Transcervical uterine flushing and embryo transfer in sheep: Morphophysiological basis for approaches currently used, major challenges, potential improvements, and new directions (alas, including some old ideas).

At present, the success of non-surgical embryo recovery (NSER) and transfer (NSET) hinges upon the cervical passage of catheters, but penetration of the uterine cervix in ewes is problematic due to its anatomical structure (i.e., long and narrow cervical lumen with misaligned folds and rings). It is a major obstacle limiting the widespread application of NSER and NSET in sheep. While initial attempts to traverse the uterine cervix focused on adapting or re-designing insemination catheters, more recent studies demonstrated that cervical relaxation protocols were instrumental for transcervical penetration in the ewe. An application of such protocols more than tripled cervical penetration rates (currently at 90-95 %) in sheep of different breeds (e.g., Dorper, Lacaune, Santa Inês, crossbred, and indigenous Brazilian breeds) and ages/parity. There is now sufficient evidence to suggest that even repeatedly performed cervical passages do not adversely affect overall health and reproductive function of ewes. Despite these improvements, appropriate selection of donors and recipients remains one of the most important requirements for maintaining high success rates of NSER and NSET, respectively. Non-surgical ovine embryo recovery has gradually become a commercially viable method as even though the procedure still cannot be performed by untrained individuals, it is inexpensive, yields satisfactory results, and complies with current public expectations of animal welfare standards. This article reviews critical morphophysiological aspects of transcervical embryo flushing and transfer, and the prospect of both techniques to replace surgical methods for multiple ovulation and embryo transfer (MOET) programs in sheep. We have also discussed some potential pharmacological and technical developments in the field of non-invasive embryo recovery and deposition.

Transcervical approach to distal extracranial internal carotid aneurysm.

We report the case of a 77-year-old woman presenting with an asymptomatic internal carotid artery (ICA) aneurysm arising at the skull base. The distal right extracranial ICA aneurysm presented as a challenging case due to difficulty in obtaining adequate surgical exposure and preserving the facial nerves present near the ICA aneurysm. Transcervical open repair with a team of vascular and otolaryngology surgeons was completed successfully. In this report, we detail the operative steps needed to complete this exposure and our perioperative management.

Surveillance and risk factors for early restenosis following transcarotid artery revascularization.

OBJECTIVE: Restenosis after transcarotid artery revascularization (TCAR) is a known complication. When identified in the early postoperative period, it may be related to technique. We evaluated our TCAR experience to identify potentially modifiable factors impacting restenosis. METHODS: This is a single-institution, retrospective review of patients undergoing TCAR from November 2017 to July 2022. Restenosis was defined as >50% stenosis on duplex ultrasound (DUS) examination or computed tomographic angiography (CTA). Continuous variables were compared using Kruskal-Wallis's test. Categorical variables were compared using the Fisher's exact test. RESULTS: Of 61 interventions, 11 (18%) developed restenosis within the median follow-up of 345 days (interquartile range, 103-623 days). Among these patients, 82% (9/11) had >50% stenosis, and 18% (2/11) had >80% stenosis. Both patients with high-grade restenosis were symptomatic and underwent revascularization. Diagnosis of post-TCAR restenosis was via DUS examination in 45% (5/11), CTA in 18% (2/11), or both CTA/DUS examination in 36% (4/11). Restenosis occurred within 1 month in 54% (6/11) and 6 months in 72% (8/11) of patients. However, three of the six patients with restenosis within 1 month had discordant findings on CTA vs DUS imaging. Patient comorbidities, degree of preoperative stenosis, medical management, balloon size, stent size, lesion characteristics, and predilatation angioplasty did not differ. Patients with restenosis were younger (P = .02), had prior ipsilateral endarterectomy (odds ratio [OR], 6.5; P = .02), had history of neck radiation (OR, 18.3; P = .01), and lower rate of postdilatation angioplasty (OR, 0.11; P = .04), without an increased risk of neurological events. CONCLUSIONS: Although post-TCAR restenosis occurred in 18% of patients, only 3% of patients had critical restenosis and required reintervention. Patient factors associated with restenosis were younger age, prior endarterectomy, and history of neck radiation. Although early restenosis may be mitigated by improved technique, the only technical factor associated with restenosis was less use of postdilatation angioplasty. Balancing neurological risk, this factor may have increased application in appropriate patients. Diagnosis of restenosis was inconsistent between imaging modalities; current surveillance paradigms and diagnostic thresholds may warrant reconsideration.

