scholarly journals The use of a ‘first-wave’ model to study the effect of nutrition on ovarian follicular dynamics and ovulation rate in the sheep

Reproduction ◽  
2010 ◽  
Vol 140 (6) ◽  
pp. 865-874 ◽  
Author(s):  
C Viñoles ◽  
B Paganoni ◽  
K M M Glover ◽  
J T B Milton ◽  
D Blache ◽  
...  
Keyword(s):  
Body Condition ◽  
Wave Model ◽  
Ovulation Rate ◽  
Short Term ◽  
Metabolic Hormones ◽  
Follicular Waves ◽  
Follicular Wave ◽  
The Third ◽  
High Concentrations ◽  
Follicular Dynamics

We have developed an experimental model in which groups of ewes are simultaneously experiencing the first ovarian follicular wave of their oestrous cycle. We used this ‘first-wave model’ in a 2×2 factorial experiment (ten ewes per group) to study the effect of body condition (BC) and a short-term supplement on follicular dynamics and ovulation rate. The ‘first-wave’ was established by giving ewes three injections of prostaglandin (PG), 7 days apart. The 6-day supplement (lupin grain) began 2 days after the second PG injection and continued until the third. Follicles were studied by ultrasound, and blood was sampled to measure glucose and hormones. The supplement increased (P<0.01) the concentrations of glucose, insulin and leptin, decreased FSH concentrations (P<0.01) and tended to increase oestradiol concentrations (P=0.06). The supplement tended to increase the number of 3 mm follicles (P=0.06). Compared with low-BC ewes, high-BC ewes had more follicular waves (P<0.05), higher concentrations of insulin, leptin and IGF1 (P<0.05) and tended to have higher FSH concentrations (P=0.09). Leptin and insulin concentrations remained high until the end of supplementation in high-BC ewes, whereas they decreased after the third day of supplementation in low-BC ewes. In conclusion, high concentrations of metabolic hormones in fat ewes are associated with the development of more follicular waves. When a supplement is superimposed on this situation, changes in glucose and metabolic hormones allow more follicles to be selected to ovulate.

scholarly journals Short-term nutritional supplementation of ewes in low body condition affects follicle development due to an increase in glucose and metabolic hormones

Reproduction ◽  
2005 ◽  
Vol 129 (3) ◽  
pp. 299-309 ◽  
Author(s):  
C Viñoles ◽  
M Forsberg ◽  
G B Martin ◽  
C Cajarville ◽  
J Repetto ◽  
...  
Keyword(s):  
Body Condition ◽  
Oestrous Cycle ◽  
Nutritional Supplementation ◽  
Ovulation Rate ◽  
Follicle Development ◽  
Short Term ◽  
Metabolic Hormones ◽  
The Third ◽  
Short Period ◽  
Igf I

This study tested whether the effects of a short period of nutritional supplementation given to ewes during the luteal phase on follicle development and ovulation rate is associated with an increase in circulating concentrations of FSH, glucose or metabolic hormones. Oestrus was synchronised with two prostaglandin injections given 9 days apart and the supplement consisted of corn grain and soybean meal. Corriedale ewes with low body condition were randomly assigned to 2 groups: the control group (C; n = 10) received a maintenance diet while the short-term supplemented group (STS; n = 10) received double the maintenance diet over days 9 to 14 of the oestrous cycle (day 0 = ovulation). Ovaries were examined daily by ultrasound and blood was sampled three times a day during the inter-ovulatory interval for measuring reproductive and metabolic hormones. On days 9, 11 and 14 of the oestrous cycle, half of the ewes from each group (n = 5) were bled intensively to determine the concentrations of glucose, insulin, IGF-I and leptin. Plasma FSH, progesterone, oestradiol and androstenedione concentrations were similar among groups. Dietary supplementation increased plasma insulin concentrations from the first to the sixth day of supplementation and increased glucose concentrations on the third day, compared with control ewes. Plasma leptin concentrations were higher in STS ewes from the second to the fifth day of supplementation. The pattern of IGF-I concentrations was similar among groups. In STS ewes, the nutritional treatment prolonged the lifespan of the last non-ovulatory follicle, so fewer follicular waves developed during the cycle. In STS ewes, increased concentrations of glucose, insulin and leptin one day before ovulatory wave emergence were associated with increased numbers of follicles growing from 2 to 3 mm and with stimulation of the dominant follicle to grow for a longer period. We suggest that the mechanism by which short-term nutritional supplementation affects follicle development does not involve an increase in FSH concentrations, but may involve responses to increased concentrations of glucose, insulin and leptin, acting directly at the ovarian level. This effect is acute, since concentrations of all three substances decrease after reaching peak values on the third day of supplementation. The status of follicle development at the time of maximum concentrations of glucose and metabolic hormones may be one of the factors that determines whether ovulation rate increases or not.

