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Background: Nipple areolar complex (NAC) reconstruction often signifies completion of the breast reconstruction process for some patients and has been shown to improve both psychosocial and sexual well-being. Several techniques have been described; however, there currently exists little evidence in the literature describing outcomes or patient satisfaction., Methods: A retrospective analysis of NAC reconstructions over the last decade was queried for patient demographics, operative technique, and postoperative outcomes. A standardized, validated survey was also utilized to evaluate overall satisfaction, with a focus on aesthetic outcome, shape, color, and projection., Results: Eighty-three patients were identified, with 49 (59.0%) completing the survey. The modalities used for reconstruction include the C-V flap (45.7%), the modified skate flap technique (42.2%), and free nipple grafting (FNG, 12.0%). No significant differences in age, BMI, or comorbidities were found among the three types. The most utilized donor site for skate flap reconstruction was the suprapubic area (37.1%). There were also no significant differences in complication rate (C-V 10.5%, FNG 10%, skate 5.7%, P = 0.630) or revision surgery (C-V 2.6%, FNG 0%, skate 5.7%, P = 0.732). The most common complication was nipple necrosis. Adjusting for time to follow-up using multivariate analysis, there was a significant difference in overall patient satisfaction when compared across all three techniques, with the modified skate flap having the highest mean overall satisfaction scores., Conclusions: NAC reconstruction can be completed safely and effectively with a variety of techniques. The modified skate flap technique was associated with high levels of patient satisfaction and a low complication rate., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Implant-based breast reconstruction (IBBR) is a complex process with significant practice variability. Infections after IBBR are associated with higher rates of readmission, reoperation, and reconstructive failure. To reduce process variability and postoperative infections, the authors implemented an evidence-based, standardized protocol for IBBR., Methods: The protocol was applied to all patients undergoing IBBR at a single institution from December of 2019 to February of 2021. Intraoperative protocol adherence was recorded, and infection events were considered minor (managed with outpatient antibiotics) or major (managed with readmission or reoperation). A historic control group was retrospectively analyzed for comparison., Results: Sixty-nine patients (120 breasts) in the protocol group were compared with 159 patients (269 breasts) in the retrospective group. No differences were found in demographic characteristics, comorbidities, or type of reconstruction (expander versus implant). Intraoperative protocol adherence was 80.5% (SD, 13.9%). Overall infection rate was significantly lower in the protocol group versus controls (8.7% versus 17.0%; P < 0.05). When dichotomized, protocol patients had a lower rate of both minor (2.9% versus 5.7%; P = 0.99) and major (5.8% versus 11.3%; P = 0.09) infections, although this was not statistically significant. Rate of reconstructive failure secondary to infection was significantly lower in the protocol group (4.4% versus 8.8%; P < 0.05). Among protocol patients, those without infection had higher protocol adherence (81.5% versus 72.2%; P < 0.06), which neared statistical significance., Conclusion: A standardized perioperative protocol for IBBR reduces process variability and significantly decreases rate of overall infections and reconstructive failure secondary to infection., Clinical Question/level of Evidence: Therapeutic, III., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: Hematoma is the most common complication after facelift surgery. Hypertension is the major risk factor for hematoma following facelift. Measures taken to reduce systolic blood pressure perioperatively significantly reduce the risk of hematoma. There is evidence that treating systolic blood pressure of 140 mmHg or above reduces hematoma; there were no studies to date in which systolic blood pressures below 120 mmHg had been evaluated., Objectives: To assess the safety and efficacy of maintaining systolic blood pressures of 120 mmHg or less postoperatively to reduce hematoma after facelift., Methods: A retrospective chart review of a single surgeon's series of facelift procedures from January 2004 to July 2018 was undertaken. Implementation of a more stringent perioperative blood pressure protocol (maintaining a systolic blood pressure of less than 120 mmHg postoperatively) was initiated in January of 2013, dividing patients into 2 groups., Results: A total of 502 consecutive patients who underwent a facelift by F.N. were included in the study. A total of 319 patients underwent a facelift before 2013, and a total of 183 patients underwent a facelift in 2013 or later. Overall, a total of 13 hematomas occurred during the entire 15-year study period (2.59%), of which 12 occurred before the implementation of a strict blood pressure regimen (3.76%), and only 1 occurred after the new protocol (0.5%). There were no adverse events related to the lower blood pressure., Conclusions: Treating systolic blood pressure greater than 120 mmHg postoperatively is a safe and effective method for reducing the risk of hematoma after facelift., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

