Impact of fenbendazole resistance in Ascaridia dissimilis on the economics of production in turkeys.

Feed conversion efficiency is among the most important factors affecting profitable production of poultry.Infections with parasitic nematodes can decrease efficiency of production, making parasite control through the use of anthelmintics an important component of health management. In ruminants and horses, anthelmintic resistance is highly prevalent in many of the most important nematode species, which greatly impacts their control. Recently, we identified resistance to fenbendazole in an isolate of Ascaridia dissimilis, the most common intestinal helminth of turkeys. Using this drug-resistant isolate, we investigated the impact that failure to control infections has on weight gain and feed conversion in growing turkeys. Birds were infected on D 0 with either a fenbendazole-susceptible or -resistant isolate, and then half were treated with fenbendazole (SafeGuard Aquasol) at 4- and 8-wk postinfection. Feed intake and bird weight were measured for each pen weekly throughout the study, and feed conversion rate was calculated. Necropsy was performed on birds from each treatment group to assess worm burdens at wk 7 and 9 postinfection. In the birds infected with the susceptible isolate, fenbendazole-treated groups had significantly better feed conversion as compared to untreated groups. In contrast, there were no significant differences in feed conversion between the fenbendazole-treated and untreated groups in the birds infected with the resistant isolate. At both wk 7 and 9, worm burdens were significantly different between the treated and untreated birds infected with the drug-susceptible isolate, but not in the birds infected with the drug-resistant isolate. These significant effects on feed conversion were seen despite having a rather low worm establishment in the birds. Overall, these data indicate that A. dissimilis can produce significant reductions in feed conversion, and that failure of treatment due to the presence of fenbendazole-resistant worms can have a significant economic impact on turkey production. Furthermore, given the low worm burdens and an abbreviated grow out period of this study, the levels of production loss we measured may be an underestimate of the true impact that fenbendazole-resistant worms may have on a commercial operation.

NURD 2.0: Prediction of tibial nonunion after intramedullary nail fixation at any time within 3 months after injury.

Introduction Nonunion after fixation of long bones negatively impacts outcomes and requires additional surgery. The ability to predict likelihood of nonunion after tibial shaft fracture would be helpful to clinicians and patients. The goal of this work was to combine three previous models of tibial shaft nonunion at different time points into one overall model that incorporates time as a continuous variable. Methods We conducted a retrospective review at a Level I academic trauma center. The study cohort consisted of patients with tibial shaft fractures treated with nail insertion from 2007 through 2014, excluding patients who did not have contact between bone ends, those who had planned bone grafting for acute bone defects, and those who lacked adequate follow-up. Three previous models were combined: 382 patients at time 0, 323 at 6 weeks, and 240 at 12 weeks. The primary outcome variable was surgery for nonunion. Bivariate and multivariate regression analyses determined which of 42 clinical and radiographic variables were significantly associated with nonunion. Predictive power was evaluated using area under the curve (AUC). Results The original nonunion risk determination (NURD) score was significantly improved through addition of 6- and 12-week radiographic union scores for tibial fractures, infection and complications, smoking status, and need for flaps. Overall, over the course of 12 weeks, the NURD-based model produced an AUC of 0.87 at initial time of fixation that improved to >0.9 at 6 and 12 weeks. Data were used to bin patients into five clinically important risk strata (p < 0.001). Patients in the lowest risk strata had 0% probability of nonunion (0 of 97 patients); in the second lowest risk strata, 4% (three of 73 patients); and in the highest risk strata, 48% (38 of 80 patients). Conclusions We created a NURD 2.0 score that predicts nonunion at various time points during the first 3 months after fracture. The new model is a notable improvement over previous models. A computerized version allows surgeons and patients to use the score when making treatment decisions regarding need for nonunion surgery.

Low Adherence to Recommended Guidelines for Open Fracture Antibiotic Prophylaxis.

