Use of an aiming device and computed tomography for assisted debridement of subchondral cystic lesions in the limbs of horses.

OBJECTIVE: To describe the use of an aiming device (AD) and computed tomography (CT) for preoperative planning and intraoperative guided debridement of subchondral cystic lesions (SCL) in the limbs of horses and to determine the outcome 12 months after surgery. STUDY DESIGN: Prospective case series. ANIMALS: Twelve horses referred because of lameness caused by 1 or 2 SCL (total of 14 SCL). METHODS: All horses underwent CT-guided debridement of the SCL. The entry point of the drill bit and direction of drilling were planned and controlled by using a series of CT images and the AD. The SCL were curetted and filled with recombinant human bone morphogenetic protein-2. Surgical times were calculated, and the outcome was determined 12 months after surgery. RESULTS: The use of an AD and CT allowed precise and straightforward drilling of the SCL. The entry point of the drill bit into the SCL was considered optimal in 11 SCL and satisfactory in 3 SCL, and the lesions could be precisely debrided with preservation of the adjacent subchondral bone in all cases. There were no complications. Mean (range) surgery time was 75 (45-115) minutes. The outcome 12 months postoperatively was favorable in 10 of 11 horses. One horse died due to unrelated reasons. CONCLUSION: The use of CT and an AD allowed precise debridement of all SCL in the limbs of 12 horses. CLINICAL SIGNIFICANCE: CT-guided surgical debridement of SCL of the equine digit appears to result in a favorable outcome.

Partner Abuse Among HIV-Positive Sexual Minority Men: "That Was All I Deserved . . ."

Living with HIV can be both a precipitant and a consequence of partner abuse (PA) across populations, including male-male partnerships. However, overlapping experiences of living with HIV and experiencing PA are not well characterized. We conducted 24 qualitative interviews with urban HIV-positive sexual minority men (SMM) recruited from a public hospital HIV clinic in Seattle, Washington, who reported lifetime PA histories, and analyzed them using content analysis. Participants reported psychological, physical, and sexual victimization from partners, varying in severity. Themes included (a) how HIV and minority stress (e.g., through self-stigma, serosorting) and (b) familial and repeated exposure to violence (e.g., through normalization or acceptance of PA, partnering as strategy for increasing one's own safety, esteem, or social status), independently and in combination, provided a context for the men's victimization. Our findings suggest that PA-related interventions might focus on coping with stigma, expanding social networks, and educating SMM about dysfunctional relationship dynamics.

Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian.

BACKGROUND: Previous studies have reported additional cancers associated with BRCA mutations; however, the type, magnitude of risk, and sex differences remain to be clarified. The purpose of this study was to evaluate the incidence of cancers other than breast and ovarian cancer in known mutation carriers. METHODS: An institutional review board-approved study identified 1072 patients who had genetic counseling at the authors' institution and tested positive for a deleterious BRCA mutation. The expected number of cancer cases was calculated from the number of individuals in the study sample multiplied by the cancer incidence rates for the general population. The expected and observed numbers of cases were calculated in 5-year intervals to accommodate different age-related incidence rates. Standardized incidence ratios (SIRs) for each cancer type were calculated. RESULTS: Among the 1072 mutation carriers, 1177 cancers of 30 different cancer types were identified. Individuals with a BRCA1 mutation did not have a significant increase in cancers other than breast and ovarian cancer; however, a trend in melanoma was observed. Individuals with a BRCA2 mutation had significantly higher numbers of observed cases versus expected cases for pancreatic cancer in both men and women (SIR, 21.7; 95% confidence interval [CI], 13.1-34.0; P < .001) and for prostate cancer in men (SIR, 4.9; 95% CI, 2.0-10.1; P = .002). CONCLUSIONS: The results of this study uphold the current recommendations for hereditary breast and ovarian cancer screening of cancers other than breast and ovarian cancer by the National Comprehensive Cancer Network. Larger cohorts and collaborations are needed to further verify these findings.

Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration.

In this manuscript we systematically reviewed 29 articles from 2010 to 2014 that addressed the association between borderline personality disorder (BPD) and intimate partner violence (IPV) perpetration, with particular attention paid to the role of perpetrator sex. Our primary objective was to provide a summary of (1) the operationalization and measurement of BPD and IPV, (2) mechanisms of the BPD-IPV association, and (3)the current understanding of the role of perpetrator sex related to BPD and IPV. We observed three distinct operational definitions of BPD which are measured in a variety of ways. IPV measurement tends to be more consistent. Further, emotion perception, impulsivity, attachment, and substance use are proposed mechanisms to explain the BPD IPV relation. The findings regarding potential perpetrator sex differences in the BPD-IPV association are mixed. Finally, we also provide recommendations for future research and clinical practice.

Tongue muscle plasticity following hypoglossal nerve stimulation in aged rats.

