Preliminary study of jointed snaffle vs. crossunder bitless bridles: quantified comparison of behaviour in four horses.

The study tested the null hypothesis that if a horse is ridden in a snaffle bridle and then a crossunder bitless bridle, there will be no change in its behaviour. It was predicted that there would be change and that behaviour would improve when bitless. Four horses, none of which had ever been ridden in a crossunder bitless bridle, were ridden through two 4 min, exercise tests, first bitted then bitless. An independent judge marked the 27 phases of each test on a 10 point scale and comments and scores were recorded on a video soundtrack. The results refuted the null hypothesis and upheld the predictions. Mean score, when bitted, was 37%; and through the first 4 min of being bitless, 64%. A binomial probability distribution suggested that the results were significantly different from random effects. All 4 horses accepted the crossunder bitless bridle without hesitation. Further studies are warranted and it is hoped that others will build on this new field of investigation. The authors are of the opinion that the bit can be a welfare and safety problem for both horse and horseman. Equestrian organisations that currently mandate use of the bit for competitions are urged to review their rules.

Chemical peel of nonfacial skin using glycolic acid gel augmented with TCA and neutralized based on visual staging.

BACKGROUND: Until recently, standard techniques for laser or chemical peeling have not always provided consistent results when applied to the nonfacial skin. OBJECTIVE: The author describes a more controlled chemical peel technique for nonfacial skin using 70% glycolic acid gel combined with 40% trichloroacetic acid (TCA). The method has given consistently good results on the skin of the neck, chest, arms, hands, back, and other nonfacial skin. METHODS: More than 3100 patients were given skin peels of the neck, chest, and other areas of the body as indicated. Seventy percent glycolic acid gel was applied to the areas to be peeled, then immediately augmented with 40% TCA. Each area was carefully monitored for the end point and then neutralized with copious amounts of 10% sodium bicarbonate solution. The end point was determined by visual observation using a six-stage classification to determine the degree of peeling. RESULTS: Clinical results were excellent, with smoother skin texture, decreased wrinkling and striae, and fading of lentigines and other pigmentary abnormalities. There was excellent blending into peeled facial skin and into adjacent areas of nonpeeled skin. Complications were minimal. CONCLUSION: This technique can provide the benefits of skin peeling to nonfacial skin with excellent cosmetic results and minimal complications.

Membrane redistribution of the Escherichia coli MinD protein induced by MinE.

Escherichia coli cells contain potential division sites at midcell and adjacent to the cell poles. Selection of the correct division site at midcell is controlled by three proteins: MinC, MinD, and MinE. It has previously been shown (D. Raskin and P. de Boer, Cell 91:685-694, 1997) that MinE-Gfp localizes to the midcell site in an MinD-dependent manner. We use here Gfp-MinD to show that MinD associates with the membrane around the entire periphery of the cell in the absence of the other Min proteins and that MinE is capable of altering the membrane distribution pattern of Gfp-MinD. Studies with the isolated N-terminal and C-terminal MinE domains indicated different roles for the two MinE domains in the redistribution of membrane-associated MinD.

"Cook Weekend Alternative to the Facelift". Liposculpture of the face, neck, and jowls with laser dermal resurfacing and platysmal plication.

The "Cook Weekend Alternative to the Facelift" is a combined liposculpture and laser surgical procedure which produces excellent cosmetic results, in many cases comparable to the results of traditional surgical rhytidectomy, without the extensive surgical intervention and prolonged recovery time needed for rhytidectomy. The procedure consists of liposculpture of the face, neck, and jowls; laser resurfacing of the platysma and underside of the dermis; vaporization of subcutaneous fat; resection of a small ellipse of excess submental skin; separation of the neck septa; and plication of the platysma, with or without chin augmentation. Cosmetic results can be dramatic, and most patients return to normal activities approximately three days postoperatively.

"Three-dimensional tumescent liposculpture" of the abdomen, waist, and flanks.