BACKGROUND: Prompt administration of antibiotics is a critical component of open fracture treatment. Traditional antibiotic recommendations have been a first-generation cephalosporin for Gustilo Type-I and Type-II open fractures, with the addition of an aminoglycoside for Type-III fractures and penicillin for soil contamination. However, concerns over changing bacterial patterns and the side effects of aminoglycosides have led to interest in other regimens. The purpose of the present study was to describe the adherence to current prophylactic antibiotic guidelines. METHODS: We evaluated the antibiotic-prescribing practices of 24 centers in the U.S. and Canada that were participating in 2 randomized controlled trials of skin-preparation solutions for open fractures. A total of 1,234 patients were evaluated. RESULTS: All patients received antibiotics on the day of admission. The most commonly prescribed antibiotic regimen was cefazolin monotherapy (53.6%). Among patients with Type-I and Type-II fractures, there was 61.1% compliance with cefazolin monotherapy. In contrast, only 17.2% of patients with Type-III fractures received the recommended cefazolin and aminoglycoside therapy, with an additional 6.7% receiving piperacillin/tazobactam. CONCLUSIONS: There is moderate adherence to the traditional antibiotic treatment guidelines for Gustilo Type-I and Type-II fractures and low adherence for Type-III fractures. Given the divergence between current practice patterns and prior recommendations, high-quality studies are needed to determine the most appropriate prophylactic protocol.

Effectiveness of Iodophor vs Chlorhexidine Solutions for Surgical Site Infections and Unplanned Reoperations for Patients Who Underwent Fracture Repair: The PREP-IT Master Protocol.

Importance: The risk of developing a surgical site infection after extremity fracture repair is nearly 5 times greater than in most elective orthopedic surgical procedures. For all surgical procedures, it is standard practice to prepare the operative site with an antiseptic solution; however, there is limited evidence to guide the choice of solution used for orthopedic fracture repair. Objective: To compare the effectiveness of iodophor vs chlorhexidine solutions to reduce surgical site infections and unplanned fracture-related reoperations for patients who underwent fracture repair. Design, Setting, and Participants: The PREP-IT (Program of Randomized Trials to Evaluate Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma) master protocol will be followed to conduct 2 multicenter pragmatic cluster randomized crossover trials, Aqueous-PREP (Pragmatic Randomized Trial Evaluating Pre-Operative Aqueous Antiseptic Skin Solution in Open Fractures) and PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities). The Aqueous-PREP trial will compare 4% aqueous chlorhexidine vs 10% povidone-iodine for patients with open extremity fractures. The PREPARE trial will compare 2% chlorhexidine in 70% isopropyl alcohol vs 0.7% iodine povacrylex in 74% isopropyl alcohol for patients with open extremity fractures and patients with closed lower extremity or pelvic fractures. Both trials will share key aspects of study design and trial infrastructure. The studies will follow a pragmatic cluster randomized crossover design with alternating treatment periods of approximately 2 months. The primary outcome will be surgical site infection and the secondary outcome will be unplanned fracture-related reoperations within 12 months. The Aqueous-PREP trial will enroll a minimum of 1540 patients with open extremity fractures from at least 12 hospitals; PREPARE will enroll a minimum of 1540 patients with open extremity fractures and 6280 patients with closed lower extremity and pelvic fractures from at least 18 hospitals. The primary analyses will adhere to the intention-to-treat principle and account for potential between-cluster and between-period variability. The patient-centered design, implementation, and dissemination of results are guided by a multidisciplinary team that includes 3 patients and other relevant stakeholders. Discussion: The PREP-IT master protocol increases efficiency through shared trial infrastructure and study design components. Because prophylactic skin antisepsis is used prior to all surgical procedures and the application, cost, and availability of all study solutions are similar, the results of the PREP-IT trials are poised to inform clinical guidelines and bring about an immediate change in clinical practice. Trial Registration: ClinicalTrials.gov Identifiers: NCT03385304 and NCT03523962.

Minimally Invasive Lumbopelvic Fixation for Unstable U-Type Sacral Fractures.

