Effect of 200 µg of gonadorelin hydrochloride at the first GnRH of a CIDR Synch program on ovulation rate and pregnancies per AI in Holstein heifers.

The initial ovulatory response during synchronization programs is often low in dairy heifers, largely due to follicular dynamics and hormonal dynamics. Specifically, the progesterone concentration (P4) at the time of the first GnRH treatment in a breeding program can influence the LH response, often resulting in a suboptimal ovulatory response. The objective of this study was to determine the effect of the highest label dose 200 µg (100 µg vs. 200 µg) of GnRH (50 µg gonadorelin hydrochloride per mL; Factrel®; Zoetis Inc. Madison, NJ) at the first GnRH of a 6-d CoSynch plus P4 device program on ovulatory response and pregnancy per AI (P/AI) in first service in Holstein heifers. A total of 1308 Holstein heifers were randomly allocated at the beginning of a 6-d CIDR-Synch program, Day 0, to receive either i.m. treatment of 100 µg (2CC, n = 655) or 200 µg (4CC, n = 653) of GnRH. Also, at Day 0, heifers received an intravaginal insert with 1.38 g of P4 (Eazi-Breed CIDR® Cattle Insert; Zoetis Inc., Madison, NJ). On Day 6, the insert was removed, and i.m. treatment of 25 mg of PGF2α (12.5 mg dinoprost tromethamine/mL; Lutalyse® HighCon Injection Zoetis) was administered. On Day 7, a second i.m. treatment of 25 mg of PGF2α was given, followed on Day 9 by concurrent i.m. treatment of 100 µg of GnRH and timed AI (TAI). A subset of 396 heifers had their ovaries scanned to evaluate ovulatory response, and blood samples were collected to measure the serum concentration of P4 at Day 0 and Day 6 of the study. The P4 concentrations at Day 0 were categorized as Low (≤3ng/mL) or High (>3ng/mL). The ovulatory response was greater for heifers receiving 4CC than 2CC at Day 0 (54.7% vs. 42.8%). The ovulatory response was greater for Low P4 than High P4 at Day 0 (54.3% vs. 37.8%). However, there was not an interaction between treatment and P4 concentrations (Low P4 2CC = 48.6% vs. High P4 2CC = 30.0%; Low P4 4CC = 60.0% vs. High P4 4CC = 45.5%). The ROC curve analysis indicates that P4 concentrations at Day 0 treatment could predict the ovulatory response, although the area under the curve was only 0.6. As expected, heifers that ovulated had increased P/AI (No = 55.6% vs. Yes = 67.7%); however, there was no effect of treatment on P/AI (2CC = 63.3% vs. 4CC = 59.6%), nor interactions between treatment and ovulation and treatment and P4 (HIGH vs LOW) for pregnancy outcomes. In summary, P4 concentration and increasing the dose of GnRH at Day 0 positively impacted ovulatory response in Holstein heifers. However, there was no interaction between treatment and P4 on ovulation and no subsequent impact of GnRH dose on P/AI.

Effect of rumen-protected choline on dairy cow metabolism, immunity, lactation performance, and vaginal discharge microbiome.

