Fragment size is associated with post-operative complications following elective arthroscopy of the tibiotarsal joint of horses.

The objective of this retrospective study was to determine the occurrence of joint-related complications after elective arthroscopy of the tibiotarsal joint (TTJ) in 329 horses, and the association with specific clinical parameters. Data were collected from medical records of horses undergoing elective tibiotarsal joint arthroscopy for fragment removal. Exact conditional univariate regression was used to determine significant risk factors for joint-related post-operative complications. Of 485 joints, 2 (0.4%) developed surgical site infection, 4 (0.8%) developed septic arthritis, 1 (0.2%) developed synovial fistula. There was a significantly increased odds of having septic arthritis as height and length of the distal intermediate ridge of the tibia (DIRT) lesion increased. The median height and length of the DIRT fragments in affected cases was 13.5 mm and 18.0 mm, respectively. For each unit (1 mm) increase in height, there was a 42% increase in the risk of septic arthritis occurrence (P = 0.0042), and a 15% increase for each unit increase in length (P = 0.035). Horses were significantly less likely to develop septic arthritis when suture smaller than USP 0 was used. Horses with larger osteochondritis dissecans lesions of the DIRT region have an increased risk of developing septic arthritis following fragment removal.

La taille des fragments est associée à des complications postopératoires après arthroscopie élective de l'articulation tibiotarsienne des chevaux. L'objectif de cette étude rétrospective était de déterminer la fréquence de complications articulaires après arthroscopie élective de l'articulation tibiotarsienne (TTJ) chez 329 chevaux, et l'association avec des paramètres cliniques spécifiques. Les données ont été recueillies à partir des dossiers médicaux de chevaux subissant une arthroscopie élective de l'articulation tibiotarsienne pour l'élimination de fragments. Une régression univariée conditionnelle exacte a été utilisée pour déterminer les facteurs de risque significatifs de complications postopératoires liées aux articulations.Sur 485 articulations, deux (0,4 %) ont développé une infection du site opératoire, quatre (0,8 %) une arthrite septique, et une (0,2 %) une fistule synoviale. Il y avait une probabilité significativement accrue d'avoir une arthrite septique à mesure que la hauteur et la longueur de la lésion de la crête intermédiaire distale du tibia (DIRT) augmentaient. La hauteur et la longueur médianes des fragments DIRT dans les cas affectés étaient respectivement de 13,5 mm et de 18,0 mm. Pour chaque unité (1 mm) d'augmentation de hauteur, il y avait une augmentation de 42 % du risque de survenue d'arthrite septique (P = 0,0042); et une augmentation de 15 % pour chaque augmentation unitaire de longueur (P = 0,035). Les chevaux étaient significativement moins susceptibles de développer une arthrite septique lorsqu'une suture plus petite que USP 0 était utilisée.Les chevaux présentant des lésions d'ostéochondrite disséquante plus importantes de la région DIRT ont un risque accru de développer une arthrite septique après le retrait des fragments.(Traduit par Dr Serge Messier).

Palaeoparasitology and palaeogenetics: review and perspectives for the study of ancient human parasites.

While some species of parasites can be identified to species level from archaeological remains using microscopy (i.e. Enterobius vermicularis, Clonorchis sinensis), others can only be identified to family or genus level as different species produce eggs with similar morphology (i.e. Tænia sp. and Echinococcus sp.). Molecular and immunological approaches offer the possibility to provide more precise determination at the species level. They can also identify taxa when classic parasite markers such as eggs or cysts have been destroyed over time. However, biomolecules can be poorly preserved and modern reference DNA is available only for a limited number of species of parasites, leading to the conclusion that classic microscopic observation should be combined with molecular analyses. Here we present a review of the molecular approaches used over the past two decades to identify human pathogenic helminths (Ascaris sp., Trichuris sp., E. vermicularis, Fasciola sp. etc.) or protists (Giardia sp., Trypanosoma sp., Leishmania sp. etc.). We also discuss the prospects for studying the evolution of parasites with genetics and genomics.

Arthroscopic removal of osteochondral fragments in the dorsal pouch of the proximal intertarsal joint in 29 horses.

