Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning.

OBJECTIVE: To report the outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning (FGNMP). STUDY DESIGN: Retrospective case series. ANIMALS: A total of 15 client owned dogs and two cats with 57 metabone fractures. METHODS: Description of FGNMP and reporting of the following data: signalment, pre- and postoperative radiographs, intramedullary pin diameter used, anesthesia, surgery and coaptation times, duration to normal weightbearing and bone union, postoperative care and complications. RESULTS: Median surgery time was 54 min (range: 26-99), median duration of coaptation was 14 days (range: 1-5 weeks), median time to normal weightbearing was 16 days (range: 2-45) and median time to bone union was 6 weeks (range: 4-12). All cases had at least 12 months of post-surgical follow-up with a median follow-up of 18 months (range: 12-70). No major complications occurred. Mild radiographic changes associated with subchondral bone sclerosis were noted on follow-up radiographs in 13/57 fractures. All cases returned to normal gait and full (15) or acceptable (2) function. CONCLUSION: In this study, FGNMP was an effective and safe technique for metabone fracture repair, requiring only short-term external coaptation in most patients. Time to bone union and return to normal function compared favorably to previously reported techniques. CLINICAL RELEVANCE: Fluoroscopically guided normograde metabone pinning provides an alternative technique for treatment of metabone fractures.

Characteristics of Gastroenteritis Outbreaks Investigated in Singapore: 2018-2021.

There is a need to study the characteristics of outbreaks via Singapore's outbreak surveillance system to understand and identify the gaps in food safety for targeted policy interventions due to the increasing trend in gastroenteritis outbreaks and consequential increase in foodborne-related deaths and economic burden on public health systems worldwide. A total of 171 gastroenteritis outbreaks were investigated in Singapore from January 2018 to December 2021. This study analyzed the annual trend of investigated gastroenteritis outbreaks, the proportion of outbreaks by implicated sources of food, and the proportion of the type of pathogens identified from human cases, food samples, and environmental swabs collected from outbreak investigations. Among the foodborne gastroenteritis outbreaks (n = 121) investigated in Singapore, approximately 42.1% of the outbreaks had food prepared by caterers, 14.9% by restaurants, and 12.4% had food prepared by in-house kitchens. Clostridium perfringens and Salmonella were the most common causative pathogens in foodborne outbreaks throughout the analysis period. The food samples and environmental swabs collected were mostly detected for Bacillus cereus. Norovirus was the most common causative pathogen in non-foodborne outbreaks and was mainly attributable to preschools. This highlights the importance of monitoring and educating the catering industry and preschools to prevent future outbreaks.

Re-description of the genus Heterobiantes and its type species H. geniculatus (Opiliones: Laniatores: Epedanidae) with additional genital and external morphology data.

The genus Heterobiantes Roewer, 1912 and its type species Epedanus geniculatus Pocock, 1903 are redescribed based on the type specimen currently housed within the British Museum of Natural History (BMNH), London, along with new specimens captured in Hong Kong, providing updated morphological data and male genital description. Closer inspections reveal how the species is different from other similar genera within Epedaninae and rationalizes its placement as a monotypic genus within the sub-family. Genetic data are also included.

Comparison of classic and needle arthroscopy to diagnose canine medial shoulder instability: 31 cases.

This retrospective study compared surgery time, anesthesia time, and costs recorded with classic arthroscopy or needle arthroscopy when diagnosing canine medial shoulder instability. Signalment, examination findings, diagnostics, anesthesia time, surgery time, treatment, invoices, and complications were reported. All cases (classic arthroscopy, 14 cases; needle arthroscopy, 17 cases) were diagnosed with medial shoulder instability. Anesthesia times, surgery times, and invoices were statistically compared for classic and needle arthroscopy (P < 0.05). No significant differences were reported for surgery time (P = 0.13) but existed for anesthesia time (35 minutes shorter with needle arthroscopy; P < 0.0001) and invoice (38% lower with needle arthroscopy; P < 0.0001). No complications were recorded by the time of last direct follow-up, which was at a mean of 12.4 weeks after surgery. Needle arthroscopy offers an alternative, safe technique to reliably diagnose canine medial shoulder instability. Shorter anesthesia times and lower costs to the client may be advantages of needle over classic arthroscopy.

