Terminal Syme Amputation of the Great Toe in the Pediatric Population.

BACKGROUND: In the pediatric population, chronic ingrown toenails (onychocryptosis) can cause infection (paronychia), debilitating pain, and may be unresponsive to conservative treatments. Following multiple failed interventions, a terminal Syme amputation is one option for definitive treatment of chronic onychocryptosis. This procedure involves amputation of the distal aspect of the distal phalanx of the great toe with complete removal of the nail bed and germinal center, preventing further nail growth and recurrence. METHODS: A retrospective review was performed to determine outcomes of a terminal Syme amputation in the pediatric population. Inclusion criteria included treatment of onychocryptosis involving terminal Syme amputation with a minimum follow-up of 1 year. The medical record was reviewed to assess previous failed treatment efforts, perioperative complications, radiographic outcomes, and the need for additional procedures. RESULTS: From 1984 to 2017, 11 patients (13 halluces) with onychocryptosis were treated with a terminal Syme amputation. There were no intraoperative complications. One hallux had a postoperative infection requiring antibiotics as well as partial nail regrowth following the terminal Syme procedure that required subsequent removal of the residual nail. Following partial nail ablation, the patient had no further nail growth. An additional patient also developed a postoperative infection requiring oral antibiotic treatment. All patients returned to full weight-bearing physical activities within 6 weeks of surgery. CONCLUSIONS: Terminal Syme amputation was successful in treating pediatric patients who have recalcitrant onychocryptosis and paronychia. There was little functional consequence following terminal Syme amputation of the great toe in this patient population, making it an effective salvage procedure. LEVEL OF EVIDENCE: Level IV-retrospective comparative study.

Meta-Fish-Lib: A generalised, dynamic DNA reference library pipeline for metabarcoding of fishes.

The accuracy and reliability of DNA metabarcoding analyses depend on the breadth and quality of the reference libraries that underpin them. However, there are limited options available to obtain and curate the huge volumes of sequence data that are available on public repositories such as NCBI and BOLD. Here, we provide a pipeline to download, clean and annotate mitochondrial DNA sequence data for a given list of fish species. Features of this pipeline include (a) support for multiple metabarcode markers; (b) searches on species synonyms and taxonomic name validation; (c) phylogeny assisted quality control for identification and removal of misannotated sequences; (d) automatically generated coverage reports for each new GenBank release update; and (e) citable, versioned DOIs. As an example we provide a ready-to-use curated reference library for the marine and freshwater fishes of the U.K. To augment this reference library for environmental DNA metabarcoding specifically, we generated 241 new MiFish-12S sequences for 88 U.K. marine species, and make available new primer sets useful for sequencing these. This brings the coverage of common U.K. species for the MiFish-12S fragment to 93%, opening new avenues for scaling up fish metabarcoding across wide spatial gradients. The Meta-Fish-Lib reference library and pipeline is hosted at https://github.com/genner-lab/meta-fish-lib.

Use of a surgical safety checklist after implementation in an academic veterinary hospital.

OBJECTIVE: To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN: Voluntary online survey and retrospective study. SAMPLE POPULATION: All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS: Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS: Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION: The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE: The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score.

STUDY OBJECTIVE: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. METHODS: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. RESULTS: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). CONCLUSION: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

In vitro elution of amikacin and Dispersin B from a polymer hydrogel.

