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The preweaning period for a dairy calf is characterized by high morbidity and mortality rates, leading to financial losses for producers. Identifying strategies to improve the health and welfare of calves while reducing antimicrobial use continues to be crucial to the success of the dairy industry. The objective of this study was to determine the effects of feeding colostrum replacer (CR) to dairy heifer calves beyond d 1 of life on growth, serum IgG, the incidence of diarrhea and bovine respiratory disease (BRD), and the risk of mortality in the preweaning period. At birth, Holstein heifer calves (n = 200; 50/treatment) weighing 40.7 ± 0.35 kg (mean ± SE) were fed 3.2 L of CR (205 g IgG/feeding) at 0 h and 12 h of life. Calves were then randomly assigned to 1 of 4 treatments: 450 g of milk replacer (MR) from d 2 to 14 (control, CON), 380 g of CR + 225 g of MR from d 2 to 3, then 450 g of MR from d 4 to 14 (transition, TRAN), 45 g of CR + 450 g of MR from d 2 to 14 (extended, EXT); or 380 g of CR + 225 g of MR from d 2 to 3, then 45 g of CR + 450 g of MR from d 4 to 14 (transition + extended, TRAN+EXT). Each treatment was reconstituted to 3 L and fed twice daily. All CR treatments were fed using bovine-derived CR containing 27% IgG. From d 15 to 41, all calves were fed 600 g of MR reconstituted to 4 L twice daily. Body weight was recorded at birth and every 7 d until study completion on d 49. Blood samples were taken daily until d 7 to evaluate serum IgG and then every 7 d until d 49. A health assessment was performed daily to evaluate calves for BRD and diarrhea. Data were analyzed using mixed linear regression, mixed logistic regression, and survival analysis models in SAS 9.4. Serum IgG concentrations were not affected by treatment for the study period. The EXT and TRAN+EXT groups had greater average daily gain (ADG) from d 7 to 14 (0.14 kg/d) and the TRAN group had greater ADG from d 14 to 21 (0.11 kg/d), compared with CON. There was no association of treatment with the odds or the duration of a diarrhea bout. However, provision of CR to the TRAN and EXT calves was associated with a reduced hazard of diarrhea compared with CON calves. Furthermore, TRAN and EXT calves have a lower hazard of mortality compared with CON calves, with TRAN and EXT calves had a 2.8- and 3.8-times lower hazard of mortality, respectively. Our findings suggest that the supplementation of CR to dairy calves positively affects ADG, and reduces the hazard of diarrhea and mortality during the preweaning period. Future research should look to further refine the supplementation strategy of CR to calves and explore the mechanism of action.
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Ingestion and absorption of greater quantities of IgG are required to increase serum IgG levels in newborn calves. This could be achieved by adding colostrum replacer (CR) to maternal colostrum (MC). The objective of this study was to investigate whether low and high-quality MC can be enriched with bovine dried CR to achieve adequate serum IgG levels. Male Holstein calves (n = 80; 16/treatment) with birth body weights (BW) of 40 to 52 kg were randomly enrolled to be fed 3.8 L of the following combinations: 30 g/L IgG MC (C1), 60 g/L IgG MC (C2), 90 g/L IgG MC (C3), C1 enriched with 551 g of CR (60 g/L; 30-60CR), or C2 enriched with 620 g of CR (90 g/L: 60-90CR). A subset of 40 calves (8/treatment) had a jugular catheter placed and were fed colostrum containing acetaminophen at a dose of 150 mg/kg of metabolic body weight, to estimate abomasal emptying rate per hour (kABh). Baseline blood samples were taken (0 h), followed by sequential samples at 1, 2, 3, 4, 5, 6, 8, 10, 12, 24, 36, and 48 h relative to initial colostrum feeding. Results for all measurements are presented in the following order, unless otherwise stated: C1, C2, C3, 30-60CR, and 60-90CR. Serum IgG levels at 24 h were different among calves fed C1, C2, C3, 30-60CR, and 60-90CR: 11.8, 24.3, 35.7, 19.9, and 26.9 mg/mL ± 1.02 (mean ± SEM), respectively. Serum IgG at 24 h increased when enriching C1 to 30-60CR, but not from C2 to 60-90CR. Similarly, apparent efficiency of absorption (AEA) values for calves fed C1, C2, C3, 30-60CR, and 60-90CR were different: 42.4, 45.1, 43.2, 36.3, and 33.4% ± 1.93, respectively. Enriching C2 to 60-90CR reduced AEA, and enriching C1 to 30-60CR tended to decrease AEA. The kABh values for C1, C2, C3, 30-60CR, and 60-90CR were also different: 0.16, 0.13, 0.11, 0.09, and 0.09 ± 0.005, respectively. Enriching C1 to 30-60CR or C2 to 60-90CR reduced kABh. However, 30-60CR and 60-90CR have similar kABh compared with a reference colostrum meal (90 g/L IgG, C3). Even though kABh was reduced for 30-60CR, results indicate that C1 has the potential to be enriched and achieve acceptable serum IgG levels at 24 h without affecting AEA.
