Effects of Dietary Fish Meal Replacement with Alternative Protein Ingredients and Their Combinations on Growth Performance, Feed Utilization, Fillet Composition, and Biochemical Parameters of Red Seabream (Pagrus major).

The experiment was conducted to evaluate alternative protein ingredients in a low-fish meal (FM) diet for red seabream (Pagrus major). Twelve experimental diets were formulated. Control diet (CON) was designed to contain 60% FM. Other experimental diets were formulated by replacing 50% of FM from the CON with soy protein concentrate (SPC), corn gluten (CG), meat meal (MM), and/or chicken byproduct meal (CBM). Four diets were designed including one of SPC, CG, MM, or CBM as FM replacer and designated as SPC, CG, MM, and CBM. Six other diets were formulated by adding two ingredients as SPC and CG, SPC and MM, SPC and CBM, CG and MM, CG and CBM, or MM and CBM, and designated as SCG, SMM, SCM, CMM, CCM, and MCM, respectively. The 12th diet (MIX) was formulated by including SPC, CGM, MM, and CBM. Triplicate fish groups (50.2 ± 0.1 g) were hand-fed for 12 weeks. Weight gain (WG) of fish was significantly improved by MM and MCM diets compared to CG, SCG, CMM, and CCM diets. WG of CON, SPC, CM, SMM, SCM, and MIX groups were comparable with MM and MCM groups. The lowest WG was observed in CG and CMM groups. Feed efficiency (FE) was significantly higher in MM group compared to SPC, CG, SGC, and CMC groups. FE of MCM group was significantly higher than CG and SCG groups. Fillet linolenic acid (C18:2n-6) level in CG group was significantly higher than CON, MM, CM, SCM, CCM, and MCM groups. Serum lysozyme activity was significantly higher in MCM and MIX groups. Therefore, a high level of dietary CG reduces the growth performance and feed utilization of red seabream. A mixture of MM and CBM seems to be more efficient in replacing FM from red seabream diet.

Biomechanical analysis of canine medial patellar luxation with femoral varus deformity using a computer model.

BACKGROUND: Femoral varus deformities complicating the realignment of the quadriceps muscles are frequently associated with medial patellar luxation (MPL) in dogs. Therefore, distal femoral osteotomy (DFO) is recommended in dogs affected with severe MPL and a distal femoral varus deformity. The presence of an anatomic lateral distal femoral angle (aLDFA) of ≥ 102° has been anecdotally recommended as an indication for performing corrective DFO in large-breed dogs. However, the effect of a femoral varus deformity on MPL has not been scientifically evaluated. We aimed to evaluate the influence of a femoral varus deformity on MPL using a finite element method based computer model. Three-dimensionally reconstructed computed tomographic images of a normal femur from a Beagle dog were deformed using meshing software to create distal varus deformities. A total of thirteen aLDFAs, including 95°, 98° and 100°-110°, were simulated. The patellar positions and reaction force between the patella and trochlear grooves were calculated for all finite element models under constant rectus femoris muscle activation. RESULTS: The patella was displaced medially from the trochlear groove at an aLDFA of ≥103°. With an aLDFA of 103° to 110°, the reaction force was equal to zero and then decreased to negative values during the simulation, while other models with aLDFAs of 95°, 98°, and 100°-102° had positive reaction force values. The patella began to luxate at 24.90 seconds (sec) with an aLDFA of 103°, 19.80 sec with an aLDFA of 104°, 21.40 sec with an aLDFA of 105°, 20.10 sec with an aLDFA of 106°, 18.60 sec with an aLDFA of 107°, 15.30 sec with an aLDFA of 108°, 16.60 sec with an aLDFA of 109°, and 11.90 sec with an aLDFA of 110°. CONCLUSION: Severe distal femoral varus with an aLDFA of ≥103° caused MPL when other anatomical factors were controlled. Thissimplified computer model provides complementary information to anecdotal cutoffs for DFO, hence it should be applied to clinical patients with caution.

Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog.

A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.

Effects of Low-Lipid Diets on Growth, Haematology, Histology and Immune Responses of Parr-Stage Atlantic Salmon (Salmo salar).

