Search

Background & Aims: Discontinuation of anti-tumor necrosis factor-α treatment (anti-TNF) (infliximab and adalimumab) in patients with inflammatory bowel disease (IBD) is associated with a high relapse risk that may be influenced by endoscopic activity at the time of stopping. We assessed the relapse rate after anti-TNF withdrawal in patients with endoscopic healing and studied predictors of relapse including the depth of endoscopic healing., Methods: This was a multicenter, prospective study in adult patients with Crohn's disease (CD), ulcerative colitis (UC), or IBD-unclassified (IBDU), with ≥6 months of corticosteroid-free clinical remission (confirmed at baseline) and endoscopic healing (Mayo <2/SES-CD <5 without large ulcers), who discontinued anti-TNF between 2018 and 2020 in the Netherlands. We performed Kaplan-Meier and Cox regression analyses to assess the relapse rate and evaluate potential predictors: partial (Mayo 1/SES-CD 3-4) versus complete (Mayo 0/SES-CD 0-2) endoscopic healing, anti-TNF trough levels, and immunomodulator and/or mesalamine use., Results: Among 81 patients (CD: n = 41, 51%) with a median follow-up of 2.0 years (interquartile range, 1.6-2.1), 40 patients (49%) relapsed. Relapse rates in CD and UC/IBDU patients were comparable. At 12 months, 70% versus 35% of patients with partial versus complete endoscopic healing relapsed, respectively (adjusted hazard rate [aHR], 3.28; 95% confidence interval [CI], 1.43-7.50). Mesalamine use was associated with fewer relapses in UC/IBDU patients (aHR, 0.08; 95% CI, 0.01-0.67). Thirty patients restarted anti-TNF, and clinical remission was regained in 73% at 3 months., Conclusions: The relapse risk was high after anti-TNF withdrawal in IBD patients with endoscopic healing, but remission was regained in most cases after anti-TNF reintroduction. Complete endoscopic healing and mesalamine treatment in UC/IBDU patients decreased the risk of relapse., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Shortening or omitting the dry period (DP) in dairy cows is of interest because of potential beneficial effects on energy balance and metabolic health. Reported effects of a short or omitted dry period on udder health are ambiguous. This study aimed to evaluate the effect of no DP (0d), a short DP (30d), or a conventional DP (60 d) on the occurrence of intramammary infections (IMI) during the precalving period and on somatic cell counts (SCC), elevations of SCC (SCC≥200,000 cells/mL), and clinical mastitis in the subsequent lactation. The study also aimed to analyze which prepartum cow characteristics are associated with udder health after different DP lengths. Holstein-Friesian dairy cows (n=167) were randomly assigned to a DP length (0, 30, or 60 d). Cows with a 0-d DP had a greater occurrence of chronic IMI and a lower occurrence of cured IMI during the precalving period than cows with a 30-d or 60-d DP. Postpartum average SCC for lactation was greater in cows with a 0-d DP than in cows with a 30-d or 60-d DP. The number of cows with at least 1 elevation of SCC, the number of elevations of SCC per affected cow, the number of cows treated for clinical mastitis, and the number of cases of mastitis per affected cow did not differ among DP lengths. Cow characteristics related to postpartum average SCC for lactation were DP length, parity, and the following interactions: DP length with prepartum elevation of SCC, DP length with fat- and protein-corrected milk (FPCM) reduction between 150 and 67d prepartum, DP length with parity and with average SCC for lactation, and last FPCM before the conventional drying-off day with average SCC for lactation. Cows with prepartum parity 1 had a lower occurrence of at least 1 elevation of SCC in subsequent lactation compared with cows with parity >2. Last SCC before the conventional drying-off day was positively associated with occurrence of clinical mastitis in the subsequent lactation. In this study, DP length was not a risk factor for either elevation of SCC or occurrence of clinical mastitis in the subsequent lactation. The identified cow characteristics could be used in a decision support model to optimize DP length for individual cows., (Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Osteochondrosis (OC) and abnormalities in conformation and locomotive characteristics (CLC) have been associated with premature culling in sows. Several CLC have been suggested to be associated with OC and might help as an in vivo indicator for and increased risk of having OC. The aim of this study was to investigate associations of OC with CLC assessed at several ages in growing gilts from 2 separate experiments over the effects of dietary restriction (Exp. 1) and floor type (Exp. 2) on OC prevalence. In Exp. 1, gilts (n = 211) were subjectively assessed for CLC at, on average, 4, 9, 11, 16, and 24 wk of age. In Exp. 2, gilts (n = 212) were subjectively assessed for CLC at, on average, 4, 9, 11, 16, and 22 wk of age. Assessment was done on 10 conformation and 2 locomotive characteristics using a 9-point grading scale by 2 observers. At, on average, 27 wk of age in Exp. 1 and 24 wk of age in Exp. 2, gilts were slaughtered and the knee, elbow, and hock joints were macroscopically assessed for OC. The CLC most frequently associated with OC were O shape or X shape of the hind legs, straight or bowed hind legs, and straight or sickled hock. X-shaped hind legs were associated with OC at slaughter in the knee joint at 4, 9, and 24 wk of age and at the animal level (all joints taken together) at 4, 9, and 16 wk of age. Straight or bowed hind legs were associated with OC at slaughter in the knee joint at 4 and 11 wk of age; in the hock joint at 11 wk of age; and at the animal level at 4, 9, 11, and 22 wk of age. Straight or sickled hock was associated with OC at slaughter in the knee joint at 4 wk of age, in the hock joint at 9 and 22 wk of age, and at the animal level at 9 and 22 wk of age. Results show that several CLC assessed at several ages were associated with OC, but consistent associations of a type of CLC in every assessment could not be found. The associations of CLC with OC are, therefore, difficult to be used as an in vivo indicator of increased risk for OC.

