Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations.

Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.

The effect of clitoral stimulation post artificial insemination on pregnancy rates of multiparous Bos indicus beef cows submitted to estradiol/progesterone-based estrus synchronization protocol.

Clitoral stimulation after artificial insemination (AI) in beef cattle is a common practice utilized by AI technicians; however, the effect of clitoral stimulation during fixed-time AI (TAI) is still unknown. The objective of the present experiment was to evaluate the effect of clitoral stimulation on temperament responses and pregnancy rates to TAI in Bos indicus beef cows. A total of 1,186 multiparous Nellore cows across three different locations were assigned to an estradiol/progesterone-based estrus synchronization + TAI protocol (day -11 to 0). Cows were randomly assigned to receive either 3 s of clitoral stimulation (n = 602) or no clitoral stimulation (n = 584) immediately after TAI (day 0). Cow body condition score (BCS) was recorded on day -11. Estrus expression was evaluated based on estrus detection visual aid patch activation on day 0 (estrus, ≥50% activated; no estrus, <50% activated). Temperament was assessed by individual chute score based on a 5-point scale before TAI, and individual exit velocity was measured after clitoral stimulation. Pregnancy diagnosis was performed 30 d after TAI via transrectal ultrasonography. Pregnancy rate to TAI was positively affected by BCS (P < 0.01) and estrus expression (P = 0.03). Pregnancy rates of cows receiving clitoral stimulation did not differ (P = 0.39) from cows non-stimulated (47.5 ± 4.6% vs. 44.3 ± 4.6%, respectively). No interaction of clitoral stimulation and estrus expression was observed (P = 0.26). Chute score was positively correlated to exit velocity (P < 0.01; r = 0.29); however, clitoral stimulation did not affect exit velocity (P = 0.86). In summary, pregnancy rates to TAI are influenced by various factors and multiple strategies have the potential to increase the fertility of beef cows submitted to TAI; however, clitoral stimulation of Bos indicus beef cows did not improve TAI pregnancy rate.