OBJECTIVE: To describe the radiographic and surgical findings of horses with osteochondral fragments (OCF) in the proximal intertarsal joint (PIJ) and to detail the technique for arthroscopic fragment retrieval and report outcomes. STUDY DESIGN: Retrospective case series. ANIMALS: Twenty-nine horses (32 tarsi) with OCF in the PIJ. METHODS: Medical records of horses with radiographic evidence of OCF in the PIJ were reviewed. Clinical features, number of fragments, location, arthroscopic appearance, and outcome were recorded. Technical modifications with visual aids specific to this arthroscopic technique are described. RESULTS: Twenty-seven horses (93%) had radiographic evidence of osteochondritis dissecans lesions in the tarsocrural joint (TCJ). OCF were most commonly located distal to the medial trochlear ridge of the talus. In all cases, fragments were successfully retrieved with a technique based on exposing the fragments after resection of the proximal intertarsal joint capsule (PIJC). Fragments were visible from the TCJ prior resection of the PIJC in 4 of 32 tarsi. A third portal was created to access fragments located distal to the lateral trochlear ridge in 3 of 32 tarsi. Moderate intra-articular bleeding occurred when the PIJC was resected in 3 of 32 tarsi. One horse had postoperative swelling that resolved with conservative medical management. All horses with long-term follow-up available (16/29) started training or returned to their athletic career. CONCLUSION AND CLINICAL SIGNIFICANCE: The arthroscopic technique based on resection of PIJC was effective in retrieving OCF in the PIJ and was associated with minor complications. The clinical relevance of these fragments in the PIJ remains unknown.

Ileal antimicrobial peptide expression is dysregulated in old age.

In an effort to understand the mechanisms underlying the high prevalence of gastrointestinal tract disorders in old age, we investigated the expression of intestinal antimicrobial peptides in the terminal small intestine of aged mice. Our results show that old mice have reduced transcript levels of ileal α-defensins and lysozyme, two important types of intestinal antimicrobial peptides produced by Paneth cells. In contrast, expression of the C-type lectins Reg3b and Reg3g, as well as ß-defensin 1, angiogenin 4 and Relmb, which are made by several epithelial cell types, was significantly upregulated in aged animals suggesting an ongoing response to epithelial distress. Those changes in antimicrobial peptide gene expression associated with histological damage of the ileal epithelium and subtle modifications in the composition of the commensal microbiota. Our findings suggest that dysregulation of antimicrobial peptides expression is a feature of homeostasis disruption in the aged intestine and may contribute to geriatric gastrointestinal dysfunction.

Retrospective study of perioperative antimicrobial use in horses undergoing elective laparoscopy at a single institution.

Antimicrobial stewardship has shown significant development in recent years. Perioperative prophylaxis accounts for a substantial volume of antimicrobial use and is a field in which improvements can likely be made. The objective of this study was to evaluate practices associated with perioperative antimicrobial use in equine elective laparoscopy at a single institution over a 21-year period and to determine whether antimicrobial therapy influenced the occurrence of postoperative complications. Medical records of horses that underwent elective laparoscopy at a teaching hospital from January 2000 to September 2021 were reviewed. Data obtained included signalment, surgeon, type and duration of procedure, perioperative antimicrobial use, and intraoperative and postoperative complications. Exact univariate logistic regression was used to explore the association between possible risk factors and occurrence of postoperative complications, as well as the association between year of presentation and time of antimicrobial administration. Duration of surgery was log-transformed to meet assumption of normality, followed by analysis of variance (ANOVA) to compare mean surgery time per procedure and postoperative complications. Significance was set at P < 0.05. Sixty horses met the inclusion criteria. All horses received antimicrobial prophylaxis, but none received intraoperative redosing. Only 13 horses (26%) received antimicrobials within 60 min of the first incision. Time of administration improved with each year of the study (P = 0.005). Only 17 horses (28%) received antimicrobials for less than 24 h, but median duration of antimicrobial therapy was 1.25 d (range: 0.25 to 10 d). Antimicrobial use practices at this institution differed from general recommendations for optimal perioperative prophylaxis, which suggests that intervention is required.