Lipids in fish diets provide energy and play important roles in immunity and metabolism. Atlantic salmon, a species that migrates from freshwater to seawater, requires high energy, especially during smoltification. Juvenile teleosts have low lipid requirements, and a high dietary lipid content is known to have negative effects on their growth and digestion. Therefore, this study evaluated the effect of two commercial rainbow trout feeds (low-lipid, 13.41% and 14.6%) on the growth and immune responses of early parr-stage Atlantic salmon compared to commercial salmon feed (high-lipid, 29.52%). Atlantic salmon parr (weight: 14.56 ± 2.1 g; length: 11.23 ± 0.44 cm) were randomly divided into three groups and fed either one of two commercial rainbow trout feeds (RTF1 and RTF2) or the commercial salmon feed (ASF) for 12 weeks. At the end of the feeding trial, growth, haematology, histology and gene expression analyses were performed. There were no significant differences in weight gain rates or feed efficiency between the groups (p > 0.05). Superoxidate dismutase, glutathione peroxidase, lysozyme and immunoglobulin M activities were not different among the experimental groups (p > 0.05). A histological examination of the liver and intestinal tissues showed no pathological symptoms of inflammatory response or lipid accumulation in any of the groups. In an intestinal transcriptome analysis using RNA-seq, the expression levels of several genes linked to lipids, immune-related proteins, cytokines and chemokines did not differ significantly between the groups (p > 0.05). Commercial rainbow trout feed with low lipid content has no clear negative impact on the development of Atlantic salmon during the early parr stage (14.5 to 39.6 g). This study provides basic information for the development of economical feed for early parr-stage Atlantic salmon.

Surgical Correction of a Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connections Using Cardiac Computed Tomography Imaging and a 3D-Printed Model.

Sinus venosus atrial septal defects (SVASDs), concurrent with partial anomalous pulmonary venous connections (PAPVCs), are a rare congenital heart disease in dogs. Surgical correction is essential when clinical signs or significant hemodynamic changes are present. We aimed to report on the successful surgical correction of an SVASD with PAPVCs, using a computed tomography (CT)-based customized 3D cardiac model. A 10-month-old male poodle was referred for corrective surgery for an ASD. Echocardiography confirmed a hemodynamically significant left-to-right shunting flow through an interatrial septal defect and severe right-sided heart volume overload. For a comprehensive diagnosis, a CT scan was performed, which confirmed an SVASD with PAPVCs. A customized 3D cardiac model was used for preoperative decision-making and surgical rehearsal. The defect was repaired using an autologous pericardial patch under a cardiopulmonary bypass (CPB). Temporary pacing was applied for sinus bradycardia and third-degree atrioventricular block. The patient recovered from the anesthesia without further complications. The pacemaker was removed during hospitalization and the patient was discharged without complications 2 weeks post-surgery. At the three-month follow-up, there was no shunting flow in the interatrial septum and the right-sided volume overload had been resolved. The cardiac medications were discontinued, and there were no complications. This report indicates the validity of surgical correction under CPB for an SVASD with PAPVCs, and the advantages of utilizing a CT-based 3D cardiac model for preoperative planning to increase the surgical success rate.

Effects of host-associated low-temperature probiotics in olive flounder (Paralichthys olivaceus) aquaculture.

This study investigated the effects of supplementation of low-temperature probiotics isolated from the intestines of olive flounder on the growth performance, digestibility, and regulation of intestinal microbiota and the expression of genes related to growth, immunity, and apoptosis in olive flounder. Bacteria showing high growth at approximately 15-20 °C, which is the temperature of olive flounder culture, were isolated and confirmed to be Pseudomonas species through 16S rRNA gene sequence analysis. Whole-genome sequencing revealed that the strain has a 6,195,122 bp single circular chromosome and a guanine-cytosine content of 59.9%. In the feeding trial, supplementation with 1 × 108 CFU/g of the isolate strain positively modulated growth performances, digestive enzyme activity, and gut microbiota composition of olive flounder. RT-qPCR for the comparison of growth, immunity, and apoptosis-related gene expression levels showed no significant differences between the groups. Therefore, the isolated host-associated low-temperature probiotics improved the growth performance of olive flounder by causing positive changes in digestive activity and intestinal microbial composition without affecting host gene expression.

Dietary Exogenous α-Amylase Modulates the Nutrient Digestibility, Digestive Enzyme Activity, Growth-Related Gene Expression, and Diet Degradation Rate of Olive Flounder (Paralichthys olivaceus).

