The effect of aquapuncture at Pericardium 6 (PC-6) on dexmedetomidine-induced nausea and vomiting in cats.

OBJECTIVE: To determine the effect of aquapuncture at acupuncture point Pericardium 6 (PC-6) on the incidence of dexmedetomidine-induced vomiting and nausea in cats. STUDY DESIGN: Randomized, prospective, crossover study. ANIMALS: A group of 22 cats, 14 females and eight males, aged 1-12 years and weighing 3.8-5.9 kg. METHODS: Each cat was administered treatments in random order at ≥1 week intervals. For treatment (DEX-A), cats were administered PC-6 stimulation by aquapuncture (0.25 mL/250 µg vitamin B12 injection subcutaneously at PC-6). After 30 minutes, dexmedetomidine (10 µg kg-1) was administered intramuscularly (IM). For control treatment (DEX), cats were administered only dexmedetomidine (10 µg kg-1) IM. Incidence of vomiting, number of vomiting episodes and time to first vomiting were recorded by an observer unaware of treatment allocation. At 30 minutes after dexmedetomidine administration, atipamezole (0.1 mg kg-1) was injected IM. Behavior was video recorded and later scored by two observers for clinical signs of nausea. A regression model (analysis of covariance) was used to detect the influence of aquapuncture on vomiting and nausea. Significance was set at p < 0.05. RESULTS: Of 21 cats, 18 (85%) and 16 cats (76%) vomited in DEX-A and DEX, respectively. There was no significant difference in the incidence of vomiting (p = 0.55), number of vomiting episodes (p = 0.55), mean time to vomit (p = 0.88) or nausea score (p = 0.51) between DEX-A and DEX. CONCLUSIONS AND CLINICAL RELEVANCE: PC-6 aquapuncture did not reduce the incidence of dexmedetomidine-induced vomiting or severity of nausea in cats.

Anthropometric Changes During Pregnancy Provide Little Explanation of Dynamic Balance Changes.

The authors investigated the relationship between anthropometric changes and dynamic balance changes during pregnancy. A total of 15 participants were recruited for testing, using a convenience sample, from 12 weeks of gestation until childbirth. The authors measured body anthropometry with a tape measure and calipers. The authors conducted a self-selected speed walking analysis using a motion capture system and measured balance deficits as increased motion of the body center of mass. While a relatively large total explained variance of preferred walking speed was achieved (R2 = .629), this study reports that body anthropometry explains little (<1%) unique variance in walking speed (P < .001) after covariates are considered. The authors also found that body anthropometry explains little (<5%) unique variance in dynamic balance control (P < .001) after covariates are considered, but total explained variance by all variables remained low to moderate (R2 = +.248). These findings indicate that while body anthropometry changes correlate with dynamic balance changes during pregnancy, these provide little to no additional information about common balance changes during pregnancy after covariates were considered. Prepregnancy differences between individuals seem to be the predominant determinant of changes during pregnancy.

FEASIBILITY AND SAFETY OF CONTRAST-ENHANCED ULTRASOUND IN THE DISTAL LIMB OF SIX HORSES.

Vascular alterations play important roles in many orthopedic diseases such as osteoarthritis, tendonitis, and synovitis in both human and equine athletes. Understanding these alterations could enhance diagnosis, prognosis, and treatment. Contrast-enhanced ultrasound (CEUS) could be a valuable method for evaluation of blood flow and perfusion of these processes in the equine distal limb, however no reports were found describing feasibility or safety of the technique. The goal of this prospective, experimental study was to describe the feasibility and safety of distal limb CEUS in a sample of six horses. For each horse, CEUS of the distal limb was performed after intravenous injections of 5 and 10 ml, as well as intra-arterial injections of 0.5 and 1 ml contrast medium. Vital parameters were monitored and CEUS images were assessed qualitatively and quantitatively for degree of contrast enhancement. None of the horses had clinically significant changes in their vital parameters after contrast medium injection. One horse had a transient increase in respiratory rate, and several horses had mild increases of systolic blood pressure of short duration after intravenous, but not after intra-arterial injections. Intra-arterial injection was possible in all horses and resulted in significantly improved contrast enhancement both quantitatively (P = 0.027) and qualitatively (P = 0.019). Findings from this study indicated that CEUS is a feasible and safe diagnostic test for evaluation of the equine distal limb. Future studies are needed to assess the clinical utility of this test for horses with musculoskeletal diseases.

