Utilizing blood filter paper and ear punch samples for the detection of rabbit hemorrhagic disease virus 2 by RT-rtPCR.

Rabbit hemorrhagic disease virus 2 (RHDV2), a virulent and contagious viral pathogen that affects wild and domestic lagomorph populations, was identified in Wyoming, USA in December 2020. A surveillance program was developed involving full-carcass submission and liver analysis, although carcass quality as a result of predation and decomposition impeded analysis. To increase the number of submissions and provide flexibility to field staff, we evaluated 2 sample types: 77 dried blood on filter paper samples, 66 ear punch samples. At initial sampling, test specificity and sensitivity of the RT-rtPCR utilizing dried blood on filter paper and ear punch samples were both 100% compared to liver. Filter paper results were consistent over time; sensitivity stayed >96% through weeks 2, 4, and 6, with a maximum mean difference of 6.0 Ct from baseline liver Ct values (95% CI: 5.0-7.3) at 6 wk. Test sensitivity of the ear punch sample at 1, 3, 5, and 7 wk post-sampling remained at 100%, with a maximum mean difference of 5.6 Ct from baseline liver Ct values (95% CI: 4.3-6.9) at 5 wk. Filter paper and ear punch samples were suitable alternatives to liver for RHDV2 surveillance in wild lagomorph populations. Alternative sampling options provide more flexibility to surveillance programs, increase testable submissions, and decrease exposure of field personnel to zoonotic disease agents.

Using whole-genome sequence data to examine the epidemiology of antimicrobial resistance in Escherichia coli from wild meso-mammals and environmental sources on swine farms, conservation areas, and the Grand River watershed in southern Ontario, Canada.

Antimicrobial resistance (AMR) threatens the health of humans and animals and has repeatedly been detected in wild animal species across the world. This cross-sectional study integrates whole-genome sequence data from Escherichia coli isolates with demonstrated phenotypic resistance that originated from a previous longitudinal wildlife study in southern Ontario, as well as phenotypically resistant E. coli water isolates previously collected as part of a public health surveillance program. The objective of this work was to assess for evidence of possible transmission of antimicrobial resistance determinants between wild meso-mammals, swine manure pits, and environmental sources on a broad scale in the Grand River watershed, and at a local scale-for the subset of samples collected on both swine farms and conservation areas in the previous wildlife study. Logistic regression models were used to assess potential associations between sampling source, location type (swine farm vs. conservation area), and the occurrence of select resistance genes and predicted plasmids. In total, 200 isolates from the following sources were included: water (n = 20), wildlife (n = 73), swine manure pit (n = 31), soil (n = 73), and dumpsters (n = 3). Several genes and plasmid incompatibility types were significantly more likely to be identified on swine farms compared to conservation areas. Conversely, internationally distributed sequence types (e.g., ST131), extended-spectrum beta-lactamase- and AmpC-producing E. coli were isolated in lower prevalences (<10%) and were almost exclusively identified in water sources, or in raccoon and soil isolates obtained from conservation areas. Differences in the odds of detecting resistance genes and predicted plasmids among various sources and location types suggest different primary sources for individual AMR determinants, but, broadly, our findings suggest that raccoons, skunks and opossums in this region may be exposed to AMR pollution via water and agricultural sources, as well as anthropogenic sources in conservation areas.

Prevalence and characteristics of cannabis-induced toxicoses in pets: Results from a survey of veterinarians in North America.

