Feasibility and Reliability of the AWIN Welfare Assessment Protocol for Dairy Goats in Semi-extensive Farming Conditions

The aim of this study was to test the feasibility and reliability of the Animal Welfare Indicators (AWIN) protocol for welfare assessment of dairy goats when applied to semi-extensive farming conditions. We recruited 13 farms located in the NW Italian Alps where three assessors individually and independently applied a modified version of the AWIN welfare assessment protocol for goats integrated with some indicators derived from the AWIN welfare assessment protocol for sheep. The applied protocol consisted of nine individual-level (body condition score, hair coat condition, abscesses, overgrown claws, udder asymmetry, fecal soiling, nasal discharge, ocular discharge, and improper disbudding) and seven group-level (severe lameness, Qualitative Behavior Assessment-QBA, thermal stress, oblivion, Familiar Human Approach Test-FHAT, synchrony at grazing, synchrony at resting) animal-based indicators. On most farms, the level of welfare was good. Many of the considered welfare problems (overgrown claws, fecal soiling, discharges, and thermal stress) were never recorded. However, oblivion, severe lameness, hair coat condition and abscesses were detected on some farms, with percentages ranging from 5 to 35%. The mean percentage of animals with normal body condition was 67.9 ± 5.7. The level of synchronization during resting was on average low (14.3 ± 7.2%). The application of the whole protocol required more than 4 h/farm and 3 min/goat. The inter-observer reliability varied from excellent (udder asymmetry, overgrown claws, discharges, synchrony at resting, use of shelter) to acceptable (abscesses, fecal soiling, and oblivion), but insufficient for hair coat condition, improper disbudding, synchrony at grazing, QBA. Differences in background of the assessors and feasibility constraints (i.e., use of binoculars in unfenced pastures, individual-level assessment conducted during the morning milking in narrow and dark pens, difficulties when using the scan and instantaneous sampling method due to the high number of animals that moved at the same time) can affect the reliability of data collection. Extensive training seems necessary for properly scoring animals when applying the QBA, whereas the FHAT to evaluate the Human-Animal Relationship of goats at pasture seems promising but needs to be validated. Indicators that evaluate the synchrony of activities require to be validated to identify the best moment to perform the observations during the day.

Sublingual Microcirculatory Evaluation of Extracorporeal Hemoadsorption with CytoSorb® in Abdominal Sepsis: A Case Report

Cytokemia is associated with microcirculatory alterations often with persistent loss of coherence between the micro- and macrocirculation, linked to organ failure and poor outcome of septic patients. Addition of a hemoadsorbant filter to an extracorporeal circuit next to conventional treatment of septic shock results in the hematological clearance of cytokines, hypothetically leading to normalization of the microcirculation and thus organ perfusion. Bedside sublingual microcirculatory assessment using handheld vital microscopy allows real-time direct visualization of the microcirculation and its response to therapy. This is demonstrated in the present case report of an 83-year-old man admitted to our intensive care unit after surgical repair of a colonic perforation for fecal soiling after a low anterior resection for a rectum carcinoma, with leakage of bowel content at the resection site. The clinical course of this patient can be described as having undergone adequate surgical treatment taking away the source of the disease, followed by optimal support including antibiotic treatment in the ICU. However, during the course of his stay in the ICU, his condition deteriorated with symptoms consistent with septic shock. Our report shows that the addition of a hemoadsorbent (CytoSorb) to the continuous renal replacement therapy circuit was associated with an improvement in the condition of our severely ill patient with abdominal sepsis. Parallel to the clinical improvement of our patient, the functional parameters of the microcirculation also showed improvement suggesting that such a noninvasive real-time evaluation of the status of the microcirculation may be a sensitive diagnostic tool to monitor the effectiveness of hemoadsorbent therapy.

Stem cell-based therapy for hirschsprung disease, do we have the guts to treat?

Hirschsprung disease (HSCR) is a congenital anomaly of the colon that results from failure of enteric nervous system formation, leading to a constricted dysfunctional segment of the colon with variable lengths, and necessitating surgical intervention. The underlying pathophysiology includes a defect in neural crest cells migration, proliferation and differentiation, which are partially explained by identified genetic and epigenetic alterations. Despite the high success rate of the curative surgeries, they are associated with significant adverse outcomes such as enterocolitis, fecal soiling, and chronic constipation. In addition, some patients suffer from extensive lethal variants of the disease, all of which justify the need for an alternative cure. During the last 5 years, there has been considerable progress in HSCR stem cell-based therapy research. However, many major issues remain unsolved. This review will provide concise background information on HSCR, outline the future approaches of stem cell-based HSCR therapy, review recent key publications, discuss technical and ethical challenges the field faces prior to clinical translation, and tackle such challenges by proposing solutions and evaluating existing approaches to progress further.

