Adverse effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: a systematic review and meta-analysis.

Sodium-glucose cotransoporter-2 inhibitors (SGLT-2Is) improve prognosis in heart failure (HF) patients both with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). However, these drugs can have some side effects. To estimate the relative risk of side effects in HF patients treated with SGLT-2Is irrespective from left ventricular EF and setting (chronic and non-chronic HF). Five randomized controlled trials (RCTs) enrolling patients with HFrEF, 4 RCTs enrolling non-chronic HF, and 3 RCTs enrolling HFpEF were included. Among side effects, urinary infection, genital infection, acute kidney injury, diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations were considered in the analysis. Overall, 24,055 patients were included in the analysis: 9020 (38%) patients with HFrEF, 12,562 (52%) with HFpEF, and 2473 (10%) with non-chronic HF. There were no differences between SGLT-2Is and placebo in the risk to develop diabetic ketoacidosis, hypoglycemia, hyperkalemia, hypokalemia, bone fractures, and amputations. HFrEF patients treated with SGLT-2Is had a significant reduction of acute kidney injury (RR = 0.54 (95% CI 0.33-0.87), p = 0.011), whereas no differences have been reported in the HFpEF group (RR = 0.94 (95% CI 0.83-1.07), p = 0.348) and non-chronic HF setting (RR = 0.79 (95% CI 0.55-1.15), p = 0.214). A higher risk to develop genital infection (overall 2.57 (95% CI 1.82-3.63), p < 0.001) was found among patients treated with SGLT-2Is irrespective from EF (HFrEF: RR = 1.96 (95% CI 1.17-3.29), p = 0.011; HFpEF: RR = 3.04 (95% CI 1.88-4.90), p < 0.001). The risk to develop urinary infections was increased among SGLT-2I users in the overall population (RR = 1.13 (95% CI 1.00-1.28), p = 0.046) and in the HFpEF setting (RR = 1.19 (95% CI 1.02-1.38), p = 0.029), whereas no differences have been reported in HFrEF (RR = 1.05 (95% CI 0.81-1.36), p = 0.725) and in non-chronic HF setting (RR = 1.04 (95% CI 0.75-1.46), p = 0.806). SGLT-2Is increase the risk of urinary and genital infections in HF patients. In HFpEF patients, the treatment increases the risk of urinary infections compared to placebo, whereas SGLT-2Is reduce the risk of acute kidney disease in patients with HFrEF.

Ex vivo biomechanical evaluation of 2.4 mm LCP plate rod constructs versus 2.7 mm LCP applied to the feline tibia.

OBJECTIVE: To compare the stiffness and strength of three plate and rod fixation constructs applied to a feline tibial gap model. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Thirty-three unpaired tibiae obtained from skeletally mature cats. METHODS: The tibiae were randomly divided into three groups. The following implants were then applied to the feline tibiae prior to the creation of a 10 mm diaphyseal gap. Group 1: 2.4 mm locking compression plate (LCP) and 1.0 mm intramedullary pin (IMP). Group 2: 2.4 mm LCP and 1.6 mm IMP. Group 3: 2.7 mm LCP. Subsequently, each specimen was tested for torsion, axial compression, and axial load until construct failure. Student's t-tests were used to compare the torsional and axial stiffness, yield load, and maximum axial force. RESULTS: Group 2 had higher axial stiffness than group 3 (p = .013). Group 1 showed a lower maximum axial force and yield point than groups 2 and 3 (p < .01; p < .05, respectively). There were no among-group differences in torsional stiffness. CONCLUSION: Constructs with a 2.4 mm LCP and 1.6 mm IMP provided the strongest and most rigid constructs in a feline tibia gap model. CLINICAL SIGNIFICANCE: A plate-rod construct combining a 2.4 mm LCP and a 1.6 mm IMP is appropriate for achieving high implant stiffness and resisting maximum axial force in treatment of tibial fractures in cats.