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Líquidos Corporais , Colostro , Feminino , Gravidez , Animais , Bovinos , Masculino , Colostro/metabolismo , Animais Recém-Nascidos , Imunoglobulina G , Líquidos Corporais/metabolismo , Peso CorporalRESUMO
Epigenetic mechanisms regulate processes of neuroplasticity critical to cocaine-induced behaviors. This includes the Class I histone deacetylase (HDAC) HDAC3, known to act as a negative regulator of cocaine-associated memory formation within the nucleus accumbens (NAc). Despite this, it remains unknown how cocaine alters HDAC3-dependent mechanisms. Here, we profiled HDAC3 expression and activity in total NAc mouse tissue following cocaine exposure. Although chronic cocaine did not affect expression of Hdac3 within the NAc, chronic cocaine did affect promoter-specific changes in HDAC3 and H4K8Ac occupancy. These changes in promoter occupancy correlated with cocaine-induced changes in expression of plasticity-related genes. To causally determine whether cocaine-induced plasticity is mediated by HDAC3's deacetylase activity, we overexpressed a deacetylase-dead HDAC3 point mutant (HDAC3-Y298H-v5) within the NAc of adult male mice. We found that disrupting HDAC3's enzymatic activity altered selective changes in gene expression and synaptic plasticity following cocaine exposure, despite having no effects on cocaine-induced behaviors. In further assessing HDAC3's role within the NAc, we observed that chronic cocaine increases Hdac3 expression in Drd1 but not Drd2-cells of the NAc. Moreover, we discovered that HDAC3 acts selectively within D1R cell-types to regulate cocaine-associated memory formation and cocaine-seeking. Overall, these results suggest that cocaine induces cell-type-specific changes in epigenetic mechanisms to promote plasticity important for driving cocaine-related behaviors.SIGNIFICANCE STATEMENT Drugs of abuse alter molecular mechanisms throughout the reward circuitry that can lead to persistent drug-associated behaviors. Epigenetic regulators are critical drivers of drug-induced changes in gene expression. Here, we demonstrate that the activity of an epigenetic enzyme promotes neuroplasticity within the nucleus accumbens (NAc) critical to cocaine action. In addition, we demonstrate that these changes in epigenetic activity drive cocaine-seeking behaviors in a cell-type-specific manner. These findings are key in understanding and targeting cocaine's impact of neural circuitry and behavior.
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Cocaína/administração & dosagem , Comportamento de Procura de Droga/fisiologia , Histona Desacetilases/biossíntese , Plasticidade Neuronal/fisiologia , Núcleo Accumbens/citologia , Núcleo Accumbens/enzimologia , Animais , Condicionamento Psicológico/efeitos dos fármacos , Condicionamento Psicológico/fisiologia , Inibidores da Captação de Dopamina/administração & dosagem , Comportamento de Procura de Droga/efeitos dos fármacos , Ativação Enzimática/efeitos dos fármacos , Ativação Enzimática/fisiologia , Epigênese Genética/efeitos dos fármacos , Epigênese Genética/fisiologia , Histona Desacetilases/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Plasticidade Neuronal/efeitos dos fármacos , Núcleo Accumbens/efeitos dos fármacos , AutoadministraçãoRESUMO
It is critical that bovine maternal colostrum is fed to newborn calves during their first hours of life. Colostrum is the secretion a cow produces after mammary involution that is rich in various nutrients. In addition to the nutritive value for newborn calves, immunoglobulins are of interest due to their role in developing the naïve immune system of calves at birth. The process by which a calf acquires immunity via absorption of immunoglobulins is defined as passive immunity. When calves consume an adequate amount of immunoglobulins, they are classified as having successful passive immunity (SPI). In contrast, if they are deprived of adequate colostrum, they are considered to have had a failure of transfer of passive immunity (FPI). Transfer of passive immunity is assessed by measuring serum IgG concentrations at 24 to 48 h of age. The major factors that influence whether a calf has SPI or FPI are colostrum IgG concentration, quantity fed, and age of calf at colostrum feeding. Monitoring apparent efficiency of immunoglobulin absorption in calves is often recommended to evaluate overall colostrum management practices. Serum IgG analyses can be determined with direct (radial immunodiffusion) or indirect (refractometry) methods and used to assess SPI or FPI prevalence.
