Hoof wall masses removal in 30 standing sedated horses: Surgical technique, postoperative complications and long-term outcome.

OBJECTIVE: To describe the surgical technique for removal of hoof wall masses in horses under standing sedation (SS) and local anesthesia (LA), and to report complications and long-term outcome following surgery. STUDY DESIGN: Observational retrospective study. ANIMALS: Client-owned horses (n = 30). METHODS: Horses undergoing keratoma removal under SS and LA in a single equine hospital between August 2016 and July 2023 were included in the study. Signalment, affected foot, history of lameness and/or foot abscesses, degree of lameness on admission, imaging findings (radiography and magnetic resonance imaging [MRI] when available), location of the mass, surgical technique, remedial farriery, postoperative care, complications and outcome were recorded. Long-term follow-up information was obtained by telephone questionnaire. RESULTS: A total of 30 horses met the inclusion criteria. Duration of lameness ranged from 1 to 289 days (mean 90 days). The degree of lameness varied from absent to grade 4/5 (AAEP) (mean grade 3/5). All horses underwent preoperative radiographic examination and 14/30 underwent MRI. All horses underwent partial hoof wall resection. The surgery was performed safely in all cases. Postoperative complications included marked lameness in the early postoperative period in 3/30 horses and exuberant granulation tissue formation in 2/30 horses. Long-term (>6 months) follow-up information was available for 28 horses, and 26/28 horses returned to previous levels of exercise. Recurrence was suspected in 1/30 horses. CONCLUSIONS: The complication rate was lower than previously reported for keratoma removal under general anesthesia (GA). CLINICAL SIGNIFICANCE: Removal of hoof wall masses under SS and LA can be considered as an alternative to removal under GA.

Evaluation of peritoneal l-lactate concentration in horses in the early post-partum period.

BACKGROUND: Peritoneal fluid lactate concentration is an important diagnostic tool in horses with abdominal pain. Information on peritoneal lactate concentrations is lacking following parturition in the mare. OBJECTIVES: To compare blood and peritoneal lactate concentrations in a population of mares within 36 h post-partum, report a normal reference range and identify any impact of retained foetal membranes (RFMs). METHODS: This is a retrospective study evaluating healthy mares from which blood and peritoneal samples had been obtained within 36 h of parturition. Exclusion criteria included signs of abdominal pain within this period. Data was interrogated for normality using a Shapiro-Wilk test. Wilcoxon signed-rank test and Bland-Altman analysis were used to compare blood and peritoneal lactate concentrations. Linear regression was used to compare age and breed data with peritoneal lactate concentrations. Significance was defined as p < 0.05. RESULTS: Forty mares met the inclusion criteria. Mean age was 12.6 ± 4.1 years, and most mares were multiparous (65%). Peritoneal lactate ((1.2 (IQR = 0.9-1.6) mmol/L) was increased compared to blood lactate concentration (0.7 (IQR = 0-1.1)mmol/L; p < 0.001). Plasma total protein (TP) concentrations were 68 (IQR = 64-74) g/L and peritoneal protein concentrations 8 (IQR = 4-9.7) g/L. Six mares developed RFM. The median fold-increase in peritoneal lactate concentration compared to blood lactate concentration was 0.9 (IQR: 0.01-1.7; range: 0-2.5). The reference range for peritoneal fluid lactate concentration was 0-2.5 mmol/L. CONCLUSION: Peritoneal lactate concentrations in healthy post-partum mares remained within the normal reference range and were not influenced by RFM or parturition. Increased peritoneal lactate in this group warrants further investigation.

Behavioural evidence for a sleep-like quiescent state in a pulmonate mollusc, Lymnaea stagnalis (Linnaeus).

The objective of this study was to determine whether the great pond snail, Lymnaea stagnalis, expresses a sleep-like behavioural state. We found that snails spontaneously enter a relatively brief (22±1 min) quiescent state characterized by postural relaxation of the foot, mantle and tentacles, and cessation of radula rasping. Quiescence was reversed ('aroused') by appetitive (sucrose solution) and aversive (tactile) stimuli. Responsiveness to both stimuli was significantly lower in quiescent snails than in active snails. However, tactile stimuli evoked a more sustained defensive response in quiescent snails. Quiescence bouts were consolidated into 'clusters' over an infradian timescale and were only weakly affected by time of day. Clusters contained 7±0.5 bouts, lasted 13±1 h and were separated by long (37±4 h) intervals of almost continuous activity. Analysis of Kaplan-Meier survival curves revealed that the quiescent bout duration was described by an exponential probability distribution (time constant 15±1 min). Active bout duration was described by a bi-exponential probability distribution (time constants 62±4 and 592±48 min). We found no evidence for a 'sleep rebound' mechanism and quiescence expression appeared to be regulated through stochastic processes causing state transitions to resemble a Markovian random walk. We conclude that Lymnaea is a potentially valuable model system for studies of cellular function in sleep.

