Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study.

STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVE: To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome. METHODS: A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6 weeks. RESULTS: A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76 years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131 days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups (P < .001) and had significant better TuG compared to hybrid stabilization (P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P > .602, Barthel: P > .252, EQ-5D 5L index value: P > .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits. CONCLUSIONS: Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.

Clinical presentation and disease prevalence of captive central bearded dragons (Pogona vitticeps) at veterinary clinics in Australia.

Central bearded dragons (Pogona vitticeps) are one of the most popular reptile pets in Australia and around the world. Diseases, including metabolic bone disease, periodontal disease, and gastrointestinal endoparasites commonly affect captive animals. To determine the common reasons these lizards were presented to the veterinarian and to establish the prevalence of disease seen in captive P. vitticeps in Australia, this retrospective study evaluated the clinical records of three exotic pet veterinary hospitals. Records from 724 P. vitticeps were analysed, with 70 reasons for presentation and 88 diseases identified across 1000 visits to the veterinarian. Lethargy was the most reported reason for presentation (n = 181). The gastrointestinal tract (18.25%) and skin (18.25%) were the equally most commonly affected organ systems, followed by the musculoskeletal system (15.17%). Endoparasites were the most common single disease process (n = 103), followed by metabolic bone disease (n = 65), skin wounds (n = 59) and periodontal disease (n = 48). Of the patients that presented for routine preventive health examinations (n = 159), 45.30% received some form of intervention to treat or prevent disease. Many of the conditions that were identified by the veterinarians in this study are traditionally correlated with suboptimal husbandry and may be easily prevented. This study identified the common reasons for presentation to the veterinarian and the prevalence of disease in captive P. vitticeps in Australia, providing the first extensive retrospective analysis of objective reference literature for central bearded dragon owners and aspiring reptile veterinarians.

A retrospective study of 333 emergency presentations and survival to discharge of backyard chickens in Australia from 2019 to 2022.

This retrospective study assessed the diagnoses of emergency presentations and the survival to discharge of backyard chickens in five veterinary clinics within Australia. A total of 333 cases were reviewed from September 2019 to March 2022. October to December was the busiest period in both 2021 and 2020, with cases steadily increasing in the warmer months. Discharge following emergency presentation occurred in 57.4% of reviewed cases. Female chickens represented 92.7% of total cases, with an average age at presentation of 2.2 years (ranging from 1 day to 10 years). The most frequent diagnoses were of reproductive disease (n = 94/333), open diagnosis (n = 55/333), respiratory disease (n = 42/333), predator attack (n = 28/333), musculoskeletal disease (n = 22/333) and parasitism (n = 22/333).

Investigation into the prevalence of Serratospiculum spp. in wild falcons of the greater Sydney region.

OBJECTIVE: To determine the prevalence of Serratospiculum spp. in falcons in the greater Sydney region. METHODS: This is a cross-sectional study; a total of 57 falcons entering wildlife rehabilitation in Sydney and surrounding areas between 2017 and 2019 were recruited into the study. Presence of Serratospiculum spp. eggs in faeces using faecal wet prep technique was used as an indicator of infection. RESULTS: Evidence of Serratospiculum spp. infection was detected in 10 out of 57 falcons, (18%). There was no significant correlation with body condition score or age group. PCR analysis of a representative nematode in a Brown Falcon (Falco berigora) was revealed to be Serratospiculum tendo. CONCLUSION: Serratospiculum spp are present in 18% of falcons coming into care in the Sydney region. The prevalence in this study is similar to that found in other parts of the world. This study provides evidence of the importance of faecal testing and treatment of falcons in a rehabilitation setting.

Inconsistent efficacy of water-soluble amphotericin B for the treatment of Macrorhabdus ornithogaster in a budgerigar (Melopsittacus undulatus) aviary.