A patient's preoperative satisfaction with their breasts and baseline psychosocial, sexual, and physical well-being are important considerations when planning breast reconstruction. We sought to elucidate variances in preoperative responses among patients undergoing postmastectomy breast reconstruction., Methods: Preoperative BREAST-Q responses and demographic data, including race, generation, median household incomeinstitutional review board and body mass index (BMI) were collected from breast cancer patients scheduled for mastectomy. Associations between demographic group and survey response were analyzed by chi-square or independent t -tests., Results: In total, 646 of 826 patients identified had complete data and were included in the final analysis. Patients in BMI group 1 (16-24.9) were more likely to report feeling "very satisfied" with how they looked unclothed compared with patients in other BMI groups ( P = 0.031). Conversely, patients in groups 3 and 4 (35+), reported lower satisfaction ( P = 0.037) and felt less attractive without clothes ( P = 0.034). Asian women were less likely to feel attractive ( P = 0.007), and Black patients were less likely to feel of equal worth to other women ( P < 0.001). Finally, patients were less likely to report confidence in social settings if they were Black ( P < 0.001), Asian ( P < 0.001), from the millennial generation ( P = 0.017), or living in zip codes with median household income less than $55,000 ( P = 0.042)., Conclusions: Breast cancer patients' feelings toward their natural breasts vary widely between demographic groups. Understanding baseline psychosocial factors in this population is key to informing preoperative discussions and interpreting postoperative satisfaction., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Minority patients and those from low socioeconomic backgrounds are faced with barriers to care regarding breast reconstruction. With this study, we seek to elucidate variances in demographics to determine predictors of complications in implant-based breast reconstruction., Methods: Patients who underwent breast reconstruction with either direct to implant or immediate expander reconstruction by 1 surgeon were identified using the preoperative Breast-Q.Current income statistics available from the US Census Bureau by self-reported zip code were used to determine the median household income (MHI) to stratify differing socioeconomic backgrounds. Demographics were compared with body mass index, comorbidities, overall rate of postoperative complications, rate of implant infection, and type of reconstruction., Results: Two hundred ninety-five patients met inclusion criteria. Overall rate of complications and rate of breast implant infection was higher for MHI of less than $50,000 compared with greater than $50,000 (P = 0.043 overall complications 40.20% vs 28.8%) (P = 0.04 implant infection 14.4% vs 7.1%). African American patients had higher body mass index (P = <0.001), rates of HTN (P = <0.001), and diabetes (P = 0.001), and were more likely to have a lower income (P = <0.001). There was, however, no difference in overall complications (P = 0.26), implant infection rate (P = 0.994), or capsular contracture (0.367) based on race. There was no difference in rate of comorbidities between low and high socioeconomic areas., Conclusion: This cohort demonstrates a higher rate of overall complications and infection in patients with a lower MHI and no difference based on race despite having higher risk factors for complications.Socioeconomic status is a multifaceted barrier to care that must be addressed in the perioperative period to decrease breast implant associated complications., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Pre-pectoral prosthetic breast reconstruction following nipple-sparing mastectomy (NSM) has become a popular approach compared with the dual plane technique. Our objective was to determine if there was a difference in time to postoperative breast drain removal in direct-to-implant or tissue expander reconstruction following NSM when comparing pre-pectoral with dual plane technique., Methods: A total of 200 patients (335 breasts) received NSM followed by implant or expander reconstruction at our institution between the years 2009 and 2020. Direct-to-implant reconstruction had 113 pre-pectoral versus 67 dual plane, and tissue expander reconstruction had six pre-pectoral versus 149 dual plane. Our analysis included age at mastectomy, body mass index, history of preoperative breast radiation, and smoking history. Case complications included seroma or hematoma, breast or axillary infection requiring antibiotics or operative washout, device replacement due to extrusion or infection, skin necrosis, and capsular contracture. Statistical analysis was completed with Pearson chi-square test, Fisher exact test, and the two-sample T -test using IBM SPSS Statistics 24.0 (IBM Corp., Armonk, N.Y.)., Results: The average time until breast drain removal in dual plane implant patients was significantly less than in pre-pectoral implant patients (9.42 versus 14.01 days). The average time until breast drain removal in dual plane expander patients was significantly less than in pre-pectoral expander patients (11.47 versus 20.30 days)., Conclusion: In both implant and expander reconstruction following NSM, patients receiving dual plane device placement had a shorter postoperative time until breast drain removal when compared with patients receiving pre-pectoral device placement., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding "best practices" in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes., Methods: We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction., Results: Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of "no-touch" techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection., Conclusions: There is a crucial need to establish an evidence-based set of "best practices" for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Patients occasionally need completion mastectomy (CM) following oncoplastic reduction for various reasons necessitating definitive reconstructive techniques. The purpose of this study was to evaluate those patients who required CM following oncoplastic reduction and evaluate indications, technique, and outcomes., Methods: Patients who underwent a completion mastectomy at some time point following the oncoplastic reduction were identified. Factors that influenced CM and additional reconstruction were analyzed. All statistical analysis was conducted using the IBM SPSS Statistics 27.0 (IBM Corp.)