Treatment of traumatic cranial fracture with sonic activated polymer pins and plates resorbable implants in a dog.

INTRODUCTION: The case report describes the use of ultrasound-activated resorbable implants for surgical repair of comminuted cranial fractures in a 10 years old medium sized mix-breed dog being injured from a horse kick.

INTRODUCTION: Ce rapport de cas décrit l'utilisation d'implants résorbables activés par ultrasons pour la réparation chirurgicale de fractures crâniennes comminutives chez un chien de race moyenne âgé de 10 ans, blessé par un coup de pied de cheval.

Sacubitril/valsartan and arrhythmic burden in patients with heart failure and reduced ejection fraction: a systematic review and meta-analysis.

The aim of this study was to assess whether angiotensin receptor/neprilysin inhibitor (ARNI) decreases ventricular arrhythmic burden compared to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonist (ACE-I/ARB) treatment in chronic heart failure with reduced ejection fraction (HFrEF) patients. Further, we assessed if ARNI influenced the percentage of biventricular pacing. A systematic review of studies (both RCTs and observational studies) including HFrEF patients and those receiving ARNI after ACE-I/ARB treatment was conducted using Medline and Embase up to February 2023. Initial search found 617 articles. After duplicate removal and text check, 1 RCT and 3 non-RCTs with a total of 8837 patients were included in the final analysis. ARNI was associated with a significative reduction of ventricular arrhythmias both in RCT (RR 0.78 (95% CI 0.63-0.96); p = 0.02) and observational studies (RR 0.62; 95% CI 0.53-0.72; p < 0.001). Furthermore, in non-RCTs, ARNI also reduced sustained (RR 0.36 (95% CI 0.2-0.63); p < 0.001), non-sustained VT (RR 0.67 (95% CI 0.57-0.80; p = 0.007), ICD shock (RR 0.24 (95% CI 0.12-0.48; p < 0.001), and increased biventricular pacing (2.96% (95% CI 2.25-3.67), p < 0.001). In patients with chronic HFrEF, switching from ACE-I/ARB to ARNI treatment was associated with a consistent reduction of ventricular arrhythmic burden. This association could be related to a direct pharmacological effect of ARNI on cardiac remodeling.Trial registration: CRD42021257977.

The extraction of microplastics from sediments: An overview of existing methods and the proposal of a new and green alternative.

Microplastics (MPs) contamination is an existing and concerning environmental issue. Plastic particles have been observed worldwide in every natural matrix, with water environments being the final sink of dispersed MPs. Microplastic distribution in water ecosystems varies as a function of multiple factors, including polymer properties (e.g., density and wettability) and environmental conditions (e.g., water currents and temperature). Because of the tendency of MPs to settle, sediment is known to be one of the most impacted environmental matrices. Despite the increasing awareness of their diffusion in sediments, a proper quantification of dispersed particles is still difficult, due to the lack of standard protocols, which avoid a proper comparison of different sites. This hampers the current knowledge on environmental implications and toxicological effects of MPs in sediments. In this work, we examined 49 studies carried out from 2004 to 2020 to describe the different extraction methods applied, and to highlight pros and cons, with the aim of evaluating the more promising protocols. Therefore, we evaluated each proposed method by considering precision, reproducibility, economic viability and greenness (in term of used reagents). Finally, we proposed a valid alternative procedure in term of reliability and costs, which can attract increasing interest for future studies.

[A new approach to treatment selection in dogs with cruciate ligament rupture: patient-specific treatment recommendations]. / Ein neuer Ansatz für die Therapie­auswahl bei Hunden mit Kreuzband­erkrankung: Patientenspezifische ­Behandlungsempfehlungen.