Multi-planar transverse, U-type, and vertical sacral fractures occur from high energy trauma or as pathologic fractures and often have associated neurologic and extremity injuries. Modern treatment algorithms fall into two broad categories: 1) percutaneous posterior pelvic fixation (iliosacral or transiliac-transsacral screws) or 2) lumbopelvic fixation. Posterior pelvic screw fixation is minimally invasive but typically requires restricted weight bearing until fracture union. In many cases, lumbopelvic fixation allows for a closed reduction and provides stability to allow full weight bearing immediately after surgery; however, this fixation is often removed in a second surgery after fracture healing. Lumbopelvic fixation was originally described as an open procedure, minimally invasive lumbopelvic fixation is a recent variation and has shown promising results with less morbidity. We present a case series of unstable U-type sacral fractures treated with minimally invasive lumbopelvic fixation with staged hardware removal to illustrate the advantages and complications associated with this new technique. Ten patients with U-type sacral fractures underwent minimally invasive lumbopelvic fixation from 2016 to 2019. Six patients underwent scheduled hardware removal an average of 3.5 (range 1.9-5.5) months after index surgery. Two patients did not undergo hardware removal due to short life expectancy and diagnosis of pathologic fractures. One patient was lost to follow-up. One patient had failed fracture reduction and went on to sacral malunion that required a late sacral extension osteotomy to restore her ability to stand upright. Final disposition of all nine patients with follow-up was normal standing upright posture and normal ambulation without assistive device. There were no late displacements on postoperative upright radiographs. Complex sacral fractures are a challenging injury that can be treated with percutaneous posterior pelvic or lumbopelvic fixation. Lumbopelvic fixation offers the advantages of closed reduction to restore pelvic incidence and immediate weight bearing but has greater surgical morbidity than percutaneous posterior pelvic fixation and often requires hardware removal. The morbidity of lumbopelvic fixation may be reduced with minimally invasive techniques. Minimally invasive lumbopelvic fixation is a treatment option to be considered for complex sacral fractures.

Productive performance, egg quality, hematological parameters and serum chemistry of laying hens fed diets supplemented with certain fat-soluble vitamins, individually or combined, during summer season.

This present study aimed to determine the efficacy of supplementing layer diets with vitamin A (0, 8,000 and 16,000 IU/kg diet) and vitamin E (0, 250 and 500 mg/kg diet) either individually or in combination on egg production and quality, and blood hematology and chemistry of birds reared under summer conditions. A total of 135 Bovans Brown laying hens were distributed to 9 treatment groups with 5 replicates of 3 hens/pen in a 3 × 3 factorial design. A significant improvement in feed conversion ratio (FCR) was observed as supplementary vitamin A or E increased (P ≤ 0.01). Hens fed diets supplemented with 16,000 IU vitamin A plus 500 mg vitamin E/kg diet had the best FCR among all groups. Egg quality traits were not significantly affected by the interaction of vitamin A and vitamin E levels. There was a significant increase in monocytes (P ≤ 0.01) and a decrease in basophils counts (P ≤ 0.05) in response to vitamin E. Significant decreases were observed in packed cell volume (PCV), thyroxine (T4), alanine transferase (ALT), albumin, total cholesterol and total lipids ( (P ≤ 0.05 or P ≤ 0.01) P ≤ 0.01) , and increases were observed in serum concentrations of globulin (P ≤ 0.05) and calcium (P ≤ 0.01) due to vitamin A. The combination of 0 IU vitamin A and 500 mg vitamin E/kg diet had the highest values of PCV (40.09%) and hemoglobin (Hb) (10.33 mg/100 mL) among all groups. Vitamin E raised serum values of total protein, total cholesterol and total lipids (P ≤ 0.05 or P ≤ 0.01). Feed intake, FCR, PCV, Hb, lymphocytes, monocytes, eosinophils, T4, ALT and total protein were significantly affected by the interaction of vitamins A and E (P ≤ 0.05 or P ≤ 0.01). The interaction of vitamins A and E was only significant with respect to serum total protein (P ≤ 0.05). It can be concluded that layer diets supplemented with vitamins A and E had good results in alleviating the harmful impacts of high ambient temperature. The combination of 16,000 IU vitamin A and 500 mg vitamin E per kilogram diet is preferable for obtaining better production of laying hens reared under hot summer conditions.