., Results: A total of 29 patients (5.3%) underwent CM during the study period with an average follow-up of 3 years since the original procedure. The most common reasons were positive margins (20/29, 69.0%) and recurrence (8/29, 27.6%). Twenty-two had reconstructive procedures (75.9%) and seven did not (24.1%). The patients who underwent CM and reconstruction were significantly younger (49.2 years) than those who had no reconstruction (64.3 years, P = 0.004). The most common type of reconstruction was transverse rectus abdominis myocutaneous (TRAM)/deep inferior epigastric perforator (DIEP) flap (12/22, 54.5%), followed by latissimus (6/22, 27.3%) and tissue expander (3/22, 13.6%). The complication rate in the CM group was 24% (N = 7/29), which included two seromas (6.9%), followed by infection, fat necrosis, mastectomy skin necrosis, and donor site necrosis (3.4% each)., Conclusions: Completion mastectomy is indicated typically for positive margins or recurrence. Reconstruction is performed more frequently in younger patients, with the TRAM/DIEP flap and latissimus dorsi reconstruction being the most common technique., Competing Interests: Disclosure: Dr. Losken is a speaker for RTI. All the other authors have no financial interest to declare in relation to the content of this article., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Summary: With plastic surgery being at the forefront of innovation and discovery in multiple research disciplines, plastic surgery is poised for M.D./Ph.D. and research-focused M.D. trainees to be attracted to this field. Surprisingly, recent reports have shown that the number of surgeon-scientists pursuing research is on the decline, with these declines being even more pronounced within plastic surgery. It is essential that plastic surgery remains a leader in translational research by cultivating a group of individuals who have been trained in basic research and are thereby competitive to obtain extramural grant funding. To address this need, the authors review data elucidating why the research-oriented trainee may forego pursuing a career in plastic surgery. Although much of the existing literature is speculative, the authors identified the current number of M.D./Ph.D.s in plastic surgery using data obtained from the American Society of Plastic Surgeons and investigated number of grants in plastic surgery compared to other medical and surgical fields using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results. The authors hypothesize that economic constraints and difficulty securing protected research time may be contributing to fewer trainees pursuing plastic surgery. The purpose of this article is (1) to discuss potential reasons deterring research-oriented trainees from pursuing careers as surgeon-scientists within plastic surgery; (2) to propose solutions that may attract more trainees interested in careers as surgeon-scientists to the field of plastic surgery; (3) to highlight the lack of quantitative data regarding surgeon-scientist training in plastic surgery; and (4) to propose and encourage future research avenues to help attract and nurture surgeon-scientists in plastic surgery., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Background: Aesthetic and reconstructive implant-based breast surgeries are some of the most frequently performed procedures by plastic surgeons. As such, prevention of implant infection is of high importance. However, there remains no criterion-standard protocol for irrigation of the breast pocket. This review focuses on current irrigation practices in implant-based breast surgery., Methods: Four databases were used to search for all studies, including randomized controlled trials, retrospective cohort, and prospective cohort, containing original data related to the outcomes investigated in this study. Search terms included "breast," "irrigation," and "infection" in different combinations to isolate studies that focused on irrigation methods in both reconstructive and augmentation surgeries. Our selection criteria specifically concentrated on those studies that explicitly related irrigation procedures to rates of clinical infection and/or capsular contracture. Each was compiled into a table in chronological order to make comparisons between the differing irrigation methods., Results: Our search returned 239 full-text articles eligible for our review. Two independent screeners identified 9 studies that met the inclusion criteria. This included 1 prospective study and 8 retrospective studies. Two studies reported the use of chlorhexidine gluconate irrigation resulting in protection from clinical infection. Two studies investigated the role of triple antibiotic solution (TAS) either alone or combined with something else on risk of infection, and 3 reported TAS use on rates of capsular contracture. Two additional studies investigated the role of single antibiotic irrigation, concluding that some antibiotic regimen for irrigation may be sufficient in the breast pocket. Interestingly, one study noted the potential use of povidone-iodine (Betadine) as a method of irrigation., Conclusions: These data suggest that chlorhexidine gluconate, Betadine, and TAS irrigation of the breast pocket can provide protection against infection and implant loss in both reconstruction and augmentation surgeries., Competing Interests: Conflicts of interest and sources of funding: A.L. is a consultant to RTI Surgical. None of the other authors have any financial disclosures., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Immediate breast reconstruction (IBR) has become the most common method for postmastectomy reconstruction. Axillary lymph node dissection is performed for the staging of patients, but the impact of IBR with nodal surgery on postoperative complications remains elusive. The present study aims to investigate the impact of concomitant axillary lymph node surgery on postoperative complications. We conducted a retrospective study of patients who underwent IBR from 2000 to 2014. We recorded and analyzed patient data to determine the association between nodal surgery and postsurgical complications. Univariate and multivariate analyses were utilized to elucidate the risk of a complication given nodal surgery, sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), and type of incision for nodal access. A total of 986 breast reconstructions were included for analysis. Overall incidence of postoperative complications per breast that received nodal surgery was 35.9% (n = 230/642), compared to 25.6% (n = 88/344) in breasts that did not have concomitant nodal surgery (P = .001). Nodal surgery was found to increase risk of all complications with an odds ratio of 1.62 (P = .001). Moreover, complications were significantly higher in patients whose nodes were accessed via mastectomy incision (39.4%) when compared to a separate incision (33.5%). Multivariate analysis showed that nodal sampling through the mastectomy incision is a significant risk factor for seroma, with an odds ratio of 3.60 (P = .002). We did not observe differences in breast complications in patients who underwent SLNB vs ALND. These factors should be taken into account in the approach to breast reconstruction during lymphadenectomy., (© 2020 Wiley Periodicals LLC.)

