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Pompermayer E, Ysebaert MP, Vinardell T, Oikawa MA, Johnson JP, Fernandes T, David F. One-stage surgical case management of a two-year-old Arabian horse affected by male-pseudo hermaphroditism. J Equine Vet Sci 2024; 133:105007. [PMID: 38237706 DOI: 10.1016/j.jevs.2024.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
A two-year-old Arabian horse presented for abnormal external genitalia and dangerous stallion-like behavior was diagnosed with disorder of sexual development (DSD), also known as intersex/hermaphroditism. Standing 1-stage surgical procedure performed under sedation, and local anesthesia to concurrently eliminate stallion-like behavior, risk of neoplastic transformation of intraabdominal gonads, and to replace ambiguous external genital with a functional, and cosmetically more acceptable anatomy. Step-1) Laparoscopic abdominal exploration and gonadectomy; Step-2) Rudimentary penis resection and perineal urethrostomy. The horse tolerated surgery well (combined surgery time 185 min) with no complications. At macroscopic examination of the gonads, they resembled hypoplastic testis-like tissues. Microscopic examination confirmed presence of seminiferous tubules, Leydig and Sertoli/granulosa cells. Cytogenetic evaluation revealed a 64,XX karyotype, SRY-negative. The stallion-like behavior subsided within days post-operatively. Long-term follow-up revealed the genitoplasty site healed without urine scalding or urethral stricture. The owner satisfaction was excellent and the horse could be used post-surgery as an athlete.
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Affiliation(s)
- E Pompermayer
- Equine Veterinary Medical Center - Member of Qatar Foundation, Al Shaqab Street, Al Rayyan, Doha, Qatar
| | - M P Ysebaert
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1601 Campus Delivery, Fort Collins, CO 80523-1601, USA
| | - T Vinardell
- Equine Care Group, Paalstraat 8, 3560 Lummen, Belgium
| | - M-A Oikawa
- Equine Veterinary Medical Center - Member of Qatar Foundation, Al Shaqab Street, Al Rayyan, Doha, Qatar
| | - J P Johnson
- Equine & Camel Hospital, Abu Dhabi, United Arab Emirates
| | - T Fernandes
- Equine Veterinary Medical Center - Member of Qatar Foundation, Al Shaqab Street, Al Rayyan, Doha, Qatar
| | - F David
- EquiTom - Namur, member of the Equine Care Group, 15 Chaussée de Nivelles, 5032 Mazy, Belgium.
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Porto ACRC, Redoan MA, Massoco CO, Furtado PV, Oliveira CA. Additional effects using progestins in mares on levels of thyroid hormones and steroids in neonates. Anim Reprod 2023; 20:e20230029. [PMID: 38148929 PMCID: PMC10750809 DOI: 10.1590/1984-3143-ar2023-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023] Open
Abstract
The risk of pregnancy loss in mares leads to the use of exogenous hormones to help pregnancy maintenance. The objective was to evaluate the proportion of thyroid hormones and steroids in neonates, in the following postpartum period, born to mares fed with synthetic progesterone and to verify the existence of a correlation between the level of progesterone between mother and neonate. Twenty-seven mares and their foals were used. The animals were divided into 5 experimental groups: group 1 (control, without hormonal supplementation), group 2 (random samples fed to 120 days of pregnancy with long-term progesterone), group 3 (mares fed with short-term progesterone as of 280.º day of pregnancy), group 4 (mares fed with long-term progesterone as of 280.º day of pregnancy) and group 5 (mares fed with synthetic hormone [altrenogest] as of 280.º day of pregnancy). The animal's blood collection took place immediately after parturition for the hormonal measurement. The hormones measured in neonates were total T3, free T4, TSH, progesterone and cortisone. In mares, only levels of progesterone. The groups of neonates showed no difference on levels of total T3, free T4, TSH and progesterone. There was no difference on levels of progesterone in mares among the groups. Neonates from groups 4 and 5 had higher and lower cortisone levels, respectively. No neonate showed clinical change. There was also no correlation between levels of progesterone in mares and foals. Thus, hormonal supplementation with long-term progesterone as of 280 days of pregnancy leds to an increase in the neonate's cortisone levels, in the meantime, supplementation with altrenogest as of 280 days of pregnancy caused a decrease on cortisone levels in foals, despite clinical signs have not been observed on these animals.
