[The effect and factors associated with outcome of extracorporeal membrane oxygenation in refractory cardiogenic shock patients].

Objective: To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation (ECMO) in refractory cardiogenic shock patients. Methods: Patients with refractory cardiogenic shock received ECMO treatment in our hospital from May 2013 to November 2015 were retrospectively analyzed. The clinical status before ECMO support, ECMO timing, complications and outcome were observed and analyzed.The hemodynamic data and the amount of vasoactive drugs at 2 hours before ECMO support and at 2, 6, 24 and 48 hours after ECMO support were collected and compared. Results: Ten refractory cardiogenic shock patients were included in this study (5 acute fulminant myocarditis patients, 4 acute myocardial infarction patients, 1 myocardial rupture patient (6 males, 4 females, age ranged 12 to 56 years). Before ECMO, the mean left ventricular ejection fraction (LVEF) was (31.4±10.2)%, the mean score of APACHE Ⅱ was 26.6±10.8. Eight patients developed cardiac arrests and the duration of CPR ranged from 10 to 300 minutes and three patients received IABP. CVP decreased, BP increased, HR decreased, ScVO2 increased, dose of dobutamine decreased at 2 hours after ECMO support. After ECMO support for 6 hours, lactate decreased, dose of norepinephrine decreased. After ECMO support for 24 and 48 hours, hemodynamics became stable and shock was significantly improved. Complication including infection of limb and catheterization site occurred in 3 patients, femoral arterial thrombosis occurred in 2 patients, critical limb ischemia occurred in 2 patients, hemorrhage at the catheterization site occurred in 2 patients. The duration of ECMO ranged from 2 to 220 hours. Nine patients could be weaned off ECMO support and 6 patients survived to hospital discharge. Two patients died due to too late ECMO support, the other two patients died due to severe complication of limb. Conclusions: ECMO can rapidly improve hemodynamic stability of patients with cardiogenic shock. Accurate assessing the timing of ECMO support and decreasing complication of limb play a critical role on improving outcome in refractory cardiogenic shock patients.

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges.

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Comparison of pregnancy outcome in mares among methods used to evaluate and select spermatozoa for insemination.

An artificial insemination dose for mares consisting of 500 million progressively motile spermatozoa is considered "standard" by most clinicians. However, little information is available directly comparing pregnancy outcome among methods of evaluating and selecting spermatozoa for insemination. The objective of this study was to determine if the method of spermatozoal evaluation and selection influences fertility as measured by pregnancy outcome. Mares were inseminated with 100 or 500 million spermatozoa that were selected for progressive motility, normal morphology, hypoosmotic swelling or absolute number regardless for evaluation method or quality. Thirty-two breeding cycles were tested for each treatment group and at each spermatozoal dose. Pregnancy outcomes were 44 and 41%, 55 and 41%, 39 and 31%, and 45 and 41%, for the 100 and 500 million progressively motile, morphologically normal, hypoosmotic swelling positive and absolute number treatment groups, respectively. Pregnancy outcome did not differ among methods of spermatozoal evaluation and selection for artificial insemination in the 100 (P=0.52) or 500 (P=0.78) million spermatozoa groups. Also the total number of spermatozoa and the absolute number of progressively motile, morphologically normal or hypoosmotic swelling positive spermatozoa inseminated, were not closely associated with pregnancy outcome in the 100 (P=0.24, 0.29, 0.33 and 0.38, respectively) or 500 (P=0.20, 0.84, 0.50 and 0.74, respectively) million spermatozoa groups. In this study, we found that the method of spermatozoal evaluation did not offer an advantage for pregnancy when used to select spermatozoa for insemination at the doses tested. These results were surprising, as we expected there would be differences among the evaluation methods. Instead, we found that evaluating spermatozoa offered no advantage for pregnancy over simply inseminating with a specified number of spermatozoa not selected for any particular characteristic under the conditions of our experiment.

Luteal and clinical response following administration of dinoprost tromethamine or cloprostenol at standard intramuscular sites or at the lumbosacral acupuncture point in mares.

OBJECTIVE: To determine whether administration of a microdose of prostaglandin at the BAI HUI acupuncture point offers any advantage over IM injections for luteolysis, ovulatory interval, or systemic response in mares. ANIMALS: 17 mature cycling mares, 3 to 20 years of age and weighing 400 to 500 kg. PROCEDURE: Conventional and microdoses of the prostaglandin dinoprost tromethamine (PGF2alpha), the analogue cloprostenol, or sterile water (control) were administered to mares in 7 treatment groups. Treatments were assigned by dose, administration site (semimembranosus, semitendinosus, or lumbosacral region), and treatment type (PGF2alpha, analogue, or sterile water). Mares were observed for ovulatory interval and systemic response to treatment, including heart, and respiratory rates, rectal temperature, and sweat score. Plasma progesterone concentrations were also determined at the time of treatment and at 24-hour intervals for 96 hours following treatment. RESULTS: Ovulatory interval was shortened and progesterone concentrations decreased in prostaglandin-treated mares, compared with control mares, regardless of dose or treatment site. However, no differences in ovulatory interval were observed among prostaglandin-treated mares. Mares treated with conventional doses of PGF2alpha had greater systemic responses than mares treated with microdoses of PGF2alpha or sterile water. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of prostaglandins at the BAI HUI acupuncture point does not appear to offer any advantage over administration at standard IM injection sites for induction of luteolysis or to shorten the ovulatory interval. However, administration of a microdose of the analogue cloprostenol was effective at inducing luteolysis and shortening ovulatory interval regardless of administration site.

