Determining the Economically Optimum Metaphylactic Strategy for Cattle Cohorts of Varied Demographic Characteristics.

Metaphylactic antibiotic use in feeder cattle is a common practice to control respiratory disease. Antimicrobial stewardship is important to ensure continued efficacy and to protect animal welfare. The objective of this study is to identify characteristics of cohorts of cattle that had not received metaphylaxis that would have benefited economically from the use of metaphylaxis. Cohorts (n = 12,785; 2,206,338 head) from 13 feedlots that did not receive metaphylaxis were modeled using an economic model to estimate net returns for three metaphylactic options. Logistic regression models with covariates for entry weight, sex, average daily weight gain, number of animals per cohort, and days on feed, with feedlot as a random effect, were used to determine the model-adjusted probability of cohorts benefiting economically from metaphylaxis. Most (72%) cohorts in this data set that had not received metaphylaxis at arrival would not economically benefit from metaphylaxis. Sex, entry weight category, number of cattle in the cohort, and average daily weight gain were associated with the likelihood of benefitting economically from metaphylaxis. The results illustrated that cattle cohort demographics influenced the probability that cohorts would benefit economically from metaphylaxis and the type of metaphylaxis utilized, and integrating this information has the potential to influence the metaphylaxis decision.

Outcomes following interval delayed first rib resection for acute axillosubclavian deep venous thrombosis.

BACKGROUND: Current management of axillosubclavian deep venous thrombosis (DVT) often uses thrombolysis for the DVT, prompt first rib removal, and occasional venoplasty or stenting. Our institution has increasingly used anticoagulation alone followed by interval first rib resection. We sought to analyze the effectiveness of this simplified technique. METHODS: Between September 2012 and April 2021, 27 patients were identified within the institution's electronic medical record as having undergone first rib resection for upper extremity DVT. Seven of these patients had undergone preoperative thrombolysis before referral and were excluded. Among the remaining 20 patients, preoperative clinic charts were evaluated for age, venous segment involvement, contralateral limb involvement, presence of documented hypercoagulable state, duration of preoperative and postoperative anticoagulation, and postoperative outcomes. RESULTS: Of the 20 patients (mean age, 26.2 years; 13 males) presenting with acute axillosubclavian DVT, all patients had right (n = 8) or left (n = 12) arm swelling. Five patients had extremity pain and four had extremity discoloration. Ten had axillosubclavian vein involvement, 9 had subclavian vein involvement, and 1 had axillary vein involvement. Two patients were on oral contraceptives and no patients had any other diagnosed hypercoagulable conditions. The mean duration of preoperative and postoperative anticoagulation was 3.2 ± 2.6 months and 2.1 ± 2.1 months, respectively. Nineteen patients underwent supraclavicular first rib resection and 1 patient underwent transaxillary resection. Twelve patients (60%) demonstrated complete DVT resolution by venous duplex examination during the postoperative period and 8 patients (40%) demonstrated partial recanalization/chronic DVT. Complications included one hemothorax and one thoracic duct injury. All 20 patients remain asymptomatic without arm swelling, with a mean follow-up of 55.1 ± 34.7 months. CONCLUSIONS: Among patients presenting with acute axillosubclavian DVT, anticoagulation alone followed by interval first rib resection proved to be successful in providing symptomatic relief in the short to medium term. By eliminating the need for preoperative thrombolysis and postoperative venograms, this potentially cost-saving algorithm simplifies our management for acute venous thoracic outlet syndrome while maintaining good clinical outcomes. Because this study only analyzed our management algorithm's effectiveness in the short to medium term, the long-term effectiveness of this treatment will need to be demonstrated.

Duplex Scans Performed Immediately Following Lower Extremity Angioplasty and Stenting are of Limited Utility.