In this study, a 12-week feeding experiment was conducted to characterize the effects of exogenous α-amylase on the growth, feed utilization, digestibility, plasma α-amylase activity, feed degradation rate, and fecal particle size of olive flounder (Paralichthys olivaceus). Diet was supplemented with 0 (AA0; control), 100 (AA100), 200 (AA200), or 400 (AA400) mg/kg of α-amylase, respectively. Fish (273.1 ± 2.3 g) were stocked into 12 tanks (25 fish/1,000-L tank) and 3 tanks were randomly selected for each diet group. As a result, α-amylase was found to have no significant effects (p ≥ 0.05) on the growth, feed utilization parameters, and whole-body proximate compositions. α-Amylase-treated fish exhibited only a significant increase in the apparent digestibility coefficient of carbohydrates compared to the controls. In addition, in vitro analyses revealed that α-amylase dose-dependently increased (p < 0.05) the feed degradation rate, while photographs of the intestinal content after 2, 4, and 8 h of feeding demonstrated an improved degradation rate in the α-amylase-treated groups. Plasma α-amylase content was higher in the AA200 and AA400 groups, whereas the control group produced significantly larger-sized fecal particles (90% size class) than these two groups. In the intestine, no changes were observed in the expression levels of the immune-related TNF-α, IL-1ß, IL-2, immunoglobulin-M, HSP-70, lysozyme, and amylase alpha-2A. However, growth-related genes IGF-1, IGF-2, TGF-ß3, and growth hormone genes were upregulated in muscle tissues. Collectively, exogenous α-amylase has positive roles in the modulation of the digestibility coefficient, blood α-amylase concentration, growth-related gene expression, and diet degradation for improved digestion in olive flounder.

Open-heart surgery using Del-Nido cardioplegia in two dogs: partial atrioventricular septal defect and mitral repair.

Del-Nido cardioplegia (DNc) is a single-dose cardioplegia that is widely used in human medicine because of its long duration. In this report, we describe two cases of open-heart surgery with cardiopulmonary bypass (CPB) using DNc. One dog was diagnosed with partial atrioventricular septal defect, and the other dog was diagnosed with myxomatous mitral valve disease stage D. Both dogs were treated with open-heart surgery with DNc to induce temporary cardiac arrest. No complications from DNc were observed, and the patients were discharged. Veterinary heart surgeons should consider DNc as an option for temporary cardiac arrest during open-heart surgery with CPB.

Partial Venous Inflow Occlusion under Mild Hypothermia for Membranectomy in a Dog with Cor Triatriatum Dexter.

Cor triatriatum dexter (CTD) is an uncommon congenital cardiac anomaly in dogs. This case report describes successful membranectomy for CTD via partial venous inflow occlusion under mild hypothermia in a dog. A 7-month-old intact male mixed-breed dog weighing 20.5 kg presented with a history of abdominal distention, lethargy, and anorexia. Clinical examination, radiography, echocardiography, microbubble testing, and computed tomography revealed a remnant right atrium membrane obscuring the venous blood inflow from the vena cava. Considering the potential risk of re-stenosis following interventional treatment, curative resection involving surgical membranectomy via venous inflow occlusion was performed. By performing partial venous inflow occlusion under mild hypothermia (34.5 °C), sufficient time was obtained to explore the defect and resect the remnant membrane. The dog recovered without any complications, and the clinical signs were relieved. This case illustrates that partial venous inflow occlusion under mild hypothermia is feasible for achieving curative resection of cor triatriatum dexter in dogs.

Evaluation of the accuracy of three-dimensionally printed patient-specific guides for transsphenoidal hypophysectomy in small-breed dogs.

OBJECTIVE: To assess the accuracy of transsphenoidal hypophysectomy using 3-D printed patient-specific guides (3D-PSGs) in small-breed dogs. ANIMALS: Heads obtained from the cadavers of 19 small-breed dogs (ex vivo portion of study) and 3 healthy adult (3 to 4 years) purpose-bred Beagles with a median body weight of 9.2 kg. PROCEDURES: In the ex vivo study, CT images of the cadavers were collected. The position, width, and length of the pituitary fossa and the pilot hole (insertion angle and place) were measured. Using PSGs, 19 pilot holes were made for the pituitary gland fossa, and CT was performed to assess the position accuracy. In the in vivo study, 3 surgical windows from the pilot holes were made using PSGs. Repeated CT and MRI were performed to evaluate the safeness and effectiveness of PSGs, followed by necropsy. RESULTS: In the ex vivo study, the median (interquartile range) difference between the pre- and postoperative insertion angles was 2° (0° to 3.5°) and the median deviation of the pilot hole was 0.46 mm (0 to 1.58 mm). In the in vivo study, the surrounding structures were not damaged, and favorable outcomes were evident in terms of the shape, size, and position of the surgical window. CLINICAL RELEVANCE: 3D-PSGs provided a safe and effective surgical window for transsphenoidal hypophysectomy. Our findings emphasized the applicability of PSGs in brain surgery, in terms of accuracy and effectiveness.