Use of meloxicam with or without dipyrone in non-surgical embryo recovery in hair sheep: Effects on animal welfare.

The aim of this study was to determine the effectiveness of meloxicam with or without dipyrone on the welfare of ewes subjected to non-surgical embryo recovery (NSER). Two studies were carried out using 51 multiparous Santa Inês ewes. All animals received a standard oestrous synchronization treatment and a superovulatory protocol. In Study 1, 12 ewes received meloxicam (GM) before cervical transposition (1 mg kg-1 , i.v.), repeated 24 h after (1 mg kg-1 , i.m.), while the other 10 received a saline solution, remaining as a control group (GC1). In Study 2, ewes were allocated into a group of 15 ewes treated as GM of Study 1 associated with dipyrone (GMD; 50 mg kg-1 , i.m.) before cervical transposition, 12 h, and 24 h after, or a control group (GC2) of 14 ewes treated with saline solution. In both studies, heart and respiratory rates (RR), cortisol, glucose, total proteins, albumin and globulins blood concentration were recorded before sedation (BS), after sedation (AS), after cervical transposition, immediately after collection (IAC), and 0.5, 1.5, 3, 6, 12, 24 and 48 h after embryo collection (hAC). In Study 1, RR tended to be greater in GC1 (p = .08), serum total proteins and globulins values were lower and serum albumin values were greater in this group than GM (p = .003, p < .0001, and p < .0001, respectively). In Study 2, treatment of GMD tended to reduce the glycaemia at AS (p = .052) and reduced it at 3hAC (p < .0001), and 6hAC (p = .03). It also tended to reduce cortisol concentrations (p = .10). The other variables varied with NSER without interaction with the experimental treatments. In conclusion, in this study condition, NSER in sheep induced transient changes indicative of stress and possibly pain, therefore, affecting animal welfare. The administration of meloxicam was ineffective to reduce those responses, and the association of dipyrone had only slight effects without modifying the main welfare indicative responses in ewes subjected to NSER.

Pregnancy success in bitches - evaluation of interactions between artificial insemination method, serum progesterone concentration and vaginal cytology parameters

Background: The artificial insemination has become a well-established method in the breeding of bitches, and evaluation of the factors that may potentially affect pregnancy success is essential. For this reason, it is essential to evaluate the factors that may affect fertility of the bitch when artificial insemination is performed. Serum progesterone concentrations and vaginal cytology have been used to determine the time of ovulation and stage of the estrus cycle. This study aimed to evaluate the artificial insemination method, the serum progesterone concentration, the breed size, age, the whelping number, vaginal cytology parameters, and their interactions on pregnancy success in bitches. Materials, Methods & Results: A total of 607 bitches that had undergone reproductive consultation with the Mexican Canine Federation from January to December 2016 were enrolled in the present study and assigned to one of 2 artificial insemination methods (intravaginal and transcervical) using fresh semen. Determination of the estrus cycle phase and the time of Artificial insemination was based on vaginal cytology and serum progesterone concentrations. Bitches inseminated by the transcervical technique had a higher pregnancy rate with respect to females inseminated by the intravaginal technique (P < 0.05). Moreover, females with a serum progesterone concentration of 5-10 ng/mL had a greater probability (> 4 times) of getting pregnant than animals with lower or higher progesterone concentrations (P < 0.05). Bitches inseminated by the intravaginal technique and with serum progesterone concentrations >10 ng/mL had a considerable reduction in pregnancy (P < 0.05) compared with females with < 10 ng/mL serum progesterone or with bitches inseminated by the transcervical technique. Discusion: Serum progesterone concentration, the artificial insemination method, and superficial cells without a nucleus modified the pregnancy rate in bitches. Females inseminated by transcervical semen deposition had a higher pregnancy rate than females inseminated by the intravaginal technique. Using fresh or frozen-thawed semen produced a higher pregnancy rate in bitches inseminated by transcervical semen deposition than females inseminated by the intravaginal technique. Differences in the pregnancy rate between transcervical and intravaginal insemination could be associated with the correct semen disposition, the distance that the sperm must travel to reach the oocyte, as well as the number of sperm that reach the oviduct ampulla. Exist evidences that after ovulation, as progesterone rises, the cervix is closed, which may compromise the passage of the sperm deposited into the vagina. Therefore, it is likely that in females with a serum progesterone concentration > 10 ng/mL, the cervix was closed, compromising the ability of the sperm to access the oviduct. Thus, the use of intravaginal insemination should be done in bitches with a serum progesterone concentrations < 11 ng/mL to reduce the possibility of cervical closure and to increase the odds of pregnancy. It is well documented that the serum progesterone concentration and vaginal cytology parameters have a great influence on pregnancy success, and the results confirm these findings. In the present study, 96% of the bitches inseminated with a serum progesterone concentration of 5-10 ng/mL got pregnant and had higher odds of pregnancy than bitches with lower or higher serum progesterone concentrations.

