Outcomes Following Pedestal Cup Reconstruction of (Impending) Pathological Fractures of the Acetabulum due to Metastatic Bone Disease.

Management of periacetabular metastatic bone disease (MBD) is challenging, specifically if associated with bone loss or fracture. The aim of this study was to evaluate the complications and outcomes after undergoing peri-acetabular reconstruction using an 'ice-cream cone' pedestal cup endoprostheses for the most severe cases of (impending) pathological acetabular fractures. Fifty cases with severe periacetabular disease were identified. Acetabular defects were classified using the Metastatic Acetabular Classification (MAC). Pre- and post-operative mobility was assessed using the Eastern Cooperative Oncology Group (ECOG) Performance Status. Pain levels were assessed using a verbal rating scale. Surgical complications and patient survival were analysed; the Prognostic Immune Nutritional Index (PINI) was applied retrospectively to survival. There were 32 females and 18 males with a median age of 65 (41-88). Median post-operative follow-up was 16 months (IQR 5.5-28.5 months). Thirty-nine had complete, and 11, impending pathological fractures. The observed five-year survival was 19%, with a median survival of 16 months (IQR 5.8-42.5 months). Significantly worse survival was observed with PINI scores < 3.0 (p = 0.003). Excluding three perioperative deaths, 13 complications occurred in 12 patients: Implant failure in six patients (four aseptic loosening, one dislocation and one infection). At the final follow-up, mobility and pain levels were improved in 85% and 100%, respectively. Reconstruction of significant pelvic MBD with the 'ice-cream cone' reduces pain and improves mobility. Whilst the mortality rate is high, it remains a reasonable option for bed-bound, immobile patients. We advocate the use of an 'ice-cream cone' prosthesis for selected patients balancing the reported risks with the observed benefits. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-024-01917-x.

Current updates in MSK infection imaging: A narrative review.

This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.

Mixed-reality technology for clinical communication: objective assessment of the HoloLens 2 as a clinical communication device in a simulated on-call scenario.

OBJECTIVE: Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario. METHOD: This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively. RESULTS: Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision. CONCLUSION: This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.

Effect of hormone replacement therapy on intervertebral disc height.

OBJECTIVE: Intervertebral discs act as shock absorbers, thereby helping to reduce the risk of vertebral body fractures. Previous studies have shown that estrogen loss following menopause is associated with disc height reduction whereas treatment with hormone replacement therapy (HRT) helps to maintain disc height. This study reports the effect of HRT on disc height from a post hoc analysis of a prospective randomized clinical trial of the effect of HRT on bone density. METHODS: A total of 355 healthy postmenopausal women aged (mean ± standard deviation) 55.4 ± 4.8 years were randomized to HRT with oral 1 mg or 2 mg estradiol plus dydrogesterone or placebo. Dual-energy X-ray absorptiometry measurements (Lunar DPX) were obtained at baseline and following 2 years of treatment. Intervertebral disc height was measured in discs between T12 and L3 using the bone densitometer ruler. RESULTS: Compared with baseline, treatment with HRT resulted in a significant increase in total disc height with 1 mg estradiol (0.16 ± 0.65 cm, p = 0.015) and with 2 mg estradiol (0.21 ± 0.86 cm, p = 0.006) whilst there was no significant increase with placebo (0.13 ± 0.65 cm, p = 0.096). Between-group differences were not statistically significant. CONCLUSIONS: These results are consistent with previous findings of a beneficial effect of estrogen on discs. This may be in part responsible for the anti-fracture efficacy of HRT on vertebral fractures.

Late-gestation ear-surface temperatures and subsequent postpartum health, activity, milk yield, and reproductive performance of dairy cows.

