Analyze Diet

Topic:Salivary Cortisol

Salivary cortisol is a biomarker used to assess stress and physiological responses in horses. It is a glucocorticoid hormone produced by the adrenal cortex and is released into the bloodstream in response to stressors, with measurable levels detectable in saliva. The non-invasive collection of saliva makes it a practical method for evaluating cortisol levels in equine studies. Salivary cortisol is utilized in research to explore stress-related conditions, welfare assessments, and the effects of training or environmental changes on horses. This page compiles peer-reviewed research studies and scholarly articles that investigate the measurement, variability, and implications of salivary cortisol in equine health and behavior.
Effect of housing system on reproductive behaviour and on some endocrinological and seminal parameters of donkey stallions.
Reproduction in domestic animals = Zuchthygiene    August 14, 2017   Volume 53, Issue 1 40-47 doi: 10.1111/rda.13050
Rota A, Sgorbini M, Panzani D, Bonelli F, Baragli P, Ille N, Gatta D, Sighieri C, Casini L, Maggiorelli MM, Aurich C, Camillo F.Reproductive management of male donkeys employed for artificial breeding has been poorly studied. The aim of this study was to evaluate the effect of housing system, with the animals grouped together in a paddock or kept in individual boxes, on sexual behaviour, cortisol and testosterone concentration and seminal characteristics of adult male donkeys. The study included four Amiata donkey jacks (stallions) from which ejaculates, saliva and blood were collected during two distinct 3 weeks periods, one in the group and one in the box housing system. Time needed for semen collection was shorter ...
The Effects of Weaning Methods on Gut Microbiota Composition and Horse Physiology.
Frontiers in physiology    July 25, 2017   Volume 8 535 doi: 10.3389/fphys.2017.00535
Mach N, Foury A, Kittelmann S, Reigner F, Moroldo M, Ballester M, Esquerré D, Rivière J, Sallé G, Gérard P, Moisan MP, Lansade L.Weaning has been described as one of the most stressful events in the life of horses. Given the importance of the interaction between the gut-brain axis and gut microbiota under stress, we evaluated (i) the effect of two different weaning methods on the composition of gut microbiota across time and (ii) how the shifts of gut microbiota composition after weaning affect the host. A total of 34 foals were randomly subjected to a progressive (P) or an abrupt (A) weaning method. In the P method, mares were separated from foals at progressively increasing intervals every day, starting from five min ...
The effects of intrauterine infusion of peanut oil on endometrial health, salivary cortisol and interovulatory period in mares.
Theriogenology    July 13, 2017   Volume 102 116-125 doi: 10.1016/j.theriogenology.2017.07.009
Campbell MLH, Hampshire D, Hamstead LE, Rose BV, Smith KC, de Mestre AM.Intrauterine infusion of peanut oil at Day 10 post-ovulation has been reported to prolong dioestrus in mares. However, the effects of peanut oil treatment on the endometrium and whether the technique is painful have not been assessed. The objectives of this study were, (i) to determine the effect of intrauterine infusion of peanut oil on endometrial health, (ii) to determine whether use of intrauterine peanut oil is painful and (iii) to confirm that peanut oil causes prolonged dioestrus. Six mares aged 3-12 years old were used in a cross-over design with each mare administered both 1 ml of in...
An exploratory study of competition scores and salivary cortisol concentrations in Warmblood horses.
Domestic animal endocrinology    June 28, 2017   Volume 61 108-116 doi: 10.1016/j.domaniend.2017.06.007
Munk R, Jensen RB, Palme R, Munksgaard L, Christensen JW.The main objective of this explorative study was to describe the relationship between competition scores and salivary cortisol concentrations in young horses during dressage and showjumping competitions. The study also investigated whether the diurnal rhythm of salivary cortisol concentrations was affected by competition over consecutive days compared with the home environment. Saliva samples were collected from 126 dressage horses and showjumpers in their home environment and at 3 different events. The relationship between scores given by judges at the competition and cortisol concentrations ...
Use of fecal glucocorticoid and salivary cortisol concentrations as a measure of well-being of New York City carriage horses.