Many studies have suggested a role for gut-resident microbes (the "gut microbiome") in modulating host health; however, the mechanisms by which they impact systemic physiology remain largely unknown. In this study, metabolomic and transcriptional profiling of germ-free and conventionalized mouse liver revealed an upregulation of the Nrf2 antioxidant and xenobiotic response in microbiome-replete animals. Using a Drosophila-based screening assay, we identified members of the genus Lactobacillus capable of stimulating Nrf2. Indeed, the human commensal Lactobacillus rhamnosus GG (LGG) potently activated Nrf2 in the Drosophila liver analog and the murine liver. This activation was sufficient to protect against two models of oxidative liver injury, acetaminophen overdose and acute ethanol toxicity. Characterization of the portal circulation of LGG-treated mice by tandem mass spectrometry identified a small molecule activator of Nrf2, 5-methoxyindoleacetic acid, produced by LGG. Taken together, these data demonstrate a mechanism by which intestinal microbes modulate hepatic susceptibility to oxidative injury., Competing Interests: Declaration of Interests The authors have no interests to disclose, (Copyright © 2020 Elsevier Inc. All rights reserved.)

Agents targeting the insulin-like growth factor receptor type 1 (IGF1R) have shown antitumor activity. Based on the evidence for interaction between the IGF-1 and TRAIL pathways, we hypothesized that the combination of ganitumab (monoclonal antibody to IGF1R) with the pro-apoptotic death receptor 5 agonist, conatumumab, might increase antitumor response. Ganitumab and conatumumab were tested in combination in a Colo-205 xenograft model. Part 1 of the clinical study was a phase Ib program of three doses of conatumumab (1, 3, 15 mg/kg) in combination with 18 mg/kg ganitumab to determine the maximum tolerated dose (MTD) in patients with advanced solid tumors. Part 2 was conducted in six cohorts with advanced non-small cell lung cancer (squamous or non-squamous histology), colorectal cancer, sarcoma, pancreatic cancer, or ovarian cancer, treated at the recommended doses of the combination. The combination was significantly more active in the Colo-205 xenograft model than either single agent alone (p < 0.0015). In part 1 of the clinical study, no dose-limiting toxicities were observed and the MTD of conatumumab was 15 mg/kg in combination with 18 mg/kg ganitumab. In part 2, 78 patients were treated and there were no objective responses but 28 patients (36 %) had stable disease (median 46 days, range 0-261). The combination was well-tolerated with no new toxicities. In conclusion, the combination of ganitumab and conatumumab was well-tolerated but had no objective responses in the population tested. The successful future application of this combination of antitumor mechanisms may rely on the identification of predictive biomarkers.