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Affiliation(s)
| | | | - Cristina Oliveira Massoco
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Priscila Viau Furtado
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Claudio Alvarenga Oliveira
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
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Administration of Altrenogest to Maintain Pregnancy in Asian Elephants (Elephas maximus). Animals (Basel) 2022; 12:ani12141852. [PMID: 35883398 PMCID: PMC9312292 DOI: 10.3390/ani12141852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The Asian Elephant (Elephas maximus) is an IUCN (International Union of the Conservation of Nature) Endangered species that has interacted with humans for centuries. Despite advances in captive elephant breeding knowledge, worldwide populations continue to decline. Progesterone is a key reproductive hormone for the maintenance of pregnancy in mammalian species. The monitoring of serum progesterone levels has become a key method of management for captive breeding of elephants. The synthetic progesterone, altrenogest, has been administered to multiple species of mammals both for management of estrus and maintenance of pregnancy. This paper details three Asian elephant pregnancies maintained by the administration of altrenogest after endogenous progesterone levels decreased below the point needed to maintain pregnancy. Pharmacokinetic parameters of altrenogest administered orally as a single dose to nonpregnant pilot study elephants are presented as preliminary data on the administration of this drug to Asian elephants as a pharmacological means of maintaining pregnancy to term. Abstract Progesterone and progesterone derivatives are key hormones in pregnancy maintenance in mammalian species. Cessation of pregnancy, including birth or miscarriage, is certain if levels of these hormones drop below a given species-specific requirement necessary to maintain pregnancy. The synthetic progestin, altrenogest, is FDA-approved in the United States for suppression of estrus or synchronization and is administered extra-label to multiple species to maintain pregnancies in cases of luteal deficiency or otherwise abnormally low progesterone levels. Three pregnant Asian elephants received altrenogest from 41 to 131 days during the final trimester of pregnancy, with parturition occurring from 15 to 31 days after altrenogest administration stopped. A single dose of 0.2 mg/kg altrenogest administered to two nonpregnant Asian elephants provided pilot pharmacokinetic data. Serum samples from two of the three clinical cases and the two pilot study elephants were analyzed using Ultra Performance Liquid chromatography coupled to a triple quadruple mass spectrometer (UPLC-MS). Small sample numbers limited analysis; however, the following were determined: AUC∞ of 635.4 ± 73.8 ng*h/mL, Cmax of 30.2 ± 14.4 ng/mL at a Tmax of 4 ± 2.8 h, terminal T1/2 of 47.5 ± 3.0 h, MRT of 36.0 + 3.4 h and Vd/F of 1243.8 + 275.0 L/kg. These data and the three described cases serve as an indication that altrenogest can be administered to Asian elephants as an exogenous progestin to support pregnancy in elephant pregnancies with low endogenous progestin levels.
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Nagel C, Aurich C. Induction of parturition in horses - from physiological pathways to clinical applications. Domest Anim Endocrinol 2022; 78:106670. [PMID: 34517269 DOI: 10.1016/j.domaniend.2021.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/03/2022]
Abstract
Based on the marked variability in physiological equine gestation length, induction of foaling in mares often results in the birth of dysmature foals. Precise prediction of preparedness of the mare for foaling is thus essential. Treatment with glucocorticoids mimics the fetal signal that initiates birth. Repeated daily dexamethasone treatment in late gestation results in birth of mature foals but the time from initiation of treatment to foaling is highly variable and complications such as dystocia have been reported. Contrary to most expectations, treatment of prepartum mares with progestogens does not delay but advances the onset of foaling. Prostaglandin F2α (PGF2α) and its analogues are effective to induce foaling but even in mares ready for parturition, foal health remains to some extent unpredictable. This may be caused by a relatively long interval between PGF2α treatment and birth, exposing the fetus for several hours to uterine contractions. Oxytocin reliably induces foaling towards the end of pregnancy, but when given at high doses is effective also in the pre-viable period of gestation, resulting in birth of premature foals. Recent research has focused on reducing the amount of oxytocin with the aim to induce foaling only in mares prepared for foaling. Mares selected on clinical criteria receive 1 dose of 2.5 to 3.5 IU of oxytocin. Mares not responding to oxytocin are judged not yet ready for foaling and treatment is repeated the earliest after 24 h. This protocol at present is the most reliable and safest way to induce parturition in mares.
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Affiliation(s)
- C Nagel
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Hauptgestüt, 1016845 Neustadt(Dosse), Germany.
