Brain catecholamine depletion and motor impairment in a Th knock-in mouse with type B tyrosine hydroxylase deficiency

Tyrosine hydroxylase catalyses the hydroxylation of L-tyrosine to l-DOPA, the rate- limiting step in the synthesis of catecholamines. Mutations in the TH gene encoding tyrosine hydroxylase are associated with the autosomal recessive disorder tyrosine hydroxylase deficiency, which manifests phenotypes varying from infantile parkinsonism and DOPA-responsive dystonia, also termed type A, to complex encephalopathy with perinatal onset, termed type B. We generated homozygous Th knock-in mice with the mutation Th-p.R203H, equivalent to the most recurrent human mutation associated with type B tyrosine hydroxylase deficiency (TH-p.R233H), often unresponsive to l-DOPA treatment. The Th knock-in mice showed normal survival and food intake, but hypotension, hypokinesia, reduced motor coordination, wide-based gate and catalepsy. This phenotype was associated with a gradual loss of central catecholamines and the serious manifestations of motor impairment presented diurnal fluctuation but did not improve with standard l-DOPA treatment. The mutant tyrosine hydroxylase enzyme was unstable and exhibited deficient stabilization by catecholamines, leading to decline of brain tyrosine hydroxylase-immunoreactivity in the Th knock-in mice. In fact the substantia nigra presented an almost normal level of mutant tyrosine hydroxylase protein but distinct absence of the enzyme was observed in the striatum, indicating a mutation-associated mislocalization of tyrosine hydroxylase in the nigrostriatal pathway. This hypomorphic mouse model thus provides understanding on pathomechanisms in type B tyrosine hydroxylase deficiency and a platform for the evaluation of novel therapeutics for movement disorders with loss of dopaminergic input to the striatum

Towards targeting prolactin signaling in human diseases: Stimulate or inhibit?

Prolactin is an anterior pituitary hormone that was originally named for its indispensable role in lactation, but increasingly it is being recognized for pleiotropic roles in metabolism, immune function, pregnancy adaptations and parental behaviour. Prolactin secretion is tightly controlled by a short-loop feedback system whereby prolactin stimulates specific neurons in the hypothalamus to release dopamine, which then inhibits prolactin secretion. During pregnancy and lactation, however, this feedback systems adapts to allow prolonged elevations in prolactin secretion, enabling a range of functions specific to these conditions. Prolactin is also released under conditions of stress in both sexes. Prolactin signals exclusively through the prolactin receptor (Prlr), but this is not a simple system. In target cells, prolactin/Prlr engages various signal transduction mechanisms including JAK2/STAT5 (canonical), PI3K/Akt, MAPK and Src family kinases. There is also evidence of local production of prolactin in non-pituitary tissues, leading to autocrine/paracrine receptor triggering independent of circulating hormone. Adding to this complexity, in many species, including humans, there are multiple ligands for the Prlr. These include placental lactogens that supplement prolactin function in pregnancy, and in primates only, pituitary growth hormone. Moreover, specific proteolytic products of these hormones exert important biological actions independent of Prlr. These functions, that are often completely distinct from those of prolactin, have led to the classification of these fragments as a new class of hormones known as vasoinhibins.Fil: Goffin, Vincent. Universite de Paris V; Francia. Inserm; FranciaFil: Becu, Damasia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Popovic, Vera. University of Belgrade; SerbiaFil: Grattan, David R.. University of Otago; Nueva Zeland