Hormonal-Induced Cervical Relaxation During Diestrus in Ewes: Cervical Transposing Feasibility and Use of hCG for Rescuing Disrupted Luteal Function.

Cervical relaxation (CR) was performed in ewes during diestrus, to prospect a feasible protocol for non-surgical embryo transfer (NSET). In Trial 1, naturally mated ewes (n=13) received CR protocols with estradiol benzoate (EB, 1 mg on D6) and oxytocin (OT, 50 IU on D7) only (G-EB+OT) or associated with human chorionic gonadotropin (hCG, 300 IU on D7, G-EB+OT+hCG) and were compared to non-hormonally treated (G-control) ewes. Estradiol concentration increased (P<0.05) from D6 to D7 in G-EB+OT and G-EB+OT+hCG, then decreased (P<0.05) on D8. The G-EB+OT had reduced (P<0.05) progesterone on D8, and 0% (0/5) pregnancy, while G-control had 100% (3/3) conception rate. The treatment with hCG mitigated the progesterone drop on D8 and resulted in 50% (2/4) conception rate. In Trial 2, cervical transposing success after treatment with EB, OT, and hCG on D6 and D7 was assessed in nulliparous (n=25) and multiparous (n=30) ewes. The EB+OT+hCG protocol allowed efficient cervical transposition (~78% of cervical transposition success into ~5 min) in nulliparous and multiparous females and did not alter total and blood perfusion areas of corpora lutea (CL). The use of EB+OT+hCG was efficient to ensure effective cervical transposing in nulliparous and multiparous ewes, with no apparent deleterious effect on CL function, and may contribute to animal welfare, allowing a less invasive NSET procedure.

Nonsurgical Embryo Recovery as a Feasible Tool for Supporting Embryo Biobanks of Locally Adapted Brazilian Sheep and Goats.

This study assessed the outcomes of nonsurgical embryo recovery (NSER) after superovulation (SOV) in five locally adapted Brazilian breeds of sheep and goats. The objective was to evaluate the feasibility and efficiency of using SOV combined with a less-invasive embryo collection technique for supplying the Brazilian animal gene bank with germplasm from specific genotypes of interest. Morada Nova (n = 20), Santa Inês (n = 20), and Somalis (n = 20) ewes received an intravaginal progesterone (330 mg) device for 9 days, while Canindé (n = 15) and Moxotó (n = 15) goats received an intravaginal medroxyprogesterone acetate (60 mg) device for 6 days. All females received 133 mg of porcine follicle-stimulating hormone (pFSH) administrated in six decreasing doses 12 hours apart, starting 60 hours before device removal, plus 37.5 µg of d-cloprostenol at the fifth and sixth pFSH dose. Donors in estrus were mated with fertile males. The corpora lutea (CL) number was assessed by ultrasonography 1 day before NSER. On day 6.5 or 7 after estrus, NSER was performed following hormonally induced cervical relaxation. A total of 97% of sheep and 90% of goats responded with estrus, and among those, 91% of sheep and 85% of goats presented a CL. In ewes, the numbers of CL were greater (p < 0.05) in the Santa Inês breed, while similar (p > 0.05) CL numbers were found among the goat breeds. All viable embryos were freezable (excellent and good quality) and the number per donor was 7.8 for sheep and 4.9 for goats. All parameters of NSER efficiency, embryo yield, and fertility post-NSER did not differ (p > 0.05) between breeds among each species. The SOV-NSER procedures applied for an embryo biobank supply of locally adapted Brazilian breeds of small ruminants were efficient regarding production of cryopreservable embryos, and preservation of donor fertility. Therefore, SOV followed by NSER is recommended for embryo biobank assembly in sheep and goats.

