Caudal thigh intermuscular lipomas in dogs: Anatomic review and approach to surgical excision.

The surgical approach for excision of caudal thigh intermuscular lipomas (IML) in dogs is described with relevant anatomy and short-term outcomes reported. Medical records were reviewed to identify dogs that underwent IML excision between 2015 to 2019. Signalment, location of the lipoma, pre-operative diagnostic tests, histopathology results, use of a closed-suction drain, and follow-up information including drain and suture removal were recorded. Mean age of patients in this study was 8.7 years. Multiple breeds were affected and there was no predilection for either left or right hind limb. Pre-operative diagnostic tests included fine-needle aspirate, radiography, peripheral ultrasonography, and/or computed tomography scan. In 45% (5/11) of the cases, a closed suction drain was placed. All masses removed were deemed grossly consistent with a lipoma by the attending clinician and 5 were confirmed by histopathology. No complications were noted in any case. Removal of caudal thigh IML requires careful identification of and dissection around the sciatic nerve, which is easily achieved with appropriate knowledge of the relevant anatomy and surgical approach.

Lipomes intermusculaires de la cuisse caudale chez le chien : revue anatomique et approche de l'exérèse chirurgicale. L'approche chirurgicale pour l'excision des lipomes intermusculaires (IML) de la cuisse caudale chez le chien est décrite avec l'anatomie pertinente et les résultats à court terme rapportés. Les dossiers médicaux ont été examinés pour identifier les chiens qui ont subi une excision IML entre 2015 et 2019. Le signalement, l'emplacement du lipome, les tests de diagnostic préopératoire, les résultats histopathologiques, l'utilisation d'un drain à aspiration fermé et les informations de suivi, y compris le retrait du drain et des sutures, ont été enregistrés. L'âge moyen des patients de cette étude était de 8,7 ans. Plusieurs races ont été affectées et il n'y avait aucune préférence pour la latéralité gauche ou droite. Les tests diagnostiques préopératoires comprenaient une aspiration à l'aiguille fine, une radiographie, une échographie périphérique et/ou une tomodensitométrie. Dans 45 % (5/11) des cas, un drain aspirant fermé a été mis en place. Toutes les masses enlevées ont été jugées grossièrement compatibles avec un lipome par le clinicien traitant et cinq ont été confirmées par histopathologie. Aucune complication n'a été notée dans tous les cas. L'ablation d'IML de la cuisse caudale nécessite une identification précise et une dissection autour du nerf sciatique, ce qui est facilement réalisé avec une connaissance appropriée de l'anatomie et de l'approche chirurgicale.(Traduit par Dr Serge Messier).

Safety of mapping the motor networks in the spinal cord using penetrating microelectrodes in Yucatan minipigs.

OBJECTIVE: The goal of this study was to assess the safety of mapping spinal cord locomotor networks using penetrating stimulation microelectrodes in Yucatan minipigs (YMPs) as a clinically translational animal model. METHODS: Eleven YMPs were trained to walk up and down a straight line. Motion capture was performed, and electromyographic (EMG) activity of hindlimb muscles was recorded during overground walking. The YMPs underwent a laminectomy and durotomy to expose the lumbar spinal cord. Using an ultrasound-guided stereotaxic frame, microelectrodes were inserted into the spinal cord in 8 animals. Pial cuts were made to prevent tissue dimpling before microelectrode insertion. Different locations within the lumbar enlargement were electrically stimulated to map the locomotor networks. The remaining 3 YMPs served as sham controls, receiving the laminectomy, durotomy, and pial cuts but not microelectrode insertion. The Porcine Thoracic Injury Behavioral Scale (PTIBS) and hindlimb reflex assessment results were recorded for 4 weeks postoperatively. Overground gait kinematics and hindlimb EMG activity were recorded again at weeks 3 and 4 postoperatively and compared with preoperative measures. The animals were euthanized at the end of week 4, and the lumbar spinal cords were extracted and preserved for immunohistochemical analysis. RESULTS: All YMPs showed transient deficits in hindlimb function postoperatively. Except for 1 YMP in the experimental group, all animals regained normal ambulation and balance (PTIBS score 10) at the end of weeks 3 and 4. One animal in the experimental group showed gait and balance deficits by week 4 (PTIBS score 4). This animal was excluded from the kinematics and EMG analyses. Overground gait kinematic measures and EMG activity showed no significant (p > 0.05) differences between preoperative and postoperative values, and between the experimental and sham groups. Less than 5% of electrode tracks were visible in the tissue analysis of the animals in the experimental group. There was no statistically significant difference in damage caused by pial cuts between the experimental and sham groups. Tissue damage due to the pial cuts was more frequently observed in immunohistochemical analyses than microelectrode tracks. CONCLUSIONS: These findings suggest that mapping spinal locomotor networks in porcine models can be performed safely, without lasting damage to the spinal cord.

Surgical and medical management in the treatment of proximal tibial metaphyseal fracture in immature dogs.