Necrotizing fasciitis: a diagnosis not be missed

Scopul lucrării. Fasceita necrozantă (FN) este o boală rară, dar de severitate deosebită. Dacă diagnosticul de FN nu este stabilit prompt infecția poate avea o evoluție rapidă cu afectarea masivă a țesuturilor, efect toxic sistemic și chiar deces. Scopul lucrării este raportarea cazurilor clinice de fasceita necrozantă la 2 persoane tinere şi analiza modalităților de tratament chirurgical. Materiale și metode. Raportăm 2 cazuri de NF la persoane tinere fără comorbidități. S-a dovedit că pacienții aveau un exces de medicamente antiinflamatoare nesteroidiene (n=2) și steroizi (n=1) înainte de spitalizare. Ambii pacienți prezentau durere locală disproporționată, eritemul moderat al zonei afectate, febra și leucocitoza neutrofilă peste 30,000/l. Pentru predicția evoluției NF a fost utilizat sistemul de scoruri LRINEC. În ambele cazuri maladia a progresat destul de rapid, în pofida administrării antibioticelor cu spectru larg, peste de mai puțin de 12 ore la ambii pacienți s-a dezvoltat o zonă extinsă de necroză a țesuturilor moi și semne de instabilitate hemodinamică. Pacienții au fost supuși intervenției chirurgicale de urgență cu efectuarea debridării țesuturilor sfacelate și fasciotomiei. Terapia plăgilor cu presiune negativă (TPPN) a fost folosită cu succes la un pacient. Rezultate. Pacienții au suferit mai mult de 4 necrectectomii succesive. Perioada de tratament în staționar a constituit mai mult de 40 zile la pacient cu tratament chirurgical tradițional și 20 zile în cazul utilizării TPPN. Concluzii. În timp ce persoane tineri și sănătoși dezvoltă NF destul de rar, evoluția bolii poate avea un caracter fulminant. Diagnosticul precoce și tratamentul chirurgical prompt al NF sunt cheia rezultatelor favorabile. Presupunem că utilizarea TPPN ar putea fi un adjuvant promițător la tratamentul multimodal al FN.Aim of study. Necrotizing fasciitis (NF) is a rare but life-threatening infection. Any delay in diagnosis may result in massive necrosis of the soft tissues, sepsis and death. The aim is a clinical case report of necrotizing fasciitis recorded in 2 young healthy individuals and the analysis of its treatment modalities. Materials and methods. We observed two consecutive cases of NF in young and healthy individuals without comorbidities. Patients were proven to have an excess of non-steroid anti-inflammatory drugs (n=2) and steroids (n=1) prior hospitalization. Both patients presented disproportionate local pain, swelling moderate erythema of affected area, flu-like signs and white blood count was in excess of 30.000/l. The Laboratory Risk Indicator for NF (LRINEC) was used for prediction of disease severity. In both cases the disease progressed quite rapidly regardless of broad-spectrum antibiotics, it took less than 12 hours for an extensive area of soft tissue necrosis and low blood pressure to develop. The emergency surgical debridement of the affected tissues and fasciotomy were performed. The negative pressure wound therapy (NPWT) therapy was successfully used in one case. Results. Patients underwent more than 4 consecutive surgical debridement procedures totally. The length of hospital stay was more than 40 days in case of conventional gauze therapy and 20 days when NPWT was used. Conclusions. While young and healthy individuals develop NF quite rare, the course of disease is fulminant. Early diagnosis and prompt surgical treatment of NF is mandatory. We assume that use of NPWT could be a promising adjuvant to the treatment strategy of NF