Retroperitoneal Metastatic Apocrine Gland Ductal Adenocarcinoma in a Beagle Dog.

Tumors of sweat glands usually originate from apocrine glands and can develop throughout the body but are rare in dogs. This report describes the retroperitoneal metastasis of primary cutaneous apocrine adenocarcinoma. An 8-year-old, spayed female beagle dog, weighing 11.7 kg, presented with a history of anorexia, hypodynamia, and weight loss. Clinical examination, radiography, ultrasonography, and computed tomography revealed a skin mass on the dorsum of the right metatarsal region, an enlarged ipsilateral popliteal lymph node, and a retroperitoneal mass. Fine-needle aspiration cytology of the popliteal lymph node suggested metastasis of an apocrine sweat gland tumor. Surgical excision of the skin mass, popliteal lymph node, and retroperitoneal mass was performed. The retroperitoneal mass was diagnosed as a metastasis of primary cutaneous apocrine adenocarcinoma. Immunohistochemistry revealed that the tumor cells were positive for cytokeratin 7 but negative for cytokeratin 20 and S100 proteins. There were no postoperative complications, except for temporary hindlimb edema, including local recurrence or metastasis, in the 6-month postoperative follow-up period. This case illustrates that although malignant apocrine gland tumors are rare in dogs, a wide resection of primary cutaneous apocrine gland adenocarcinomas is recommended because of the risk of local invasion or distant metastasis.

Pelvic Endoprosthesis after Hemipelvectomy Using a 3D-Printed Osteotomy Guide for Infiltrative Osteoma in a Cat.

With the development of 3D printing and surgical techniques, various defect reconstruction methods after tumor resection have been applied not only in humans but also in veterinary medicine. This report describes a case of reconstruction after hemipelvectomy for an osteoma in a cat using a 3D-printed pelvic endoprosthesis and micro total hip replacement (mTHR). A 5-year-old spayed female Turkish Angora cat was referred for a 1-month history of constipation and intermittent weight-bearing lameness in the left hindlimb. An osteoma in the pelvis measuring 4.5 × 3 × 5.4 cm was identified based on diagnostic examinations. A left mid-to-caudal partial and right caudal partial hemipelvectomy, and a left femoral head and neck osteotomy, were planned to remove the mass. Reconstruction of the bone defect using 3D-printed metal endoprosthesis and mTHR in the left hindlimb was intended. During right caudal partial hemipelvectomy, right femoral head and neck osteotomy was performed because there was infiltration in the medial wall of the acetabulum. Histopathological examination confirmed the diagnosis of an osteoma. Two weeks post-surgery, surgical debridement and femoral stem removal were performed because of delayed wound healing and sciatic neurapraxia, leading to femoral stem dislocation from the cup. The delayed wound healing and sciatic neurapraxia were appropriately addressed. The cat regained normal weight and defecation 4 weeks post-operatively. Two years post-surgery, the patient recovered with an almost normal gait. Hemipelvectomy with 3D-printed endoprosthesis provides a safe surgical option with favorable outcomes for neoplasms in the pelvis of cats.

Epineural Neurorrhaphy of a Large Nerve Defect Due to IatroGenic Sciatic Nerve Injury in a Maltese Dog.