Mediastinitis necrotizante descendente de origen odontogénico / Descending necrotizing mediastinitis of odontogenic origin

Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.

Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.

Transcervical Access for Endograft Exclusion of a Postendarterectomy Carotid Pseudoaneurysm in a Patient With Type III Aortic Arch.

Postendarterectomy carotid pseudoaneurysms are infrequent. The endovascular treatment is less invasive, with a minor risk of complications. However, the presence of a highly angulated aortic arch (type III) is a challenge, since the navigation of endovascular devices is not favorable. Through transcervical access, it is possible to deliver the devices directly into the carotid artery. We herein present a case of a postendarterectomy carotid pseudoaneurysm in a patient with type III aortic arch that was successfully treated with transcervical endograft exclusion.

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

In vivo embryo production and recovery in lacaune ewes after imposing a superovulation treatment regimen is related to pFSH dose.

This study was conducted to assess effects of different doses of pFSH on follicular recruitment, superovulatory response, ova/embryo recovery, and embryo yield in lactating ewes. Ewes (n = 24) had a superovulation treatment regimen imposed. All ewes were implanted with a progesterone intravaginal device for 9 d, and administered either 100 (G-100) or 200 (G-200) mg pFSH, proportioned into six doses administered at 12-h intervals, starting 60 h before device removal. At 7 days subsequent to progesterone device removal, there were non-surgical embryo recoveries (NSER) from ewes having three or more corpora lutea. At the time of the first pFSH injection, number of antral follicles were similar (P < 0.05) between ewes in the G-100 and G-200 group, however, there were more 3.1-4.0 mm follicles in ewes of the G-200 than G-100 group at the time of the second pFSH administration. Estrous response and CL number were less (P < 0.05) in ewes of the G-100 (66.7 % and 2.6 ±â€¯0.7) than G-200 (91.7 % and 11.6 ±â€¯1.2) group. There were embryo collections from 100 % and 90.9 % of ewes in the G-100 and G-200 groups, respectively (P > 0.05). Viable embryo numbers and ova/embryo recovery rate were greater (P < 0.05) in ewes of the G-200 (6.9 ±â€¯1.1 and 67.8 %) than G-100 (1.0 ±â€¯0.5 and 27.6 %) group. A dose of 200 mg pFSH was more effective in inducing a superovulatory response and embryo yield after NSER in ewes, however, the 100 mg dose was insufficient for these purposes.

Embryo development is impaired in goats that are treated for hydrometra and subsequently subjected to superovulation.

BACKGROUND: Reproductive efficiency after hydrometra (HD) treatment is usually unsatisfactory. METHODS: To identify mechanisms involved in low reproductive efficiency of HD-treated goats, pluriparous dairy goats treated for HD (n=10, HD) or with no reproductive disorders (n=11, control: CONT) were induced to oestrus and superovulated. Goats were mated with fertile bucks and seven days after oestrus, non-surgical embryo recovery was performed. Embryos were evaluated and gene expression was performed. RESULTS: There were no differences (P>0.05) in sexual behaviour parameters, superovulation response, mean number of retrieved structures and viable embryos between groups; although embryo recovery rate was higher (P=0.01) in CONT group. Structures in delayed stage (8-16 cells) were more frequent (P<0.05) in HD (29 vs 1 per cent) goats, as well as the percentage of advanced embryos was greater (P<0.05) for CONT (59.3 vs 33.3 per cent) goats. However, the expression of genes related to apoptosis (BAX and Bcl-2), trophectoderm differentiation (CDX2) and pluripotency maintenance (NANOG) was not affected (P>0.05) in embryos that reached the morulae and blastocyst stages. CONCLUSION: Although the HD embryos that developed to morula and blastocyst stages showed no change in the expression of genes related to their quality and implantation capacity, overall, embryo development was impaired in HD-treated goats.

