A Novel Approach to Minimising Acute Equine Endometritis That May Help to Prevent the Development of the Chronic State

One of the most commonly encountered challenges in equine breeding is endometritis, which can be difficult to resolve and causes considerable economic losses to the industry. It is a multifactorial condition, developing as an exaggerated form of the normal physiological response to breeding. Seminal plasma proteins, spermatozoa, bacteria and debris initiate an inflammatory response; the resulting fluid and neutrophils are then cleared from the uterus along with the debris. However, in some mares, the response is prolonged or exaggerated, with much fluid formation and neutrophil infiltration leading to acute endometritis. A bacterial cause has been implicated, although in some cases no pathogenic organisms can be isolated on culture. It has been postulated that any one of a variety of bacteria could be involved, or dysbiosis of the uterine microbiome could be responsible. Repeated episodes of acute endometritis may lead to the pathology associated with chronic endometritis, with mucociliary dysfunction, vascular degeneration and plasma cell infiltration. This review examines the information that is currently available about equine endometritis, particularly about the role of the inseminate in the uterus, and its current treatment. There are some promising lines of research into treatment or prevention that may help to resolve the issue.

Pushing the Frontier in Deepwater HP/HT Drilling by Application of Wellbore Strengthening—A Practical Approach

This paper presents a comprehensive laboratory and field study, discussing the development, formulation, and application of a wellbore strengthening mechanism, for strengthening weak formations while drilling in a deepwater high-pressure/high-temperature (HP/HT) well environment. The use of this technology has potential to eliminate nonproductive time (NPT) related to downhole losses, along with extending the drillability of sections and eliminating additional casing strings, during exploratory drilling. During the planning phase of a sequence of deepwater and HP/HT exploration wells, the potential high-pressure case scenario drove the planned and contingency well casing designs. This led to an extensive casing program with a 16-in. sub mudline hanger casing string added to the base design, as well as the normal 36-in. conductor, 20-in. surface casing, 13 ⅜-in. intermediate casing, and 9 ⅝-in. casing, which would enable reaching total depth (TD) within a planned 8 ½-in. hole. The realistic offset well driven by the high-pressure case also required two further contingency liner strings (11 ¾ in. and 7 in.), to be included in the well design. A key enabler for the sequence of wells was that the semisubmersible rig was upgraded to include a managed pressure drilling (MPD) below tension ring (BTR) arrangement. This was enhanced by the MPD well control system and associated risk assessment, allowing working to reduced acceptable kick tolerance limits. In addition to the outlined base and contingency plans, wellbore strengthening was also to be available, as an additional contingency application, to reach TD objectives. Thus, extensive laboratory tests were performed for wellbore strengthening design, using proprietary software, along with past established practices. Subsequent to laboratory testing and the optimal formulation, a detailed wellbore strengthening program was prepared and included in the drilling program, for potential use at any point while drilling ahead. On one well, after cementing of 13 ⅜-in. casing and performing a leakoff test (LOT), it was found that the value was insufficient for drilling through the entire planned section. A contingency 11 ¾-in. liner was being enabled before it was decided to pump the wellbore strengthening pill and strengthen the casing shoe. The pill application gave sufficient increased formation strength, leading to the well section being successfully drilled and cased with no losses, even though the high-pressure well scenario was actually encountered. This solution eliminated the time and cost implication and considerable operational challenges of the 11 ¾-in. contingency liner. This paper presents the study of conceptualizing the wellbore strengthening mechanism and implementing this customized solution in the field. A detailed analysis is also done to identify the optimal products, compatibility with drilling fluid, formation and existing chemical permit, and cost-effectiveness and savings using wellbore strengthening practice. The paper also discusses the comprehensive pit management program and required treatment plan while drilling.

Capture and metabolomic analysis of the human endometrial epithelial organoid secretome

Suboptimal uterine fluid (UF) composition can lead to pregnancy loss and likely contributes to offspring susceptibility to chronic adult-onset disorders. However, our understanding of the biochemical composition and mechanisms underpinning UF formation and regulation remain elusive, particularly in humans. To address this challenge, we developed a high-throughput method for intraorganoid fluid (IOF) isolation from human endometrial epithelial organoids. The IOF is biochemically distinct to the extraorganoid fluid (EOF) and cell culture medium as evidenced by the exclusive presence of 17 metabolites in IOF. Similarly, 69 metabolites were unique to EOF, showing asymmetrical apical and basolateral secretion by the in vitro endometrial epithelium, in a manner resembling that observed in vivo. Contrasting the quantitative metabolomic profiles of IOF and EOF revealed donor-specific biochemical signatures of organoids. Subsequent RNA sequencing of these organoids from which IOF and EOF were derived established the capacity to readily perform organoid multiomics in tandem, and suggests that transcriptomic regulation underpins the observed secretory asymmetry. In summary, these data provided by modeling uterine luminal and basolateral fluid formation in vitro offer scope to better understand UF composition and regulation with potential impacts on female fertility and offspring well-being.

A Rare Case of a Large Meningocele Posterior Sacrococcygeal

We report a case of sacrococcygeal meningocele simulating a sacrococcygeal teratoma. Likewise, there are a discussion of the pathophysiology and surgical approach of these types of lesions. We present a case of an exceptionally large posterior coccygeal meningocele of a newborn, and show the interest of radio-echographic couple and the interest of a management surgical approach. This was a case of posterior coccygeal meningocele, in a 10-day-old newborn born at term, with no known maternal history other than active smoking. The clinical examination finds a eupneic newborn, presents a median mass at the level of the sacrococcygeal part, of soft consistency, painless, without signs of inflammation, of normal skin, volume 18 x 21 x 19 cm, with positive transillumination test, no sensitivomotor deficit of both limbs, no other malformative anomalies detected clinically, but presence of anal atony and vesico-anal inconstancy. The ultrasound reveals a fluid formation containing small cysts. The x-ray revealed the absence of the posterior coccyx arch, an appearance in favor of a posterior sacrococcygeal meningocele. The surgery consisted of a meningocele cure followed by a buttock plasty. The postoperative follow-up was simple, without infectious or metabolic complications. Standardization and improvement of accessibility to ultrasound and obstetric MRI could improve the antenatal diagnosis of this pathology in Madagascar.