A retrospective study was conducted to determine if postpartum health, milk yield, and reproductive traits in addition to peripartum daily physical activities (resting, eating, active time, and rumination) differ in dairy cows having greater or lesser ear-surface temperatures during late gestation (Days 230-239) compared with contemporary herd mates within season. Herd records collected from Holstein heifers (n = 348) and dry cows (n = 503; second through seventh lactations) were fitted with SensOor ear tags to collect hourly ear-surface temperatures. Mean temperatures were calculated from 240 hourly measures during Days 230-239 of gestation and cows within season were grouped into two median temperature groups. On Days 230-239 of gestation during May through September (hotter months) cows with high (H, range of 33.67-38.89 °C, mean ± SEM = 32.9 ± 0.2 °C) or medium high (MH, 25.06-31.66 °C, 29.4 ± 0.2 °C) temperatures were grouped together (n = 209 per group). For comparable gestational days during October through April (colder months), cows with medium low (ML, 17.82-25.00 °C, 21.1 ± 0.2 °C) and low (L, -0.70 to 17.80 °C, 13.4 ± 0.2 °C) temperatures were grouped together (n = 216 per group). Prepartum traits including mean ear temperature, gestation length, days in milk at dry-off, days in close-up pen, previous 305-d milk yield, proportion of heifer calves born, and cow PTA for milk differed (P < 0.05) between seasons, but not between temperature groups within season, except predicted transmitting ability for milk was greater (P = 0.02) for ML than L cows. Postpartum treatment with antimicrobials occurred more (P = 0.02) often in H than MH cows, whereas more (P = 0.04) lameness and greater (P = 0.05) projected 305-d mature equivalent milk yield was observed in ML vs. L cows. No other health or reproductive traits were associated with temperature group, but many seasonal effects were observed across temperature groups. Less (P = 0.04) prepartum eating time during the last 10 d before calving was detected in L than in ML cows, less (P = 0.06) rumination time in ML than L cows, and more (P = 0.03) activity time was observed in H than MH cows. After calving, H cows were more (P = 0.03) active than MH cows and ML cows tended (P = 0.07) to be more active than L cows. In conclusion, late gestational ear-surface temperatures were associated with some postpartum health disorders and modifications in daily eating, ruminating, and active times during the transition period of gravid heifers and dry cows.

Transition cow metabolites and physical traits influence days to first postpartum ovulation in dairy cows.

Physical activities are associated with the health of transition dairy cows and pregnancy outcomes are positively related to early resumption of postpartum estrous cycles. The objective was to assess key metabolites and patterns of prepartum and postpartum physical activity as they relate to the onset of first postpartum ovulation in lactating dairy cows. Close-up dry Holstein cows (n = 82) and late gestation heifers (n = 78) were enrolled beginning 3 wk before expected calving date (Day 0). Cows were fit with Cow SensOor ear tags to assess transitional changes in eating, resting, rumination, high activity, and ear-surface temperatures. Rectal temperatures were assessed and blood samples were collected on Days 0, 3, 7, and 14 to measure concentrations of glucose, free fatty acids (FFA), ß-hydroxybutyrate (BHB), calcium, and haptoglobin. Body condition scores (BCS) and body weights (BW) were measured weekly, and blood samples were collected weekly from Day 21 ± 3 through 70 ± 3 to quantify changes in progesterone to detect luteal function after ovulation. Cows first ovulating before median Day 33 were classified as early (n = 76), whereas those first ovulating after Day 33 were classified as late (n = 84). Early ovulating cows first ovulated earlier (P < 0.001) than the late ovulation cows (24.3 ± 1.2 d [range: 16-32 d] vs. 48.8 ± 1.2 d [range: 33-74 d]), respectively. Mean days to first ovulation excluded seven cows that failed to ovulate before insemination. Compared with late ovulating cows, early ovulating cows had lesser (P < 0.05) concentrations of FFA, BHB, and haptoglobin on Days 0, 3, 7, and 14 in addition to having lesser (P < 0.05) rectal temperatures and ear-surface temperatures. Ear-surface temperatures began to decrease 4 d before parturition and remained less (P < 0.05) after calving than cows that subsequently ovulated late. Early ovulating cows tended (P = 0.07) to spend more time eating, and less (P = 0.02) time resting and being active during the first 3 wk after calving, and lost less (P = 0.03) BW and BCS during the first 9 wk compared with late ovulating cows. Although no differences were detected in yields of milk or energy-corrected milk during the first 9 wk after calving, early compared with late ovulating cows produced more (P < 0.01) milk protein. We concluded that metabolic measures during the first 2 wk after calving, and physical and behavioral traits are associated with the onset of postpartum ovarian activity.