Perianesthetic morbidity and mortality in dogs undergoing cervical and thoracolumbar spinal surgery.

OBJECTIVE: To evaluate and compare perioperative morbidity and mortality in dogs undergoing cervical and thoracolumbar spinal surgery. STUDY DESIGN: Prospective case series. ANIMALS: 157 dogs undergoing cervical or thoracolumbar spinal surgery. METHODS: Data were collected sequentially on canine cases presented from the Neurology Section of the North Carolina State University Veterinary Teaching Hospital for anesthesia and surgery for cervical spinal cord disease. Simultaneously, data were collected on all thoracolumbar spinal surgery cases during the same time period. Data included signalment, drugs administered, surgical approach, disease process, cardiac arrhythmias during anesthesia, and outcome. RESULTS: Data were collected from 164 surgical events in 157 dogs. There were 52 cervical approaches; four dorsal and 48 ventral. All thoracolumbar surgeries were approached dorsolaterally. Four dogs 4/52 (7.6%) undergoing a cervical approach did not survive to discharge. Two dogs (2/8; 25%) underwent atlanto-axial (AA) stabilization and suffered cardiovascular arrest and two dogs (2/38; 5.2%) undergoing cervical ventral slot procedures were euthanized following anesthesia and surgery due to signs of aspiration pneumonia. All dogs undergoing thoracolumbar surgery survived until discharge (112/112). Mortality in dogs undergoing cervical spinal surgery was greater compared with dogs undergoing thoracolumbar spinal surgery (p = 0.009), however, in dogs undergoing decompressive disc surgery, intraoperative death rates were not different between dogs undergoing a cervical compared with thoracolumbar approaches (p = 0.32) nor was there a significant difference in overall mortality (p = 0.07). CONCLUSION AND CLINICAL RELEVANCE: Overall, dogs undergoing cervical spinal surgery were less likely to survive until discharge compared with dogs undergoing thoracolumbar spinal surgery. Mortality in dogs undergoing cervical intervertebral disc decompression surgery was no different than for dogs undergoing thoracolumbar intervertebral disc decompression surgery. However, dogs undergoing cervical intervertebral disc decompression surgery should be considered at risk for aspiration pneumonia.

Diode laser endoscopic cyclophotocoagulation in the normal equine eye.

OBJECTIVE: To determine the clinical and histologic effects of diode endoscopic cyclophotocoagulation (ECP) in the phakic equine eye. ANIMALS STUDIED: Phase I: 10 equine cadaver eyes. Phase II: four normal adult horses. PROCEDURES: Phase I: ECP probe angle of reach (AR) was determined. Multiple ECP energy levels: 0.75, 0.90, 1.05, 1.20, 1.35, 1.50 J, and the resulting visible and histologic ciliary process changes were evaluated. Phase II: Ocular quadrants were treated with ECP at 0.90, 1.14, 1.38 J, and a control. The contralateral eye underwent a sham operation. Tissue changes (clinical and histologic) were evaluated. RESULTS: Phase I: Mean combined AR was 162 ± 29 degrees. Mean visible tissue scores: 2.60 ± 0.58 (0.75 J) to 5.04 ± 0.30 (1.50 J) from possible total of 6. Tissue 'popping' was observed at 1.50 J. Histologic ciliary tissue damage was present at all settings. Phase II: Mean visible tissue scores: 2.90 ± 0.48 (0.90 J), 3.61 ± 0.57 (1.14 J), and 4.52 ± 0.56 (1.38 J). Tissue 'popping' was observed at 1.38 J. Histologic ciliary tissue damage was present at all settings. Clinical effects included acute inflammation, intraocular pressure reduction, cataract formation, corneal edema, corneal ulceration, and postoperative ocular hypertension. CONCLUSIONS: Diode ECP between 0.90 and 1.14 J is a potential treatment option for glaucoma in horses based on visible tissue effects and target ciliary epithelium damage. Iatrogenic cataract development may limit the use of an anterior chamber approach in phakic horses. Supported in part by an ACVO VAF grant.

