Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy.

BACKGROUND: Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to biventricular pacing (BVP) for the delivery of cardiac resynchronisation therapy (CRT). This study assessed the feasibility and outcomes of LBBP in comparison to BVP. METHODS: LBBP was attempted in 40 consecutive patients as the first-line method for delivering CRT. To evaluate LBBP versus BVP, 40 patients with identical inclusion criteria who received BVP were compared with the LBBP group. Acute success rate, complications, functional and echocardiographic outcomes as well as hospitalisation for heart failure and all-cause mortality 6 months after implantation were evaluated. RESULTS: LBBP was successfully performed in 31 (78%) patients and resulted in significant QRS narrowing (from 166 ± 16 to 123 ± 18 ms, p < 0.001), improvement in left ventricular ejection fraction (LVEF; from 28 ± 8 to 43 ± 12%, p < 0.001) and New York Heart Association functional class (from 2.8 ± 0.5 to 1.6 ± 0.6, p < 0.001) at 6 months. No LBBP-related complications occurred. Compared to BVP, LBBP resulted in a greater reduction in QRS duration (44 ± 17 vs 15 ± 26 ms, p < 0.001) with comparable absolute improvement in LVEF (15.2 ± 11.7 vs 9.6 ± 12.1%, p = 0.088). Hospitalisation for heart failure and all-cause mortality were similar in the two groups. CONCLUSIONS: LBBP is feasible and was safe in 78% of patients with favourable electrical resynchronisation and functional improvement and may serve as an alternative to BVP.

Heat stress in a temperate climate leads to adapted sensor-based behavioral patterns of dairy cows.

Most research on heat stress has focused on (sub)tropical climates. The effects of higher ambient temperatures on the daily behavior of dairy cows in a maritime and temperate climate are less studied. With this retrospective observational study, we address that gap by associating the daily time budgets of dairy cows in the Netherlands with daily temperature and temperature-humidity index (THI) variables. During a period of 4 years, cows on 8 commercial dairy farms in the Netherlands were equipped with neck and leg sensors to collect data from 4,345 cow lactations regarding their daily time budget. The time spent eating, ruminating, lying, standing, and walking was recorded. Individual cow data were divided into 3 data sets: (1) lactating cows from 5 farms with a conventional milking system (CMS) and pasture access, (2) lactating cows from 3 farms with an automatic milking system (AMS) without pasture access, and (3) dry cows from all 8 farms. Hourly environment temperature and relative humidity data from the nearest weather station of the Dutch National Weather Service was used for THI calculation for each farm. Based on heat stress thresholds from previous studies, daily mean temperatures were grouped into 7 categories: 0 = (<0°C), 1 = (0-12°C, reference category), 2 = (12-16°C), 3 = (16-20°C), 4 = (20-24°C), 5 = (24-28°C), and 6 = (≥28°C). Temperature-humidity index values were grouped as follows: 0 = (THI <30), 1 = (THI 30-56, reference category), 2 = (THI 56-60), 3 = (THI 60-64), 4 = (THI 64-68), 5 = (THI 68-72) and 6 = (THI ≥72). To associate daily mean temperature and THI with sensor-based behavioral parameters of dry cows and of lactating cows from AMS and CMS farms, we used generalized linear mixed models. In addition, associations between sensor data and other climate variables, such as daily maximum and minimum temperature, and THI were analyzed. On the warmest days, eating time decreased in the CMS group by 92 min/d, in the AMS group by 87 min/d, and in the dry group by 75 min/d compared with the reference category. Lying time decreased in the CMS group by 36 min/d, in the AMS group by 56 min/d, and in the dry group by 33 min/d. Adaptation to daily temperature and THI was already noticeable from a mean temperature of 12°C or a mean THI of 56 or above, when dairy cows started spending less time lying and eating and spent more time standing. Further, rumination time decreased, although only in dry cows and cows on AMS farms. With higher values for daily mean THI and temperature, walking time decreased as well. These patterns were very similar for temperature and THI variables. These results show that dairy cows in temperate climates begin to adapt their behavior at a relatively low mean environmental temperature or THI. In the temperate maritime climate of the Netherlands, our results indicate that daily mean temperature suffices to study the effects of behavioral adaptation to heat stress in dairy cows.

Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study.