INTRODUCTION: Age-related decreases in tongue muscle mass and strength have been reported. It may be possible to prevent age-related tongue muscle changes using neuromuscular electrical stimulation (NMES). Our hypothesis was that alterations in muscle contractile properties and myosin heavy chain composition would be found after NMES. METHODS: Fifty-four young, middle-aged, and old 344/Brown Norway rats were included in this study. Twenty-four rats underwent bilateral electrical stimulation of the hypoglossal nerves for 8 weeks and were compared with control or sham rats. Muscle contractile properties and myosin heavy chain (MHC) in the genioglossus (GG), styloglossus (SG), and hyoglossus (HG) muscles were examined. RESULTS: Compared with unstimulated control rats, we found reduced muscle fatigue, increased contraction and half-decay times, and increased twitch and tetanic tension. Increased type I MHC was found, except for in GG in old and middle-aged rats. CONCLUSION: Transitions in tongue muscle contractile properties and phenotype were found after NMES.

Differences of morphological attributes between 62 proximal and distal subchondral cystic lesions of the proximal phalanx as determined by radiography and computed tomography.

OBJECTIVE: To determine morphological characteristics of subchondral cystic lesions (SCLs) in the proximal phalanx (PP) of adult horses. SAMPLE: Radiographs and/or CT scans of PP from 46 horses. PROCEDURES: There were horses with a SCL in PP, which was diagnosed by radiography and/or computed tomography, included. Additional data (signalment, history, orthopedic examination) were collected retrospectively for each case. RESULTS: Forty-six horses met the required inclusion criteria, with a total of 62 SCLs. Forty-three SCLs (70.5%) were located in the proximal PP (group A). Forty-four percent of these were associated with short, incomplete fractures, while 30 of the proximal PP SCLs (69.7%) were found mid sagittal. Proximal SCLs mostly showed a blurred, irregular shape (62.8%) and long, as well as wide, but shallow shapes in CT. Eighteen SCLs (29.5%) were found in the distal PP, near the proximal interphalangeal joint (group B). In contrast to the described proximal SCLs, the distal SCLs were of circular or oval shape, well delineated (77.8%), and distinctly larger. Horses of group A were significantly older (mean age, 11.47 years) than horses of group B (mean age, 6.72 years). CLINICAL RELEVANCE: The distribution and morphological attributes of proximal PP SCLs as well as their association to subchondral bone lesions and short, incomplete proximal fractures indicate more recently developed lesions due to chronic stress factors, such as repetitive trauma to the cartilage and subchondral bone. In contrast, morphology and distribution of distal SCLs showed high accordance with developmental bone cysts originating from a failure of endochondral ossification.

Simulated Kick Injury to the Mandible in Horses: Study of Fracture Configurations and Physical Parameters of the Impact.

OBJECTIVE: The goal of this study was to generate mandibular fractures in three regions of the diastema using a metal impactor to simulate a kick from a horse and to determine the mean deceleration in the initial phase of the impact event, the maximum contact force, the impact energy necessary to create a fracture and the duration of the impact. STUDY DESIGN: Thirty heads of horses aged between 5 and 20 years and euthanatized for various reasons were used. The heads were attached to a steel bar at the occiput at an axial angle of 45 degrees so that the body of the mandible was positioned horizontally and directly under the trajectory of the impactor. A 2 kg solid impactor was dropped with velocities of 6 to 14 m/s to simulate a kick from a horse. The impact was recorded using a high-speed video camera with a frame rate of 30,000 frames per second. Radiographs of the heads were obtained before and after the simulated kick. RESULTS: Mandibular fractures with configurations similar to those seen in clinical practice were generated at all three locations. The mean deceleration increased with impact velocity and with more cranially located impact positions. Absorbed energy increased with increasing impact velocity when no fracture was generated. CONCLUSION: The susceptibility to experimental fracture of the diastema increased from rostral to caudal locations, which is most probably caused by decreasing mandibular bone strength and an increase in the curvature at the lateroventral aspect of the mandible in that region. Physical parameters depended on fracture occurrence and type.

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses.

OBJECTIVE: The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures. STUDY DESIGN: Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed. RESULTS: The most common bones involved were the ulna (n = 19) and third metacarpal and metatarsal bones (n = 14). A total of 63 plates were removed from 48 horses during 53 separate surgeries, and the complication rate was 6/48; six horses had complications related to implant removal, which included persistent infection (n = 1) and refracture (n = 5). Complications related to implant removal were associated with comminuted fractures (p = 0.002), age > 3 years (p = 0.016) and the presence of surgical site infection (p = 0.001). CONCLUSION: Plate removal after fracture healing is necessary in patients with implant-associated clinical signs. There is a strong relationship between the complication rate and the degree of comminution of the original fracture, increasing age and the presence of surgical site infection. The surgeon must be aware of these risk factors when planning plate removal.

Effect of tongue exercise on protrusive force and muscle fiber area in aging rats.