Review: Perspective on high-performing dairy cows and herds.

Milk and dairy products provide highly sustainable concentrations of essential amino acids and other required nutrients for humans; however, amount of milk currently produced per dairy cow globally is inadequate to meet future needs. Higher performing dairy cows and herds produce more milk with less environmental impact per kg than lower performing cows and herds. In 2018, 15.4% of the world's dairy cows produced 45.4% of the world's dairy cow milk, reflecting the global contribution of high-performing cows and herds. In high-performing herds, genomic evaluations are utilized for multiple trait selection, welfare is monitored by remote sensing, rations are formulated at micronutrient levels, health care is focused on prevention and reproduction is managed with precision. Higher performing herds require more inputs and generate more waste products per cow, thus innovations in environmental management on such farms are essential for lowering environmental impacts. Our focus is to provide perspectives on technologies and practices that contribute most to sustainable production of milk from high-performing dairy cows and herds.

Cardiometabolic health in premature ovarian insufficiency.

Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.

Resynchronizing the first eligible estrus in dairy cattle after a prior insemination and fertility of the prior insemination after gonadotropin-releasing hormone and progesterone treatments.

The hypothesis of this study tested whether application of designed treatments to synchronize estrus in nonpregnant previously inseminated lactating dairy cows increased the proportion of nonpregnant cows in estrus before early pregnancy diagnosis on Day 32 after the previous insemination (Day 0) and increase fertility of the pretreatment insemination. A progesterone insert (CIDR) and GnRH were applied to cows after insemination to resynchronize the returning estrus of cows that failed to conceive on Day 0. The combination of GnRH (Day 14) and a CIDR insert (d 17 through 24) in experiment 1 (n = 347 cows) did not increase (P = 0.13) the proportion of nonpregnant cows returning to estrus before pregnancy diagnosis, but increased (P < 0.01) the synchrony of their return by 24.4% points, and delayed (P < 0.01) that return by 2.3 ± 0.3 d compared with controls. Ovulation risk after GnRH treatment on Day 14 was only 10%. For cows that failed to return to estrus before Day 32, progesterone concentration on Days 14 and 17 were less than that in cows that returned to estrus by Day 32 and in pregnant cows. Cows that returned to estrus had larger follicles and fewer numbers of CL on Day 21 than pregnant cows and cows that failed to return to estrus, but concentrations of pregnancy-associated glycoproteins on Day 28 indicated that cows failing to return to estrus were likely pregnant but suffered embryo death. In experiment 2 (n = 881), use of GnRH alone (Day 7), a CIDR insert alone (Days 14 through 21), or in combination, failed to increase the proportion of nonpregnant cows in estrus before pregnancy diagnosis on Day 32 compared with controls. Cows receiving the CIDR insert had increased (P < 0.01) synchrony of estrus by 24-34% points compared with cows that did not receive a CIDR insert. More cows receiving GnRH had 2 or more CL on Days 14 and 21 compared with controls. Ovulation risk after GnRH on Day 7 was greater than 66%. In both experiments combined, treatments with GnRH or GnRH + CIDR insert increased (P = 0.015) pretreatment pregnancy per AI by 7.1% points, but did not affect pregnancy loss. Although administering GnRH with or without a CIDR insert synchronized returns to estrus, treatments failed to increase the proportion of nonpregnant cows reinseminated before pregnancy diagnosis, but increased pretreatment pregnancy risk.