Cannabis legalization in North America has coincided with an increase in reports of cannabis-induced toxicosis in pets, but the magnitude of this problem, as well as outcomes of these incidents remain unknown. Therefore, we examined the frequency, diagnostic criteria, clinical signs, and prognoses of cannabis toxicoses in pets in North America. We conducted an online survey between January, 2021 and April, 2021 targeting veterinarians practicing in Canada and the United States (US). Out of the 251 study participants, 191 practiced in Canada. Cannabis toxicosis was most commonly reported in dogs (n = 226 veterinarians), and the number of toxicosis cases increased significantly in Canada (p<0.0001) and the US (p = 0.002) after October, 2018. Frequently reported clinical signs of cannabis toxicosis included: urinary incontinence (n = 195), disorientation (n = 182), ataxia (n = 178), lethargy (n = 150), hyperesthesia (n = 134), and bradycardia (n = 112). Edibles were most commonly suspected to be the cause of toxicosis (n = 116). The most common route of exposure was ingestion (n = 135), while the most cited reason was ingestion while unattended (n = 135). Cannabis toxicosis was mostly diagnosed using supportive clinical signs (n = 229), the most common treatment was outpatient monitoring (n = 182), and pets were most often treated as out-patients (n = 103). The legalization of cannabis use in Canada and the US is likely an important factor associated with the increased cannabis toxicosis cases in pets; however, the legal status may also increase reporting. The medicinal use of cannabis by pet-owners for pets may also contribute to a portion of the reported toxicoses. Most pets that experienced cannabis toxicosis recovered completely, suggesting that most cannabis toxicoses do not result in long-term ill effects. Even though some deaths (n = 16) were reported in association with cannabis toxicosis, the presence of confounders such as toxins, and underlying conditions cannot be ruled out, emphasizing the need for rigorous controlled laboratory studies to investigate this important issue.

Rural Raccoons (Procyon lotor) Not Likely to Be a Major Driver of Antimicrobial Resistant Human Salmonella Cases in Southern Ontario, Canada: A One Health Epidemiological Assessment Using Whole-Genome Sequence Data.

Non-typhoidal Salmonella infections represent a substantial burden of illness in humans, and the increasing prevalence of antimicrobial resistance among these infections is a growing concern. Using a combination of Salmonella isolate short-read whole-genome sequence data from select human cases, raccoons, livestock and environmental sources, and an epidemiological framework, our objective was to determine if there was evidence for potential transmission of Salmonella and associated antimicrobial resistance determinants between these different sources in the Grand River watershed in Ontario, Canada. Logistic regression models were used to assess the potential associations between source type and the presence of select resistance genes and plasmid incompatibility types. A total of 608 isolates were obtained from the following sources: humans (n = 58), raccoons (n = 92), livestock (n = 329), and environmental samples (n = 129). Resistance genes of public health importance, including bla CMY-2, were identified in humans, livestock, and environmental sources, but not in raccoons. Most resistance genes analyzed were significantly more likely to be identified in livestock and/or human isolates than in raccoon isolates. Based on a 3,002-loci core genome multi-locus sequence typing (cgMLST) scheme, human Salmonella isolates were often more similar to isolates from livestock and environmental sources, than with those from raccoons. Rare instances of serovars S. Heidelberg and S. Enteritidis in raccoons likely represent incidental infections and highlight possible acquisition and dissemination of predominantly poultry-associated Salmonella by raccoons within these ecosystems. Raccoon-predominant serovars were either not identified among human isolates (S. Agona, S. Thompson) or differed by more than 350 cgMLST loci (S. Newport). Collectively, our findings suggest that the rural population of raccoons on swine farms in the Grand River watershed are unlikely to be major contributors to antimicrobial resistant human Salmonella cases in this region.

Using whole-genome sequence data to examine the epidemiology of Salmonella, Escherichia coli and associated antimicrobial resistance in raccoons (Procyon lotor), swine manure pits, and soil samples on swine farms in southern Ontario, Canada.

To better understand the contribution of wildlife to the dissemination of Salmonella and antimicrobial resistance in Salmonella and Escherichia coli, we examined whole-genome sequence data from Salmonella and E. coli isolates collected from raccoons (Procyon lotor) and environmental sources on farms in southern Ontario. All Salmonella and phenotypically resistant E. coli collected from raccoons, soil, and manure pits on five swine farms as part of a previous study were included. We assessed for evidence of potential transmission of these organisms between different sources and farms utilizing a combination of population structure assessments (using core-genome multi-locus sequence typing), direct comparisons of multi-drug resistant isolates, and epidemiological modeling of antimicrobial resistance (AMR) genes and plasmid incompatibility (Inc) types. Univariable logistic regression models were fit to assess the impact of source type, farm location, and sampling year on the occurrence of select resistance genes and Inc types. A total of 159 Salmonella and 96 resistant E. coli isolates were included. A diversity of Salmonella serovars and sequence types were identified, and, in some cases, we found similar or identical Salmonella isolates and resistance genes between raccoons, soil, and swine manure pits. Certain Inc types and resistance genes associated with source type were consistently more likely to be identified in isolates from raccoons than swine manure pits, suggesting that manure pits are not likely a primary source of those particular resistance determinants for raccoons. Overall, our data suggest that transmission of Salmonella and AMR determinants between raccoons and swine manure pits is uncommon, but soil-raccoon transmission appears to be occurring frequently. More comprehensive sampling of farms, and assessment of farms with other livestock species, as well as additional environmental sources (e.g., rivers) may help to further elucidate the movement of resistance genes between these various sources.