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Colostro , Imunoglobulina G , Animais , Animais Recém-Nascidos , Bovinos , Feminino , Imunodifusão/veterinária , Parto , GravidezRESUMO
Calves might experience an upper limit of IgG absorption from colostrum ingestion at birth, but it is not clear whether the total IgG mass fed in the first meal or feeding frequencies can saturate the IgG transport mechanism and therefore limit IgG absorption. The objective of this study was to determine whether different colostrum replacer (CR) feeding frequencies affect serum IgG levels or apparent efficiency of absorption (AEA) in neonatal calves. Male Holstein calves (n = 40) were separated from their dams immediately after parturition and randomly assigned to receive CR [12% of birth body weight (BW)], following either (1) a low-frequency (LF; n = 20) or (2) a high-frequency (HF; n = 20) feeding protocol. Low-frequency calves received 2 CR meals (8% and 4% birth BW within 1 h after birth and 12 h after first CR feeding, respectively), whereas HF calves received 3 CR meals (4% of BW for each meal; within 1 h after birth, 6, and 12 h after first CR feeding). The CR powder fed had a dry matter IgG concentration of 30% and an IgG concentration of 70.5 g/L when reconstituted. All CR was fed via esophageal tube within 1 h after birth. Calves were bottle-fed pasteurized milk (5% birth BW) at 24, 36, and 48 h after the first CR feeding. Blood was collected before first CR feeding and at the following intervals post-CR feeding: every 2 h until 18 h; every 3 h from 18 to 30 h; and every 6 h from 30 to 48 h after the first CR feeding. Serum IgG values at 24 h did not differ between LF and HF (25.79 ± 0.93 and 25.66 ± 0.88 g/L, respectively). In the first meal, calves fed LF ingested a higher total IgG mass than HF (257.98 ± 4.16 g and 126.72 ± 4.05 g, respectively); however, AEA at 24 h did not differ for calves fed HF or LF (27.68 ± 1.16% and 27.63 ± 1.26%, respectively). The IgG area under the curve (AUC) at 24 h was greater for calves fed LF than HF (443.13 ± 15.17 and 379.59 ± 13.99 g of IgG/L × h, respectively). Additionally, AUC at 6 h, 12 h, and 48 h were greater for calves fed LF than HF. These results indicate that, although LF calves had a greater AUC, HF calves were still able to absorb IgG in the second and third meal, allowing HF calves to achieve serum IgG levels similar to those of LF calves at 24 h. In addition, the provision of 3 meals at 70.5 g/L of IgG within the first 12 h of life did not result in added benefits to serum IgG or AEA levels.
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Líquidos Corporais , Colostro , Ração Animal/análise , Animais , Animais Recém-Nascidos , Bovinos , Ensaios Clínicos Veterinários como Assunto , Feminino , Imunoglobulina G , Masculino , GravidezRESUMO
Serum total protein (STP) refractometry is a widely used indicator of failed transfer of passive immunity (FTPI), defined as serum IgG concentrations of <10 mg/mL or STP levels <5.2 g/dL measured at 24 h of life. However, recent reports have demonstrated that refractometry could be inaccurate at estimating serum IgG concentrations and FTPI when calves are fed colostrum replacer (CR). The objective of this study was to evaluate the accuracy of STP measurements to estimate FTPI in calves fed CR compared with calves fed maternal colostrum. Blood was collected from dairy calves fed maternal colostrum (n = 927) or colostrum-derived CR (n = 1,258) and analyzed for STP and serum IgG. Serum total protein was measured with a digital refractometer, whereas radial immunodiffusion was used to determine IgG concentrations. Calves fed maternal colostrum had a mean STP of 5.80 ± 0.72 (standard deviation) g/dL and a mean IgG concentration of 22.81 ± 10.14 mg/mL, respectively, whereas calves fed CR had a mean STP and IgG concentration of 5.14 ± 0.50 g/dL and 12.78 ± 4.60 mg/mL, respectively. Rates of FTPI for calves fed maternal colostrum or CR were 4.2% and 27.26%, respectively. Calves were considered to have FTPI if their IgG postcolostrum feeding was <10 mg/mL. Logistic and linear regression analyses were performed to determine cutoff points and existent relationships between STP and IgG. Serum total protein and IgG for calves fed maternal colostrum were highly correlated. In contrast, STP and IgG for calves fed CR were lowly correlated. A receiver operator characteristic curve analysis demonstrated that an STP cutoff point that could predict FTPI when calves are fed CR would be 4.9 g/dL (sensitivity = 0.68; specificity = 0.75). This study suggests that current cutoff points used for STP inflates the number of calves estimated to have FTPI when they are fed CR.