OBJECTIVE: To characterize the in vitro elution of amikacin and Dispersin B (ß-N-acetylglucosaminidase) in a degradable hydrogel. STUDY DESIGN: In vitro, prospective study. METHODS: Amikacin (group A; 40 mg/mL), Dispersin B (group D; 70 µg/mL), or combined amikacin and Dispersin B (group AD; 40 mg/mL and 70 µg/mL, respectively) were added to a hydrogel. Ten aliquots per group were incubated in phosphate-buffered saline that was exchanged at 1, 4, 8, 12, and 24 hours and then once daily for 10 days. Eluted amikacin and Dispersin B were quantitated by using an amikacin reagent kit and a Dispersin B enzyme-linked immunosorbent assay kit, respectively. Time point drug concentrations were compared between groups by using repeated-measures analysis of variance, and total drug elution was compared by using an area under the curve calculation. RESULTS: Amikacin alone, Dispersin B alone, and amikacin and Dispersin B combined together underwent rapid elution in the first 24 hours, followed by a gradual decrease over 10 days. The concentration of Dispersin B eluted in group D was higher at 1 day and lower from day 5 to day 10 compared with that in group AD. The concentration of amikacin eluted in group A was higher at 1, 4, and 8 hours and on day 10 and lower on day 1 compared with that in group AD. The total elution of amikacin was greater from group AD compared with that from group A (P = .02). CONCLUSION: Combining amikacin and Dispersin B had an affect on the total elution of amikacin but not Dispersin B. CLINICAL SIGNIFICANCE: The combination of amikacin and Dispersin B in a degradable hydrogel could allow local treatment of complex infections without the requirement for multiple invasive procedures.

Body composition of medium to giant breed dogs with or without cranial cruciate ligament disease.

OBJECTIVE: To describe the body composition of dogs with or without cranial cruciate ligament (CCL) disease. STUDY DESIGN: Cross-sectional. ANIMALS: Adult dogs in which CCL disease was diagnosed (n = 30) and adult dogs without clinical signs of orthopedic disease (n = 30). METHODS: Body weight, body condition score, and muscle condition score (MCS) were recorded. Body composition of the whole body and pelvic limbs were assessed by dual-energy x-ray absorptiometry. Body condition score, whole body, and pelvic limb body composition measurements were compared by using general linear mixed-model analysis of variance. Muscle condition score between groups was assessed by using a Mann-Whitney U test, while paired data were analyzed by using a Wilcoxon signed-rank test. RESULTS: Body fat percentage (P < .0001) was higher in affected dogs (38.78% ± 1.40) than in control dogs (27.49% ± 1.24). Affected dogs had lower MCS (1.90 ± 0.13, P < .0001) compared with control dogs (2.77 ± 0.08). The affected pelvic limb of affected dogs contained less lean soft tissues (P < .0001) but more fat (P = .0451) compared with the contralateral pelvic limb. CONCLUSION: Dogs with CCL disease were overweight compared with the control group. CLINICAL SIGNIFICANCE: Dogs that are overweight may be predisposed to developing CCL disease. Body composition changes in the pelvic limbs should be considered when managing the care of these dogs.

Contributing factors to surgical site infection after tibial plateau leveling osteotomy: A follow-up retrospective study.

OBJECTIVE: To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 541) that underwent TPLO (n = 659). METHODS: Medical records of dogs that underwent TPLO from 2011-2018 were reviewed. Data collected included perioperative and postoperative antimicrobial administration, stifle inspection, duration of surgery and anesthesia, comorbidities, and development of SSI including timing, microbiological investigation, and implant removal. Referring veterinarians were contacted for all dogs without a recorded return visit. Risk factors for SSI were assessed by using a multivariable logistic regression model built by using a stepwise approach. RESULTS: Surgical site infection was documented in 71 of 659 (11%) TPLO, with methicillin-resistant Staphylococcus pseudintermedius accounting for 20 of 71 (28%) infections. Protective factors against SSI included administration of postoperative antimicrobials (odds ratio [OR] 0.263; 95% CI = 0.157, 0.442) and timing of preoperative antimicrobial administration. Preoperative antimicrobial timing was protective against SSI when it was administered more than 60 minutes before the first incision compared with administration within 30 minutes (OR 0.275; 95% CI = 0.112, 0.676) or within 60 minutes (OR 0.419; 95% CI = 0.189, 0.929) of the first incision. CONCLUSION: Early administration of perioperative antimicrobials and postoperative antimicrobial administration were protective against SSI after TPLO. CLINICAL SIGNIFICANCE: Antimicrobials can influence the risk of SSI after TPLO. Perioperative and postoperative antimicrobial administration timing should be considered to reduce SSI.

Clinical outcomes following prenatal diagnosis of asymmetric ventriculomegaly, interhemispheric cyst, and callosal dysgenesis (AVID).