Reproductive performance and luteal function of Santa Ines ewes inseminated by cervical retraction with fresh or frozen semen / Desempenho reprodutivo e função luteal de ovelhas Santa Inês inseminadas por retração cervical com sêmen fresco ou congelado

The artificial insemination (AI) by cervical retraction using fresh or commercially available frozen semen was evaluated. Santa Inês ewes (n=151) were assigned in five groups. Natural mating (NM) composed the control group. Four groups were submitted to hormonal treatment and timed insemination by cervical retraction (CRI) or laparoscopy (LAI), using fresh or frozen semen. To perform CRI, the ewes were kept in standing position. The time required to penetrate the cervical canal and to perform CRI were recorded; local deposition of semen and the reaction intensity of the ewe (weak, moderate or strong) were measured. Blood samples were collected to perform the progesterone dosage at days 0, 3, 5, 12 and 17 (day 0 = AI/NM). Non-return to estrus rate (NRE), pregnancy (at D35) and fertility (birth / mated ewes) were evaluated. Mean time for cervical penetration and CRI were 52.8 ± 21.2s and 3:26min ± 47s, respectively. Reaction intensity to CRI was weak or moderate in 92.3% of the ewes. Serum levels of progesterone after CRI, LAI or NM were similar. NRE of the inseminated ewes were similar, except for CRI with frozen semen, which was lower (P<0.05). Fertility rates were similar between CRI and LAI (35.4% and 42.2%, respectively). Artificial insemination by cervical retraction with ewes in a standing position is practical, and does not change the progesterone profile, providing reproductive rates similar to laparoscopy. However, the use of this technique along with commercial frozen semen presents low fertility rate.(AU)

Avaliou-se a inseminação artificial por retração cervical usando sêmen fresco ou congelado disponível comercialmente. Ovelhas Santa Inês foram divididas em cinco grupos. A monta natural (MN) correspondeu ao grupo controle. Quatro grupos foram submetidos a um tratamento hormonal e inseminação artificial por retração cervical (CRI) ou laparoscopia (LAI) usando sêmen fresco ou congelado. Para a CRI, ovelhas foram mantidas em estação. O tempo para penetrar o canal cervical e realizar a CRI foi mensurado, bem como o local de deposição do sêmen e intensidade de reação da ovelha (fraca, moderada, forte). Amostras de sangue foram coletadas para dosagem de progesterona aos dias 0, 3, 5, 12 e 17 (dia 0 = inseminação ou monta). Foram avaliadas as taxas de não retorno ao estro (NRE), gestação (ao dia 35) e fertilidade (nascimento / ovelhas acasaladas). O tempo médio para penetração cervical foi de 52,8 ± 21,2s e para a CRI foi de 3:26min ± 47s. A intensidade de reação à CRI foi fraca ou moderada em 92,3% das ovelhas. Os níveis séricos de progesterona após CRI, LAI e MN foram similares. NRE das ovelhas inseminadas foi similar, exceto em ovelhas com CRI e sêmen congelado, que foi inferior (P<0,05). As taxas de fertilidade foram semelhantes entre CRI e LAI (35,4% e 42,2%, respectivamente). A inseminação artificial por retração cervical com ovelhas em estação se mostrou prática e não alterou o perfil de progesterona, possibilitando índices reprodutivos similares à laparoscopia. No entanto, o uso desta técnica com sêmen disponível comercialmente apresentou baixa taxa de fertilidade.(AU)

Embryo yield and quality are associated with progestogen treatment during superovulation protocol in lactating Lacaune ewes.