Metritis in dairy cows: Risk factors and reproductive performance

The objectives of this study were to assess the risk factors for metritis, its effects on milk yield and on reproductive performance, and the efficacy of ceftiofur therapy in Holstein dairy cows. Cows (n. =. 303) from a commercial dairy herd in Argentina were studied. Cows were scored for body condition, and blood samples were collected on d -14, 7, 21, 31, 41, and 50 relative to parturition. Cows having a watery, purulent, or brown, and fetid vaginal discharge (VD) and rectal temperature ≤39.2°C were diagnosed as having clinical metritis, and those having a similar VD and rectal temperature >39.2°C were diagnosed as having puerperal metritis. Both clinical and puerperal metritis cows were randomly assigned to control (no treatment) or ceftiofur group (2.2. mg/kg. ×. 3 consecutive days). Cure was declared if clear VD was observed at 21 d in milk (DIM). Blood samples were analyzed for nonesterified fatty acids, β-hydroxybutyrate, and blood urea nitrogen using commercial kits, and for insulin-like growth factor-1, insulin, and leptin by RIA. Data were analyzed with PROC MIXED, GENMOD, PHREG, and LIFETEST from SAS (SAS Institute Inc., Cary, NC). The risk for metritis increased with dystocia, retained fetal membranes, and dead calf [AOR (adjusted odds ratio). =. 2.58, 95% CI: 1.189-5.559], and as prepartum nonesterified fatty acids levels increased (AOR. =. 1.001, 95% CI: 0.999-1.002). Conversely, risk decreased as prepartum insulin-like growth factor-1 increased (AOR. =. 0.65, 95% CI: 0.349-1.219). Cows having either clinical or puerperal metritis produced less milk by 90 DIM than did healthy cows (2,236. ±. 172 vs. 2,367. ±. 77 vs. 2,647. ±. 82 kg, respectively). Cows with puerperal metritis had lower risk for pregnancy by 100 DIM (AOR. =. 0.189, 95% CI: 0.070-0.479) and a lower hazard rate for pregnancy by 150 DIM (hazard rate: 0.753, 95% CI: 0.621-0.911), and took longer to get pregnant (129 vs. 111 vs. 109 d, for puerperal metritis, clinical metritis, and healthy cows, respectively). Ceftiofur treatment was not associated with cure rate or milk yield but was related to increased risk for pregnancy at timed artificial insemination (AOR. =. 2.688, 95% CI: 0.687-10.832), and for lower risk of reproductive cull (AOR. =. 0.121, 95% CI: 0.014-1.066). In conclusion, abnormal calving and negative energy balance are associated with increased risk for metritis. Metritis, especially puerperal metritis, correlates with reduced milk production and poor reproductive performance. Finally, the likelihood for having a normal VD (indicative of cure) increased 2.6% for every day of increase in postpartum time and was 2 times higher for cows with clinical metritis than for those with puerperal metritis.Facultad de Ciencias Veterinaria

Surgical tactics in anorectal associated pathology

Catedra de chirurgie nr. 5, Facultatea stomatologie, Unversitatea de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Problema abordului chirurgical al hemoroizilor cronici (HC) asociați cu fistulă pararectală, paraproctită acută, fisură anală cronică preocupă majoritatea chirurgilor, iar dilema chirurgului este de a efectua intervenție unimomentană sau de a planifica în doi sau mai mulți timpi, scopul fiind izbăvirea pacientului de operații repetate, sindromul algic persistent postoperator, cât și de cheltuelile financiare suportate. Scopul: ameliorarea rezultatelor tratamentului chirurgical al patologiei asociate al zonei anorectale cît și aprecierea tacticii chirurgicale abordate. Material și metode: În secţia chirurgie a SCC or. Chișinău s-au aflat la tratament chirurgical în perioada anilor 2008-2017, 345 pacienţi cu diverse patologii a zonei anorectale: HC 217; fisură anală cronică 67; paraproctită acută 19 pacienți; paraproctită cronică 42. Raportul barbaţi / femei fiind 295 / 50, vârsta între 18-82 ani. Rezultate: Hemoroidectomia Milligan-Morgan sau Whithead - 192 cazuri, pentru HC stadiu IV si prolaps rectal gr.I-II- WhitheadVercescu- 25 cazuri,HC si fisura anală cronică complicată cu strictură a canalului anal- Milligan- Morgan cu sfincterotomie dozată extramucoasă tip Rijih- 67 cazuri,HC asociați cu fistula pararectală s-a practicat metoda Gabriel si hemoroidectomia cu restabilirea partială a punţilor cutaneo-mucoase sau plaga semideschisă 42 cazuri. Concluzii: Tactica chirurgicală depinde de localizarea proceselor purulente, gradul de complexitate a traiectului fistulos si stadiul bolii hemoroidale asociate, intervenția unimomentană are o perspectivă de dezvoltare cu impact economic al tacticii alese, îmbunataţirea stării psiho-emoţionale a pacientului și integrarea precoce în câmpul muncii.Background: The surgical approach problem of chronic hemorrhoids (CH) associated with pararectal fistula, acute paraproctitis, chronic anal fissure concerns most surgeons, and surgeon’ dilemma is to perform unimomental surgery or to plan it in a short period of time, the aim being to protect patient from repeated surgeries, persistent painful postoperative syndrome, and incurred financial expenses. Purpose: improvement of the surgical treatment results of the associated pathology of the anorectal area and appreciation of the approached surgical tactics. Methods and materials: 345 patients with various anorectal pathologies underwent surgical treatment in 2008-2017 at CSS Surgery Department from Chisinau: CH 217; chronic anal fissure 67; acute paraproctitis 19 patients; chronic paraproctitis 42; male / female ratio being 295/50, ages 18-82 years. Results: Milligan-Morgan or Whithead hemorrhoidectomy - 192 cases for CH stage IV and rectal prolapse gr.I-II- WhitheadVercescu- 25 cases, CH and chronic anal fissure complicated with anal canal stricture Milligan-Morgan with Rijih dosed extramucosal sphincterotomy - 67 cases, CH associated with the pararectal fistula Gabriel method and hemorrhoidectomy with partial restoration of cutaneous mucosal bridges or semi-open wound was used in 42 cases. Conclusions: Surgical tactics depends on purulent processes location, complexity degree of the fistula tract and associated hemorrhoidal disease stage, unimomental intervention has a developmental perspective with economic impact of the chosen tactics, the improvement of patient’s psycho-emotional state and the early integration into the workplace