BACKGROUND: Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. METHODS: Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. RESULTS: The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R­wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6­month follow-up. No complications occurred during implant or follow-up. CONCLUSION: LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.

The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer.

BACKGROUND: MRI detected extramural vascular invasion (mrEMVI) is a poor prognostic factor in rectal cancer patients. The objectives of this study were to assess survival outcomes in patients with and without mrEMVI and to compare the prognostic value of mrEMVI with other rectal cancer features. METHODS: In a Dutch high volume rectal cancer center cohort of sixty-seven locally advanced rectal cancer patients, an independent radiologist reviewed all primary staging MRI scans. The presence of mrEMVI was correlated to tumor specific and survival outcomes. RESULTS: 20/67 patients had mrEMVI positive rectal cancer. 55% (11/20) developed metachronous metastases, compared with 23% (11/47) in the mrEMVI negative group (OR 4.0, p = 0.01). Overall survival was also decreased with a Hazard ratio of 3.3 (p = 0.01). A multivariable logistic regression with a backward selection procedure was conducted including cT-stage, c-N-stage, extramural tumor invasion depth, mesorectal fascia involvement, distance to anorectal junction, tumor length, mrEMVI, CEA level, and synchronous metastases. After stepwise removal based on p value, only positive mrEMVI remained as a single significant predictor for metachronous metastases (OR: 4.16 , p < 0.05). CONCLUSION: Positive mrEMVI is a poor prognostic factor in locally advanced rectal cancer with a 4-fold increased risk of developing metachronous metastases after surgery and a worsened overall survival. mrEMVI also appeared an independent risk factor, with a stronger prediction for metachronous metastases than other MRI-detectable tumor characteristics. mrEMVI should be incorporated in all risk stratification guidelines for rectal cancer.

Acute gastric necrosis caused by a ß-hemolytic streptococcus infection: a case report and review of the literature.

Acute necrotizing gastritis, which appears to be a variant of phlegmonous gastritis is the rarest cause of gastric necrosis. We report a case of a 57-year-old female patient with an acute necrotizing gastritis caused by a Group A ß-hemolytic streptococcus. The case presented herein is of unusual interest because only a limited number of case reports on this etiology have been published. Diagnosing infectious necrotizing gastritis remains complex because of its rarity and nonspecific clinical presentation. Nevertheless, prompt diagnosis is of high importance because necrotizing gastritis can progress rapidly into a more advanced stage causing septic shock or even death. In our opinion, early resection of necrotic gastric wall combined with adequate antimicrobial therapy is the cornerstone in treatment of necrotizing gastritis. We will present a case in which adequate medical treatment was not successful.

Highly selective detection of methanol over ethanol by a handheld gas sensor.

Methanol poisoning causes blindness, organ failure or even death when recognized too late. Currently, there is no methanol detector for quick diagnosis by breath analysis or for screening of laced beverages. Typically, chemical sensors cannot distinguish methanol from the much higher ethanol background. Here, we present an inexpensive and handheld sensor for highly selective methanol detection. It consists of a separation column (Tenax) separating methanol from interferants like ethanol, acetone or hydrogen, as in gas chromatography, and a chemoresistive gas sensor (Pd-doped SnO2 nanoparticles) to quantify the methanol concentration. This way, methanol is measured within 2 min from 1 to 1000 ppm without interference of much higher ethanol levels (up to 62,000 ppm). As a proof-of-concept, we reliably measure methanol concentrations in spiked breath samples and liquor. This could enable the realization of highly selective sensors in emerging applications such as breath analysis or air quality monitoring.

Sensor based eating time variables of dairy cows in the transition period related to the time to first service.

In dairy cattle, reproductive diseases and infertility are some of the most important reasons for culling, where postpartum negative energy balance (NEB) reduces reproductive performance. This single cohort observational study reports the association between eating time and the interval between calving and first service in 2036 dairy cows on 17 commercial farms in The Netherlands. Cows were equipped with a commercially available neck sensor (Nedap, Groenlo, The Netherlands), that measured the time cows spent eating, from 28 days (d) before until 28 d after parturition. Primiparous cows spent a mean of +45 minutes (min) eating time per day ante partum and +15 min eating time post partum more than multiparous cows. A Cox proportional hazard model was used to analyze eating time variables in relation to the interval between calving and first service. From 4 weeks before until 4 weeks after calving eating time variables per week were used. Weeks -4, -3 + 3 and +4 were used as weeks with stable eating time patterns and therefore the mean eating time per week and the standard deviation of the mean eating time per week were used. Weeks -2, -1, +1 and +2 were addressed as periods with unstable eating patterns and therefore the slope in eating time per week and the residual variance of the slope per week were modeled. Significant results were the mean eating time in week -4 and +3 where in both weeks higher eating time lead to a higher hazard for first service. Difference between primiparous and multiparous cows were also significant with a higher hazard for first service for primiparous cows. Week 4 post partum presented a significant difference between eating time of primiparous cows and multiparous cows. These results display how eating time variables in the transition period could be related to the interval between calving and first service, and that there is a relation between mean eating time in week -4, +3, +4 and the interval between calving and first insemination.