L'antibiogouvernance a connu un développement significatif ces dernières années. La prophylaxie peropératoire représente un volume important d'utilisation d'antimicrobiens et constitue un domaine dans lequel des améliorations peuvent probablement être apportées. L'objectif de cette étude était d'évaluer les pratiques associées à l'utilisation peropératoire d'antimicrobiens en laparoscopie élective équine dans un seul établissement sur une période de 21 ans et de déterminer si le traitement antimicrobien influençait la survenue de complications postopératoires. Les dossiers médicaux des chevaux ayant subi une laparoscopie élective dans un centre hospitalier universitaire de janvier 2000 à septembre 2021 ont été examinés. Les données obtenues comprenaient le signalement, le chirurgien, le type et la durée de la procédure, l'utilisation d'antimicrobiens peropératoires et les complications intra-opératoires et postopératoires. Une régression logistique univariée exacte a été utilisée pour explorer l'association entre les facteurs de risque possibles et la survenue de complications postopératoires, ainsi que l'association entre l'année de présentation et le moment de l'administration des antimicrobiens. La durée de la chirurgie a été transformée en log pour répondre à l'hypothèse de normalité, suivie d'une analyse de variance (ANOVA) pour comparer la durée moyenne de la chirurgie par procédure et les complications postopératoires. La signification a été fixée à P < 0,05. Soixante chevaux répondaient aux critères d'inclusion. Tous les chevaux ont reçu une prophylaxie antimicrobienne, mais aucun n'a reçu de dose supplémentaire durant la chirurgie. Seuls 13 chevaux (26 %) ont reçu des antimicrobiens dans les 60 minutes suivant la première incision. Le temps d'administration s'est amélioré avec chaque année d'étude (P = 0,005). Seulement 17 chevaux (28 %) ont reçu des antimicrobiens pendant moins de 24 heures, mais la durée médiane du traitement antimicrobien était de 1,25 jour (plage : 0,25 à 10 jours). Les pratiques d'utilisation des antimicrobiens dans cet établissement différaient des recommandations générales pour une prophylaxie peropératoire optimale, ce qui suggère qu'une intervention est nécessaire.(Traduit par Docteur Serge Messier).

microRNAs are differentially expressed in equine plasma of horses with osteoarthritis and osteochondritis dissecans versus control horses.

Osteoarthritis (OA) is a leading cause of lameness in horses with no effective disease-modifying treatment and challenging early diagnosis. OA is considered a disease of the joint involving the articular cartilage, subchondral bone, synovial membrane, and ligaments. Osteochondritis dissecans (OCD) is a joint disease consisting of focal defects in the osteochondral unit which may progress to OA later in life. MicroRNAs (miRNAs) have been recognized as small non-coding RNAs that regulate a variety of biological processes and have been detected in biological fluids. MiRNAs are currently investigated for their utility as biomarkers and druggable targets for a variety of diseases. The current study hypothesizes that miRNA profiles can be used to actively monitor joint health and differences in miRNA profiles will be found in healthy vs diseased joints and that differences will be detectable in blood plasma of tested horses. Five horses with OA, OCD, and 4 controls (C) had blood plasma and synovial fluid collected. Total RNA, including miRNA was isolated before generating miRNA libraries from the plasma of the horses. Libraries were sequenced at the Schroeder Arthritis Institute (Toronto). Differential expression analysis was done using DESeq2 and validated using ddPCR. KEGG pathway analysis was done using mirPath v.3 (Diana Tools). 57 differentially expressed miRNAs were identified in OA vs C plasma, 45 differentially expressed miRNAs in OC vs C plasma, and 21 differentially expressed miRNAs in OA vs OCD plasma. Notably, miR-140-5p expression was observed to be elevated in OA synovial fluid suggesting that miR-140-5p may serve as a protective marker early on to attenuate OA progression. KEGG pathway analysis of differentially expressed plasma miRNAs showed relationships with glycan degradation, glycosaminoglycan degradation, and hippo signaling pathway. Interestingly, ddPCR was unable to validate the NGS data suggesting that isomiRs may play an integral role in miRNA expression when assessed using NGS technologies.

Physical Rehabilitation Before and After Lung Transplantation for COVID-19 ARDS: A Case Report.