Urodynamic disorders in patients with proctologic operations

Catedra de chirurgie nr. 5, Facultatea stomatologie, Universitate de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Retenţia acută a urinei si ischuria postoperatorie după operaţiile efectuate la nivelul zonei anorectale ramân a fi într-un procent înalt. Datele literaturii relatează, că după orice operaţie, chiar și minim-invazivă, pot surveni aceste dereglări. Scopul: Profilaxia apariției manifestărilor disurice la pacienții cu operații proctologice. Material și metode: În secţia chirurgie a SCC or. Chișinău s-au aflat la tratament chirurgical în perioada anilor 2008-2017, 345 pacienţi cu diverse patologii a zonei anorectale: HC 217; fisură anală cronică 67; paraproctită acută 19 pacienți; paraproctită cronică 42; raportul barbaţi / femei fiind 295 / 50, vârsta între 18-82 ani. Rezultate: Hemoroidectomia Milligan-Morgan sau Whithead - 192 cazuri, pentru HC stadiu IV și prolaps rectal gr. I-II - WhitheadVercescu- 25 cazuri, HC si fisura anală cronică complicată cu strictură a canalului anal- Milligan- Morgan cu sfincterotomie dozată extramucoasă tip Rijih- 67 cazuri,HC asociați cu fistula pararectală s-a practicat metoda Gabriel si hemoroidectomia cu restabilirea parțială a punţilor cutaneo-mucoase sau plaga semideschisă 42 cazuri. Retentie acută urinară s-a constatat la 30 pacienți (17 bărbați și 13 femei), care s-a rezolvat ulterior prin administrarea preparatului ,,Omnic” 4 mg, uroseptice și antispastice, iar la 3 pacienti a fost necesar de aplicat cateter Foley pe 5 zile. Concluzii: Administrarea preparatelor α-adrenoblocatori, urosepticelor și antispasticelor duc la lichidarea semnelor clinice ale manifestărilor disurice, un rol important în profilaxie revenindu-i examenului USG al bazinului mic.Background: Acute retention of urine and postoperative ischuria after anorectal surgeries remain to have a high percentage. Literature data report that these disturbances may occur after any surgical intervention even though it is minimally invasive. Aim of the study: Prophylaxis of dysuria manifestations in patients with proctologic operations. Methods and Materials: 345 patients with various anorectal pathologies underwent surgical treatment in 2008-2017 at CCS Surgery Department from Chisinau: CH 217; chronic anal fissure 67; acute paraproctitis 19 patients; chronic paraproctitis 42; male / female ratio being 295/50, aged 18-82 years. Results: Milligan-Morgan or Whithead hemorrhoidectomy - 192 cases for CH stage IV and rectal prolapse gr.I-II- Whithead- Vercescu25 cases, CH and chronic anal fissure complicated with stricture of the anal canal -Milligan-Morgan with Rijin dosed extramucosal sphincterotomy - 67 cases, CH associated with pararectal fistula, Gabriel method and hemorrhoidectomy with partial restoration of cutaneous mucosal bridges or semi-open wound were performed in 42 cases. Acute urinary retention was found in 30 patients (17 males and 13 females) being subsequently resolved administering 4mg ,,Omnic”, uroseptic and antispasmodic preparations, whereas Foley catheter was necessary to be applied for 5 days in 3 patients. Conclusions: The administration of α-adrenoblocker, uroseptic and antispastic preparations, leads to the elimination of disuric manifestations clinical signs, USG examination of the pelvis plays an important role in prophylaxis