Factors affecting the likelihood of pregnancy and embryonic loss after transfer of cryopreserved in vitro produced equine embryos.

BACKGROUND: In vitro embryo production (IVEP) is increasingly popular but data assessing the outcome of transferred embryos are scarce. OBJECTIVES: To determine the likelihood of pregnancy and embryonic loss after transfer of frozen-thawed IVP embryos and identify factors influencing success. STUDY DESIGN: Retrospective clinical study. METHODS: Blastocysts (n = 261) were produced from immature oocytes of Warmblood mares (n = 116) by Intracytoplasmic Sperm Injection (ICSI) and in vitro culture, and cryopreserved. Thawed IVP embryos were transferred into recipient mares on day 4, 5 or 6 after ovulation. The influence of donor mare (age, reproductive history), recipient mare (age, reproductive status, management; in-house vs. outpatient, day post-ovulation), embryo (interval from ICSI to blastocyst formation) and management factors (season when ovum pickup was performed, year and method of transfer) on likelihood of pregnancy and embryonic loss was examined, and the developmental stage of the IVP embryo at the time of transfer was estimated. RESULTS: The percentage of mares pregnant 7-10, 23 and 37 days after transfer was 56% (147/261), 49% (129/261), and 48% (124/261), respectively. Development of IVP embryos after transfer equated to day 5 or 6 in vivo embryos. With the exception of year of transfer, none of the factors had an impact on the likelihood of pregnancy or embryonic loss. Nevertheless, the likelihood of pregnancy tended to be lower for IVP embryos from infertile mares or when embryos were transferred into recipient mares on day 6 after ovulation rather than on day 4 or 5. Finally, the diameter of the embryonic vesicle 7 days post transfer was lower for pregnancies that were lost compared to those that were maintained. MAIN LIMITATIONS: Small sample size in some of the donor and recipient mare categories. CONCLUSIONS: Cryopreserved IVP embryos should be transferred into recipient mares on day 4 or 5 after ovulation and a slower rate of post transfer vesicle expansion indicates a higher risk of subsequent embryonic loss The Summary is available in Portuguese - see Supporting Information.

Caregivers' perceptions towards communication with mechanically ventilated patients: The results of a multicenter survey.

PURPOSE: The purpose of this study was to investigate ICU health care providers' perception towards communication and associated problems with mechanically ventilated (MV) patients. The primary aim was to quantify the extent of the problem and to determine its effect on patient care and job satisfaction. METHODS: A multicenter survey study was conducted among nurses, residents and intensivists of 15 ICUs in the Netherlands using an online questionnaire. RESULTS: Out of 1740 caregivers, 457 responses were received. Communication difficulties were experienced in half of the interactions with MV patients. Over 75% of participants indicated that patient care was negatively affected. Job satisfaction was negatively affected in 43% of the participants, primarily with feelings of unfulfillment (76%) and frustration (72%). Patient factors considered relevant to communication difficulties were delirium, disease severity and anxiety, among others. To facilitate communication, the use of basic gestures remained the most preferred method. CONCLUSIONS: In half of the interactions with MV patients, health care professionals experience significant communication difficulties. The respondents indicated that these difficulties frequently lead to negative effects on patient care and job satisfaction. These results emphasize the need for improvements such as the development of communication protocols, skills training and continued research into new communication methods.

A randomized clinical trial of topical treatments for mild and severe udder cleft dermatitis in Dutch dairy cows.

