A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.

BACKGROUND: To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. OBJECTIVE: To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. STUDY DESIGN: Retrospective case series. METHODS: All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. RESULTS: During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. MAIN LIMITATIONS: Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. CONCLUSIONS: The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.

Motor imagery in people with a history of back pain, current back pain, both, or neither.

INTRODUCTION: There is mounting evidence that cortical maps are disrupted in chronic limb pain and that these disruptions may contribute to the problem and be a viable target for treatment. Little is known as to whether this is also the case for the most common and costly chronic pain-back pain. OBJECTIVES: To investigate the effects of back pain characteristics on the performance of left/right trunk judgment tasks, a method of testing the integrity of cortical maps. METHODS: A total of 1008 volunteers completed an online left/right trunk judgment task in which they judged whether a model was rotated or laterally flexed to the left or right in a series of images. RESULTS: Participants who had back pain at the time of testing were less accurate than pain-free controls (P=0.027), as were participants who were pain free but had a history of back pain (P<0.01). However, these results were driven by an interaction such that those with current back pain and a history of back pain were less accurate (mean [95% CI]=76% [74%-78%]) than all other groups (>84% [83%-85%]). DISCUSSION: Trunk motor imagery performance is reduced in people with a history of back pain when they are in a current episode. This is consistent with disruption of cortical proprioceptive representation of the trunk in this group. On the basis of this result, we propose a conceptual model speculating a role of this measure in understanding the development of chronic back pain, a model that can be tested in future studies.

Left/right neck rotation judgments are affected by age, gender, handedness and image rotation.

Understanding motor imagery of the hands and feet has led to promising new treatments for neurological and chronic pain disorders. We aimed to extend this line of research to the neck with a view to developing the definitive platform study upon which clinical and experimental studies can be based. In a cross-sectional experiment with a convenience sample, volunteers were shown 40 photographs of a model with their head turned to the left or right. Images were presented in random order and orientation. Participants judged the direction of neck rotation. They also completed a left/right hand judgment task. 1361 pain-free participants volunteered. Mean ± standard deviation response time (RT) for making left/right judgments of neck rotation was 1.621 ± 0.501 s. Median accuracy was 92.5%. RT was related to age, gender, and handedness (p < 0.001). That is, RT increased with age, was greater in females than in males and was greater in left-handers than in right-handers. Accuracy reduced with age (p < 0.001), but was unaffected by gender or handedness. Judgments were more accurate when images showed a neck rotated to the right than when they showed a neck rotated to the left (p < 0.001). The magnitude of image rotation affected both response time and accuracy (p < 0.001). In general, the performance parameters established for left/right limb judgments also apply for left/right neck rotation judgments. The current work establishes the definitive normative values against which clinical and experimental groups can be compared and reveals unpredicted effects of the direction neck rotation and the orientation of the image.

Transversus abdominis: changes in thickness during the unsupported upper limb exercise test in older adults.

Novel, short-lived upper limb tasks performed by young adults have been used to investigate the role of transversus abdominis (TrA) in maintaining postural stability. Little information exists concerning the behaviour of TrA in older adults during protracted postural challenges. The primary aim of this study was to describe the change in thickness of TrA during an incremental upper limb exercise test in older adults. A secondary analysis was undertaken to compare the results between younger and older subjects. Healthy subjects aged between 40 and 70 years performed the Unsupported Upper Limb Exercise Test (UULEX) while activity of TrA was continuously monitored by using rehabilitative ultrasound imaging. Changes in muscle dimensions were measured every minute during the test. The thickness of TrA increased significantly and exponentially between minutes 8 and 13 of the UULEX. Although there was a significant difference between older and younger subjects in absolute measures of TrA thickness, the change in TrA thickness as a percentage of resting thickness during the UULEX demonstrated an identical pattern between younger and older subjects. This study suggests that TrA is continually and increasingly active during an upper limb task in both younger and older asymptomatic subjects.