INTRODUCTION: Cranial cruciate ligament rupture is one of the most important diseases in canine orthopedics. Despite the frequent occurrence of the disease and the extensive literature available, there is still controversy about the best treatment method. The aim of this review article is to present a new, more specific approach to treatment selection in dogs with cranial cruciate ligament rupture. Patients are divided into different groups and particular treatment methods are then recommended according to group membership. In order to develop the treatment recommendations, the patient groups were initially defined based on criteria that are important for treatment selection, such as type of cranial cruciate ligament rupture, chronicity, degree of instability, size and weight of the patient, stage of osteoarthritis, the presence of bone deformities, concurrent medial patellar luxation or rotational instability. A detailed literature search was conducted through MEDLINE/PUBMED; CAB Abstracts, Google -Scholar and in conference proceedings abstracts from 1990-2019. Based on the available literature, treatment recommendations were developed for each patient group. These patient group-specific recommendations based on best available evidence are intended to simplify the decision-making process for treatment selection in dogs with cranial cruciate ligament disease.

INTRODUCTION: La rupture du ligament croisé antérieur est l'une des affections orthopédiques les plus importantes chez le chien. Malgré sa fréquence et la vaste littérature disponible, il existe toujours un désaccord sur la meilleure méthode de traitement. Le but de cet article de revue est donc de présenter une approche actuelle et plus spécifique pour la sélection de traitements chez les chiens présentant une déchirure du ligament croisé antérieur. Les patients sont divisés en différents groupes, pour lesquels une méthode spécifique est alors recommandée. Afin d'élaborer ces recommandations de traitement, différents groupes de patients ont été initialement définis sur la base de plusieurs critères importants pour la sélection de la méthode (type de déchirure du ligament croisé, chronicité, degré d'instabilité, taille et poids du patient, stade de l'arthrose, présence de déformations osseuses, luxation patellaire médiale simultanée ou instabilité rotationnelle). Par la suite, une recherche documentaire détaillée a été effectuée via MEDLINE/PUBMED; CAB Abstracts, Google Scholar et dans les actes de conférences de 1990 à 2019. Des recommandations de traitement ont ensuite été formulées pour chacun des groupes sur la base de la littérature disponible. Ces recommandations spécifiques aux groupes de patients sont destinées à permettre au praticien des petits animaux de prendre plus facilement sa décision lors de la sélection des méthodes thérapeutiques chez les chiens présentant des déchirures des ligaments croisés.

The effects of foraminotomy and intervertebral distraction on the volume of the lumbosacral intervertebral neurovascular foramen: An ex vivo study.

Degenerative lumbosacral stenosis in dogs frequently involves L7-S1 foraminal stenosis and L7 nerve root compression. Surgical techniques to decompress the L7 nerve root include foraminotomy and intervertebral distraction. The objective of this study was to compare the effect of foraminotomy and intervertebral distraction on the total, cranial, and caudal compartmental volumes of the L7-S1 intervertebral neurovascular foramen (NF). CT images were obtained from eight canine lumbosacral (L5-CD1) specimens in the following sequential conditions: native spine (1), after dorsal laminectomy and partial discectomy of L7-S1 (2), after L7-S1 foraminotomy (3), after distraction with an interbody cage between L7 and S1 (4), after cage distraction stabilized with pedicle screw-rod fixation in neutral (5) and flexed position (6). The volume of the complete NF and its cranial and caudal subcompartments were calculated using the CT images and statistically compared between conditions. P < 0.05 was considered statistically significant. The volume of the complete NF was significantly increased after foraminotomy (mean ± standard deviation (146.8 ± 26.5%, P < 0.01) and after distraction (Condition 4, 121.0 ± 19.1%; Condition 5, 116.6 ± 29.3 %; Condition 6, 119.0 ± 21.8 %; P = 0.01) with no difference between the distraction conditions. Foraminotomy induced a significantly larger increase in total NF volume compared to distraction. Foraminotomy, but not distraction, induced a significant increase in volume of the cranial subcompartment (158.2 ± 33.2 %; P < 0.01). Foraminotomy is more effective in increasing the foraminal volume and especially the cranial subcompartment, which is where the L7 nerve root traverses the NF. Hence, foraminotomy may be more effective in decompressing the L7 nerve root.