OBJECTIVES: When identified prenatally, the imaging triad of asymmetric ventriculomegaly, interhemispheric cyst, and dysgenesis of the corpus callosum (AVID) can indicate a more serious congenital brain anomaly. In this follow-up series of 15 fetuses, we present the neurodevelopmental outcomes of a single institution cohort of children diagnosed prenatally with AVID. METHODS: Our fetal ultrasound database was queried for cases of AVID between 2000 and 2016. All available fetal MR imaging studies were reviewed for the presence of (a) interhemispheric cysts or ventricular diverticula and (b) dysgenesis or agenesis of the corpus callosum. Clinical records were reviewed for perinatal management, postnatal surgical management, and neurodevelopmental outcomes. RESULTS: Fifteen prenatal cases of AVID were identified. Twelve were live-born and three pregnancies were terminated. Of the 12 patients, 11 underwent neurosurgical intervention. Of the eight patients surviving past infancy, seven of eight have moderate to severe neurodevelopmental delays or disabilities, encompassing both motor and language skills, and all have variable visual abnormalities. CONCLUSION: In our cohort of 15 prenatally diagnosed fetuses with AVID, eight survived past infancy and all have neurodevelopmental disabilities, including motor and language deficits, a wide range of visual defects, craniofacial abnormalities, and medical comorbidities.

Alveolar echinococcosis in an Ontario dog resembling an hepatic abscess.

A boxer dog was evaluated because of lethargy, vomiting, and abdominal pain. Ultrasonography revealed multiple cystic structures in the abdomen. Exploratory laparotomy revealed 3 well-encapsulated hepatic masses and abdominal effusion with suppurative inflammation. Collectively, these findings suggested the hepatic masses were most likely abscesses. However, histologic examination of the hepatic masses revealed multi-cystic structures, consistent with alveolar echinococcosis. The diagnosis was confirmed by DNA sequencing. The dog was treated with daily albendazole, but within a few weeks exhibited adverse side effects. After 6 months, the dog's condition deteriorated, and it was euthanized.

Échinococcose alvéolaire ressemblant à un abcès hépatique chez un chien en Ontario. Un chien de race boxer fut évalué à cause de léthargie, vomissements, et douleur abdominale. Une échographie révéla de multiples structures kystiques dans l'abdomen. Une laparotomie exploratoire révéla trois masses hépatiques bien encapsulées et une effusion abdominale avec inflammation suppurative. Collectivement, ces données suggéraient que les masses hépatiques étaient fort probablement des abcès. Toutefois, l'examen histologique des masses hépatiques révéla des structures multi-kystiques, compatibles avec une échinococcose alvéolaire. Le diagnostic fut confirmé par séquençage d'ADN. Le chien fut traité avec de l'albendazole quotidiennement, mais en quelques semaines il montra des signes d'effets adverses. Après 6 mois la condition du chien se détériora et il fut euthanasié.(Traduit par Dr Serge Messier).

Diagnostic accuracy and clinical outcomes associated with prenatal diagnosis of fetal absent cavum septi pellucidi.

BACKGROUND: Absence of the cavum septi pellucidi (CSP) on prenatal imaging is historically associated with additional anomalies; however, recent cases of isolated absent CSP have also been identified. This study seeks to assess the accuracy of prenatal imaging in evaluating isolated absent CSP and to describe the spectrum of clinical outcomes. METHODS: This is a retrospective observational study of all prenatally diagnosed absent CSP cases between 2011 and 2016 at our institution. Cases with additional structural parenchymal abnormalities were excluded. Clinical outcomes were abstracted from available records. RESULTS: We identified 15 cases of prenatally diagnosed isolated absent CSP. All patients were initially diagnosed on ultrasound (US) and 11/15 patients had fetal magnetic resonance imaging (MRI) confirming the diagnosis. Prenatal US and MRI were concordant in all cases. Of the continuing pregnancies, 2 neonatal deaths occurred related to extreme prematurity. Two cases of septo-optic dysplasia were identified in our cohort. DISCUSSION: In this study, fetal MRI and US had a high degree of accuracy with concordant postnatal imaging. Our study is similar to other case series suggesting that a range of clinical outcomes is possible with isolated absent CSP, but long-term patient follow up is necessary.