BACKGROUND: Together with clinical examination, surveillance duplex examination represents the Society of Vascular Surgery recommendations for follow-up after endovascular intervention on the superficial femoral artery (SFA) and popliteal arterial segments. Compliance with postprocedural follow-up remains challenging. To establish a postangioplasty physiologic baseline, our institution began obtaining immediate postprocedural surveillance studies following lower extremity arterial interventions. We reviewed the utility of immediate postprocedural surveillance to determine if these studies enhanced postoperative care. METHODS: Serial patients undergoing SFA and popliteal angioplasty and stenting from January 2014 to December 2020 were identified from our prospectively maintained Vascular Surgery database. Patient demographic information, procedural details, and procedural outcomes were subsequently analyzed from the electronic medical record. RESULTS: Two hundred and sixty-three patients underwent 385 SFA and/or popliteal angioplasty/stenting interventions. Mean patient age was 64.8 ± 10 years. Among these 385 procedures, 350 (90.9%) were followed by immediate (<4 hours) postprocedural lower extremity arterial duplex scans. These 350 procedures included percutaneous transluminal angioplasty and/or stenting of the SFA (n = 236), popliteal artery (n = 34), or both (n = 80). Of these studies, 25 results (7.1%) were abnormal. One asymptomatic patient was admitted to hospital for immediate thrombolysis; however, the remaining 24 patients were followed clinically with no immediate intervention required. Abnormal results included 13 abnormalities appreciated on the final angiogram with 9 patients with known occlusions or stenoses, and 4 patients with mild to moderate CFA stenosis. Abnormal findings not detected on the final angiogram included 7 patients with mild to moderate stenosis and 5 patients with short occlusions (1.4%). All 5 patients with short segmental occlusions not detected on final arteriogram had preprocedural anatomy classified as either TASC C (TransAtlantic Inter-Society Consensus: SFA occlusions > 15 cm in length, n = 1) or TASC D (SFA occlusions > 20 cm in lenth, n = 4). CONCLUSIONS: Immediate postprocedural duplex scans demonstrate significant vessel stenosis or occlusion in approximately 7% of cases but most stenoses and occlusions were noted on final arteriography. Duplex detected short segmental occlusions not noted on final arteriography were rare (1.4%), and occurred among patients with TASC C or TASC D occlusive disease. These duplex detected abnormalities rarely changed the patient's immediate plan of care. The performance of these immediate postprocedural duplex scans demonstrated limited clinical utility.

Epidemiological Factors Associated with Gross Diagnosis of Pulmonary Pathology in Feedyard Mortalities.

Respiratory disease continues to be the major cause of mortality in feedyard cattle, with bronchopneumonia (BP) and acute interstitial pneumonia (AIP) as the two most common syndromes. Recent studies described a combination of these pathological lesions with the presence of AIP in the caudodorsal lungs and BP in the cranioventral lungs of necropsied cattle. This pulmonary pathology has been described as bronchopneumonia with an interstitial pneumonia (BIP). The epidemiological characteristics of BIP in U.S. feedyard cattle are yet to be described. This study's objectives were to describe the agreement between feedyard clinical and necropsy gross diagnosis and to characterize epidemiological factors associated with four gross pulmonary diagnoses (AIP, BIP, BP, and Normal pulmonary tissue) observed during feedyard cattle necropsies. Systemic necropsies were performed at six feedyards in U.S. high plains region, and gross pulmonary diagnoses were established. Historical data were added to the dataset, including sex, days on feed at death (DOFDEATH), arrival weight, treatment count, and feedyard diagnosis. Generalized linear models were used to evaluate epidemiological factors associated with the probability of each pulmonary pathology. Comparing feedyard clinical diagnosis with gross pathological diagnosis revealed relatively low agreement and the frequency of agreement varied by diagnosis. The likelihood of AIP at necropsy was higher for heifers than steers and in the 100-150 DOFDEATH category compared with the 0-50 DOFDEATH (p = 0.05). The likelihood of BIP increased after the first treatment, whereas the DOFDEATH 0-50 category had a lower likelihood compared with the 150-200 category (p = 0.05). These findings highlight the importance of necropsy for final diagnosis and can aid the development of future diagnosis and therapeutic protocols for pulmonary diseases.

Evaluation of predictive models to determine final outcome for feedlot cattle based on information available at first treatment for bovine respiratory disease.

OBJECTIVE: To evaluate predictive model ability to determine whether an animal finished the feeding period using data known at first treatment for bovine respiratory disease (BRD). Additional comparisons evaluated the potential benefits of predictions by adding weather data, utilizing balancing techniques, and creating models for individual feedyards. ANIMALS: This retrospective study included animal, pen, and feedyard data from 12 US feedyards from 2016 to 2021. The final dataset consisted of 96,382 BRD cases of which 14.2% did not finish the feeding phase. PROCEDURES: Five predictive models were trained and underwent threshold probability adjustment to maximize F1 score. Model performance was evaluated using accuracy, sensitivity specificity, positive and negative predictive values, and area under the receiver operating characteristics curve (AUC). RESULTS: Overall, model performance was low with a median AUC value of 0.675. The addition of weather data had little effect on AUC but resulted in more variation in sensitivity and specificity. Resampling the dataset had a limited effect on performance. Individual feedlot models had higher AUC values than others with the decision tree typically performing best in most feedyards. CLINICAL RELEVANCE: Results indicated some utility of predictive models evaluating BRD cases to predict cattle that did not finish the feeding phase. These models could be valuable in assisting health providers making decisions on individual cases.