Ovarian follicular dynamics and endocrine profiles in Polwarth ewes with high and low body condition

2002 ◽  
Vol 74 (3) ◽  
pp. 539-545 ◽  
Author(s):  
C. Viñoles ◽  
L. J. Harris ◽  
M. Forsberg ◽  
G. Banchero ◽  
E. Rubianes
Keyword(s):  
Body Condition ◽  
Follicular Development ◽  
Extended Period ◽  
Inhibitory Effect ◽  
Follicular Phase ◽  
Follicular Waves ◽  
Follicular Wave ◽  
Similar Inhibitory Effect ◽  
Turn Over ◽  
Follicular Dynamics

AbstractIn this investigation we tested the hypothesis that static body condition (BC) of the ewe affects oestradiol and FSH with implications for subsequent follicular growth and turn-over. Sixteen Polwarth ewes were selected from a flock according to their BC score (scale: 1 emaciated; 5 obese). High BC (HBC) ewes (no. = 8) had a BC score of 4·1 (s.e. 0·1) and low BC (LBC) ewes (no. = 8) had a BC score of 1·9 (s.e. 0·1). Daily ultrasound examinations were performed and blood samples for progesterone, oestradiol and follicle-stimulating hormone (FSH) determination were collected. All HBC ewes (8/8) exhibited three waves of follicular development, while four LBC ewes (4/8) had two waves and the other four (4/8) had three waves of follicular development (P ≤ 0·05) during the interovulatory period. Overall, the emergences of 33 out of 44 follicular waves were preceded by significant increases in FSH concentrations. Maximum FSH concentrations were detected 0·9 ± 0·2 days before wave emergence. Oestradiol concentrations increased significantly during the growing phase in 38 out of 44 large follicles. A negative correlation between oestradiol and FSH was observed in HBC ewes. A similar inhibitory effect of oestradiol on FSH was observed in LBC ewes, irrespective of whether they developed two or three follicular waves. However, a longer period with high FSH was needed to promote the emergence of the second follicular wave in two-wave LBC ewes. Four HBC ewes had twin ovulations but no LBC ewes did (P ≤ 0·05). In HBC ewes, the follicular phase was characterized by lower oestradiol (6·5 (s.e. 1·0) pmol/l) but higher mean FSH concentrations (2·4 (s.e.0·4) μg/l) than in LBC ewes (8·9 (s.e. 1·2) pmol/l and 2·0 (s.e. 0·3) μg/l, respectively; P ≤ 0·05). The present results suggest that BC influences the pattern of follicular dynamics through changes in the endocrine milieu. Higher FSH concentrations during the follicular phase in HBC ewes, which allowed an extended period of follicular recruitment from a significantly larger pool of small antral follicles could explain the higher ovulation rate observed in this group.

scholarly journals Follicle development, endocrine profiles and ovulation rate in adult Merino ewes: effects of early nutrition (pre- and post-natal) and supplementation with lupin grain