Quantifying dog meniscal volume at 1.5T and 3.0T MRI.

The dog has been used extensively as an experimental model to study meniscal treatments such as meniscectomy, meniscal repair and regeneration. Accurate quantification of meniscal size and morphology are a crucial step for developing models of the meniscus. 3.0T magnetic resonance imaging (MRI) has been found to be highly accurate in analyzing the meniscus in both clinical and research fields. However, 3.0T MRI systems are still uncommonly used in veterinary medicine. The goal of the study was to compare meniscal volume measurements from 1.5T MRI system with 3.0T MRI system using proton density sequence, a clinically relevant protocol. The MR images were segmented to reconstruct 3D surface representations of both medial and lateral menisci to compare the meniscal volumes measurements. Average volume differences were 8.8% (P=0.42) and 8.9% (P=0.535) for medial and lateral meniscus, respectively. No significant volume differences were found between 1.5T and 3.0T magnetic resonance (MR) measurements, with high Pearson's correlation coefficient of r > 0.8 and the intraclass correlation coefficient (ICC) of 0.899. For inter- and intra-observer reproducibility, high correlation (ICC = 0.942 and 0.814) was observed, but with high variability for intra-observer reproducibility (lower bound 0.478, upper bound 0.949). We have shown that common clinical MR scanners and pulse sequences can be used to quantify dogs' meniscal volumes with good reproducibility. We believe that repeatable measurements of meniscal volumes using MR may provide a useful capability for assessment of postoperative results following meniscal treatments such as meniscectomy and meniscal regeneration.

[Treatment of a hip and patella luxation in a toy dog]. / Behandlung einer Hüftgelenks- und Kniescheiben-Luxation bei einer Zwerghunderasse.

INTRODUCTION: The present case report describes the surgical treatment of a traumatic craniodorsal luxation of the hip and a concomitant medial congenital luxation of the patella (3rd grade) in an 11-year-old Yorkshire Terrier. First the hip luxation was corrected with a cemented hip prosthesis. The femoral stem was inserted in slight anteversion (15°) with respect to the preoperative condition (5°), this contributed contrasting the medial traction of the femoral quadriceps on the patella, improving patellar luxation from 3rd to 2nd grade. However, the persistent patellar luxation and intermittent lameness reduced limb function and made a second intervention necessary. Four weeks after prosthetic surgery, a femoral trocleoplasty and lateral transposition of the tibial crest were performed to definitively re-establish a correct replacement of the patella in the femoral trochlea. No perioperative complications were found. At the final examination the patient did not show any lameness or pain that could be evoked when manipulating the surgically corrected limb. The surgical treatment allowed a restoration of the hip function and the alignment of the extensor mechanism of the femoral quadriceps and ensured a complete return to normal motor activities.

INTRODUCTION: Nous décrivons le traitement chirurgical d'une luxation traumatique cranio-dorsale de la hanche et d'une luxation patellaire de degré 3 concomitante chez un chien Yorkshire Terrier âgé de 11 ans. La luxation de la hanche a d'abord été traitée avec une prothèse totale cimentée. L'insertion de la tige fémorale en légère antéversion (15°) par rapport à l'état préopératoire (5°) contrecarrait la traction médiale des muscles quadriceps sur la rotule et réduisait la luxation patellaire du degré 3 au degré 2. Cependant la présence d'une boiterie intermittente due à la luxation patellaire de degré 2 persistante a réduit la fonction du membre et a rendu nécessaire une seconde intervention chirurgicale. Quatre semaines après le remplacement total de la hanche, une trochléoplastie fémorale et une transposition latérale de la crête tibiale ont été réalisées afin d'établir définitivement un alignement correct de la rotule dans la trochlée fémorale. Aucune complication périopératoire n'a été rencontrée. Lors de dernier contrôle, le patient ne présentait pas de boiterie ni de douleur lors de la manipulation du membre opéré Le traitement chirurgical a permis de rétablir la fonction de la hanche et d'aligner correctement le mécanisme extenseur des muscles quadriceps, tout en garantissant un retour complet du patient à une activité physique normale.