Context: Meta-analyses are regularly used to inform healthcare decisions. Concerns have been expressed about the quality of meta-analyses and, in particular, about those supported by the pharmaceutical industry., Objective: The objective of this study is to compare the quality of pharmaceutical-industry-supported meta-analyses with academic meta-analyses and of meta-analyses published before and after companies started to disclose their data., Data Sources: We identified industry-supported meta-analyses by searching the Scopus bibliographic database, using author affiliations. We matched each industry-supported meta-analysis with an academic meta-analysis using high-level MeSH terms in PubMed., Study Selection: We included meta-analyses of randomized trials assessing the efficacy or safety of any pharmaceutical intervention in humans, published in 2002-2004 or 2008-2009. Cochrane reviews were excluded. Two individuals independently selected papers, with discrepancies resolved by two further individuals., Assessment: We developed and piloted a quality-assessment tool, consisting of 43 questions in four domains, with a key summary question covering each domain. Two individuals independently assessed each meta-analysis., Results: We examined 126 meta-analysis publications in 63 matched pairs. The average quality was low, with fewer than 50% adequate in three of the four domains. Industry-supported meta-analyses less often demonstrated adequate methods for locating studies and assessing their quality (odds ratio 0.44, 95% confidence interval 0.21 to 0.92), for analysing the included studies (0.52, 0.25 to 1.06), for undertaking meta-analyses (0.82, 0.40 to 1.68) and in reaching sound conclusions (0.62, 0.30 to 1.28). Quality generally improved over time, particularly for some aspects of industry reports., Conclusions: Academic meta-analysis papers are generally of higher quality than industry-supported ones. This is largely due to less detailed reporting in industry-supported meta-analyses and a tendency for them to take the included studies at face value, probably arising from the implicit assumption that these studies already have high methodological standards to meet licensing requirements. The improved quality over time does not appear to be due to the use of data disclosed by industry. The main limitations of this study are the small sample of papers and the subjective nature of some of the assessment processes., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Because meta-analyses are increasingly prevalent and cited in the medical literature, it is important that tools are available to assess their methodological quality. When performing an empirical study of the quality of published meta-analyses, we found that existing tools did not place a strong emphasis on statistical and interpretational issues., Methods: We developed a quality-assessment tool using existing materials and expert judgment as a starting point, followed by multiple iterations of input from our working group, piloting, and discussion. After having used the tool for our empirical study, agreement for four key items in the tool was measured using weighted kappa coefficients., Results: Our tool contained 43 items divided into four key areas (data sources, analysis of individual studies, meta-analysis methods, and interpretation), and each area ended with a summary question. We also produced guidance for completing the tool. Agreement between raters was fair to moderate., Conclusions: The tool should usefully inform subsequent initiatives to develop quality-assessment tools for meta-analysis. We advocate use of consensus between independent raters when assessing statistical appropriateness and adequacy of interpretation in meta-analyses., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Darbepoetin alfa is a glycoprotein with a three-fold longer terminal half-life than recombinant human erythropoietin (rHuEPO). We aimed to determine whether darbepoetin alfa is as effective and well tolerated as rHuEPO for treating renal anemia in dialysis patients when administered at a reduced dose frequency., Methods: A total of 522 European and Australian hemodialysis and peritoneal dialysis patients receiving stable rHuEPO therapy by either the intravenous (IV) or subcutaneous (SC) route were randomized, open-label in a 1:2 ratio to continue rHuEPO or to receive an equivalent dose of darbepoetin alfa at a reduced dose frequency. Patients receiving rHuEPO once weekly changed to once every other week darbepoetin alfa, and those receiving rHuEPO two or three times weekly changed to once-weekly darbepoetin alfa. The doses of rHuEPO and darbepoetin alfa were titrated to maintain hemoglobin close to the patient's baseline level for up to 52 weeks. The primary endpoint was the change in hemoglobin between baseline and the evaluation period at weeks 25 to 32 of treatment., Results: The mean change in hemoglobin from baseline to the evaluation period was similar in the darbepoetin alfa (-0.03 g/dL; SE 0.11) and rHuEPO (-0.06 g/dL; SE 0.13) groups, and the difference between the two treatments was 0.03 g/dL (95% CI -0.16, 0.21). This was not a statistically significant or clinically relevant difference, despite the reduced frequency of darbepoetin alfa administration. At the end of the evaluation period, >/=95% of patients had their hemoglobin successfully maintained on their assigned dose frequency for darbepoetin alfa (once weekly and once every other week) and rHuEPO (once, twice and three times weekly). The safety profiles of darbepoetin alfa and rHuEPO were similar, and no antibodies to either treatment were detected., Conclusions: Darbepoetin alfa maintains hemoglobin as effectively as rHuEPO, but with a reduced dose frequency.

On the basis of the hypothesis that the peak numbers of infective nematode third-stage larvae (L3) on herbage in winter months results from fall contamination of pastures, 2 methods to reduce fall contamination were tested. In trial 1, morantal sustained-release boluses were administered to 15 fall-calving cows on Sept 7, 1982. Fifteen untreated cows (controls) were placed on separate pastures. Numbers of L3 on herbage during the winter and spring were assessed by use of worm-free tracer calves. In trial 2, 19 cattle due to calve in the fall were administered 200 micrograms of invermectin/kg of body weight, SC, on Sept 2, 1983. Also, 17 cattle similarly were given a placebo injection and served as control animals. Treated cattle were placed on the pasture used by control cattle in trial 1 and control cattle on the pasture used by treated cattle in trial 1. Worm-free tracer calves were again used to assess numbers of L3 on herbage. In trial 1, tracer calves grazing the control animal pasture from January 14 to 28 acquired 37 times as many nematodes as did those grazing the treated animal pasture. In trial 2, the greatest difference observed was a 10-fold increase of nematodes in calves grazing control animal pastures, compared with worm numbers in tracer calves grazing the treated animal pasture.

Many dairy cattle are housed under drylot conditions, which generally are not considered conducive to elevated populations of gastrointestinal parasites. Thus, an examination of the potential benefits to be obtained by anthelmintic treatment of lactating cows under these circumstances was initiated. Because there were no statistically significant differences in milk production between control and treated groups, routine deworming cannot be considered economically sound under the management conditions described.

Two worm-free calves were allowed to graze on irrigated pasture with a naturally infected herd for each of 34 one-month periods from November 1979 to August 1982. After each grazing period, the calves were transferred to a cement-floored pen for 3 weeks and then were euthanatized and necropsied. Ostertagia ostertagi and Cooperia oncophora were the most prevalent species of nematodes recovered. Adults and larvae of Ostertagia spp and Cooperia spp were most numerous in winter and spring and least numerous during summer. The proportions of Ostertagia spp that were inhibited as fourth-stage larvae increased in late fall, peaked from March through April, and then decreased to low values during summer. The maximal inhibition in 1980, 1981, and 1982 was 72, 65, and 62%, respectively. The number of larval Cooperia spp was highest in winter months and, except for one grazing period when 55% of the Cooperia spp were larvae, the total numbers represented less than 15% of the nematode population during all grazing periods. Other nematodes encountered were Trichostrongylus axei, Haemonchus spp, O lyrata, and O occidentalis in the abomasum; C surnabata, C punctata, Nematodirus helvetianus, T colubriformis, and Bunostomum phlebotomum in the small intestine; and Oesophagostomum venulosum and Trichuris ovis in the large intestine.