Fresh water leaching of alkaline bauxite residue after sea water neutralization.

Processing of bauxite to extract alumina produces a strongly alkaline waste, bauxite refining residue, which is commonly stored in engineered structures. Once full, these waste dumps must be revegetated. In many alumina refineries, the waste is separated into fine-textured red mud and coarse-textured residue sand (RS). The sand component has physical characteristics that make it a suitable plant growth medium, provided the adverse chemical characteristics can be addressed. Neutralization of the highly saline-sodic RS with sea water lowers pH, reduces Na saturation, and adds plant nutrients. However, sea water-neutralized RS remains saline sodic and needs fresh water leaching before use as a plant growth medium. Columns containing sea water-neutralized RS were leached with 30 m depth-equivalent of fresh water to evaluate the effects of rainfall on the RS and its leachate. Entrained cations were rapidly displaced by the fresh water, lowering salinity to non-plant-limiting levels (< or =0.3 dS m(-1)). The percentage of the effective cation exchange capacity (ECEC) saturated by Na decreased from 71 to 62% due to a reduction in soil solution ionic strength (causing a decrease in the ECEC) and the preferential displacement of Na(+) (and K(+)) from the exchange. Fresh water leaching increased pH (leachate pH increased from 8.0 to 10.1). This pH increase is attributed to the slow dissolution of the Na-containing mineral sodalite. Under the current experimental conditions, the application of 30 m depth-equivalent of leaching reduced the total RS sodalite content by <10%.

Effect of time of day on the vertical spinal creep response.

Vertical spinal creep (VSC) is height loss during sustained postures over a set period of time. While total stature has been demonstrated to decrease throughout the day, whether a diurnal effect applies to the VSC response has not been reported. The aim of this study was to investigate whether time of day had an effect on the magnitude of the VSC response in young subjects asymptomatic for musculoskeletal pathologies. The VSC response was recorded over 25 min while subjects remained seated on the stadiometer, at three times (morning, midday and afternoon) on the same day, in 48 asymptomatic volunteers aged 20-39 years. While no significant differences were calculated for the magnitude of the VSC responses on the three occasions of testing, differences in magnitude of VSC response may have been confounded by preloading activities. Where magnitude of the VSC response is the primary outcome measure, measurement protocols should control preloading activities and continue to conduct measurements at the same time of day, until further studies conclusively refute the existence of a diurnal effect.

Transversus abdominis: changes in thickness during an incremental upper limb exercise test.

The aim of this study was to measure transversus abdominis (TrA) during an incremental fatiguing task. Using real-time ultrasound, TrA thickness was measured in 26 healthy subjects (18-25 years, 9 male) during an unsupported upper limb exercise test (UULEX). Repeatability of changes in TrA thickness during the UULEX was established by using a test-retest process (n=9, intraclass correlation coefficient=0.62 (95% CI 0.38-0.82), standard error of measurement approximately 1 (95% CI 0.87-1.08)). Using mixed model analysis with time as an independent variable, TrA thickness changed significantly throughout the UULEX (p < 0.05). Measures of TrA thickness at minutes 10, 11, and 12 were significantly greater than at baseline (p=0.006 (95% CI 0.23-1.35), 0.001 (95% CI 0.45-1.61), and <0.0001 (95% CI 0.77-2.03), respectively). Transversus abdominis was shown to be continuously and increasingly active over the 12 minutes of an incremental bilateral upper limb test in young healthy adults. As increases in TrA thickness occurred at the points of greatest postural and ventilatory demands, these findings may have implications for subjects with musculoskeletal or respiratory impairments who are often challenged by upper limb tasks.

Revegetation strategies for bauxite refinery residue: a case study of Alcan Gove in Northern Territory, Australia.