Efficacy of high-level disinfection of endoscopes contaminated with Streptococcus equi subspecies equi with 2 different disinfectants.

BACKGROUND: Prevention of spread of Streptococcus equi subspecies equi (S. equi) after an outbreak is best accomplished by endoscopic lavage of the guttural pouch, with samples tested by culture and real time, quantitative polymerase chain reaction (qPCR). Disinfection of endoscopes must eliminate bacteria and DNA to avoid false diagnosis of carrier horses of S. equi. HYPOTHESIS/OBJECTIVES: Compare failure rates of disinfection of endoscopes contaminated with S. equi using 2 disinfectants (accelerated hydrogen peroxide [AHP] or ortho-phthalaldehyde [OPA]). The null hypothesis was that there would be no difference between the AHP and OPA products (based on culture and qPCR results) after disinfection. METHODS: Endoscopes contaminated with S. equi were disinfected using AHP, OPA or water (control). Samples were collected before and after disinfection and submitted for detection of S. equi by culture and qPCR. Using a multivariable logistic regression model-adjusted probability, with endoscope and day as controlled variables, the probability of an endoscope being qPCR-positive was determined. RESULTS: After disinfection, all endoscopes were culture-negative (0%). However, the raw unadjusted qPCR data were positive for 33% AHP, 73% OPA, and 71% control samples. The model-adjusted probability of being qPCR-positive after AHP disinfection was lower (0.31; 95% confidence interval [CI], -0.03-0.64) compared to OPA (0.81; 95% CI, 0.55-1.06), and control (0.72; 95% CI, 0.41-1.04). CONCLUSION AND CLINICAL IMPORTANCE: Disinfection using the AHP product resulted in significantly lower probability of endoscopes being qPCR-positive compared to the OPA product and control.

A meta-analysis on the effect of proximal landing zone location on stroke and mortality in thoracic endovascular aortic repair.

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) involving the aortic arch may increase the opportunity for stroke owing to disruption of cerebral circulation and embolization. In this study, a systematic meta-analysis was performed to examine the impact of proximal landing zone location on stroke and 30-day mortality after TEVAR. METHODS: MEDLINE and Cochrane Library were searched for all original studies of TEVAR reporting outcomes of stroke or 30-day mortality for at least two adjacent proximal landing zones, based on the Ishimaru classification scheme. Forest plots were created using relative risks (RR) with 95% confidence intervals (CI). An I2 of <40% was regarded as minimal heterogeneity. A P value of <.05 was considered significant. RESULTS: Of the 57 studies examined, a total of 22,244 patients (male 73.1%, aged 71.9 ± 11.5 years) were included in the meta-analysis, with 1693 undergoing TEVAR with proximal landing zone 0, 1931 with zone 1, 5839 with zone 2, and 3089 with zone 3 and beyond. The overall risk of clinically evident stroke was 2.7% for zones ≥3, 6.6% for zone 2, 7.7% for zone 1, and 14.2% for zone 0. More proximal landing zones were associated with higher risks of stroke compared with distal (zone 2 vs ≥3: RR, 2.14; 95% CI, 1.43-3.20; P = .0002; I2 = 56%; zone 1 vs 2: RR, 1.48; 95% CI, 1.20-1.82; P = .0002; I2 = 0%; zone 0 vs 1: RR, 1.85; 95% CI, 1.52-2.24; P < .00001; I2 = 0%). Mortality at 30 days was 2.9% for zones ≥3, 2.4% for zone 2, 3.7% for zone 1, and 9.3% for zone 0. Zone 0 was associated with higher mortality compared with zone 1 (RR, 2.30; 95% CI, 1.75-3.03; P < .00001; I2 = 0%). No significant differences were found in 30-day mortality between zones 1 and 2 (P = .13) and between zone 2 and zones ≥3 (P = .87). CONCLUSIONS: The risk of stroke from TEVAR is lowest in zone 3 and beyond, increasing significantly as the landing zone is moved proximally. Furthermore, perioperative mortality is increased with zone 0 compared with zone 1. Therefore, risk of stent grafting in the proximal arch should be weighed against alternative surgical or nonoperative options. It is anticipated that the risk of stroke will improve with further development of stent graft technology and implantation technique.

Retrospective analysis of risk and timing of death from right heart failure in United States and Canadian feedlot necropsied cattle.