Comparison of methicillin-resistant Staphylococcus pseudintermedius adherence to 2 canine limb salvage endoprosthesis implants.

The objective of our study was to compare adhesion of methicillin-resistant Staphylococcus pseudintermedius (MRSP) to stainless steel (SS) and to tantalum (TA) canine limb salvage endoprosthesis implants in an in vitro experimental study. The median of the mean log10 colony forming units/mL for adherent MRSP was 4.96 (range: 4.63 to 6.33) for the TA endoprosthesis and 4.31 (range: 3.86 to 5.05) for the SS endoprosthesis (P = 0.009). Although the trabecular and porous design of the TA endoprosthesis provides mechanical benefits over the SS endoprosthesis, it may increase the risk of developing infection due to higher levels of bacterial adherence.

Comparaison de l'adhérence deStaphylococcus pseudintermediusrésistant à la méthicilline à deux implants d'endoprothèse pour sauver des membres canins. L'objectif de notre étude consistait à comparer l'adhésion de Staphylococcus pseudintermedius résistant à la méthicilline (MRSP) à des implants d'endoprothèse en acier inoxydable (AI) et en tantale (TA) pour sauver des membres canins lors d'une étude expérimentale in vitro. La médiane des moyennes en log10 des unités formatrices de colonies/mL pour le MRSP adhérent était de 4,96 (écart : de 4,63 à 6,33) pour l'endoprothèse TA et 4,31 (écart : de 3,86 à 5,05) pour l'endoprothèse d'AI (P = 0,009). Même si la conception trabéculaire et poreuse de l'endoprothèse de TA offre des avantages mécaniques par rapport à l'endoprothèse d'AI, elle peut accroître le risque de développer une infection en raison des taux supérieurs d'adhérence bactérienne.(Traduit par Isabelle Vallières).

An in vitro method to test the safety and efficacy of low-level laser therapy (LLLT) in the healing of a canine skin model.

BACKGROUND: Low-level laser therapy (LLLT) has been used clinically as a treatment modality for a variety of medical conditions including wound-healing processes. It is an attractive and emerging method to enhance wound healing and improve clinical outcomes both in human and veterinary medicine. Despite the fact that the use of LLLT continues to gain in popularity, there is no universally accepted theory that defends all its cellular effects and beneficial biological processes in tissue repair. The present study was designed to evaluate the effect of LLLT on cellular migration and proliferation of cultured canine epidermal keratinocytes (CPEK) in an in vitro wound healing model. RESULTS: Keratinocyte migration and proliferation were assessed using a scratch migration assay and a proliferation assay, respectively. Fifteen independent replicates were performed for each assay. Canine epidermal keratinocyte cells exposed to LLLT with 0.1, 0.2, and 1.2 J/cm(2) migrated significantly more rapidly (p < 0.03) and showed significantly higher rates of proliferation (p < 0.0001) compared to non-irradiated cells cultured in the same medium and cells exposed to the higher energy dose of 10 J/cm(2). Irradiation with 10 J/cm(2) was characterized by decreased cellular migration and proliferation. These results revealed that LLLT has a measurable, dose-dependent effect on two different aspects of keratinocyte biology in vitro. CONCLUSION: In this in vitro wound-healing model, LLLT increased cellular migration and proliferation at doses of 0.1, 0.2, and 1.2 J/cm(2) while exposure to 10 J/cm(2) decreased cellular migration and proliferation. These data suggest that the beneficial effects of LLLT in vivo may be due, in part, to effects on keratinocyte behavior.

Biofilm-Associated Gene Expression in Staphylococcus pseudintermedius on a Variety of Implant Materials.