A quasi-experimental feasibility study to determine the effect of a systematic treatment programme on the scores of the Nottingham Adjustment Scale of individuals with visual field deficits following stroke.

OBJECTIVE: To evaluate a systematic treatment programme developed by the researcher that targeted aspects of visual functioning affected by visual field deficits following stroke. DESIGN: The study design was a non-equivalent control (conventional) group pretest-posttest quasi-experimental feasibility design, using multisite data collection methods at specified stages. SETTING: The study was undertaken within three acute hospital settings as outpatient follow-up sessions. SUBJECTS: Individuals who had visual field deficits three months post stroke were studied. INTERVENTIONS: A treatment group received routine occupational therapy and an experimental group received, in addition, a systematic treatment programme. The treatment phase of both groups lasted six weeks. MAIN MEASURES: The Nottingham Adjustment Scale, a measure developed specifically for visual impairment, was used as the primary outcome measure. RESULTS: The change in Nottingham Adjustment Scale score was compared between the experimental (n = 7) and conventional (n = 8) treatment groups using the Wilcoxon signed ranks test. The result of Z = -2.028 (P = 0.043) showed that there was a statistically significant difference between the change in Nottingham Adjustment Scale score between both groups. CONCLUSIONS: The introduction of the systematic treatment programme resulted in a statistically significant change in the scores of the Nottingham Adjustment Scale.

Energy expenditure is affected by rate of accumulation of sleep deficit in rats.

STUDY OBJECTIVES: Short sleep is a putative risk factor for obesity. However, prolonged total sleep deprivation (TSD) leads to negative energy balance and weight loss in rodents, whereas sleep-restricted humans tend to gain weight. We hypothesized that energy expenditure (VO2) is influenced by the rate of accumulation of sleep deficit in rats. DESIGN AND INTERVENTION: Six Sprague-Dawley rats underwent chronic sleep-restriction (CSR, 6-h sleep opportunity at ZT0-6 for 10 days) and stimulus-control protocols (CON, 12-h sleep opportunity for 10 days, matched number of stimuli) in a balanced cross-over design. Four additional rats underwent TSD (4 days). Sleep was manipulated using a motor-driven walking wheel. MEASUREMENTS AND RESULTS: Electroencephalography, electromyography, and body temperature were measured by telemetry, and VO2, by respirometry. Total sleep deficits of 55.1 +/- 6.4 hours, 31.8 +/- 6.8 hours, and 38.2 +/- 2.3 hours accumulated over the CSR, CON, and TSD protocols, respectively. Responses to TSD confirmed previous reports of elevated VO2 and body temperature. These responses were attenuated in CSR, despite a greater cumulative sleep deficit. Rate of rise of VO2 was strongly correlated with rate of accumulation of sleep deficit, above a threshold deficit of 3.6 h x day(-1). CONCLUSION: The change in VO2 is affected by rate of accumulation of sleep deficit and not the total sleep loss accrued. Negative energy balance, observed during TSD, is strongly attenuated when brief daily sleep opportunities are available to rats (CSR), despite greater accumulated sleep deficit.

Synthesis and structure of pillared molybdates and tungstates with framework layers.

Six new layered lanthanide molybdate and tungstate phases pillared by either naphthalenedisulfonate (NDS) or fumarate anions have been synthesized hydrothermally and structurally characterized. Five of these materials, [Nd(H(2)O)MoO(4)](2)[2,6-NDS] (1), [Nd(H(2)O)MoO(4)](2)[1,5-NDS] (2), [La(H(2)O)WO(4)](2)[1,5-NDS] (3), [La(H(2)O)WO(4)](2)[2,6-NDS] (4), and [Ce(H(2)O)MoO(4)](2)[fumarate] (6), have a closely related cationic inorganic layer structure which comprises a bilayer of polyhedra leading to the formation of a framework layer containing small, inaccessible pores. These layers are pillared by the organic anions which also bridge between the lanthanide cations within the layers. In the La/WO(4)/2,6-NDS system, a second polymorph, [La(2)(H(2)O)(2)W(2)O(8)][2,6-NDS] (5), is observed. In this compound, the tungstate anions have dimerized, forming W(2)O(8)(4-). This dimer is unique and comprises two square-based pyramidal tungsten centers which are opposed to each other.

