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.