Lactating dairy cows managed for second and greater artificial insemination services with the Short-Resynch or Day 25 Resynch program had similar reproductive performance.

The objective of this randomized controlled experiment was to evaluate reproductive performance and reproductive physiological outcomes of lactating Holstein cows managed for second and greater artificial insemination (AI) services with the Short-Resynch or Day 25 Resynch program. Cows from 2 commercial farms were randomly assigned after first service to the Short-Resynch (SR; n = 870) or Day 25 Resynch (D25R; n = 917) program in which they remained until 210 d after first service or left the herd. Cows in D25R received GnRH 25 ± 3 d after AI, whereas cows in SR did not. Cows not reinseminated at detected estrus (AIE) by 32 ± 3 d after AI underwent nonpregnancy diagnosis (NPD) through transrectal ultrasonography (TUS). Nonpregnant cows from both treatments with a corpus luteum (CL) ≥15 mm and an ovarian follicle ≥10 mm (hereafter, CL cows) received 2 PGF2α treatments 24 h apart, GnRH 32 h after the second PGF2α, and timed AI 16 to 18 h later. Cows that did not meet the criteria to be included in the CL group (NoCL cows) received a modified Ovsynch protocol with progesterone (P4) supplementation [P4-Ovsynch; GnRH and controlled internal drug-release device (CIDR) in, 7 d later CIDR removal and PGF2α, 24 h later PGF2α, 32 h later GnRH, and 16 to 18 h later timed AI]. In a subgroup of cows, blood samples were collected and TUS conducted at each treatment to evaluate ovarian responses to resynchronization. Binary data were analyzed with logistic regression, continuous data by ANOVA, and time-to-event data by Cox's proportional hazard regression. A greater proportion (mean; 95% CI) of cows were AIE before NPD in the SR (60.5%; 57.0-63.8; n = 3,416) than the D25R (50.1%; 46.5-53.7; n = 3,177) treatment, whereas pregnancy per AI (P/AI) at 32 d for AIE services before NPD was greater for the D25R (41.3%; 38.8-43.8; n = 1,560) than the SR (37.6%; 35.5-39.8; n = 1,961) treatment. At NPD, a greater proportion of cows in the D25R (84.3%; 82.2-86.2) than the SR (77.0%; 74.4-79.4) treatment were considered CL cows. Pregnancy per AI at 32 d was greater for the D25R than the SR treatment for all timed AI services (D25R = 43.0%; 40.2-45.9 vs. SR = 36.8%; 33.8-39.8) and for CL cows (D25R = 42.8%; 39.7-45.9 vs. SR = 33.8%; 30.6-37.2) but did not differ for NoCL cows (D25R = 39.4%; 32.1-47.3 vs. SR = 44.0%; 36.8-51.4). The hazard ratio for time to pregnancy (1.03; 0.93-1.14) and the proportion of cows not pregnant at the end of the observation period (D25R = 5.9%; 4.4-7.8 vs. SR = 6.7%; 5.0-8.7) did not differ between SR and D25R treatments. The GnRH treatment 25 d after AI resulted in more cows with P4 >1 ng/mL (D25R = 80.5%; 75.3-84.9 vs. SR = 63.6%; 57.3-69.4) and smaller follicle diameter at NPD 32 ± 3 d after AI for D25R (16.2 ± 0.4 mm) than for SR (17.5 ± 0.4 mm); however, it did not affect follicle diameter and luteal regression risk (CL cows only) before TAI. We concluded that the use of reproductive management programs including SR and D25R for CL cows and the P4-Ovsynch protocol for NoCL cows resulted in similar hazard of pregnancy and proportion of nonpregnant cows for up to 210 d after first service.

Intravaginal instillation of prostaglandin F2α was as effective as intramuscular injection for induction of luteal regression in lactating dairy cows.