Three-dimensional computer-assisted corrective osteotomy with a patient-specific surgical guide for an antebrachial limb deformity in two dogs.

INTRODUCTION: We describe patient-specific surgical guide prototyping and surgical treatment of a complex antebrachial deformity in two skeletally mature dogs presented with chronic lameness. Computer-assisted surgery was elected to increase accuracy in the correction of the complex deformity. Radiographs and computed tomography (CT) scans revealed a biplane deformity with valgus, procurvatum and external torsion of the right radius in both cases. The pre-surgical planning started from the quantification of the angular deformity, followed by computer simulated correction and to end up with a rehearsal surgery on 3D printed bone models. During the surgery, the custom-made osteotomy guides closely fitted the bone, allowing for a precise corrective osteotomy, that was stabilized with two locking plates. Postoperative radiographs showed the successful correction of the deformity. Eight and 12 weeks postoperative follow up examinations showed improved lameness, weight-bearing and progression of bone healing in both dogs. Patient-specific surgical guides allowed for a satisfactory correction of the antebrachial deformity. Additional benefits of using customized surgical devices include standardization and reduced surgical time.

INTRODUCTION: Nous décrivons le prototypage d'une procédure chirurgicale spécifique au patient et le traitement chirurgical d'une déformation antébrachiale complexe chez deux chiens ayant atteint leur maturité squelettique et présentant une boiterie chronique. La chirurgie assistée par ordinateur a été choisie pour accroître la précision de la correction de la déformation complexe. Les radiographies et la tomodensitométrie (TDM) ont révélé une déformation dans deux plans avec valgus, procurvatum et torsion externe du radius droit dans les deux cas. La planification préopératoire a commencé par la quantification de la déformation angulaire, suivie par une correction simulée sur ordinateur et a abouti à une opération de répétition sur des modèles d'os imprimés en 3D. Pendant l'intervention, des guides d'ostéotomie sur mesure ont ajusté l'os de manière exacte, permettant ainsi une ostéotomie correctrice précise, stabilisée avec deux plaques de verrouillage. Les radiographies postopératoires ont montré la réussite de le correction de la déformation. Les examens de suivi postopératoires effectués à huit et douze semaines ont montré une amélioration de la boiterie et de la mise en charge ainsi que la progression de la cicatrisation des os chez les deux chiens. Les guides chirurgicaux spécifiques au patient ont ­permis une correction satisfaisante de la déformation antébrachiale. L'utilisation de matériel chirurgical personnalisé comporte d'autres avantages, tels que la standardisation et la réduction du temps de l'intervention chirurgicale.

In Planta Sporulation of Frankia spp. as a Determinant of Alder-Symbiont Interactions.