Luteolysis, progesterone, and pregnancy per insemination after modifying the standard 7-day Ovsynch program in Holstein-Friesian and Holstein cows.

Two experiments were conducted with Holstein-Friesian cows in the Republic of North Macedonia and with Holstein cows in Kansas. We hypothesized that 1 dose of PGF2α administered on d 8 (Ov-8×1) instead of d 7 (Ov-7×1) in an Ovsynch program [GnRH-1 (d 0)-7 d-PGF2α-56 h-GnRH-2-16 h-timed artificial insemination (AI)] would increase the proportion of cows with complete luteolysis compared with controls receiving a single dose on d 7. Cows were treated with Ov-7×1 or with Ov-8×1 in experiment 1 (n = 347), using only a single dose of PGF2α. In experiment 2 (n = 452), a third treatment was added (Ov-7×2), in which a second dose of PGF2α was administered on d 8. Progesterone was measured in blood samples collected before the first or only PGF2α administration and 72 h later before insemination. Complete luteolysis was defined as having occurred when progesterone was ≥1 ng/mL before PGF2α and ≤0.3 ng/mL 72 h later (time of AI). Follicles and luteal structures were mapped before GnRH-1 and PGF2α administrations. The results of experiment 1 demonstrated a greater percentage of multiparous cows in OV-8×1 having complete luteal regression compared with multiparous Ov-7×1 cows, whereas treatments were equally effective in primiparous cows, as reflected in the concentrations of progesterone before AI. Furthermore, pregnancy per AI did not differ between treatments. Results in experiment 2 revealed that 99.3% of cows in the Ov-7×2 treatment receiving the second dose of PGF2α had complete luteolysis, regardless of parity, compared with significantly fewer cows in the Ov-7×1 and Ov-8×1 treatments (91.2 and 90.6%, respectively). Neither concentrations of progesterone, which averaged <0.4 ng/mL at AI, nor pregnancy per AI differed among the 3 treatments. In both experiments, when status of luteal function before PGF2α treatment was examined [cows with no corpus luteum (CL) before GnRH-1 but which had formed a new CL in response to ovulation after GnRH-1; cows with an older CL (the same CL that was detected before GnRH-1); or cows with both a new and an older CL], treatments did not differ in causing complete luteolysis. Furthermore, complete luteolysis in experiment 2 did not differ regardless of whether cows had 1, 2, or 3 or more CL before PGF2α administration. Pregnancy per AI did not differ among treatments, indicating that any of the 3 treatments might produce similar pregnancy outcomes with the flexibility of applying either of the 7- or the 8-d treatments.

Indeterminate pulmonary nodules are not associated with worse overall survival in Ewing Sarcoma.

AIM: Lung metastases are a negative prognostic factor in Ewing sarcoma, however, the incidence and significance of sub-centimetre pulmonary nodules at diagnosis is unclear. The aims of this study were to (1): determine the incidence of indeterminate pulmonary nodules (IPNs) in patients diagnosed with Ewing sarcoma (2); establish the impact of IPNs on overall and metastasis-free survival and (3) identify patient, oncological and radiological factors that correlate with poorer prognosis in patients that present with IPNs on their staging chest CT. MATERIALS & METHODS: Between 2008 and 2016, 173 patients with a first presentation of Ewing sarcoma of bone were retrospectively identified from an institutional database. Staging and follow-up chest CTs for all patients with IPN were reviewed by a senior radiologist. Clinical and radiologic course were examined to determine overall- and metastasis-free survival for IPN patients and to identify demographic, oncological or nodule-specific features that predict which IPN represent true lung metastases. RESULTS: Following radiologic re-review, IPN were found in 8.7% of patients. Overall survival for IPN patients was comparable to those with a normal staging chest CT (2-year overall survival of 73.3% [95% CI 43.6-89] and 89.4% [95% CI 81.6-94], respectively; p = 0.34) and was significantly better than for patients with clear metastases (46.0% [95% CI 31.9-59]; p < 0.0001). Similarly, there was no difference in metastasis-free survival between 'No Metastases' and 'IPN' patients (p = 0.16). Lung metastases developed in 40% of IPN patients at a median 9.6 months. Reduction of nodule size on neoadjuvant chemotherapy was associated with worse overall survival in IPN patients (p = 0.0084). CONCLUSION: IPN are not uncommon in patients diagnosed with Ewing sarcoma. In this study, we were unable to detect a difference in overall- or metastasis-free survival between patients with IPN at diagnosis and patients with normal staging chest CTs.