PURPOSE: Age-related changes in tongue function may contribute to dysphagia in elderly people. The authors' purpose was to investigate whether aged rats that have undergone tongue exercise would manifest increased protrusive tongue forces and increased genioglossus (GG) muscle fiber cross-sectional areas. METHOD: Forty-eight young adult, middle-aged, and old Fischer 344/Brown Norway rats received 8 weeks of tongue exercise. Protrusive tongue forces were measured before and after exercise. GG muscle fiber cross-sectional area was measured in exercised rats and was compared with cross-sectional areas in a no-exercise control group. RESULTS: A significant increase in maximum tongue force was found following exercise in all age groups. In addition, a trend for increased GG muscle fiber cross-sectional area and a significant increase in variability of GG muscle fiber cross-sectional area was identified postexercise. CONCLUSION: The findings of this study have implications for treatment of elderly persons with dysphagia using tongue exercise programs. Specifically, increases in tongue force that occur following 8 weeks of progressive resistance tongue exercise may be accompanied by alterations in tongue muscle fiber morphology. These changes may provide greater strength and endurance for goal-oriented actions associated with the oropharyngeal swallow and should be investigated in future research.

The influence of aluminium, steel and polyurethane shoeing systems and of the unshod hoof on the injury risk of a horse kick. An ex vivo experimental study.

OBJECTIVES: To evaluate the damage inflicted by an unshod hoof and by the various horseshoe materials (steel, aluminium and polyurethane) on the long bones of horses after a simulated kick. METHODS: Sixty-four equine radii and tibiae were evaluated using a drop impact test setup. An impactor with a steel, aluminium, polyurethane, or hoof horn head was dropped onto prepared bones. An impactor velocity of 8 m/s was initially used with all four materials and then testing was repeated with a velocity of 12 m/s with the polyurethane and hoof horn heads. The impact process was analysed using a high-speed camera, and physical parameters, including peak contact force and impact duration, were calculated. RESULTS: At 8 m/s, the probability of a fracture was 75% for steel and 81% for aluminium, whereas polyurethane and hoof horn did not damage the bones. At 12 m/s, the probability of a fracture was 25% for polyurethane and 12.5% for hoof horn. The peak contact force and impact duration differed significantly between 'hard materials' (aluminium and steel) and 'soft materials' (polyurethane and hoof horn). CLINICAL SIGNIFICANCE: The observed bone injuries were similar to those seen in analogous experimental studies carried out previously and comparable to clinical fracture cases suggesting that the simulated kick was realistic. The probability of fracture was significantly higher for steel and aluminium than for polyurethane and hoof horn, which suggests that the horseshoe material has a significant influence on the risk of injury for humans or horses kicked by a horse.

Compensatory weight control behaviors of women in emerging adulthood: associations between childhood abuse experiences and adult relationship avoidance.

OBJECTIVE: To examine correlates of compensatory weight control behaviors among women in transition between adolescence and adulthood. PARTICIPANTS: The authors recruited a sample of undergraduate women (N = 759) at a large northwestern university during the 2009-2010 academic year. METHODS: Logistic regression was used to assess relations among childhood abuse, psychosocial functioning, adult dating relationship factors, and women's endorsement of compensatory weight control behaviors. RESULTS: The final model reliably distinguished between participants who endorsed versus denied use of compensatory behaviors (χ(2)[5, N = 747] = 36.37, p < .001), with global psychosocial functioning and relationship avoidance accounting for the most variance. CONCLUSIONS: These findings illustrate the importance of considering childhood abuse histories and adult relationships while assessing young women's compensatory weight control behaviors.

Effect of aging on tongue protrusion forces in rats.

The purpose of this study was to ascertain the effect of aging on muscle contractile properties associated with tongue protrusion in a rat model. Fischer 344/Brown Norway hybrid rats, ten young (9 months old) and ten old (32 months old), were used to measure protrusive contractile properties. Results showed a significant reduction in tetanic forces in the old animals. The following measures of muscle contraction were not different between age groups: mean twitch contraction force, twitch contraction time, twitch contraction half-decay time, and a calculated measure of fatigability. In conclusion, aging influenced protrusive tongue muscle contractions in a rat model such that tetanic forces were reduced. The reduction of tetanus force may parallel findings in human subjects relative to isometric tongue force generation and may be associated with age-related disorders of swallowing.

Biochemistry of anterior, medial, and posterior genioglossus muscle in the rat.

The tongue plays a vital role in swallowing actions. However, tongue muscles have been understudied, and it is unclear if tongue muscles are homogeneous with respect to muscle fiber-type distribution. We examined myosin heavy chain (MHC) composition of anterior, medial, and posterior sections of the genioglossus muscle (GG) using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in ten adult (9 months old) male Fischer 344/Brown Norway hybrid rats. We found that Type IIx MHC predominated in the anterior, medial, and posterior regions of the GG muscle (p=0.002), followed by IIa, then IIb. The anterior GG contained a significantly greater (p=0.004) proportion of Type IIa than did the medial or posterior regions, while the posterior GG contained a significantly greater (p=0.002) proportion of Type IIb MHC than did the medial or anterior GG. Accordingly, we found variable expression of MHC isoforms across anterior, medial, and posterior portions of the GG muscle, with more fast-contracting isoforms found posteriorly. Because motor control of the tongue requires precise and rapid movements for bolus manipulation and airway protection, variable expression of MHC isoforms along the anteroposterior axis of the GG muscle may be required to efficiently achieve deglutition and maintenance of airway patency.