Treating the entire area as a cosmetic unit is the best approach to tumescent liposculpture of the abdomen, waist, and flanks. This "Three-Dimensional Tumescent Liposculpture" procedure is performed under tumescent local anesthesia with optional intraoperative external ultrasound. Areas treated are the abdomen, waist, flanks, and infrascapular fat pad if indicated. Postoperatively, patients show a flatter abdomen, a smaller and better-defined waist (the "Cook waist"), reduction of unsightly bulges, and a smoother, better proportioned and more attractive overall contour. Patient recovery is rapid with minimal complications.

Advanced techniques in liposuction.

Liposuction is a procedure that has been widely used since the 1980s. The introduction of the tumescent technique in 1987 greatly improved the safety of the procedure. Innovative techniques and equip ment modifications have continued to evolve, broadening the scope of application and improving the results that can be obtained. This article discusses several recent advancements in liposuction techniques. Three-Dimensional Tumescent Liposculpture (William R. Cook, Coronado, CA) was developed to view contiguous areas of the body as a unit rather than to simply suction fat from one particular area. Advanced techniques have improved the ability to liposuction difficult areas, such as the arms, calves, medial thighs, and the male breast. A combination of syringe-suction and machine-assisted liposculpture is sometimes used. Tumescent liposculpture has been combined with pulsed CO2 laser surgery to produce a more effective and less invasive treatment for the aging face, neck, and jowls. External ultrasound-assisted liposculpture can produce excellent results.

Nucleoid-independent identification of cell division sites in Escherichia coli.

The mechanism used by Escherichia coli to determine the correct site for cell division is unknown. In this report, we have attempted to distinguish between a model in which septal position is determined by the position of the nucleoids and a model in which septal position is predetermined by a mechanism that does not involve nucleoid position. To do this, filaments with extended nucleoid-free regions adjacent to the cell poles were produced by simultaneous inactivation of cell division and DNA replication. The positions of septa that formed within the nucleoid-free zones after division was allowed to resume were then analyzed. The results showed that septa were formed at a uniform distance from cell poles when division was restored, with no relation to the distance from the nearest nucleoid. In some cells, septa were formed directly over nucleoids. These results are inconsistent with models that invoke nucleoid positioning as the mechanism for determining the site of division site formation.

Laser neck and jowl liposculpture including platysma laser resurfacing, dermal laser resurfacing, and vaporization of subcutaneous fat.

BACKGROUND: Submental tumescent liposculpture alone is not able to achieve the results of rhytidectomy. OBJECTIVE: To improve the results of submental tumescent liposculpture new laser techniques were developed to provide maximum cosmetic results with minimal disability and rapid recovery. METHODS: Extensive tumescent liposculpture of the lower face, jowls, neck, and subplatysma was performed on 100 patients. Platysma fascia and undersurface of the dermis of the neck were laser resurfaced. Septae and platysma insertions were separated. Subcutaneous fat was laser vaporized. Platysma muscle was plicated. Where indicated, a chin implant was inserted. RESULTS: Clinical results far superior to tumescent liposculpture alone included improved cervico-mental angle and marked reduction in laxity of the neck skin, platysma banding, and horizontal neck creases. Patients recovered rapidly with minimal to no bruising, scarring, or pain. CONCLUSION: Laser neck and jowl liposculpture produces superior results to standard submental tumescent liposculpture with no increase in recovery time and no complications to date.

Utilizing external ultrasonic energy to improve the results of tumescent liposculpture.