Comparaison de l'arthroscopie classique à l'arthroscopie l'aiguille pour diagnostiquer l'instabilité médiale de l'épaule chez le chien : 31 cas. Cette étude rétrospective a comparé le temps de chirurgie et d'anesthésie ainsi que les coûts engendrés entre une arthroscopie classique et une arthroscopie à l'aiguille lors du diagnostic de l'instabilité médiale de l'épaule chez le chien. Sont rapportés dans cette étude, les commémoratifs, les résultats de l'examen clinique, les diagnostics, le temps d'anesthésie, le temps de chirurgie, le traitement, les coûts et les complications. Le temps d'anesthésie et de chirurgie ainsi que leur coût ont été comparés pour les deux techniques arthroscopie classique et arthroscopie à l'aiguille (P < 0,05) pour tous les cas diagnostiqués avec une instabilité médiale de l'épaule (classique = 14; aiguille = 17). Aucune différence significative n'a été mise en évidence pour la durée de la chirurgie (P = 0,13) à contrario de la durée de l'anesthésie, plus courte (35 min de moins avec la technique à l'aiguille; P < 0,0001) et moins coûteuse (38 % plus économique avec la technique à l'aiguille; P < 0,0001). Aucune complication n'a été enregistrée lors de la dernière consultation de contrôle post-opératoire qui avait lieu en moyenne 12,4 semaines après la chirurgie. Pour diagnostiquer une instabilité médiale de l'épaule, la technique à l'aiguille offre une alternative sûre, avec comme avantages, des durées d'anesthésie plus courtes et des coûts inférieurs pour le client, par rapport à la technique classique.(Traduit par les auteurs).

Impact of 24-hour specialist coverage and an on-site CT scanner on the timely diagnosis of acute aortic dissection.

INTRODUCTION: Acute aortic dissection (AAD) is a rare and potentially fatal condition that has been known to be missed in diagnoses. Our primary objective was to determine if the availability of 24-hour emergency department (ED) specialist coverage and an on-site computed tomography (CT) scanner reduced the rate of missed diagnoses of AAD. METHODS: We selected records of patients diagnosed with dissection of the aorta from a hospital's discharge database and death register in the period of January 1998 to December 2014. AAD was defined as missed if imaging to diagnose AAD or a cardiology/cardiothoracic surgical consultation was not obtained in the ED. We compared the rates of missed diagnosis before and after the availability of 24-hour ED specialist coverage and an on-site CT scanner in the ED. RESULTS: Among 145 patients, 42 (29.0%) had a missed diagnosis. The proportion of missed AAD was lower in the post-implementation period compared to the pre-implementation period (20.0% vs. 37.3%, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.20‒0.89; p = 0.023). After adjusting for confounders, the difference remained significant (OR 0.31, 95% CI 0.14‒0.70; p = 0.005). In the post-implementation period, concurrent signs of congestive cardiac failure (OR 33.51, 95% CI 1.42‒789.20; p = 0.024) and absence of a widened mediastinum on chest radiography (OR 11.52, 95% CI 1.37‒96.80; p = 0.029) were independent predictors of missed diagnoses. CONCLUSION: The availability of 24-hour ED specialist coverage and an on-site CT scanner improved the diagnosis of AAD in our study.

Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats.