OBJECTIVE: To assess the efficacy of a commercially available in-water amphotericin B treatment for Macrorhabdus ornithogaster. DESIGN: Clinical treatment trial. METHODS: Faecal shedding of 16 naturally infected budgerigars (Melopsittacus undulatus) was monitored while they were being treated using in-water amphotericin B, as per the manufacturer's instructions, for 10 days. Any birds that remained positive after 10 days received a further 10 day course of treatment. All birds were rechecked 16 days after the end of the second treatment period. RESULTS: At the conclusion of treatment, 11 birds had stopped shedding M. ornithogaster, and 5 birds were still shedding. Sixteen days after the conclusion of the second treatment period, four birds that were negative after 10 days of treatment were shedding again, and two of the birds that were treated for 20 days were shedding. In addition, one bird from each treatment group died after treatment and before follow-up testing. CONCLUSION: These findings represent a 36% treatment failure, suggesting that treatment with the commercially available, water-soluble amphotericin B has inconsistent efficacy against M. ornithogaster in some budgerigars in Australia and is not effective for eliminating it from budgerigar aviaries.

Humeral air sac cystadenocarcinoma in a rainbow lorikeet (Trichoglossus moluccanus).

BACKGROUND: A 17-year-old female rainbow lorikeet (Trichoglossus moluccanus) was presented for a swelling over the right proximal humerus and an inability to fly. CASE REPORT: Radiographs revealed a markedly osteoproductive and moderately osteolytic lesion of the proximal left humerus with marked associated soft tissue swelling. Biopsy of the proximal humerus was consistent with an air sac cystadenocarcioma. The bird's condition deteriorated over 25 days after initial presentation and it developed a respiratory wheeze, tail bob, tachypnea and died. On postmortem examination, the bird was found to have an air sac cystadenocarcinoma associated with the proximal humerus, extending into the thoracic cavity through a network of fibrous sheets and displaying infiltration into the lung tissue bilaterally. CONCLUSION: This is the first report of a humeral air sac cystadenocarcinoma in a lorikeet and it builds on our understanding of the species affected by avian neoplasia.

Compensatory gastric stretching following subtotal gastric resection due to gastric adenocarcinoma in a diamond python (Morelia spilota spilota).

CASE REPORT: A 7-year-old male diamond python (Morelia spilota spilota) presented with a 2-month history of anorexia and a discrete intracoelomic mass, approximately 15 cm in length, located 90 cm from the head and approximately two-thirds of the snout to vent length. Physical examination determined the mass was likely to be stomach, testes or the right kidney. Radiographs showed a soft tissue opacity mass in the region of the stomach; fine needle aspirate demonstrated cellular debris admixed with bacteria and degenerate heterophils. Exploratory coeliotomy revealed a gastric mass involving 90% of the length of the stomach, partially occluding the gastric lumen. A subtotal gastrectomy was performed; the neoplastic tissue was removed with 2 cm margins, leaving 1 cm of stomach wall and the pyloric sphincter caudally that was anastomosed to the oesophagus. Four large nematodes were found within the necrotic lumen of the mass tightly adhered to the gastric mucosa. Ascarid nematodes were identified morphologically and further confirmed by molecular diagnostics as Ophidascaris spp. Histopathological evaluation of the excised mass revealed a gastric adenocarcinoma. Postoperatively the snake suffered from gastrointestinal dysfunction and maldigestion and was managed with slurry feeding for month. Three months postoperatively the snake was gaining weight, eating without assistance and digesting whole prey, which was incrementally increased in size. Gastroscopy 6 months postoperatively revealed the presence of a functional stomach with a functional pyloric sphincter and 8.5 cm of gastric mucosa caudal to the anastomosis between the oesophagus and stomach. CONCLUSION: This is the first report of almost complete subtotal gastric resection in an Australian python, with evidence of compensatory gastric stretching resulting in a functional stomach.

Gastric adenocarcinoma in a diamond python (Morelia spilota spilota).