A detailed investigation of the aza-Prins reaction.

The development of a Lewis acid-promoted aza-Prins reaction to form piperidines and pyrrolidines is described. Indium trichloride has been found to be a highly successful and mild Lewis acid for promoting this reaction. A thorough mechanistic investigation is described, including the factors that influence the formation of the 5- or 6-membered ring product(s).

Methylnaltrexone for treatment of opioid-induced constipation in advanced illness patients.

Methylnaltrexone, a peripheral mu-opioid receptor antagonist with restricted ability to cross the blood-brain barrier, may relieve opioid-induced constipation (OIC) without reversing analgesia. A total of 154 patients with advanced illness and OIC enrolled in a double-blind, randomized, placebo-controlled trial, with optional open-label phases (up to 4 months) in hospice and palliative care centers during 2003-2005. They received a single subcutaneous injection of methylnaltrexone (0.15 mg/kg or 0.3 mg/kg) or placebo. Laxation response within 4 hours was 62% and 58% for methylnaltrexone 0.15 mg/kg and 0.3 mg/kg, respectively, compared with 14% for placebo (P < 0.0001; each dose vs placebo). Approximately half of the methylnaltrexone responders defecated within 30 minutes of dosing. Open-label phase response rates mirrored those for methylnaltrexone during the double-blind phase.There was no change in pain scores or evidence of central opioid withdrawal.The most common adverse events (AEs) were abdominal pain and flatulence.Three patients had serious AEs attributed to methylnaltrexone. Subcutaneous methylnaltrexone was efficacious in rapidly inducing laxation and was generally well tolerated in patients with advanced illness and OIC.

A case report of spontaneous rupture of a renal angiomyolipoma in a post-partum 21-year-old patient.

INTRODUCTION: Renal angiomyolipomas (AML) are benign tumours containing vascular, smooth muscle and fatty elements. The majority of renal AML run an asymptomatic, benign course. The main associated complication is that of retro-peritoneal or intra-tumoural haemorrhage. Treatment options include conservative management versus interventional procedures such as total or partial nephrectomy, cryotherapy or embolization. CASE: We describe a case of symptomatic, spontaneous rupture of AML in the immediate post-partum period of a patient treated under our care. DISCUSSION: This case highlights the presentation in the form of an acute abdomen in the immediate post-partum period. This is important as acute abdomen following delivery can be attributed to a number of other causes. It also demonstrates that further complications of renal angiomyolipoma rupture can arise, emphasising the importance of post treatment vigilance for signs of infection, further haemorrhage and post embolic events.

Building an interprofessional curriculum framework for health: a paradigm for health function.

There is an increasing call for curricula in health care to facilitate interprofessional client-centred evidence-based decision making through a reflective and reflexive framework. This discussion paper proposes that adoption of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) as a framework for curricula of health professionals promotes the necessary paradigm shift needed to legitimise a broad evidence base as the foundation of interprofessional dialogue. Client function is seen as the product of an open system incorporating the individual, social and environmental influences on behaviour, with the role of the professional being to acknowledge the context of individual behaviour through an understanding of individual's functioning in their environment. It is concluded that client focused practice and an iterative process of clinical reasoning based on a broad evidence base that conceptualises health care as the maintenance and promotion of health across the lifespan requires a re-conceptualising of health. The emerging concept shifts the primary emphasis of health care away from post-diagnosis tertiary care towards clients who maintain a life-long independence in the community.

Renal injury in a patient with lumbar scoliosis.

Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.

Circadian rhythms and sleep-related breathing disorders.

Recent studies have provided evidence that the human circadian timing system has an influence on respiration and respiratory control. Both sleep and circadian mechanisms combine to mediate the rise in lower airway resistance in nocturnal asthma. In rats, circadian rhythms in minute ventilation are present in both wakefulness and sleep, implying that circadian and sleep mechanisms also combine to influence the control of breathing. The circadian timing system causes a nocturnal increase in the chemoreflex threshold and it is suggested that this may increase the propensity for nocturnal sleep apnea. This hypothesis is supported by a model analysis of human chemoreflex control, and relevant published data are reviewed. The clinical implications of this putative circadian contribution to sleep apnea are potentially very significant, but relevant data are scarce and directions for future research are discussed.

A comparison of manual therapy and active rehabilitation in the treatment of non specific low back pain with particular reference to a patient's Linton & Hallden psychological screening score: a pilot study.