Worm-free Holstein calves were used to assess the seasonal variation in numbers of nematode infective larvae on herbage at 2 commercial cow-calf ranches in the Sierra Nevada mountains. Both ranches used Herefords as their basic breed. One ranch near Sattley, California, is at an elevation of approximately 1,500 m above sea level, whereas the study area on the 2nd ranch near Susanville is at an elevation of approximately 1,250 m above sea level. Worm-free tracer calves were allowed to graze for approximately 30 days and were then kept free of further nematode infection until euthanasia and necropsy approximately 30 days after removal from the pastures. At necropsy, the number, species, and stages of development of nematodes in the gastrointestinal tract were determined. The most common species of nematode in the abomasum was Ostertagia ostertagi and in the small intestine Cooperia oncophora. Infection levels decreased during early summer and were low in midsummer to early fall. In late fall and winter, infection levels began to increase, and highest infection levels were obtained during the spring. A low level of inhibited development (up to 18%) of 4th-stage O ostertagi occurred in November and December. Considerably higher levels of inhibition (up to 61%) were observed in March, April, and May. Inhibition of development in Cooperia spp was not noticed. Other nematodes seen were O lyrata, C mcmasteri, C punctata, Trichostrongylus axei, Haemonchus sp, and Nematodirus helvetianus.

Controlled trials were conducted to evaluate the anthelmintic action of haloxon in 2 phenotypes of lambs, 1 having an A esterase in plasma which rapidly hydrolyzes di-(2-chloroethyl)aryl phosphates and the other without this enzyme. A total of 116 lambs, 57 with and 59 without the plasma A esterase, 6 to 9 months old, harboring naturally acquired nematode infections were used in 3 trials. Haloxon was administered orally at 20, 25, and 35 mg/kg of body weight. Nematodes against which haloxon was evaluated in the abomasum were Ostertagia circumcincta and Trichostrongylus axei and in the small intestine were T vitrinus, T colubriformis, Nematodirus spathiger, and N filicollis. The anthelmintic efficiency of haloxon did not differ in the 2 phenotypes of sheep.

Determination of the acute oral medial lethal dose (LD50) of haloxon for lambs classified as to the presence or absence of plasma esterases (A esterase; EsA) rapidly hydrolyzing haloxon revealed markedly different values for the 2 phenotypes of sheep. The LD50 for EsA- lambs was 763 mg/kg of body weight with 95% confidence limits of 543 to 1,072 mg/kg. The acute oral LD50 for EsA+ lambs remains undetermined but was demonstrated to be in excess of 11,392 mg/kg. The acute oral LD50 for a closely related organophosphate (coumaphos) was not different in the 2 phenotypes of sheep.

Oxfendazole, methyl [5-(Phenylsulfinyl)-1H-benzimidazol-2-yl]carbamate given to calves at dose level of 2.5 mg/kg as a paste, as a bolus, or as a drench resulted in excellent (97 to 100%) anthelmintic efficacy against mature Ostertagia ostertagi, Trichostrongylus axei, Cooperia oncophora, C mcmasteri, C pectinata, C punctata, Nematodirus helvetianus, Trichostrongylus longispicularis, Chabertia ovina, and Oesophagostomum radiatum. Against the early 4th stage larvage of O ostertagia and N helvetianus, these formulations had anthelmintic efficacies of 71% to 87% and 21% to 65%, respectively. As the result of differences in drug intake by individual calves, a pelleted feed additive given as top dress on chopped alfalfa hay gave an unsatisfactory mean anthelmintic response. Anthelmintic action in individual calves ranged from none to 98--100%.

Worm-free Holstein tracer calves were used to assess the seasonal variation in number and course of development of nematode parasites of cattle on an irrigated pasture located in the California Sierra foothills. The most common genera of nematodes found in the abomasum and small intestine were Ostertagia and Cooperia, respectively. The infective Ostertagia larvae on herbage were most numerous in early spring and lowest in summer months. Arrested development of Ostertagia occurred in mid-to-late spring. The percentage of the population of Ostertagia found to be arrested larvae was constant (73% to 95%) over 4 years, even though the total number of nematodes in the genus was markedly different. Levels of infection with Ostertagia and Cooperia were found to correlate with pasture contamination occurring in the preceding fall and concurrent winter months. In the cecum and large intestine, Oesophagostomum venulosum was found to be the most common nematode. It is suggested that this species may replace Os radiatum as the cattle nodular worm in regions where climate is similar to that of the southwestern coast of North America. Evidence of seasonal hypobiotic development of Oe venulosum was found. Other genera of nematodes observed in tracer calves were Trichostrongylus, Haemonchus, Bunostomum, Trichuris, and Dictyocaulus.