An investigation into the impact of nine catchment characteristics on the accuracy of two phosphorus load apportionment models.

Phosphorus (P) load apportionment models (LAMs), requiring only spatially and temporally paired P and flow (Q) measurements, provide outputs of variable accuracy using long-term monthly datasets. Using a novel approach to investigate the impact of catchment characteristics on accuracy variation, 91 watercourses' Q-P datasets were applied to two LAMs, BM and GM, and bootstrapped to ascertain standard errors (SEs). Random forest and regression analysis on data pertaining to catchments' land use, steepness, size, base flow and sinuosity were used to identify the individual relative importance of a variable on SE. For BM, increasing urban cover was influential on raising SEs, accounting for c.19% of observed variation, whilst analysis for GM found no individually important catchment characteristic. Assessment of model fit evidenced BM consistently outperformed GM, modelling P values to ±10% of actual P values in 85.7% of datasets, as opposed to 17.6% by GM. Further catchment characteristics are needed to account for SE variation within both models, whilst interaction between variables may also be present. Future research should focus on quantifying these possible interactions and should expand catchment characteristics included within the random forest. Both LAMs must also be tested on a wide range of high temporal resolution datasets to ascertain if they can adequately model storm events in catchments with diverse characteristics.

First postpartum ovulation, metabolites and hormones in follicular fluid and blood in transition dairy cows supplemented with a Saccharomyces cerevisiae fermentation product.

We hypothesized that feeding a Saccharomyces cerevisiae fermentation product (SCFP) from -4 through +7 wk (calving = Day 0) facilitates early first postpartum ovulation and alters blood and follicular fluid concentrations of glucose, beta-hydroxybutyrate (BHB), free fatty acids (FFA), and steroid hormones favorable to subsequent fertility. Holstein cows were fed individually a SCFP product (n = 24) or served as controls (n = 23). Blood samples were collected at wk -4 and -2 from expected calving and at 1, 2, 5, and 7 wk postpartum to determine plasma concentrations of FFA and BHB. Early spontaneous ovulation (progesterone > 1 ng/mL or corpus luteum presence by postpartum median Day 33) or late ovulation was determined. Plasma FFA in weekly samples was not affected by SCFP supplementation, but FFA was greater (P < 0.01; week by ovulation status) in late compared with early ovulating cows during and after postpartum wk 2. Plasma BHB in weekly samples was greater (P = 0.03) in SCFP than control cows and tended (P = 0.06) to be greater in late than early ovulating cows. Cows were exposed to ovulation synchronization (GnRH, PGF2α, and GnRH on Days 33, 40, and 43 ± 3, respectively). Transvaginal dominant follicle aspiration was conducted at Day 50, 7 d after GnRH on Day 43. Metabolites (FFA, BHB, and glucose) and steroid hormones (progesterone, androstenedione, and estradiol) measured in follicular fluid and blood samples collected at aspiration revealed that androstenedione in serum was numerically less (P = 0.11) in SCFP-treated compared with control cows, whereas androstenedione in serum was less (P < 0.05) in late than early ovulating cows. Concentrations of BHB (r = 0.75) and glucose (r = 0.52) in follicular fluid were positively correlated (P < 0.01) with those in blood. Body weight at calving and Day 42 was less (P ≤ 0.05), and energy balance through Days 28 and 42 was more positive (P < 0.05) in early than late ovulating cows and in SCFP-supplemented compared with control cows (P < 0.05). Dry matter intake, daily milk yield, and yields of fat, protein, lactose, and total solids were less (P < 0.01) in early compared with late ovulating cows, whereas milk fat percentage was increased (P < 0.01) by SCFP supplementation. We conclude that elevated postpartum BHB and FFA in plasma, greater negative energy balance, and greater milk yield and components were associated with later postpartum ovulation, but metabolites and steroid hormones in blood and follicular fluid were unaffected by SCFP treatment or ovulation status except for androstenedione.