Purpose: To describe the functional trajectory and physical rehabilitation of an individual who underwent lung transplantation for COVID-19 acute respiratory distress syndrome (ARDS). Client Description: A previously healthy 60-year-old man admitted to critical care pre-transplantation and followed six months post-transplant. Intervention: Physical rehabilitation in the critical care, acute ward and in-patient rehabilitation settings. Measures and Outcome: Despite a successful surgery, a long and complex acute care admission contributed to a slow and variable functional recovery. Significant functional limitations and physical frailty were present in the early post-transplant period. Implications: Little is known of the effects of COVID-19 superimposed upon lung transplantation on muscle function, exercise capacity, and physical activity. Future research should include case series to further understand the functional deficits and trajectory of recovery in this emerging clinical population. Standard core outcome measures should be identified for this population to enable synthesis of findings and inform short- and long-term rehabilitation strategies.

Objectif: décrire la trajectoire fonctionnelle et la réadaptation physique d'une personne qui a subi une transplantation pulmonaire à cause d'un syndrome de détresse respiratoire aiguë consécutif à la COVID-19. Description du client: un homme de 60 ans auparavant en santé a été admis en soins intensifs avant la transplantation et a été suivi pendant six mois par la suite. Intervention: réadaptation physique en soins intensifs, à l'aile de soins aigus et en milieu de réadaptation pour patients hospitalisés. Mesures et résultats cliniques: malgré une opération réussie, une hospitalisation longue et complexe en soins aigus a contribué à un rétablissement fonctionnel lent et variable. D'importantes limites fonctionnelles et une fragilité physique ont été observées au début de la période suivant la transplantation. Implications: On sait peu de choses sur les effets de la COVID-19 qui s'ajoutent à la transplantation pulmonaire sur le fonctionnement musculaire, la capacité à l'exercice et l'activité physique. Les futures recherches devraient inclure des séries de cas pour mieux comprendre les déficits fonctionnels et la trajectoire de la convalescence auprès de cette population clinique en émergence. Il faudrait établir des mesures de résultats de référence standards dans cette population afin de synthétiser les observations et d'éclairer les stratégies de réadaptation à court et à long terme.

Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service.

BACKGROUND: With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. METHODS: In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. RESULTS: Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. CONCLUSIONS: Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.

Requesting cesareans without medical indications: an option being considered by young canadian women.

BACKGROUND: Cesarean delivery on maternal request is a worldwide growing phenomenon. The goal of this study was to describe young nulliparous women's attitudes about cesarean delivery on maternal request. METHODS: A total of 140 nulliparous women in Canada aged between 18 and 24years and attending school from the vocational (n=53), college (n=61), and university (n=18) levels (n=8 other) participated in the survey. The self-administered questionnaire consisted of 23 open-ended questions. The outcome measure was the participant's attitude toward cesarean delivery on maternal request. Descriptive, bivariate, and multiple regression analyses were performed. RESULTS: Many of the respondents (63%) had previously heard about cesarean delivery on maternal request, and of these women 28.6 percent had a favorable attitude toward the procedure. Sociodemographic variables were not associated with participants' attitudes toward cesarean delivery on maternal request except for place of residence and type of professional preferred for pregnancy care. Thinking that vaginal birth was more painful than cesarean delivery (p=0.012) and had more consequences for the mother (p<0.001) were related to a positive attitude toward cesarean delivery on maternal request. A positive attitude by peers was also associated with participants' favorable attitude toward cesarean delivery on maternal request (p<0.001). The overall predictive success of the model was 66.5 percent. CONCLUSIONS: Young women are spreading the word about cesarean delivery on maternal request and may influence one another about their preferred delivery method. During prenatal visits practitioners need to address women's fear of vaginal birth and its consequences for the mother, counseling, and women's understanding of the consequences of cesarean delivery. This study supports the urgent need to systematically document cesarean delivery on maternal request as a medical procedure and to study its prevalence and related factors.

Liquid biopsy-based targeted gene screening highlights tumor cell subtypes in patients with advanced prostate cancer.

