Fetal maceration and partial retention of fetal bones in 2 mares.

Pregnancy loss after Day 40 in mares usually results in the expulsion (abortion) of the fetus and placental membranes. However, fetal retention within the uterus is also a possible outcome, leading to either fetal mummification or maceration. Fetal maceration is septic decomposition of fetal tissues within the uterus following failure of expulsion. It requires the presence of bacteria and oxygen within the uterus, likely originating from an open cervix, and results in tissue autolysis, leaving only fetal bones remaining in the mare. Fetal maceration is a rare complication of pregnancy in mares that is usually associated with a recent history of abortion, a persistent vaginal discharge, and retention of numerous fetal bones. Here, we report 2 cases of fetal maceration with retention of only a few fetal bones in mares that were presented without noticeable clinical signs. Key clinical message: The unusual presentation of fetal maceration in these mares (only a few fetal bones and no noticeable clinical signs) brings attention to the potential insidious nature of fetal retention. It highlights the importance of a thorough reproductive examination before breeding, along with careful and ongoing monitoring after breeding and throughout pregnancy.

Macération fœtale et rétention partielle d'os fœtaux chez 2 juments. L'interruption de gestation après le Jour 40 chez les juments résulte généralement par l'expulsion (avortement) du fœtus et des membranes fœtales. Toutefois, une rétention fœtale dans l'utérus est également un résultat possible, entraînant soit une momification ou une macération fœtale. La macération fœtale est la décomposition septique des tissus fœtaux à l'intérieur de l'utérus à la suite d'un échec d'expulsion. Elle nécessite la présence de bactéries et d'oxygène dans l'utérus, résultant probablement d'une ouverture du cervix, et résulte en une autolyse des tissus, laissant uniquement des os fœtaux à l'intérieur de la jument. La macération fœtale est une complication rare de la gestation chez les juments qui est généralement associée avec une histoire récente d'avortement, une décharge vaginale persistante, et la rétention de nombreux os fœtaux. Nous rapportons ici 2 cas de macération fœtale avec rétention de seulement quelques os chez des juments présentées avec aucun signe clinique notable.Message clinique clé :La présentation inhabituelle de macération fœtale chez ces juments (uniquement quelques os fœtaux et aucun signe clinque notable) met en lumière la nature potentiellement insidieuse de la rétention fœtale. Elle souligne l'importance d'un examen reproducteur complet avant l'accouplement, avec un suivi minutieux et continu après l'accouplement et durant toute la gestation.(Traduit par Dr Serge Messier).

Endothelial cell regulation of salivary gland epithelial patterning.

Perfusion-independent regulation of epithelial pattern formation by the vasculature during organ development and regeneration is of considerable interest for application in restoring organ function. During murine submandibular salivary gland development, the vasculature co-develops with the epithelium during branching morphogenesis; however, it is not known whether the vasculature has instructive effects on the epithelium. Using pharmacological inhibitors and siRNA knockdown in embryonic organ explants, we determined that VEGFR2-dependent signaling is required for salivary gland epithelial patterning. To test directly for a requirement for endothelial cells in instructive epithelial patterning, we developed a novel ex vivo cell fractionation/reconstitution assay. Immuno-depletion of CD31+ endothelial cells in this assay confirmed a requirement for endothelial cells in epithelial patterning of the gland. Depletion of endothelial cells or inhibition of VEGFR2 signaling in organ explants caused an aberrant increase in cells expressing the ductal proteins K19 and K7, with a reduction in Kit+ progenitor cells in the endbuds of reconstituted glands. Addition of exogenous endothelial cells to reconstituted glands restored epithelial patterning, as did supplementation with the endothelial cell-regulated mesenchymal factors IGFBP2 and IGFBP3. Our results demonstrate that endothelial cells promote expansion of Kit+ progenitor cells and suppress premature ductal differentiation in early developing embryonic submandibular salivary gland buds.

Working together to improve patient safety.

One of our core aims at the Royal Belfast Hospital for Sick Children (RBHSC) emergency department (ED) is to ensure patient safety within financial and resource constraints.

Is Corynebacterium pseudotuberculosis infection (pigeon fever) in horses an emerging disease in western Canada?

This report describes 5 horses in the southern Alberta region with typical and atypical external abscessation due to Corynebacterium pseudotuberculosis (pigeon fever). "Pigeon fever" has recently been diagnosed in new geographic regions in North America and should be kept as a differential diagnosis by practitioners when an external or internal abscess is identified in a horse.