The impact of the COVID pandemic on primary care diabetes services in the UK: A cross-sectional national survey of views of health professionals delivering diabetes care.

BACKGROUND: Healthcare systems worldwide have been adversely affected by the Coronavirus disease 2019 (COVID-19) pandemic. There has been a substantial decrease in admissions for acute medical conditions with longer delays between the onset of the symptoms and hospital treatment compared to the pre-pandemic period. The impact of the COVID pandemic on primary care services is uncertain. AIM: Using an online survey, we examined the impact of the COVID pandemic on primary care diabetes services in the UK. METHODS: An online survey was developed by the Primary Care Diabetes Society research group and administered to healthcare and allied health professionals delivering diabetes care in the UK from January to May 2021. Descriptive statistics and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS: Of the 1070 professionals surveyed, 975 (91.1%) completed the questionnaire. Most respondents were nurses or nurse practitioners (59.7%) and doctors (32.9%). The mean age of respondents was 52 years and 79% were female. The majority of respondents felt overloaded with work (71.2%) or emotionally drained at the end of a working day (79.1%) compared with the pre-pandemic period. Being a doctor and worried about infecting a family member with the Coronavirus were each associated with an increased odds of being substantially overworked or emotionally drained: (OR = 2.52; 95% CI, 1.25-5.07) and (OR = 2.05; 95% CI, 1.24-3.39), respectively. The most common consultation method used to provide diabetes care during the pandemic was telephone consultation (92.0%). Overall 79.1% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine diabetes care; 70.6% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine health checks or screening for type 2 diabetes and approximately half of respondents (48.3%) reported encountering mental health concerns in people with diabetes. CONCLUSIONS: COVID-19 pandemic has had significant impact on the ability of healthcare professionals and their practices to deliver routine diabetes care. Failure to restore primary care provision urgently and safely to at least pre-pandemic levels in a sustainable manner may lead to emotionally drained and overworked workforce in primary care, place additional burden on the already overburdened healthcare system and worse outcomes for patients.

Evaluation of 30- and 25-diopter intraocular lens implants in equine eyes after surgical extraction of the lens.

OBJECTIVE: To determine appropriate intraocular lens (IOL) implant strength to approximate emmetropia in horses. SAMPLE POPULATION: 16 enucleated globes and 4 adult horses. PROCEDURES: Lens diameter of 10 enucleated globes was measured. Results were used to determine the appropriate-sized IOL implant for insertion in 6 enucleated globes and 4 eyes of adult horses. Streak retinoscopy and ocular ultrasonography were performed before and after insertion of 30-diopter (D) IOL implants (enucleated globes) and insertion of 25-D IOL implants (adult horses). RESULTS: In enucleated globes, mean +/- SD lens diameter was 20.14 +/- 0.75 mm. Preoperative and postoperative refractive state of enucleated globes with 30-D IOL implants was -0.46 +/- 1.03 D and -2.47 +/- 1.03 D, respectively; preoperative and postoperative difference in refraction was 2.96 +/- 0.84 D. Preoperative anterior chamber (AC) depth, crystalline lens thickness (CLT), and axial globe length (AxL) were 712 +/- 0.82 mm, 11.32 +/- 0.81 mm, and 40.52 +/- 1.26 mm, respectively; postoperative AC depth was 10.76 +/- 1.16 mm. Mean ratio of preoperative to postoperative AC depth was 0.68. In eyes receiving 25-D IOL implants, preoperative and postoperative mean refractive error was 0.08 +/- 0.68 D and -3.94 +/- 1.88 D, respectively. Preoperative AC depth, CLT, and AxL were 6.36 +/- 0.22 mm, 10.92 +/- 1.92 mm, and 38.64 +/- 2.59 mm, respectively. Postoperative AC depth was 8.99 +/- 1.68 mm. Mean ratio of preoperative to postoperative AC depth was 0.73. CONCLUSIONS AND CLINICAL RELEVANCE: Insertion of 30-D (enucleated globes) and 25-D IOL implants (adult horses) resulted in overcorrection of refractive error.