Adaptation of the hypoosmotic swelling test to assess functional integrity of stallion spermatozoal plasma membranes.

Hypoosmotic swelling (HOS) is used for assessing plasma membrane function and fertilizing capacity of human spermatozoa. However, HOS solutions and methodologies have not been evaluated specifically for assessing stallion spermatozoa. The objective of this study was to identify a HOS solution and assay conditions specifically for stallions that would maximize spermatozoal plasma membrane swelling. The HOS solutions and assay conditions, including incubation time (15 to 180 min), temperature (25 degrees vs 37 degrees C), and total number of cells examined (100, 200 or 500) were evaluated. Assay consistency, accuracy, reliability and repeatability also were determined. Maximum spermatozoal plasma membrane swelling was observed in a 100 mosmol sucrose solution (P < 0.001). Incubation time (P = 0.67), temperature (P = 0.70) and total number of spermatozoa examined (P = 0.38 and P = 0.24 for 100 vs 200 and 100 vs 500, respectively) did not influence percent of HOS positive spermatozoa observed. A high degree of assay accuracy was indicated when a correlation of r = 0.998 was obtained between the HOS positive spermatozoa observed and expected when known amounts of heat-treated spermatozoa, unable to undergo swelling, were added to untreated spermatozoa. Assay consistency was demonstrated, as reflected by a mean coefficient of variation of 0.073 for 4 stallions. Also, the coefficient of variation from 2 analyses of variance was 0.168 and 0.096, indicating reasonably good assay reliability; estimates of repeatability from the same analyses were 0.794 and 0.968. The HOS test adapted to stallion spermatozoa in this study is a simple, highly accurate and consistent assay with good reliability and repeatability. Results observed under the conditions evaluated also permit some flexibility in adapting this assay to individual laboratory and practice settings for evaluating stallion spermatozoal plasma membranes.

Persistent penile prolapse associated with acute blood loss and acepromazine maleate administration in a horse.

Prolonged penile prolapse in horses has been reported in association with administration of phenothiazine tranquilizers, trauma, neuropathies, severe general debilitation or exhaustion, starvation, rabies, herpes myeloencephalitis, equine infectious anemia, and purpura hemorrhagica. A 5-year-old gelding was admitted for treatment of prolonged penile prolapse of 12 days' duration that developed after acepromazine maleate was administered to allow examination of a laceration that had resulted in severe blood loss. The horse was sedated, and the penis was replaced in the preputial cavity by use of a combination of massage and bandaging. Treatment was successful, and recovery was complete.

Ovarian mass in three mares with regular estrous cycles.

Three mares with regular estrous cycles and a large ovary were examined. In each case, the ovary was composed of a single, fluid-filled cavity with a thick capsule. The ovarian mass was surgically removed from each mare. Histologic diagnosis of each mass was different.

[Liability, prostaglandins and Clostridium]. / Aansprakelijkheid, prostaglandinen, Clostridium.

A case of malignant oedema following injection of fenprostalene in cattle is reported. The question is asked whether the vasoconstrictive action of prostaglandins may predispose to the establishment of anaerobes.

[Tuberculosis in raptorial birds. Clinical cases and differential diagnosis]. / Tuberculose bij roofvogels (I) Casuïstiek en differentiële diagnose.

Four cases of avian tuberculosis in two goshawks (Accipiter gentilis gentilis), a lanner falcon (Falco biarmicus sp.) and a kestrel (Falco tinnunculus tinnunculus) are reported. All birds, except for the kestrel, were affected with generalized tuberculosis. Clinically, the lanner falcon and kestrel showed lameness due to tuberculous arthritis of a knee joint. One of the goshawks died suddenly. On post-mortem examination, the bird was found to be emaciated, and there was involvement of one knee joint. The other goshawk showed convulsive seizures for three weeks before she died. Histological examination revealed tuberculous meningitis and encephalitis. The diagnosis was based on the detection of acid-fast organisms in every case and was verified in three cases by cultures of the causative organism. Tuberculosis should be considered in the differential diagnosis of emaciation, lameness, arthritis, skin lesions, convulsions and frounce in raptors.

[Tuberculosis in raptorial birds (II). Review of the literature and suggestions for clinical diagnosis and vaccination]. / Tuberculose bij roofvogels (II). Literatuuroverzicht en suggesties voor klinische diagnostiek en vaccinatie.

Although avian tuberculosis is a common disease in raptors, the diagnosis is not often established in vivo. Mycobacterium avium, serotype 2, is the aetiological agent most commonly involved. As the disease may become apparent in a variety of clinical forms and as it is so common, routine screening for avian tuberculosis is advocated in any diseased raptor. X-ray examination should be a routine diagnostic procedure in diseased raptors. Laparoscopy is an important diagnostic tool in raptors. Laparoscopy followed by liver biopsy may be essential in the diagnosis of generalized avian tuberculosis. The usefulness of haematological examination in the diagnosis of avian tuberculosis in raptors should be studied. A diagnosis may be established by identifying acid-fast rods in a smear, followed by cultures of the organism on specific media. Of the immunological methods, tuberculination in conjunction with a rapid whole blood agglutination test would seem to be the most practical technique. However, closer examination of the practicability of the rapid whole blood agglutination test in the diagnosis of avian tuberculosis in raptors is desirable. Other immunological methods referred to in the literature are haemagglutination tests, an enzyme-labeled antibody test and a lymphocyte transformation test. Vaccination of birds against avian tuberculosis would appear to be possible, judging by the literature on the subject. Further study of this subject, however, is indicated to investigate the use of vaccinating birds of prey against this disease.