Epineural neurorrhaphy is a standard nerve repair method, but it is rarely reported in veterinary literature. Epineural neurorrhaphy in canine sciatic nerve injury are described in this report. An 11-month-old, castrated male Maltese dog, presented with an one-month history of non-weight bearing lameness and knuckling of the right pelvic limb. The dog showed absence of superficial and deep pain perception on the dorsal and lateral surfaces below the stifle joint. The dog had undergone femoral head and neck osteotomy in the right pelvic limb one month prior to referral at a local hospital. Based on physical and neurological examinations, peripheral nerve injury of the right pelvic limb was suspected. Radiography showed irregular bony proliferation around the excised femoral neck. Magnetic resonance imaging revealed sciatic nerve injury with inconspicuous continuity at the greater trochanter level. A sciatic nerve neurotmesis was suspected and surgical repair was decided. During surgery, non-viable tissue of the sciatic nerve was debrided, and epineural neurorrhaphy was performed to bridge a large, 20-mm defect. The superficial and deep pain perception was progressively improved and restored at 3 weeks postoperatively, and the dog exhibited a gradual improvement in motor function. At 10 weeks postoperatively, the dog showed no neurological deficit including knuckling but the tarsal joint hyperextension did not improve due to ankylosis. The dog had undergone tarsal arthrodesis and exhibited almost normal limb function without any neurologic sequela until the last follow-up at 2.5 years postoperatively.

Case report: Block recession calcaneoplasty of the calcaneal tuber for treating lateral superficial digital flexor tendon luxation in a dog.

A 4-year-old, intact, female, Collie was presented with 5 month history of right hindlimb lameness. Lateral luxation of the superficial digital flexor tendon (SDFT) was diagnosed on the basis of the clinical, radiographic and ultrasonographic finding. Intraoperatively, shallow right calcaneal tuber was observed. Block recession calcaneoplasty with retinaculum repair using anchor screw were performed to manage SDFT luxation. Additionally, temporary restraining pin was placed on lateral aspect of the calcaneal tuber. The patient demonstrated mild lameness at 2 weeks postoperatively and improved to normal limb function at 12 weeks postoperatively. As the gold standard of surgical techniques for SDFT luxation has not yet been reported, block recession calcaneooplasty may be an alternative surgical option for patients with calcaneal morphologic abnormalities causing SDFT luxation.

Successful mitral repair in dogs by mitral annuloplasty using Hegar dilator: two case reports.

Mitral regurgitation (MR) is the most common heart disease in small-breed dogs. Mitral repair, which comprise artificial chorda tendineae implantation and mitral annuloplasty, has become the mainstay of treatment in the veterinary field. We report on two small dogs who underwent mitral repair surgery for MR. A Hegar dilator was used during mitral annuloplasty for accurate and reproducible surgery. In both cases, mitral regurgitant flow almost disappeared after surgery, and clinical signs improved. The treatment regimen was terminated 3 months after the surgery. We concluded that using a Hegar dilator may facilitate mitral valve repair surgery.

Granulomatous Inflammation and Pericarditis Induced by Silk Granuloma Related to Previous Surgical Ligation of Patent Ductus Arteriosus in a Dog.

Surgical ligation of a patent ductus arteriosus is regarded as a standard treatment approach with a low complication rate if performed by experienced surgeons, and it has been performed successfully for decades in dogs. However, there are no reports describing the clinical symptoms related to granulomatous inflammation after the surgical ligation of the patent ductus arteriosus. This report describes the clinical symptoms caused by granulomatous inflammation and subacute pericarditis in a dog that had undergone the surgical closure of a patent ductus arteriosus 2 years previously. Exploratory thoracotomy was performed for subtotal pericardiectomy, and a biopsy was performed to obtain specimens for histopathological examination and culture tests. The clinical symptoms were relieved after surgery. The persistent leukocytosis improved with steroid administration. This case illustrates that the granulomatous inflammatory response associated with silk suture granuloma is a rare postoperative complication of ductal ligation. In such cases, pericardiectomy can help relieve the clinical symptoms.

Undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma) of the head in a dog.

A six year-old intact female miniature poodle was presented with a soft mass of the forehead region. Computed tomography identified generalized frontal bone loss and a large extracranial mass, which had a low attenuation area of hemorrhagic necrosis with septation and enhancement of solid components. In magnetic resonance imaging, the mass was isointense in T1-weighted images except its fluid parts and hyperintense in T2-weighted images with lobulated by low-signal septa. Surgery was performed to remove the mass, and histopathologic examination revealed that the mass was consistent with undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). The dog died from the rapidly recurrent mass and severe pulmonary metastasis.

Ischiocavernosus Muscle Release for Urethral Obstruction Treatment after Pelvic Symphyseal Distraction Osteotomy in a Cat with Pelvic Stenosis.