The hemodynamic effects of medetomidine continuous rate infusions in the dog.

OBJECTIVE: To characterize the hemodynamic effects of continuous rate infusions (CRI) of medetomidine administered at doses ranging from 0 to 3 microg kg(-1) hour(-1). STUDY DESIGN: Prospective, blinded, randomized experimental trial. ANIMALS: Six adult purpose-bred mongrel dogs. METHODS: Anesthesia was induced with sevoflurane for placement of arterial and venous catheters. Dogs recovered from anesthesia after which baseline hemodynamic measurements were obtained via lithium dilution cardiac output (CO) determination, with subsequent measurements via pulse power analysis to provide continuous CO determinations. Medetomidine, 1, 2, or 3 microg kg(-1) hour(-1) or a volume equivalent placebo, was administered via CRI for 60 minutes. Systolic, mean, and diastolic arterial pressure, heart rate (HR), CO and stroke volume were measured and stroke index (SI), cardiac index (CI), total peripheral resistance (TPR), and total peripheral resistance index (TPRI) were calculated at 3, 7, 10, 20, 30, 45, 60, 90, and 120 minutes from the start of the infusion. RESULTS: Increase in dose decreased SI by 25%, 19%, and 30%, HR by 33%, 57%, and 60%, CI by 50%, 65%, 70% and increased TPRI by 109%, 235%, and 222% from baseline to the 60-minute measurement for the 1, 2, and 3 microg kg(-1) hour(-1) doses, respectively. HR, TPRI, and CI all showed significant differences over the duration of the study from the placebo treatment. CONCLUSIONS: Medetomidine CRI produces clinically relevant changes in CO, TPR, and HR. The demonstrated decrease in CO is largely because of bradycardia and the degree of cardiovascular depression appears to be dose-dependent. These findings are consistent with previously described hemodynamic changes with single bolus administration of medetomidine. CLINICAL RELEVANCE: Low-dose medetomidine CRIs produce clinically relevant hemodynamic depression at doses as low as 1 microg kg(-1) hour(-1) and should be used cautiously in dogs.

Correlations between joint kinematics and dynamic balance control during gait in pregnancy.

BACKGROUND: Dynamic balance control degrades during pregnancy, but it is not yet understood why. Mechanical aspects of the body should directly affect walking balance control, but we have recently published papers indicating that weight gains during pregnancy explain very little dynamic balance changes. Our goal was to determine if lower extremity joint kinematic changes are an indicator of walking balance control. This information is vital to understanding the route by which pregnancy increases fall risk. METHODS: Twenty-three pregnant women were tested at five different times in the 2nd and 3rd trimesters of pregnancy. Participants performed walking trials at a self-selected pace. Motion capture was used to measure joint kinematics (discrete and coordination variables) and body center of mass motion. Changes over time were statistically analyzed. Correlations between kinematics and walking balance were modelled with hierarchical multiple regression models. RESULTS: As pregnancy progresses, it appears that a more flexed hip posture could be driving lower extremity kinematic changes toward increased coordination between joints and increased knee and ankle motions. Walking balance changes were also detected through increased COM motion (lateral range of motion and velocity) in the lateral directions. However, there was little correlation between kinematic and balance changes (r2 < 0.4). Strong correlations were only observed when all kinematics (including those that don't ubiquitously change during pregnancy) were used in the regression model (r2 > 0.7). SIGNIFICANCE: Our findings suggest that walking balance control is not altered by a common kinematic change between all pregnant women. While increased lateral center of mass motion should be expected with pregnancy, the kinematics leading to this increase may be person-specific. The cause of dynamic imbalance in each pregnant women (physiological, mechanical, and neurocognitive) may play an important role in determining the kinematic means by which lateral center of mass motion increases.