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Colostro , Imunização Passiva/veterinária , Imunoglobulina G/sangue , Refratometria/veterinária , Animais , Animais Recém-Nascidos , Bovinos , Colostro/imunologia , Feminino , Imunodifusão/veterinária , Gravidez , Refratometria/normas , Reprodutibilidade dos TestesRESUMO
Dairy calf nutrition is traditionally one of the most overlooked aspects of dairy management, despite its large effect on the efficiency and profitability of dairy operations. Unfortunately, among all animals on the dairy farm, calves suffer from the highest rates of morbidity and mortality. These challenges have catalyzed calf nutrition research over the past decade to mitigate high incidences of disease and death, and improve animal health, growth, welfare, and industry sustainability. However, major knowledge gaps remain in several crucial stages of development. The purpose of this review is to summarize the key concepts of nutritional physiology and programming from conception to puberty and their subsequent effects on development of the calf, and ultimately, future performance. During fetal development, developmental plasticity is highest. At this time, maternal energy and protein consumption can influence fetal development, likely playing a critical role in calf and heifer development and, importantly, future production. After birth, the calf's first meal of colostrum is crucial for the transfer of immunoglobulin to support calf health and survival. However, colostrum also contains numerous bioactive proteins, lipids, and carbohydrates that may play key roles in calf growth and health. Extending the delivery of these bioactive compounds to the calf through a gradual transition from colostrum to milk (i.e., extended colostrum or transition milk feeding) may confer benefits in the first days and weeks of life to prepare the calf for the preweaning period. Similarly, optimal nutrition during the preweaning period is vital. Preweaning calves are highly susceptible to health challenges, and improved calf growth and health can positively influence future milk production. Throughout the world, the majority of dairy calves rely on milk replacer to supply adequate nutrition. Recent research has started to re-evaluate traditional formulations of milk replacers, which can differ significantly in composition compared with whole milk. Transitioning from a milk-based diet to solid feed is critical in the development of mature ruminants. Delaying weaning age and providing long and gradual step-down protocols have become common to avoid production and health challenges. Yet, determining how to appropriately balance the amount of energy and protein supplied in both liquid and solid feeds based on preweaning milk allowances, and further acknowledging their interactions, shows great promise in improving growth and health during weaning. After weaning and during the onset of puberty, heifers are traditionally offered high-forage diets. However, recent work suggests that an early switch to a high-forage diet will depress intake and development during the time when solid feed efficiency is greatest. It has become increasingly clear that there are great opportunities to advance our knowledge of calf nutrition; yet, a more concentrated and rigorous approach to research that encompasses the long-term consequences of nutritional regimens at each stage of life is required to ensure the sustainability and efficiency of the global dairy industry.
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Ração Animal , Distinções e Prêmios , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Feminino , Leite , Maturidade Sexual , DesmameRESUMO
Serum IgG concentrations in dairy calves change throughout their first weeks of life, peaking at 24 h and then steadily decreasing until calves begin to produce endogenous IgG. The objective of this study was to observe serum IgG dynamics from birth until 16 wk of life in calves fed either maternal colostrum (MC) or colostrum replacer (CR). A total of 44 Holstein calves were randomly assigned to 1 of the 4 colostrum treatments and followed throughout the study. Treatments consisted of feeding high-quality MC, low-quality MC supplemented with CR, or 1 of 2 distinct levels of IgG concentration from CR. Overall, the interaction between type of colostrum fed and sampling time was significant. Individual differences for this effect were found at d 1, 7, 14, 21, 28, and 98, while the other time points were not different.