Alumina extraction from bauxite ore with strong alkali produces waste bauxite refinery residue consisting of residue sand and red mud. The amount and composition of refinery residue depend on the purity of the bauxite ore and extraction conditions, and differs between refineries. The refinery residue is usually stored in engineered disposal areas that eventually have to be revegetated. This is challenging because of the alkaline and sodic nature of the residue. At Alcan Gove's bauxite refinery in Gove, Northern Territory, Australia, research into revegetation of bauxite residue has been conducted since the mid-1970s. In this review, we discuss approaches taken by Alcan Gove to achieve revegetation outcomes (soil capping of refinery residue) on wet-slurry disposal areas. Problems encountered in the past include poor drainage and water logging during the wet season, and salt scalding and capillary rise during the dry season. The amount of available water in the soil capping is the most important determinant of vegetation survival in the seasonally dry climate. Vegetation cover was found to prevent deterioration of the soil cover by minimising capillary rise of alkalinity from the refinery residue. The sodicity and alkalinity of the residue in old impoundments has diminished slightly over the 25 years since it was deposited. However, development of a blocky structure in red mud, presumably due to desiccation, allows root penetration, thereby supplying additional water to salt and alkali-tolerant plant species. This has led to the establishment of an ecosystem that approaches a native woodland.

Comminuted fracture of the distal sesamoid bone and distal rupture of the deep digital flexor tendon.

A 10-year-old show jumper was evaluated for an acute severe lameness (grade 4 of 5) of the right foreleg. During weight bearing, the toe of the affected limb rotated dorsally suggesting rupture of the deep digital flexor tendon (DDFT). Upon radiographic examination of the hoof, a severe erosion at the flexor surface and a parasagittal fracture of the distal sesamoid bone were found. Ultrasonographic examination confirmed rupture of the DDFT. These findings were confirmed on post-mortem examination. Prior to the acute lameness, the horse was treated with corticosteroid injections into the podotrochlear bursa. Repeated intra-bursal injections of corticosteroids as a possible cause for DDFT rupture are discussed as well as the possible association between a degenerative distal sesamoid bone, a distal sesamoid bone fracture and a DDFT rupture.

Laryngeal reinnervation in the horse.

Left laryngeal hemiplegia is a frustrating condition for the equine athlete and equine veterinarian. Treatment for the past 30 years has centered on the prosthetic laryngoplasty ("tie-back") with or without ventriculectomy. Laryngeal reinnervation has been used successfully in people and has been shown experimentally to benefit affected horses. This article reviews equine laryngeal reinnervation using the nerve muscle pedicle graft and describes the surgical technique, its complications, and the follow-up in 146 cases treated over the past 10 years. Also discussed is ongoing research into stimulation studies to improve the success of equine laryngeal reinnervation.

Virtual reality as a pediatric pain modulation technique: a case study.

Post-surgical pain has been consistently reported in pediatrics as being difficult to manage and limiting to surgical outcomes. Pain management of children is not ideal, and some children unable to tolerate traditional pharmacological agents. Virtual reality (VR) is a new and promising form of non-pharmacologic analgesia. This case study explored the use of VR analgesia with a 16-year-old patient with cerebral palsy participating in a twice-daily physiotherapy program following Single Event Multi-Level Surgery. Over 6 days, the patient spent half of his physiotherapy sessions using VR and the other half without (order randomized). Traditional pharmacological pain management was administered throughout the trial. Using a subjective pain scale (five faces denoting levels of pain), the patient's overall pain ratings whilst in the VR (experimental) condition were 41.2% less than those in the no-VR (control) condition. This case report provides the first evidence that VR may serve as a powerful non-pharmacologic analgesic for children following surgery.

On the constructs of quality physiotherapy.

The quality of physiotherapy services invites evaluation using a range of constructs. These must reflect the needs of different stakeholders and the different elements of the "package" of physiotherapy. Measurement of quality can consider organisation of the service, the way in which care is provided, the way in which information about care is recorded and used for evaluation purposes, and the outcome of care. A clear understanding of the elements of quality is essential for physiotherapists to be competitive by providing consistently effective services.