An analysis of postpartum walking balance and the correlations to anthropometry.

BACKGROUND: Falls caused by balance issues during pregnancy are quite common, and these issues can continue postpartum, potentially posing a danger to both the mother and baby. While there has been research on changes to walking gait during pregnancy, walking balance in the postpartum period has yet to be examined. Therefore, the aims of this study were to examine if balance changes persist in postpartum and the contribution of anthropometry changes. METHODS: This was done through longitudinal observational cohort study at 16 and 40 weeks gestation and at four-week intervals postpartum. Balance was measured as lateral center of mass motion during treadmill walking, and recorded with motion capture cameras following anthropometric measurements. Balance variables were statistically analyzed to observe how they changed over time. Hierarchical regression analyses determined correlations between balance and anthropometry. RESULTS: Balance was observed to improve significantly just following birth. Additionally, there were changes that continued to indicate improvement throughout the postpartum period. Anthropometry changes were significantly, but minimally, correlated with balance changes. SIGNIFICANCE: Many women begin to return to normal activities soon after birth. With women participating in various forms of exercise, potentially rigorous work requirements, and tasks around the home, it is important that they, their medical providers, and employers understand and consider the continued risks of imbalance.

Effect of firocoxib or flunixin meglumine on recovery of ischemic-injured equine jejunum.

OBJECTIVE: To determine whether treatment of horses with firocoxib affects recovery of ischemic-injured jejunum, while providing effective analgesia. ANIMALS: 18 horses. PROCEDURES: Horses (n = 6 horses/group) received saline (0.9% NaCl) solution (1 mL/50 kg, IV), flunixin meglumine (1.1 mg/kg, IV, q 12 h), or firocoxib (0.09 mg/kg, IV, q 24 h) before 2 hours of jejunal ischemia. Horses were monitored via pain scores and received butorphanol for analgesia. After 18 hours, ischemic-injured and control mucosa were placed in Ussing chambers for measurement of transepithelial resistance and permeability to lipopolysaccharide. Histomorphometry was used to determine denuded villus surface area. Western blots for cyclooxygenase (COX)-1 and COX-2 were performed. Plasma thromboxane B(2) and prostaglandin E(2) metabolite (PGEM) concentrations were determined. RESULTS: Pain scores did not significantly increase after surgery in horses receiving flunixin meglumine or firocoxib. Transepithelial resistance of ischemic-injured jejunum from horses treated with flunixin meglumine was significantly lower than in saline- or firocoxib-treated horses. Lipopolysaccharide permeability across ischemic-injured mucosa was significantly increased in horses treated with flunixin meglumine. Treatment did not affect epithelial restitution. Cyclooxygenase-1 was constitutively expressed and COX-2 was upregulated after 2 hours of ischemia. Thromboxane B(2) concentration decreased with flunixin meglumine treatment but increased with firocoxib or saline treatment. Flunixin meglumine and firocoxib prevented an increase in PGEM concentration after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Flunixin meglumine retarded mucosal recovery in ischemic-injured jejunum, whereas firocoxib did not. Flunixin meglumine and firocoxib were effective visceral analgesics. Firocoxib may be advantageous in horses recovering from ischemic intestinal injury.

Anti-inflammatory effects of intravenously administered lidocaine hydrochloride on ischemia-injured jejunum in horses.