CASE REPORT: A 5-year-old captive male diamond python (Morelia spilota spilota) was presented with a 1-month history of regurgitation and anorexia and discrete coelomic distention. Physical examination revealed a firm, immobile mass at approximately two-thirds of the snout-vent length from the front of the head. Ultrasound-guided fine needle aspirate biopsy of the mass in the region of the stomach showed necrosis with bacterial infiltration and possibly neoplastic changes. A gastroscopy was conducted, but showed grossly normal gastric mucosa, confirmed by biopsy. On exploratory coeliotomy, it was confirmed the mass involved most of the stomach wall and occluded the gastric lumen. The mass was completely excised and based on histopathology, a diagnosis of gastric adenocarcinoma was made. The snake was found dead 12 h postoperatively, but no specific cause of death was found on postmortem examination. CONCLUSION: Most cases of adenocarcinoma in snakes go undiagnosed. This case report illustrates that the architecture of gastric masses may lead to false-negative gastric biopsy results in snakes with neoplasia.

[Refracture of long bones after implant removal. An avoidable complication?]. / Refrakturen nach Entfernung von Osteosynthesematerialien. Eine vermeidbare Komplikation?

Refractures of long bones after implant removal are a rare but serious complication, which in most cases make a reoperation necessary. We analysed our own cases and reviewed the scarce literature on this subject. As a result we found that it is possible to reduce this complication by performing thorough preoperative preparation, observing an adequate interim time between initial osteosynthesis and hardware removal, cautiously exposing the weakened bone to force for a certain time period after implant removal and taking the character of the fracture healing into consideration. It is not possible to entirely eradicate this complication because a lot of patients demand the implant removal even though it is known that demineralisation and residual screw holes both induce a reduction of energy-absorbing capacity and therefore predispose the patient to refracture. In some cases the surgeon should recommend that the implants remain in situ.

[Hardware removal after pelvic ring injury]. / Implantatentfernung nach Beckenringfraktur.

BACKGROUND: Pelvic ring fractures are considered as rare injuries. Minimally invasive sacroiliac screw fixation has been used increasingly in recent years as an operative strategy for the treatment of these injuries, if the dorsal pelvic ring needed to be addressed. Treatment options for the anterior pelvic ring comprise plates, screws or external fixation. METHOD: Based on the limited number of publications on this subject and our own experience with 80 patients who suffered pelvic ring B- or C-type injuries during a period of 8 years we are able to show that the indication for hardware removal in the pelvic ring should be strictly defined. RESULTS: In some cases like external fixation, implant-associated infection, malpositioning, allergic implant reaction, critical soft tissue covering, palpable hardware and consolidated juvenile fractures implant removal is certainly indicated. In patients without symptoms and in patients with trauma-associated symptoms which are not definitely associated with the hardware, the removal should be only indicated after thorough consideration of the risks versus the benefits and additionally by taking the initial injury pattern into account. If despite all these objections the hardware removal has been indicated it should always be considered that hardware removal may be challenging with several possible severe complications.

[Hardware removal after spinal instrumentation]. / Metallentfernung an der Wirbelsäule.

Because of the increasing number of patients with surgically treated injuries of the spine we more often have to answer the question of indication for hardware removal. In the cervical spine and after anterior instrumentations of the thoracic and lumbar spine hardware removal is only indicated as part of the management of postoperative complications. After dorsal instrumentation for fractures of the thoracic and lumbar spine, implant-associated discomfort is possible. In addition, in non-fusion procedures there is the risk of implant failure. In these cases the hardware should be removed. If the consolidation of the fracture is in doubt, a preoperative CT scan is useful.

[The advantages of neuropsychological examination batteries in attention deficit hyperactivity disorder]. / Ventajas de las baterías de exploración neuropsicológica en el trastorno por déficit de atención/hiperactividad.