Symphyseal distraction osteotomy (SDO) with a polymethyl methacrylate (PMMA) spacer is an effective surgical treatment for cats with pelvic stenosis. This study reports the successful treatment of urethral obstruction due to ischiocavernosus muscle (IM) tension after SDO with a PMMA spacer. A 2-year-old castrated male Korean domestic shorthair feline had megacolon and pelvic canal stenosis. The ratio of the maximal diameter of the colon to the L5 length and the pelvic canal diameter ratio were 1.6 and 0.45, respectively. Pelvic SDO was performed with a PMMA spacer, leading to pelvic canal enlargement (pelvic canal diameter ratio: 0.73). Two days after surgery, dysuria was identified immediately after removing the preoperatively placed urinary catheter. Complete blood counts and serum biochemical profiles were within the reference intervals, and a positive contrast retrograde urethrogram confirmed urethral obstruction at the level of the membranous-pelvic urethra region. Increased tension of the IM leading to a narrowed urethra was suspected as the cause of urethral obstruction. After IM release at the level of origin on the ischium, the patient had an uneventful recovery with spontaneous urination. Muscle release resulted in excellent functional restoration, with no intraoperative or postoperative complications reported during the 12-month long-term follow-up. Therefore, SDO with IM release could be a feasible therapeutic option for severe pelvic stenosis without complications, such as urethral obstruction, in cats.

Transgastric cecectomy in canine models: natural orifice transluminal endoscopic surgery (NOTES).

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) for bowel resection is a challenging procedure. We studied the feasibility and safety of NOTES by performing cecectomy in dogs, which is equivalent to simple bowel resection in man. METHODS: Three dogs underwent transgastric endoscopic cecectomy with laparoscopic assistance. Antibiotics and irrigation were administered as preoperative preparation. A single-channel endoscope was introduced through the stomach into the peritoneal cavity, and the cecum was dissected and ligated with an L-knife and endoloops, respectively. Laboratory blood testing, peritoneal bacterial culture, and radiologic testing were performed perioperatively. Animals underwent autopsies on postoperative day (POD) 14. RESULTS: All subjects survived surgery and remained alive until POD 14. Mean operative time was 126.6 min. The absence of bacterial infections and anatomic leaks was verified by peritoneal swap culture, blood count, air leak testing, and bowel contrast radiology. However, a temporary mild elevation in white blood cell count was noted. No abscess or sign of infection was observed during autopsy, although adhesion was evident. CONCLUSIONS: Transgastric endoscopic cecectomy with minimal laparoscopic assistance is a feasible and safe procedure. Cecectomy in dogs is equivalent to procedures such as appendectomy, resection of Meckel's diverticulum, and oophorectomy in man. Natural orifice transluminal endoscopic surgery could prove to be a good optional surgical procedure.

Clinical efficacy and safety of thread-embedding acupuncture for treatment of the sequelae of Bell's palsy: A protocol for a patient-assessor blinded, randomized, controlled, parallel clinical trial.

BACKGROUND: The sequelae of Bell's palsy cause critical problem in facial appearance, as well as social and psychological problems in the patient's life. The aim of the present study is to establish clinical evidence of thread-embedding acupuncture (TEA) in the treatment of sequelae of Bell's palsy. METHOD/DESIGN: This is a patient-assessor blinded, randomized, sham-controlled trial with two parallel arms. Fifty-six patients aged 19-65 years, who have experienced sequelae of Bell's palsy for >3 months, will be recruited and screened using the eligibility criteria. After screening, they will be randomly allocated to a TEA group or a sham TEA (STEA) group. Both groups will receive TEA or STEA treatment on ten predefined acupoints once a week for 8 weeks. Additionally, both groups will receive the same acupuncture treatment twice a week for 8 weeks as a concurrent treatment. Changes in the Facial Disability Index over 8 weeks will be assessed as the primary outcome. Furthermore, the House-Brackmann Grade, Facial Nerve Grading System 2.0, Sunnybrook Facial Grading System, facial stiffness score, lip mobility score, and treatment satisfaction score will be measured and analyzed as secondary outcomes. All outcomes will be assessed at baseline and at 4 and 8 weeks after screening. DISCUSSION: The results from this trial will help establish clinical evidence regarding the efficacy and safety of TEA in the treatment of patients with sequelae of Bell's palsy. TRIAL REGISTRATION NUMBER: KCT0002557 (Clinical Research Information Service of the Republic of Korea).