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Ração Animal , Bovinos/imunologia , Colostro , Imunoglobulina G/sangue , Envelhecimento/sangue , Envelhecimento/imunologia , Animais , Animais Recém-Nascidos/sangue , Animais Recém-Nascidos/imunologia , Bovinos/sangue , Suplementos Nutricionais , Feminino , MasculinoRESUMO
Successful passive transfer of antibodies in neonatal calves can be achieved by feeding an adequate quantity and quality of maternal colostrum (MC) or colostrum replacer (CR). An alternative could be feeding low-quality maternal colostrum (LMC) with added IgG from a CR. The objective of this study was to determine if a commercial whey-based CR product containing low levels of casein (Premolac PLUS Bovine IgG; Zinpro Corporation, Eden Prairie, MN) fed to replace MC or supplement LMC could lead to adequate serum IgG levels and apparent efficiency of absorption (AEA) in neonatal dairy calves. Holstein calves (n = 20 per treatment) were separated from their dam after birth and randomly assigned to be fed 3.79 L of MC (106 g/L of IgG; 401 g of IgG fed), LMC (30 g/L IgG) supplemented with CR (41 g/L IgG; 154 g of IgG total fed; LMC-CR), or 1.3 L of 1 of 2 levels of CR (110 or 150 g of IgG fed; CR-110 or CR-150) within 1.5 h of birth. Colostrum was obtained from the first (MC) or second and third milkings (LMC) of cows from Pennsylvania State University dairy and pooled by source into large batches. Blood samples were taken from calves before colostrum feeding and 24 h after birth and were analyzed for serum total protein, total IgG, hematocrit, and Brix percentage. Calves fed MC had higher 24-h IgG values (means ± SEM) than calves fed LMC-CR (27.04 ± 1.07 vs. 22.33 ± 1.08 mg/mL, respectively). Feeding 150 g of IgG from CR led to higher 24-h serum IgG values than feeding 110 g of IgG (16.90 ± 1.09 vs. 12.79 ± 1.08 mg/mL). Serum IgG levels were different between the CR-fed calves and the calves fed LMC-CR and MC, but all had average values >10 mg/mL IgG. Calves fed LMC-CR had greater AEA than calves fed MC (54.58 ± 2.39 vs. 24.38 ± 2.36%, respectively). Among calves fed CR-110 or CR-150, AEA did not differ. Serum total protein and Brix percentage had strong correlations with actual IgG values across the entire study. We found no differences in average daily gain or health variables measured, and no differences in final hip width, withers height, or body weight for calves fed MC, LMC-CR, CR-150, or CR-110. These results indicate that CR can be fed successfully as an alternative to MC or as a supplement to colostrum with low IgG.
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Ração Animal , Bovinos/imunologia , Colostro , Imunoglobulina G/sangue , Soro do Leite , Animais , Animais Recém-Nascidos , Peso Corporal , Suplementos Nutricionais , Feminino , Masculino , Substitutos do Leite/farmacologia , Pennsylvania , GravidezRESUMO
In this work we implemented dynamic speckle and holographic interferometry techniques to characterize the drying process of solvent-based paint coatings. We propose a simple way to estimate drying time by measuring speckle activity and incrementally fitting experimental data through standard regression algorithms. This allowed us to predict drying time after about 20-30 min of paint application, which is fast compared to usual times required to reach the so-called tack-free state (≈2 h). In turn, we used holographic interferometry to map small thickness variations in the coating surface during drying. We also demonstrate that results obtained from both techniques correlate with each other, which allows us to improve the accuracy of the drying time estimation.
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BACKGROUND: The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement. METHODS: The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis. RESULTS: Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to apply new learnings in local contexts. CONCLUSIONS: Study findings offer insights into collaborative, inter-organizational CoP learning approaches to build QI capabilities amongst clinicians, staff, and managers. In particular, our study delineates the need to contextualize QI learning by using deliberate learning activities to balance systematic and structured approaches alongside pragmatic and accommodating approaches with expert mentors.
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Relações Interinstitucionais , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/normas , Comportamento Cooperativo , Grupos Focais , Humanos , Gestão do Conhecimento , Mentores , Inovação Organizacional , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito/normas , Prática Profissional , Melhoria de Qualidade/normas , Qualidade da Assistência à Saúde/organização & administraçãoRESUMO
Evidence suggests the involvement of the cannabinoid system in the pathogenesis of multiple sclerosis (MS). We studied cannabinoid receptor (CB)1 and CB2 receptor gene expression in B, natural killer (NK) and T cells from MS patients before and after 1 year of interferon beta therapy, and compared these levels to those of healthy controls. We also measured the production of the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) and the gene expression of the endocannabinoid-degrading enzyme fatty acid amide hydrolase (FAAH) in these cells. Prior to interferon therapy, MS patients showed significantly elevated CB2 expression in B cells, but not in T or NK cells. These levels decreased gradually within 6 months to 1 year of interferon treatment. CB1 expression was elevated in all cell subsets, but only reached statistical significance in T cells; all levels decreased progressively over time. Before treatment, AEA but not 2-AG levels were significantly elevated in the three cell populations; after 1 year of treatment, all values decreased to control levels. The expression of FAAH was unchanged. The different expression of cannabinoid receptor genes and the increased level of AEA in lymphocytes point to a possible role of the cannabinoid system in MS immune response and its modulation by interferon.