Osteochondrosis (OC) is a degenerative joint condition developing in a short time frame in young growing gilts that may cause lameness at an older age, affecting welfare and leading to premature culling of breeding sows. Causes of OC are multifactorial including both genetic and environmental factors. Floor type has been suggested to affect OC prevalence and effects might be age dependent during the rearing period. The aim of this study was to investigate possible age-dependent effects of floor type, conventional concrete partially slatted versus wood shavings as deep bedding, on OC prevalence in gilts (Dutch Large White × Dutch Landrace) at slaughter (24 wk of age; 106.5 [14.7 SD] kg of BW). At weaning (4 wk of age; 6.9 [1.3 SD] kg of BW), 212 gilts were subjected to 1 of 4 flooring regimens. Gilts were either subjected to a conventional floor from weaning until slaughter (CC), wood shavings as bedding from weaning until slaughter (WW), a conventional floor from weaning until 10 wk of age after which gilts were switched to wood shavings as bedding (CW), or wood shavings as bedding from weaning until 10 wk of age after which gilts were switched to a conventional floor (WC). After slaughter the elbow, hock, and knee joints were macroscopically examined for OC and scored on a 5 point scale where 0 indicates no OC and 4 indicates the severest form of OC. There was no significant difference (P > 0.4) between treatments on the overall OC prevalence for any joint assessed or at the animal level (all joints combined). At the animal level, however, gilts had greater odds to have OC scores 3 and 4 in the CW treatment (odds ratios [OR] = 2.3; P = 0.05), WC treatment (OR = 2.6; P = 0.02), and WW treatment (OR = 3.7; P < 0.001) compared with gilts in the CC treatment. The results indicate that there are no age-dependent effects of floor types on overall OC prevalence. However, wood shavings as bedding seems to increase the odds for severe OC and might affect animal welfare in the long term.

Osteochondrosis (OC) is one of the main causes of leg weakness causing premature culling in breeding sows and develops in a short time frame in young growing gilts. Dietary restriction may have different effects on OC prevalence depending on the age of the gilts. The aim of this study is to investigate age-dependent effects of dietary restriction, ad libitum vs. restricted (80% of ad libitum), on the occurrence of OC in gilts at slaughter (26 wk of age). At weaning (4 wk of age), 211 gilts were subjected to one of 4 treatments of a feeding regime. Gilts were administered either ad libitum feeding from weaning until slaughter (AA); restricted feeding from weaning until slaughter (RR); ad libitum feeding from weaning until 10 wk of age, after which gilts were switched to restricted feeding (AR); or restricted feeding from weaning until 10 wk of age, after which gilts were switched to ad libitum feeding (RA). At slaughter, the elbow, hock, and knee joints were harvested. Joints were scored macroscopically for articular surface deformations indicative of OC. Gilts in the RA treatment had significantly higher odds of being affected by OC than gilts in the RR and AR treatments in the hock joint (OR=3.3, P=0.04 and OR=8.5, P=0.002, respectively) and at animal level (OR=2.5, P=0.001 and OR=1.9, P=0.01, respectively). Gilts in the AA treatment had higher odds of being affected by OC than gilts in the AR treatment in the hock joint (OR=5.3, P=0.01). The results indicate a possible pathway to reduce the prevalence of OC in breeding gilts that will have to last several parities. Switching from restricted feeding to ad libitum feeding after 10 wk of age increases OC prevalence as opposed to restricted feeding after 10 wk of age.