Clinical Course, Myopathology and Challenge of Therapeutic Intervention in Pediatric Patients with Autoimmune-Mediated Necrotizing Myopathy.

(1) Background: Immune-mediated necrotizing myopathy (IMNM) is a rare form of inflammatory muscle disease which is even more rare in pediatric patients. To increase the knowledge of juvenile IMNM, we here present the clinical findings on long-term follow-up, myopathological changes, and therapeutic strategies in two juvenile patients. (2) Methods: Investigations included phenotyping, determination of antibody status, microscopy on muscle biopsies, MRI, and response to therapeutic interventions. (3) Results: Anti-signal recognition particle (anti-SRP54) and anti- 3-hydroxy-3-methylglutarly coenzyme A reductase (anti-HMGCR) antibodies (Ab) were detected in the patients. Limb girdle presentation, very high CK-levels, and a lack of skin rash at disease-manifestation and an absence of prominent inflammatory signs accompanied by an abnormal distribution of α-dystroglycan in muscle biopsies initially hinted toward a genetically caused muscle dystrophy. Further immunostaining studies revealed an increase of proteins involved in chaperone-assisted autophagy (CASA), a finding already described in adult IMNM-patients. Asymmetrical muscular weakness was present in the anti-SRP54 positive Ab patient. After initial stabilization under therapy with intravenous immunoglobulins and methotrexate, both patients experienced a worsening of their symptoms and despite further therapy escalation, developed a permanent reduction of their muscle strength and muscular atrophy. (4) Conclusions: Diagnosis of juvenile IMNM might be complicated by asymmetric muscle weakness, lack of cutaneous features, absence of prominent inflammatory changes in the biopsy, and altered α-dystroglycan.

Epidemiology of Campylobacter jejuni in raccoons (Procyon lotor) on swine farms and in conservation areas in southern Ontario.

Campylobacter is a leading cause of foodborne illness in humans worldwide. Sources of infection are often difficult to identify, and are, generally, poorly understood. Recent work suggests that wildlife may represent a source of Campylobacter for human infections. Using a repeated cross-sectional study design, raccoons were trapped on five swine farms and five conservation areas in southern Ontario from 2011 to 2013. Our objectives were to: (a) assess the impact of seasonal, climatic, location, annual and raccoon demographic factors on the occurrence of Campylobacter jejuni in these animals; and (b) identify clusters of C. jejuni in space, time and space-time using spatial scan statistics. Multi-level multivariable logistic regression was used to examine the odds of isolating C. jejuni, with site and animal modelled as random intercepts. The following independent variables were examined: raccoon age and sex, year, location type, season, temperature and rainfall. A total of 1,096 samples were obtained from 627 raccoons; 46.3% were positive for C. jejuni. The following interactions and their main effects were significant (p < .05) and retained in the final model: season × temperature, year × rainfall, year × temperature. Based on the results from our multivariable model and spatial scan statistics, climatic variables (i.e. rainfall, temperature and season) were associated with the carriage of C. jejuni by raccoons, but the effects were not consistent, and varied by location and year. Although raccoons may pose a zoonotic risk due to their carriage of Campylobacter, further work is required to characterize the transmission and movement of this microorganism within the ecosystem.

A RETROSPECTIVE SUMMARY OF CERVID MORBIDITY AND MORTALITY IN ONTARIO AND NUNAVUT REGIONS OF CANADA (1991-2017).

