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The aim of this study was to investigate the effect of different heparin concentrations in the course of sexed in vitro fertilization (IVF), on bovine embryonic development and development to term following embryo transfer (ET). With a total of 9156 oocytes for IVF, sorted as well as unsorted sperm from four bulls had different heparin requirements for achieving the highest rate of development in vitro. However, when optimal heparin concentrations were used (40 to 80 µg/ml), the performance of X-sorted sperm (0.3 × 106/ml/IVF droplet) from all four bulls, as judged by blastocyst development (Bulls A, B, C, and D: 25.2, 19.7, 25.1, and 9.8%, respectively), was significantly increased, and the blastocyst rate was comparable to that observed with unsorted sperm at certain heparin concentrations within the four bulls. We determined that near-optimal blastocyst development was possible with sorted sperm from all four bulls, when a heparin concentration of 40 µg/ml was used. Pregnancy rates at d 70 post ET ranged from 39.1 to 40.3% (P > 0.05), and the calving rates ranged from 34.4 to 35.1% (P > 0.05), when heparin was used at a concentration of 10 μg/ml (n = 236), 20 μg/ml (n = 189), and 40 μg/ml (n = 305), respectively. Our study demonstrates that, although the sorted sperm of different bulls performed optimally over a range of heparin concentrations, a generally accepted heparin concentration of 40 µg/ml can be set for sexed IVF. This improvement is beneficial when sexed embryo production by ovum pickup and IVF is an essential component of genetic breeding programs.

Background: The 2018 WAKE-UP Trial established the safety and efficacy of administering IV-tPA in patients who presented within 4.5 hours of symptom discovery based on specific MRI sequences. Implementation of the study results remains limited at Primary Stroke Centers (PSCs). We assessed the feasibility of a Comprehensive Stroke Center (CSC) MRI based unwitnessed thrombolysis protocol at 13 PSCs. Methods: A committee consisting of vascular neurologists, neuroradiologists and MRI technologists developed the protocol. The protocol was utilized at the CSC for one year, and subsequently expanded to the PSCs. A specific "WAKE-UP MRI”" order was created which consisted of only DWI, GRE and FLAIR sequences. MRI technologists were trained to ensure that the "WAKE-UP MRI” would take priority over other patients; eg: if there was no one in MRI, it would be held for the stroke patient, and if MRI was occupied, the stroke patient would be next. The acute stroke care was managed by an integrated telestroke system at the PSCs. All telestroke providers were educated on the protocol. Standard stroke time metrics were collected and analyzed over 2 years. Data from the CSC was compared with its 13 PSC spokes. A student’s t-test was used for data analysis. Results: A total of 190 patients who arrived with 4.5 hours of symptom discovery were screened; 62 at CSC and 128 at PSCs. Forty underwent emergent MRI at CSC and 29 at PSCs. Median door to MRI time was longer for patients presenting to PSC compared to CSC (78 vs 53.5 mins; p = 0.0002). Twenty-one vs 9 patients received tPA at CSC and PSC hospitals respectively. Median door to needle (DTN) times were longer for patients at PSC vs CSC (106 vs 67 mins; p = .018). The most common reasons for not administering IV-tPA was a negative MRI (40% at PSCs vs 47% at CSC) and a lack of DWI and FLAIR mismatch (40% at PSCs vs 42% at CSC). Conclusion: Use of emergent MRI in unwitnessed stroke for thrombolysis is feasible at PSCs. There remain barriers to implementation, with PSCs showing more delayed access to MRI and thrombolysis compared to CSC.

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Introduction: In-hospital strokes (IHS) often have delayed recognition time and a delay in physician assessment, playing a role in unfavorable outcomes. Telestroke (TS) participation is linked to lower odds of hospital mortality and is safe and effective in treating acute ischemic stroke. We implemented a TS program for IHS patients at primary stroke centers (PSC) and assessed tPA time metrics, complications and 90-day functional outcomes as compared to a robust in hospital stroke system of care at a comprehensive stroke center (CSC). Methods: Using a network database, data for all in-hospital code strokes were retrospectively abstracted between 2010-2020 at a CSC and 11 PSC’s. The CSC was compared to PSC’s pre and post implementation of a TS program. Data were analyzed using Wilcoxon rank-sum test, chi-square and exact tests. Results: We identified 193 patients, 77 at the CSC, 71 at pre-tele PSC’s, and 45 at post-tele PSC’s. Symptom-recognition-time (SRT) to neurology evaluation (median 15min {IQR 10-27} vs 75min {IQR 45-126, p=<0.0001) and SRT to IV t-PA (median 65min {IQR 46-91} vs 94min {IQR 73-112}, p=<0.001) were all faster at the CSC vs pre-tele PSC’s. There was no difference in rate of complications (p=0.05). When stroke mimics were excluded, CSC patients had a favorable 90-day mRS of 0-1 (24 patients, 35% vs 11 patients, 19%, p=0.04). After implementation of TS at PSC’s, there was no difference in tPA time metrics, except SRT to neurology evaluation remained faster at CSC (median 15min {IQR 10-27} vs 31min {IQR 18.5-52.5}, p=0.0002). There was no difference in rate of complications (p=0.21) and mRS at 90 days (p=0.82). Conclusions: Implementation of a TS program for IHS at PSC’s may improve tPA time metrics and 90 functional outcomes to the standards of CSC’s without increasing complication rates. Our study was limited by retrospective design and small sample size.