EFFECT OF THE FOLLICULAR DEVELOPMENT STAGE AT THE TIME OF MATING ON THE OVULATION AND EMBRYONIC SURVIVAL IN ALPACAS

El objetivo del presente estudio fue evaluar el efecto del estadio del desarrollo folicular del folículo dominante (fd) al momento de la cópula, sobre la ovulación y supervivencia embrionaria en alpacas. Se utilizaron 116 animales con descanso post-parto ³15 días, que fueron evaluadas por ecografía transrectal para distribuirlas en 4 grupos: G1 (fd en estadio de crecimiento, diámetro: 6 mm), G2 (fd en estadio de crecimiento, diámetro: ³ 7 y £ 12 mm), G3 (fd en estadio estático, diámetro: ³7 mm) y G4 (fd en estadio de regresión, diámetro: ³7 mm). Posteriormente, fueron sometidos a monta controlada, a excepción de 5 alpacas del grupo G1 que rechazaron al macho. El día del empadre fue considerado el día 0. Evaluaciones ecográficas adicionales se realizaron los días 2 (ocurrencia de ovulación), 9 (presencia y tamaño del cuerpo lúteo); 20, 25, 30 y 35 (presencia de vesícula embrionaria o embrión). El día 15 post cópula se realizó la prueba de receptividad sexual. El 97.3% de alpacas empadradas (n = 111) presentaron ovulación al día 2 post cópula, sin diferencia significativa (p<0.05) entre grupos. En el día 9 post cópula, no se encontraron diferencias significativas en el tamaño promedio del cuerpo lúteo entre grupos. El porcentaje de supervivencia embrionaria fue estadísticamente similar para todos los grupos, aunque hubo una tendencia a un mayor nivel de supervivencia para el grupo G2 (65.5%) en comparación con los demás grupos al día 35 post cópula. Estos resultados indicarían que el estadio del desarrollo folicular del folículo dominante al momento de la monta no tendría efecto significativo sobre la tasa de ovulación y supervivencia embrionaria enThe objective of this study was to evaluate the effect of the stage of the dominant follicle (df) at mating on the ovulation and embryonic survival in alpacas. A total of 116 alpacaswith ³15 day-post-partum resting period were used and evaluated by transrectal ultrasonography in order to distribute them in 4 groups: G1 (df in growing stage, diameter: 6 mm), G2 (df in growing stage, diameter: ³ 7 £ 12 mm), G3 (df in static stage, diameter: ³7 mm,) and G4 (df in regression stage, diameter: ³7 mm). Subsequently, all alpacas were mated except 5 alpacas of group G1 that rejected the male. Mating day was considered as day 0. Additional ultrasound evaluations were carried out on days 2 (occurrence of ovulation), 9 (presence and size of the corpus luteum); 20, 25, 30 and 35 (presence of embryonic vesicle or embryo). On day 15, a sexual receptiveness test was performed. Ovulationoccurredin97.3% ofalpacasthatweremated(n=111) butwithoutsignificant differences(p<0.05) betweengroups. Onday9, nosignificantdifferenceintheaverage sizeofthecorpusluteumwasobservedamonggroups. Theembryonicsurvivalratewas alsonotsignificantlydifferentamongthegroups, buttherewasatendencytoagreater rateofsurvivalforgroupG2(65.5% ) onday35aftermating. Theseresultssuggestedthat thestageoffolliculardevelopmentofthedominantfollicleduringmatingdoesnothave asignificanteffectontherateofovulationandembryonicsurvivalinalpacas

RELACIÓN ENTRE EL DÍA DE COLECCIÓN Y LA RECUPERACIÓN DE EMBRIONES EN ALPACAS SUPEROVULADAS.