Rumen-protected choline (RPC) promotes benefits in milk production, immunity, and health in dairy cows by optimizing lipid metabolism during transition period management and early lactation. However, the RPC success in dairy cows depends on choline bioavailability, which is affected by the type of protection used in rumen-protected choline. Therefore, our objectives were to determine the effects of a novel RPC on dry matter intake (DMI), identify markers of metabolism and immunity, and evaluate lactation performance. Dry Holstein (n = 48) cows at 245 ± 3 d of gestation were blocked by parity and assigned to control or RPC treatment within each block. Cows enrolled in the RPC treatment received 15 g/d of CholiGEM (Kemin Industries, Cavriago RE, Italy) from 21 d prepartum and 30 g/d of CholiGEM from calving to 21 d postpartum. During the transition period, DMI was measured daily, and blood was sampled weekly for energy-related metabolites such as ß-hydroxybutyrate (BHB), glucose, and nonesterified fatty acids (NEFA), as well as immune function markers such as haptoglobin (Hp) and lipopolysaccharide-binding protein (LPB). Vaginal discharge samples were collected at the calving and 7 d postpartum and stored in microcentrifuge tubes at -80°C until 16S rRNA sequencing. The main responses of body condition score, body weight, DMI, milk yield, milk components, and immune function markers were analyzed using the GLIMMIX procedure of SAS with the effects of treatment, time, parity, and relevant covariates added to the models. The relative abundance of microbiome α-diversity was evaluated by 3 indexes (Chao1, Shannon, and Simpson) and ß-diversity by principal coordinate analysis and permutational multivariate ANOVA. We found no differences in DMI in the pre- and postpartum periods. Cows fed RPC increased the yields of energy- and 3.5% fat-corrected milk and fat yield in primiparous and multiparous cows, with an interaction between treatment and parity for these lactation variables. However, we found no differences in milk protein and lactose up to 150 DIM between treatments. Glucose, NEFA, and BHB had no differences between the treatments. However, RPC decreased BHB numerically (control = 1.07 ± 0.13 vs. RPC = 0.63 ± 0.13) in multiparous on the third week postpartum and tended to reduce the incidence of subclinical ketosis (12.7% vs. 4.2%). No effects for Hp and LPB were found in cows fed RPC. Chao1, Shannon, and Simpson indexes were lower at calving in the RPC treatment than in the Control. However, no differences were found 7 d later for Chao1, Shannon, and Simpson indexes. The vaginal discharge microbiome was altered in cows fed RPC at 7 d postpartum. Fusobacterium, a common pathogen associated with metritis, was reduced in cows fed RPC. Rumen-protected choline enhanced lactation performance and health and altered the vaginal discharge microbiome which is a potential proxy for uterine healthy in dairy cows. The current study's findings corroborate that RPC is a tool to support adaptation to lactation and shed light on opportunities for further research in reproductive health.

A randomized controlled trial examining the effects of treatment with propylene glycol and injectable cyanocobalamin on naturally occurring disease, milk production, and reproductive outcomes of dairy cows diagnosed with concurrent hyperketonemia and hypoglycemia.

The objective of this study was to assess the effects of treatment with propylene glycol (PG) and cyanocobalamin (B12) on health, milk production, and reproductive outcomes of cows diagnosed with hyperketonemia (HK), hypoglycemia (HG), or concurrent HKHG. Glucose and ß-hydroxybutyric acid (BHBA) concentrations were assessed in whole blood using a handheld device in lactating dairy cows (n = 2,418) between 3 and 9 d postpartum. Cows categorized as HK (n = 232, BHBA ≥1.2 mmol/L), HG (n = 161, glucose ≤2.2 mmol/L), and concurrent HKHG (n = 204, BHBA ≥1.2 mmol/L, and glucose ≤2.2 mmol/L) were randomized to receive treatment or to remain untreated (control). Treatment consisted of a single dose of B12 (10 mg, intramuscularly) and 300 mL of PG orally for 5 d, starting on the day of cow-side testing. Milk production, health, and reproductive outcomes were analyzed according to groups. Statistical analysis was carried out using SAS version 9.4 (SAS/STAT, SAS Institute Inc.). Treatment in HG cows decreased clinical ketosis, increased milk production in the fifth week of lactation for multiparous cows, and tended to increase 305-d mature-equivalent milk yield (305ME) for primiparous cows compared with untreated cows with the same metabolic profile. For cows with HKHG, treatment increased 305ME in multiparous cows and tended to increase 305ME in primiparous cows. No differences were found for treatment among any of the metabolic groups regarding reproductive outcomes, nor were any treatment effects found among HK cows. Glycemic status may help identify metabolically challenged early postpartum dairy cows, which may have differential response to PG and B12 treatment.

Characterization of metabolic profile, health, milk production, and reproductive outcomes of dairy cows diagnosed with concurrent hyperketonemia and hypoglycemia.