Journal of the American Veterinary Medical Association    January 25, 2017   Volume 250, Issue 3 316-321 doi: 10.2460/javma.250.3.316
Mercer-Bowyer S, Kersey DC, Bertone JJ.OBJECTIVE To use noninvasive approaches to assess stress in New York City (NYC) carriage horses during the course of their daily routine to determine whether use of these horses affected their well-being. DESIGN Prospective case control study. ANIMALS 13 (5 mares and 8 geldings) stabled working NYC carriage horses and 5 pastured (nonworking) NYC carriage horses (1 mare and 4 geldings). PROCEDURES Samples for determination of fecal glucocorticoid and salivary cortisol concentrations were collected on 3 successive days from 10, 8, and 9 working carriage horses during rest (time 1), preparation f...
Oxytocin treatment does not change cardiovascular parameters, hematology and plasma electrolytes in parturient horse mares.
Theriogenology    December 24, 2016   Volume 91 69-76 doi: 10.1016/j.theriogenology.2016.12.028
Nagel C, Trenk L, Wulf M, Ille N, Aurich J, Aurich C.In mares, foaling is associated with changes in hematology, plasma electrolytes, blood pressure and heart rate and it has been hypothesized that these are induced by oxytocin. To test this hypothesis, mares (n = 8-14/group) were treated with oxytocin (OT; 20 I.U.) or saline (CON) at 1 h (test A) and 12 h after foaling (test B) and during first postpartum diestrus (test C). Heart rate, heart rate variability (HRV), atrioventricular blocks, salivary cortisol concentration, blood pressure, plasma electrolytes and blood count were determined. Heart rate decreased from test A to C (P < 0.001)...
Influence of transvaginal ultrasound-guided follicular punctures in the mare on heart rate, respiratory rate, facial expression changes, and salivary cortisol as pain scoring.
Theriogenology    June 6, 2016   Volume 86, Issue 7 1757-1763 doi: 10.1016/j.theriogenology.2016.05.040
Diego R, Douet C, Reigner F, Blard T, Cognié J, Deleuze S, Goudet G.Transvaginal ultrasound-guided follicular punctures are widely used in the mare for diagnosis, research, and commercial applications. The objective of our study was to determine their influence on pain, stress, and well-being in the mare, by evaluating heart rate, breath rate, facial expression changes, and salivary cortisol before, during, and after puncture. For this experiment, 21 pony mares were used. Transvaginal ultrasound-guided aspirations were performed on 11 mares. After injections for sedation, analgesia, and antispasmodia, the follicles from both ovaries were aspirated with a needl...
Validation of a novel saliva-based ELISA test for diagnosing tapeworm burden in horses.
Veterinary clinical pathology    May 24, 2016   Volume 45, Issue 2 335-346 doi: 10.1111/vcp.12364
Lightbody KL, Davis PJ, Austin CJ.Tapeworm infections pose a significant threat to equine health as they are associated with clinical cases of colic. Diagnosis of tapeworm burden using fecal egg counts (FECs) is unreliable, and, although a commercial serologic ELISA for anti-tapeworm antibodies is available, it requires a veterinarian to collect the blood sample. A reliable diagnostic test using an owner-accessible sample such as saliva could provide a cost-effective alternative for tapeworm testing in horses, and allow targeted deworming strategies. Objective: The purpose of the study was to statistically validate a saliva ta...
Repeatability of the ACTH stimulation test as reflected by salivary cortisol response in healthy horses.
Domestic animal endocrinology    May 12, 2016   Volume 57 43-47 doi: 10.1016/j.domaniend.2016.04.002
Scheidegger MD, Gerber V, Ramseyer A, Schüpbach-Regula G, Bruckmaier RM, van der Kolk JH.The aim of this study was to further characterize the ACTH stimulation test as reflected by salivary cortisol response and to measure the short- and long-term repeatability of it in healthy horses as a tool to assess the capacity of the adrenal cortex to secrete cortisol. Nineteen healthy horses were subjected to 3 ACTH stimulation tests. Intervals were 2 wk and 5 mo between the first and second and the second and third tests, respectively. A dose of 1-μg/kg BW synthetic ACTH was injected intravenously. Saliva samples were collected at baseline and at 30, 60, 90, 120, 150, and 180 min afte...
Influence of Horse and Rider on Stress during Horse-riding Lesson Program.