Factors Affecting the Welfare of Unweaned Dairy Calves Destined for Early Slaughter and Abattoir Animal-Based Indicators Reflecting Their Welfare On-Farm

In many dairy industries, but particularly those that are pasture-based and have seasonal calving, “surplus calves,” which are mostly male, are killed at a young age because they are of low value and it is not economically viable to raise them. Such calves are either killed on farm soon after birth or sent for slaughter at an abattoir. In countries where calves are sent for slaughter the age ranges from 3-4 days (New Zealand and Australia; “bobby calves”) to 3-4 weeks (e.g., Ireland); they are not weaned. All calves are at the greatest risk of death in the 1st month of life but when combined with their low value, this makes surplus calves destined for early slaughter (i.e., <1 month of age) particularly vulnerable to poor welfare while on-farm. The welfare of these calves may also be compromised during transport and transit through markets and at the abattoir. There is growing recognition that feedback to farmers of results from animal-based indicators (ABI) of welfare (including health) collected prior to and after slaughter can protect animal welfare. Hence, the risk factors for poor on-farm, in-transit and at-abattoir calf welfare combined with an ante and post mortem (AM/PM) welfare assessment scheme specific to calves <1 month of age are outlined. This scheme would also provide an evidence base with which to identify farms on which such animals are more at risk of poor welfare. The following ABIs, at individual or batch level, are proposed: AM indicators include assessment of age (umbilical maturity), nutritional status (body condition, dehydration), behavioral status (general demeanor, posture, able to and stability while standing and moving, shivering, vocalizations, oral behaviors/cross-sucking, fearfulness, playing), and evidence of disease processes (locomotory ability [lameness], cleanliness/fecal soiling [scour], injuries hairless patches, swellings, wounds], dyspnoea/coughing, nasal/ocular discharge, navel swelling/discharge); PM measures include assessment of feeding adequacy (abomasal contents, milk in rumen, visceral fat reserves) and evidence of disease processes (omphalitis, GIT disorders, peritonitis, abscesses [internal and external], arthritis, septicaemia, and pneumonia). Based on similar models in other species, this information can be used in a positive feedback loop not only to protect and improve calf welfare but also to inform on-farm calf welfare management plans, support industry claims regarding animal welfare and benchmark welfare performance nationally and internationally.

OBLIQUE VS. CIRCULAR ANASTOMOSIS IN THE CHILDREN UNDERWENT SOAVE’S PULL-THROUGH SURGERY FOR THE TREATMENT OF HIRSCHSPRUNG’S DISEASE: WHICH IS THE BEST?

ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung’s disease. Aim: To compare circular and oblique anastomoses following Soave’s procedure for the treatment of Hirschsprung’s disease. Methods: Children who underwent Saove’s pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave’s procedure.

BioSphincters to treat Fecal Incontinence in Nonhuman Primates

Loss of anorectal resting pressure due to internal anal sphincter (IAS) dysfunctionality causes uncontrolled fecal soiling and leads to passive fecal incontinence (FI). The study is focused on immediate and long-term safety and potential efficacy of bioengineered IAS BioSphincters to treat passive FI in a clinically relevant large animal model of passive FI. Passive FI was successfully developed in Non-Human Primates (NHPs) model. The implantation of autologous intrinsically innervated functional constructs resolved the fecal soiling, restored the resting pressure and Recto Anal Inhibitory Reflex (RAIR) within 1-month. These results were sustained with time, and efficacy was preserved up to 12-months. The histological studies validated manometric results with the regeneration of a well-organized neuro-muscular population in IAS. The control groups (non-treated and sham) remained affected by poor anal hygiene, lower resting pressure, and reduced RAIR throughout the study. The pathological assessment of implants, blood, and the vital organs confirmed biocompatibility without any adverse effect after implantation. This regenerative approach of implanting intrinsically innervated IAS BioSphincters has the potential to offer a better quality of life to the patients suffering from FI.