Prediction of tibial nonunion at the 6-week time point.

INTRODUCTION: Intramedullary (IM) nail fixation is a common operative treatment, yet concerns regarding the frequency of complications, such as nonunion, remain. Treatment of tibial shaft fractures remains a challenge, and little evidence of prognostic factors that increase risk of nonunion is available. The aim of this study was to develop a predictive model of tibial shaft fracture nonunion 6 weeks after reamed intramedullary (IM) nail fixation based on commonly collected clinical variables and the radiographic union score for tibial fractures (RUST). METHODS: A retrospective case-control study was conducted. All tibial shaft fractures treated at our level I trauma center from 2007 to 2014 were retrospectively reviewed. Only patients with follow-up until fracture healing or secondary operation for nonunion were included. Fracture gaps ≥3 mm were excluded. A total of 323 patients were included for study. RESULTS: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). The NURD score was increasingly predictive of nonunion with decreasing RUST. All patients in the high RUST group (RUST ≥ 10), achieved union regardless of NURD score. In the medium RUST group (RUST 6-9), 25% of patients with a NURD score ≥7 experienced nonunion. In the low RUST group (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. CONCLUSION: Three variables predicted nonunion. Based on these variables, we created a clinical prediction tool of nonunion that could aid in clinical decision making and discussing prognosis with patients.

The utility of the King-Devick test as a sideline assessment tool for sport-related concussions: a narrative review.

OBJECTIVE: The objective of this paper is to review existing literature surrounding the utility of the King-Devick test which is a commonly used sideline assessment tool for sport-related concussions. METHODS: A review of the literature was performed using MEDLINE, CINHAL, and SportDiscus databases. The search was performed from the beginning of the record through November 16th, 2015. RESULTS: This search strategy yielded 27 articles from aforementioned databases. Further searching in The Cochrane Library with King-Devick AND Concuss* search terms yielded one additional article, summing a total of 28 articles. After removal of duplicates and implementation of the inclusion/exclusion criteria, 8 articles for extensively reviewed. CONCLUSION: This narrative review suggests that the King-Devick test is an efficient sideline assessment tool for sport-related concussions. However, we recommend that the King-Devick should be used as a sideline screening tool, not a concussion diagnosis tool at this time. A proper baseline time including multiple tests may be recommended to negate the learning affect and to have a reliable baseline in which to measure from for future reference. A three second difference appears appropriate to identify the possibility of concussion and to remove an athlete from play. At this time, the athlete should be monitored and further evaluated as symptoms are sometimes delayed. We suggest that further research may be useful to better determine the efficacy of the K-D test in detecting concussions across a broader range of athletes and sports. We also suggest further research may investigate the K-D test a potential return-to-play tool for clinicians and medical personnel.

OBJECTIF: L'objectif de cet article est de passer en revue la documentation scientifique existante concernant l'utilité du test King-Devick qui est un outil auxiliaire couramment utilisé pour évaluer les commotions cérébrales liées au sport. MÉTHODOLOGIE: Une analyse des documents scientifiques a été réalisée en recherchant dans les bases de données MEDLINE, CINAHL et SportDiscus. La recherche a été effectuée du début des registres jusqu'au 16 novembre 2015. RÉSULTATS: Cette stratégie de recherche a donné 27 articles des bases de données précitées. Une recherche plus poussée dans la bibliothèque Cochrane avec les termes de recherche King-Devick ET Concuss* a révélé un autre article, pour un total de 28 articles. Après l'élimination des doublons et la mise en œuvre des critères d'inclusion et d'exclusion, 8 articles ont fait l'objet d'un examen approfondi. CONCLUSION: Cet examen narratif suggère que le test King-Devick est un outil d'évaluation auxiliaire efficace pour les commotions cérébrales liées au sport. Cependant, nous recommandons qu'à l'heure actuelle King-Devick soit utilisé comme un outil auxiliaire de dépistage, et non comme un outil de diagnostic de commotion cérébrale. Une période de référence appropriée comprenant des tests multiples peut être recommandée pour annuler l'effet d'apprentissage et avoir une référence fiable à partir de laquelle il soit possible de mesurer pour des références futures. Une différence de trois secondes semble appropriée pour reconnaître la possibilité d'une commotion cérébrale et pour retirer un athlète du jeu. À ce moment-là, l'athlète doit être surveillé et évalué de plus près, car les symptômes apparaissent parfois tardivement. Selon nous, d'autres recherches pourraient être utiles pour mieux déterminer l'efficacité du test K-D dans la détection des commotions cérébrales chez une plus grande variété d'athlètes dans diverses autres disciplines sportives. En outre, il nous semble que d'autres recherches pourraient étudier le test K-D comme un outil potentiel pour évaluer le retour au jeu par les cliniciens et le personnel médical.