Asian-Australasian journal of animal sciences    March 22, 2016   Volume 29, Issue 6 895-900 doi: 10.5713/ajas.15.1068
Kang OD, Yun YM.The present study aims to confirm the influence of a horse-riding lesson program (HRLP) on the stress level of horses and riders by respectively analyzing their salivary cortisol concentration. Twenty-four healthy horses and 23 riders participated in this study. The horses were randomly classified into two groups for the horse riding lesson program: Class 1 (for the beginner lesson) and Class 2 (for the intermediate lesson). The Class 1 group consisted of 12 horses and 12 riders, while the Class 2 group consisted of 12 horses and 11 riders. Salivettes cotton wool swabs were used for saliva col...
Changes in Salivary Cortisol Concentration in Horses during Different Types of Exercise.
Asian-Australasian journal of animal sciences    March 4, 2016   Volume 29, Issue 5 747-752 doi: 10.5713/ajas.16.0009
Kang OD, Lee WS.This study aimed to estimate the change of stress level in horses based on cortisol concentration levels in their saliva. A total of 61 horses were divided into the following three groups: i) tourist riding experience (TR, n = 23); ii) resting group (RR, n = 14); and iii) horse-riding education (ER, n = 24). The saliva samples of TR and ER groups were taken using plain cotton Salivettes four times a day: at 07:00 (basal), 11:00 (Exercise 1, after 1-hour exercise in the morning), 14:00 (Exercise 2, after 1-hour exercise in the afternoon), and 16:00 (Exercise 3, after 1-hour exercise in the afte...
The PGF2α agonists luprostiol and d-cloprostenol reliably induce luteolysis in luteal phase mares without evoking clinical side effects or a stress response.
Animal reproduction science    March 2, 2016   Volume 168 92-99 doi: 10.1016/j.anireprosci.2016.02.031
Kuhl J, Nagel C, Ille N, Aurich JE, Aurich C.In the present study we have evaluated a possible stress reaction in response to two different PGF2α analogs-luprostiol and D-cloprostenol--and their effects on estrous cycle characteristics. In a cross-over-design eight mares received in alternating order either luprostiol (Treatment LUP; 3.75 mg im), D-cloprostenol (Treatment CLO; 22.5μg im) or saline (Treatment CON; NaCl 0.9% 0.5ml im) on day 8 after ovulation. Injection of either LUP or CLO, but not of CON resulted in a significant decline of progesterone concentration in plasma to baseline concentrations within two days (time: p<0.00...
Sialolithiasis in horses: A retrospective study of 25 cases (2002-2013).
The Canadian veterinary journal = La revue veterinaire canadienne    December 15, 2015   Volume 56, Issue 12 1239-1244 
Carlson N, Eastman T, Winfield L.This study evaluated outcomes of surgical treatment of equine sialolithiasis, highlighting cases involving the proximal parotid salivary duct. Sialoliths in the proximal parotid duct were difficult to identify radiographically and more frequently associated with draining tracts and sialadenitis compared with sialoliths in the distal parotid duct. Ultrasonography confirmed the diagnosis of sialolithiasis in all cases in which there was no radiographic evidence of a sialolith. All cases of proximal parotid duct sialolithiasis required transcutaneous removal. A longer duration of illness was obse...
Stress Response of Veterinary Students to Gynaecological Examination of Horse Mares – Effects of Simulator-Based and Animal-Based Training.
Reproduction in domestic animals = Zuchthygiene    August 26, 2015   Volume 50, Issue 5 866-871 doi: 10.1111/rda.12600
Nagel C, Ille N, Erber R, Aurich C, Aurich J.Invasive procedures in animals are challenging for veterinary students who may perceive a gynaecological examination of mares as stressful. Simulator-based training may reduce stress. In this study, students received equine gynaecology training 4 times either on horses (group H; n = 14) or a teaching simulator (group SIM; n = 13). One day and 14 days thereafter, their diagnostic skills were tested on horses (skills tests 1 and 2). During the skills tests, the students' stress response was analysed by heart rate, heart rate variability (HRV) parameters SDRR (standard deviation of beat-to-b...
Presence and distribution of leptin and its receptor in the minor salivary glands of the donkey.