OBJECTIVE: To evaluate the risk and timing of right heart failure (RHF) in feedlot cattle. ANIMALS: Study population consisted of 1,717,356 cattle (5,527 cohorts) in 13 US and Canadian feedlots. There were 1,336 RHF diagnosed at necropsy. PROCEDURES: Multivariable models were utilized to evaluate risk and timing of RHF death. RESULTS: Arrival year was associated with RHF and was influenced by arrival quarter on the magnitude of risk of RHF (P < .01), but no linear increase over years was identified. The impact of feedlot elevation on RHF was modified by breed (beef, dairy, or dairy-cross; P < .01) with beef cattle in the highest elevation category having 0.54 times the risk of RHF as dairy cattle in the same elevation category (LCL = 0.31; UCL = 0.962). Cattle that died due to RHF and were treated for bovine respiratory disease died 11 days (LCL = 1.33, UCL = 20.2 days) sooner than cattle never treated for bovine respiratory disease (P = .03). Cattle breed was associated with RHF timing (P = .01), and dairy-cross cattle RHF cases died approximately 37 days earlier (SE = 13.0 days; P = .01) compared to beef cattle. CLINICAL RELEVANCE: This research showed demographic factors associated with RHF and their respective influence on risk and timing of RHF. Risk rates of RHF were similar to previous research. This could allow for comparisons across different feedlot populations, using different diagnoses at necropsy and RHF risk/rates do not appear to be increasing.

No evidence for a negative association between bovine leukemia virus status and fertility in Kansas beef herds: a cross-sectional study.

OBJECTIVE: Determine the association between bovine leukemia virus (BLV) status and fertility in beef cows. BLV-status was defined using 3 different testing strategies (ELISA-, quantitative polymerase chain reaction- [qPCR], and high proviral load [PVL]-status). Fertility was defined as the overall probability of pregnancy as well as the probability of becoming pregnant in the first 21 days of the breeding season. ANIMALS: Convenience sample of 2,820 cows from 43 beef herds. PROCEDURES: The association of BLV-status with the probability of becoming pregnant was evaluated with a multivariable logistic regression analysis that used pregnancy status as a binary outcome, herd nested within ranch as a random effect, and BLV-status (ELISA-, qPCR-, and PVL-status as separate models) and potential covariates (eg, age, Body Condition Score [BCS] category, and interactions) as fixed effects. RESULTS: Raw data revealed that 55% (1,552/2,820) of cows were classified as BLV-positive by ELISA, and 95.3% (41/43) of herds had a least 1 ELISA-positive cow. Classification as BLV ELISA-positive was positively associated with the probability of being pregnant; however, when qPCR or PVL were used to classify BLV-status, there was no association with the probability of being pregnant. None of the methods of classifying BLV-status were associated with the probability of becoming pregnant in the first 21 days of the breeding season. CLINICAL RELEVANCE: This study did not find evidence that testing beef cows for BLV-status using ELISA, qPCR, or a cut-off of 0.9 PVL and removing test-positive cows will improve cowherd fertility as described by the probability of becoming pregnant during the breeding season or becoming pregnant during the first 21 days of the breeding season.

Evaluation of First Treatment Timing, Fatal Disease Onset, and Days from First Treatment to Death Associated with Bovine Respiratory Disease in Feedlot Cattle.

Bovine respiratory disease (BRD) is a frequent beef cattle syndrome. Improved understanding of the timing of BRD events, including subsequent deleterious outcomes, promotes efficient resource allocation. This study's objective was to determine differences in timing distributions of initial BRD treatments (Tx1), days to death after initial treatment (DTD), and days after arrival to fatal disease onset (FDO). Individual animal records for the first BRD treatment (n = 301,721) or BRD mortality (n = 19,332) were received from 25 feed yards. A subset of data (318-363 kg; steers/heifers) was created and Wasserstein distances were used to compare temporal distributions of Tx1, FDO, and DTD across genders (steers/heifers) and the quarter of arrival. Disease frequency varied by quarter with the greatest Wasserstein distances observed between Q2 and Q3 and between Q2 and Q4. Cattle arriving in Q3 and Q4 had earlier Tx1 events than in Q2. Evaluating FDO and DTD revealed the greatest Wasserstein distance between cattle arriving in Q2 and Q4, with cattle arriving in Q2 having later events. Distributions of FDO varied by gender and quarter and typically had wide distributions with the largest 25-75% quartiles ranging from 20 to 80 days (heifers arriving in Q2). The DTD had right-skewed distributions with 25% of cases occurring by days 3-4 post-treatment. Results illustrate temporal disease and outcome patterns are largely right-skewed and may not be well represented by simple arithmetic means. Knowledge of typical temporal patterns allows cattle health managers to focus disease control efforts on the correct groups of cattle at the appropriate time.