Conformation and locomotive characteristics (CLC; i.e., leg conformation and gait movement patterns) may be associated with osteochondrosis (OC) in pigs. Osteochondrosis and CLC increase the risk of premature culling. This study investigated whether CLC have an explanatory value, over the previously modeled effects of sex, feeding, and housing conditions, on the occurrence and severity of OC in several joints and at the animal level. At 154 to 156 d of age, 267 pigs were subjectively scored on 9 conformation and 2 locomotive characteristics. Scoring was performed on a 9-point linear grading scale. For conformation characteristics, score 5 indicated normal conformation and scores 1 and 9 indicated severe deviations from normal. For the locomotive characteristics, score 1 indicated normal locomotion and score 9 indicated severe deviation from normal. At 161 to 176 d of age, pigs were slaughtered and joints were dissected for macroscopic evaluation of OC status. Results showed that swaying hindquarters and a stiffer gait were associated with greater scores for OC in, respectively, the femoropatellar (P = 0.018) and tarsocrural joint (P = 0.005), smaller inner claws as compared with the outer claws of the front legs was associated with lower scores for OC than equally sized claws in the femoropatellar joint (P = 0.021) and on animal level (P = 0.010), steep and weak pasterns of the front legs were associated with greater scores for OC in the elbow joint (P = 0.004) and on animal level (P = 0.018), X-shaped hind legs was associated with greater scores for OC on animal level (P = 0.037), and steep and weak pasterns of the hind legs were associated with lower scores for OC than normal conformation in the tarsocrural joint (P = 0.05). This study found several CLC that were associated with OC in several joints and at an animal level. This study showed that certain CLC might be used as indicators of OC and included in the criteria for selection of replacement animals for the breeding herd.

Background and Aim: Isolated polycystic liver disease (PCLD) is characterized by the presence of multiple cysts in the liver in the absence of polycystic kidneys. The clinical profile of PCLD is poorly defined and we set up a study for the clinical characteristics of PCLD., Methods: We collected clinical data on 188 PCLD patients (defined as >10 liver cysts) from five tertiary referral centres, and 137 patients were selected for the purpose of this study. We performed molecular analysis of the PCLD associated genes PRKCSH and SEC63 in 91 patients., Results: A total of 118 (86%) patients were female. The majority of patients (88%) had >20 cysts. The median age at diagnosis was 47 years (range 23-84). 37 (41%) patients carried a mutation. Clinical symptoms at presentation were present in 111 (84%) patients. γ-glutamyl transferase was elevated to 1.4 times upper limit of normal (interquartile range 1.0-2.7). The presence of a mutation and female gender predicted a more severe course: female patients were 9 years younger at the time of diagnosis (47 years; range 23-84) and 91% had symptoms (P<0.01); likewise, mutation carriers were younger at presentation (39 years; range 35-48) and 95% of this cohort had symptoms (P<0.01). During follow-up [median 8.2 years (range 0-35)], 10% of untreated and 51% of treated patients developed complications. Mortality in this cohort was 8%, but only 2% died of PCLD-related causes. 58% of patients were treated a median of 2 years (range 0-25) after diagnosis., Conclusion: Symptomatic PCLD patients are mainly females. Females and mutation carriers were younger at diagnosis and had a more severe course of disease., (© 2010 John Wiley & Sons A/S.)

Purpose: To study the extent to which aspiration-sclerotherapy reduces liver volume and whether this therapy results in relief of symptoms., Results: Four patients, group I, with isolated large liver cysts, and 11 patients, group II, with polycystic livers, underwent aspiration-sclerotherapy. Average volume of aspirated cyst fluid was 1,044 ml (range 225-2,000 ml) in group I and 1,326 ml (range 40-4,200 ml) in group II. Mean liver volume before the procedure was 2,157 ml (range 1,706-2,841 ml) in group I and 4,086 ml (range 1,553-7,085 ml) in group II. This decreased after the procedure to 1,757 ml (range 1,479-2,187 ml) in group I. In group II there was a statistically significant decrease to 3,347 ml (range 1,249-6,930 ml, P = 0.008). Volume reduction was 17.1% (range -34.7% to -4.1%) and 19.2% (range -53.9% to +2.4%) in groups I and II, respectively. Clinical severity of all symptoms decreased, except for involuntary weight loss and pain in group II., Conclusion: Aspiration-sclerotherapy is an effective means of achieving liver volume reduction and relief of symptoms.

We present a 53-year-old female suffering from familial adenomatous polyposis, who was found to have a positive nodus, lateral to the hilus of the left lung, on routine FDG-PET scan. This lesion was found to be a sclerosing hemangioma. We found an aberrant beta-catenin expression on immunohistochemical staining, suggesting that sclerosing hemangioma and familial adenomatous polyposis share the same pathophysiology. It is important to be aware of the association of familial adenomatous polyposis and sclerosing hemangioma.

Two female patients, 86 and 80 years of age, had been treated with blood transfusions for several years and several months, respectively, due to iron-deficiency anaemia caused by gastrointestinal blood loss. Angiodysplasias were detected and subsequently coagulated in the course of repeated gastroscopies and colonoscopies. Due to the failure of this treatment, treatment with thalidomide was started. Thereafter, the gastrointestinal bleeding stopped and there was no longer any need for blood transfusions. Treatment with thalidomide seems an effective therapy for patients with frequently recurring gastrointestinal blood loss due to angiodysplasias who no longer tolerate conventional and invasive procedures due to their physical condition.