Acta histochemica    March 20, 2015   Volume 117, Issue 3 305-308 doi: 10.1016/j.acthis.2015.03.001
Dall'Aglio C, Bazzucchi C, Mercati F, Ceccarelli P.Leptin is a hormone widely diffused in the mammalian body in which it plays functions that go far beyond control of appetite and energy metabolism. The finding that it is present in the major salivary glands of various animal species is of interest for the functional implications that it may imply. Since there are no data on the presence of leptin and its receptor in the minor salivary glands, the aim of this study was to demonstrate their presence and distribution in such glands of donkeys. This latter was chosen as species of reference because the monogastric herbivore shows intense salivati...
Increased cortisol release and transport stress do not influence semen quality and testosterone release in pony stallions.
Theriogenology    February 19, 2015   Volume 84, Issue 1 70-75 doi: 10.1016/j.theriogenology.2015.02.015
Deichsel K, Pasing S, Erber R, Ille N, Palme R, Aurich J, Aurich C.The use of breeding stallions for equestrian competitions requires that fertility is not negatively affected by competition or transport to the competition site. In this study, effects of cortisol release induced by road transport (600 km), adrenocorticotropic hormone (ACTH) administration (3 × 0.5 mg synthetic ACTH) and placebo treatment on semen quality and testosterone release were investigated in Shetland stallions (N = 13) using a crossover design. Saliva for cortisol and blood for testosterone analysis were collected for 10 weeks after treatments. Semen was collected daily for 5 days di...
Effects of season, age, sex, and housing on salivary cortisol concentrations in horses.
Domestic animal endocrinology    January 21, 2015   Volume 52 11-16 doi: 10.1016/j.domaniend.2015.01.003
Aurich J, Wulf M, Ille N, Erber R, von Lewinski M, Palme R, Aurich C.Analysis of salivary cortisol is increasingly used to assess stress responses in horses. Because spontaneous or experimentally induced increases in cortisol concentrations are often relatively small for stress studies, proper controls are needed. This requires an understanding of the factors affecting salivary cortisol over longer times. In this study, we have analyzed salivary cortisol concentration for 6 mo in horses (n = 94) differing in age, sex, reproductive state, and housing. Salivary cortisol followed a diurnal rhythm with the highest concentrations in the morning and a decrease throug...
Heart rate and salivary cortisol concentrations in foals at birth.
Veterinary journal (London, England : 1997)    November 27, 2014   Volume 203, Issue 2 250-252 doi: 10.1016/j.tvjl.2014.11.013
Nagel C, Erber R, Ille N, Wulf M, Aurich J, Möstl E, Aurich C.Heart rate (HR), HR variability (HRV) and salivary cortisol concentrations were determined in foals (n = 13) during the perinatal phase and until 5 months of age. In the fetus, HR decreased from 77 ± 3 beats/min at 120 min before birth to 60 ± 1 beats/min at 5 min before birth (P <0.01). Within 30 min of birth, HR increased to 160 ± 9 beats/min (P <0.01). Salivary cortisol concentrations immediately after birth were 11.9 ± 3.6 ng/mL and within 2 h increased to a maximum of 52.5 ± 12.3 ng/mL (P <0.01). In conclusion, increases in HR and sa...
Influence of transrectal and transabdominal ultrasound examination on salivary cortisol, heart rate, and heart rate variability in mares.
Theriogenology    November 13, 2014   Volume 83, Issue 4 749-756 doi: 10.1016/j.theriogenology.2014.11.010
Schönbom H, Kassens A, Hopster-Iversen C, Klewitz J, Piechotta M, Martinsson G, Kißler A, Burger D, Sieme H.Pregnancy diagnostics in equine reproduction are routinely performed using transrectal ultrasonography, although it is also possible to visualize the fetus by transabdominal ultrasound examinations from the 90th day of gestation onward. We hypothesized that ultrasound examinations may stress the mare and that the gestational stage status and lactation may influence the mare's stress reaction. To investigate the stress reaction, 25 thoroughbred mares of different age, pregnancy and lactational status underwent a transrectal examination. In pregnant mares, an additional transabdominal examinatio...
Effect of different head and neck positions on behaviour, heart rate variability and cortisol levels in lunged Royal Dutch Sport horses.