Reproduction ◽  
2014 ◽  
Vol 147 (1) ◽  
pp. 101-110 ◽  
Author(s):  
C Viñoles ◽  
B L Paganoni ◽  
K P McNatty ◽  
D A Heath ◽  
A N Thompson ◽  
...  
Keyword(s):  
Early Life ◽  
Ovarian Function ◽  
Ovulation Rate ◽  
Aromatase Activity ◽  
Follicle Development ◽  
Short Term ◽  
Antral Follicles ◽  
Cell Numbers ◽  
Metabolic Hormones ◽  
The Third

In adult ewes, we tested whether ovarian function, including the response to short-term supplementation, was affected by the nutrition of their mothers during the pre-/post-natal period. A 2×2 factorial design was used with nutrition in early life (low or high) and a 6-day supplement (with or without) as factors. All ewes received three prostaglandin (PG) injections 7 days apart, and the supplement (lupin grain) was fed for 6 days from 2 days after the second until the third PG injection. We measured reproductive and metabolic hormones, studied follicle dynamics (ultrasonography), and evaluated granulosa cell numbers, aromatase activity and oestradiol (E2) concentrations in follicular fluid in healthy follicles at days 3 and 7 of supplementation. Ovulation rate was increased by 25% by exposure to high pre-/post-natal nutrition (1.5 vs 1.2; P<0.05), in association with a small decrease in FSH concentrations (P=0.06) and a small increase in insulin concentrations (P=0.07). The number of healthy antral follicles was not affected. Acute supplementation increased the number of granulosa cells (3.7±0.2 vs 3.0±0.2 million; P<0.05) in the largest follicle, and the circulating concentrations of E2 (4.6±0.3 vs 3.9±0.3 pmol/l; P<0.05) and glucose (3.4±0.03 vs 3.3±0.03 mmol/l; P<0.01). Both early life nutrition and acute supplementation appear to affect ovulation rate through changes in glucose–insulin homoeostasis that alter follicular responsiveness to FSH and therefore E2–FSH balance.

scholarly journals Relationships between changes in Holstein cow’s body condition, acetone and urea content in milk and cervical mucus and sperm survival

2012 ◽  
Vol 60 (5) ◽  
pp. 39-48 ◽  
Author(s):  
Jan Beran ◽  
Luděk Stádník ◽  
Jaromír Ducháček ◽  
Monika Okrouhlá
Keyword(s):  
Body Condition ◽  
Body Condition Score ◽  
Cervical Mucus ◽  
Short Term ◽  
Data Set ◽  
The Third ◽  
Urea Content ◽  
Condition Score ◽  
Sperm Survival ◽  
The Relationship

The objectives of this study were to evaluate the relationship between changes in Holstein cow’s body condition score (BCS), acetone and urea content in the milk and cervical mucus (CM) and sperm survival in CM. At insemination, samples of milk and CM were collected from 64 Holstein cows. Content of acetone and urea were determined. Sperm motility was assessed subjectively at the beginning and after 30, 60 and 90 minutes of the short-term heat test in CM. Data about evaluation of cow’s BCS were taken from farm evidence. The data set was analyzed using SAS/STAT software. Effect of change in cow’s BCS one month before insemination was significant only in relation to the acetone content in milk (P < 0.05). Higher values of acetone and urea content were found in the CM compared to milk. Higher levels of both metabolites were detected in primiparous cows and in cows on the third and subsequent lactation, resp. in cows inseminated 3 times and more. The highest values of both metabolites negatively affected sperm survival during the short-term heat test, especially after 90 minutes (P < 0.05–0.01). Significant decreases (P < 0.05–0.01) were detected in cows with the highest level of acetone and urea.