Determining Frequency of Common Pulmonary Gross and Histopathological Findings in Feedyard Fatalities.

Pulmonary disease is often associated with feedlot cattle mortality, and the most common syndromes include bronchopneumonia, acute interstitial pneumonia, and bronchopneumonia with an interstitial pneumonia. The study objective was to utilize gross necropsy and histopathology to determine the frequency of pulmonary lesions from three major syndromes and agreement between gross and histopathological diagnosis. A cross sectional, observational study was performed at six U.S. feedyards using a full systematic necropsy to assess mortalities during summer 2022. A subset of mortalities had four lung samples submitted for histopathological diagnosis. Gross necropsy was performed on 417 mortalities, 402 received a gross diagnosis and 189 had a histopathological diagnosis. Descriptive statistics were used to evaluate pulmonary diagnosis frequency based on method (gross/histopathology), and generalized linear mixed models were used to evaluate agreement between histopathological and gross diagnoses. Using gross diagnosis, bronchopneumonia represented 36.6% of cases with acute interstitial pneumonia and bronchopneumonia with an interstitial pneumonia representing 10.0% and 35.8%, respectively. Results identified bronchopneumonia with an interstitial pneumonia as a frequent syndrome which has only been recently reported. Histopathological diagnosis had similar findings; bronchopneumonia represented 32.3% of cases, with acute interstitial pneumonia and bronchopneumonia with an interstitial pneumonia representing 12.2% and 36.0%, respectively. Histopathological diagnosis tended (p-VALUE = 0.06) to be associated with gross diagnosis. Pulmonary disease was common and both diagnostic modalities illustrated three primary syndromes: bronchopneumonia, acute interstitial pneumonia, and bronchopneumonia with an interstitial pneumonia with similar frequencies. Improved understanding of pulmonary pathology can be valuable for evaluating and adjusting therapeutic interventions.

Stochastic, individual animal systems simulation model of beef cow-calf production: development and validation.

A stochastic, individual animal systems simulation model describing U.S. beef cow-calf production was developed and parameterized to match typical U.S. Angus genetics under cow-calf production conditions in the Kansas Flint Hills. Model simulation results were compared to available actual, multivariate U.S. cow-calf production data reported according to beef cow-calf standardized performance analysis (SPA) methodology through North Dakota State University's CHAPS program to assess model validity. Individual animal nutrition, reproduction, growth, and health characteristics, as well as production state are determined on a daily time step. Any number of days can be simulated. These capabilities allow for decision analysis and assessment of long-run outcomes of various genetic, management, and economic scenarios regarding multiple metrics simultaneously. Parameterizing the model to match Kansas Flint Hills production conditions for the years 1995 through 2018, 32 different genetic combinations for mature cow weight and peak lactation potential were simulated with 100 iterations each. Sire mature cow weight genetics ranged from 454 to 771 kg in 45 to 46 kg increments. Sire peak lactation genetics were considered at 6.8, 9, 11.3, and 13.6 kg/d for all eight mature cow weights. Utilizing model results for the years 2000 to 2018, raw model results were assessed against actual historical cow-calf production data. Exploratory factor analysis was applied to interpret the underlying factor scores of model output relative to actual cow-calf production data. Comparing modeled herd output with CHAPS herd data, median average calf weaning age, average cow age, percent pregnant per cow exposed, and percent calf mortality per calf born of model output was 3.4 d greater, 0.2 yr greater, 1 percentage point less, and 1.7 percentage points greater, respectively. Subtracting the median CHAPS pre-weaning average daily gain from the median modeled pre-weaning average daily gain for each of the eight respective mature cow weight genetics categories, and then calculating the median of the eight values, the median difference was -0.21 kg/d. Performing the same calculation for birth weight and adjusted 205 d weaning weight, the modeled data was 4.9 and 48.6 kg lighter than the CHAPS data, respectively. Management and genetic details underlying the CHAPS data were unknown.

An Evaluation of Temporal Distributions of High, Low, and Zero Cohort Morbidity of Cumulative First Treatment Bovine Respiratory Disease and Their Associations with Demographic, Health, and Performance Outcomes in US Feedlot Cattle.