Veterinary journal (London, England : 1997)    July 16, 2014   Volume 202, Issue 1 26-32 doi: 10.1016/j.tvjl.2014.07.005
Smiet E, Van Dierendonck MC, Sleutjens J, Menheere PP, van Breda E, de Boer D, Back W, Wijnberg ID, van der Kolk JH.Different head-and-neck positions (HNPs) are discussed in relation to potential welfare issues. To evaluate the effect on welfare, seven Royal Dutch Sport horses were studied in five predetermined HNPs: (1) unrestrained (HNP1); (2) neck raised, bridge of nose around the vertical (HNP2); (3) neck lowered and considerably flexed, bridge of nose pointing towards the chest (HNP4); (4) neck raised and extended, bridge of nose in front of the vertical (HNP5), and (5) neck lowered and flexed, bridge of nose pointing towards the carpus (HNP7). A standardised exercise test (SET) of 34 min consisted o...
Parturition in horses is dominated by parasympathetic activity of the autonomous nervous system.
Theriogenology    March 27, 2014   Volume 82, Issue 1 160-168 doi: 10.1016/j.theriogenology.2014.03.015
Nagel C, Erber R, Ille N, von Lewinski M, Aurich J, Möstl E, Aurich C.External and internal stressors prolong parturition in different species. At parturition, sympathoadrenal activation should be avoided because an increased sympathetic tone may cause uterine atonia via β2-receptors. We hypothesized that at physiological parturition, horses are under parasympathetic dominance, and stress-response mechanisms are not activated during delivery of the foal. To evaluate stress responses, heart rate, heart rate variability, catecholamines, and cortisol were analyzed in mares (n = 17) throughout foaling. Heart rate decreased from 2 hours before (51 ± 1 beats/minute)...
Effects of hyperflexion on acute stress responses in ridden dressage horses.
Physiology & behavior    February 8, 2014   Volume 128 39-45 doi: 10.1016/j.physbeh.2014.01.024
Christensen JW, Beekmans M, van Dalum M, VanDierendonck M.The effects of hyperflexion on the welfare of dressage horses have been debated. This study aimed to investigate acute stress responses of dressage horses ridden in three different Head-and-Neck-positions (HNPs). Fifteen dressage horses were ridden by their usual rider in a standardised 10-min dressage programme in either the competition frame (CF), hyperflexion ("Low-Deep-and-Round"; LDR) or a looser frame (LF) in a balanced order on three separate test days. Heart rate (HR), heart rate variability parameters (HRV), behaviour and rein tension were recorded during the test. Salivary cortisol c...
Changes in salivary and plasma cortisol levels in Purebred Arabian horses during race training session.
Animal science journal = Nihon chikusan Gakkaiho    November 21, 2013   Volume 85, Issue 3 313-317 doi: 10.1111/asj.12146
Kędzierski W, Cywińska A, Strzelec K, Kowalik S.Physical activity and stress both cause an increase in cortisol release ratio. The aim of this study was to evaluate the use of saliva samples for the determination of cortisol concentrations indicating the work-load level in horses during race training. Twelve Purebred Arabian horses aged 3-5 years were studied during the routine training session. After the warm-up, the horses galloped on the 800 m sand track at a speed of 12.8 m/s. Three saliva samples, and three blood samples were collected from each horse. Both types of samples were taken at rest, immediately after return from the trac...
The influence of selected factors and sport results of endurance horses on their saliva cortisol concentration.
Polish journal of veterinary sciences    November 8, 2013   Volume 16, Issue 3 533-541 doi: 10.2478/pjvs-2013-0074
Janczarek I, Bereznowski A, Strzelec K.The aim of the study was to define the influence of the selected factors (gender, age, transportation time, riding distance and air temperature during the ride) on the cortisol secretion and finding a correlation between the hormone level and the horses' sport results (veterinary parameters and the ride route parameters). The research was performed on 38 Arabian pure breed horses taking part in the endurance rides. The cortisol level was measured with enzyme-immunological method in saliva samples, taken four times from each horse. In order to verify the differences between the mean results the...
An assessment of the aversive nature of an animal management procedure (clipping) using behavioral and physiological measures.
Physiology & behavior    May 14, 2013   Volume 118 32-39 doi: 10.1016/j.physbeh.2013.05.013
Yarnell K, Hall C, Billett E.Animal management often involves procedures that, while unlikely to cause physical pain, still cause aversive responses. The domestic horse (Equus caballus) regularly has excessive hair clipped off to facilitate its use as a riding/driving animal and this procedure causes adverse behavioral responses in some animals. The aim of this study was to compare behavioral and physiological measures to assess the aversive effect of this procedure. Ten horses were selected on the basis of being either compliant (C: n=5) or non-compliant (NC: n=5) during this procedure. The horses were subjected to a sha...