Free-ranging cervids in Canada face diverse threats such as climate change, human population expansion, and the northward spread of vector-borne pathogens. However, we currently have a limited understanding of the impacts of these health challenges in Ontario cervids. Our objective was to identify and characterize causes of morbidity and mortality in free-ranging cervids submitted to the Ontario and Nunavut node of the Canadian Wildlife Health Cooperative (CWHC) over a 27-yr period (1991 to 2017). Submissions included carcasses submitted for full postmortem examination (gross and histopathology; n=196) and field-collected tissues (n=384). Ancillary tests were performed on a case-by-case basis. Univariable logistic regression was used to test for associations between select causes of morbidity and mortality, and factors such as sex, age, and season. Four cervid species were examined: white-tailed deer (Odocoileus virginianus; n=211), moose (Alces alces; n=140), elk (Cervus canadensis; n=136), and caribou (Rangifer tarandus caribou; n=93). Noninfectious disease was the most common general cause of morbidity and mortality (38.1%; 221/580) and was most commonly attributed to trauma (49.7%; 110/221). Deaths attributed to infectious diseases (34.3%; 199/580) were most often bacterial in etiology (45.7%; 91/199). The most common primary infectious disease diagnosed in caribou was digital limb infection, and moose were most commonly diagnosed with parasitic causes, including meningeal worm (Parelaphostrongylus tenuis) and winter tick (Dermacentor albipictus). Chronic wasting disease was not diagnosed among cervids tested during the study period, consistent with the previous lack of detection of the disease in Ontario. These results reveal that anthropogenic, infectious, and environmentally associated causes of morbidity and mortality are commonly diagnosed in cervids submitted to the CWHC Ontario and Nunavut regions, and represent potential population threats that should continue to be monitored.

Generalizability and comparability of prevalence estimates in the wild bird literature: methodological and epidemiological considerations.

Wild birds have been the focus of a great deal of research investigating the epidemiology of zoonotic bacteria and antimicrobial resistance in the environment. While enteric pathogens (e.g. Campylobacter, Salmonella, and E. coli O157:H7) and antimicrobial resistant bacteria of public health importance have been isolated from a wide variety of wild bird species, there is a considerable variation in the measured prevalence of a given microorganism from different studies. This variation may often reflect differences in certain ecological and biological factors such as feeding habits and immune status. Variation in prevalence estimates may also reflect differences in sample collection and processing methods, along with a host of epidemiological inputs related to overall study design. Because the generalizability and comparability of prevalence estimates in the wild bird literature are constrained by their methodological and epidemiological underpinnings, understanding them is crucial to the accurate interpretation of prevalence estimates. The main purpose of this review is to examine methodological and epidemiological inputs to prevalence estimates in the wild bird literature that have a major bearing on their generalizability and comparability. The inputs examined here include sample type, microbiological methods, study design, bias, sample size, definitions of prevalence outcomes and parameters, and control of clustering. The issues raised in this review suggest, among other things, that future prevalence studies of wild birds should avoid opportunistic sampling when possible, as this places significant limitations on the generalizability of prevalence data.

A Scoping Review of the Evidence for the Medicinal Use of Natural Honey in Animals.