Effects of a Calcium Bentonite Clay in Diets Containing Aflatoxin when Measuring Liver Residues of Aflatoxin B1 in Starter Broiler Chicks.

Research has shown success using clay-based binders to adsorb aflatoxin in animal feeds; however, no adsorbent has been approved for the prevention or treatment of aflatoxicosis. In this study, growth and relative organ weights were evaluated along with a residue analysis for aflatoxin B1 in liver tissue collected from broiler chickens consuming dietary aflatoxin (0, 600, 1200, and 1800 µg/kg) both with and without 0.2% of a calcium bentonite clay additive (TX4). After one week, only the combined measure of a broiler productivity index was significantly affected by 1800 µg/kg aflatoxin. However, once birds had consumed treatment diets for two weeks, body weights and relative kidney weights were affected by the lowest concentration. Then, during the third week, body weights, feed conversion, and the productivity index were affected by the 600 µg/kg level. Results also showed that 0.2% TX4 was effective at reducing the accumulation of aflatoxin B1 residues in the liver and improving livability in birds fed aflatoxin. The time required to clear all residues from the liver was less than one week. With evidence that the liver's ability to process aflatoxin becomes relatively efficient within three weeks, this would imply that an alternative strategy for handling aflatoxin contamination in feed could be to allow a short, punctuated exposure to a higher level, so long as that exposure is followed by at least a week of a withdrawal period on a clean diet free of aflatoxin.

Calculated rates of diffusion-limited reactions in a three-dimensional network of connected compartments: application to porous catalysts and biological systems.

We describe the diffusion limit for reaction rates in a three-dimensional system of connected compartments. This model exhibits the length-scale dependent diffusion that can be observed in many heterogeneous environments, such as porous catalysts and biological environments. We obtain a simple analytical expression for the diffusion limit applicable to any scale of the compartment confinement. This diffusion limit exceeds the classic Smoluchowski diffusion limit that was derived for homogeneous environments but is often applied to biological reactions in heterogeneous environments. We expect our new diffusion limit to provide a more appropriate upper bound on reaction rates in biological systems, porous structures, and other heterogeneous environments where obstacles create local confinement.

Allograft reconstruction of chronic pectoralis major tendon ruptures.

In chronic pectoralis tendon tears, primary repair may not be possible and allograft reconstruction may be required. The goal of this study was to report the authors' experience with chronic pectoralis major tendon reconstructions using an Achilles tendon allograft in three military patients. Three consecutive patients presenting with chronic, complete pectoralis major tendon tears underwent reconstruction by a single surgeon using the same described technique at a mean of 22.2 months after initial injury. Final outcomes were assessed at a mean of 24.5 months postoperatively, yielding one excellent and two good results. All patients were satisfied. All patients returned to full active duty military service and recreational weight lifting by 6 months. Achilles allograft reconstruction of chronic pectoralis major tendon ruptures is a viable treatment option. Good to excellent results can be achieved in active patients, even when reconstruction is performed nearly 2 years from the time of injury.

Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus.