| | - C Aurich
- Department for Small Animals and Horses, Artificial Insemination and Embryo Transfer, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
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Affiliation(s)
- C. E. Fedorka
- Maxwell H. Gluck Equine Research Center Department of Veterinary Science University of Kentucky Lexington KY USA
| | - M. H. T. Troedsson
- Maxwell H. Gluck Equine Research Center Department of Veterinary Science University of Kentucky Lexington KY USA
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Nagel C, Melchert M, Aurich C, Aurich J. Differences in Endocrine and Cardiac Changes in Mares and Her Fetus before, during, and after Parturition in Horses of Different Size. Animals (Basel) 2020; 10:ani10091577. [PMID: 32899617 PMCID: PMC7552300 DOI: 10.3390/ani10091577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Monitoring of the pregnant mare and her fetus is based on hormone analysis and heart rate recordings which may differ among small, medium-size, and full-size horses. Therefore, Shetland (n = 6), Haflinger (n = 8), and Warmblood pregnancies (n = 9) were studied before and at foaling. Foal weight always approximated 10% of mare weight but relative placenta weight was highest in full-size mares. The concentrations of progestins (hormones that maintain pregnancy) and cortisol (a hormone involved in the onset of foaling but also in an animal’s response to stress) was highest in full-size mares. Progestin concentration decreased towards foaling while cortisol concentration increased. Heart rate of mares increased before foaling with the most pronounced increase in small mares. Overall, Shetland mares foaled earlier than larger-size mares. At foaling, atrio-ventricular blocks (physiological omission of heart beats) regularly occurred in full-size mares but only occasionally in medium-size and small mares, reflecting differences in heart efficiency. In conclusion, some differences exist before and at foaling in horses of different size. Abstract Equine fetomaternal monitoring is based on endocrine and cardiac parameters which may differ among small, medium-size, and full-size horses. Therefore, Shetland (n = 6), Haflinger (n = 8), and Warmblood pregnancies (n = 9) were studied during late gestation and at foaling. Weight of mares, foals and placenta, plasma progestin and cortisol concentration, heart rate and heart rate variability (HRV) were determined. Foal weight always approximated 10% of mare weight but relative placenta weight was highest in full-size mares (p < 0.05). Progestin (p < 0.001) and cortisol (p < 0.05) concentration was highest in full-size mares. Progestin concentration decreased towards parturition (p < 0.001) while cortisol concentration increased (p < 0.01). Maternal heart rate increased before foaling with the most pronounced increase in small mares (p < 0.001). The HRV increased during foaling and decreased when delivery was completed (p < 0.001). Changes were most pronounced in full-size mares (p < 0.001). Atrio-ventricular blocks regularly occurred in parturient full-size mares but only occasionally in medium-size and small mares (time p < 0.05, time × group p < 0.05). This may reflect breed differences in cardiovascular efficiency. Fetal heart rate decreased towards birth (p < 0.001) with the most pronounced decrease in full-size horses (p < 0.01). Fetal HRV showed no consistent changes before birth but increased when the foal was born (p < 0.001), this increase being most pronounced in full-size foals (p < 0.05). In conclusion, this study demonstrates both similarities and differences in peripartum endocrine and cardiac changes in horses of different size.
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Affiliation(s)
- Christina Nagel
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, 16845 Neustadt (Dosse), Germany;
| | - Maria Melchert
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, 1210 Vienna, Austria; (M.M.); (C.A.)
| | - Christine Aurich
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, 1210 Vienna, Austria; (M.M.); (C.A.)
| | - Jörg Aurich
- Obstetrics, Gynecology and Andrology, Department for Small Animals and Horses, Vetmeduni Vienna, 1210 Vienna, Austria
- Correspondence:
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Xiao H, Sun P, Sun F, Qiu J, Wang J, Wang J, Lin Y, Gong X, Zhang L, Zhang S, Cao X. Pharmacokinetics of altrenogest in gilts. J Vet Pharmacol Ther 2019; 42:660-664. [PMID: 31222770 DOI: 10.1111/jvp.12755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
Altrenogest, a synthetic progestogen, is characterized by its estrus synchronization in mares, ewes, sows, and gilts. To investigate the pharmacokinetic profile and evaluate its accumulation in gilts, 18 oral doses of 20 mg altrenogest/gilt/day were given to eight healthy gilts at an interval of 24 hr. Plasma samples were collected, and altrenogest was determined by ultra-high-performance liquid chromatography with mass spectrometry. WinNonlin 6.4 software was used to calculate the pharmacokinetic parameters through noncompartmental model analysis. After the first administration (D 1), the pharmacokinetic parameters, including Tmax , Cmax , and the elimination half-life (T1/2λz ), were similar to those observed after the final administration (D 18). However, the mean residence time at D 1 was significantly lower than D 18. As a whole, the mean steady-state plasma concentration (Css ), degree fluctuation (DF), accumulation factor (Rac ), and area under the plasma concentration-time curve in steady state (AUCss ) were 22.69 ± 6.15 ng/ml, 270.64 ± 42.51%, 1.53 ± 0.23, and 544.63 ± 147.49 ng hr/ml, respectively. These results showed that after 18 consecutive days of oral administration of altrenogest, plasma concentrations of altrenogest had a certain degree of fluctuation, without significant accumulations.