Surgical treatment of obesity in the presence of abdominal wall eventrations

Spitalul Clinic Militar Central al Armatei Naționale, Chişinău, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Actualitatea temei: țesutul adipos pe peretele abdomenului cu herniile peretelui abdominal sau chiar fiind un factor etiologic în apariția lor necesită o conduită chirurgicală modernă nu doar etio-patogenetică ci şi estetică. Materiale şi metode: S-au luat în calcul datele activitătii chirurgicale de 4 ani. Procedeele de hernioplastii utilizate: cu plasă sintetică, cu țesuturi proprii , dermolipectomii şi abdomenoplastii. Rezultate obținute: Între 2008-2011 în secția chirurgie generală a SCMC s-au tratat- 130 pacienți cu obezitate: supraponderali cu indicele de masă corporală-27- 30kgmp-80(61%); obezitate moderată-30-40kgmp- 30(23%); şi obezitate morbidă peste- 40kgmp-20(15%) pacienți. Bărbați-55(42%), femei-75(57%). Vîrsta medie-65 ani.Cu hernii ale peretelui abdominal-68(52%) pacienți. Eventrații postoperatorii-45(34%). La acest lot s-a efectuat şi hernioplastia cu utilizarea meşelor sintetice. Asocierea herniilor ombelicale cu sau fără diastaza recților abdominali s-a înregistrat în-23(17,6%) cazuri. În-15(11,5%) cazuri s-a efectuat hernioplastia cu țesuturi proprii. Hernioplastia cu plasă de prolen a fost executată în 53(39,2%) cazuri.În toate cele-68(52%) cazuri s-a efectuat corecția cosmetică a peretelui abdominal. În-24(18,4%) cazuri s-a efectuat dermolipectomia- îndepărtarea excesului cutanat şi a țesutului adipos subiacent. În-20(15,3%) cazuri s-a executat abdomenoplastia, adică corectarea peretelui anterior prin înlăturarea lamboului cutaneo adipos, menajarea ombilicului şi omfaloplastia. În-24(18,4%) cazuri la pacienții cu flaciditate cutanată extremă „abdomen ptozat” s-a efectuat dermolipectomia cu omfalectomia. Anestezia generală s-a utilizat în-58(%) cazuri, în rest peridurală şi intravenoasă. Complicații majore nu s-au înregistrat, doar-7 cazuri cu seroame între 7-20 de zile. Cazuri de liposucțiune nu au fost.Concluzii:Operațiile cu scop estetic şi reparator ale peretelui abdominal sunt practicate de chirurgi pregătiți cu echipament corespunzător. Procedeele de abdominoplastie, dermolipectomie cu reinserția ombilicului sînt indicate candidaților cu o stare bună de sănătate.Novelty: The fat tissue on the abdominal wall with abdominal wall hernias being an etiological factor in their occurrence requires modern surgical management both etiopathogenetic and aesthetic. Materials and methods: Data within 4 years of surgical activity have been analyzed. The following procedures of hernioplasties were used: synthetic mesh, the body proper tissues, dermolipectomies, and abdomenoplasties. Results: 130 patients suffering from obesity were treated in the Department of General Surgery of SCMC between 2008-2011. Categories of patients included: overweight patients with body mass index-27-30 kgmp - 80(61%); moderate obesity 30-40 kgmp - 30(23%); morbid obesity over 40 kgmp - 20 (15%) patients. There were 55 (42%) men and 75 (57%) women. The average age was 65 years. Abdominal wall hernias were revealed in 68 (52%) patients. Postoperative eventrations were recorded in 45 (34%) patients. This lot underwent hernioplasty using synthetic mesh. Association of umbilical hernias with or without diastase of the abdominal recti was revealed in-23 (17.6%) cases. Hernioplasty using the body proper tissues was performed in 15 (11.5%) cases. Hernioplasty with mesh was performed in 53 (39.2%) cases. In all 68 (52%) cases cosmetic correction of the abdominal wall was performed. Dermolipectomy-removal of excess skin and underlying fat tissue was performed in 24 (18.4%) cases. In 20 (15.3%) cases abdominoplasty, i.e. correction of the anterior wall by removing the cutaneous fat flap, taking care of the navel, and omphalloplasty, was performed. In 24 (18.4%) cases in patients with extreme skin flaccidity “ abdomen ptosis “was performed dermolipectomy with omphalectomy. General anesthesia was used in 58 (%) cases, otherwise epidural and intravenous ones. No major complications were recorded, only 7 cases with seromas between 7-20 days. There were no cases of liposuction. Conclusions: Aesthetic and repairing surgeries are performed by well-trained and experienced surgeons with appropriate equipment to restore the abdominal wall. Abdominoplasty procedures, dermolipectomy with navel reinsertion are indicated to patients in good health