The relationship between day of collection and embryo recovery was studied inmultiparous adult alpacas. Females with ?7 mm follicles were superovulated, mated withfertile males (day 0 = day of service) and embryos were recovered on day 5 (G1), 6 (G2) and 7 (G3) post copula, where the number and size of corpora lutea were echographicallyevaluated. In Exp. 1, 14 females were slaughtered and embryos were recovered from theuterine horns and the oviduct. In Exp. 2, embryos were recovered in vivo from 21 females.Each uterine horn was flushed with 250 ml of PBS using a Foley catheter; and oviductswere flushed from the utero-tubal junction to the fimbria using 20 ml of PBS. The numberand rate of embryos recovered from the uterine horns was higher in G2 and G3 as comparedto G1 (p<0.05), while in the oviduct was higher in G1. Collected embryos from uterinehorns had the condition of excellent and good in 81.4% (35/43) in Exp. 1 and 74.5% (38/51)in Exp. 2, and without statistical differences between treatments in each experiment. Themost frequent level of embryo development was hatching blastocyst (77.7%, 73/94), andwithout differences between G2 and G3. It was concluded that embryos could be recovereduntil day 5 after mating in oviducts and from day 6 onwards in the uterine horns.Se estudió la relación entre el día de colección y la recuperación embrionaria en alpacas adultas multíparas. Alpacas con folículos ≥7 mm se sometieron a un protocolo de superovulación, se cubrieron con machos fértiles (día 0 = día de servicio), y los embriones se recuperaron en el día 5 (G1), 6 (G2) y 7 (G3) post cópula, previa evaluación del número y tamaño de los cuerpos lúteos por ecografía transrectal ovárica. En el Exp. 1 se usaron 14 alpacas, que fueron sacrificadas para recuperar los embriones de los cuernos uterino y del oviducto. En el Exp. 2 se realizó la recuperación embrionaria in vivo a 21 alpacas. El lavado de los cuernos uterinos se hizo con 250 ml de PBS a través de un catéter Foley y en los oviductos se hizo con 20 ml de PBS desde la unión útero tubal hacia la fimbria. El número de embriones recuperados de cuerno uterino así como el porcentaje de recuperación embrionaria fue mayor en G2 y G3 respecto a G1 (p<0.05), mientras que en el oviducto hubo mayor recuperación en G1. Los embriones recolectados de los cuernos uterinos considerados como buenos y excelentes fue de 81.4% (35/43) en el Exp. 1 y de 74.5% (38/51) en el Exp. 2, sin encontrar diferencias significativas entre tratamientos dentro de cada experimento. El estadio de desarrollo embrionario más frecuente en ambos experimentos fue de blastocisto eclosionado (77.7%, 73/94), sin diferencia estadística entre G2 y G3. Se concluye que los embriones pueden ser recuperadas del oviducto hasta el día 5 y del cuerno uterino desde el día 6 post cópula

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Periapical Lesions and Their Relationship to Schneider’s Membrane in Cone-Beam Computed Tomography

Objective. To determine the relationship between the height of the periapical lesions adjacent to the maxillary sinus and the thickness of the Schneider membrane evaluated with cone-beam tomography. Materials and Methods. The universe was made up of 2432 tomography scans and a sample of 976, by systematic random sampling, and took into account those that presented any of the variables and/or both. For the relationship analysis, the sample was distributed according to sex, maxillary side, and age; it was formed between 18 and 86 years, in age groups of 18–36 years, 37–48 years, 49–59 years, and 60–86 years. The quantitative variables of the statistic descriptive analysis, hypothesis tests, and Spearman correlation were recorded. Results. A significantly low correlation (p<0.010) was observed between the periapical lesions and the thickness of the Schneider membrane in women (rho = 0.38) and men (rho = 0.32); in the same way, a significantly low correlation was observed in the age groups of 18–36 years (rho = 0.27) and 37–48 years (rho = 0.28), while a significantly moderate correlation was observed in the age groups of 49–59 years (rho = 0.45) and 60–86 years (rho = 0.44), and with respect to the sides, a significantly low correlation (rho = 0.28) was obtained for the right side and a significantly moderate correlation (rho = 0.45) was obtained on the left side. Conclusion. We found that the height of the periapical lesions and the thickness of the Schneider membrane are significantly related according to age, sex, and maxillary side, this relationship being accentuated at an older age and on the left side

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013