Dogs and cats were treated with 2% temephos [0,0'-(thiodi-p-phenylene) 0,0',0'-tetramethyl bis (phosphorothioate)] powder to evaluate its insecticidal activity against the cat flea (Ctenocephalides felis). Dogs and cats were infested each week with approximately 100 unfed, unsexed fleas less than 14 days old. Live-flea counts were made each day. The experiment was terminated when all dogs and cats retained live fleas for 6 days or more. The 2% temephos powder resulted in excellent flea control on dogs and cats for 2 weeks, partial control for 3 to 4 weeks, and no effective control beyond 4 weeks.

Serum IgE concentration has been considered a valuable measurement in parasitic infections, yet little has been reported regarding cattle. This study examines the association of IgE levels of nematode-naïve Holstein steer calves and the level of gastrointestinal parasitism acquired by grazing irrigated pasture for 30 days. Total IgE levels were determined by enzyme-linked immunosorbent assay (ELISA) specific for bovine IgE on serum collected both before and after exposure to parasite-infected pastures. Following necropsy, parasite loads were determined by direct count from the contents of the abomasum, small intestine, cecum and large intestine; species of Ostertagia and Cooperia being the most common helminths found. Significant increases of IgE in the serum of calves with light infestations were seen, whereas calves with moderate to heavy infestations showed only mild IgE increases. With increased parasite burden, the frequency of increased IgE levels was reduced. Additionally, there appeared to be a seasonal correlation relating the level of serum IgE detected to the number of worms counted and to the course of parasite development.

Efficacy of polyvinyl chloride collars containing temephos [0,0'-(thiodi-4,1-phenylene) 0,0,0',0'-tetramethyl bis-(phosphorothioate)] was elevaluated in dogs and cats against the cat flea (Ctenocephalides felis). Over a period of 42 weeks, collared (treated) and control dogs were experimentally infested with 100 fleas 23 times, and control and treated cats were similarly infested 20 times during a 41-week period. Flea populations on treated dogs were reduced by 80% or more for at least 36 weeks. Initially, flea reduction by 80% occurred within 1 day, but in dogs wearing the same collars for 26 weeks, this reduction occurred in 3 to 6 or more days. Only during the first 2 weeks of wearing the collars were all fleas killed on all dogs within a 6-day period after infestation. Residual efficiency was lowest on highly active dogs and greatest on inactive dogs. The residual efficiency on cats was somewhat better than on dogs. At the end of 41 weeks, collars on cats reduced the flea population by 85 to 90% within 1 to 5 days following infestation. Collars on cats, as on dogs, were 100% efficacious only during the first 2 weeks of the trial.

Oxfendazole, methyl 5(6)-phenylsulfinyl-2-benzimidazole carbamate, was given by oral drench (5 mg/kg) to California lambs harboring natural infections of gastrointestinal nematodes. Ninety-nine percent of adult Ostertagia circumcincta, Ostertagia trifurcata, Trichostrongylus axei, Trichostrongylus vitrinus, Trichostrongylus colubriformis, Nematodirus filicollis, and Nematodirus spathiger were removed by the anthelmintic.

Homogenates of individual adult Fasciola hepatica, collected from bile ducts of sheep, were subjected to isoelectric focusing in polyacrylamide flat-bed gels after which zymograms were made by enzymatic and staining reactions. Seven identifiable isozymes that hydrolyzed alpha-naphthyl acetate were found. These 7 isozymes were identified by their isoelectric points as 5.10, 5.15, 5.25, 5.40, 5.55, 5.65, and 5.75. None of these isozymes was common to all F hepatica examined. Combinations of these isozymes in individual flukes revealed 7 distinct phenotypes, the frequency of which varied between local populations, i.e., populations of flukes obtained from individual sheep of different origin. In addition to these 7 isozymes, there were weak staining bands of enzyme activity, between pH 5.8 and the cathode end of the gels, which could not be accurately identified. The method of isoelectric focusing and zymogram preparation used in the present study did not reveal cholinesterase activity, even though the presence of activity in homogenates was demonstrated by polyacrylamide disc-gel electrophoresis. Strong activity of acid phosphatase between pH 5 and 6 was found, but poor resolution prevented obtaining accurate identification of isozymes. Weak activity with poor resolution of isozymes of alkaline phosphatase was observed between pH 4.4 and 5.75.

Active and inactive brewer's yeast, when given as a dietary supplement to dogs at the rate of 14 g/day, failed to repel or kill fleas. Twenty dogs in each of 3 groups were inoculated weekly for 7 weeks with 100 unfed cat fleas (Ctenocephalides felis). One group served as a control while one group received inactive and the other active yeast during the last 5 weeks of the trial. There were no significant differences in flea counts among the 3 groups during the first 4 weeks of yeast supplemental feedings. Total flea counts during the 5th week of yeast supplementation did not differ significantly from the counts on control dogs, although there was a significant difference between counts from dogs receiving active and those receiving inactive yeast.