The objective of this prospective cohort study was to characterize the metabolic profile, health, milk production, and reproductive outcomes of cows diagnosed with hyperketonemia (HK; ß-hydroxybutyrate ≥1.2 mmol/L), hypoglycemia (HG; glucose ≤2.2 mmol/L), or concurrent HK and HG (HKHG). Glucose and ß-hydroxybutyrate concentrations in whole blood were assessed using a handheld device (Precision Xtra, Abbott Laboratories) in lactating dairy cows (n = 2,418) between 3 and 9 d postpartum. Cows were categorized into 4 groups: no HK or HG (healthy; Norm = 1,821), HK only (HK = 232), HG only (HG = 161), and concurrent HK and HG (HKHG = 204). Subsequent milk production, along with health and reproductive outcomes, as recorded by farm personnel, were analyzed according to metabolic category. Serum collected on the day of cow-side diagnosis of hyperketonemia and hypoglycemia was evaluated for total calcium (tCa), magnesium (Mg), nonesterified fatty acids (NEFA), triglycerides (TG), and urea using an automated chemistry analyzer (Randox Daytona; Randox Laboratories Ltd.). Statistical analysis was carried out using SAS version 9.4 (SAS Institute Inc.). Hyperketonemia in multiparous cows was associated with greater incidence of metabolic abnormalities (hypomagnesemia, hypocalcemia, and elevated NEFA and urea). Hyperketonemia in primiparous and multiparous cows led to increased adverse health events (culling rate, retained fetal membranes, puerperal metritis, clinical ketosis, left displaced abomasum) relative to Norm cows. Multiparous cows with HKHG had fewer metabolic disturbances (hypomagnesemia, hypocalcemia, elevated NEFA) than HK cows. Cows with HKHG had an increased incidence of clinical ketosis and left displaced abomasum relative to Norm cows. Cows with HG had similar metabolic profiles to Norm cows and had lower incidence of retained fetal membranes and puerperal metritis than cows with HK. Multiparous cows with HG produced more milk than Norm cows from wk 10 to 20, whereas multiparous cows with HK produced less milk than Norm cows. For primiparous cows, HK did not have a negative effect on milk production compared with Norm cows.

Effect of nerve growth factor-ß administered at insemination for lactating Holstein dairy cows bred after timed-artificial insemination protocol.

The objectives of this study were to determine the effects of nerve growth factor-ß (NGF), purified from bulls' seminal plasma and administered at the time of artificial insemination (AI), on progesterone post-AI, interferon-stimulated genes (ISG), and pregnancy per AI (P/AI) for lactating Holstein dairy cows enrolled in a timed-AI protocol. We hypothesized that administration of NGF at the time of AI would increase plasma progesterone post-AI, upregulate relative abundance of ISG, and improve P/AI in lactating dairy cows. Holstein cows (n = 557) from a single commercial dairy farm were blocked by parity and randomly assigned to receive an intramuscular injection containing 296 µg of bovine purified NGF at the time of AI, diluted in 2 mL of phosphate-buffered saline (NGF: n = 275), or receive only the 2 mL of phosphate-buffered saline (control: n = 282). Plasma progesterone and corpus luteum size were assessed in a subset of cows (NGF: n = 32; control: n = 36) at d 7, 14, and 19 post-AI. Relative mRNA abundance of ISG (ISG15, MX1, MX2, and RTP4) was assessed in peripheral blood leukocytes on d 19 post-AI. Pregnancy diagnosis was performed at 37 and 65 d post-AI. There was an interaction effect between treatment and parity for plasma progesterone; however, plasma progesterone and ISG did not differ between treatments. There were no effects of NGF for P/AI at 37 d post-AI (NGF = 40.0% vs. control = 41.6%), 65 d post-AI (NGF = 36.0% vs. control = 38.1%), and for pregnancy loss (NGF = 8.4% vs. control = 7.7%). The current study revealed that effects to NGF in lactating Holstein cows were minor and contingent with parity for progesterone, and no improvement in ISG relative abundance and P/AI were observed.

[Treatment of membranous subaortic stenosis with balloon dilatation]. / Tratamento de estenose subaórtica em membrana por cateter balão.