OBJECTIVE: To evaluate the expression of biofilm-associated genes in Staphylococcus pseudintermedius on multiple clinically relevant surfaces. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Two strains of methicillin-resistant S. pseudintermedius isolated from clinical infections representing the most common international isolates. METHODS: A quantitative polymerase chain reaction (qPCR) assay for expression of genes related to biofilm initial adhesion, formation/maturation, antimicrobial resistance, and intracellular communication was developed and validated. S. pseudintermedius biofilms were grown on 8 clinically relevant surfaces (polymethylmethacrylate, stainless steel, titanium, latex, silicone, polydioxanone, polystyrene, and glass) and samples of logarithmic and stationary growth phases were collected. Gene expression in samples was measured by qPCR. RESULTS: Significant differences in gene expression were identified between surfaces and between bacterial strains for most gene/strain/surface combinations studied. Expression of genes responsible for production of extracellular matrix were increased in biofilms. Expression of genes responsible for initial adhesion and intracellular communication was markedly variable. Antimicrobial resistance gene expression was increased on multiple surfaces, including stainless steel and titanium. CONCLUSION: A method for evaluation of expression of multiple biofilm-associated genes in S. pseudintermedius was successfully developed and applied to the study of biofilms on multiple surfaces. Variations in expression of these genes have a bearing on understanding the development and treatment of implant-associated biofilm infections and will inform future clinical research.

Evaluation of the Impact of Methicillin-Resistant Staphylococcus pseudintermedius Biofilm Formation on Antimicrobial Susceptibility.

OBJECTIVE: To compare the minimum inhibitory concentration (MIC) of four antimicrobials in planktonic vs. biofilm-associated Staphylococcus pseudintermedius. STUDY DESIGN: In vitro study. SAMPLE POPULATION: 78 isolates from dogs colonized or infected with methicillin-resistant S. pseudintermedius (MRSP, n=39) or methicillin-susceptible S. pseudintermedius (MSSP, n=39). METHODS: Agar dilution was used to determine the MIC of amikacin, cefazolin, enrofloxacin, and gentamicin for planktonic bacteria. A modified broth microdilution assay was used to assess the MIC of biofilm-associated bacteria. RESULTS: MIC were significantly higher in biofilm-associated vs. planktonic bacteria for all antimicrobials; amikacin (median MIC: biofilm >2,000 µg/mL vs. planktonic 3 µg/mL, P<.0001), cefazolin (>1,000 vs. 0.5 µg/mL, P<.0001), enrofloxacin (>1,000 vs. 0.25 µg/mL, P<.0001), and gentamicin (>1,000 vs. 0.3 µg/mL, P<.001). For all antimicrobials, there were significant differences in planktonic MIC for MRSP and MSSP (all P<.0001) but no differences between biofilm MIC for MRSP and MSSP (P=.08-1.0). CONCLUSION: The MIC for biofilm-associated S. pseudintermedius are significantly higher than for planktonic bacteria. Standard methods for determining MIC are not appropriate for biofilm-associated infections. This must be considered when determining treatment regimens for infections that potentially involve biofilms, and further study of methods to control biofilm-associated infections is needed.

Internal hemipelvectomy for treatment of obstipation secondary to pelvic malunion in 3 cats.

Pelvic fractures are a common injury in cats, and both surgical and conservative management approaches have been described. One of the major complications of pelvic fractures managed conservatively is narrowing of the pelvic canal. Severe pelvic canal narrowing can result in constipation and subsequent megacolon. The purpose of this case series is to describe the long-term outcome for 3 cats with obstipation treated with internal hemipelvectomy because of megacolon secondary to pelvic canal narrowing after conservative management. All cats had a good functional outcome of the affected limb. Two cats required ongoing medical management for recurrent constipation. Overall, internal hemipelvectomy offers good long-term limb function; however, its success in relieving clinical signs of constipation requires additional research.