Prostate cancer (PCa) clinical heterogeneity underscores tumor heterogeneity, which may be best defined by cell subtypes. To test if cell subtypes contributing to progression can be assessed noninvasively, we investigated whether 14 genes representing luminal, neuroendocrine, and stem cells are detectable in whole blood RNA of patients with advanced PCa. For each gene, reverse transcription quantitative polymerase chain reaction assays were first validated using RNA from PCa cell lines, and their traceability in blood was assessed in cell spiking experiments. These were next tested in blood RNA of 40 advanced PCa cases and 40 healthy controls. Expression in controls, which was low or negative, was used to define stringent thresholds for gene overexpression in patients to account for normal variation in white blood cells. Thirty-five of 40 patients overexpressed at least one gene. Patients with more genes overexpressed had a higher risk of death (hazard ratio 1.42, range 1.12-1.77). Progression on androgen receptor inhibitors was associated with overexpression of stem (odds ratio [OR] 7.74, range 1.68-35.61) and neuroendocrine (OR 13.10, range 1.24-142.34) genes, while luminal genes were associated with taxanes (OR 2.7, range 1.07-6.82). Analyses in PCa transcriptomic datasets revealed that this gene panel was most prominent in metastases of advanced disease, with diversity among patients. Collectively, these findings support the contribution of the prostate cell subtypes to disease progression. Cell-subtype specific genes are traceable in blood RNA of patients with advanced PCa and are associated with clinically relevant end points. This opens the door to minimally invasive liquid biopsies for better management of this deadly disease.

Advancements in web-database applications for rabies surveillance.

BACKGROUND: Protection of public health from rabies is informed by the analysis of surveillance data from human and animal populations. In Canada, public health, agricultural and wildlife agencies at the provincial and federal level are responsible for rabies disease control, and this has led to multiple agency-specific data repositories. Aggregation of agency-specific data into one database application would enable more comprehensive data analyses and effective communication among participating agencies. In Québec, RageDB was developed to house surveillance data for the raccoon rabies variant, representing the next generation in web-based database applications that provide a key resource for the protection of public health. RESULTS: RageDB incorporates data from, and grants access to, all agencies responsible for the surveillance of raccoon rabies in Québec. Technological advancements of RageDB to rabies surveillance databases include (1) automatic integration of multi-agency data and diagnostic results on a daily basis; (2) a web-based data editing interface that enables authorized users to add, edit and extract data; and (3) an interactive dashboard to help visualize data simply and efficiently, in table, chart, and cartographic formats. Furthermore, RageDB stores data from citizens who voluntarily report sightings of rabies suspect animals. We also discuss how sightings data can indicate public perception to the risk of racoon rabies and thus aid in directing the allocation of disease control resources for protecting public health. CONCLUSIONS: RageDB provides an example in the evolution of spatio-temporal database applications for the storage, analysis and communication of disease surveillance data. The database was fast and inexpensive to develop by using open-source technologies, simple and efficient design strategies, and shared web hosting. The database increases communication among agencies collaborating to protect human health from raccoon rabies. Furthermore, health agencies have real-time access to a wide assortment of data documenting new developments in the raccoon rabies epidemic and this enables a more timely and appropriate response.

A Collaborative Model to Implement Flexible, Accessible and Efficient Oncogenetic Services for Hereditary Breast and Ovarian Cancer: The C-MOnGene Study.

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics.

[Spontaneous preterm birth and the maternal microbiome]. / La prématurité spontanée et le microbiote maternel.

Preterm birth is the leading cause of perinatal mortality and morbidity. Despite the efforts spent over the past 40 years to solve the physiopathological processes involved in the triggering of prematurity, efficient therapeutics are still lacking. Recently, growing body of evidence suggests that the maternal microbiome is a major player for a normal pregnancy and that dysbiosis is associated with preterm birth. The vaginal microbiome and its commensal Lactobacillus species may protect the uterus of ascending dissemination of pathogens. The uterus can also be contaminated with oral bacteria by the blood stream. Thus, the maternal microbiome can play both a protective role or a causal role in the triggering of preterm birth.

Two exo-beta-D-glucosaminidases/exochitosanases from actinomycetes define a new subfamily within family 2 of glycoside hydrolases.

