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Olsen RG, Hartwell D, Dalsgaard T, Madsen ME, Bjerrum F, Konge L, Røder A. First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:368-377. [PMID: 38031442 PMCID: PMC10823395 DOI: 10.1111/aogs.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. MATERIAL AND METHODS Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. RESULTS The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. CONCLUSIONS In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Hartwell
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Torur Dalsgaard
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Mette Elkjær Madsen
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Department of Surgery, Herlev‐Gentofte HospitalHerlevDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Thomsen LH, Vexø LE, Schnack TH, Hansen KE, Forman A, Hartwell D, Nielsen HS, Hummelshoj L, Nyegaard M, Madsen ME. Danish translation, cross-cultural adaptation, and electronic migration of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project Endometriosis Patient Questionnaire. Front Glob Womens Health 2023; 4:1102006. [PMID: 36994241 PMCID: PMC10042231 DOI: 10.3389/fgwh.2023.1102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
ObjectivesThis study aims to translate and cross-culturally adapt the standard version of the World Endometriosis Research Foundation (WERF) EPHect Endometriosis Patient Questionnaire (EPQ) into Danish and to ensure equivalence of a Danish electronic version.MethodsThe translation, cultural adaption, and electronic migration followed recommendations from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Critical Path Institute. Ten women with endometriosis were enrolled for cognitive debriefing of the paper version (pEPQ) after translation and back translation. The questionnaire was then migrated into an electronic version (eEPQ) and subsequently tested for usability and measurement equivalence by five women with endometriosis.ResultsCross-cultural alterations were needed for medical terms, response options for ethnicity, the educational system, and measurement units. Thirteen questions were altered after back translation, while 21 underwent minor changes after cognitive debriefing. After testing the eEPQ, 13 questions were altered. Questions tested for measurement equivalence across the two modes of administration were found comparable. The median time-to-complete the pEPQ and eEPQ was 62 min (range: 29–110) and 63 min (range: 31–88), respectively. General comments included the questionnaire being relevant but long and repetitive.ConclusionsWe find the the Danish pEPQ and eEPQ similar and comparable to the original English instrument. However, attention must be drawn to questions regarding measurement units, ethnicity, and educational systems before cross-country comparison. The Danish pEPQ and eEPQ are suitable for obtaining subjective data on women with endometriosis.
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Affiliation(s)
- Line Holdgaard Thomsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Line Holdgaard Thomsen
| | - Laura Emilie Vexø
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Hartwell
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Endometriosis.org, London, United Kingdom
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Elkjær Madsen
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Krog MC, Madsen ME, Bliddal S, Bashir Z, Vexø LE, Hartwell D, Hugerth LW, Fransson E, Hamsten M, Boulund F, Wannerberger K, Engstrand L, Schuppe-Koistinen I, Nielsen HS. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac015. [PMID: 35441092 PMCID: PMC9014536 DOI: 10.1093/hropen/hoac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY QUESTION What is the microbiome profile across different body sites in relation to the normal menstrual cycle (with and without hormonal contraception), recurrent pregnancy loss (RPL) (before and during pregnancy, pregnancy loss or birth) and endometriosis (before, during and after surgery)? How do these profiles interact with genetics, environmental exposures, immunological and endocrine biomarkers? WHAT IS KNOWN ALREADY The microbiome is a key factor influencing human health and disease in areas as diverse as immune functioning, gastrointestinal disease and mental and metabolic disorders. There is mounting evidence to suggest that the reproductive microbiome may be influential in general and reproductive health, fertility and pregnancy outcomes. STUDY DESIGN, SIZE, DURATION This is a prospective, longitudinal, observational study using a systems biology approach in three cohorts totalling 920 participants. Since microbiome profiles by shot-gun sequencing have never been investigated in healthy controls during varying phases of the menstrual cycle, patients with RPL and patients with endometriosis, no formal sample size calculation can be performed. The study period is from 2017 to 2024 and allows for longitudinal profiling of study participants to enable deeper understanding of the role of the microbiome and of host–microbe interactions in reproductive health. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants in each cohort are as follows: Part 1 MiMens—150 healthy women with or without hormonal contraception; Part 2 MiRPL—200 couples with RPL, 50 healthy couples with prior uncomplicated pregnancy and 150 newborns; Part 3 MiEndo—120 patients with endometriosis requiring surgery with or without hormonal treatment. Microbiome profiles from saliva, faeces, rectal mucosa, vaginal fluid and endometrium will be studied, as well as the Omics profile, endocrine disrupting chemicals and endocrine and immune factors in blood, hair, saliva and urine. Pregnancy loss products, seminal microbiome, HLA types, endometriotic tissue and genetic risk and comprehensive questionnaire data will also be studied, where appropriate. Correlations with mental and physical health will be evaluated. STUDY FUNDING/COMPETING INTEREST(S) This work is supported by funding from Ferring Pharmaceuticals ([#MiHSN01] to H.S.N., M.C.K., M.E.M., L.E.V., L.E., I.S.-K., F.B., L.W.H., E.F. and M.H.), Rigshospitalet’s Research Funds ([#E-22614-01 and #E-22614-02] to M.C.K. and [#E-22222-06] to S.B.), Niels and Desiree Yde’s Foundation (S.B., endocrine analyses [#2015-2784]), the Musikforlæggerne Agnes and Knut Mørk’s Foundation (S.B., endocrine and immune analyses [#35108-001]) and Oda and Hans Svenningsen’s Foundation ([#F-22614-08] to H.S.N.). Medical writing assistance with this manuscript was provided by Caroline Loat, PhD, and funded by Ferring Pharmaceuticals. H.S.N. reports personal fees from Ferring Pharmaceuticals, Merck Denmark A/S, Ibsa Nordic, Astra Zeneca and Cook Medical outside the submitted work. K.W. is a full-time employee of Ferring Pharmaceuticals. No other conflicts are reported. TRIAL REGISTRATION NUMBER N/A TRIAL REGISTRATION DATE N/A DATE OF FIRST PATIENT’S ENROLMENT N/A
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Affiliation(s)
- Maria Christine Krog
- Correspondence address. The Recurrent Pregnancy Loss Unit, The Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. E-mail:
| | | | - Sofie Bliddal
- The Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Zahra Bashir
- The Recurrent Pregnancy Loss Unit, The Capital Region, The Fertility Clinic, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Slagelse Hospital, Slagelse, Denmark
| | - Laura Emilie Vexø
- The Recurrent Pregnancy Loss Unit, The Capital Region, The Fertility Clinic, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
- Department of Gynecology, The Endometriosis Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Dorthe Hartwell
- Department of Gynecology, The Endometriosis Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Luisa W Hugerth
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Fransson
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Marica Hamsten
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Boulund
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Lars Engstrand
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Ina Schuppe-Koistinen
- Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Henriette Svarre Nielsen
- The Recurrent Pregnancy Loss Unit, The Capital Region, The Fertility Clinic, Copenhagen University Hospitals Rigshospitalet and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen N, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
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Dyre L, Nørgaard LN, Tabor A, Madsen ME, Sørensen JL, Ringsted C, Tolsgaard M. Collecting Validity Evidence for the Assessment of Mastery Learning in Simulation-Based Ultrasound Training. Ultraschall Med 2016; 37:386-92. [PMID: 27112623 DOI: 10.1055/s-0041-107976] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE To collect validity evidence for the assessment of mastery learning on a virtual reality transabdominal ultrasound simulator. MATERIALS AND METHODS We assessed the validity evidence using Messick's framework for validity. The study included 20 novices and 9 ultrasound experts who all completed 10 obstetric training modules on a transabdominal ultrasound simulator that provided automated measures of performance for each completed module (i. e., simulator metrics). Differences in the performance of the two groups were used to identify simulator metrics with validity evidence for the assessment of mastery learning. The novices continued to practice until they had attained mastery learning level. RESULTS One-third of the simulator metrics discriminated between the two groups. The median simulator scores from a maximum of 40 metrics were 17.5 percent (range 0 - 45.0 percent) for novices and 90.0 percent (range 85.0 - 97.5) for experts, p < 0.001. Internal consistency was high, with a Cronbach's alpha value of 0.98. The test/retest reliability gave an intra-class correlation coefficient (ICC) of 0.62 for novices who reached the mastery learning level twice. Novices reached the mastery learning level within a median of 4 attempts (range 3 - 8) corresponding to a median of 252 minutes of simulator training (range 211 - 394 minutes). CONCLUSION This study found that validity evidence for the assessment of mastery learning in simulation-based ultrasound training can be demonstrated and that ultrasound novices can attain mastery learning levels with less than 5 hours of training. Only one-third of the standard simulator metrics discriminated between different levels of competence.