Honey has a history of medicinal use that predates written records. In recent decades, there has been renewed interest in the use of honey in human medicine, particularly for the treatment of burns and other wounds. Several recent systematic reviews in the human literature have demonstrated the efficacy of honey in the treatment of a number of conditions, including burns, wounds and oral mucositis. The goal of this scoping review was to describe the nature and extent of the current body of evidence addressing the medicinal use of natural honey and/or its derivatives in animals. Although the focus of this review was the veterinary literature, all animal species except insects and humans were eligible, including animals used for biomedical research. Electronic databases searched were MEDLINE, CAB Abstracts, AGRICOLA, Web of Science Core Collection, and Web of Science SciELO Citation Index. A total of 397 articles reporting 436 primary research studies were included in this review. The majority of the articles were biomedical research articles (n = 350); fewer veterinary research articles were identified (n = 47). Apart from one systematic review, all biomedical studies were challenge trials. Most veterinary studies were case reports/series (n = 23), followed by challenge trials (n = 18) and controlled trials (n = 8). The animal species examined within veterinary articles consisted primarily of dogs, horses, cats and cattle, whereas the majority of biomedical research articles examined rats and mice. Wound healing was the most common indication examined; other indications examined included the prevention or treatment of gastric ulcers, bacterial and parasitic infections, toxic exposures, metabolic conditions (e.g., diabetes) and neoplasia. The majority of interventions consisted of non-medical grade honey (n = 412/436), followed by medical-grade honey (n = 29/436) and derivatives of natural honey (n = 9/436). With much of the current veterinary literature consisting of case reports and case series, high-quality primary veterinary research in the form of controlled trials or challenge trials is needed to advance this field, as well as to provide sound data for evidence-based assessments of the efficacy of honey in clinical veterinary practise.

A survey of veterinary student attitudes concerning whether marijuana could have therapeutic value for animals.

Marijuana is increasingly recognized for its therapeutic value in human medicine. Although most veterinary research to date has been concerned with marijuana toxicity, there is some interest in the potential therapeutic value of marijuana in veterinary medicine. With the recent legalization of marijuana for recreational use in Canada in October 2018, there is a need for veterinarians and veterinary students to be in a position to address client questions and concerns on this topic. We distributed a questionnaire to current veterinary students at the Ontario Veterinary College in Guelph, Ontario, to determine their attitude(s) towards marijuana as a potential therapeutic agent in animals. The overall response rate for the questionnaire was 43.5% (207/476). Most students felt that marijuana has potential therapeutic value in animals (53.6%; 111/207), fewer were unsure (38.6%; 80/207), and a small number of students felt that marijuana does not have potential therapeutic value in animals (7.7%; 16/207). Data generated by this questionnaire identified an important distinction between two major active compounds found in marijuana: cannabidiol (CBD) and tetrahydrocannabinol (THC). Potential barriers to use in veterinary practice were also identified, including stigma and toxicity. Finally, many respondents showed an awareness of the limited scientific research regarding the safety and efficacy of marijuana in animals. Until a body of scientific literature on marijuana in animals becomes available, veterinarians may benefit from having an awareness of the different physiological and pharmacokinetic effects produced by different strains (including any adverse effects, and half-life), and a general understanding of current therapeutic applications of marijuana in humans.

Carriage of Campylobacter, Salmonella, and Antimicrobial-Resistant, Nonspecific Escherichia coli by Waterfowl Species Collected from Three Sources in Southern Ontario, Canada.

Wild birds are considered a potential source of zoonotic pathogens. We report on the occurrence of Campylobacter, Salmonella, and antimicrobial-resistant, nonspecific Escherichia coli in ducks, grebes, and swans obtained by convenience while conducting related research with Canada Geese (Branta canadensis). Samples were obtained in southern Ontario, Canada, between 2013 and 2015 from hunter-caught birds, birds submitted for postmortem diagnosis, and fresh feces from live birds in parks. A secondary objective was to characterize Campylobacter genotypes using comparative genomic fingerprinting. Salmonella and E. coli isolates were tested for susceptibility to 15 antimicrobials using the Canadian Integrated Program for Antimicrobial Resistance Surveillance test panel. A total of 71 samples were collected from 15 different waterfowl species. We detected Campylobacter, Salmonella, and E. coli in 17, 3, and 84% of samples, respectively. Ten unique Campylobacter subtypes were identified, some of which had been identified previously in water, poultry, waterfowl, and human clinical cases. Both Salmonella isolates were pansusceptible and 15% of E. coli isolates were resistant to at least one antimicrobial, including resistance to antimicrobials of highest importance to human health. Source attribution studies should examine the role of waterfowl in the dissemination of these pathogens.

A repeated cross-sectional study of the epidemiology of Campylobacter and antimicrobial resistant Enterobacteriaceae in free-living Canada geese in Guelph, Ontario, Canada.