231 SUPEROVULATORY RESPONSE AND EMBRYO YIELD OF SANTA INES EWES SUBMITTED TO FOLLICLE STIMULATING HORMONE TREATMENTS STARTED NEAR THE TIME OF EMERGENCE OF THE FIRST AND LAST FOLLICULAR WAVE OF A PROGESTERONE-BASED PROTOCOL

2012 ◽  
Vol 24 (1) ◽  
pp. 228
Author(s):  
M. E. F. Oliveira ◽  
C. C. D'Amato ◽  
L. G. Oliveira ◽  
S. D. Bicudo ◽  
J. F. Fonseca ◽  
...  
Keyword(s):  
Buenos Aires ◽  
Animal Health ◽  
Follicle Stimulating Hormone ◽  
Corpora Lutea ◽  
Chi Square ◽  
Follicular Waves ◽  
Follicular Wave ◽  
Embryo Yield ◽  
Santa Inês ◽  
Follicular Dynamics

This study was designed to investigate if the superovulatory response and embryo yield in Santa Ines ewes are influenced by the time that FSH treatments are inititiated: near the emergence of the first or last follicular wave of a progesterone-based (P4) protocol. Days of emergence of the follicular waves was defined in a previous study that evaluated follicular dynamics in oestrus synchronization treatments (Oliveira et al. 2011 Acta Sci. Vet. 40). Twenty Santa Ines cyclic ewes were submitted to 2 superovulatory protocols according to the time that FSH treatments were initiated (G-first wave, n = 10 and G-last wave, n = 10). Thus, the FSH treatment started on Day 4 and 10 of protocol for G-first and G-last, respectively (Day 0 = onset of protocol). Ewes were treated with a P4 device (CIDR®; Pfizer-New Zealand) for 6 and 12 days for G-first and G-last, respectively. Additionally, in G-last, the CIDR was replaced by a new one on Day 7. All ewes received 2 injections of 37.5 μg of D-cloprostenol (Prolise®, Arsa-Argentina) on Day 0 and at CIDR removal. The superovulatory regimen consisted of 8 IM injections of pFSH (Folltropin®; Bioniche Animal Health, Belleville, Ontario, Canada) administrated twice daily (40, 40, 30, 30, 20, 20, 10 and 10 mg of porcine FSH). A single IM dose of 200 IU of eCG (Novormon®, Syntex, Buenos Aires, Argentina) was given concurrently with CIDR removal. Ewes were mated by a fertile ram. Embryo collections were accomplished 7 days after CIDR removal. The superovulatory response was classified in scores: (0) 4 or fewer corpora lutea (CL); (1) between 5 and 10 CL and (2) 11 or more CL. Means (± SD) were compared using Kruskal-Wallis test and percentages using Chi-square (P < 0.05). Most donors (70%, 7/10) from G-last had a superovulatory response classified as score 2 and the remainder (30%, 3/10) as score 1, whereas half of ewes from G-first were classified as score 2 and half as score 1 (P > 0.05).There was no effect between treatments (P > 0.05) for ovulation rate (G-first: 90.7 ± 10.2% vs G-last: 93.0 ± 7.2%), number of ovulations (G-first: 13.1 ± 7.3 vs G-last: 14.0 ± 5.8), or number of luteinized unovulated follicles (G-first: 1.4 ± 1.3 vs G-last: 0.9 ± 1.0). Furthermore, there was no effect between G-first and G-last (P > 0.05) in the rate of ova/embryos recovered (55.1 ± 27.1% vs 67.0 ± 19.4%), mean number of ova/embryos recovered (7.0 ± 5.5 vs 9.1 ± 3.8), number of viable embryos (3.9 ± 6.1 vs 5.7 ± 4.4), or viability rate (49.1 ± 43.7 vs 58.5 ± 34.6). In conclusion, superovulatory response and embryo yield did not differ between FSH treatments initiated during the first or last follicular wave of a progesterone-based treatment in Santa Ines ewes. Financial support of FAPESP is acknowledged.

scholarly journals Comparación ultrasonográfica transvaginal y transrectal de la dinámica folicular en ondas sucesivas de llamas (Lama glama)