INTRODUCTION: The neuropsychological assessment of the functions of attention and the executive functions in patients with clinical features compatible with a diagnosis of attention deficit hyperactivity disorder (ADHD) is considered a priority study to be able to offer a basic study. It is also necessary to be able to carry out a short- and long-term developmental follow-up of patients. DEVELOPMENT: An algorithm for diagnosing ADHD is proposed that includes both traditional and computerised tests for assessing the functions of attention and the executive functions. The development of new neuropsychological batteries for this purpose involves the use of several tests in computerised form that offer technical and methodological advantages as regards their use and the later treatment of the data obtained. CONCLUSIONS: The advantages of computerised assessment include management of answer times, minimum expression of the effect exerted by the researcher, savings in time, accurate and fast scoring, statistical management of new scores, and greater proximity to research programmes.

Ventajas de las baterías de exploración neuropsicológica en el trastorno por déficit de atención/hiperactividad / The advantages of neuropsychological examination batteries in attention deficit hyperactivity disorder

Introducción. La evaluación neuropsicológica de las funciones de atención y de las funciones ejecutivas en pacientes con una sintomatología compatible con el diagnóstico de trastorno por déficit de atención/hiperactividad (TDAH) supone un estudio prioritario para poder ofrecer un estudio básico, así como para poder llevar a cabo un seguimiento evolutivo a corto y a largo plazo de los pacientes. Desarrollo. Se plantea un algoritmo diagnóstico del TDAH, en el que se incluyen pruebas tradicionales e informatizadas para evaluar las funciones de atención y las funciones ejecutivas. El desarrollo de nuevas baterías neuropsicológicas con esta finalidad supone el empleo informatizado de diversos test que demuestran ventajas técnicas y metodológicas en cuanto a su empleo y en referencia al manejo posterior de los datos obtenidos. Conclusiones. Entre las ventajas de la evaluación informatizada destacan el manejo temporal de las respuestas, la mínima expresión del efecto experimentador, el ahorro de tiempo, la precisión y rapidez de las puntuaciones, el tratamiento estadístico de nuevas puntuaciones y la mayor cercanía respecto a los programas de investigación (AU)

Introduction. The neuropsychological assessment of the functions of attention and the executive functions in patients with clinical features compatible with a diagnosis of attention deficit hyperactivity disorder (ADHD) is considered a priority study to be able to offer a basic study. It is also necessary to be able to carry out a short- and long-term developmental followup of patients. Development. An algorithm for diagnosing ADHD is proposed that includes both traditional and computerised tests for assessing the functions of attention and the executive functions. The development of new neuropsychological batteries for this purpose involves the use of several tests in computerised form that offer technical and methodological advantages as regards their use and the later treatment of the data obtained. Conclusions. The advantages of computerised assessment include management of answer times, minimum expression of the effect exerted by the researcher, savings in time, accurate and fast scoring, statistical management of new scores, and greater proximity to research programmes (AU)

Noninvasive discrimination of rejection in cardiac allograft recipients using gene expression profiling.

Rejection diagnosis by endomyocardial biopsy (EMB) is invasive, expensive and variable. We investigated gene expression profiling of peripheral blood mononuclear cells (PBMC) to discriminate ISHLT grade 0 rejection (quiescence) from moderate/severe rejection (ISHLT > or = 3A). Patients were followed prospectively with blood sampling at post-transplant visits. Biopsies were graded by ISHLT criteria locally and by three independent pathologists blinded to clinical data. Known alloimmune pathways and leukocyte microarrays identified 252 candidate genes for which real-time PCR assays were developed. An 11 gene real-time PCR test was derived from a training set (n = 145 samples, 107 patients) using linear discriminant analysis (LDA), converted into a score (0-40), and validated prospectively in an independent set (n = 63 samples, 63 patients). The test distinguished biopsy-defined moderate/severe rejection from quiescence (p = 0.0018) in the validation set, and had agreement of 84% (95% CI 66% C94%) with grade ISHLT > or = 3A rejection. Patients >1 year post-transplant with scores below 30 (approximately 68% of the study population) are very unlikely to have grade > or = 3A rejection (NPV = 99.6%). Gene expression testing can detect absence of moderate/severe rejection, thus avoiding biopsy in certain clinical settings. Additional clinical experience is needed to establish the role of molecular testing for clinical event prediction and immunosuppression management.