From May through October 2016, we conducted a repeated cross-sectional study examining the effects of temporal, spatial, flock and demographic factors (i.e. juvenile vs. adult) on the prevalence of Campylobacter and antimicrobial resistant Enterobacteriaceae among 344 fresh faecal samples collected from Canada geese (Branta canadensis) from four locations where birds nested in Guelph, Ontario, Canada. The overall prevalence of Campylobacter among all fresh faecal samples was 9.3% and was greatest in the fall when these birds became more mobile following the nesting season. Based on 40 gene comparative genomic fingerprinting (CGF40), the increase in prevalence noted in the fall was matched by an increase in the number of unique CGF40 subtypes identified. Resistance to colistin was detected most commonly, in 6% of Escherichia coli isolates, and was highest in the late summer months. All colistin-resistant isolates were negative for the mcr-1 to mcr-5 genes; a chromosomal resistance mechanism (PmrB) was identified in all of these isolates. The prevalence of samples with E. coli exhibiting multi-class resistance or extended spectrum beta-lactamase was low (i.e. <2% of samples). The intra-class correlation coefficients, estimated from the variance components of multilevel logistic regression models, indicated that the shedding of Campylobacter and antimicrobial resistant E. coli among geese within a flock (i.e. birds collected from the same site on the same day) was moderately correlated. Spatial, temporal, and spatiotemporal clusters identified using the spatial scan statistic, largely supported the findings from our multi-level models. Salmonella was not isolated from any of the fresh faecal samples collected suggesting that its prevalence in this population of birds was very low.

Efficacy of Borrelia burgdorferi vaccine in dogs in North America: A systematic review and meta-analysis.

BACKGROUND: Lyme borreliosis, a tick-borne disease, is endemic to some parts of North America and is an emerging disease in other parts of the world. Vaccination is an increasingly common, although controversial, method used in the prevention of Lyme disease in dogs; the reported efficacies of Borrelia burgdorferi vaccines in dogs are highly variable, ranging from 50% to 100%. OBJECTIVES: To determine the efficacy of vaccines for prevention of Lyme disease in dogs in North America. METHODS: Experimental and observational study designs were eligible for inclusion. The outcome of interest was the reduction of incidence of clinical illness after exposure to B. burgdorferi. Electronic databases searched were MEDLINE, Web of Science, and Centre for Agricultural Biosciences Abstracts. Clinical signs were extracted as dichotomous outcomes: lameness, anorexia, pyrexia, depression, and lymphadenopathy. Study quality was assessed using tools from the Cochrane collaboration. RESULTS: In total, 3 observational studies and 13 challenge trials were included. None of the challenge trials assessed lymphadenopathy, but for each of the remaining 4 clinical signs, a meta-analysis was performed. Compared to unvaccinated dogs, vaccinated dogs had a reduced odds of developing lameness, depression, pyrexia, and anorexia (odds ratio: 0.15-0.23). CONCLUSIONS AND CLINICAL IMPORTANCE: Based on the quantitative synthesis of results from challenge studies, vaccinated dogs are less likely to develop clinical signs after exposure to B. burgdorferi compared to unvaccinated dogs. These results should be interpreted with caution, however, as several shortcomings related to quality and study design were identified. Future studies should focus on larger sample sizes in field conditions.

Epidemiology of Campylobacter, Salmonella and antimicrobial resistant Escherichia coli in free-living Canada geese (Branta canadensis) from three sources in southern Ontario.

Antimicrobial resistant bacteria and zoonotic pathogens have previously been isolated from Canada geese. We examined the prevalence of three enteric bacteria (i.e. Campylobacter, Salmonella, Escherichia coli) among Canada geese from three sampling sources in southern Ontario from 2013 through 2015. Samples were obtained by convenience from hunting groups, diagnostic birds submitted for post-mortem, and fresh faeces from live birds in parks. Escherichia coli isolates were isolated and tested for susceptibility to 15 antimicrobials using the Canadian Integrated Program for Antimicrobial Resistance Surveillance test panel. The prevalences of Salmonella, Campylobacter and E. coli were 0%, 11.2% and 72.6%, respectively. Among E. coli isolates, 7.9% were resistant to ≥1 class of antimicrobials and 5.6% were resistant to ≥2 classes of antimicrobials, with some including resistance to antimicrobials of highest importance in human medicine. A significant association between season and E. coli resistance among samples from live birds was noted; summer samples had no resistant E. coli isolates, whereas spring samples demonstrated the highest prevalence of E. coli resistant to ≥1 class of antimicrobials (20.0%) among all sources. In addition, Campylobacter coli were only isolated from the spring faecal samples. Flock-level clustering was an important statistical consideration, as flock was a significant random effect in all but two of our models. Detection of Campylobacter and antimicrobial resistant E. coli from Canada geese suggests that these birds may play a role in disseminating these organisms within the environment.