Hémipelvectomie interne pour le traitement de la constipation opiniâtre secondaire à un cal vicieux pelvien chez 3 chats. Les fractures pelviennes sont une blessure commune chez les chats et les approches chirurgicales et prudentes ont toutes deux été décrites. L'une des complications majeures des fractures pelviennes gérées de manière prudente consiste à raccourcir le canal pelvien. Un rétrécissement sévère du canal pelvien peut se traduire par la constipation et un mégacôlon subséquent. Le but de cette série de cas consiste à décrire le résultat à long terme pour 3 chats souffrant de constipation opiniâtre traitée par une hémipelvectomie interne en raison d'un mégacôlon secondaire au rétrécissement du canal pelvien après une gestion prudente. Tous les chats ont obtenu de bons résultats fonctionnels du membre affecté. Deux chats ont nécessité une gestion médicale permanente pour une constipation opiniâtre. En général, l'hémipelvectomie interne offre une bonne fonction du membre, mais son succès dans le soulagement des signes cliniques de la constipation exige de la recherche additionnelle.(Traduit par Isabelle Vallières).

Central polydactyly of the foot: surgical management with plantar and dorsal advancement flaps.

BACKGROUND: Central polydactyly is the least common form of foot polydactyly, and the intercalary location of the duplicated ray makes the surgical exposure, excision, and closure more complex. For these reasons there is little consensus concerning the optimal technique for surgical management. METHODS: A retrospective case series of 22 patients with 27 feet with central polydactyly, treated surgically by the dorsal and plantar advancement flap technique, was performed. Change in width of the forefoot was measured from radiographs by the metatarsal gap ratio. Functional outcomes were assessed by the Foot and Ankle Ability Measure. RESULTS: Signficant narrowing of the forefoot, as measured radiographically by the metatarsal gap ratio, was achieved after surgery (P<0.0001). This radiographic narrowing was maintained with growth after a mean follow-up of 8 years (P=0.0001). In 7 of the unilateral cases, the mean forefoot radiographic width of the affected side, after surgical resection and reconstruction of the central polydactyly, was 2% greater than the contralateral, uninvolved side. Persistent clinical widening of the forefoot after surgery was reported in the majority (82%) of cases. The Foot and Ankle Ability Measure results showed near-normal functional outcomes in itemized activities of daily living, itemized sports, and overall function categories. The few reports of less than normal foot function were related to shoe wear issues and incisional scarring that was painful or cosmetically unappealing. CONCLUSIONS: The radiographic and functional outcomes after surgical management of central polydactyly with the dorsal and plantar advancement flap technique are excellent. The technique successfully narrows the forefoot on radiographs, and this narrowing is maintained with growth over time. However, families should be advised that persistent perceived widening of the forefoot relative to normal is common, despite successful radiographic narrowing after surgery. LEVEL OF EVIDENCE: IV.

Intra-articular pharmacokinetics of a gentamicin impregnated collagen sponge in the canine stifle: an experimental study.

OBJECTIVE: To investigate local and systemic pharmacokinetics of gentamicin after intra-articular implantation of a gentamicin impregnated collagen sponge (GICS) in the inflamed canine joint. STUDY DESIGN: Descriptive repeated measures experimental study. ANIMALS: Dogs (n = 9). METHODS: Stifle joint inflammation was caused by urate injection. Twenty-four hours later a GICS (gentamicin dose, 6 mg/kg) was arthroscopically implanted. Synovial fluid and plasma gentamicin concentrations were measured for 14 days after implantation, and pharmacokinetic parameters modeled using statistical moment analyses. RESULTS: Intra-articular gentamicin concentrations fell to sub-MIC for Staphylococcus sp. (4 µg/mL) by 22.4 hours (95% CI: 18.6-26.2) after sponge implantation. Cmax synovial was 2397 µg/mL (95%CI: 1161-3634 µg/mL) at 1.2 hours (95%CI: 0.5-1.8 hours). Plasma gentamicin concentrations achieved levels of Cmax plasma = 8.0 µg/mL (95%CI: 6.1-10.0 µg/mL) at 1.5 hours (95%CI: 0.8-2.1) after GICS placement and fell below target trough of 2.0 µg/mL by 5.6 hours (95%CI: 4.7-6.5 hours) after GICS placement. CONCLUSIONS: Intra-articular gentamicin concentration after GICS placement at an IV-equivalent dose reached high levels and declined rapidly. The maximum plasma levels attained were ∼1/3 of the recommended sub-toxic target for people after parenteral gentamicin administration.

