CT characterisation and classification of feline temporomandibular joint trauma: a case series of 79 cats.

OBJECTIVES: The aim of this study was to characterise and describe patterns of temporomandibular joint (TMJ) injuries occurring in cats using CT. METHODS: A cross-sectional study was carried out in adherence with the STROBE guidelines. Among the medical and CT records of 79 cats, 158 TMJs were reviewed in a collaborative study between six institutions. RESULTS: TMJ injuries were most commonly unilateral, representing 70.9% of cases. The mandibular condyle was fractured in 88 cases (55.7%) of the 158 TMJs observed. Of those, 84.0% were intra-articular condyle fractures, with the medial half of the mandibular condyle over-represented. Luxations occurred in 32.9% of cases, which was 19.0% of all evaluated TMJs. Rostrodorsal luxations were most common representing 87.0% of all luxations. Temporal bone fractures were observed in 30.4% of all cases, which was 18.4% of TMJs. The majority of fractures were of an unknown cause. When the cause was determined, road traffic accident (RTA) was the most frequent, followed by animal interaction, other external forces (sharp or blunt force) and high-rise trauma. Bilateral injuries were 13.1 times more likely to occur in high-rise trauma (P = 0.01) and temporal bone fracture was significantly associated with RTAs (P = 0.016). No other significant associations were observed between cause of injury and the resulting TMJ injury pattern. CONCLUSIONS AND RELEVANCE: Various TMJ injury patterns can occur in cats as a result of trauma. Intra-articular fractures of the medial half of the mandibular condyle occur most commonly. Although unilateral injuries are more frequent, high-rise trauma tends to present with bilateral lesions. Further studies with a larger sample size should be performed to better understand TMJ patterns of injury and how they relate to possible causes.

Association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery.

OBJECTIVE: To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. METHODS: A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency thoracic aortic surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. RESULTS: A total of 12,004 patients underwent emergency thoracic aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. CONCLUSIONS: No significant association was found between surgical mortality and prehospital transfer distance in emergency thoracic aortic surgery cases. Suspected cases of acute thoracic aortic syndrome may be transferred safely to distant high-volume hospitals.

Mechanisms of GABA-mediated inhibition of the angiotensin II-induced cytosolic Ca2+ increase in rat subfornical organ neurons.

Neurons in the subfornical organ (SFO) sense both neurotransmitters and circulating humoral factors such as angiotensin II (AII) and atrial natriuretic peptide (ANP), and regulate multiple physiological functions including drinking behavior. We recently reported that AII at nanomolar concentrations induced a persistent [Ca2+]i increase in acutely dissociated SFO neurons and that this effect of AII was reversibly inhibited by GABA. In the present study, we studied the inhibitory mechanism of GABA using Ca2+ imaging and patch-clamp electrophysiology. The AII-induced persistent [Ca2+]i increase was inhibited by GABA in more than 90% of AII-responsive neurons and by other two SFO inhibitory ligands, ANP and galanin, in about 60 and 30% of neurons respectively. The inhibition by GABA was mimicked by the GABAA and GABAB receptor agonists muscimol and baclofen. The involvement of both GABA receptor subtypes was confirmed by reversal of the GABA-mediated inhibition only when the GABAA and GABAB receptors antagonists bicuculline methiodide and CGP55845 were both present. The GABAB agonist baclofen rapidly and reversibly inhibited voltage-gated Ca2+ channel (VGCC) currents recorded in response to depolarizing pulses in voltage-clamp electrophysiology using Ba2+ as a charge carrier (IBa). Baclofen inhibition of IBa was antagonized by CGP55845, confirming GABAB receptor involvement; was reduced by N-ethylmaleimide, suggesting downstream Gi-mediated actions; and was partially removed by a large prepulse, indicating voltage-dependency. The magnitude of IBa inhibition by baclofen was reduced by the application of selective blockers for N-, P/Q-, and L-type VGCCs (ω-conotoxin GVIA, ω-agatoxin IVA, and nifedipine respectively). Overall, our study indicates that GABA inhibition of the AII-induced [Ca2+]i increase is mediated by both GABAA and GABAB receptors, and that GABAB receptors associated with Gi proteins suppress Ca2+ entry through VGCCs in SFO neurons.