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Affiliation(s)
- Hongzhi Xiao
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Pan Sun
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Feifei Sun
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Jicheng Qiu
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Jie Wang
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Jianzhong Wang
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Yalong Lin
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Xiaohui Gong
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Lu Zhang
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Suxia Zhang
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China
| | - Xingyuan Cao
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, China Agricultural University, Beijing, China.,Laboratory of Quality & Safety Risk Assessment for Animal Products on Chemical Hazards (Beijing), Ministry of Agriculture, Beijing, China.,Key Laboratory of Detection for Veterinary Drug Residue and Illegal Additives, Ministry of Agricultural, Beijing, China
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Scarlet D, Wulf M, Kuhl J, Köhne M, Ille N, Conley AJ, Aurich C. Anti-Müllerian hormone profiling in prepubertal horses and its relationship with gonadal function. Theriogenology 2018; 117:72-77. [PMID: 29784463 DOI: 10.1016/j.theriogenology.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 10/16/2022]
Abstract
Anti-Müllerian hormone (AMH) has gained increasing interest as a biomarker for assessment of gonadal activity. The ability to predict the ovarian follicular reserve of prepubertal female horses (fillies) or to identify stallions with testicular pathologies already during their prepubertal life has not been analyzed so far. Both would help to select fertile horses and reduce costs associated with keeping animals. The objectives of the present study were to (1) assess AMH, LH, FSH, progesterone (females) and testosterone (males) dynamics in prepubertal horses from birth onwards and (2) determine whether AMH concentrations detected in plasma of prepubertal female and male horses are correlated with postpubertal gonadal development. Warmblood foals (n = 30, 14 females, 10 normal males and 6 males with abnormal testicular development) born between February and May of two consecutive years (n = 28 in the first year and n = 2 the next year), were included in the study. Information on gestational length, parity of the dam and placental weight was collected for all foals. Blood samples for hormone analysis were collected from birth onwards every four weeks up to the age of one year. At two years, blood samples were collected on the day when antral follicle count (AFC) and total testicular volume (TTV) were assessed. AMH was detectable in the plasma of all animals from birth onwards and its concentration was significantly higher (P < .001) in males than in females, regardless of testicular development. In males, AMH and testosterone concentration were similar for all animals during the first year of life, regardless of testicular development. At two years, AMH concentration was higher (P < .05) in males with abnormal testicular development than in those with normal testes. In females, AMH concentration at two years was correlated with AMH concentration at birth (P < .05) and with AFC (P < .001). At birth, LH concentration was lower (P < .05) in stallions with abnormal testes (0.3 ± 0.2 ng/ml) than in controls (0.6 ± 0.2 ng/ml). A high negative correlation between AMH concentration and gestation length was observed in males during the first eight weeks of life (P < .01, r = -0.64 to -0.71). Elevated progesterone concentrations over 1 ng/ml were observed in several females starting with 20 weeks of age. This was paralleled by an increase in AMH concentration and was preceded by FSH and LH increases. In conclusion, AMH determination can be reliably used from two years onwards to identify stallions with abnormal testicular development, but it is inconclusive before puberty. In female horses, determination of AMH concentration at a prepubertal age allows for prediction of AMH and AFC after puberty. We suggest that premature luteinisation occurs before the onset of puberty in female horses and that LH secretion in the perinatal period is involved in testicular development and descent in the horse.
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Affiliation(s)
- Dragos Scarlet
- Obstetrics, Gynecology and Andrology, University of Veterinary Medicine Vienna, Austria.
| | - Manuela Wulf
- Graf Lehndorff Institute for Equine Science, Neustadt (Dosse), Germany
| | - Juliane Kuhl
- Center for Artificial Insemination and Embryo Transfer, University of Veterinary Medicine Vienna, Austria
| | - Martin Köhne
- Center for Artificial Insemination and Embryo Transfer, University of Veterinary Medicine Vienna, Austria
| | - Natascha Ille
- Center for Artificial Insemination and Embryo Transfer, University of Veterinary Medicine Vienna, Austria
| | - Alan J Conley
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Christine Aurich
- Graf Lehndorff Institute for Equine Science, Neustadt (Dosse), Germany
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Conley A. Review of the reproductive endocrinology of the pregnant and parturient mare. Theriogenology 2016; 86:355-65. [DOI: 10.1016/j.theriogenology.2016.04.049] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
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Palm F, Walter I, Nowotny N, Budik S, Helmreich M, Aurich C. Progestin treatment does not affect expression of cytokines, steroid receptors, oxytocin receptor, and cyclooxygenase 2 in fetal membranes and endometrium from pony mares at parturition. Theriogenology 2013; 79:59-68. [DOI: 10.1016/j.theriogenology.2012.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 11/25/2022]
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