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Endocanabinoides/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Interferon beta/farmacologia , Subpopulações de Linfócitos/metabolismo , Esclerose Múltipla/genética , Esclerose Múltipla/metabolismo , Receptores de Canabinoides/genética , Adolescente , Adulto , Amidoidrolases/genética , Amidoidrolases/metabolismo , Feminino , Humanos , Interferon beta/uso terapêutico , Estudos Longitudinais , Subpopulações de Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/imunologia , Esclerose Múltipla Recidivante-Remitente/genética , Esclerose Múltipla Recidivante-Remitente/imunologia , Esclerose Múltipla Recidivante-Remitente/metabolismo , RNA Mensageiro/genética , Receptor CB1 de Canabinoide/genética , Receptor CB2 de Canabinoide/genética , Adulto JovemRESUMO
OBJECTIVES: Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors aimed to investigate whether or not vessel diameter can be used as an indicator of reflux in the ovarian veins. METHODS: Nineteen female patients (mean 40.2 years, range 29-60) presenting to a specialist vein unit with leg varicose veins underwent duplex ultrasonography (DUS). All were found to have a significant pelvic contribution to their leg reflux on transvaginal duplex ultrasonography (TVS) and were referred to an interventional radiologist for treatment by transjugular coil embolization. During the procedure, the diameter of the ovarian veins was measured using digital subtraction venography. RESULTS: Thirty-four ovarian veins were measured (17 right, 17 left) and of these 18 were found to be non-refluxing while 16 displayed reflux. The mean diameter of the non-refluxing veins was 7.2 mm (range 3-13 mm)and that of the refluxing veins was 8.5 mm (range 4-13 mm). This difference was found to be insignificant at a 95% confidence level (Student t test, p = .204). CONCLUSIONS: There is no significant difference between the diameters of competent and refluxing ovarian veins and, as such, techniques that measure vein diameter may not be suitable for the diagnosis of venous reflux in the ovarian veins.
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Ovário/irrigação sanguínea , Varizes/diagnóstico por imagem , Veias/diagnóstico por imagem , Adulto , Pesos e Medidas Corporais/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Flebografia , Sensibilidade e Especificidade , Ultrassonografia Doppler DuplaRESUMO
PURPOSE: Gastrointestinal adenomyoma is a rare benign tumor most frequently located in the stomach. The differential diagnosis is wide because of its large clinical spectrum and unspecific radiological findings. Surgical excision is both diagnostic and therapeutic. CASE REPORT: A 49-days old girl presented with nonbilious vomiting of 48 hours of evolution. Infantile hypertrofic pyloric stenosis was suspected. Ultrasound showed a nonobstructive nodular lesion in the anterior pyloric wall. MRI suggested a myofibroblastic tumor. We proceeded to laparotomy and complete resection of the pyloric tumor. Histologic diagnosis was gastric adenomyoma. CONCLUSIONS: Pyloric adenomyoma causes obstructive symptoms similar to other common entities such as hypertrophic pyloric stenosis or cystic duplication. We have to consider this condition in children with digestive symptoms and radiological images of intussusceptions or duplication. Surgical excision is recommended to reach a definitive diagnosis and to avoid a possible malignant degeneration.
INTRODUCCION: El adenomioma gastrointestinal es una tumoración benigna rara cuya localización más frecuente es gástrica. Su diagnóstico diferencial es amplio debido a su gran espectro clínico y baja especificidad radiológica. La escisión quirúrgica es diagnóstico-terapeútica. CASO CLINICO: Niña de 49 días que presenta vómitos no biliosos de 48 horas de evolución. Ante sospecha de estenosis hipertrófica de píloro se solicita ecografía que muestra lesión nodular no obstructiva en pared anterior del píloro. Se realiza RM sugestiva de tumor miofibroblástico. Se procede a laparotomía y resección completa de tumoración pilórica, informada histológicamente como adenomioma gástrico. COMENTARIOS: El adenomioma pilórico produce clínica obstructiva y se confunde con entidades comunes como la estenosis hipertrófica de píloro o la duplicación quística. En un niño con síntomas digestivos e imagen radiológica de invaginación o duplicación, debemos tener en cuenta esta patología. La resección quirúrgica es de elección para un diagnóstico certero y para evitar una posible degeneración maligna.
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OBJECTIVES: To highlight the risk factors for the occurrence of this complication in order to achieve an early diagnosis. METHODS: Retrospective descriptive study in which the medical records of patients diagnosed with enterocolitis and who have previously undergone surgery for Hirschsprung's disease in a tertiary hospital from 1994 to 2013, inclusive (N=29), were reviewed. Epidemiological, surgical and clinical data from two groups of patients: Group A (6 patients with ECPD) and Group B (23 patients without ECPD) were compared. Enterocolitis episode data in the Group A were studied too. RESULTS: The incidence of an episode of ECPD was 20.6% and the incidence of two episodes of ECPD was 33.3%. The onset occurred at 12.17 months (SD 13.04) after pull-through procedure. The incidence was higher in patients operated at a younger age [10 months in Group A [6-16] versus 14 months in the group B (1-153)] and in those patients with the longest segment resected [23.20 cm in group A (DS 10,52) versus 19.20 cm in group B (DS 6.92)]. No patient with a discharge colostomy before pull-through surgery showed this complication. It must be highlighted the highest incidence in patients undergone by Swenson's technique (25%) compared to other surgical techniques (Georgeson (15.80%), Soave (0%)). CONCLUSION: Just the length of the resected segment and the patient's age at the time of the pull-through procedure appear to influence the outcome. It is considered advisable to be extremely vigilant in children operated at an early age and subjected to extensive intestinal resection for an early diagnosis and establishment of a treatment to avoid high morbidity.