BACKGROUND: External ultrasound has been used safely for many years for therapy and diagnosis by multiple medical specialists. It has also been utilized safely to treat postoperative swelling after liposculpture. Recently, internal tumescent ultrasonic liposculpture has been introduced. Since internal and external ultrasonic devices utilize injected fluid to create an environment in the fat that efficiently transmits sound waves, it seemed logical that external ultrasound incorporated with tumescent liposculpture would be successful. This study was designed to compare tumescent liposculpture combined with external ultrasound with tumescent liposculpture alone. OBJECTIVE: A side-by-side comparison of the results of tumescent liposculpture combined with external ultrasound versus tumescent liposculpture alone was performed. METHODS: Thirty patients were infused with therapeutic amounts of tumescent solution to achieve anesthesia and vasoconstriction in the areas to be treated. External ultrasound was then applied to one-half of the areas to be treated in a randomized fashion. Either the left side or the right side of the body was treated with ultrasound. Liposculpture was then performed using a variety of cannulas. Evaluations were made of the temperature of the tissues, the ease of cannula movement by the surgeon, and the time of performing the technique in each area. Postoperatively, the amount of bruising and swelling were evaluated, as was the discomfort of the patient. RESULTS: Clinical assessment results revealed that external ultrasound combined with tumescent liposculpture was easier for the surgeon, requiring less physical effort with less operating time, and less bruising, swelling, and discomfort for the patient postoperatively. CONCLUSIONS: External ultrasound combined with tumescent liposculpture produced significant doctor and patient benefit both operatively and postoperatively. Ongoing studies are currently being performed to evaluate higher wattage ultrasonic units.

The effect of reversible left recurrent laryngeal neuropathy on the metabolic cost of locomotion and peak aerobic power in thoroughbred racehorses.

The effect of left recurrent laryngeal neuropathy (LRLN) on the metabolic cost of locomotion (MCL) and peak aerobic power (VO2peak) was evaluated in four trained Thoroughbred racehorses. Oxygen consumption (VO2), carbon dioxide production (VCO2), venous lactate concentrations (LAC), and heart rate (HR) were measured during a treadmill exercise test (TET). Each horse performed the exercise test four times, alternating between normal upper airway function and reversibly induced LRLN. Subcutaneous infusion of 2% mepivicaine, a local anesthetic, into the region were the left recurrent laryngeal nerve passes caudal to the cricoid cartilage was used to induce LRLN. The induction of LRLN did not alter the relationship between VO2 and treadmill speed at exercise intensities where VO2 was less than VO2peak (< 9 m/sec). However, a 15.3% reduction in VO2peak (Normal = 165.3 +/- 3.4, LRLN = 140.0 +/- 3.2 mL/kg/min +/- SE, P < .001) occurred at higher treadmill speeds in horses with induced LRLN. A significant group (Normal v LRLN) by treadmill speed effect was found for LAC and R only at treadmill speeds where VO2 = VO2peak. Peak lactate (LACpeak) did not change after the induction of LRLN. The relationship between HR and treadmill speed increased in horses with induced LRLN at exercise intensities where VO2 < VO2peak. Peak heart rate (HRpeak) remained unchanged. Performance as indicated by the maximum number of speed intervals completed (STEPmax) decreased 7% in horses with induced LRLN (Normal = 9.1 +/- 0.04, LRLN = 8.5 +/- 0.2 minutes +/- SE, P < .04). A comparison of paired exercise test measurements showed no evidence of a training effect, or decreased performance caused by a learned response, over the course of the experiment.(ABSTRACT TRUNCATED AT 250 WORDS)

Early stages in development of the Escherichia coli cell-division site.

Development of the Escherichia coli cell division site was studied in wild-type cells and in non-septate filaments of ftsZnull and ftsZTs mutant cells. Localized regions of plasmolysis were used as markers for the positions of annular structures that are thought to be related to the periseptal annuli that flank the ingrowing septum during cytokinesis. The results show that these structures are localized at potential division sites in non-septate filaments of FtsZ- cells, contrary to previous reports. The positions of the structures along the long axis of the cells in both wild-type cells and FtsZ- filaments were unaffected by the presence of plasmolysis bays at the cell poles. These results do not agree with a previous suggestion that the apparent association of plasmolysis bays with future division sites was artefactual. They support the view that division sites begin to differentiate before the initiation of septal ingrowth and that plasmolysis bays and the annular attachments that define them, mark the locations of these early events in the division process.

Development of the cell-division site in FtsA- filaments.