Udder cleft dermatitis (UCD) is a skin lesion in dairy cows affecting the anterior parts of the udder, with the lesions often needing a long time to heal. The lesions can be characterized as mild or severe. The etiology of UCD is not fully understood and studies on the effectiveness of topical treatments have not been published. The objective of this study, therefore, was to conduct a randomized clinical trial to investigate the effectiveness of 2 different topical treatments, one for mild and one for severe UCD lesions, compared with untreated control groups. The treatment and control groups were randomized within herd for mild and severe UCD. The treatments were applied for a maximum period of 12 wk on 8 Dutch dairy farms. Mild UCD lesions were treated once a d 3 times a week on fixed days with a non-sting barrier film. Severe UCD lesions were first stratified into class A (lesion length <5 cm) or class B (lesion length ≥5 cm) and then randomly allocated to treatment or control groups within herd. Both severe lesion classes were treated once per day every day with an enzyme alginogel. Every week, the lesions of affected animals were inspected and photographed by the investigator. These photographs were reviewed weekly by an external wound expert who classified the lesions as mild, severe class A, severe class B, or healed. Based on this classification, the investigator judged weekly whether the lesions had improved compared with their classification of the previous week. For mild UCD lesions, improvement was defined as occurring when lesions were healed. For severe UCD lesions, improvement was defined as a transition from class B to class A, transition from any severe UCD lesion (class A or B) to a mild UCD lesion, or when the lesion was defined as healed. Data were analyzed using a discrete time survival analysis with time to first improvement as dependent variable. In total, data from 214 animals were analyzed to estimate the effectiveness of treatment. Results showed that treatment of mild UCD lesions had no influence on improvement compared with untreated lesions. Treated severe lesions, however, showed 3.4 times more improvement compared with the untreated controls. Improvement varied between herds, and cows with a parity of 5 or higher showed significantly less improvement than first parity animals. Early identification of severe UCD lesions followed by prompt treatment with an enzyme alginogel supports the healing process.

Response to a Salmonella Enteritidis challenge in old laying hens with different vaccination histories.

Extending the laying period of laying hens is beneficial for economic and sustainability purposes. Because vaccines were designed with a shorter laying period envisaged, it is unclear whether current Salmonella vaccines can provide sufficient levels of protection against infection at an older age. The purpose of this experiment was to determine the efficacy of early rearing vaccination schemes against Salmonella challenge late in the laying period. There were four treatment groups: birds that had not been vaccinated (Group 1), birds vaccinated with live Salmonella Enteritidis (SE) (Group 2), with live and inactivated SE (Group 3), or with live SE and live Salmonella Typhimurium (Group 4). At the end of the laying period, the birds were transported from the laying farm to the research facility where they were orally challenged with 2.06 × 109 colony-forming units SE at around 82 wk of age. Hens were euthanized and bacteriology was performed on cecum, liver, spleen, and follicular fluid samples to determine SE colonization 7 and 14 d after challenge. Clinical and bacteriological findings of hens vaccinated with different vaccination schemes and the non-vaccinated control group were compared. No significant differences in SE colonization were found for vaccinated groups compared to the non-vaccinated control group. This may be a result of waning immunity due to the long time between vaccination and challenge. Also, as vaccination took place in the rearing period in the field, initial levels of immunity may not have been optimal due to shortcomings in the vaccination technique. Furthermore, the results of this study may have been affected by differences in age, breed, and origin between the groups. Therefore, controlled studies from early age onwards are necessary for more accurate comparisons between vaccines.

The preventive effects of two nutraceuticals on experimentally induced acute synovitis.

BACKGROUND: Nutraceuticals are often used in the management of equine osteoarthritis, but scientific evidence of their efficacy is lacking. OBJECTIVES: To study the preventive effects of two new nutraceuticals after the experimental induction of synovitis in comparison with positive and negative control treatments. STUDY DESIGN: Blinded, controlled, randomised experiment. METHODS: Twenty-four healthy Standardbred horses were randomly allocated to supplement AT (multi-ingredient, 28 days), supplement HP (collagen hydrolysate, 60 days), meloxicam (4 days) or placebo (60 days). Synovitis was induced in the right intercarpal joint by intra-articular injection of 0.5 ng lipopolysaccharide (LPS) of Escherichia coli while treatments were continued. Blood and synovial fluid were sampled before treatment, immediately prior to LPS injection, and at 8, 24 and 48 h post-injection. Synovial fluid samples were analysed for total nucleated cell count (TNCC), total protein (TP) and selected biomarkers (prostaglandin E2 [PGE2 ], interleukin-6 [IL-6], glycosaminoglycans [GAGs], type II collagen synthesis [CPII], matrix metalloproteinase [MMP]). Lameness was scored by visual examination and pressure plate analysis immediately prior to LPS injection, and at 8, 24 and 48 h post-injection. Clinical examinations were performed before treatment, immediately prior to LPS injection, at 2, 4 and 6 h post-injection, and then twice per day during the test period. RESULTS: Before treatment and intra-articular challenge, there were no statistically significant differences among the treatment groups for any of the parameters. After intra-articular challenge, the placebo group showed significantly higher synovial fluid TP, TNCC and PGE2 compared with the meloxicam group, although the model did not induce a relevant amount of lameness. Both nutraceuticals resulted in significantly lower synovial fluid TP, TNCC and PGE2 compared with placebo. No statistical differences in IL-6, GAGs, CPII or MMPs were observed among treatment groups. No adverse effects were observed. MAIN LIMITATIONS: Despite evidence of synovitis, lameness was too mild to detect. CONCLUSIONS: The preventive administration of these nutraceuticals showed anti-inflammatory effects in this validated synovitis model. Therefore, further studies of their clinical applicability are warranted.

Longitudinal study of udder cleft dermatitis in 5 Dutch dairy cattle herds.

Udder cleft dermatitis (UCD) is a skin lesion in dairy cows, most often located between anterior parts of the udder and abdomen, but also found between the front quarters. A few recent studies have investigated the prevalence of UCD, but relatively little is known about its pathogenesis, clinical course, and duration. Therefore, the aim of this study was to investigate the incidence and recovery of UCD on high-prevalence herds. Five Dutch dairy herds with a UCD prevalence of at least 6% were visited weekly for 19 wk, followed by visits every other week for 26 wk. During each visit, all dry and lactating cows were inspected for the presence of UCD signs. If a UCD case was detected, the affected skin was photographed and the photo was subsequently examined by a research assistant. Cows were then classified according to the appearance of the skin into 3 categories: healthy (no photo: no signs), mild (photo: affected skin but no wound), or severe (photo: open wound). The overall mean within-herd prevalence of UCD was 38% and the overall mean incidence was 1.94 UCD episodes per 100 cow-weeks at risk. Incidence of UCD was significantly higher in cows in third or higher parity and significantly increased with DIM. Median observed duration of UCD was 16 wk. The UCD recovery was 3 times more likely for mild than for severe lesions. The probability of moving from one category to another between 2 consecutive visits was very low, indicating that rapid changes in appearance did not occur. The observed incidence of UCD was rather low, and the relatively high prevalence in the selected herds was most likely due to the long duration of lesions rather than a high incidence of new UCD cases.

Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

REASONS FOR PERFORMING STUDY: Atrial fibrillation is a common equine arrhythmia. Quinidine alone, or with digoxin are common treatments. Studies on outcome in Warmblood populations in which duration of the AF is often unknown are limited. OBJECTIVES: To identify the factors that are associated with the success of full treatment cardioversion with oral medication, and establish whether there are differences in these factors between institutions. STUDY DESIGN: Retrospective case series using patient records of Equine University Clinic of Utrecht University and Rossdales Equine Hospital, Newmarket. METHODS: Forty-nine horses treated with quinidine were identified (29 Warmbloods, 20 Thorougbreds, 1 Anglo-Arabian). Details of signalment, history, duration physical examination and echocardiography including left atrial size and presence of mitral regurgitation were retrieved. Clinical details including mean weight, age and left atrial size were compared between clinics using independent samples t test. Association between variables and cardioconversion were evaluated in a backwards logistic regression using Akaike's information criterium (AIC) and odds ratios were calculated. Factors were sex, clinic, breed, mitral regurgitation, duration and poor performance. Covariates were age, weight and the size of the left atrium. Significance was set at 0.05. RESULTS: Fifty-one horses (mean age 8.8 s.d. 4.5 years) were treated with quinidine sulfate, 18 also received digoxin. Eighty per cent converted to sinus rhythm. In 8 horses the known duration was less than 3 months. The only factor associated with successful treatment was the use of digoxin in combination with quinidine sulfate (odds ratio 12.4; 95% CI 2.61 and 91.85 according to AIC analysis). CONCLUSIONS: In this retrospective case series, there is much potential for bias in the data; however, the use of digoxin in addition to quinidine was associated with improved conversion rates regardless of breed even though AF duration was unknown in most horses. Ethical animal research: Research ethics committee oversight not currently required by this conference: retrospective study of clinical records. Explicit owner informed consent for inclusion of animals in this study was not stated. SOURCE OF FUNDING: None. Competing interests: None declared.

Extensive cervicomediastinal hematoma due to spontaneous hemorrhage of a parathyroid adenoma: a case report.

Spontaneous extracapsular hemorrhage is a rare but potentially life-threatening manifestation of parathyroid gland adenomas. We present a case demonstrating that even in a patient with increased bleeding tendency due to anticoagulants, combined with compression of trachea and esophagus, conservative treatment can be successful.

Western Pacific Regional Green Light Committee: progress and way forward.

The Western Pacific Regional Green Light Committee (rGLC WPR) was established in 2011 to promote the rational scale-up of programmatic management of drug-resistant tuberculosis (PMDT). We reflect on its achievements, consider the challenges faced, and explore its potential future role. Achievements include the supervision and support of national PMDT action plans, increased local ownership, contextualized guidance, and a strong focus on regional capacity building, as well as a greater awareness of regional challenges. Future rGLC activities should include (1) advocacy for high-level political commitment; (2) monitoring, evaluation, and supervision; (3) technical support and contextualized guidance; and (4) training, capacity building, and operational research. Regional activities require close collaboration with both national and global efforts, and should be an important component of the new Global Drug-resistant TB Initiative.

Transmission of Actinobacillus pleuropneumoniae among weaned piglets on endemically infected farms.

Clinical outbreaks due to Actinobacillus pleuropneumoniae occur recurrently, despite the wide-scale use of antimicrobials or vaccination. Therefore, new approaches for the prevention and control of these outbreaks are necessary. For the development of alternative measures, more insight into the transmission of the bacterium on farms is necessary. The aim of this cohort study was to quantify transmission of A. pleuropneumoniae amongst weaned piglets on farms. We investigated three possible transmission routes: (i) indirect transmission by infected piglets within the same compartment, (ii) transmission by infected pigs in adjacent pens and (iii) transmission by direct contact within pens. Additionally, we evaluated the effect of independent litter characteristics on the probability of infection. Two farms participated in our study. Serum and tonsil brush samples were collected from sows pre-farrowing. Serum was analysed for antibodies against Apx toxins and Omp. Subsequently, tonsil brush samples were collected from all piglets from these dams (N=542) in three cohorts, 3 days before weaning and 6 weeks later. Tonsil samples were analysed by qPCR for the presence of the apxIVA gene of A. pleuropneumoniae. Before weaning, 25% of the piglets tested positive; 6 weeks later 47% tested positive. Regression and stochastic transmission models were used to assess the contribution of each of the three transmission routes and to estimate transmission rates. Transmission between piglets in adjacent pens did not differ significantly from that between non-adjacent pens. The transmission rate across pens was estimated to be 0.0058 day(-1) (95% CI: 0.0030-0.010), whereas the transmission rate within pens was ten times higher 0.059 day(-1) (95% CI: 0.048-0.072). Subsequently, the effects of parity and serological response of the dam and litter age at weaning on the probability of infection of pigs were evaluated by including these into the regression model. A higher dam ApxII antibody level was associated with a lower probability of infection of the pig after weaning; age at weaning was associated with a higher probability of infection of the pig after weaning. Finally, transmission rate estimates were used in a scenario study in which the litters within a compartment were mixed across pens at weaning instead of raising litter mates together in a pen. The results showed that the proportion of infected piglets increased to 69% if litters were mixed at weaning, indicating that farm management measures may affect spread of A. pleuropneumoniae.

The effect of long-term oral L-carnitine administration on insulin sensitivity, glucose disposal, plasma concentrations of leptin and acylcarnitines, and urinary acylcarnitine excretion in warmblood horses.

BACKGROUND: Insulin resistance in horses is an emerging field of interest as it is thought to be a contributing factor in the pathogenesis of many equine conditions. OBJECTIVES: The objectives of the present study were to determine the effects of long-term oral administration of L-carnitine on insulin sensitivity, glucose disposal, plasma leptin concentrations and acylcarnitine spectrum both in plasma and urine. ANIMALS AND METHODS: Six 3-year-old healthy warmblood geldings were used. In a double blind 2 × 2 Latin square design at a dosage of 100 mg/kg body weight (BW)/day for 28 days the effects of oral supplementation of L-carnitine (as fumarate) were assessed. Glucose disposal and insulin sensitivity were measured by means of the euglycemic-hyperinsulinemic clamp technique. Radioimmunoassays were used to determine plasma leptin and insulin concentrations. Electrospray tandem mass spectrometry was used to assess acylcarnitines both in plasma and urine. Statistical analysis was performed using a linear mixed-effects model and P values <0.05 were considered significant. RESULTS: Long-term L-carnitine administration did not affect insulin sensitivity. Plasma leptin and free carnitine concentrations in plasma and urine increased significantly (P = 0.047 and 0.000, respectively) following L-carnitine administration as well as short-chain acylcarnitines in plasma and urinary excretion of short- and medium-chain acylcarnitines. CONCLUSION AND CLINICAL RELEVANCE: Given the effects of oral administration of L-carnitine further clinical study is necessary in order to assess the potential beneficial effects in equine patients suffering from metabolic myopathies such as acquired multiple acyl-CoA dehydrogenase deficiency. IMPACT FOR HUMAN MEDICINE: The current study supports the treatment rationale of short-chain acyl-CoA dehydrogenase deficiency in humans with L-carnitine at an oral dosage of 100 mg/kg BW/day.

A cohort study on Actinobacillus pleuropneumoniae colonisation in suckling piglets.

Actinobacillus pleuropneumoniae causes respiratory disease in pigs and despite the use of preventive measures such as vaccination and antimicrobials clinical outbreaks still occur. At weaning often many piglets are not colonised. If differences in prevalence between litters are large and if factors were known that could explain these differences, this may provide an opportunity to raise groups of A. pleuropneumoniae free piglets. To this end, a cohort study was performed on two endemically infected farrow-to-finish farms. Seventy-six of 133 sows were selected using stratified random selection by parity. Farmers complied with a strict hygiene and animal management protocol to prevent transmission between litters. Tonsil brush and serum samples taken three weeks before parturition were tested for antigen with an apxIVA qPCR and antibodies with Apx and Omp ELISAs, respectively. Three days before weaning tonsil brush samples from all piglets (n=871) were collected and tested for antigen. Whereas all sows tested positive both in serology tests as well as qPCR, 0.41 of the litters tested fully negative and 0.73 of all piglets tested negative. The proportion of positively tested piglets in positive litters ranged from 0.08-1.0 (median=0.36). A grouped logistic regression model with a beta binomial distribution of the probability for piglets to become infected was fitted to the data and associations with explanatory variables were explored. To test the possibility that alternatively the clustering was caused by onwards transmission among the piglets, a transmission model was fitted to the data incorporating sow-piglet and piglet-piglet transmission, but this model did not fit better. The results of this study showed that the number of colonised suckling piglets was highly clustered and mainly attributable to the variability of infectiousness of the dam, but no dam related risk factor for colonisation status of litter or piglets within litters could be identified.

Principal climatic and edaphic determinants of Culicoides biting midge abundance during the 2007-2008 bluetongue epidemic in the Netherlands, based on OVI light trap data.

Palaearctic Culicoides midges (Diptera: Ceratopogonidae) represent a vital link in the northward advance of certain arboviral pathogens of livestock such as that caused by bluetongue virus. The effects of relevant ecological factors on weekly Culicoides vector abundances during the bluetongue virus serotype 8 epidemics in the Netherlands in 2007 and 2008 were quantified within a hurdle modelling framework. The relative role of meteorological parameters showed a broadly consistent association across species, with larger catches linked to temperature-related variables and lower wind speed. Moreover, vector abundance was found to be influenced by edaphic factors, likely related to species-specific breeding habitat preferences that differed markedly amongst some species. This is the first study on Culicoides vector species in the Netherlands identified during an entomological surveillance programme, in which an attempt is made to pinpoint the factors that influence midge abundance levels. In addition to providing key inputs into risk-mitigating tools for midge-borne pathogens and disease transmission models, the adoption of methods that explicitly address certain features of abundance datasets (frequent zero-count observations and over-dispersion) helped enhance the robustness of the ecological analysis.