OBJETIVOS: Identificar los factores de riesgo de la aparición de esta complicación para conseguir un diagnóstico precoz. MATERIAL Y METODOS: Estudio descriptivo retrospectivo en el que se revisan las historias clínicas de pacientes diagnosticados de enterocolitis e intervenidos previamente de la enfermedad de Hirschsprung en un hospital de tercer nivel desde 1994 hasta el 2013, ambos inclusive (N=29). Se comparan datos epidemiológicos, quirúrgicos y clínicos entre dos grupos de pacientes: grupo A (6 pacientes con enterocolitis postdescenso abdómino-perineal (ECPD) y grupo B (23 pacientes sin ECPD). Se estudian, además, los datos sobre el episodio de ECPD en el grupo A. RESULTADOS: La incidencia de un episodio de ECPD fue de 20,6% y la incidencia de dos episodios de ECPD fue de 33,3%. El inicio del cuadro se produjo a los 12,17 meses (DS 13,04) tras la cirugía. Su incidencia fue más alta en aquellos pacientes intervenidos con menor edad [10 meses en el Grupo A (6-16) frente a 14 meses en el grupo B (1-153)] y con mayor longitud del segmento resecado [23,20 cm del grupo A (DS 10,52) frente a 19,20 cm del grupo B (DS 6,92)]. Ningún paciente portador de una colostomía de descarga previa a la cirugía de descenso presentó esta complicación. Destaca, además, la mayor incidencia en pacientes intervenidos mediante la técnica de Swenson (25%) frente a otras técnicas quirúrgicas [Georgeson (15,80%), Soave (0%)]. CONCLUSION: Solo la longitud del segmento resecado y la edad del paciente en el momento de la cirugía de descenso parecen influir en la evolución de los pacientes. Se considera aconsejable extremar la vigilancia en los niños intervenidos a edades tempranas y sometidos a una resección intestinal amplia para realizar un diagnostico precoz e instaurar un tratamiento precoz que evite su alta morbilidad.
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OBJECTIVES: For anterior protruding chest wall deformities treatment, mainly pectus carinatum, pediatric surgeons have been managing either orthotic methods or open surgical repairs. Anterior compressive thoracoplasty (Abramson's technique) has widened the therapeutic options. We describe herein a modification of this technique in the first reported Europen series. PATIENTS AND METHODS: From 2010 to 2012, a total of five patients (four male and one female) underwent a modified Abramson's technique to correct pectus carinatum or combined protrusion of the chest at our center. We report the operative technique used for these reconstructions. RESULTS: In all five cases, the operation was completed uneventfully and with excellent results either for the surgical team or the patients. Mean operative time was 190 minutes and hospitalization lasted for three to six days, at the time of analgesic drugs withdrawal. CONCLUSIONS: We consider the anterior compresive thorocoplasty (modified Abramson's technique) a safe and feasible method to correct protruding chest deformities, particularly in those patients with stiff chest or lack of compliance, in order to avoid the agressive open procedures.
INTRODUCCION: Entre las opciones terapéuticas para las deformidades anteriores del tórax, la cirugía pediátrica ha dispuesto de tratamientos ortóticos y de técnicas quirúrgicas "abiertas". La toracoplastia compresiva anterior se une a las anteriores y amplía las opciones terapéuticas. Se describe aquí esta técnica en lo que supone la primera serie europea comunicada. MATERIAL Y METODOS: Revisión retrospectiva de las toracoplastias por técnica de Abramson modificada para el tratamiento del pectus carinatum y protrusiones costales en nuestro servicio entre 2010 y 2012. Descripción de la técnica a partir de los primeros cinco casos completados de nuestra serie, cuatro varones y una mujer, con edades entre los 13 y los 19 años. RESULTADOS: En todos los casos la técnica se ha podido completar sin complicaciones intra o perioperatorias y con resultados excelentes, tanto para el equipo quirúrgico como para los pacientes. El tiempo operatorio medio ha sido de 190 minutos y el alta hospitalaria se ha conseguido entre los tres y seis días después de la intervención, una vez completado el control analgésico. CONCLUSIONES: Consideramos que la toracoplastia compresiva anterior es una técnica mínimamente invasiva para la corrección del pectus carinatum y deformidades afines que resulta particularmente útil en los casos en los que la rigidez del tórax impide la adopción de tratamientos ortopédicos, en casos de no aceptación del tratamiento ortótico o cuando la cirugía convencional se considera demasiado agresiva.