OBJECTIVE: To investigate effects of lidocaine hydrochloride administered IV on mucosal inflammation in ischemia-injured jejunum of horses treated with flunixin meglumine. ANIMALS: 24 horses. PROCEDURES: Horses received saline (0.9% NaCl) solution (SS; 1 mL/50 kg, IV [1 dose]), flunixin meglumine (1 mg/kg, IV, q 12 h), lidocaine (bolus [1.3 mg/kg] and constant rate infusion [0.05 mg/kg/min], IV, during and after recovery from surgery), or both flunixin and lidocaine (n = 6/group). During surgery, blood flow was occluded for 2 hours in 2 sections of jejunum in each horse. Uninjured and ischemia-injured jejunal specimens were collected after the ischemic period and after euthanasia 18 hours later for histologic assessment and determination of cyclooxygenase (COX) expression (via western blot procedures). Plasma samples collected prior to (baseline) and 8 hours after the ischemic period were analyzed for prostanoid concentrations. RESULTS: Immediately after the ischemic period, COX-2 expression in horses treated with lidocaine alone was significantly less than expression in horses treated with SS or flunixin alone. Eighteen hours after the ischemic period, mucosal neutrophil counts in horses treated with flunixin alone were significantly higher than counts in other treatment groups. Compared with baseline plasma concentrations, postischemia prostaglandin E(2) metabolite and thromboxane B(2) concentrations increased in horses treated with SS and in horses treated with SS or lidocaine alone, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: In horses with ischemia-injured jejunum, lidocaine administered IV reduced plasma prostaglandin E(2) metabolite concentration and mucosal COX-2 expression. Coadministration of lidocaine with flunixin ameliorated the flunixin-induced increase in mucosal neutrophil counts.

Anthropometry, standing posture, and body center of mass changes up to 28 weeks postpartum in Caucasians in the United States.

BACKGROUND: Anthropometric models are used when body center of mass motion is calculated for assessment of dynamic balance. It is currently unknown how body segments and posture change in the postpartum period. Therefore, this study was conducted to evaluate the longitudinal changes in anthropometry, center of mass, and standing posture postpartum. METHODS: Seventeen pregnant women were tested at nine different times: 16-20 weeks and 36-40 weeks gestation, and then in 4-week intervals from childbirth to 28 weeks postpartum. Anthropometry was measured and then participants conducted a static standing and static laying trial. Force plate data and motion capture data were used in combination with anthropometry to calculate the masses of individual segments and the body center of mass. Change over time was determined through a linear mixed model analysis. RESULTS: Anthropometric changes related to the abdomen or fluid retention during pregnancy immediately regress to early pregnancy levels following childbirth. However, other changes related to breast tissue and fat deposits persist postpartum. As such, masses of different segments affect an anthropometric model for center of mass calculation, and body center of mass changes in the lateral and anterior directions postpartum. Vertical body center of mass position was unaffected. SIGNIFICANCE: Increased postpartum breast mass may be the cause of persistent lordotic curvature changes in the lumbar spine. There is potential that this affects postpartum back pain. Future research should explore how body center of mass changes postpartum for individuals that do not breast feed, and thus may not have significant breast mass postpartum.

Stand-to-sit kinematic changes during pregnancy correspond with reduced sagittal plane hip motion.