Functional Outcomes and Quality of Life in Elderly Patients after Restorative Proctocolectomy for Ulcerative Colitis

<b><i>Background/Aim:</i></b> Ileal pouch anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). However, to date few studies have examined functional outcomes or quality of life (QOL) in elderly patients after pouch construction. <b><i>Methods:</i></b> In December 2017, we sent questionnaires to 224 patients aged 65 years and older at the time who underwent an IPAA at our hospital between June 1987 and May 2015 regarding issues related to QOL and functional outcomes. Responders aged 65–69 years old were defined as the elderly group (EG), while those 70 years old and over comprised the super-EG (SEG). <b><i>Results:</i></b> The response rate was 60.7% (136/224); 70 patients were classified as EG, and 66 were classified as SEG. The SEG were older at the time of the IPAA and during the follow-up period (<i>p</i> &#x3c; 0.01). The stool frequency per day was 8 times in both groups (<i>p</i> = 0.21). There was no significant difference between the EG and SEG with regard to daytime (53 vs. 56%, <i>p</i> = 0.73) or nighttime (65.7 vs. 53%, <i>p</i> = 0.16) soiling. There was also no difference in the exacerbation of daytime or nighttime soiling compared to the first year after the operation (daytime 5.7 vs. 12.1%, <i>p</i> = 0.23; nighttime 7.1 vs. 9.1%, <i>p</i> = 0.76). QOL was evaluated using the modified fecal incontinence QOL (mFIQL) scale, with no significant difference between the EG and SEG (27 vs. 31 points). Since both groups had mFIQL scores &#x3c;50, QOL was considered to be maintained. <b><i>Conclusion:</i></b> In our analysis of elderly patients in the long-term period following surgery for UC, some noted fecal soiling, though QOL was largely maintained, and there were no serious effects on daily life.

Adolescents with anorectal malformation: physical outcome, sexual health and quality of life

Background: The necessity of referring adolescents with anorectal malformation (ARM) from pediatric units to adult care is unclear. The issue requires knowledge about the health of the adolescent. Objective: To examine the physical outcome, sexual health and quality of life (QoL) in adolescents with ARM. Methods: At medical counseling, 24 adolescents with ARM, 15–21 years of age, answered questionnaires about physical outcome according to the Krickenbeck follow-up and QoL according to SF 36 and gastrointestinal quality of life (Giqli). Matched control groups were used; 15 adolescents participated in deep interviews about sexual health and body imaging. Results: Fecal soiling, constipation and gas incontinence were much higher for ARM patients compared with controls (p<0.05). QoL regarding large bowel function was lower for both genders compared with controls (p<0.05). Females scored lower in physically related QoL (p<0.05). Social and sexual adaption to the symptoms was obvious in the deep interviews. Conclusion: Adolescents with ARM have considerable intestinal symptoms, which influence QoL and require adaption in intimate situations. A referral to adult care seems to be important, and continuous cooperation between the pediatric surgeon and adult care is suggested.

Contamination of Healthcare Workers' Hands with Clostridium difficile Spores after Caring for Patients with C. difficile Infection

Objective.We determined the percentage of healthcare workers' (HCWs') hands contaminated with Clostridium difficile spores after caring for patients with C. difficile infection (CDI) and risk factors associated with contamination.Design.Prospective study.Setting.A French university hospital.Methods.We compared the hand contamination rate among HCWs caring for patients with CDI (exposed group; n = 66) with that among an unexposed group (n = 44). Spores of C. difficile were recovered from the hands of HCWs after rubbing their fingers and palms in alcohol shortly after patient care. Associations between hand contamination and HCW category, type (patient or environment), and risk level (high or low risk) of HCW contacts and their respective duration as well as use of gloves were analyzed by bivariate and multivariate analysis.Results.C. difficile spores were detected on 24% of HCWs' hands in the exposed group and on 0% in the unexposed group (P < .001). In the exposed group, logistic regression, which adjusted for high-risk contact (ie, exposure to fecal soiling), contact with the environment, and contact with or without use of gloves, revealed that high-risk contact (adjusted odds ratio [aOR] per 1 contact increment, 2.78; 95% confidence interval [CI], 1.42–5.45; P = .003) and at least 1 contact without use of gloves (aOR, 6.26; 95% CI, 1.27–30.78; P = .02) were independently associated with HCW hand contamination by C. difficile spores.Conclusions.Nearly one-quarter of HCWs have hands contaminated with C. difficile spores after routine care of patients with CDI. Hand contamination is positively associated with exposure to fecal soiling and lack of glove use.