Timing and magnitude of bovine respiratory disease (BRD) can impact intervention and overall economics of cattle on feed. Furthermore, there is a need to better describe when cattle are being treated for BRD. The first objective was to perform a cluster analysis on the temporal distributions of cumulative first treatment BRD from HIGH (≥15% of cattle received treated for BRD) and LOW cohorts (>0 and <15% of cattle received treated for BRD) to assess cohort-level timing (days on feed) of BRD first treatments. The second objective was to determine associations among cluster groups (temporal patterns) and demographic risk factors, health outcomes, and performance. Cluster analysis determined that optimal number of clustering groups for the HIGH morbidity cohort was six clusters and LOW morbidity cohort was seven clusters. Cohorts with zero BRD treatment records were added for statistical comparisons. Total death loss, BRD morbidity, average daily gain (ADG), railing rate, days to 50% BRD, cattle received, shrink, arrival weight, and sex were associated with temporal groups (p < 0.05). These data could be used as a tool for earlier identification and potential interventions for cohorts based on the BRD temporal pattern.

Image Classification and Automated Machine Learning to Classify Lung Pathologies in Deceased Feedlot Cattle.

Bovine respiratory disease (BRD) and acute interstitial pneumonia (AIP) are the main reported respiratory syndromes (RSs) causing significant morbidity and mortality in feedlot cattle. Recently, bronchopneumonia with an interstitial pattern (BIP) was described as a concerning emerging feedlot lung disease. Necropsies are imperative to assist lung disease diagnosis and pinpoint feedlot management sectors that require improvement. However, necropsies can be logistically challenging due to location and veterinarians' time constraints. Technology advances allow image collection for veterinarians' asynchronous evaluation, thereby reducing challenges. This study's goal was to develop image classification models using machine learning to determine RS diagnostic accuracy in right lateral necropsied feedlot cattle lungs. Unaltered and cropped lung images were labeled using gross and histopathology diagnoses generating four datasets: unaltered lung images labeled with gross diagnoses, unaltered lung images labeled with histopathological diagnoses, cropped images labeled with gross diagnoses, and cropped images labeled with histopathological diagnoses. Datasets were exported to create image classification models, and a best trial was selected for each model based on accuracy. Gross diagnoses accuracies ranged from 39 to 41% for unaltered and cropped images. Labeling images with histopathology diagnoses did not improve average accuracies; 34-38% for unaltered and cropped images. Moderately high sensitivities were attained for BIP (60-100%) and BRD (20-69%) compared to AIP (0-23%). The models developed still require fine-tuning; however, they are the first step towards assisting veterinarians' lung diseases diagnostics in field necropsies.

Differential engagement of inhibitory and excitatory cardiopulmonary reflexes by capsaicin and phenylbiguanide in C57BL/6 mice.

The Bezold-Jarisch reflex is a powerful inhibitory reflex initiated by activation of cardiopulmonary vagal nerves during myocardial ischemia, hemorrhage, and orthostatic stress leading to bradycardia, vasodilation, hypotension, and vasovagal syncope. This clinically relevant reflex has been studied by measuring heart rate (HR) and mean arterial pressure (MAP) responses to injections of a variety of chemical compounds. We hypothesized that reflex responses to different compounds vary due to differential activation of vagal afferent subtypes and/or variable coactivation of excitatory afferents. HR and MAP responses to intravenous injections of the transient receptor potential vanilloid-1 (TRPV1) agonist capsaicin and the serotonin 5-HT3 receptor agonist phenylbiguanide (PBG) were measured in anesthetized C57BL/6 mice before and after bilateral cervical vagotomy. Capsaicin and PBG evoked rapid dose-dependent decreases in HR and MAP followed by increases in HR and MAP above baseline. Bezold-Jarisch reflex responses were abolished after vagotomy, whereas the delayed tachycardic and pressor responses to capsaicin and PBG were differentially enhanced. The relative magnitude of bradycardic versus depressor responses (↓HR/↓MAP) in vagus-intact mice was greater with capsaicin. In contrast, after vagotomy, the magnitude of excitatory tachycardic versus pressor responses (↑HR/↑MAP) was greater with PBG. Although capsaicin-induced increases in MAP and HR postvagotomy were strongly attenuated or abolished after administration of the ganglionic blocker hexamethonium, PBG-induced increases in MAP and HR were mildly attenuated and unchanged, respectively. We conclude that responses to capsaicin and PBG differ in mice, with implications for delineating the role of endogenous agonists of TRPV1 and 5-HT3 receptors in evoking cardiopulmonary reflexes in pathophysiological states.

The influence of bed height as a percentage of participant height on low back forces when boosting a patient up in bed.