BACKGROUND: Despite multiple dilatation procedures, benign esophageal strictures (BES) remain a recurring cause of morbidity and mortality in dogs and cats. OBJECTIVE: Investigate the use of an indwelling Balloon Dilatation esophagostomy tube (B-Tube) for treatment of BES in dogs and cats. ANIMALS: Nine dogs and 3 cats. METHODS: Animals with BES were recruited for our prospective study. Endoscopic and fluoroscopic evaluation of the esophagus and balloon dilatation were performed under general anesthesia, followed by placement of an indwelling B-Tube. The animals' owners performed twice daily at-home inflations for approximately 6 weeks. Repeat endoscopy was performed before B-Tube removal. Animals were reevaluated for changes in modified dysphagia score (MDS) after B-Tube removal. RESULTS: The B-Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place. These animals underwent a median of 2 anesthetic episodes and were monitored for a median of 472 days (range, 358-1736 days). The mean MDS before treatment was 3.1 ± 0.5/4.0 and final follow-up MDS were significantly (P < .0001) improved at 0.36 ± 0.65/4.0. Eleven of 12 animals (91.7%) had improved MDS at the end of the follow-up period, with 8/12 (66.7%) having an MDS of 0/4, 2/12 (16.7%) an MDS of 1/4, and 1/12 (8.3%) an MDS of 2/4. One dog died. CONCLUSIONS AND CLINICAL IMPORTANCE: The B-Tube offers an effective, and more economical method, and often decreased anesthetic time to repeated balloon dilatation procedures for the treatment of BES in dogs and cats.

Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil?

INTRODUCTION: This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability to the Singapore adult population with minor head injury. METHODS: We conducted a retrospective study over six months of consecutive patients who presented to the adult emergency department (ED) with minor head injury. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR was assessed by comparing the recommendations for head computed tomography (CT) to its actual usage. RESULTS: In total, 349 patients satisfied the inclusion criteria. Common mechanisms of injury were falls (59.3%), motor vehicle crashes (16.9%) and assault (12.0%). 249 (71.3%) patients underwent head CT, yielding 42 (12.0%) clinically significant findings. 1 (0.3%) patient required neurosurgical intervention. According to the CCHR, head CT was recommended for 209 (59.9%) patients. Compliance with the CCHR was 71.3%. Among the noncompliant group, head CT was overperformed for 20.1% and underperformed for 8.6% of patients. Multivariate logistic regression analysis revealed that absence of retrograde amnesia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.8-9.7) was associated with noncompliance to the CCHR. Factors associated with underperformance were absence of motor vehicle crashes as a mechanism of injury (OR 6.6, 95% CI 1.2-36.3) and absence of headache (OR 10.8, 95% CI 1.3-87.4). CONCLUSION: Compliance with the CCHR for adult patients with minor head injury remains low in the ED. A qualitative review of physicians' practices and patients' preferences may be carried out to evaluate reasons for noncompliance.

Using Reduced Inoculum Densities of Mycobacterium tuberculosis in MGIT Pyrazinamide Susceptibility Testing to Prevent False-Resistant Results and Improve Accuracy: A Multicenter Evaluation.

The primary platform used for pyrazinamide (PZA) susceptibility testing of Mycobacterium tuberculosis is the MGIT culture system (Becton Dickinson). Since false-resistant results have been associated with the use of this system, we conducted a multicenter evaluation to determine the effect of using a reduced cell density inoculum on the rate of false resistance. Two reduced inoculum densities were compared with that prescribed by the manufacturer (designated as "BD" method). The reduced inoculum methods (designated as "A" and "C") were identical to the manufacturer's protocol in all aspects with the exception of the cell density of the inoculum. Twenty genetically and phenotypically characterized M. tuberculosis isolates were tested in duplicate by ten independent laboratories using the three inoculum methods. False-resistant results declined from 21.1% using the standard "BD" method to 5.7% using the intermediate ("A") inoculum and further declined to 2.8% using the most dilute ("C") inoculum method. The percentages of the resistant results that were false-resistant declined from 55.2% for the "BD" test to 28.8% and 16.0% for the "A" and "C" tests, respectively. These results represent compelling evidence that the occurrence of false-resistant MGIT PZA susceptibility test results can be mitigated through the use of reduced inoculum densities.

Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: A comparative study with surgical findings and timings of scans.

OBJECTIVE: This study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing lateral ankle ligament injuries and the effect of differences in time duration from injury to MRI. METHODS: Data were collected prospectively from 82 patients who underwent MRI and lateral ligament reconstruction, and were divided into either acute (≤3 months) or chronic (>3 months) group based on injury interval. Findings were classified as normal, partial, or complete tears of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). MRI results were compared with intraoperative findings and their accuracies were assessed using descriptive statistics. RESULTS: The accuracy of MRI for partial and complete tears of the ATFL was 74% and 79%, respectively, with sensitivity and specificity of 64% and 86% for partial tears, and 78% and 80% for complete tears, respectively. The accuracy of MRI was 66% and 88% for partial and complete tears of the CFL with a sensitivity and specificity of 41% and 87% for partial tears, and 61% and 95% for complete tears, respectively. A decrease in the MRI accuracy was observed in the chronic group. CONCLUSION: MRI is accurate in diagnosing ATFL injuries. It is specific but not sensitive for CFL tears. The accuracy is higher in the acute setting of 3 months or less from time of injury to MRI.

Extremely low catalyst loading for electroless deposition on a non-conductive surface by a treatment for reduced graphene oxide.

Enhancement of electroless deposition using reduced-graphene-oxide (rGO) coating for a conductive surface on the non-conductive substrate is proposed and demonstrated. We confirmed that the rGO treatment enhanced the Pd catalytic activity and achieved a sufficient rate in electroless deposition with extremely low Pd loading (3.94 × 10-2 µg cm-2).

Enhancing Catalytic Activity of Bioanode for Glucose Biofuel Cell by Compressing Enzyme, Mediator and Carbon Support through Centrifugation.

In this study, the fabrication of a graphene-based bioanode utilizing ferrocenemethanol as mediator and glucose oxidase as enzyme catalyst through centrifugation was demonstrated. The enhanced in catalytic activity for glucose oxidation was achieved via centrifuge compressing respective components within the mixture. The glucose/O2 biofuel cell (GBFC) was assembled by having the bioanode integrated with Pt wire as cathode. The GBFC produced maximum power density and open circuit voltage of approximately 70 µW cm-2 and 0.38 V.

Theoretical Modelling and Facile Synthesis of a Highly Active Boron-Doped Palladium Catalyst for the Oxygen Reduction Reaction.

A highly active alternative to Pt electrocatalysts for the oxygen reduction reaction (ORR), which is the cathode-electrode reaction of fuel cells, is sought for higher fuel-cell performance. Our theoretical modelling reveals that B-doped Pd (Pd-B) weakens the absorption of ORR intermediates with nearly optimal binding energy by lowering the barrier associated with O2 dissociation, suggesting Pd-B should be highly active for ORR. In fact, Pd-B, facile synthesized by an electroless deposition process, exhibits 2.2 times and 8.8 times higher specific activity and 14 times and 35 times less costly than commercial pure Pd and Pt catalysts, respectively. Another computational result is that the surface core level of Pd is negatively shifted by B doping, as confirmed by XPS, and implies that filling the density of states related to the anti-bonding of oxygen to Pd surfaces with excess electrons from B doping, weakens the O bonding to Pd and boosts the catalytic activity.

Traumatic fracture of the medial coronoid process in 24 dogs.

OBJECTIVE: To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia. METHODS: Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks. RESULTS: Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process. CLINICAL SIGNIFICANCE: Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

Body Mass Changes Across a Variety of Running Race Distances in the Tropics.