This study assessed the effect of progestogen treatment length on ovarian parameters and embryo yield in superovulated Lacaune ewes collected by nonsurgical embryo recovery. Twenty-three lactating ewes were superovulated 30 d apart using a cross-over design. All ewes received 60 mg of MAP intravaginal sponges for 6 (G-6 group) or 9 (G-9 group) d. A total dose of 133 mg pFSH was given in six decreasing doses (twice a day) starting at 60 h before device removal. Ultrasound examination of the ovaries was performed at the first pFSH injection and one day before embryo recovery, which was performed 6-7 d after the onset of estrus. Embryo recovery was conducted only in ewes that expressed estrus and were mated. There was no difference (P > 0.05) in the total number of follicles between G-6 (15.7 ± 1.0) and G-9 (15.6 ± 0.8) at the time of the first pFSH treatment. The percentage of responding donors with ≥3 corpora lutea (CL; 78.2% [18/23] vs 69.5% [16/23]), mean (±SEM) CL number (7.0 ± 1.2 vs 8.1 ± 1.6), transcervical passage rate (94.4% [17/18] vs 83.3% [15/18], and ova/embryo recovery rate (54.5% [60/110] vs 68.0% [83/122]) were not different (P > 0.05) between the G-6 and G-9 groups. However, the mean number of viable embryos was lower (P < 0.05) in the G-6 group (1.8 ± 0.7) than in the G-9 group. (3.5 ± 1.1). In conclusion, treatment with an intravaginal MAP sponge for 9 d during a superovulation protocol is beneficial for viable embryo yield in Lacaune ewes out of the breeding season.

Papel actual de la videomediastinoscopía en el cáncer pulmonar / Current Role of Videomediastinoscopy in Lung Cancer

RESUMEN La exploración mediastinal comienza desde la época de Galeno. Su desarrollo se alcanzó en la segunda mitad del siglo XX, utilizada para el estudio de los ganglios y tumores mediastinales. En la actualidad su uso se ha ampliado no solo como diagnóstico, sino con fines terapéuticos, al lograr realizar resecciones pulmonares. El objetivo es realizar una revisión actualizada de la literatura, acerca del uso de la mediastinoscopia en el diagnóstico del cáncer pulmonar. Se realizó una revisión de la literatura médica donde se utilizaron las bases de datos Scopus, Medline y Cochrane bajo los criterios de sus revisores. Se emplearon las palabras claves en idioma español e inglés. El método de análisis y síntesis se usó para la interpretación de la bibliografía. Se revisaron 173 artículos, de los cuales, se escogieron 58, que cumplían con los criterios de selección, entre ellos, 6 meta análisis, 11 artículos de revisión y 41 artículos originales. La videomediastinoscopía constituye una herramienta válida para el diagnóstico, así como para el estadiamiento de enfermedades dentro y fuera de la cavidad torácica y mediastino. Por otra parte, permite el tratamiento de algunas enfermedades(AU)

ABSTRACT The mediastinal exploration begins from the time of Galen. Its development was reached in the second half of the 20th century, used for the study of lymph nodes and mediastinal tumors. At present its use has been expanded not only as a diagnosis, but also for therapeutic purposes, by achieving lung resections. The objective is to carry out an updated review of the literature on the use of mediastinoscopy in the diagnosis of lung cancer. A review of the medical literature was carried out where the Scopus, Medline and Cochrane databases were used under the criteria of their reviewers. The keywords in Spanish and English were used. The method of analysis and synthesis was used for the interpretation of the bibliography. 173 articles were reviewed, of which 58 were chosen, which met the selection criteria, including 6 meta-analyzes, 11 review articles, and 41 original articles. Videomediastinoscopy is a valid tool for diagnosis, as well as for the staging of diseases inside and outside the thoracic cavity and mediastinum. On the other hand, it allows the treatment of some diseases(AU)

Successful transcervical uterine flushing can be performed without or reduced dose of oestradiol benzoate in cervical relaxation protocol in Dorper ewes.