BACKGROUND: Repositioning patients is a frequent task for healthcare workers causing substantial stress to the low back. Patient handling methodologies that reduce low back load should be used. Some studies have observed the effect of bed height on back forces using a limited range of heights. This study details a wider range. OBJECTIVE: The aim of this study was to discover an optimal bed height for reducing low back force when boosting a patient. METHODS: 11 university students and local residents participated by completing a series of boosts with a 91.6 kg research assistant acting as dependent. The bed was adjusted 3% of participant height and 3 boosts were completed at each height which resulted in 8-10 different bed heights depending on the height of the participant. Motion and force data were collected to estimate low back forces via 3DSSPP. Pearson's R was performed to observe the correlation between caregiver height and low back forces. RESULTS: There were significant negative correlations between bed height and low back compression force at L4-L5 (r = -0.676, p = <0.001) and L5-S1 (r = -0.704, p = <0.001). There were no significant correlations with any shear forces. CONCLUSION: The highest bed height led to decreased low back compression forces regardless of participant height, but there was not a significant difference in shear forces. Thus, healthcare workers may experience less low back stress with the bed at a higher height. There may be a force tradeoff between the low back and other parts of the body that needs further exploration. Healthcare workers need to be made aware of the implications of adjusting the environment when performing patient handling tasks.

Safety of Utilizing Ultrasound as the Sole Modality of Follow-Up after Endovascular Aneurysm Repair.

BACKGROUND: Post endovascular aneurysm repair (EVAR), surveillance with computed tomography-aortography (CTA) remains the most common practice, per Society for Vascular Surgery (SVS) guidelines. Chronic exposure to both radiation and intravenous (IV) contrast has raised concerns about long-term CTA follow-up (FU). As we have selectively used ultrasound (US) as a sole modality for post-EVAR surveillance, we sought to review our outcomes in this subset of patients. METHODS: Retrospective review of our institution's vascular database identified 213 EVAR patients from 2013 to 2021. Fenestrated-EVAR and snorkel reconstructions were excluded. Patient demographics/outcomes, abdominal aortic aneurysm (AAA) characteristics, and FU modalities and outcomes were analyzed. Unpaired Student's t-test, ANOVA, and chi-squared test were used to assess group differences. RESULTS: Eighty-five of the 213 EVAR patients (39.9%) were lost to FU within 3 months. Among the 128 remaining patients, 91 underwent FU using initial US, while 37 patients underwent post-EVAR FU initially using CTA. There were no significant differences (P > 0.05) between patient age (75.5 ± 9.4 vs. 75.3 ± 8.5), body mass index (BMI) (27.7 ± 5.4 vs. 28.9 ± 7.4), or mean AAA size (5.6 ± 1.1 vs. 5.9 ± 1.2) in US-surveilled and computed tomography (CT)-surveilled groups, respectively. Of the 91 patients, initially surveilled with US, 15 patients demonstrated endoleak and/or AAA growth (>5 mm). The 15 patients with US-demonstrated endoleak and/or growth underwent confirmatory CTA, with 3 patients eventually requiring EVAR revision. Among 37 patients initially surveilled with CT, 10 demonstrated significant growth and 2 patients eventually required EVAR revision. There were no patients with AAA rupture during post-EVAR surveillance. FU data were analyzed among a select lower-risk group of patients (preoperative AAA diameter ≤5.5 cm, BMI ≤30, and no endoleak at completion of EVAR). Among this group, there were no surveilled patients who required EVAR reintervention, regardless of surveillance modality (US n = 32; CT n = 4). The average FU was 29.5 ± 26.4 months in the US group and 26.4 ± 22.3 months in the CT group (P > 0.05). CONCLUSIONS: Although initial CT surveillance following EVAR remains ideal, in select lower-risk patients, US is a viable alternative even for the initial post-procedure study. Advantages include decreased radiation exposure and cost. Our data suggest that US is a safe sole modality for surveillance following EVAR in selective patients.

Spinal drain for aortic aneurysm repairs: tool or toy?