A GlcNase (exo-beta-D-glucosaminidase) was purified from culture supernatant of Amycolatopsis orientalis subsp. orientalis grown in medium with chitosan. The enzyme hydrolysed the terminal GlcN (glucosamine) residues in oligomers of GlcN with transglycosylation observed at late reaction stages. 1H-NMR spectroscopy revealed that the enzyme is a retaining glycoside hydrolase. The GlcNase also behaved as an exochitosanase against high-molecular-mass chitosan with K(m) and kcat values of 0.16 mg/ml and 2832 min(-1). On the basis of partial amino acid sequences, PCR primers were designed and used to amplify a DNA fragment which then allowed the cloning of the GlcNase gene (csxA) associated with an open reading frame of 1032 residues. The GlcNase has been classified as a member of glycoside hydrolase family 2 (GH2). Sequence alignments identified a group of CsxA-related protein sequences forming a distinct GH2 subfamily. Most of them have been annotated in databases as putative beta-mannosidases. Among these, the SAV1223 protein from Streptomyces avermitilis has been purified following gene cloning and expression in a heterologous host and shown to be a GlcNase with no detectable beta-mannosidase activity. In CsxA and all relatives, a serine-aspartate doublet replaces an asparagine residue and a glutamate residue, which were strictly conserved in previously studied GH2 members with beta-galactosidase, beta-glucuronidase or beta-mannosidase activity and shown to be directly involved in various steps of the catalytic mechanism. Alignments of several other GH2 members allowed the identification of yet another putative subfamily, characterized by a novel, serine-glutamate doublet at these positions.

Systematic investigations of gene effects on both topologies and supports: An Echinococcus illustration.

In this paper, we propose a high performance computing toolbox implementing efficient statistical methods for the study of phylogenies. This toolbox, which implements logit models and LASSO-type penalties, gives a way to better understand, measure, and compare the impact of each gene on a global phylogeny. As an application, we study the Echinococcus phylogeny, which is often considered as a particularly difficult example. Mitochondrial and nuclear genomes (19 coding sequences) of nine Echinococcus species are considered in order to investigate the molecular phylogeny of this genus. First, we check that the 19 gene trees lead to 19 totally different unsupported topologies (a topology is the sister relationship when both branch lengths and supports are ignored in a phylogenetic tree), while using the 19 genes as a whole are not sufficient for estimating the phylogeny. In order to circumvent this issue and understand the impact of the genes, we computed 43,796 trees using combinations ranging from 13 to 19 genes. By doing so, 15 topologies are obtained. Four particular topologies, appearing more robust and frequent, are then selected for more precise investigation. Refining further our statistical analysis, a particularly robust topology is extracted. We also carefully demonstrate the influence of nuclear genes on the likelihood of the phylogeny.

Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

RATIONALE: There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). OBJECTIVES: We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality. METHODS: We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO. MEASUREMENTS AND MAIN RESULTS: Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy. CONCLUSIONS: Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile.

Postoperative effects of anesthesia and surgery on resting energy expenditure in horses as measured by indirect calorimetry.

In this study, we aimed to define the effects of anesthesia and surgery on the resting energy expenditure of horses in experimental conditions. Six horses were used in a longitudinal study with 2 study periods: before and after anesthesia and surgery. Every horse underwent a standard 90-min ventral midline exploratory laparotomy. Oxygen uptake (VO2) and carbon dioxide output (VCO2) were measured, with the use of a closed-circuit spirometry system, on 5 consecutive days immediately before and after the surgery. In 3 consecutive 5-min periods each day, the expired air was collected in a Collins spirometer. Samples of the expired gas were drawn from the spirometer through a drying column into O2 and CO2 analyzers. Resting energy expenditure was calculated as [(VO2 STPD*3.94) + (VCO2 STPD*1.11)]*1.44. This study showed that anesthesia and ventral midline exploratory laparotomy in experimental conditions increase the postoperative caloric demand in horses by an average of 1.0 Mcal/d, which represents approximately a 10% increase (P = 0.03). Additional studies in critically ill horses after surgery are needed to determine their caloric needs and to optimize their nutritional management.

Effect of intraluminal distension or ischemic strangulation obstruction of the equine jejunum on jejunal motilin receptors and binding of erythromycin lactobionate.