PURPOSE: This study sought to evaluate the immediate and follow-up results of percutaneous balloon dilatation for the treatment of membranous subaortic stenoses. METHODS: Fourteen patients with mean age 11.4 +/- 5.2 years, were submitted to the procedure. They were selected when the echocardiogram showed a thin subaortic membrane that was far from the aortic valve, no fibro-muscular obstruction and only mild or moderate aortic regurgitation. After measuring the pressure gradient and analysis of the angiographic features, the balloon dilatation was made by applying a fast manual inflation until the balloon waist disappeared. The balloon diameter was the same as that of the outflow tract of left ventricle, immediately bellow the aortic valve. Pressure measurement, left ventriculogram and aortogram were repeated. Doppler echocardiogram was repeated in the following day, after 3 months and every 6 months thereafter. RESULTS: All 17 procedures were successful. The mean gradient was 76.1 +/- 21.2 mmHg before and 29.8 +/- 8.8 mmHg after dilatation (p < 0.01). There was no increase in aortic regurgitation or death after the procedure or during the follow-up. Twelve patients were discharged 24h after the procedure. Surgical treatment for femoral artery thrombosis was performed in 2 patients. In the follow-up of 33.3 +/- 23.6 months, 4 patients developed restenosis and 3 of them were submitted to successful redilatation. CONCLUSION: We conclude that in selected cases, the procedure is safe and effective, and restenosis may be treated by percutaneous balloon redilatation.

Tratamento de estenose subatória em membrana por cateter baläo / Ballon dilatation for the treatment of membranous subaortic stenosis

OBJETIVO - Avaliar os resultados imendiatos e a médio prazo de tratamento da estenose subaórtica em membrana através da dilataçÝo percutânea por cateter baläo. MÉTODOS - Os 14 pacientes, com idade média de 11,4ñ5,2 anos, foram selecionados pelo estudo ecodopplercardiográfico, mediante evidência de membrana subaórtica de fina espessura e distante das válvulas aórticas, ausência de componente muscular associado ou insuficiência aórtica (IAo) importante. Após a medida do gradiente e comprovaçÝo dos achados pela cineangiocardiografia, as dilataçöes eram feitas por insuflaçäo manual e rápida até o desaparecimento da constricçÝo do baläo. O diâmetro do baläo era no máximo igual ao da via de saída de ventrículo esquerdo, medida logo abaixo da valva aórtica. Manometria, ventriculografia esquerda era realizado no dia seguinte, após 3 meses e a cada 6 meses após o procedimento. RESULTADO - Os 17 procedimentos foram realizados com sucesso. O gradiente médio da amostra foi 76,1ñ21,1mmHg (41-115) pré dilataçäo e 29,8ñ8,8mmHg (13-45) pós dilataçäo (p menor que 0,01). Näo houve aumento do IAo pós procedimento. Doze pacientes receberam alta em 24h e 2 apresentaram oclusäo de artéria femoral, tratados cirurgicamente. Näo houve óbito imediato ou tardio. No acompanhamento de 33,3+23,6 meses (1-75) ocorreu reestenose em quatro pacientes, sendo três deles redilatados com sucesso. CONCLUSÄO - Em casos selecionados, o procedimento é seguro e eficaz e a ocorrência de reestenose pode ser tratada com nova dilataçäo percutânea.

Transcatheter occlusion of patent ductus arteriosus using coil embolization.

We studied 31 procedures of coil embolization for occlusion of ductus arteriosus, attempted in 29 patients. The mean age was 4.8+/-3.4 years (1-16 years) and the mean diameter of ductus was 1.8+/-0.7 mm (0.8-3.1 mm). Femoral artery approach was used and aortogram in 90 degrees lateral view was performed. Through a Judkin right coronary catheter, the coil was delivered for occlusion of the ductus. In 5 cases, 2 coils were delivered using retrograde and anterograde techniques. Successful placement of coil was accomplished in 29 procedures. Coils 0.038 inch (diameter)-5 cm (length)-5 mm (helical diameter) (Cook, Inc) were used in 16 procedures, coils 0.035 inch-5 cm-5 mm in 9, coil 0.038 inch-8 cm-8 mm in 1, two coils 0.038 inch-5 cm-5 mm in 2, coils 0.038 inch-5 cm-5 mm+0.038 inch-5 cm-8 mm in 1, and 2 coils 0.035 inch-5 cm-5 mm in 2. Aortogram 20 min after the occlusion, showed residual shunt in 9. Coil migration occurred in a ductus type B in the following day. One patient developed severe haemolysis, due to a change in the coil position, 12 h after the procedure. Echodopplercardiogram 4 to 6 h after the procedure showed a residual shunt in 5 patients, 24 h after in 3 and 30 days after, in 1(3.8%). Heparin therapy started 10 days after occlusion of the ductus, caused reappearance of the shunt in 1 patient. This technique is simple and effective, but complications may occur hours or days after successful ductus occlusion.