PURPOSE OF REVIEW: Spinal cord injury (SCI) is one of the biggest complications in open and endovascular aortic repairs. Historically, cerebrospinal fluid drains (CSFD) have been one of the most effective modalities in reducing SCI and one of the most studied. CSFD placement also carries its' own set of procedural risks. This editorial intends to evaluate recent literature to determine whether CSFDs remain a valuable tool in aortic repair. RECENT FINDINGS: As the surgical management of thoracic aortic aneurysms has evolved, there has been an increasing number of endovascular repairs. Current recommendations emphasize prophylactic CSFD placement in endovascular repair cases deemed 'high risk.' However, several meta-analyses differ on whether prophylactic CSFD placement reduced the risk of SCI. The incidence of SCI decreased between 2014 and 2018, despite a similar rate of prophylactic CSFD placement suggesting other techniques are being performed and may be effective in spinal cord protection as well. SUMMARY: There has been conflicting data on whether CSFDs have a role in reducing the risk of SCI in endovascular aortic repair. Some studies suggest that there is no benefit to placement while others suggest that routine prophylactic drains should be placed for all endovascular cases. Despite this, efforts have been made to selectively place CSFDs in those patients deemed at 'high risk' for SCI. CSFDs also remain a part of rescue treatment for postoperative SCI. This suggests that CSFDs continue to be a valuable tool that we need to better comprehend. Future research is necessary to better understand how patient risk factors can be balanced with perioperative management to help identify patients who may benefit from CSFD placement.

Nasopharyngeal Bacterial Prevalence and Microbial Diversity at First Treatment for Bovine Respiratory Disease (BRD) and Its Associations with Health and Mortality Outcomes in Feedyard Cattle.

Bovine respiratory disease (BRD) is an economically important disease in feedyards influencing both animal welfare and antimicrobial utilization. Major pathogens associated with BRD have been identified in previous research, but little information is available on the relationship between nasopharyngeal microbiota and health outcomes. The objective of this study was to identify potential associations between nasopharyngeal microbiota and antimicrobial resistance patterns of clinical cases that lived or died compared to non-diseased controls. Enrolled animals were subdivided based on clinical disease status and case outcome (subsequent mortality). Deep nasopharyngeal swabs were collected on enrolled animals and submitted for bacterial isolation, antimicrobial susceptibility determination, and metagenomics analysis. Enrolled cattle were represented in three groups: animals at first treatment for BRD that subsequently died (BRDM, n = 9), animals at first treatment for BRD that subsequently lived (BRDL, n = 15), and animals that were never treated for BRD during the feeding phase (CONT, n = 11). Antimicrobial resistance patterns for Pasteurella multocida illustrated cattle in each outcome category had isolates that were pan-susceptible or only showed resistance to oxytetracycline. The relative abundance of species and genera illustrated few differences among the three outcomes. Higher alpha diversity was identified in BRDL compared to CONT at the species level, and both BRDL and BRDM showed increased alpha diversity compared to CONT at the general level. Overall, this work illustrated nasopharyngeal microbiota showed relatively few differences among BRD cases that lived or died compared to animals without BRD.

Cross-sectional study to describe bovine leukemia virus herd and within-herd ELISA prevalence and bovine leukemia virus proviral load of convenience-sampled Kansas beef cow-calf herds.

OBJECTIVE: Determine bovine leukemia virus (BLV) seroprevalence of adult female cattle in Eastern Kansas beef herds and the proviral load (PVL) of those cattle found to be ELISA positive. ANIMALS: Convenience sample of 2,845 cows from 44 beef herds. PROCEDURES: BLV serostatus was determined using an ELISA antibody test (gp-51; IDEXX). BLV quantitative PCR (qPCR) status and PVL were determined utilizing a qPCR test (SS1 qPCR test; CentralStar Laboratories). The association of age, herd size, and body condition score (BCS) category on the probability of being BLV positive was evaluated with a multiple variable logistic regression analysis that used BLV status as a binary outcome, herd nested within ranch as a random effect, and BCS, herd size, and age category as fixed effects. RESULTS: Forty-two of 44 herds had at least 1 BLV ELISA-positive cow (95.5% herd seroprevalence). Overall, 1,564 of the 2,845 cows were BLV ELISA positive (55.0% individual animal prevalence). No association between BLV ELISA status and herd size or BCS was identified. When evaluated by age, the model-adjusted probability of being BLV ELISA positive was lowest for heifers (1 year of age, first parity) and increased until 5 to 6 years of age. Of the 1,564 ELISA-positive animals, 838 were qPCR positive (53.6%). The model-adjusted probability of being qPCR positive was not associated with age, herd size, or BCS category. CLINICAL RELEVANCE: This study indicated that BLV-seropositive status both as a herd classification and individual animal classification was very common in this population. Because the percentage of BLV-seropositive cows varied between herds and by age, this study provides evidence that it is essential for investigators to control for herd and age in any analysis of the association of BLV serostatus and health and production outcomes of interest. Some BLV ELSIA-seropositive cows were classified as BLV negative by qPCR, and risk factors may differ between classification status by ELISA and qPCR.