Persistent cytosolic Ca2+ increase induced by angiotensin II at nanomolar concentrations in acutely dissociated subfornical organ (SFO) neurons of rats.

It is known that angiotensin II (AII) is sensed by subfornical organ (SFO) to induce drinking behaviors and autonomic changes. AII at picomolar concentrations have been shown to induce Ca2+ oscillations and increase in the amplitude and frequency of spontaneous Ca2+ oscillations in SFO neurons. The present study was conducted to examine effects of nanomolar concentrations of AII using the Fura-2 Ca2+-imaging technique in acutely dissociated SFO neurons. AII at nanomolar concentrations induced an initial [Ca2+]i peak followed by a persistent [Ca2+]i increase lasting for longer than 1 hour. By contrast, [Ca2+]i responses to 50 mM K+, maximally effective concentrations of glutamate, carbachol, and vasopressin, and AII given at picomolar concentrations returned to the basal level within 20 min. The AII-induced [Ca2+]i increase was blocked by the AT1 antagonist losartan. However, losartan had no effect when added during the persistent phase. The persistent phase was suppressed by extracellular Ca2+ removal, significantly inhibited by blockers of L and P/Q type Ca2+ channels , but unaffected by inhibition of Ca2+ store Ca2+ ATPase. The persistent phase was reversibly suppressed by GABA and inhibited by CaMK and PKC inhibitors. These results suggest that the persistent [Ca2+]i increase evoked by nanomolar concentrations of AII is initiated by AT1 receptor activation and maintained by Ca2+ entry mechanisms in part through L and P/Q type Ca2+ channels, and that CaMK and PKC are involved in this process. The persistent [Ca2+]i increase induced by AII at high pathophysiological levels may have a significant role in altering SFO neuronal functions.

The cytosolic Ca2+ concentration in acutely dissociated subfornical organ (SFO) neurons of rats: Spontaneous Ca2+ oscillations and Ca2+ oscillations induced by picomolar concentrations of angiotensin II.

Characteristics of subfornical organ (SFO) neurons were examined by measuring the cytosolic Ca2+ concentration ([Ca2+]i) in acutely dissociated neurons of the rat. SFO neurons, defined by the responsiveness to 50 mM K+ (n = 67) responded to glutamate (86%), angiotensin II (AII) (50%), arginine vasopressin (AVP) (66%) and/or carbachol (CCh) (61%), at their maximal concentrations, with marked increases in [Ca2+]i. More than a half (174/307) of SFO neurons examined exhibited spontaneous Ca2+ oscillations, while the remainder showed a relatively stable baseline under unstimulated conditions. Spontaneous Ca2+ oscillations were suppressed when extracellular Ca2+ was removed and were inhibited when extracellular Na+ was replaced with equimolar N-methyl-D-glucamine. Ca2+ oscillations were unaffected by the inhibitor of Ca2+-dependent ATPases cyclopiazonic acid, the N-type Ca2+ channel blocker ω-conotoxin GVIA and the P/Q-type Ca2+ channel blocker ω-agatoxin IVA, but significantly inhibited by the high-voltage-activated Ca2+ channel blocker Cd2+ and the L-type Ca2+ channel blocker nicardipine. Ca2+ oscillations were also completely arrested by the voltage-gated Na+ channel blocker tetrodotoxin in 50% of SFO neurons but only partially in the remaining neurons. These results suggest that SFO neurons exhibit spontaneous membrane Ca2+ oscillations that are dependent in part on Ca2+ entry through L-type Ca2+ channels, whose activation may result from burst firing. Moreover, AII at picomolar concentrations induced Ca2+ oscillations in neurons showing no spontaneous Ca2+ oscillations, while spontaneous Ca2+ oscillations were arrested by gamma-aminobutyric acid (10 µM), suggesting that rises in [Ca2+]i during Ca2+ oscillations may play an important role in the modulation of SFO neuron function.