipation. Studying the relationship between turbulent dissipation, reconnection, and intermittency is crucial for understanding the dynamics of laboratory and astrophysical plasmas.

Efeito da utilização de diferentes diluidores para a produção in vitro de embriões bovinos / Effect of different bovine semen extenders on in vitro development of bovine embryos

Objetivou-se avaliar as características morfológica e funcional do sêmen bovino congelado comparando-se a eficácia de dois diferentes diluidores. O ejaculado de quatro touros foi dividido em duas partes iguais, uma submetida ao diluidor Tris e gema de ovo (A) e outra ao diluidor à base de lecitina de soja (Andromed®) (B). No experimento I, cinco palhetas dos diluidores A e B de cada touro foram descongeladas e avaliadas quanto à motilidade, vigor, concentração, morfologia espermática e teste de termor-resistência lento. Foram feitas, ainda, avaliação da integridade de membranas, por meio da associação das sondas iodeto de propídio, isotiocionato de fluoresceína - Pisum sativum e carbocianina catiônica lipofílica, e avaliação funcional da membrana plasmática com teste hiposmótico. A avaliação da integridade da cromatina foi realizada pelo método de coloração com laranja de acridina. No experimento II, o sêmen com os diferentes diluidores foi utilizado na fecundação in vitro, sendo observadas taxas de clivagem e desenvolvimento embrionário in vitro. Em relação aos resultados obtidos, apenas a porcentagem de espermatozoides no sêmen congelado foi discretamente maior com o diluidor A, concluindo-se que o diluidor composto por lecitina de soja pode substituir o composto por Tris e gema de ovo, respeitando-se as variações individuais de cada touro utilizado no presente experimento.

The goal of this study was to evaluate the protective effect of egg yolk compared with a soybean lecithin-based extender on morphologic and functional characteristics of frozen bovine semen. The ejaculate of four bulls was divided into two equal parts, one diluted with egg-yolk-Tris extender (A) and the other with a soy-lecithin based extender (Andromed®) (B). In experiment I, five straws of extender A and B from each bull were thawed and assessed regarding motility (subjective and computerized analysis), vigor, concentration, sperm morphology and slow thermoresistance (STR), evaluation of membrane integrity through association of propidium iodite probes (PI), fluorescein isotiocianate - Pisum sativum (FITC-PSA) and lipophilic cationic carbocyanine (JC-1) and functional evaluation of the plasmatic membrane through Hyposmotic Swelling Test (HOST). An evaluation of chromatin integrity was performed with the acridine orange staining procedure. In experiment II, the frozen semen with different extenders was used for in vitro fertilization (IVF), analyzing cleavage rates and in vitro embryo development. No statistical difference between extenders was identified, suggesting that the soy lecithin extender may substitute egg-yolk-Tris extender, considering the individual variations of each bull used in this experiment.