2021 ◽  
Vol 32 (1) ◽  
pp. e19504
Author(s):  
Uri Perez G. ◽  
David Pari P. ◽  
Fidel Gutierrez Y. ◽  
Julio Málaga A. ◽  
Natalio Luque M. ◽  
...  
Keyword(s):  
Growth Rate ◽  
Negative Correlation ◽  
Reproductive Season ◽  
Maximum Diameter ◽  
Follicular Waves ◽  
Follicular Wave ◽  
Linear Transducer ◽  
Lama Glama ◽  
The Relationship ◽  
Follicular Dynamics

La dinámica folicular ovárica monitoreada por vía transrectal (TR) y transvaginal (TV) en ondas sucesivas en llamas fue estudiada en 10 llamas con más de 4 años, multíparas, sin cría, estado corporal de 3.0, durante un periodo de 90 días en la época reproductiva. Se utilizó el ecógrafo Sonostar SS8® con un transductor lineal para el examen transrectal y transductor microconvexo endocavitario para el examen transvaginal, ambos con frecuencia de 6.5 MHz. El intervalo inter-onda fue de 20±4.4 y 22.5±5.3 por vía TR y TV, respectivamente; el número de folículos por cohorte fue 5.21±0.92 y 6.38±1.26 para TR y TV, respectivamente (p=0.0011); el diámetro máximo de folículos fue 12.49±3.57 mm para TR y 13.56±3.91 mm para TV; la tasa de crecimiento fue de 0.70±0.35 y 0.67±0.32 mm/día para TR y TV, respectivamente. La ecuación de regresión para relación del diámetro máximo folicular y duración de onda folicular vía TR fue de y=0.89766x+6.5554 (R²=0.423) y para la vía TV de y=0.8466x+10.184 (R²=0.479). La duración de las fases foliculares fue similar entre ambas técnicas con excepción de la fase de dominancia (10.2±3.19 días para TR y 8.67±2.46 para TV, p=0.0418). La relación entre el diámetro folicular y número de folículos detectados presentó una correlación negativa baja (R²=-0.0827 para TV y R²=-0.0876 para TR). En conclusión, el transductor endocavitario transvaginal permite determinar con mayor precisión las características de dinámica folicular en llamas en sus fases de reclutamiento, dominancia y regresión con sobreposición de ondas foliculares como característica importante.The ovarian follicular dynamics monitored by transrectal (TR) and transvaginal (TV) routes in successive waves was studied in 10 llamas older than 4 years, multiparous, without calves at foot, body condition of 3.0, during a period of 90 days in the reproductive season. The Sonostar SS8® ultrasound equipment was used with a linear transducer for transrectal examination and endocavitary microconvex transducer for transvaginal examination, both with a frequency of 6.5 MHz. The inter-wave interval was 20 ± 4.4 and 22.5 ± 5.3 via TR and VT, respectively; the number of follicles per cohort was 5.21 ± 0.92 and 6.38 ± 1.26 for TR and TV, respectively (p=0.0011); the maximum diameter of follicles was 12.49 ± 3.57 mm for TR and 13.56 ± 3.91 mm for TV; the growth rate was 0.70 ± 0.35 and 0.67 ± 0.32 mm/day for TR and TV, respectively. The regression equation for the ratio of the maximum follicular diameter and duration of follicular wave via TR was y=0.89766x+6.5554 (R²=0.423) and for the TV route y=0.8466x+10.184 (R²=0.479). The duration of the follicular phases was similar between both techniques except for the dominance phase (10.2±3.19 days for TR and 8.67±2.46 for TV, p=0.0418). The relationship between the follicular diameter and the number of follicles detected showed a low negative correlation (R²=-0.0827 for TV and R²=-0.0876 for TR). In conclusion, the transvaginal endocavitary transducer makes it possible to determine with greater precision the characteristics of llama follicular dynamics in their recruitment, dominance and regression phases with overlapping of follicular waves as an important characteristic.

scholarly journals Risk factors for ovarian postpartum resumption in Holstein cows, under high tropical conditions