Early changes at cell-division sites were studied in non-septate filaments induced by growth of ftsATs mutant cells under non-permissive conditions. The positions of localized regions of plasmolysis were used as markers for the locations of partial and complete annular structures that are thought to be precursors of the periseptal annuli that flank the septum during cytokinesis. The results confirmed that these structures were localized at potential division sites and suggested a model in which older division sites play a role in the generation of new sites for future use, with each older site being used only once for this purpose. The results also suggest that the details of division-site development can profitably be studied in cells in which early events in the differentiation process are uncoupled from the septation event.

Attitudes of physicians in northern Ontario to medical malpractice litigation.

OBJECTIVE: To survey medical practitioners' experience with and attitudes toward litigation alleging medical malpractice. DESIGN: A survey using a questionnaire. SETTING: The Sudbury and Manitoulin Health District of Northern Ontario. PARTICIPANTS: Medical practitioners in the area. RESULTS: Physicians are sometimes negligent; malpractice is not simply created by entrepreneurial lawyers and patients with unrealistic expectations. At present malpractice is restrained by both the threat of civil litigation and the disciplinary committee of the Ontario College of Physicians and Surgeons. CONCLUSION: We must address the fear of malpractice suits if the North is to attract and retain the physicians it needs to provide modern standards of medical care.

Failure of the circulatory system limits exercise performance in patients with systemic sclerosis.

OBJECTIVE: To determine the mechanisms for exercise impairment in symptomatic patients with systemic sclerosis (SSc) using breath-by-breath expired-gas analysis with incremental exercise testing. DESIGN: Prospective, open trial. PATIENTS AND METHODS: Fifteen consecutive patients with SSc seen at the Medical University Hospital (a tertiary referral center) with complaints of exercise intolerance underwent pulmonary function testing (spirometry, helium dilution lung volumes, and diffusing capacity of carbon monoxide) and incremental exercise testing on a cycle ergometer measuring oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (R), oxygen saturation, blood pressure, and heart rate (HR). Values for oxygen uptake at anaerobic threshold (VO2AT) were derived graphically by blinded clinicians experienced in exercise testing, and the results were averaged. Ventilatory reserve and oxygen pulse were calculated from measured values, and all data were subjected to analysis by standard clinical algorithms. MEASUREMENTS AND MAIN RESULTS: Of 15 patients studied, 14 had either restrictive lung disease or normal results of spirometry on pulmonary function testing. One patient with a history of tobacco use had evidence of airways obstruction. Three patients were unable to exercise maximally (as determined by maximum respiratory exchange ratio [Rmax] greater than 1.09 or maximum heart rate [HRmax] greater than 85% predicted), and exercise testing was terminated in one with Mobitz type II atrioventricular block. The following data (mean +/- SEM) were obtained from 11 maximally exercising patients: VO2max 795 +/- 75 mL oxygen (O2)/min, R 1.34 +/- 0.05, VO2AT/VO2max predicted 0.21 +/- 0.02, O2 pulse 5.1 +/- 0.4 mL O2/beat, ventilatory reserve 0.52 +/- 0.06, and tidal volume/forced vital capacity ratio 0.46 +/- 0.02. Of the 11 patients completing breath-by-breath expired-gas analysis, all had circulatory impairment to exercise, as determined by low O2 pulse and low VO2 at anaerobic threshold, and circulatory impairment was limiting in 9 of 11 patients. Of those nine patients, four had evidence of impaired gas exchange compatible with pulmonary vascular disease. Arterial oxygen desaturation occurred in 2 of 11 patients. CONCLUSION: Circulatory impairment to exercise is common in SSc patients with exercise intolerance. Restrictive lung disease, although also common, does not limit exercise tolerance in patients capable of maximal effort.

Attitudes of physicians to medical malpractice litigation in Canada.

This article reports the results of a survey of the attitudes of medical practitioners in the Sudbury and Manitoulin Health District of Northern Ontario with respect to their experience of litigation alleging medical malpractice. The survey is part of a research project, funded by the Foundation for Legal Research, Montreal, investigating the extent to which the very high incidence of medical litigation in the United States of America is likely to spread to Canada.