BACKGROUND: Clinical guidelines for the management of back pain frequently recommend 'manual therapy' as a first line intervention, with psychosocial screening and 'active rehabilitation' for those not improving at 6 weeks post onset. The potential for psychosocial factors to predict treatment response and therefore outcome has not been adequately explored. The purpose of this pilot study was to determine the feasibility of a study to compare manual therapy and active rehabilitation outcomes for subjects with sub-acute/chronic back pain, investigate whether any difference in outcome was related to psychosocial factors, and to inform the design of a main study. METHODS: A convenience sample of 39 patients with non-specific low back pain referred to the physiotherapy department of an acute NHS Trust hospital was recruited over a nine month period. Patients completed the Linton and Hallden psychological screening questionnaire (LH) and were allocated to a low LH (105 or below) or high LH (106 or above) scoring group. The low or high LH score was used to sequentially allocate patients to one of two treatment groups - Manual Therapy comprising physiotherapy based on manual means as chosen by the treating therapist or Active Rehabilitation comprising a progressive exercise and education programme - with the first low LH scoring patient being allocated to active rehabilitation and the next to manual therapy and so on. Treatment was administered for eight sessions over a four-week period and outcome measures were taken at baseline and at four weeks. Measures used were the Roland Morris Questionnaire (RMQ), two components of the Short Form McGill (total pain rating index [PRI] and pain intensity via visual analogue scale [VAS]), and the LH. RESULTS: The manual therapy group demonstrated a greater treatment effect compared with active rehabilitation for RMQ (mean difference 3.6, 95% CI 1.1 - 6.2, p = 0.006) and PRI (7.1, 95% CI 2.0 - 12.2, p = 0.007) and marginally significant results for VAS (15, 95% CI -1.1 to 31.2, p = 0.067). A linear model allowing for confounding effects and the interaction between high or low LH scores supported these results. The interaction effect was not significant for any outcome measure but this could be due to an insufficient number of subjects to detect this effect. CONCLUSION: Comparative evaluation of manual therapy and active rehabilitation with reference to LH psychosocial scores is likely to be detectable by the methods used here. However several alterations to the study design are recommended for the main study. A pragmatic trial using a randomisation process with stratification on the LH score and priori power analysis to determine sample size are suggested for the main study.

The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer.

INTRODUCTION: Prior research has shown that advanced stage nonsmall cell lung cancer (NSCLC) patients enrolled in hospice care receive less aggressive treatment at the end of life (EOL) without compromising survival. Our purpose was to profile the continuum of care of these patients, exploring the connection between hospice enrollment and quality indicators for excellence in EOL cancer care. METHODS: One hundred ninety-seven deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment, postdiagnosis hospital visits and admissions, hospice referrals and enrollments, and circumstances surrounding the patient's death. Patients were grouped by their status of hospice enrollment, and the remainder of the measures compared accordingly. RESULTS: There was no significant difference found in total number of postdiagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations (p < 0.001), emergency department visits (p < 0.01), and intensive care unit admissions in the last 30 days of life (p < 0.001). The number of lines of chemotherapy received did not differ significantly between the groups. Median survival, measured by the length of time between diagnosis and death, was significantly longer for hospice patients (p = 0.02). CONCLUSIONS: This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized EOL oncological care and a significantly longer median survival.

The effect of time of day on apnoea index in the sleeping rat.

This study tested the hypothesis that apnoea index would be greater during daytime sleep than nighttime sleep in the rat. Electroencephalogram and electromyogram were monitored via biotelemetry implant and respiration was measured using whole body plethysmography in six male rats in two separate 34h recording sessions per animal. Apnoeas were classified as "spontaneous" or "post-sigh". Daily average spontaneous apnoea index was 35 times greater (p<0.0001) during rapid eye movement (REM) sleep than in non-REM (NREM) sleep. In contrast, daily average post-sigh apnoea index was not significantly greater in REM sleep than in non-REM (NREM) sleep (p=0.39). There was a greater post-sigh apnoea index during daytime REM than during nighttime REM (p=0.043) but REM-related spontaneous apnoea index was unaffected by time of day. There was no day to night difference in spontaneous apnoea index or post-sigh apnoea index during NREM sleep. Respiratory variability (coefficient of variation for breath duration and tidal volume) was not affected by time of day in REM or NREM sleep. We conclude that the circadian timing system has no effect on apnoea index during NREM sleep in the rat, but it may influence the propensity for post-sigh apnoea during REM sleep.

The 20-item Toronto Alexithymia Scale: validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients.

