Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy.

OBJECTIVE: Intraperitoneal (IP) bupivacaine provides postoperative analgesia in dogs undergoing ovariohysterectomy (OHE) alone or in combination with incisional (INC) bupivacaine. This study investigated whether the combination of INC and IP bupivacaine is superior to IP bupivacaine alone. STUDY DESIGN: Prospective, randomized, blinded clinical study. ANIMALS: Thirty-nine privately owned dogs undergoing OHE, aged 25 ± 23 months and weighing 11.8 ± 5.7 kg. METHODS: Dogs were premedicated with acepromazine (0.05 mg kg(-1) ) and morphine (0.5 mg kg(-1) ) intramuscularly (IM); anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Carprofen (4 mg kg(-1) ) was administered subcutaneously (SC) after intubation. Bupivacaine (3 mg kg(-1) ) IP was administered before complete closure of the linea alba to all dogs. Dogs were randomly assigned into two groups: group B received bupivacaine (n = 20; 1 mg kg(-1) ) and group S received saline (n = 19; 0.2 mL kg(-1) ) INC as a subcutaneous 'splash' before skin closure. Postoperative analgesia was assessed with a dynamic interactive visual analogue scale, the short form of the Glasgow Composite Pain Scale, and mechanical nociceptive threshold (MNT) measurement at 0.5, 1, 2, 4, 6, 8, 12 and 20 hours after surgery by one blinded observer. Parametric data were tested using t-test; nonparametric data were analysed using the two-sample Wilcoxon test (p < 0.05). RESULTS: There was no significant difference between groups with regard to age, weight, surgical and anaesthetic duration, incision length, sedation and pain scores. MNT values decreased in both groups at all time points as compared with the baseline. No dog required rescue analgesia. No postoperative complications were observed. CONCLUSION AND CLINICAL RELEVANCE: Bupivacaine IP and carprofen SC after morphine IM did provide satisfactory postoperative analgesia in dogs undergoing OHE with the anaesthetic protocol used. There appears to be no clinical advantage to adding bupivacaine INC. Neither protocol could prevent the development of primary hyperalgesia.

The Advanced Locking Plate System (ALPS): a retrospective evaluation in 71 small animal patients.

OBJECTIVE: To evaluate use of the Advanced Locking Plate System (ALPS) in dogs and cats and report outcome. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 29) and cats (n = 42). METHODS: The medical records (April 2007-April 2010) of dogs and cats treated with ALPS were reviewed evaluated. Data retrieved included signalment, indication for surgery, complications, and outcome. RESULTS: ALPS was used for 54 fractures, 12 tarsal or carpal ligament injuries and in 6 cases, to prevent or treat fractures during total hip replacement. Complications needing revision surgery occurred in 4 cases (5.5%): fixation failure was identified in 3 (2 fracture-fixations, 1 pancarpal arthrodesis), and a fracture occurred through a screw hole. The most common complication after tarsal arthrodesis was suture dehiscence. All cases had healed by study end. CONCLUSIONS: ALPS offers a reliable alternative for fracture treatment and some other orthopedic conditions in small animals.

Comparison of ventriculotomy closure with and without a coelomic fat patch in Japanese quail (Coturnix coturnix japonica).

Removal of foreign bodies from the ventriculus in birds may necessitate ventriculotomy. Complications with this intervention include leakage and adhesion formation. To investigate if the use of a coelomic fat patch and a tension-relieving suture in addition to a simple interrupted pattern would improve the healing process after ventriculotomy, 2 groups of 9 Japanese quail (Coturnix coturnix japonica) underwent ventriculotomy. In group 1, only simple-interrupted and tension-relieving sutures were used for closure of the ventriculotomy. In group 2, a coelomic fat patch from the surrounding adipose tissue was applied to the incision site in addition to the sutures. All quail recovered normally and were considered clinically healthy after surgery. Three birds from each group were euthanatized at days 7, 14, and 21 after surgery. On histologic examination, the suture techniques used for closure of the ventriculotomy led to minimal inflammation of the surrounding tissues in both groups. Serosal inflammation was significantly greater in group 2 birds that had the adipose patch at closure compared with group 1 birds. Therefore, the use of a coelomic fat patch to cover the site of ventriculotomy did not result in an improved healing process and its use is not recommended in quail.

Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint.