Metritis in dairy cows: Risk factors and reproductive performance

The objectives of this study were to assess the risk factors for metritis, its effects on milk yield and on reproductive performance, and the efficacy of ceftiofur therapy in Holstein dairy cows. Cows (n. =. 303) from a commercial dairy herd in Argentina were studied. Cows were scored for body condition, and blood samples were collected on d -14, 7, 21, 31, 41, and 50 relative to parturition. Cows having a watery, purulent, or brown, and fetid vaginal discharge (VD) and rectal temperature ≤39.2°C were diagnosed as having clinical metritis, and those having a similar VD and rectal temperature >39.2°C were diagnosed as having puerperal metritis. Both clinical and puerperal metritis cows were randomly assigned to control (no treatment) or ceftiofur group (2.2. mg/kg. ×. 3 consecutive days). Cure was declared if clear VD was observed at 21 d in milk (DIM). Blood samples were analyzed for nonesterified fatty acids, β-hydroxybutyrate, and blood urea nitrogen using commercial kits, and for insulin-like growth factor-1, insulin, and leptin by RIA. Data were analyzed with PROC MIXED, GENMOD, PHREG, and LIFETEST from SAS (SAS Institute Inc., Cary, NC). The risk for metritis increased with dystocia, retained fetal membranes, and dead calf [AOR (adjusted odds ratio). =. 2.58, 95% CI: 1.189-5.559], and as prepartum nonesterified fatty acids levels increased (AOR. =. 1.001, 95% CI: 0.999-1.002). Conversely, risk decreased as prepartum insulin-like growth factor-1 increased (AOR. =. 0.65, 95% CI: 0.349-1.219). Cows having either clinical or puerperal metritis produced less milk by 90 DIM than did healthy cows (2,236. ±. 172 vs. 2,367. ±. 77 vs. 2,647. ±. 82 kg, respectively). Cows with puerperal metritis had lower risk for pregnancy by 100 DIM (AOR. =. 0.189, 95% CI: 0.070-0.479) and a lower hazard rate for pregnancy by 150 DIM (hazard rate: 0.753, 95% CI: 0.621-0.911), and took longer to get pregnant (129 vs. 111 vs. 109 d, for puerperal metritis, clinical metritis, and healthy cows, respectively). Ceftiofur treatment was not associated with cure rate or milk yield but was related to increased risk for pregnancy at timed artificial insemination (AOR. =. 2.688, 95% CI: 0.687-10.832), and for lower risk of reproductive cull (AOR. =. 0.121, 95% CI: 0.014-1.066). In conclusion, abnormal calving and negative energy balance are associated with increased risk for metritis. Metritis, especially puerperal metritis, correlates with reduced milk production and poor reproductive performance. Finally, the likelihood for having a normal VD (indicative of cure) increased 2.6% for every day of increase in postpartum time and was 2 times higher for cows with clinical metritis than for those with puerperal metritis.Facultad de Ciencias Veterinaria