Initial experience with balloon dilatation of supravalvar aortic stenosis.

Primary balloon dilatation of supravalvar aortic stenosis was attempted in three patients: a 20 year old woman, a seven month old boy, and a 12 year old girl. Balloon catheters (Mansfield) with diameters of 25 mm, 8 mm, and 15 mm were used in the three patients respectively. The systolic pressure gradient across the aortic narrowing decreased considerably and the diameter of the constricted area increased significantly. Balloon dilatation was feasible and provided good immediate results and sustained relief of supravalvar aortic stenosis in these three patients. However, a larger study is needed to establish the place of this procedure in treatment.

[Double aortic arch associated with stenosis of left pulmonary artery]. / Duplo arco aórtico associado a estenosa da artéria pulmonar esquerda.

Case report on a 6-year-old patient with vascular ring, due to double aortic arch. The patient was asymptomatic. The barium-filled esophagus showed bilateral indentations and a large posterior indentation. Echocardiographic study in notch suprasternal view revealed features of this pathology. The diagnosis was made by the cineangiocardiographic study that showed double aortic arch with separate carotid and subclavian arteries arising from each arch. The right arch was larger than the left, and the descending aorta was on the left side. There was severe left pulmonary artery stenosis associated. The clinical management was chosen, because the patient was asymptomatic.

[Transluminal coronary angioplasty combined with cardiomyoplasty in the treatment of coronary disease associated with dilated cardiomyopathy]. / Angioplastia transluminal coronária combinada à cardiomioplastia no tratamento de doença coronária associada à cardiomiopatia dilatada.

A 53-year-old white female candidate to cardiomyoplasty to control heart failure class III (NYHA). Submitted to coronary angioplasty, presented at the coronarography 75% obstruction of the left anterior descending (LAD) artery and at the left ventriculography diffuse and severe hypocontractility ejection fraction (EF) = 17%. After primary success of the coronary dilatation, she was operated on with a good surgical outcome. Six months after the surgery, she did well clinically (class II) and at the coronarography the LAD artery presented free from restenosis or progression of the disease and the left ventriculography showed improvement of the ventricular function (EF = 28%).

[Fibrinolytic therapy in non-coronary diseases]. / Terapêutica fibrinolítica em doenças não coronarianas.

Utilization of fibrinolytic drugs in non-coronary diseases has been described since 1949, but despite of that, works about that subject are very rare in the literature. In this paper we discuss the cases of three patients that were treated with such compounds for pulmonary embolism, peripheral arterial embolism, and thrombosis in mechanical aortic prosthesis. All patients had excellent in-hospital outcome, and were totally asymptomatic at the discharge time. It is emphasized the clinical symptoms, sometimes unexpected, and the importance of the complementary tests not only in the disease's diagnosis, but also in some decisions that must be taken during the patient's evolution, where they can help us to decide, for example, about the correct moment to stop the thrombolytic infusion. In conclusion, fibrinolytic drugs can be utilized in the management of many affections that otherwise would be treated by emergency surgery.

Coronary angioplasty--unstable lesions and prolonged balloon inflation time.

One of the most important complications after percutaneous transluminal coronary angioplasty is the abrupt closure of the dilated vessel (unstable lesion). The treatment of choice for this complication is a new dilation, but unfortunately many of these cases require immediate surgery to avoid an acute myocardial infarction. Prolonged balloon inflations have been suggested to control this kind of complication. In order to discover the effect of prolonged inflations on the incidence of unstable lesions we studied 439 patients enrolled in two groups: Group I (195 patients and 207 arteries) treated with balloon inflation time less than 40 sec per session and Group II (244 patients and 265 arteries) treated with inflation time over 60 sec since the first series of inflations. As a result there was a significantly lower incidence of unstable lesions and immediate surgery in Group II without an increase in the incidence of diffuse ischemia.