The Alnus genus forms symbiosis with the actinobacteria Frankia spp. and ectomycorrhizal fungi. Two types of Frankia lineages can be distinguished based on their ability to sporulate in planta Spore-positive (Sp+) strains are predominant on Alnus incana and Alnus viridis in highlands, while spore-negative (Sp-) strains are mainly associated with Alnus glutinosa in lowlands. Here, we investigated whether the Sp+ predominance in nodules is due to host selection of certain Frankia genotypes from soil communities or the result of the ecological history of the alder stand soil, as well as the effect of the sporulation genotype on the ectomycorrhizal (ECM) communities. Trapping experiments were conducted using A. glutinosa, A. incana, and A. viridis plantlets on 6 soils, differing in the alder species and the frequency of Sp+ nodules in the field. Higher diversity of Frankia spp. and variation in Sp+ frequencies were observed in the trapping than in the fields. Both indigenous and trapping species shape Frankia community structure in trapped nodules. Nodulation impediments were observed under several trapping conditions in Sp+ soils, supporting a narrower host range of Sp+ Frankia species. A. incana and A. viridis were able to associate equally with compatible Sp+ and Sp- strains in the greenhouse. Additionally, no host shift was observed for Alnus-specific ECM, and the sporulation genotype of Frankia spp. defined the ECM communities on the host roots. The symbiotic association is likely determined by the host range, the soil history, and the type of in plantaFrankia species. These results provide an insight into the biogeographical drivers of alder symbionts in the Holarctic region.IMPORTANCE Most Frankia-actinorhiza plant symbioses are capable of high rates of nitrogen fixation comparable to those found on legumes. Yet, our understanding of the ecology and distribution of Frankia spp. is still very limited. Several studies have focused on the distribution patterns of Frankia spp., demonstrating a combination of host and pedoclimatic parameters in their biogeography. However, very few have considered the in planta sporulation form of the strain, although it is a unique feature among all symbiotic plant-associated microbes. Compared with Sp- Frankia strains, Sp+ strains would be obligate symbionts that are highly dependent on the presence of a compatible host species and with lower efficiency in nitrogen fixation. Understanding the biogeographical drivers of Sp+ Frankia strains might help elucidate the ecological role of in planta sporulation and the extent to which this trait mediates host-partner interactions in the alder-Frankia-ECM fungal symbiosis.

[Arthroscopic-assisted stabilization of medial shoulder instability in a Miniature Poodle]. / Arthroskopisch-assistierte Stabilisation einer medialen Schulterinstabilität bei einem Zwergpudel.

INTRODUCTION: A 12-year old female miniature Poodle was presented because of a 4/4 right fore-limb lameness. The orthopedic examination demonstrated pain at palpation of the right shoulder and an abduction angle of 55 °. MRI examination confirmed injuries consistent with a traumatic medial shoulder instability with no evidence of shoulder dysplasia. A partial rupture of the subscapularis tendon and complete detachment of the cranial gleno- humeral ligament were confirmed with arthroscopy. The joint was successfully stabilized using an arthroscopic assisted prosthetic suture.

Retrospective evaluation of the efficacy of minimally invasive, fluoroscopic-assisted reduction and stabilisation of unicondylar humeral fractures.

OBJECTIVE: This study evaluated the proficiency in executing closed, fluoroscopic-assisted reduction of unicondylar humeral fractures. The following were hypothesised: experienced surgeons would be highly successful in performing closed reduction; body weight, time to surgery and surgeon experience would influence the reduction method; and the reduction method would not affect technical aspects of the repair. METHODS: All unicondylar humeral fractures stabilised between January 2007 and January 2017 were reviewed. Signalment and time to surgery, experience of the attending surgeon, and the initial and definitive reduction methods were recorded. Initial and subsequent postoperative radiographs were used to assess fracture reduction, implant placement and complications. Univariate polychotomous logistic regressions, Fisher's exact test, Kruskal-Wallis rank sums non-parametric test or equivalence tests were used to compare parameters evaluated based on the approach employed (P < 0.05 significant). RESULTS: A total of 36 dogs with 37 fractures were identified (median weight: 5.4 kg; median time to surgery: 3 days). Of these, 11 of 15 attempted closed reductions were successful. Successful closed reductions had shorter times to surgery than limited open or open reductions (P = 0.009). Age, weight and surgeon experience did not influence the definitive reduction method. Technical aspects of reduction and stabilisation were similar among the reduction methods. Surgery times were shorter for closed reductions (P = 0.034). Of the fractures, 75% healed without complications and 85% had excellent long-term function. CONCLUSION: The results suggested that closed, fluoroscopic-assisted reduction is a proficient (73% successful) and efficient (shorter surgery times with comparable technical results compared with other limited open and open reduction) means of stabilising acute unicondylar humeral fractures.

Radiosurgery-assisted gingival displacement: a proof of concept technique to enhance the efficiency of intraoral digital impression.