Global surgery and burn injuries; experience from a 25 year partnership in Malawi.

The Incidence of Burn Injuries - especially in Children - remains high in LMICs; The Lancet Commission on Global Surgery highlights the important role for increased investment to support surgically treatable conditions - including Trauma - in Developing Countries; the emphasis on delivering Funding for Healthcare improvement in Developing countries through a long-term Partnership is illustrated; encouraging early results in managing the challenge of Paediatric Burns are presented.

Recurrent outbreaks of mumps in Lothian and the impact of waning immunity.

Another large outbreak of mumps occurred in Lothian from October 2017, which coincided with the commencement of the higher education term. During this period 324 cases were notified, most of whom were aged 18-22 years old. Although previous outbreaks had a focus in student populations, 43% of current cases reported that they were not a student. There has been increases in private student housing where students from all universities live, which may have contributed to the wide spread of the outbreak and complicated outbreak control. Information on vaccination status was available for 244 cases (75%), of whom the majority (75.8%) reported having two MMR doses. To investigate potential waning vaccine immunity the mean length of time since last mumps containing vaccine was calculated as 14.3 years. The outbreak was declared over in May 2018 after case numbers returned to background levels. This outbreak highlighted that mumps outbreaks occur cyclically coinciding with new cohorts of susceptible students entering the Lothian population. The lessons from this outbreak are to encourage students to have two MMR doses and also be prepared for mumps outbreaks in the near future. In future outbreaks the utility of a third MMR for outbreak control could be examined.

Physiologic responses to feeding rumen-protected glucose to lactating dairy cows.

It was hypothesized that rumen-protected glucose (RPG) in diets of dairy cows increases concentrations of insulin resulting in greater blood progesterone concentrations because elevated insulin decreases activity of liver enzymes inactivating steroid hormones. Timing of ovulation was synchronized among 64 postpartum Holstein cows using GnRH and PGF2α (Day 0 = ovulation). Cows were milked thrice daily and assigned randomly a basal diet supplemented with 0, 1, 2, or 4 kg of an RPG product in place of corn grain, top-dressed in the diet beginning on Day -3. Blood was collected pre- and post-prandial on Days 0, 2, and 4 to determine plasma glucose and insulin concentrations and daily from Days 2 through 12. Intake of crude protein and energy-soluble carbohydrates increased linearly with dose, whereas starch intake decreased linearly with dose. Neither daily milk yield nor dry matter intake (DMI), energy-corrected milk (ECM), somatic cell count, or percentages of milk fat, protein and lactose on Day 8 differed among dietary treatments. Neither pre- nor post-prandial changes in plasma glucose differed among treatments. In contrast, post-prandial glucose decreased from Days 0 through 4. A change in plasma insulin (post-prandial minus pre-prandial) was detected. Milk urea nitrogen increased linearly with RPG dose. Concentrations of progesterone were unaffected by RPG dose. It is concluded that insulin response to RPG was decreased relative to the control and RPG supplementation linearly increased crude protein intake and milk urea nitrogen with increasing dose, but did not affect concentrations of progesterone, milk yield, or dry matter intake.