Influence of semen collection on salivary cortisol release, heart rate, and heart rate variability in stallions.
Theriogenology    May 9, 2013   Volume 80, Issue 3 256-261 doi: 10.1016/j.theriogenology.2013.04.003
Pasing S, von Lewinski M, Wulf M, Erber R, Aurich C.The aim of this study was to evaluate the stress response of stallions (n = 16) aged 3-13 years with previous sexual experience to semen collection by determination of heart rate, heart rate variability, and cortisol in saliva. Recordings were done on two consecutive days. The time intervals from leaving the box until arrival in the collection barn and from first exposure to the teaser mare until ejaculation as well as the number of mounts until ejaculation were neither affected by collection day nor by age, sexual experience (i.e., the number of breeding seasons the stallion experienced), or ...
Monitoring the circadian rhythm of serum and salivary cortisol concentrations in the horse.
Domestic animal endocrinology    May 4, 2013   Volume 45, Issue 1 38-42 doi: 10.1016/j.domaniend.2013.04.001
Bohák Z, Szabó F, Beckers JF, Melo de Sousa N, Kutasi O, Nagy K, Szenci O.Daily fluctuations of cortisol concentration in the blood or saliva have been repeatedly reported. However, several contradictions in the existing literature appear on this subject. The present study was performed to definitively establish options for testing adrenocortical function. To the best of our knowledge, this is the first study to evaluate parallel circadian rhythms in salivary and serum cortisol concentrations during a 24-h period. Twenty horses were examined under the same conditions. Blood and saliva samples were taken every 2 h for 24 h to determine the daily changes in cortisol c...
Cortisol release, heart rate and heart rate variability in the horse and its rider: different responses to training and performance.
Veterinary journal (London, England : 1997)    February 4, 2013   Volume 197, Issue 2 229-232 doi: 10.1016/j.tvjl.2012.12.025
von Lewinski M, Biau S, Erber R, Ille N, Aurich J, Faure JM, Möstl E, Aurich C.Although some information exists on the stress response of horses in equestrian sports, the horse-rider team is much less well understood. In this study, salivary cortisol concentrations, heart rate (HR) and heart rate variability (HRV), SDRR (standard deviation of beat-to-beat interval) and RMSSD (root mean square of successive beat-to-beat intervals) were analysed in horses and their riders (n=6 each) at a public performance and an identical rehearsal that was not open to the public. Cortisol concentrations increased in both horses and riders (P<0.001) but did not differ between performan...
Cortisol and progestin release, heart rate and heart rate variability in the pregnant and postpartum mare, fetus and newborn foal.
Theriogenology    May 22, 2012   Volume 78, Issue 4 759-767 doi: 10.1016/j.theriogenology.2012.03.023
Nagel C, Erber R, Bergmaier C, Wulf M, Aurich J, Möstl E, Aurich C.The mechanisms leading to parturition in the horse in many aspects differ from those in other species. Pregnancy is maintained not by progesterone but by 5α-pregnanes and the progestin precursor pregnenolone originates from the fetus. As parturition approaches, the fetal adrenal switches from pregnenolone to cortisol synthesis but it is not known whether cortisol crosses the placenta. We hypothesized that in parallel to fetal cortisol release, cortisol in the maternal circulation increases before foaling and this increase can be determined in both saliva and plasma. In addition, maternal, fet...
Stent reconstruction of an injured parotid duct in a thoroughbred colt.
Veterinary surgery : VS    April 30, 2012   Volume 41, Issue 4 536-539 doi: 10.1111/j.1532-950X.2012.00960.x
Lempe A, Brehm W, Scharner D.To report successful use of stent repair for a chronically injured parotid duct in a thoroughbred colt. Methods: Clinical report. Methods: A 2-year-old thoroughbred colt. Methods: Chronic injury to the parotid duct was identified 4-cm caudal to the facial vessel notch on the ventral border of the right mandible. After careful surgical dissection of the surrounding firm fibrous tissue, the defect was temporarily stented using an 8-Fr human ureteral catheter (223600 ERU(®) SOFT URETERAL(®) , Laboratoires pharmaceutique, Betschdorf, France) to bridge the tissue loss. The rostral end of the cath...