The Use of Acellular Dermal Matrices (ADM) in Breast Reconstruction: A Review.

The use of acellular dermal matrices (ADM), sometimes referred to as extracellular matrix (ECM), has become an interesting aspect of breast reconstruction. A great deal of literature is available, totaling over 7000 ADM-based reconstructions. Most often, ADMs are used in a skin sparing mastectomy (SSM) scenario, although heterologous breast augmentation with a sub-pectoral fixation may also require an ADM application. Their use has become an attractive, but expensive option. Available data shows head to head comparisons between individual ADMs to be mostly retrospective in nature with only a few prospective trials available. Points of interest include postoperative hematoma, postoperative skin irritation, infection, red breast syndrome, and revision surgery. This work will, therefore, highlight the individual properties of ADMs used in breast reconstruction and compare the available data on complication rates and costs for these devices.

A Head-to-head Comparison between SurgiMend and Epiflex in 127 Breast Reconstructions.

BACKGROUND: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head-to-head comparisons between SurgiMend and Epiflex are not yet reported. In fact, this is the first clinical data report on the use of Epiflex. This work will, therefore, compare postoperative complication rates and costs for these ADMs. METHODS: This analysis is a retrospective review of a single surgeon's 6-year experience with both SurgiMend-an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex-a decellularized human skin tissue from 2008 to 2013. RESULTS: One hundred patients had a total of 127 implant-based reconstructions using SurgiMend (64 cases; 50.4%) or Epiflex (63 cases; 49.6%). Gross complication rates were 11.1% for SurgiMend and 40.6% for Epiflex including hematoma, postoperative skin irritation, infection, necrosis, and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%). CONCLUSIONS: This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates. Severe complication rates are comparable with those reported in literature for both products. Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

Factors influencing mortality in a captive breeding population of Loggerhead Shrike, Eastern subspecies (Lanius ludovicianus ssp.) in Canada.

BACKGROUND: The Loggerhead Shrike, Eastern subspecies (Lanius ludovicianus ssp.) (LOSH) is a predatory songbird native to Eastern North America. It is estimated that there are fewer than 55 breeding pairs of this subspecies in North America. Captive breeding plays a critical role in preventing the extirpation of this subspecies from its Canadian range. Unfortunately, high numbers of unexplained deaths among young birds in the captive breeding population threatened the success of this program. This paper describes fledgling mortality in the captive breeding population, and seeks to identify factors associated with fledgling survival and, ultimately, to identify steps to mitigate fledgling mortality. RESULTS: Over the study period (2006-2011) at two breeding sites, 696 LOSH were fledged. Among these, 68 % (n = 474) were released, 10 % (n = 69) were retained in the captive breeding population, and 22 % (n = 155) died. Fledgling survival declined from 99 % in 2006 to 44 % in 2011. The odds of survival were significantly lower for fledglings that were part of a second clutch. As the number of fledglings in a clutch increased, the odds of surviving increased significantly. As the breeding female aged from one to four years of age, there was a marked increase in the odds of a fledgling surviving, which then subsequently declined as females aged further. CONCLUSIONS: Based on our analyses, clutch number (first or second), number of fledglings in the brood, and age of breeding females were significant predictors of fledgling survival. Long-term breeding management decisions will have to balance the need to increase the number of individuals and breeding pairs in the wild by releasing large numbers of young, against the need to maintain a genetically viable captive population, until the wild population is large enough to be self-sustaining.