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Affiliation(s)
- L Dyre
- Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L N Nørgaard
- Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjaelland Hospital, Hilleroed, Denmark
| | - A Tabor
- Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M E Madsen
- Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - J L Sørensen
- Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Ringsted
- Faculty of Health, University of Aarhus, Denmark
| | - M Tolsgaard
- Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Tolsgaard MG, Ringsted C, Dreisler E, Nørgaard LN, Petersen JH, Madsen ME, Freiesleben NLC, Sørensen JL, Tabor A. Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial. Ultrasound Obstet Gynecol 2015; 46:312-8. [PMID: 25580809 PMCID: PMC4600230 DOI: 10.1002/uog.14780] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/27/2014] [Accepted: 01/03/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency. METHODS In a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. RESULTS During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001). CONCLUSION Simulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M G Tolsgaard
- Centre for Clinical Education, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - C Ringsted
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - E Dreisler
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - L N Nørgaard
- Department of Obstetrics and Gynecology, Nordsjaelland Hospital Hillerød, University of Copenhagen, Hillerød, Denmark
| | - J H Petersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M E Madsen
- Centre for Clinical Education, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - N L C Freiesleben
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Naestved Hospital, University of Copenhagen, Naestved, Denmark
| | - J L Sørensen
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - A Tabor
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
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Madsen ME, Konge L, Nørgaard LN, Tabor A, Ringsted C, Klemmensen AK, Ottesen B, Tolsgaard MG. Assessment of performance measures and learning curves for use of a virtual-reality ultrasound simulator in transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2014; 44:693-9. [PMID: 24789453 DOI: 10.1002/uog.13400] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/13/2014] [Accepted: 04/20/2014] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To assess the validity and reliability of performance measures, develop credible performance standards and explore learning curves for a virtual-reality simulator designed for transvaginal gynecological ultrasound examination. METHODS A group of 16 ultrasound novices, along with a group of 12 obstetrics/gynecology (Ob/Gyn) consultants, were included in this experimental study. The first two performances of the two groups on seven selected modules on a high-fidelity ultrasound simulator were used to identify valid and reliable metrics. Performance standards were determined and novices were instructed to continue practicing until they attained the performance level of an expert subgroup (n = 4). RESULTS All 28 participants completed the selected modules twice and all novices reached the expert performance level. Of 153 metrics, 48 were able to be used to discriminate between the two groups' performance. The ultrasound novices scored a median of 43.8% (range, 17.9-68.9%) and the Ob/Gyn consultants scored a median of 82.8% (range, 60.4-91.7%) of the maximum sum score (P < 0.001). The ultrasound novices reached the expert level (88.4%) within a median of five iterations (range, 5-6), corresponding to an average of 219 min (range, 150-251 min) of training. The test/retest reliability was high, with an intraclass correlation coefficient of 0.93. CONCLUSIONS Competence in the performance of gynecological ultrasound examination can be assessed in a valid and reliable way using virtual-reality simulation. The novices' performance improved with practice and their learning curves plateaued at the level of expert performance, following between 3 and 4 h of simulator training.
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Affiliation(s)
- M E Madsen
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Madsen ME, Carnahan KG, Thwaits RN. Evaluation of pig lungs following an experimental challenge with Actinobacillus pleuropneumoniae serotype 1 and 5 in pigs inoculated with either hemolysin protein and/or outer membrane proteins. FEMS Microbiol Lett 1995; 131:329-35. [PMID: 7557344 DOI: 10.1111/j.1574-6968.1995.tb07796.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Histopathological changes were compared in pigs challenged with Actinobacillus pleuropneumoniae serotype 1 and serotype 5 after inoculation with subunit vaccines. The vaccines consisted of outer membrane protein and/or hemolysin protein isolated from Actinobacillus pleuropneumoniae serotype 1 or both subunits combined. Twenty-seven cross-bred pigs were separated into six groups: Groups I and IV were vaccinated and boostered with 1500 micrograms outer membrane protein; Groups II and V were vaccinated and boostered with 250 micrograms hemolysin protein; Groups III and VI were vaccinated and boostered with a combination of 1500 micrograms outer membrane protein and 250 micrograms hemolysin protein. Groups I, II and III were challenged with A. pleuropneumoniae serotype 1; and Groups IV, V and VI were challenged with A. pleuropneumoniae serotype 5. Groups III and VI demonstrated the least severe lung tissue damage, with significantly lower (P < 0.05) lung involvement as compared to the other groups. Lesions were noted in all six groups. These results showed that complete protection against A. pleuropneumoniae infection was not feasible using a subunit vaccine consisting of just outer membrane protein and hemolysin protein, and that some cross-protection did occur.
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Affiliation(s)
- M E Madsen
- Department of Animal Science, College of Biology and Agriculture, Brigham Young University, Provo, UT 84602, USA
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