This study assessed the efficiency of cervical relaxation protocol using none, half or full dose (1.0 mg) of oestradiol benzoate in Dorper ewes subjected to non-surgical embryo recovery (NSER). Thirty-six pluriparous ewes received progestogen sponge (60 mg) for 9 days plus eCG administration (300 IU i.m.) 24 hr before sponge removal. Ewes were not mated and were randomly assigned to receive at 16 hr before NSER 37.5 µg d-cloprostenol i.m. and different doses of oestradiol benzoate: 0.0 mg (0EB group; n = 12); 0.5 mg (0.5EB group; n = 12) or 1.0 mg of oestradiol (1.0EB group, n = 12). All ewes received oxytocin (50 IU) i.v. 20 min before NSER, which was performed 8 days after sponge removal. Corpora lutea were counted by transrectal ultrasonography 24 hr before NSER. After procedure, the ewes were kept in natural breeding period to check their post-NSER fertility. NSER was performed in 91.7% (33/36) of the animals with overall fluid recovery efficiency over 97% (p > .05). The cervical transposing with Hegar dilator was longer (p < .05) in 0EB (4.2 ± 0.3 min) compared to 0.5EB (1.7 ± 0.3 min) and 1.0EB group (1.5 ± 0.3 min). The cervical transposing with mandrel/catheter was longer (p < .05) in 0EB (2.4 ± 0.5 min) than 1.0EB group (1.3 ± 0.5 min). Overall duration of uterine flushing was 25.4 min with structure recovery rate of 43.5%, with no difference among groups (p > .05). The post-NSER fertility was higher (p < .05) in 0.0EB (90%) than 0.5EB group (36.4%). In conclusion, NSER can be successfully performed in Dorper ewes by using a cervical relaxation protocol without oestradiol benzoate.

Reproductive performance and luteal function of Santa Ines ewes inseminated by cervical retraction with fresh or frozen semen / Desempenho reprodutivo e função luteal de ovelhas Santa Inês inseminadas por retração cervical com sêmen fresco ou congelado

The artificial insemination (AI) by cervical retraction using fresh or commercially available frozen semen was evaluated. Santa Inês ewes (n=151) were assigned in five groups. Natural mating (NM) composed the control group. Four groups were submitted to hormonal treatment and timed insemination by cervical retraction (CRI) or laparoscopy (LAI), using fresh or frozen semen. To perform CRI, the ewes were kept in standing position. The time required to penetrate the cervical canal and to perform CRI were recorded; local deposition of semen and the reaction intensity of the ewe (weak, moderate or strong) were measured. Blood samples were collected to perform the progesterone dosage at days 0, 3, 5, 12 and 17 (day 0 = AI/NM). Non-return to estrus rate (NRE), pregnancy (at D35) and fertility (birth / mated ewes) were evaluated. Mean time for cervical penetration and CRI were 52.8 ± 21.2s and 3:26min ± 47s, respectively. Reaction intensity to CRI was weak or moderate in 92.3% of the ewes. Serum levels of progesterone after CRI, LAI or NM were similar. NRE of the inseminated ewes were similar, except for CRI with frozen semen, which was lower (P<0.05). Fertility rates were similar between CRI and LAI (35.4% and 42.2%, respectively). Artificial insemination by cervical retraction with ewes in a standing position is practical, and does not change the progesterone profile, providing reproductive rates similar to laparoscopy. However, the use of this technique along with commercial frozen semen presents low fertility rate.

Avaliou-se a inseminação artificial por retração cervical usando sêmen fresco ou congelado disponível comercialmente. Ovelhas Santa Inês foram divididas em cinco grupos. A monta natural (MN) correspondeu ao grupo controle. Quatro grupos foram submetidos a um tratamento hormonal e inseminação artificial por retração cervical (CRI) ou laparoscopia (LAI) usando sêmen fresco ou congelado. Para a CRI, ovelhas foram mantidas em estação. O tempo para penetrar o canal cervical e realizar a CRI foi mensurado, bem como o local de deposição do sêmen e intensidade de reação da ovelha (fraca, moderada, forte). Amostras de sangue foram coletadas para dosagem de progesterona aos dias 0, 3, 5, 12 e 17 (dia 0 = inseminação ou monta). Foram avaliadas as taxas de não retorno ao estro (NRE), gestação (ao dia 35) e fertilidade (nascimento / ovelhas acasaladas). O tempo médio para penetração cervical foi de 52,8 ± 21,2s e para a CRI foi de 3:26min ± 47s. A intensidade de reação à CRI foi fraca ou moderada em 92,3% das ovelhas. Os níveis séricos de progesterona após CRI, LAI e MN foram similares. NRE das ovelhas inseminadas foi similar, exceto em ovelhas com CRI e sêmen congelado, que foi inferior (P<0,05). As taxas de fertilidade foram semelhantes entre CRI e LAI (35,4% e 42,2%, respectivamente). A inseminação artificial por retração cervical com ovelhas em estação se mostrou prática e não alterou o perfil de progesterona, possibilitando índices reprodutivos similares à laparoscopia. No entanto, o uso desta técnica com sêmen disponível comercialmente apresentou baixa taxa de fertilidade.