BACKGROUND: The stand-to-sit motion has been linked to falls during pregnancy. It is also used in the clinical evaluation of functional performance. The physical and physiological changes during pregnancy may necessitate a change in stand-to-sit kinematic performance. Therefore, this study was conducted to evaluate the longitudinal changes to stand-to-sit kinematics during pregnancy. METHODS: Fifteen pregnant women were tested in 4-week intervals from 16 weeks to 36 weeks gestational age. They performed a 60-second trial of semi-continuous stand-to-sit motion. Sagittal plane motions at the ankle, knee, spine, and shoulders were measured. Additionally, three-dimensional hip motion was measured. Discrete variables (e.g. range of motion) and joint coordinations (through vector coding) were analyzed over time through a linear mixed model analysis. FINDINGS: The results indicate a shift away from sagittal hip motion throughout pregnancy. Hip range of motion and standing angle changed in favor of spine motion. Joint coordination shifted from hip dominant to spine- and shoulder-dominate coordination just before the start of sitting motion. Hip-knee joint coordination just before seat contact shifted from hip to a knee-dominant motion during pregnancy. INTERPRETATION: Discrete variable changes in the entire stand-to-sit motion seem to be driven by initial standing posture related to an increase in gestational lordosis. Likewise, standing joint coordination shift to upper body motion can be attributed to gestational lordosis limiting functional ability around the hip. The shift in motion away from the hip may provide insight into why both fall rates and low back pain rates increase during stand-to-sit during pregnancy.

Sedative and cardiopulmonary effects of buccally administered detomidine gel and reversal with atipamezole in dogs.

OBJECTIVE To evaluate hemodynamic, respiratory, and sedative effects of buccally administered detomidine gel and reversal with atipamezole in dogs. ANIMALS 8 adult purpose-bred dogs. PROCEDURES Arterial and venous catheters were placed. Baseline heart rate, respiratory rate, cardiac output (determined via lithium dilution with pulse contour analysis), oxygen delivery, systemic vascular resistance, arterial blood gas values, and sedation score were obtained. Detomidine gel (2.0 mg/m2) was administered on the buccal mucosa. Cardiopulmonary data and sedation scores were obtained at predetermined times over 180 minutes. Atipamezole (0.1 mg/kg) was administered IM at 150 minutes. Reversal of sedation was timed and scored. Data were analyzed with an ANOVA. RESULTS Compared with baseline values, heart rate was lower at 45 to 150 minutes, cardiac output and oxygen delivery were lower at 30 to 150 minutes, and systemic vascular resistance was increased at 30 to 150 minutes. There were no significant changes in Paco2, Pao2, or lactate concentration at any time point, compared with baseline values, except for lactate concentration at 180 minutes. All dogs became sedated; maximum sedation was detected 75 minutes after administration of detomidine. Mean ± SD time to recovery after atipamezole administration was 7.55 ± 1.89 minutes; sedation was completely reversed in all dogs. No adverse events were detected. CONCLUSIONS AND CLINICAL RELEVANCE Buccally administered detomidine gel was associated with reliable and reversible sedation in dogs, with hemodynamic effects similar to those induced by other α2-adrenoceptor agonists. Buccally administered detomidine gel could be an alternative to injectable sedatives in healthy dogs.

Walking balance on a treadmill changes during pregnancy.

BACKGROUND: Altered standing balance during pregnancy has been previously reported. To date, body center of mass (bCOM) motion has not been used to track balance changes in this population. We recently compared three methods to determine the torso center of mass (tCOM) location (via force plate acquired center of pressure calculation, using Pavol surface anthropometry measurements, and a combination of the two) to use in calculating the bCOM during pregnancy. RESEARCH QUESTION: This current research explored two questions: (1) does walking balance change during pregnancy, and (2) do the methods for identifying tCOM location affect the resulting balance measures? METHODS: Fifteen pregnant women were recruited to perform 60-second trial of treadmill walking at 4-week intervals from 12 weeks gestation until delivery. Walking balance was measured as bCOM motion within the base of support. Gestation time and anthropometric model (force plate, Pavol, and combination) were repeated-measures independent variables in a general linear mixed model analysis. RESULTS: There was a significant decrease in walking balance during pregnancy. As gestation progressed, we observed non-linear changes in the bCOM motion within the base of support over time, with some changes starting early in pregnancy and others not starting until late 2nd trimester. The anthropometric model used to locate the bCOM significantly influences balance measures. The results of this study indicate that the force plate method is more appropriate for locating the tCOM in the anterior and lateral directions. SIGNIFICANCE: The results of this study will inform clinicians and patients about the gestational stage-associated changes in balance during pregnancy that increase the risk of falling and injury. Researchers should also carefully consider the method for locating the bCOM.