L'infection parCorynebacterium pseudotuberculosis(fièvre du pigeon) chez les chevaux est-elle une maladie émergente dans l'Ouest canadien? Ce rapport décrit cinq chevaux dans la région sud de l'Alberta atteints d'abcès externes typiques et atypiques causés par Corynebacterium pseudotuberculosis (fièvre du pigeon). La «fièvre du pigeon¼ a récemment été diagnostiquée dans de nouvelles régions géographiques de l'Amérique du Nord et devrait être conservée comme diagnostic différentiel par les praticiens lorsqu'un abcès externe ou interne est identifié.(Traduit par Isabelle Vallières).

Acclimation to chronic constant-rate peripheral stimulation provided by a vestibular prosthesis.

We are developing two types of vestibular prosthetics that electrically stimulate afferent neurons. One type replaces absent sensory function by providing stimulation that modulates above and below a baseline established with the head stationary. The other type provides constant stimulation and is turned on only when necessary, for example, to override unnatural variations like those experienced by patients suffering from Ménère's syndrome; this prosthesis does not provide motion information. Both prostheses require neural plasticity, which we investigated by providing chronic constant-rate stimulation to semicircular canal neurons in three guinea pigs. The stimulation was alternately switched on or off for eight consecutive weeks before being switched daily. A brisk horizontal nystagmus was measured when the stimulation was first turned on and then dissipated over the course of a day. The nystagmus demonstrated an after-effect in the opposite direction when the stimulation was turned off. The nystagmus that we measured after just a few (2 to 5) off-to-on transitions returned to baseline more rapidly than when first turned on. In fact, after many such off-to-on or on-to-off transitions, little nystagmus was evoked by turning the stimulation on or off. These findings show that the brain acclimates to constant-rate stimulation.

Impact of point-of-care B-type natriuretic peptide (BNP) measurement on medical decision-making for older emergency department patients with dyspnea.

Measurement of B-type natriuretic peptide (BNP) has been shown to aid in the Emergency Department (ED) diagnosis of heart failure. We sought to determine how point-of-care BNP measurement influences real-world medical decision-making. Using a commercially available, point-of-care assay, BNP levels were measured in a convenience sample of ED patients over the age of 55 years who complained of dyspnea. Blinded to BNP results, emergency physicians were asked to formulate a differential diagnosis and management plan for each patient. Immediately thereafter, BNP results were disclosed and the physicians were asked what (if any) decisions they would change. With physicians blinded to BNP results, 24 of 88 patients (27%) were given a primary diagnosis of heart failure, and 18 patients (20%) were given a secondary or alternative diagnosis of heart failure. For the former group, disclosure of BNP results resulted in no changes in diagnosis or management. For the latter group, disclosure of BNP results caused heart failure to become the primary diagnosis in 4 patients (22%), and led to five changes in medical management. For the 46 patients initially given neither a primary nor secondary diagnosis of heart failure, disclosure of BNP results caused heart failure to become the primary diagnosis in one patient (2%) and a secondary diagnosis in 4 patients (9%), and led to five changes in medical management. Thus, for ED patients with a primary clinical diagnosis of heart failure, BNP testing had no impact on medical decision-making. However, for other patients with dyspnea, elevated BNP levels did influence medical decision-making, particularly when heart failure was in the differential diagnosis.

A patient education intervention does not improve satisfaction with emergency care.

STUDY OBJECTIVE: We determine whether a patient education intervention based on a previously validated model increases satisfaction with emergency department (ED) care. METHODS: A single-page patient education form was distributed on alternating 2-week time blocks for 8 weeks at the triage desk of a single academic ED. Alert, discharged patients were administered an exit interview assessing satisfaction on a 5-point ordinal scale. Secondary outcomes included patient satisfaction measured on a bivariate scale, willingness to return, and process of care indicators previously demonstrated to be associated with satisfaction. Exclusion criteria included air or ground transport to the ED, inability to speak English or Spanish, and refusal to participate. Differences in patient satisfaction and other outcomes were adjusted for predefined covariates, including age, sex, triage severity, race, language, location in ED, total ED length of stay, and time to room, using multivariable logistic regression. RESULTS: Of 1,934 patients discharged during study periods, 1,233 (64%) were approached and 860 (44%) were enrolled. There were no important covariate differences between the control and intervention groups. There was no important correlation between intervention and patient satisfaction on univariate (odds ratio [OR] 0.840; 95% confidence interval [CI] 0.650 to 1.086) and multivariate analysis (OR 0.874; 95% CI 0.672 to 1.136). There were no important correlations between the intervention and secondary outcomes on multivariate analysis. CONCLUSION: A triage-based, patient education intervention did not significantly improve patient satisfaction or performance on predictors of satisfaction at the study site.