Preovulatory follicular dynamics, ovulatory response and embryo yield in Lacaune ewes subjected to synchronous estrus induction protocols and non-surgical embryo recovery.

The objective of this study was to assess the effect of the duration of progesterone-based estrus induction protocols on preovulatory follicular dynamics, ovulatory response, and embryo yield after non-surgical embryo recovery (NSER) in Lacaune ewes. Females received acetate medroxyprogesterone intravaginal sponges for six (G-6; n = 14) or nine (G-9; n = 14) days plus d-cloprostenol and eCG 24 h before sponge removal (Day 0). Preovulatory follicular dynamics and the luteal characteristics are evaluated by B-mode and Color-Doppler ultrasonography. NSER was performed five to six days after ovulation. The estrous behavior rate was 85.7% for both groups, and the percentage of ewes that ovulated was 92.9% in G-6 and 100% in G-9. The day of wave emergence (relative to Day 0) did not differ (P > 0.05) between G-6 (-3.0 ±â€¯0.5) and G-9 (-4.2 ±â€¯0.5). The number of follicles of size 4.1-5.0 mm was higher (P < 0.05) in G-9 (1.4 ±â€¯0.2) compared to G-6 (0.8 ±â€¯0.2) during the Days -4 to 0. At NSER, the transcervical penetration rate was 95.2% (20/21) and its duration time was lower (P < 0.05) in G-9 (3.4 ±â€¯0.6 min) than in G-6 (7.2 ±â€¯1.3 min). The number of ovulations and viable embryos was higher (P < 0.05) in G-9 (2.9 ±â€¯0.3 and 1.3 ±â€¯0.4, respectively) than in G-6 (1.9 ±â€¯0.3 and 0.4 ±â€¯0.2, respectively). In conclusion, the 9-day protocol promoted higher ovulation rate and embryo yield; moreover, the cervical dilation treatment allowed NSER in a high percentage of Lacaune ewes.

A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space.

Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS-TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET-CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS-TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.

Comparison of the intravenous and intravaginal route of oxytocin administration for cervical dilation protocol and non-surgical embryo recovery in oestrous-induced Santa Inês ewes.

This study compared the effects of intravaginal and intravenous routes of oxytocin (OT) administration in 46 oestrous-induced Santa Inês ewes (6-day treatment with progestin-releasing intravaginal sponges and a single injection of 200 IU of eCG at the time of sponge removal) that underwent transcervical embryo recovery 6-7 days after oestrous onset and mating. All ewes received 37.5 µg of d-cloprostenol via latero-vulvar route, and 1 mg of oestradiol benzoate i.m. 16 hr before and 50 IU of OT 20 min before non-surgical embryo recovery (NSER), with OT being administered intravenously (n = 21) or intravaginally (n = 21). An overall oestrous response was 95.6% (44/46), and adequate cervical retraction could be accomplished in 78.6% (33/42) of ewes. The percentage of successful NSER procedures was 57% (24/42) or 72.7% (24/33) of animals with sufficient cervical retraction. The duration of NSER procedure averaged 28 min (range: 17-40 min) and ~96% of flushing fluid could be recovered (range: 85%-100%). Out of 18 ewes that could not undergo NSER, 12 (66.6%) presented various anatomical barriers, whilst the other 33.4% did not present these barriers and still could not be traversed. Excluding the ewes with those anatomical features, the overall success rate of NSER was 80% (24/30). The route of OT administration had no effect on NSER efficiency or the ease with which transcervical embryo flushing was performed. Both routes of OT administration can be used for cervical dilation protocol. Discarding ewes with anatomical features precluding cervical penetration is highly recommended to increase the efficacy of NSER in sheep.