OBJECTIVE: Whilst the 20-item Toronto Alexithymia Scale (TAS-20) was developed to measure three intercorrelated dimensions, there is some debate as to whether the scale is best served by a two- or three-factor construct. In particular, there is some doubt as to whether clinical data exhibit the third factor. This study uses data from a sample of physiotherapy (physical therapy) out-patients in the UK to validate the factorial structure of a set of models postulated in the literature, including the three-factor model hypothesized by Bagby et al. (1994). METHOD: Data were collected from a sample of physiotherapy out-patients (N=242). Specialist factor analysis software (LISREL 8.54) was used to perform confirmatory factor analyses on a range of models proposed in the literature. RESULTS: The analysis supports the three-factor model assumed by Bagby et al. (1994), as well as most of the two-factor models suggested in the literature. CONCLUSIONS: This new set of clinical data supports most of the two- and three-factor models postulated in the recent literature, including the three-factor model advocated by Bagby et al. (1994).

Significance of the zero sum principle for circadian, homeostatic and allostatic regulation of sleep-wake state in the rat.

Sleep-wake behavior exhibits diurnal rhythmicity, rebound responses to acute total sleep deprivation (TSD), and attenuated rebounds following chronic sleep restriction (CSR). We investigated how these long-term patterns of behavior emerge from stochastic short-term dynamics of state transition. Male Sprague-Dawley rats were subjected to TSD (1day×24h, N=9), or CSR (10days×18h TSD, N=7) using a rodent walking-wheel apparatus. One baseline day and one recovery day following TSD and CSR were analyzed. The implications of the zero sum principle were evaluated using a Markov model of sleep-wake state transition. Wake bout duration (a combined function of the probability of wake maintenance and proportional representations of brief and long wake) was a key variable mediating the baseline diurnal rhythms and post-TSD responses of all three states, and the attenuation of the post-CSR rebounds. Post-NREM state transition trajectory was an important factor in REM rebounds. The zero sum constraint ensures that a change in any transition probability always affects bout frequency and cumulative time of at least two, and usually all three, of wakefulness, NREM and REM. Neural mechanisms controlling wake maintenance may play a pivotal role in regulation and dysregulation of all three states.

A visual aid for computer-based analysis of sleep-wake state in rats.

Computer-based sleep scoring systems are often calibrated by reference to a conventional visual analysis of electroencephalographic (EEG) and electromyographic (EMG) traces. However, these types of data place high demands on digital storage capacity which may limit the duration or feasibility of some studies. The present paper describes an approach to visual analysis that involves reconstruction of a waveform (termed a "pseudopolygram" (PPG)) from conditioned data derived from the EEG and EMG. The PPG is the sum of three sine waves, each of which has a distinct frequency (non-REM sleep (NREM), 3 Hz; rapid eye movement sleep (REM), 7 Hz and wakefulness (WAKE), 60 Hz) and amplitude proportional to the value of a state-specific scoring variable. Thus, in NREM sleep the wave depicting the NREM quantifier has high amplitude and produces a PPG with dominant 3 Hz frequency. In REM sleep, the wave depicting the REM quantifier has high amplitude and produces a PPG with a dominant 7 Hz frequency, and in WAKE the PPG is dominated by 60 Hz. Thus, the PPG provides a means for visual discrimination of the three behavioural states. Validation studies found an overall reliability of 94% compared with conventional visual analysis of EEG and EMG. The PPG was also found to remain accurate in rats after 24 h of sleep deprivation.

A theoretical analysis of diving performance in the Weddell seal (Leptonychotes weddelli).

Marine mammals are constrained in their foraging behaviour because, as obligate air breathers, they must undertake regular trips to the water surface to satisfy the need for respiratory gas exchange. Maximum underwater endurance time is determined by O2 supply and demand, but this does not necessarily imply that O2 is the main factor regulating individual dive and surface times. This study presents a theoretical analysis of diving performance that emphasizes a key role for CO2 in the proximate control of diving behaviour. Computer simulations, based on a mathematical model of the mammalian cardiorespiratory control system, are used to investigate the influence of swimming to depth and other energetic stresses (feeding, thermogenesis, sleep) on predicted diving behaviour in an average adult Weddell seal. The plausibility of the proposed model is supported by the study, which replicated published observations of natural diving behaviour in this species. It is suggested that diving behaviour is tuned to oscillations in respiratory drive and that behavioural and physiological factors can alter the dynamic characteristics of the system to achieve a highly adaptable reciprocal interaction that blurs the boundary between physiology and behaviour.