A comparison of methods to determine center of mass during pregnancy.

Balance changes during pregnancy likely occur because of mass gains and mass distribution changes. However, to date there is no way of tracking balance through center of mass motion because no method is available to identify of the body center of mass throughout pregnancy. We compared methods for determining segment masses and torso center of mass location. The availability of a method for tracking these changes during pregnancy will make determining balance changes through center of mass motion an option for future pregnancy balance research. Thirty pregnant women from eight weeks gestation until birth were recruited for monthly anthropometric measurements, motion capture analysis of body segment locations, and force plate analysis of center of pressure during quiet standing and supine laying. From these measurements, we were able to compare regression, volume measurement, and weighted sum methods to calculate body center of mass throughout pregnancy. We found that mass changes around the trunk were most prevalent as expected, but mass changes throughout the body (especially the thighs) were also seen. Our findings also suggest that a series of anthropometric measurements first suggested by Pavol et al. (2002), in combination with quiet standing on a force plate, can be used to identify the needed components (segment masses and torso center of mass location in three dimensions) to calculate body center of mass changes during pregnancy. The results of this study will make tracking of center of mass motion a possibility for future pregnancy balance research.

Therapeutic inertia amongst general practitioners with interest in diabetes.

INTRODUCTION: As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists. METHODS: In this retrospective audit, we assessed the prevalence of the phenomenon of therapeutic inertia amongst primary care physicians with an interest in diabetes in UK. We also assessed the predictive abilities of various patient level characteristics on therapeutic inertia amongst this group of clinicians. RESULTS: Out of the 240 patients reported on, therapeutic inertia was judged to have occurred in 53 (22.1%) of patients. The full model containing all the selected variables was not statistically significant, p=0.59. So the model was not able to distinguish between situations in which therapeutic inertia occurred and when it did not occur. None of the patient level characteristics on its own was predictive of therapeutic inertia. CONCLUSION: Therapeutic inertia was present only in about a fifth of patient patients with diabetes being managed by primary care physicians with an interest in diabetes.

Tissue-disruptive forces during median sternotomy.

BACKGROUND: Acute and chronic pain after median sternotomy is common and often underestimated. The mechanical retractors used for median sternotomy exert significant forces on the skeletal cage. We hypothesized that instrumented retractors could be developed to enable real-time monitoring and control of retraction forces, functions that may provide equivalent exposure with significantly reduced forces and tissue damage, and thus, less postoperative pain. METHODS: We developed a novel instrumented retractor designed to enable real-time force monitoring during surgical retraction and then tested it by performing median sternotomies on 16 mature sheep. For 8 of these median sternotomies, retraction was performed to 7.5 cm at a standard "clinical pace" of 7.25 +/- 0.97 minutes without real-time monitoring of retraction forces. For the other 8 median sternotomies, we performed retraction to the same exposure using real-time visual force feedback and, consequently, a more deliberate pace of 12.05 +/- 1.73 minutes (P <.001). Retraction forces, blood pressure, and heart rate were monitored throughout the procedure. RESULTS: Full retraction resulted in an average force of 102.99 +/- 40.68 N at the standard clinical pace, compared to 64.68 +/- 17.60 N with force feedback (a 37.2% reduction, P = .021). Standard retraction produced peak forces of 368.79 +/- 133.61 N, whereas force feedback yielded peak forces of 254.84 +/- 75.77 N (a 30.9% reduction, P = .1152). Heart rate was significantly higher during standard clinical retraction (P = .025). CONCLUSIONS: Use of the novel instrumented retractor resulted in lower average and peak retraction forces during median sternotomy. Moreover, these reduced retraction forces correlated to a reduction in animal stress, as documented by heart rate.