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.

BACKGROUND: Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). METHODS: From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). RESULTS: The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. CONCLUSIONS: This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.

[Mechanisms of transplant vasculopathy]. / Mechanismen der Transplantatvaskulopathie.

Cardiac allograft vasculopathy is a diffuse, obliterative form of arteriosclerosis that is characterized by the production of a neointima rich in vascular smooth muscle cells that progressively obstructs the lumen. Pathophysiologically, after heart transplantation, alloantigens (e. g. on donor endothelial cells) are presented by antigen presenting cells to the T-cells of the body's immune system. With the appropriate costimulatory signal, this signal pattern generates a differentiated T-cell, B-cell, and inflammatory cell response whereas without the second signal, the immune cells undergo apoptosis. In case of immune cell proliferation and differentiation, a coordinated pattern of cytokine release is initiated. Cells of innate immunity, monocyte-derived macrophages, are involved in this process. The inflammatory response culminates in rolling, sticking, and diapedesis through the coronary vascular endothelium and migration and phenotype switch of medial smooth muscle cells mediated by generation of growth-promoting cytokines.

Improved conformation-dependent immunoassay: suitability for human prion detection with enhanced sensitivity.

The presence of pathogenic prion protein (PrP(Sc)) in lymphoid tissues of variant Creutzfeldt-Jakob disease (vCJD) patients raises questions as to whether prions may be present in bodily fluids as well. Currently, transgenic mice are highly sensitive in vivo tools for the study of prions in tissues or fluids containing high levels of normal prion protein (PrP(C)). We report here an in vitro assay with virtually equivalent sensitivity incorporating a capture antibody into a sandwich conformation-dependent immunoassay (CDI), resulting in 30- to 100-fold increased sensitivity compared with the original, direct CDI. Furthermore, spiking plasma with vCJD prions in different preparations demonstrated that sandwich CDI detects prions with different biophysical properties at high sensitivity, even without proteinase K pretreatment of samples. Thus, sandwich CDI represents a powerful tool to study prions in bodily fluids of CJD/vCJD patients, with a turnaround time of less than 24 h.

Purity of spiking agent affects partitioning of prions in plasma protein purification.

Prions are not detectable in the blood or plasma of persons afflicted with classical or variant Creutzfeldt-Jakob disease, and they have never been shown to be transmitted by blood or plasma products. Despite the uncertainty as to the presence and biophysical properties of prions in plasma, prion removal studies have been conducted using brain homogenate or microsomes prepared from prion-infected rodent brains as model prions. In this study, we compare the partitioning of different prion spiking agents, having different biophysical properties, in the processes used for plasma protein purification. We have found that membrane-bound prion spiking agents partition similarly, whereas purified, unbound pathogenic prion proteins can have significantly different partitioning properties depending on the conditions in the production process. We conclude that prion spiking studies for the evaluation of prion reduction in plasma protein purification should employ spiking agents with different biophysical properties to mimic partitioning of the theoretical prion contaminant. This will give greater assurance as to the prion safety margins of the life-saving plasma protein therapeutics and excipients.

Efficient and cost-effective single nucleotide polymorphism detection with different fluorescent applications.

Three methods-5'nuclease assay with TaqMan, minisequencing, and oligonucleotide ligation assay (OLA)-were compared to detectfive single nucleotide polymorphisms (SNPs) in three separate genes. Each method had advantages and disadvantages. The 5' nuclease assay was the fastest and required only a single step. OLA was the most time consuming to optimize, but once running it was the least expensive method. Minisequencing was universal; however, the technique was also the most expensive. All three methods were reliable and highly effective. Investigators must consider their goals in terms of time, sample number, and expense when selecting among these genotyping techniques.