Ten dogs were fitted with 10% propoxur-(0-isopropoxyphenyl methylcarbamate) and 10 dogs were fitted with 16% carbaryl-(1-naphthyl-N-methylcarbamate) impregnated flea collars. Ten cats were fitted with carbaryl-impregnated flea collars. There were 5 control animal for each trial. Insecticidal activity against experimental infestations with the cat flea (Ctenocephalides felis) was evaluated. The propoxur collars on dogs reduced the flea populations by 90% within 2 days of infestation for at least 13 weeks. By the 16th week, the flea population was reduced 65% in 2 days and 87% in 7 days. In subsequent infestations, efficiency was less than 80% after 7 days. Carbaryl collars on dogs reduced the flea population by as much as 80% in 2 days for a period of 16 weeks. An efficiency of at least 80% at 7 days was maintaned for 17 weeks. Carbaryl collars on cats reduced the flea population within 2 days by 80% or more for a period of at least 19 weeks--the last experimental infestation.

Ten parasite-free experimental lambs were inoculated intraruminally with a mixed-larvae inoculum which contained approximately 5,000 Haemonchus contortus infective larvae. Five lambs were treated with thiabendazole (66 mg/kg of body weight) and 5 were untreated controls. All lambs were killed 35 days after inoculations were done, and parasites present were recovered. Reduction in numbers of recovered Haemonchus contortus (25.7%) and Ostertagia spp (26.8%) were not significant (P greater than 0.05).

A fraction of larval Taenia hydatigena cyst fluid was shown to have high sensitivity and specificity in the enzyme-linked immunosorbent assay (ELISA) for the detection of bovine antibodies to the heterologous parasite Taenia saginata. This antigenically active lipoprotein fraction was isolated by ultracentrifugal density flotation using either ammonium sulfate (specific gravity = 1.231 g per ml) or NaCl/KBr (specific gravity = 1.225 g per ml), followed by ion-exchange chromatography. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) indicated that this fraction was composed of high molecular weight (65,000 to 77,000 Mr) and low molecular weight (9,500 to 16,000 Mr) proteins. Electrophoresis under non-denaturing conditions in either acrylamide (5%) or agarose (1%) resulted in 1 major diffuse band staining for both protein and lipid. The high and low molecular weight proteins observed on SDS-PAGE under reducing conditions could not be resolved by gel filtration chromatography and emerged as a single lipoprotein peak. This T. hydatigena cyst fluid fraction appears promising as a diagnostic reagent in the ELISA for bovine cysticercosis.

According to results of disc gel electrophoresis of homogenates prepared from individual female nematodes of the species Ostertagia circumcincta and subsequent staining of gel preparations, a maximum of 5 isozymes, hydrolyzing alpha-naphthyl acetate, were present. On the basis of resolution and mobility, these isozymes could be classified as 2 slow and 3 fast bands. Phenotypic differences were observed in the intensity of individual bands, as well as in the presence (or absence) of bands.

The relationship of anthelmintic treatment for subclinical gastrointestinal nematode parasitism with resultant milk production was studied on 3 California dairies where animals were maintained on a pasture-based nutritional program. All of the animals that started lactating (freshened) during a 12-month period participated in trials in which coumaphos was given as a feed top dressing to animals averaging 30 days into lactation. All of the animals that freshened during the subsequent 12-month period from 2 of the same 3 dairies participated in trials in which thiabendazole was administered at or within 2 weeks before freshening. Anthelmintic administration during 2 consecutive lactation cycles under the conditions of the present study resulted in no consistent reproducible significant changes in milk production.

During the period extending from Dec 1, 1975, to Dec 22, 1976, 3 distinct peaks in the concentration of infective nematode larvae on pasture forage were detected by use of helminth-free tracer calves. Two of these peaks, 1 occurring in the spring and 1 in the fall, consisted mainly of Ostertagia ostertagi and Cooperia sp. It is concluded that these 2 peaks can be anticipated annually and constitute unsafe periods of grazing. The 3rd peak was comprised largely of Haemonchus placei and Cooperia sp. It is concluded that this peak occurred as the result of unusual rainfall and reduced evaporation in August. Arrested developed (24% to 30%) of O ostertagi larvae occurred only during the spring peak. This finding indicates that on irrigated pastures in California, type I ostertagiasis can be expected to occur as the result of infection during the spring and/or fall peaks, whereas type II ostertagiasis can be expected to occur in the fall as a result of infection obtained during the spring peak. Arrestment in development of Cooperia sp occurred during spring (14%) and fall (23%) peaks. Haemonchus placei larvae increased their propensity for arrestment in development from zero to 82% during the months following the peak level of infection in summer. Other nematodes encountered were Trichostrongylus axei and Nematodirus helvetianus.