The purpose of this study was to report approaches to surgical and medical management of proximal tibial metaphyseal fractures (PTMF) and short-term case outcome. Medical records of immature dogs with PTMF were reviewed and data were collected including history, signalment and side affected. Data pertaining to surgical and medical management including radiographic evaluation and short-term complications were recorded. Forty-five dogs with a total of 47 PTMF identified and treated between 2007-2019 were included in this study. Six cases were managed with external coaptation alone. Forty-one cases were treated surgically with constructs including K-wires in different configurations, bone plate and screws, and external skeletal fixation. Of the cases managed conservatively, 4 developed complications, including bandage sores, diffuse osteopenia of the tarsus/metatarsus, and angular limb deformities. Surgical complications including pin migration necessitating removal, osteopenia, and screw placement in the proximal tibial growth plate or into the stifle joint were found in 16 cases. PTMF treated with surgery had a subjectively more predictable outcome compared to those treated with external coaptation alone. Conservative management may result in complications including development of excessive tibial plateau angle (TPA) as well as distal tibial valgus.

Overground gait kinematics and muscle activation patterns in the Yucatan mini pig.

Objective.The objectives of this study were to assess gait biomechanics and the effect of overground walking speed on gait parameters, kinematics, and electromyographic (EMG) activity in the hindlimb muscles of Yucatan minipigs (YMPs).Approach.Nine neurologically-intact, adult YMPs were trained to walk overground in a straight line. Whole-body kinematics and EMG activity of hindlimb muscles were recorded and analyzed at six different speed ranges (0.4-0.59, 0.6-0.79, 0.8-0.99, 1.0-1.19, 1.2-1.39, and 1.4-1.6 m s-1). A MATLAB program was developed to detect strides and gait events automatically from motion-captured data. The kinematics and EMG activity were analyzed for each stride based on the detected events.Main results.Significant decreases in stride duration, stance and swing times and an increase in stride length were observed with increasing speed. A transition in gait pattern occurred at the 1.0 m s-1walking speed. Significant increases in the range of motion of the knee and ankle joints were observed at higher speeds. Also, the points of minimum and maximum joint angles occurred earlier in the gait cycle as the walking speed increased. The onset of EMG activity in the biceps femoris muscle occurred significantly earlier in the gait cycle with increasing speed.Significance.YMPs are becoming frequently used as large animal models for preclinical testing and translation of novel interventions to humans. A comprehensive characterization of overground walking in neurologically-intact YMPs is provided in this study. These normative measures set the basis against which the effects of future interventions on locomotor capacity in YMPs can be compared.

Analysis of Adherence to Acute Inpatient Rehabilitation in Patients with Cancer.

Importance: The need for cancer rehabilitation is expected to continue to dramatically increase with the aging population and increasing number of cancer survivors. These survivors experience a wide range of physical limitations and symptoms that negatively affect their health and quality of life. Research is needed to determine the rate of adherence, reasons for non-adherence, and interventions to improve adherence to acute inpatient rehabilitation among patients with cancer. Objective: To evaluate the rate of adherence and reasons for non-adherence to acute inpatient rehabilitation in patients with cancer. Design, Setting, and Participants: This was a secondary analysis of a retrospective study that assessed medical complications in 165 patients with cancer who had a median length of stay of 11 days (interquartile range of 8-14) in acute inpatient rehabilitation. We reviewed the records of all consecutive patients who underwent acute inpatient rehabilitation from September 1, 2017 through February 28, 2018 at a large academic, quaternary National Cancer Institute-designated Cancer Center. Main Outcomes and Measures: We calculated the rehabilitation session adherence rate and descriptively summarized the reasons for non-adherence. Results: There were 78/165 (47%) patients that had 1 or more incomplete rehabilitation sessions due to medical complications. These patients had a median of 2 (interquartile range of 1-4) incomplete rehabilitation sessions. We noted other reasons for incomplete rehabilitation sessions in 146/165 (89%) patients, who had a median of 3 (interquartile range of 2-4) incomplete rehabilitation sessions. The median total number of days with incomplete rehabilitation sessions in the entire cohort was 2 (interquartile range 1-3). Conclusion and Relevance: Among patients with cancer undergoing acute inpatient rehabilitation, the adherence rate to 1-hour long intensive rehabilitation sessions were low due to medical complications and other reasons. This in turn affected compliance with the 3 hours of rehabilitation a day requirement for acute inpatient rehabilitation. Patients with cancer undergoing acute inpatient rehabilitation are medically complex and further research at multiple institutions with larger cohorts may be beneficial in further assessing adherence rates and reasons for non-adherence to improve participation in acute inpatient rehabilitation.

A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management.

BACKGROUND: Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. OBJECTIVE: Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. METHODS: Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. RESULTS: A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. CONCLUSIONS: Our findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed.

Systematic review of surgical treatments for cranial cruciate ligament disease in dogs.

Surgery for cranial cruciate ligament disease is often recommended; however, it is unclear if one procedure is superior. The aim of this systematic review was to answer the a priori question, "Is there a surgical procedure that will allow a consistent return to normal clinical function in dogs with cranial cruciate ligament disease and is that procedure superior to others?" A systematic literature search was performed through September 2013. Peer reviewed publication in the English language and 6 mo of postoperative follow-up were required. In total, 444 manuscripts were identified and reviewed, and 34 met the inclusion criteria. Two studies provided level 1, 6 provided level 2, 6 provided level 3, and 20 provided level 4 evidence relative to the study question. The most common surgical procedures included tibial plateau leveling osteotomy (TPLO, n = 14), lateral extracapsular suture (n = 13), tibial tuberosity advancement (n = 6). The strength of the evaluated evidence most strongly supports the ability of the TPLO in the ability to return dogs to normal function. It also provided strong support that functional recovery in the intermediate postoperative time period was superior following TPLO compared with lateral extracapsular suture. There was insufficient data to adequately evaluate other surgical procedures.