Nowadays, an increasing number of dentists are using intraoral scanners (IOS) in their daily practice as an alternative to conventional impression taking. One of the main concerns is related to the capability of scanning the subgingival anatomy of the die, usually very challenging due to the limited operative field and the presence of oral fluids. The radiosurgery assisted gingival displacement technique (RAGD) may enhance the intraoral optical scanning of the finish line and neighbor tooth anatomy. The contour of the interim prosthesis is used to drive the tip of radiosurgery electrode along the tooth surface and open selectively the gingival crevice with a prosthetically-driven and minimally invasive approach. The clinical implication of this technique is related to increasing the efficiency and accuracy of the digital impression technique in the critical zone of the prosthetic shoulder.

The role of sentinel lymph node mapping in small animal veterinary medicine: A comparison with current approaches in human medicine.

The relevance of regional lymph node (LN) assessment to quantify the metastatic spread of cancer is well recognized in veterinary oncology. Evaluation of LNs is critical for tumour staging. However, sampling the correct LN may not be possible without sentinel lymph node (SLN) mapping. Methods for diagnostic imaging and intraoperative detection of SLNs are well established in human medicine, in particular, the combination of lymphoscintigraphy and intraoperative application of blue dyes. Nevertheless, alternative imaging techniques are available and have gained increasing interest. Successful implementation of these techniques in dogs have been reported in both clinical and experimental studies. This review aims to provide an overview of SLN mapping techniques in human and veterinary medicine.

Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja.

INTRODUCTION: Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

Multi-Visceral Transplantation in a 21-Year-Old Man with Prior Pancreatoblastoma.

Organ transplantation in patients with prior malignancy increases the risk of tumor recurrence post-transplantation due to immunosuppression. Only two cases of liver transplantation have so far been reported in children with hepatic metastases from pancreatoblastoma, a rare malignant neoplasm originating from the epithelial exocrine cells of the pancreas. Herein, we describe a case of a successful multi-visceral transplant in a man with intestinal failure after surgical resection of pancreatoblastoma.

Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long Term Follow-up.

BACKGROUND: Chronic exertional compartment syndrome of the forearm is an uncommon condition, occurring in some populations such as athletes. The standard surgical treatment for professional athletes who cannot avoid trigger activity is an open forearm fasciotomy, which may require a long recovery time. The aim of this study is to present a new endoscopic single approach forearm fasciotomy technique and outcomes of at least 3 years follow up. METHODS: We performed the endoscopic single approach forearm fasciotomy in 4 forearms in 3 men with the mean age of 25 years. All of the patients were evaluated at a mean follow up of 46 months using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: DASH improved from 21.71 to 5.39, VAS score improved too All the patients referred pain absence after the stress test performed at 20 kilos and 40 kilos. In our series no post-operative complications were observed. CONCLUSIONS: The new mini-invasive technique has proved to be safe, reliable in a long-term follow-up. The main advantage is the shortening of the recovering time, that leads to a faster return to the professional activity.

Hand Injury in Rock Climbing: Literature Review.

With the amazing increasing in number of participants, rock climbing has become a popular sport in the last decade. A growing number of participants, with different skill level, inevitably leads to an increased number of injuries related to this practice. The kind of lesions that can be observed in rock-climbers is very specific and often involves the hand. For this reason is very important for any hand surgeon that is exposed to sport injuries to know which and the most common injuries related to this sport and which are the basic principles for the treatment of those. The aim of this article is to review the literature that has been published in the last ten year in this topic. On the NCBI database 22 articles where found that where related to rock climbing lesion affecting the hand or the whole body. Differences where found according to kind of rock climbing activity that was analyzed, alpine climb leads to more serious injuries, often affecting the lower limb, while in sport and recreational rock climbing the upper limb and the hand are definitely the most affected parts. Flexor pulley lesions, followed by fractures and strains are the most common lesions affecting the hand that are related to this practice.