Non-Hodgkin Lymphoma Presenting with Recurrent Pleural Effusion: A Rare Case Report

Non-Hodgkin lymphoma (NHL) is a type of carcinoma which usually begins with lymph nodes. Pathogenesis of pleural fluid formation and reabsorption is also associated with pulmonary lymphatic system. Usually pleural effusions are encountered as complications due to infective aetiologies and non-infective causes. Pleural fluid formation and reabsorption in pulmonary lymphatic system are associated with pathogenesis. Authors present here a case report of a patient who presented with left sided severe chest pain investigated to have recurrent pleural effusion, and different clinico-radiological presentations. Computed Tomography (CT) scan showed a mediastinal mass from which CT guided biopsy was done and suggestive of Lymphoma. The patient responded to pleurodesis and chemotherapy.

Transcriptomic analysis of the Echinococcus granulosus protoscolex in the encystation process

Back ground: Echinococcosis (CE) is a zoonosis and in humans it occurs as a result of infection by the larva of Echinococcus granulosus . CE is seriously affects the development of animal husbandry and endangers human health. Due to the lack of in-depth understanding of the cystic fluid formation pathway, prevention and treatment of CE have been lack of innovative methods. Result: High throughput RNA-sequencing (RNA-seq) of protoscoleces (PSCs) in the encystation process of total three biological replicates for each period on 0d, 10d, 20d, 40d and 80d were analyzed. The results demonstrated, a total of 32,401 transcripts and 14,903 genes, including numbers new genes, new transcript, stage-specific genes and differently expression genes (DEGs). Genes encoding proteins involved in several signaling pathways, such as putative G-protein coupled receptor (GPCR), tyrosine kinases and serine/threonine protein kinase were predominantly up-regulated during encystation process of PSCs. Moreover, three major antioxidant proteins of PSCs were identified, and these proteins demonstrated have a high expression level, including cytochrome c oxidase, thioredoxin glutathione, and glutathione peroxidase. Intriguingly, The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested that up-regulated DEGs involved in the vasopressin-regulated water reabsorption metabolic pathway might play important roles in the protein, carbohydrate, and other substances transport. Conclusions: The present study carried out the transcriptomic analysis of the encystation process of E. granulosus PCSs, which provide valuable information for the mechanism of cystic fluid formation during the encystation process. These results provide a basis and reference for further studies for investigation of the molecular mechanisms involved in PSC growth and development. Keywords: Echinococcus granulosus , Encystation process, Differentially expressed genes, Protoscolex, RNA-seq

The formation of perianchor fluid associated with various suture anchors used in rotator cuff repair

Aims The aim of this study was to compare the osseous reactions elicited by all-suture, polyetheretherketone (PEEK), and two different biodegradable anchors used during rotator cuff repair. Patients and Methods Transosseous-equivalent rotator cuff repair was performed in 73 patients. The patients were divided into two groups, in both of which two different medial-row anchors were used. In group 1, anchor A comprised 30% β-tricalcium phosphate (TCP) + 70% fast-absorbing poly lactic-co-glycolic acid copolymer (85% polylactic acid enantiomers + 15% polyglycolic acid) and anchor B comprised all-sutures. In group 2, anchor C comprised 23% micro β-TCP + 77% polylactic acid enantiomers and anchor D comprised PEEK polymer. There were 37 patients in group 1 and 36 patients in group 2. The presence and severity of fluid collection around anchors and healing of the rotator cuff were assessed using MRI scans, approximately one year postoperatively. The severity of the collection was graded as 0 (no perianchor fluid signal), 1 (minimal perianchor fluid), 2 (local collection of fluid), 3 (fluid collection around the whole length of the anchor but of a diameter less than twice the anchor diameter), or 4 (fluid collection around the whole length of the anchor and of a diameter greater than twice the anchor diameter). Results A perianchor fluid signal was seen in three patients (8.1%) with anchor A, four (10.8%) with anchor B, 15 (41.7%) with anchor C, and 15 (41.7%) with anchor D. The severity of the collection around anchor was grade 2:1:0:0 for anchor A, grade 2:2:0:0 for anchor B, grade 12:2:0:1 for anchor C, and grade 11:3:0:1 for anchor D (grade 1:2:3:4, respectively). The prevalence and severity of fluid formation was not significantly different between anchors A and B, and anchors C and D. However, on intergroup analysis, there were significant differences for the prevalence and severity of fluid formation between anchors in group 1 and group 2. The prevalence of failure to heal was not significant in group 1 (seven, 18.9%) or group 2 (nine, 25.0%). There was no relationship between the presence of perianchor fluid and each type of anchor, and the integrity of the rotator cuff repair, in either group. Conclusion Despite the nonabsorbable nature of all-suture and PEEK anchors, all-suture anchors produced less osseous reaction after rotator cuff repair. In deciding which kind of anchor to use, consideration should be given not only to the strength of the initial fixation, but also to the postoperative biological reaction. Cite this article: Bone Joint J 2019;101-B:1506–1511