BACKGROUND: Historically, osteochondral lesions of the talus (OCLTs) were thought to occur most commonly in the anterolateral and posteromedial talar dome; however, new classification systems are able to describe OCLT location more precisely. A recent magnetic resonance imaging (MRI) study introduced a novel nine-zone anatomic grid of the talar dome, demonstrating that most OCLTs occur in the central portion of the medial and lateral talar dome, with medial lesions being more common as well as larger in depth and surface area. The current study sought to determine if similar location and morphology patterns were consistent in symptomatic, operatively treated OCLTs. MATERIALS AND METHODS: The preoperative MRI images of 65 consecutive patients who underwent operative management for symptomatic OCLTs at a single institution were reviewed using a previously described nine-zone anatomic grid of the talar dome to determine location frequency, morphology, and Hepple et al. MRI staging classification characteristics. All patients were active-duty service members in the United States Armed Forces. The cohort consisted of 60 (92%) males and 5 (8%) females with an overall mean patient age of 34 (range, 19 to 58) years. Statistical analyses were performed, and significant differences are reported. RESULTS: The most common location for symptomatic, operatively treated OCLTs was the central third of the lateral talar dome, followed by the central third of the medial talar dome. Anterolateral and posteromedial lesions accounted for relatively few OCLTs. Compared with lateral OCLTs, medial OCLTs were significantly larger in transverse and anteroposterior diameters and surface area, but no significant differences existed with regard to lesion depth. Overall, the majority of lesions were MRI stage II; however, stage II lesions were more likely located laterally, whereas stage III lesions were more likely located medially. CONCLUSIONS: With regard to symptomatic, operatively treated OCLTs, the results of the current study parallel current evidence that posteromedial and anterolateral OCLTs are not the most common locations of OCLTs. As well, medial OCLTs were larger in surface area than lateral OCLTs, but no differences existed with regard to lesion depth. It is interesting that operatively treated OCLTs were twice as commonly located in the centrolateral third rather than the centromedial third of the talar dome.

Camelina meal increases egg n-3 fatty acid content without altering quality or production in laying hens.

Camelina sativa is an oilseed plant rich in n-3 and n-6 fatty acids and extruding the seeds results in high protein meal (*40%) containing high levels of n-3 fatty acids. In this study, we examined the effects of feeding extruded defatted camelina meal to commercial laying hens, measuring egg production, quality, and fatty acid composition. Lohmann White Leghorn hens (29 weeks old) were randomly allocated to three dietary treatment groups (n = 25 per group) and data was collected over a 12 week production period. All the treatment groups were fed a corn soy based experimental diet containing 0% (control), 5, or 10% extruded camelina meal. We found no significant differences in percent hen-day egg production and feed consumed per dozen eggs. Egg shell strength was significantly higher in both camelina groups compared to the controls. Egg total n-3 fatty acid content increased 1.9- and 2.7-fold in 5 and 10% camelina groups respectively relative to the control. A similar increase in DHA content also occurred. Further camelina meal did not alter glucosinolate levels and no detectable glucosinolates or metabolic product isothiocyanates were found in the eggs from either the 5 or 10% camelina groups. These results indicate that camelina meal is a viable dietary source of n-3 fatty acids for poultry and its dietary inclusion results in eggs enriched with n-3 fatty acids.

Abdominal compartment syndrome after hip arthroscopy.

As hip arthroscopy becomes a more common procedure, more complications may occur. We present a case of abdominal compartment syndrome resulting from fluid extravasation in a 42-year-old man who underwent routine hip arthroscopy for femoral acetabular impingement. He had not had previous surgeries to that hip, and arthroscopy was performed in the supine position. After adequate distraction, arthroscopy was performed with an automated pressure- and flow-controlled pump with the pressure maintained between 40 and 60 mm Hg. We performed debridement of a degenerative tear of the anterosuperior labrum, removal of a pincer lesion, and a psoas tenotomy through a capsular window. A distended abdomen was noted on drape removal, and the patient required decompressive laparotomy for abdominal compartment syndrome. Extravasation of arthroscopy fluid is a potentially devastating complication during hip arthroscopy, and there should be careful monitoring by the surgeons, anesthesiologists, and operating room staff.