2014 ◽  
pp. 3970-3983 ◽  
Author(s):  
Humberto Guáqueta M ◽  
Jorge Zambrano V ◽  
Claudia Jiménez E
Keyword(s):  
Risk Factors ◽  
Body Condition ◽  
Holstein Cows ◽  
Experimental Conditions ◽  
Serum Progesterone ◽  
Factors Associated ◽  
Follicular Waves ◽  
Uterine Involution ◽  
Tropical Conditions ◽  
Follicular Dynamics

ABSTRACTObjective. To evaluate the factors associated with postpartum ovarian resumption and follicular dynamics in Holstein cows under high altitude conditions (2,600 masl). Materials and methods. Forty-five Holstein cows were studied between 14 days before and 120 days after calving. Uterine involution, follicular dynamics, serum progesterone and peripartum pathologies were evaluated; additionally, body condition (BC), calving type, milk yield, were also evaluated. According to hormonal and reproductive findings, cows were classified into two groups: early ovarian resumption (EOR) or delayed ovarian resumption (DOR). Results. The occurrence of the first follicular for EOR animals (n=31) was produced on average 9.58±3.45 days postpartum and was similar to the DOR group (n=10) [10.8±4.83 days; p>0.05)]. The first postpartum ovulation occurred at 21.55±5.90 days (EOR) and was significantly delayed (48.7±27.85 days) for DOR animals (p<0.05). Thirty-six point five percent of the cows (n=f) had normal estrus cycles (18 to 24 days), while 63.5% (n=26) showed dysciclia. The factors associated with ovarian resumption and cyclicity were the loss of BC [OR=3.3, CI 95% (1.2-13.3) (p<0.05)] and lameness [OR= 9.0, CI 95% (1.2-13.3) (p<0.05)]. Conclusions. Although the emergence of postpartum follicular waves was observed early, under the experimental conditions of this study there are factors that may affect the first ovulation favoring the occurrence of anovulatory conditions. The determinant factors were low body condition and lameness.

The Effects of Shock Vancomycin Concentrations on the Formation of Heteroresistance in Staphylococcus aureus

2020 ◽  
Vol 65 (9-10) ◽  
pp. 3-7
Author(s):  
V. V. Gostev ◽  
Yu. V. Sopova ◽  
O. S. Kalinogorskaya ◽  
M. E. Velizhanina ◽  
I. V. Lazareva ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
In Vitro Selection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
High Concentration ◽  
Short Term ◽  
High Concentrations ◽  
Selection Of ◽  
Selection Of Resistance ◽  
Test Cultures

Glycopeptides are the basis of the treatment of infections caused by MRSA (Methicillin-Resistant Staphylococcus aureus). Previously, it was demonstrated that antibiotic tolerant phenotypes are formed during selection of resistance under the influence of high concentrations of antibiotics. The present study uses a similar in vitro selection model with vancomycin. Clinical isolates of MRSA belonging to genetic lines ST8 and ST239, as well as the MSSA (ATCC29213) strain, were included in the experiment. Test isolates were incubated for five hours in a medium with a high concentration of vancomycin (50 μg/ml). Test cultures were grown on the medium without antibiotic for 18 hours after each exposure. A total of ten exposure cycles were performed. Vancomycin was characterized by bacteriostatic action; the proportion of surviving cells after exposure was 70–100%. After selection, there was a slight increase in the MIC to vancomycin (MIC 2 μg/ml), teicoplanin (MIC 1.5–3 μg/ml) and daptomycin (MIC 0.25–2 μg/ml). According to the results of PAP analysis, all strains showed an increase in the area under curve depending on the concentration of vancomycin after selection, while a heteroresistant phenotype (with PAP/AUC 0.9) was detected in three isolates. All isolates showed walK mutations (T188S, D235N, E261V, V380I, and G223D). Exposure to short-term shock concentrations of vancomycin promotes the formation of heteroresistance in both MRSA and MSSA. Formation of VISA phenotypes is possible during therapy with vancomycin.

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

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