Investigation of incidence and risk factors for surgical glove perforation in small animal surgery.

OBJECTIVE: To identify incidence and risk factors for surgical glove perforation in small animal surgery. STUDY DESIGN: Observational cohort study. SAMPLE POPULATION: Surgical gloves (n = 2132) worn in 363 surgical procedures. METHODS: All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure. RESULTS: At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery >1 hour OR = 1.79, 95% CI = 1.12-2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23-2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21-3.09) or surgical wire (OR = 3.02; 95% CI = 1.50-6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05-2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35-2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%. CONCLUSIONS: There is a high incidence of unrecognized glove perforations in small animal surgery.

Ablation of IL-17A abrogates progression of spontaneous intestinal tumorigenesis.

The intrinsic role of endogenous IL-17A in spontaneous intestinal tumorigenesis has not been addressed previously to our knowledge. Ablation of IL-17A significantly reduced tumor development in mice bearing a heterozygote mutation in the adenomatous polyposis coli (APC) gene (Apc(Min/+) mice). There was also a decrease in inflammatory cytokines and proinflammatory mediators, reduced infiltration of lymphocytes including T cells, and preservation of intestinal architecture and the presence of APC protein in intestinal epithelial cells. Interestingly, IL-17A ablation also corrected immunological abnormalities such as splenomegaly and thymic atrophy in Apc(Min/+) mice. CD4 T cells from Apc(Min/+) mice showed hyperproliferative potential in vitro and in vivo and increased levels of IL-17A and IL-10. The effector CD4 T cells from Apc(Min/+) mice were more resistant to regulatory T cell-mediated suppression. Finally, these CD4 T cells induced colitis in immunodeficient mice upon adoptive transfer, whereas the ablation of IL-17A in CD4 T cells in Apc(Min/+) mice completely abolished this pathogenic potential in vivo. Taken together, our results show that CD4 T cell-derived IL-17A promotes spontaneous intestinal tumorigenesis with altered functions of CD4 T cells in Apc(Min/+) mice.

Proximal femoral geometry before and after varus rotational osteotomy in children with cerebral palsy and neuromuscular hip dysplasia.

BACKGROUND: Surgical management of hip dysplasia in children with cerebral palsy (CP) usually includes varus rotational osteotomy (VRO) of the proximal femur. Several techniques of VRO (end-to-end, EE; end-to-side, ES) have been designed to maximize correction and minimize associated deformities. The goals of the current study were to establish the prevalence and contribution of caput valgum to coxa valga deformity in children with CP, compare the geometry of the proximal femur after EE and ES techniques of VRO, and document the response of the proximal femur to subsequent growth after VRO. METHODS: The records of 75 children with CP (Gross Motor Function Classification System, levels IV and V) with 137 surgically treated hips were retrospectively reviewed. Outcomes were limited to the technical domain (eg, radiographic measurements and surgical complications). Measurements made for each hip (preoperative, operative, and follow-up) included the neck-shaft angle (NSA), head-shaft angle (HSA), and the medialization index. RESULTS: The mean age at the time of surgery was 7 years. The mean follow-up was 5 years and 6 months. Caput valgum was present in all hips, increasing the actual geometric valgus by a mean of 10%. The ES technique was more effective at medializing the femoral shaft; however, this benefit was lost with growth (P = 0.891). The ES technique was more effective at achieving and maintaining correction of the NSA (P = 0.026). Maintenance of correction of the HSA was comparable for both ES and EE surgical techniques (P = 0.099). Subsequent growth of the proximal femur resulted in loss of correction of the NSA (mean 29%) and HSA (mean 21%). DISCUSSION: Caput valgum is usually present in children with CP who are undergoing surgical hip reconstruction. The ES technique is a reasonable alternative for the correction of neuromuscular hip dysplasia associated with extreme coxa valga and long femoral necks. Recurrence of coronal plane deformity with growth after VRO is common, and further study is required to determine how best to control this phenomena. LEVEL OF EVIDENCE: Level IV-therapeutic.