OBJECTIVE: To determine whether inflammation of the jejunum of horses decreases the number of motilin receptors and amounts of motilin receptor mRNA and alters erythromycin lactobionate binding affinity to the motilin receptor in jejunal tissues. SAMPLE POPULATION: Jejunal segments in 6 adult horses. PROCEDURE: Each horse was anesthetized, and a ventral median celiotomy was performed; 2 segments of jejunum underwent a sham operation, 2 segments underwent ischemic strangulation obstruction (ISO), and 2 segments underwent intraluminal distension (ILD). Treatments were maintained for 120 minutes. From each segment, full-thickness biopsy samples were collected and smooth-muscle homogenates were prepared. Affinity and distribution of motilin binding to these preparations were determined by use of iodine 125 (125I)-labeled synthetic porcine motilin. Via displacement experiments, competition between 125I-labeled motilin and erythromycin lactobionate for binding to motilin receptors in the different segments was investigated. A quantitative real-time PCR technique was used to assess motilin receptor mRNA content in the muscle preparations. RESULTS: Compared with the ISO or ILD segments, the number of motilin receptors was significantly higher in the sham-operated segments; ILD segments contained the lowest number of motilin receptors. The expression of motilin receptor mRNA was significantly decreased in ILD segments but not in ISO segments. Erythromycin lactobionate displacement of 125I-labeled motilin from motilin receptors did not differ significantly among the jejunal segments. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that downregulation and decreased production of motilin receptors in inflamed jejunal tissue contribute to the altered prokinetic response to erythromycin in horses with gastrointestinal disease.

Equine gastrointestinal motility--ileus and pharmacological modification.

Colic is a common problem encountered in equine practice. Alteration of gastrointestinal motility is often the underlying cause for abdominal pain. Gastrointestinal motility can be measured as myoelectric activity, mechanical activity, and transit of intraluminal contents. Regulation of motility is based on a complex interaction between central innervation, autonomic innervation, and the enteric nervous system. Various humoral and neurochemical substances are required to interact flawlessly to allow propulsive motility. Ileus is defined as the absence of propulsive aboral movement of gastrointestinal contents, irrespective of its pathophysiology. Potential etiologies for ileus are described in this review. The prokinetic drugs available for clinical use are discussed. Choosing the appropriate prokinetic drug requires knowledge about the complex nature of gastrointestinal motility and its abnormalities.

Prevalence and risk factors for Campylobacter spp., Salmonella spp., Coxiella burnetii, and Newcastle disease virus in feral pigeons (Columba livia) in public areas of Montreal, Canada.

Feral pigeons (Columbia livia) can harbor a range of zoonotic pathogens. A transversal study was undertaken to estimate the prevalence of feral pigeons infected by various pathogens in public areas in Montreal, Quebec. Cloacal swabs from captured birds were cultured for Salmonella spp. and Campylobacter spp. and tested by real-time polymerase chain reaction (RT-PCR) for the detection of Coxiella burnetii. An oropharyngeal swab was also submitted to real-time reverse-transcription polymerase chain reaction (RRT-PCR) for the detection of Newcastle disease virus. Among the 187 pigeons tested from 10 public areas, 9.1% (95% CI: 3.0 to 15.2) were positive for Campylobacter spp. with all strains identified as Campylobacter jejuni. The Campylobacter status of birds was not associated with individual characteristics of birds, with the exception of body score. None of the pigeons tested positive for the other pathogens. Direct or indirect contacts with feral pigeons may constitute a potential risk for Campylobacter infection in humans.

Les pigeons sauvages (Columbia livia) peuvent être porteurs d'une variété d'agents pathogènes zoonotiques. Une étude transversale a été réalisée dans le but d'estimer la prévalence de pigeons sauvages infectés par différents agents pathogènes dans des aires publiques de la ville de Montréal, Québec (Canada). Des écouvillons cloacaux d'oiseaux capturés ont été cultivés pour Salmonella spp. et Campylobacter spp. et testés par une réaction en chaîne par polymérase en temps réel (RT-PCR) pour la détection de Coxiella burnetii. Des écouvillons oropharyngés ont également été testés par une réaction en chaîne par polymérase en temps réel après transcription inverse (RRT-PCR) pour la détection du virus de la maladie de Newcastle. Parmi les 187 pigeons testés provenant de 10 aires publiques, 9,1 % (IC 95 % : 3,0­15,2) étaient positifs à Campylobacter spp.; toutes les souches ont été identifiées en tant que Campylobacter jejuni. L'infection par Campylobacter n'était pas associée aux caractéristiques individuelles des oiseaux, à l'exception de l'état de chair. Aucun pigeon n'était positif aux autres agents pathogènes. Le contact direct ou indirect avec des pigeons sauvages peut représenter un risque potentiel pour les infections à Campylobacter jejuni chez l'humain.(Traduit par les auteurs).