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Diluents using components of plant origin have been developed as an alternative to animal based extenders for the dilution of bull semen, however, it is unclear if use of these diluents results in in vivo fertility rates similar to those that occur with use of traditional egg yolk-based diluents. The aim of this study was to assess the effect of semen diluent on 60-day non-return rate (NRR) following artificial insemination (AI) with frozen-thawed bull semen. The effect of semen dilution in one of three different commercial diluents (BullXcell – egg yolk-based, OptiXcell – plant-based or AndroMed – plant-based) on post-thaw total and progressive motility as well as kinematic parameters (Experiment 1) and field fertility (Experiment 2, n  = 1,480 inseminations) was assessed. Semen stored in OptiXcell had greater post-thaw total and progressive motility than AndroMed ( P  < 0.05) but did not differ from BullXcell. Semen stored in BullXcell had a greater beat cross frequency and straight line velocity compared to semen stored in AndroMed ( P  < 0.05) but did not differ when compared with use of OptiXcell; while values for these variables when using OptiXcell and AndroMed did not differ from each other ( P  > 0.05). There was no difference in any other sperm kinematic parameters ( P  > 0.05). There was no effect of diluent on 60-day NRR (71.5%, 67.8% and 70.6% for BullXcell, OptiXcell and AndroMed, respectively). In conclusion, while diluent significantly affected post-thaw sperm motility and kinematics, no effect on 60-day NRR was observed. Given that OptiXcell and AndroMed are animal protein-free media these diluents may be a suitable alternative to BullXcell for the storage of frozen-thawed bull semen. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Peritoneal mesothelioma is a rare disease and traditionally has been associated with a gloomy prognosis. The present study aimed to report the outcomes following surgery and intraperitoneal chemotherapy in selected patients with peritoneal mesothelioma. Methods: Clinicopathological features, operative procedures, early outcomes and survival were analysed for 17 consecutive patients who underwent surgery for peritoneal mesothelioma between 1998 and 2007. Seventeen consecutive patients who underwent surgery for peritoneal mesothelioma between 1998 and 2007 were analysed for clinicopathological features, operative procedures, early outcomes and survival. Results: Seventeen patients underwent 18 laparotomies. Most presented with abdominal distension (71%) and abdominal pain or discomfort (53%). Complete cytoreduction was achieved in 8 patients, major debulking in 8, and 1 patient had an exploratory laparotomy only due to extensive disease. One patient died on day 30 postoperatively due to a chest infection and pulmonary embolism. The median survival for 8 patients who underwent complete cytoreduction was 3.7years (range, 0.7–6.9), whereas that for 8 patients with palliative debulking was 1.0years year (range, 0.3–5.7). Among the 12 patients who had significant ascites as a presenting symptom, 10 reported good palliation of ascites. Conclusions: Cytoreductive surgery combined with intraperitoneal chemotherapy appears to be the optimal treatment for selected patients with peritoneal mesothelioma. Increased familiarity with this condition''s presentation and natural history, and knowledge of available treatment options, will hopefully facilitate treatment of these patients and expedite speedy referral to appropriate treatment centres. [Copyright &y& Elsevier]

Background: Gastro-oesophageal reflux disease (GORD) is, in the main, treated with either proton pump inhibitor (PPI) drugs or a Nissen fundoplication operation. Recently, BARD developed Endocinch, a device used to place sutures just below the oesophagogastric junction (OGJ) to treat GORD. Aim: To evaluate the long term benefit of the Endocinch technique in patients seen up to 12 months post procedure. Patients: Twenty six patients with symptoms of GORD were recruited and had the procedure performed. Four patients were lost to follow up. Methods: Twenty two patients completed their one year follow up. Pre procedure and post procedure (up to 12 months) assessments included symptom scoring (DeMeester), upper intestinal endoscopy, oesophageal manometry and 24 hour oesophageal pH, and completion of quality of life (QOL) questionnaires. Results: Mean age was 39 years (range 22-62). Heartburn symptom score was reduced from a mean value of 19.22 at baseline to 7.5 at 12 months (n=22) (p<0.0001). Regurgitation score reduced from a mean of 2.27 at baseline to 0.86 at 12 months (n=22) (p<0.001). Mean (SEM) pH DeMeester acid score was reduced from 44.1 (4.3) to 33.32 (4.73) (p=0.028) at three month post procedure. Percentage upright acid exposure and number of reflux episodes were also reduced significantly. Use of PPIs was reduced by 64% at 12 months post procedure. All QOL assessments showed significant improvement (p=0.01). All transient post procedure complaints resolved within 72 hours. Conclusion: The Endocinch procedure is an effective and safe outpatient procedure that offers GORD patients significant improvement in symptomatology, QOL, and reduced requirements for PPIs over at least a one year period. [ABSTRACT FROM AUTHOR]

ISSUE: Influenza is a serious nosocomial pathogen in high risk patient populations and causes an average of 36,000 deaths per year in the United States. Those at greatest risk of serious complications are persons aged less than 2 and greater than 65, and those with chronic medical conditions. Nosocomial acquisition of influenza should be minimized by effective vaccination, surveillance, and aggressive outbreak abatement. PROJECT: In 2003, a nosocomial outbreak of influenza was detected in the pediatric ICU. Control measures included vaccination of staff, patients and visitors, visitor curtailment and post exposure chemoprophylaxis. A survey of 142 healthcare workers (HCWs) receiving post-exposure chemoprophylaxis revealed that amongst the 69 (49%) respondents, amantadine was poorly tolerated and adherence was poor (41%). The most frequent side effects consisted of insomnia, nausea, diarrhea and dizziness. In response to this outbreak, a comprehensive re-evaluation of the influenza prevention program was conducted. A housewide questionnaire determined barriers to vaccination. An online survey targeted approximately 4500 employees resulting in 1939 completed surveys (response rate of 43%). Of those responding, 542 (28%) indicated they did not receive the influenza vaccine. Of those electing not to receive the vaccine, 153 (28%) indicated that the vaccine was not efficacious, 146 (27%) responded that the vaccine was associated with systemic toxicity, and 125 (23%) responded they were not at risk for influenza infection. Data obtained from the survey was utilized to develop educational material and to address these and other identified issues. RESULTS: Subsequent vaccination campaigns increased the overall rate of vaccination in high risk areas from 78% to 88% (p < 0.0001). In 2005-06, 50% of high risk units achieved vaccination rates of greater than 90%. No cases of nosocomial influenza have been detected since the 2003 outbreak. LESSONS LEARNED: 1) Effective influenza vaccination programs require yearly re-evaluation and strategies for improvement. Vaccination rates of 90% or greater are possible. Convenient vaccine delivery with local unit champions appears important in boosting vaccination rates. 2) Amantidine is poorly tolerated by HCWs, resulting in sub-optimal chemoprophylaxis and alternative (neuramindase inhibitor) chemoprophylaxis should be considered. [Copyright &y& Elsevier]