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BACKGROUND AND OBJECTIVE: To describe visual function, macular integrity, and fixation stability using MAIA microperimetry (macular integrity assessment) after retinal detachment surgery. Evaluate if there are statistically significant differences between surgical approaches. MATERIALS AND METHODS: A prospective, comparative, interventional study was conducted, recruiting a total of 21 patients with rhegmatogenous retinal detachment and macula-off. Eleven patients underwent surgery using pars plana vitrectomy (PPV), and 10 patients underwent scleral buckle surgery. Clinical examinations and optical coherence tomography (OCT) were performed post-surgery. MAIA microperimetry was conducted at 6 months. RESULTS: Best-corrected visual acuity (BCVA) and the number of letters read improved over time in the operated eye but did not reach the level of the control eye (p = 0.001). No significant differences were found between the two surgical approaches in BCVA (p = 0.230) or the number of letters read (p = 0.608). Macular integrity in the operated eye did not match that of the control eye in both procedures (p = 0.05). No differences were detected between the two surgeries, either in macular integrity (p = 0.512) or fixation stability (p = 0.835). CONCLUSIONS: Following retinal detachment surgery, a decrease in BCVA and the number of letters read occurs, which does not reach the level of the control eye. No significant differences were observed between the two surgical approaches. Macular integrity in the operated eye does not match that of the control eye.
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Macula Lutea , Descolamento Retiniano , Recurvamento da Esclera , Acuidade Visual , Testes de Campo Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Estudos Prospectivos , Pessoa de Meia-Idade , Feminino , Masculino , Macula Lutea/diagnóstico por imagem , Idoso , Tomografia de Coerência Óptica , AdultoRESUMO
INTRODUCTION: Lymphatic malformations are congenital lesions usually placed in the head and neck, the abdominal location is infrequent. OBJECTIVES: Analyze our experience in ALM management. METHOD: Retrospective study of pediatric patients with ALM from 1996 to 2011. It is a descriptive analysis of clinical, diagnostic and therapeutic features. RESULTS: 10 patients with ALM were treated (6 girls: 4 boys), with a median age of 4.03 years (3 days-13 years). Acute abdomen was the most common presenting feature (40%). Ultrasound was carried out in all these cases, completing the study with CT (9 cases), MRI (1) or both (1). Treatment was surgical, excepting one case that presented infection of the ALM. The approach by laparotomy allowed total resection in all cases, involving bowel resection in 6. The mass was located in small bowel mesentery (6), mesocolon (1), liver (1), and in retroperitoneum (1). The final pathologic diagnosis showed an error in diagnostic imaging of 60%.The mean follow-up was 18 months (SD: 12.8), with not recurrences. CONCLUSIONS: ALM often manifests in a non-specific form and it may remain silent. Imaging studies guide the diagnosis, but only the histology provides a definitive result. Total resection is the best option to prevent recurrences and minimize complications.
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Linfonodos/anormalidades , Adolescente , Criança , Pré-Escolar , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: This study addresses the survival of consecutive patients with high-grade gliomas (HGG) treated at the same institution over a period of 10 years. We analyse the importance of associated factors and the role of salvage surgery at the time of progression. METHODS: We retrospectively analysed a series of patients with World Health Organization (WHO) grade III/IV gliomas treated between 2008 and 2017 at Hospital Gregorio Marañón (Madrid, Spain). Clinical, radiological, and anatomical pathology data were obtained from patient clinical histories. RESULTS: Follow-up was completed in 233 patients with HGG. Mean age was 62.2 years. The median survival time was 15.4 months. Of 133 patients (59.6%) who had undergone surgery at the time of diagnosis, 43 (32.3%) underwent salvage surgery at the time of progression. This subgroup presented longer overall survival and survival after progression. Higher Karnofsky Performance Status score at diagnosis, a greater extent of surgical resection, and initial diagnosis of WHO grade III glioma were also associated with longer survival. CONCLUSIONS: About one-third of patients with HGG may be eligible for salvage surgery at the time of progression. Salvage surgery in this subgroup of patients was significantly associated with longer survival.
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Neoplasias Encefálicas , Glioma , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Encefálicas/diagnóstico , Glioma/cirurgia , Glioma/diagnóstico , Glioma/patologia , Análise de Sobrevida , EspanhaRESUMO
Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human´s eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants.