Fertility of Angus cross beef heifers after GnRH treatment on day 23 and timing of insemination in 14-day CIDR protocol.

This study compared artificial insemination pregnancy rate (AI-PR) between 14-day CIDR-GnRH-PGF2α-GnRH and CIDR-PGF2α-GnRH synchronization protocol with two fixed AI times (56 or 72 hr after PGF2α). On day 0, heifers (n = 1311) from nine locations assigned body condition score (BCS: 1, emaciated; 9, obese), reproductive tract score (RTS: 1, immature, acyclic; 5, mature, cyclic) and temperament score (0, calm; and 1, excited) and fitted with a controlled internal drug release (CIDR, 1.38 g of progesterone) insert for 14 days. Within herd, heifers were randomly assigned either to no-GnRH group (n = 635) or to GnRH group (n = 676), and heifers in GnRH group received 100 µg of GnRH (gonadorelin hydrochloride, IM) on day 23. All heifers received 25 mg of PGF2α (dinoprost, IM) on day 30 and oestrous detection aids at the same time. Heifers were observed for oestrus thrice daily until AI. Within GnRH groups, heifers were randomly assigned to either AI-56 or AI-72 groups. Heifers in AI-56 group (n = 667) were inseminated at 56 hr (day 32 PM), and heifers in AI-72 group (n = 644) were inseminated at 72 hr (day 33 AM) after PGF2α administration. All heifers were given 100 µg of GnRH concurrently at the time AI. Controlling for BCS (p < .05), RTS (p < .05), oestrous expression (p < .001), temperament (p < .001) and GnRH treatment by time of insemination (p < .001), the AI-PR differed between GnRH treatment [GnRH (Yes - 60.9% (412/676) vs. No - 55.1% (350/635); p < .05)] and insemination time [AI-56 - 54.6% (364/667) vs. AI-72 - 61.8% (398/644); (p < .01)] groups. The GnRH treatment by AI time interaction influenced AI-PR (GnRH56 - 61.0% (208/341); GnRH72 - 60.9% (204/335); No-GnRH56 - 47.9% (156/326); No-GnRH72 - 62.8% (194/309); p < .001). In conclusion, 14-day CIDR synchronization protocol for FTAI required inclusion of GnRH on day 23 if inseminations were to be performed at 56 hr after PGF2α in order to achieve greater AI-PR.

Prior infections are associated with increased mortality from subsequent blood-stream infections among patients with hematological malignancies.

Many patients who are evaluated and treated for sepsis have histories of recent infections. The prognostic implications of surviving an infectious process are not well understood. We undertook this study to determine the clinical impact of prior infections among patients with hematological malignancies, a population at high risk for developing and dying from sepsis. The medical records of 203 patients with hematological malignancies and blood-stream infections admitted over a 3-year period to an urban teaching hospital were retrospectively reviewed. The 30-day mortality after blood-stream infection in these high-risk patients was 24 %. There were 46 patients (23 %) who had inpatient infections in the 90 days prior to the index blood-stream infection. History of recent infection portended worse prognosis from blood-stream infection under multivariable analysis [odds ratio (OR) 2.60, p = 0.04, 95 % confidence interval (CI) 1.04-6.47]. There were 86 patients (42 %) who had subsequent infections in the first 90 days after the index blood-stream infection. Patients with subsequent infections had greater mortality during days 91-365 than patients without subsequent infections [hazard ratio (HR) 1.97, p = 0.02, 95 % CI 1.13-3.44]. Recent infections prognosticate worse outcomes from subsequent blood-stream infections for this high-risk population. Further research into the clinical and biochemical reasons for this observation may lead to targets for intervention, and, ultimately, improvements in long-term mortality from sepsis.

Calm temperament improves reproductive performance of beef cows.

Profitability of a beef operation is determined by the proportion of cows attaining pregnancy early in the breeding season and those that are pregnant at the end of breeding season. Many factors, including temperament, contribute to those reproductive parameters. The objective of this study was to evaluate effects of temperament on reproductive performance of beef cows. In Experiment 1, Angus and Angus-cross beef cows (n = 1546) from eight locations were assigned a body condition score (BCS; 1 = emaciated; 9 = obese) and chute exit and gait score (1 = slow exit, walk; calm temperament; 2 = jump, trot or run; excitable temperament). Cows were grouped with bulls (1 : 25 to 1 : 30; with satisfactory breeding potential and free of venereal disease) for an 85-day breeding season. Pregnancy status and stage of gestation were determined (transrectal palpation) 35 days after the end of the breeding season. Controlling for BCS (p < 0.01) and handling facility (p < 0.0001) and handling facility by temperament score interaction (p < 0.001), breeding season pregnancy rate was lower in excited versus calm cows [88.6% (798/901) vs 94.1% (607/645); p < 0.001]. Cows with an excitable temperament took 24 more days to become pregnant compared to calm cows (median days to pregnancy, 35 vs 59 days; p < 0.0001). In Experiment 2, Angus and Angus-cross beef cows (n = 1407) from 8 locations were assigned scores for body condition and chute exit and gait (as described in Experiment 1) and assigned to bulls (breeding sound and free of venereal disease; 1 : 25 to 1 : 30) for 85 days. Pregnancy status was determined by transrectal palpation at 2 and 6 months after the onset of the breeding season. Controlling for BCS (p < 0.05), pregnancy loss was higher in excited versus calm cows [5.5% (36/651) vs 3.2% (20/623), p < 0.0001]. In conclusion, beef cows with an excitable temperament had significantly lower reproductive performance than calmer cows. The modified two-point chute exit-gait scoring method was repeatable and identified cattle with an excitable temperament.

Pre-synchronization of ovulation timing and delayed fixed-time artificial insemination increases pregnancy rates when sex-sorted semen is used for insemination of heifers.

This study was conducted to determine effects of pre-synchronization of ovulation timing among heifers and delayed fixed-time artificial insemination (TAI) with sex-sorted semen on proportion of heifers pregnant after TAI (PR/AI). Heifers were assigned to one of eight treatments: 1 and 2), 7-d CO-Synch + CIDR treatment regimen with administration of gonadotropin-releasing hormone and a CIDR insert on Day 0, prostaglandin F2α (PGF) at CIDR removal on Day 7, and TAI occurring 54 h later with conventionally processed (CTRL54-CNV) or sex-sorted semen (CTRL54-SEX); 3 and 4), same as CTRL54 but TAI delayed to 72 h with conventionally processed (CTRL72-CNV) or sex-sorted semen (CTRL72-SEX); 5 and 6), same as CTRL54 but additional administration of PGF on Day -7 and TAI with conventionally processed (PRE54-CNV) or sex-sorted semen (PRE54-SEX); 7 and 8), same as PRE54 treatments but TAI delayed to 72 h with conventionally processed (PRE72-CNV) or sex-sorted semen (PRE72-SEX). Proportion of heifers pregnant after TAI was greater (P ≤  0.02) with conventionally processed semen compared with sex-sorted semen, yet PR/AI did not differ (P =  0.14) between heifers in PRE72-CNV and PRE72-SEX groups. There were greater PR/AI in the PRE72-SEX (P =  0.03) than CTRL54-SEX group (46.1 % and 36.9 %) and there was no difference (P =  0.31) in PR/AI between CTRL54-CNV and PRE72-SEX groups (50.4 % and 46.1 %). In conclusion, pre-synchronization of ovulation timing among heifers combined with delayed TAI resulted in increased PR/AI with sex-sorted semen compared with the 7-d CO-Synch+CIDR treatment regimen.

Pregnancy rates in angus cross beef cows bred at observed oestrus with or without second GnRH administration in fixed-time progesterone-supplemented Ovsynch and CO-Synch protocols.

Crossbred cows (n = 1073) from five locations had oestrous cycles synchronized with 100 microg of GnRH IM and insertion of controlled internal drug release device (CIDR) on Day 0 followed by 25 mg of PGF(2alpha) IM and CIDR removal on Day 7. Kamar patches were placed on all cows at CIDR removal. Cows were observed three times daily for oestrus after PGF(2alpha) administration. In the Ovsynch-CIDR group, cows detected in oestrus (n = 193) within 48 h after PGF(2alpha) were inseminated using the AM-PM rule. Among these cows, 80 received and 113 did not receive a second GnRH at 48 h after PGF(2alpha). Cows (n = 345) not detected in oestrus received a second GnRH at 48 h after PGF(2alpha) on Day 9, and fixed-time AI 16 h after the GnRH on Day 10. In the CO-Synch-CIDR group, cows detected in oestrus (n = 224) within 48 h after PGF(2alpha) were inseminated using the AM-PM rule. Among these cows, 79 received and 145 did not receive a second GnRH at 64 h after PGF(2alpha). Cows (n = 311) not detected in oestrus received a second GnRH on Day 10 at the time of AI, 64 h after PGF(2alpha). The AI pregnancy rates were not different between the Ovsynch-CIDR and CO-Synch-CIDR groups (p = 0.48). There were no differences in the AI pregnancy rates for cows inseminated at a fixed time (p = 0.26) or at detected oestrus (p = 0.79) between the treatment groups. Among cows inseminated in oestrus, there were no differences in the AI pregnancy rates between cows that received or did not receive the second GnRH (p = 0.47). In conclusion, acceptable AI pregnancy rates can be achieved with or without inclusion of oestrus detection in the Ovsynch-CIDR and CO-Synch-CIDR protocols. Among cows detected in oestrus, cows that received a second GnRH yielded similar pregnancy rates when compared with cows that did not receive the second GnRH.

Two doses of prostaglandin improve pregnancy rates to timed-AI in a 5-day progesterone-based synchronization protocol in beef cows.

The objective was to compare reproductive performance of Angus-cross beef cows synchronized with GnRH, a progesterone-based intravaginal insert (Controlled Internal Drug Release, CIDR) for 5-d, and one dose of either dinoprost (PGF) or cloprostenol (CLP, a PGF analogue) or two doses of PGF on the day of CIDR withdrawal. All cows (N=830) at six locations received 100microg of GnRH and a CIDR on Day 0. Within farm, cows were randomly allocated to receive 25mg of PGF at the time of CIDR insert removal on Day 5 (1xPGF; N=277), two 25mg doses of PGF, the first given on Day 5 at the time of CIDR removal and the second 7h later (2xPGF; N=282), or 500microg of CLP at the time of CIDR removal on Day 5 (1xCLP; N=271). All cows were given 100microg of GnRH on Day 8 (72h after CIDR removal) and concurrently inseminated (5-d CO-Synch+CIDR). Cows were fitted with a pressure-sensitive estrus detection device at the time of CIDR withdrawal. Timed-AI pregnancy rates were greater (P<0.0001) in the 2xPGF (69.0%) than the 1xPGF (52.0%) and 1xCLP (54.3%) treatments. However, breeding-season pregnancy rates were not different among treatments (87.0% for 1xPGF, 92.9% for 2xPGF and 87.5% for 1xCLP; P>0.1). In conclusion, cows that received two doses of PGF on the day of CIDR removal in a 5-d CO-Synch+CIDR synchronization protocol had excellent timed-AI pregnancy rates that were greater than in cows receiving a single treatment with either PGF or CLP.

Fixed-time AI pregnancy rate following insemination with frozen-thawed or fresh-extended semen in progesterone supplemented CO-Synch protocol in beef cows.

The objective of this study was to compare fixed-time AI pregnancy rate in Angus crossbred beef cows inseminated with frozen-thawed or fresh-extended semen. Two ejaculates from each of two Angus bulls were collected by artificial vagina and pooled for each bull. The pooled semen from each bull was divided into two aliquots; Aliquot 1 was extended using Caprogen (LIC, Hamilton, New Zealand) to a concentration of 3 x 10(6)sperm/straw and Aliquot 2 was extended using egg-yolk-glycerol extender to a concentration of 20 x 10(6)sperm/straw. Semen extended with Caprogen was maintained at ambient temperature and semen extended with egg-yolk-glycerol extender was frozen and maintained at -196 degrees C until insemination. In each of two breeding seasons (Fall 2007 and Spring 2008), Angus-crossbeef cows (N=1455) at 12 locations were randomly assigned within location to semen type [Fresh (N=736) vs. Frozen (N=719)] and sire [1 (N=731) vs. 2 (N=724)]. All cows were synchronized with 100 microg of GnRH im and a progesterone Controlled Internal Drug Release insert (CIDR) on Day 0, and on Day 7, 25mg of PGF2(alpha) im and CIDR removal. All cows received 100 microg of GnRH im and were inseminated at a fixed-time on Day 10, 66 h after CIDR removal. Timed-AI pregnancy rates were influenced by season (P<0.05), cows detected in estrus prior to and at AI (P<0.001), and dam age (P<0.01). Pregnancy rates were not affected by semen type (Fresh=51.5% vs. Frozen=50.4%; P=0.66) and there were no significant interactions of semen type by estrus expression, semen type by sire, or semen type by season (P>0.1). In conclusion, commercial beef cows inseminated with fresh-extended semen (3 x 10(6)sperm/straw) yielded comparable pregnancy rates to conventional frozen-thawed semen in a progesterone supplemented, CO-Synch fixed-time AI synchronization protocol and may provide an alternate to frozen semen for more efficient utilization of superior genetics.

Sire effect on the pregnancy outcome in beef cows synchronized with progesterone based Ovsynch and CO-Synch protocols.

The objective was to determine the sire effect on the pregnancy outcome in beef cows in which stage of estrus was synchronized with progesterone based fixed-time artificial insemination (AI) protocols. Three Angus sires with more than 300 breedings were evaluated for differences in pregnancy outcome from 1868 inseminations. Angus cross beef cows (N=1868) were synchronized with Ovsynch-CIDR or CO-Synch-CIDR protocols for fixed-time AI. Cows in both groups that showed estrus on day 9 before 1500 h were designated to Selectsynch-CIDR group and were inseminated according to AM-PM rule. Results indicated that Sire 2 had lower fixed-time AI pregnancy rate compared to Sire 3 (48.1% versus 58.7%; P=0.01). Significant sirexsynchronization program and sirexlocation interactions were observed for fixed-time AI (P<0.05). Sire 2 had a lesser fixed-time AI pregnancy in both Ovsynch-CIDR and CO-Synch-CIDR groups compared to Sire 3. In two of four locations, Sire 2 had a lesser fixed-time pregnancy rate compared to Sire 3. No sire differences were observed in AI pregnancy for cows in Selectsynch-CIDR group. In conclusion, evidence in this study suggest that there are differences in sire fertility when they were used in fixed-time AI protocols, possibly due to the sire differences in sperm capacitation process. Further studies are needed to investigate association of the sire differences in fixed-time AI protocols with sire differences in the sperm capacitation process.

Flunixin meglumine improves pregnancy rate in embryo recipient beef cows with an excitable temperament.

Objectives were to determine effects of: 1) handling temperament and administration of flunixin meglumine, an inhibitor of prostaglandin F2a (PGF2a) synthesis, given at the time of embryo transfer, on pregnancy rates in beef cattle embryo transfer recipients; 2) handling temperament and flunixin meglumine on peripheral concentrations of progesterone, cortisol, substance-P, prostaglandin F metabolites (PGFM, (13,14-dihydro-15-keto-PGF2a) and isoprostane 8-epi PGF2a; and 3) flunixin meglumine treatment on proportion of non-pregnant recipient cows returning to estrus within an expected interval. Angus cross beef cows (n = 710) at 7 locations were assigned a body condition score (BCS: 1, emaciated; 9, obese) and a temperament score [0, calm, slow chute exit; walk (n = 352), 1, excited, fast chute exit; jump, trot or run (n = 358)] and were synchronized with Select-Synch with a controlled internal drug release (CIDR) protocol. Estrus detection aids were applied at CIDR removal and cows were observed thrice daily for estrus until 72 h. Recipient cows that expressed estrus and had a corpus luteum received a frozen-thawed embryo on Day 7 after estrus. At the time of transfer, recipient cows were randomly allocated to receive 10 mL of flunixin meglumine im, immediately after transfer (n = 365) or served as an untreated control (n = 345). In a subset of cows (n = 80), ovarian ultrasonography was performed on the day of embryo transfer to determine corpus luteum volume and blood samples were collected twice, at the time of embryo transfer and 7 d later. All cows received estrus detection aids again on Day 14 (7 d after embryo transfer) and were observed for estrus twice daily until Day 24. Accounting for treatment (P > 0.1), embryo transfer difficulty score (P < 0.1), temperament by treatment interaction (P < 0.05), recipient cows with calm temperament had a higher pregnancy rate compared to those with an excited temperament [59.4 (209/352) vs 51.7% (185/358)]. The pregnancy rate for excitable cows without flunixin meglumine was lower (46.3% 81/175) compared to excitable cows that did received flunixin meglumine [56.8% (104/183)], and calm cows that did [59.3% (108/182)] or did not [59.4% (104/170)] receive flunixin meglumine. Proportions of non-pregnant recipient cows returning to estrus on Days 18-24 were not different between flunixin meglumine and control groups, 87.6% (134/153) and 84.0% (137/163), respectively (P > 0.1). At the time of embryo transfer and 7 d later, there were moderate to strong correlations among circulating concentrations of progesterone, cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a. Among excitable cows, progesterone concentrations were lower and cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a concentrations were greater for cows in the control group compared to cows that received flunixin meglumine. In conclusion, administration of flunixin meglumine improved pregnancy rates in excitable recipient cows following embryo transfer without affecting the proportion of non-pregnant cows returning to estrus.

Impact of delayed insemination on pregnancy rates to gender selected semen in a fixed-time AI system.

The objectives of the current experiment were to determine if delaying insemination by 8 h in a FTAI protocol would alter estrus expression and pregnancy rates in cows inseminated with sex-sorted semen, characterize bull variation in pregnancy rates to sex-sorted semen and examine the impact of repeated years of FTAI to sex-sorted semen on calving distribution. Over three breeding seasons, postpartum cows (n = 839) were estrous synchronized using the 5-day CO-Synch + CIDR system. Cows were given GnRH (100 µg i.m., Factrel) at time of insertion of a controlled internal drug releasing device (CIDR; Eazi-Breed CIDR). Five d later CIDR was removed and PGF2α (25 mg i.m., Lutalyse) was given at removal and 8 h later. Estrus detection aids were applied at CIDR removal. Cows were inseminated with X-sorted or Y-sorted sex-sorted semen at 72 h (NORM) or 80 h (DELAY) after CIDR removal, and GnRH was administered at AI. At insemination, estrus status was categorized as positive (YES), partial (QUES), unknown (NR) or negative (NO). Bulls were introduced to cows at 14 d and removed at 60 d after FTAI. Pregnancy diagnosis was performed by ultrasound at d 60 after FTAI and via palpation at 60 d after bull removal. There was no difference (P > 0.05) in pregnancy rates to sex-sorted semen or final pregnancy rates between NORM and DELAY cows. Pregnancy to sex-sorted semen averaged 35.2% whereas final pregnancy rates were 90.6%. More cows (P < 0.05) in the DELAY group expressed estrus before FTAI, but this increase did not alter pregnancy rates to sex-sorted semen. Expression of estrus before FTAI increased (P < 0.02) pregnancy rates to sex-sorted semen across treatments with differences being YES > QUES or NR > NO. There was considerable variation in pregnancy rate by bull (P < 0.05) with pregnancy rates ranging from 55.6% to 19.3%. Whole herd calving distribution was altered (P < 0.05) after 3 y of use of sex-sorted semen compared to the previous 3 y when conventional semen was used. We conclude that delaying insemination by 8 h in an FTAI protocol did not improve pregnancy rates to sex-sorted semen despite more cows exhibiting estrus before FTAI. In addition, a high bull to bull variation in pregnancy rates to sex-sorted semen is a limitation in FTAI systems. Further research into FTAI strategies for use with sex-sorted semen is warranted.

Effective use of SexedULTRA™ sex-sorted semen for timed artificial insemination of beef heifers.

An experiment was designed to evaluate the relative fertility of SexedULTRATM sex-sorted semen compared to conventional, non-sex-sorted semen when used among beef heifers in conjunction with split-time AI following the 14-d CIDR-PG protocol. Units of conventional semen were generated with 25.0 × 106 live cells per 0.5 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRATM Genesis III sorting technology with 4.0 × 106 live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Estrus was synchronized in 851 heifers at four locations using the 14-d CIDR-PG protocol: controlled internal drug release (CIDR) insert (1.38 g progesterone) on Day 0, CIDR removal on Day 14, and administration of prostaglandin F2α (PG; 25 mg im) on Day 30. Estrus detection aids were applied at PG on Day 30 to evaluate estrous response rate, and split-time AI was performed based on estrous response. At 66 h after PG (Day 33), heifers having expressed estrus received timed AI. Heifers failing to express estrus by 66 h received timed AI 24 h later (90 h after PGF2α on Day 34). Heifers failing to express estrus by 90 h were administered gonadotropin-releasing hormone (GnRH; 100 µg im) concurrent with AI. Heifers were preassigned to treatment (insemination with either conventional or SexedULTRATM sex-sorted semen), and treatments were balanced within each location based on source, reproductive tract score, and weight. Heifers were exposed for natural service beginning 14 d after AI for the remainder of a 60 d breeding season. Pregnancy rates to AI across locations tended to be higher (P = 0.09) for heifers inseminated with conventional semen (60%; 257/429) compared to sex-sorted semen (52%; 218/422). Higher pregnancy rates to AI (P < 0.0001) were obtained among heifers that expressed estrus prior to AI than among heifers that failed to express estrus prior to AI at 90 h. Total pregnancy rates at the end of the 60 d breeding season did not differ between heifers that received sex-sorted semen at AI (89%; 376/422) and heifers that received conventional semen at AI (89%; 382/429). In summary, the pregnancy rates observed suggest that SexedULTRATM sex-sorted semen can be used effectively for timed AI of beef heifers when split-time AI is performed following the 14-d CIDR-PG protocol.

Effect of timing of prostaglandin administration, controlled internal drug release removal and gonadotropin releasing hormone administration on pregnancy rate in fixed-time AI protocols in crossbred Angus cows.

Two experiments were conducted to investigate the effects of timing of prostaglandin F2(alpha) (PGF2(alpha)) administration, controlled internal drug release device (CIDR) removal and second gonodotropin releasing hormone (GnRH) administration on the pregnancy outcome in CIDR-based synchronization protocols. In Experiment 1, suckled Angus crossbred beef cows (n = 580) were given 100 microg of GnRH+a CIDR on Day 0. Cows in Group 1 (modified Ovsynch-P) received 25 mg of dinoprost (PGF2(alpha)) and CIDR device removal on Day 8 (AM), 100 microg of GnRH 36 h later on Day 9 (p.m.), and fixed-time AI (FTAI) 16 h later on Day 10 (47.5+/-1.1 h after PGF2(alpha)). Cows in Group 2 (Ovsynch-P) received 25mg of PGF2(alpha) and CIDR device removal on Day 7 (p.m.), 100 microg of GnRH 48 h later on Day 9 and FTAI 16 h later on Day 10 (66.6+/-1.2 h after PGF2(alpha)). Pregnancy rates were 56.5% (170/301) for Group 1 and 55.6% (155/279) for Group 2, respectively (P = 0.47). In Experiment 2, beef cows (n=734) were synchronized with 100 microg of GnRH+CIDR on Day 0, 25 mg of PGF2(alpha) and CIDR device removal on Day 7 and either 100 microg of GnRH 48 h later on Day 9 (Ovsynch-P) and FTAI 16 h later on Day 10 (64.9+/-3.3 h from PGF2(alpha)) or 100 microg of GnRH on Day 10 (CO-Synch-P) at the time of AI (63.2+/-4.2 h from PGF2(alpha)). Pregnancy rates were 48.8% (180/369) for Ovsynch-P and 44.7% (163/365) for CO-synch-P groups, respectively (P = 0.11). In both experiments, there was a locationxtreatment interaction (P<0.05); pregnancy rates between locations were different (P < 0.05) in the Ovsynch-P group. In conclusion, in a CIDR-based Ovsynch synchronization protocol, delaying administration of prostaglandin and CIDR removal by 12 h, or timing of the second GnRH by 16 h, did not affect pregnancy rates to FTAI. Therefore, there may be an opportunity to make changes in synchronization protocols with out adversely affecting FTAI pregnancy rates.

Fertility after implementation of long- and short-term progesterone-based ovulation synchronization protocols for fixed-time artificial insemination in beef heifers.

Two experiments were conducted to evaluate the effect of long-term (LT; a 14-day controlled internal drug release insert [CIDR]-PGF2α [PGF]-GnRH) and short-term (ST; 5-day CO-Synch + CIDR) progesterone-based protocols on pregnancy rate to fixed-time artificial insemination (FTAI) in beef heifers. In experiment 1, Angus cross beef heifers (N = 1887) at nine locations received a body condition score and a reproductive tract score (RTS). Within the herd, heifers were randomly assigned to LT-72 and ST-56 protocol groups. Heifers in the LT-72 group received a CIDR from Days 0 to 14, followed by 25 mg of PGF 16 days later (Day 30). Heifers in the ST-56 group received a CIDR and 100 µg of gonadorelin hydrochloride (GnRH) on Day 25 followed by 25 mg of PGF at CIDR removal on Day 30 and a second dose of PGF 6 hours later (Day 30). Artificial insemination was performed at 56 hours (Day 32) after CIDR removal for the ST-56 group and at 72 hours (Day 33) after CIDR removal for the LT-72 group, and all heifers were given GnRH (100 µg, intramuscular) at the time of AI. In experiment 2, Angus cross beef heifers (N = 718) at four locations received a body condition score and an RTS. Within the herd, heifers were randomly assigned to LT-72 and ST-72 protocol groups. The protocol was similar to experiment 1 except that AI was performed at 72 hours after CIDR removal for both LT-72 and ST-72 groups. In experiment 1, no difference in AI pregnancy rates between the LT-72 and ST-56 groups was observed (54.5% [489 of 897] and 55.5% [549 of 990], respectively; P = 0.92) after accounting for the RTS. The AI pregnancy rates for heifers with RTS 3 or less, 4, and 5 were 52.6%, 53.6%, and 59.9%, respectively (P < 0.05). In experiment 2, controlling for the RTS, no difference in AI pregnancy rates was observed between the LT-72 and ST-72 groups, 56.9% (198 of 347) and 57.8% (214 of 371), respectively (P = 0.87). The AI pregnancy rates for heifers with RTS 3 or less, 4, and 5 were 49.3%, 58.4%, and 62.1%, respectively (P < 0.05). In conclusion, heifers synchronized for fixed-time AI with LT and ST protocols resulted in a similar AI pregnancy rate. Approximately, 55% of the herd was pregnant to one insemination in 33 days with the LT protocol compared with just 8 days with the ST protocol.

Antimicrobial action of compound 48/80--II mechanism of action.

The mixture of compounds called compound 48/80 had been shown to have antimicrobial activity against a wide variety of microorganisms. In this paper it is shown that its primary site of attack appears to be on the membrane of the cell. In its presence, Tetrahymena became much more sensitive to osmotic stress, and alpha-methylglucose was rapidly released from preloaded Escherichia coli cells. The drug also had effects on cell viability, respiration, cell division, and the release of material absorbing at 260 nm. In general, its effects paralleled those of polymyxin B, although its structure is quite different except for the presence of amino groups and hydrophobic regions in both molecules. The activity of 48/80 was not due to detergent-like, surface-active properties and was antagonized by magnesium and other cations and by phosphatidylserine. Purification of the active principle might provide a relatively simple and readily modifiable probe of membrane function and possibly a new family of useful antimicrobial compounds.

Effects of a medical intensivist on patient care in a community teaching hospital.

OBJECTIVE: To determine the effect of adding a trained intensivist on patient care and educational outcomes in a community teaching hospital. MATERIAL AND METHODS: We retrospectively reviewed outcomes for patients admitted to the medical intensive-care unit (MICU) of a 270-bed community teaching hospital between July 1992 and June 1994. Mortality rates and durations of stay were determined for the year before (BD, 1992 through 1993) and the first year after (AD, 1993 through 1994) introduction of a full-time director of critical care. Performance of resident trainees on a standardized critical-care examination was measured for the same periods. RESULTS: Overall, 459 patients in the BD period were compared with 471 patients in the AD period. The mix of cases and severity of illness (acute physiology and chronic health evaluation or APACHE II scores) on admission were similar for the BD and AD periods. MICU mortality decreased from 20.9% during the BD to 14.9% during the AD period (P = 0.02), and in-hospital mortality decreased from 34.0% to 24.6% (P = 0.002). Disease-specific mortalities were lower during the AD period for most categories of illness. Detailed analysis of a subgroup of patients (those with pneumonia) demonstrated no differences in distribution of patients by gender, race, or acuity of illness (APACHE II scores). The mortality rate due to pneumonia decreased from 46% during the BD period to 31% during the AD period. This decrease was consistent across categories of APACHE II scores. From BD to AD periods, mean durations of total hospital stay decreased from 22.6 +/- 1.4 days to 17.7 +/- 1.0 days, and mean MICU stay decreased from 5.0 +/- 0.3 days to 3.9 +/- 0.3 days (P < 0.05). Critical-care in-service examination scores for 22 residents increased from 53.8 +/- 1.7% to 67.5 +/- 2.2% (P < 0.01), and AD scores were significantly higher than BD scores for residents at similar levels of training. CONCLUSION: Addition of a medical intensivist was temporally associated with improved clinical and educational outcomes in our community teaching hospital.

Cyclophosphamide in the treatment of pulmonary diseases: survey of use, training, and practitioner knowledge base.

OBJECTIVE: To assess pulmonologists' use, training in the use, and knowledge base of the drug cyclophosphamide. DESIGN: Survey through questionnaire. Testing of knowledge base before and after instructional conference. PARTICIPANTS AND METHODS: Pulmonologists (94 attendings, 31 fellows), selected randomly at the 1996 and 1997 annual meetings of The American Thoracic Society, completed surveys of their use and training in the use of cyclophosphamide. Thirty-five attending at the 1998 meeting completed a test of knowledge base of the drug. Members of the pulmonary teaching service at The University of Chicago Hospitals completed the test before and after a case-based conference designed to educate pulmonologists in the use of the drug. RESULTS: Forty-three percent of the attending pulmonologists and 55% of the fellows were currently using the drug in the management of their patients; 77% of the attending pulmonologists had prescribed the drug in the past. Nonmalignant diseases for which the drug was prescribed included usual interstitial pneumonitis/desquamative interstitial pneumonitis, vasculitis, collagen vascular disease, constrictive bronchiolitis, sarcoid, and Goodpasture's disease. Sixty-eight percent of attending pulmonologists and 81% of fellows had no training in the drug's use. Of the attending pulmonologists who made use of the drug, 64% were prescribing and managing its use themselves. Of those who prescribed and managed the drug's use themselves, 65% had had no training in its use. Of those fellows who prescribed and managed the drug's use themselves, 73% had had no training in the drug's use. On knowledge-based testing, the average correct score was 30 +/- 10%. With an educational conference, average pre- and post-test scores rose from 40 +/- 10% to 80 +/- 10% (p < 0.001). CONCLUSION: Cyclophosphamide had been used by the vast majority of pulmonologists, either currently or in the past, for a wide variety of lung diseases. Its use is commonly managed by physicians who have no specific training relevant to this agent. Practitioner knowledge base of the drug is poor, and case-based conferences in fellowship may be an effective means of imparting information concerning this drug.

Control of hypertension with nifedipine in the setting of aortic dissection.

We report a 61-year-old man with dissection of the descending aorta and hypertension in whom medical management with beta-blocking antihypertensives was precluded by a history of asthma. The calcium channel blocker nifedipine was successfully employed in this setting and the rationale for its use is discussed.

An approach to mediastinal masses associated with hyperthyroidism.

Benign thymic hyperplasia (BTH) is a known feature of hyperthyroidism, but is infrequently appreciated by clinicians. In most cases thymic enlargement is minimal; however, it may occasionally present as an appreciable anterior mediastinal mass. While surgical resection is a common approach to such a mass, recognition of the benign nature of BTH and its regression following treatment of hyperthyroidism would prevent a major surgical procedure. We present three cases of BTH associated with hyperthyroidism and describe our approach to this syndrome.

Pleural effusion masquerading as myocardial infarction.

The effects of pleural effusions on the ECG have not been well studied. We report herein the case of a patient with extreme QRS axis deviation mimicking acute myocardial infarction. Thoracentesis caused the return of a more normal axis.

Treatment of bronchospasm by metered-dose inhaler albuterol in mechanically ventilated patients.

beta 2-agonist bronchodilators delivered by metered-dose inhalers (MDI) are commonly used in the treatment of bronchospasm in both intubated and nonintubated patients. Substantial data support the effectiveness of MDI delivery systems in nonintubated patients. However, few studies have examined the effectiveness of MDIs in intubated, mechanically ventilated patients. MDIs are often used in conjunction with a spacing device that may enhance delivery of drug to the airways, but few in vivo data have demonstrated efficacy of this delivery method in ventilated patients. We studied ten critically ill patients who had a peak (Ppeak) to pause (Ppause) gradient of more than 15 cm H2O during sedated, quiet breathing on assist control ventilation. We administered 5, 10, and 15 puffs (90 micrograms per puff) of MDI albuterol through a specific spacer (Aerovent) at 30-min intervals, while measuring resistive pressure (defined as Ppeak-Ppause) before and after treatments. Resistive airway pressure after 5 puffs decreased in nine of ten patients, from 25.1 +/- 7.2 to 20.8 +/- 5.6 cm H2O (p < 0.12). The addition of 10 more puffs further reduced resistive pressure in nine of nine patients from 20.8 +/- 5.6 to 19.0 +/- 4.4 (p < 0.01). Fifteen more puffs (30 cumulative puffs) did not result in further improvement (p > 0.5). A toxic reaction occurred in one patient (systolic blood pressure decreased 20 mm Hg) after 5 puffs of albuterol. We conclude that MDI administered through this specific spacer is effective in mechanically ventilated patients in doses up to 15 puffs, and that therapy should be titrated to effectiveness and toxicity.