BACKGROUND: Current literature evaluating body mass (BM) changes across a variety of running race distances is limited. The primary objective of this study was to profile the range of BM changes across race distances. The secondary objective was to evaluate the prevalence of exercise-associated hyponatremia (EAH) in runners admitted to the on-site medical tent following participation of race events of different distances. METHODS: A total of 1934 runners across seven footrace categories (10-, 21-, 25-, 42-, 50-, 84-, and 100-km) were included in the study. One thousand eight hundred eighty-seven runners had their BM measured before and after each race. Blood sodium concentrations were measured from the remaining 47 symptomatic runners admitted to the on-site medical tents and did not complete the race. RESULTS: In terms of hydration status, 106 (6 %) were overhydrated, 1377 (73 %) were euhydrated, and 404 (21 %) were dehydrated. All race distances exhibited similar percentage of overhydrated runners (5 % in 10 km, 3 % in 21 km, 5 % in 25 km, 6 % in 42 km, 8 % in 50 km, 7 % in 84 km, and 6 % in 100 km). Forty-seven runners were admitted to the medical tents. Eight (17 %) were diagnosed with EAH (4 from 42 km, 2 from 84 km, 2 from 100 km), 38 (81 %) were normonatremic, and 1 (2 %) was hypernatremic. The % ΔBM across all races ranged from -8.0 to 4.1 % with a greater decrement noted in the 42-, 50-, 84-, and 100-km categories. CONCLUSIONS: Approximately 3-8 % runners had increased post-race BM, suggesting overhydration regardless of race distance. Symptomatic EAH was seen at race distances at or above 42 km, where BM changes demonstrated the widest range of values.

Newly developed stepwise electroless deposition enables a remarkably facile synthesis of highly active and stable amorphous Pd nanoparticle electrocatalysts for oxygen reduction reaction.

This paper reports on highly active and stable amorphous Pd nanoparticle electrocatalysts for the oxygen reduction reaction. The amorphous catalysts were synthesized by a remarkably facile and quick electroless deposition process newly developed in this study (process time <5 min). An electrode substrate (glassy carbon, carbon cloth) was sequentially dipped for 10 s into two separate solutions of a reducing agent (sodium hypophosphite (NaH2PO2)) and Pd ions to deposit amorphous Pd nanoparticles containing phosphorus (Pd-P). By repeating the deposition cycles, the specific and mass activities of the Pd nanoparticles can be actively tuned. Owing to the nanoscale amorphous nature, the obtained Pd-P nanoparticle electrocatalysts exhibited superior specific and mass activities compared with crystalline Pd nanoparticles synthesized by another reducing agent (N2H4) and commercial Pt-loaded carbon (Pt/C) and Pd-loaded carbon (Pd/C). The specific and mass activities of the amorphous Pd-P nanoparticles were over 4.5 times and 2.6 times higher than previously reported values of Pd and Pt catalysts.

Fabrication of highly ordered P3HT:PCBM nanostructures and its application as a supercapacitive electrode.

In this paper, we successfully demonstrated the fabrication of highly ordered and large-scale P3HT:PCBM nanowires via a slow-drying method, which allows for the convenient and cost-effective preparation of well-defined P3HT:PCBM nanostructures with large domains. The formation of the organic nanowires can be explained by the self-organization of polymer chains under favorable thermodynamic conditions in the slow-drying process. Furthermore, the C-V measurements revealed that the P3HT:PCBM nanowires possess high capacitance. This supercapacitive behavior of the nanowires is related to their large surface area and open structure, which can facilitate ion transport and accumulation. Owing to their extremely easy preparation and excellent capacitance performance, the P3HT:PCBM nanowires offer a promising electrode material for supercapacitor devices.

Survival of an octogenarian after rupture of the left ventricular free wall caused by myocardial infarction.

Left ventricular free wall rupture is an uncommon complication after a myocardial infarction that is associated with a high mortality rate from pericardial tamponade, especially in the elderly. Early recognition and management of this clinical entity affects the outcome; therefore, a high index of suspicion is imperative. We present a case of an 80-year-old man admitted with myocardial infarction, who had subsequent findings of left ventricular free wall rupture complicated by pericardial tamponade. Emergent surgical repair led to successful recovery. A brief overview of the clinical presentation, diagnosis, and management of this challenging and potentially fatal complication is presented.