Our objectives were to test the efficacy of intravaginal (IVG) administration of PGF2α to induce corpus luteum (CL) regression, compare circulating progesterone (P4) profiles in cows receiving IVG versus intramuscular (IM) treatment with PGF2α, and evaluate reproductive outcomes. Lactating Holstein cows were synchronized using a Double-Ovsynch protocol [GnRH, 7 d later PGF2α, 3 d later GnRH, 7 d later GnRH, 7 d later PGF2α, 1 d later PGF2α, 32 h later GnRH, 16 to 20 h timed artificial insemination (TAI)] to receive TAI at 67 ± 3 d in milk. Seven days after the first GnRH treatment (time 0), cows with at least 1 visible CL ≥15 mm were blocked by parity and randomly assigned to a treatment that consisted of IM injection (IM-PGF; n = 201) or IVG instillation (IVG-PGF; n = 201) of PGF2α. Cows in IM-PGF received a single 25-mg dose of PGF2α (dinoprost tromethamine) intramuscularly. Cows in IVG-PGF received two 25-mg doses of PGF2α 12 h apart delivered through a catheter in the cranial portion of the vagina. Blood samples were collected at 0, 12, 48, and 72 h after treatment. Ovulation to the first GnRH of Double-Ovsynch was determined through transrectal ultrasonography. Only cows with P4 ≥1 ng/mL (functional CL) at time 0 (IM-PGF = 169; IVG-PGF = 179) were included in the analyses. Binary and quantitative data were analyzed by logistic regression and ANOVA with repeated measures, respectively. Results are presented as least squares means. Concentrations of P4 and the proportion of cows with a new CL at time 0 did not differ. Overall, the proportion of cows with CL regression using 1 ng of P4/mL (IM-PGF = 89.0%; IVG-PGF = 86.7%) or 0.5 ng of P4/mL (IM-PGF = 82.2%; IVG-PGF = 82.1%) as the cutoff did not differ. Concentrations of P4 were affected by treatment, time, and treatment × time interaction. Cows in IVG-PGF had greater mean P4 at 12 h than cows in IM-PGF. Mean P4 did not differ at 48 or 72 h after treatment. The proportion of cows with estrus recorded within 3 d of treatment (IM-PGF = 45.4%; IVG-PGF = 48.9%), ovulation risk after treatment (IM-PGF = 88.5%; IVG-PGF = 85.1%), and pregnancies per artificial insemination after TAI (IM-PGF = 51.5%; IVG-PGF = 57.8%) did not differ. We concluded that 2 IVG doses of 25 mg of PGF2α 12 h apart were as effective as a single 25-mg IM dose of PGF2α for inducing luteal regression in lactating dairy cattle.

[Evaluation of the appropriateness of public hospital use using AEP in the Abruzzo Region of Italy: results by hospital and ward, main predictors and potential implications]. / Valutazione dell'appropriatezza dei ricoveri ospedalieri pubblici nella regione abruzzo tramite PRuo: risultati per presidio e disciplina, principali predittori e potenziali implicazioni.

In the context of a wide healthcare system reorganization, the Abruzzo Region of Italy used the Appropriateness Evaluation Protocol (AEP) to carry out a systematic evaluation of the appropriateness of the admissions performed during 2006 in all public hospitals. After specific training courses, a sample representative of all ordinary admissions was assessed twice: first by regional investigators (external assessment) then by the local personnel (internal assessment). Random-effect logistic regression was used to evaluate potential inappropriateness predictors. On a total of 13081 hospital days (2393 hospitalizations), 39.7% (95% Confidence interval: 38.9%-40.6%) were inappropriate at the regional assessment; 39.5% at the internal assessment, with high correlation between the two controls (K = 0.73). Another 10.4% of admissions, excluded by the evaluation, was assigned to DRGs at high risk of inappropriateness and should be considered. In single hospitals, the inappropriateness ranged between 17.9% and 57.9%, with large variation across wards. Additional significant predictors of inappropriateness were the day and hour of admission and hospital size, with lower inappropriateness in bigger ones. In 2006, there was a large degree of hospital misuse in public hospitals in the Abruzzo Region. The approach used in the survey may have contributed to the drastic reduction of the number of ordinary admissions observed in the Region between 2006 and 2007.

Preliminary study on relevant data for health management in hospitals.

Data and information are nowadays keys of success. We experienced the building of an hospital Information System (IS) selecting data from those already routinely produced and sharing them with health care units and general management. IS should be shaped to accomplish mission, vision and strategic direction of the hospital and in this direction our efforts are oriented.

Cell cycle synchronization of FRTL5 cells. A physiological model system.

We describe a "physiological" cell cycle synchronization model system. FRTL5 cells, TSH-dependent for proliferation, were starved from TSH. The cell cycle phases and the expression of markers associated to different cycle phases were evaluated. TSH starvation blocks proliferation without provoking death and induces virtually all the cells to accumulate in G0/G1 phase. TSH readdition allows 30% of these cells to enter the S phase. DNA topoisomerase II 170-kDa isoform is not expressed in G0/G1 synchronized cells while it is expressed in logarithmic growing cells. The 180-kDa isoform is not expressed in G0/G1 synchronized cells while it is expressed in 20% of logarithmic growing cells regardless of the cycle phase. c-myc mRNA is not expressed in G0/G1 synchronized cells while it is detectable upon TSH readdition. This system provides a tool for the analysis of events associated with the G0/G1 phase and the transition from G0/G1 to S phase.