OBJECTIVE: To evaluate the effect of 15° external rotational humeral osteotomy (ERHO) on canine elbow joint contact mechanics. STUDY DESIGN: Ex vivo biomechanical study. SAMPLE POPULATION: Unpaired cadaveric canine thoracic limbs (n = 8) METHODS: Digital pressure sensors placed in a subchondral osteotomy distal to the elbow joint were used to measure contact area, peak and mean contact pressure, peak pressure location, center of pressure, and total force in the subchondral bone of the radius and the ulna. Measurements were taken in the following sequence: (i) neutral and (ii) after 15° external rotation. The distal aspect of the humerus was externally rotated by a middiaphyseal osteotomy and stabilized with an internal fixator. Data were normalized and analyzed using paired t-tests; P ≤ .05 was considered significant. RESULTS: Peak pressure location and center of pressure shifted 37.5 ± 15.9% and 21.5 ± 6.8% laterally after ERHO (P < .001 for both). Both were situated over the subchondral bone of the ulna in neutral position and over the radius after rotation in all 8 specimens (P < .001). Pressure measured in the ulnar part of the osteotomy was reduced from 58.7 ± 9.1% to 27.1% after ERHO (P < .001). Contact area, peak and mean contact pressure, and total force did not vary significantly between conditions. CONCLUSION: ERHO shifts the peak pressure location and the center of pressure laterally, toward the radial head and reduced the pressure acting on the ulna. The lateral shift of peak pressure may be beneficial in dogs with medial compartment disease.

Intraoperative contamination of the suction tip in clean orthopedic surgeries in dogs and cats.

OBJECTIVE: To (1) determine suction tip (intermittent and continuous mode) contamination rate in orthopedic surgery in dogs and cats; (2) examine the effect of surgical time on contamination; and (3) report bacteria isolated. STUDY DESIGN: Clinical study. SAMPLE POPULATION: Clean orthopedic surgeries (n = 50). METHODS: Surgical procedures were assigned to 1 of 2 groups: (1) continuous (n = 25) or (2) intermittent suction (n = 25). A control suction was operated in each surgery. Samples for aerobic and anaerobic bacteriologic examination were collected from the surgical suction at 0, 20, 60 minutes, and at the end of surgery, and from the control suction at the end of the surgery only. Comparison of continuous and intermittent suction data, and the effect of surgical time on contamination rate were analyzed using a Kaplan-Meier survival analysis followed by a Cox proportional hazards model. P < .05 was considered significant. RESULTS: Aerobic contamination occurred in 22 of 50 surgical procedures and there was no anaerobic growth. There was no significant difference between continuous and intermittent suction mode groups (P = .40). Surgical time did not influence the contamination rate (P = .79). Bacterial cultures mainly revealed coagulase-negative Staphylococci, however multiresistant bacteria were isolated. CONCLUSIONS: We failed to find superiority of the intermittent operation mode of the suction tip over the continuous mode. A safe time frame before contamination of the suction tip occurs that could not be defined.

Comparison between a novel bovine xenoimplant and autogenous cancellous bone graft in tibial tuberosity advancement.

OBJECTIVE: To compare radiographic healing and clinical outcome of a frontal-opening wedge osteotomy of canine tibiae when the osteotomy site is packed with either a novel bovine xenograft or standard autogenous cancellous bone graft (ACBG). STUDY DESIGN: Cohort study. ANIMALS: Dogs (n = 82) with partial or complete rupture of the cranial cruciate ligament that had tibial tuberosity advancement (TTA). METHODS: In 48 dogs, the osteotomy was packed with a novel bovine xenograft and in 34 dogs, ACBG was used. Eight week postoperative radiographs from both groups were graded for osteotomy healing using a 0-4-point scale. Data were analyzed using a Mann-Whitney test with significance set at P < .05. RESULTS: Thirty-four dogs (39 stifles) with xenoimplants had complete records and radiographic follow-up at 8 weeks. No significant differences between xenografting and autografting were identified in grading of osteotomy fill, osteointegration, or healing of the distal osteotomy. Significant differences were noted in grading of osteotomy healing proximally (autograft > xenoimplant) and of opacity in the osteotomy site (xenoimplant > autograft). CONCLUSIONS: Radiographic evidence of healing of the xenoimplanted portion of the TTA osteotomy was equivalent to results with ACBG. Healing of the proximal osteotomy site (above the cage) was improved when ACBG was used as the graft.

Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints.

OBJECTIVE: To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs. STUDY DESIGN: Ex vivo biomechanical study. ANIMALS: Unpaired cadaveric hind limbs (n=9). METHODS: Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk-Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferroni's correction was used when needed. RESULTS: A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control. CONCLUSION: TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.

Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft.

OBJECTIVE: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). STUDY DESIGN: Prospective study and case series. ANIMALS: Dogs treated with TTA (n=67). METHODS: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). CASE SERIES: nongrafted TTA (4-25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05. RESULTS: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2-4). No healing related complications were observed. CONCLUSION: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.

Mannich bases of hydroxycoumarins: synthesis, DFT/QTAIM computational study and assessment of biological activity.

The synthesis of six Mannich bases derived from hydroxycoumarins was carried out in moderate yields, two of these derivatives were described for the first time. Conformational analysis was performed through DFT theoretical calculations explaining the formation of stable six membered rings based on intramolecular hydrogen bonds within the structure. These findings were correlated with the antiproliferative activity. The biological activity of the Mannich bases through their antiproliferative activity in the HeLa cancer cell line is described for the first time, showing that the compounds were able to inhibit proliferation in cervical cancer by more than 60%. Likewise, the theoretical modeling of the photophysical properties was realized with promising results, showing that the HOMO-LUMO energies of the new compounds present the lowest electronic gap values for those with donor groups in their structure, which makes them potential fluorophores.

Correlation of radiographic changes after tibial tuberosity advancement in dogs with cranial cruciate-deficient stifles with functional outcome.

OBJECTIVE: To (1) evaluate radiographic changes associated with osteoarthrosis (OA) before and after tibial tuberosity advancement (TTA) and (2) determine if these changes are indicative of limb function as determined by kinetic gait analysis. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=35) with cranial cruciate ligament (CCL) deficient stifles (38). METHODS: Variables recorded were: complete or partial CCL rupture, meniscal lesions, arthroscopically graded cartilage lesions, complications, and revision surgeries. Radiographic evaluation and kinetic gait analysis (vertical ground reaction forces [GRFs]) were conducted pre- and 4-16 months postoperatively (mean, 5.9 months). Radiographs were evaluated without knowledge of operative findings and functional outcome. A score (0-3) based on new bone production at 11 specific sites was used to grade OA. Soft tissue changes were classified separately as normal or excessive. Preoperative scores were correlated with clinical variables. Postoperative scores and progression of OA scores were correlated with clinical variables and GRFs. RESULTS: OA remained unchanged in 17 joints and progressed in 21 (55%). Dogs with meniscal lesions had higher OA scores preoperatively, but not at follow-up. Dogs with severe cartilage lesions at surgery had more progression of OA. GRFs improved after surgery and were not correlated with any of the radiographic OA scores. CONCLUSION: Progression of OA was greater in the presence of severe cartilage lesions at surgery. OA scores were not correlated with GRFs. CLINICAL RELEVANCE: Progression of OA is generally expected to occur after TTA despite improvement of limb function.

Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study.

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson's χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89-73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03-133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99-20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.

Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs.

OBJECTIVE: To evaluate the results of application, and identify complications, of the 2nd generation of Zurich Cementless Total Hip Replacement (ZCTHR). STUDY DESIGN: Case series. ANIMALS: Client-owned dogs (n=60) that had ZCTHR (n=65). METHODS: Dogs with ZCTHR (2001-2003) with a minimum follow-up > or =6 months were evaluated. Data included signalment, cup position, longest follow-up, complications, management of complications and outcome. RESULTS: Mean follow-up was 22.68 months. Eleven cases (17%) had postoperative complications: femoral fracture (n=1; 1.5%), prosthesis luxation (7; 11%), cup loosening (2; 3%), and implant failure (1; 1.5%); 9 cases were successfully revised. Explantation of implants was performed in 1 case because of infection, and 1 dog was euthanatized after reluxation. CONCLUSIONS: ZCTHR can restore function in dogs affected by disabling diseases of the coxofemoral joint. The press-fit fixation of the cup allowed for corrections in cases of incorrect positioning. Cases with aseptic loosening were revised successfully by impacting larger cups. Newer stems of this generation are shot peening treated to increase their resistance to breakage. In our cases, infection is a disastrous event, leading to implant removal. After resolution of complications, a successful final outcome was achieved in 97% of THR. CLINICAL RELEVANCE: ZCTHR offers a reliable alternative for treating dogs with disabling diseases of the hip joints.

New paths of cyanogenesis from enzymatic-promoted cleavage of ß-cyanoglucosides are suggested by a mixed DFT/QTAIM approach.

Cyanogenesis is an enzyme-promoted cleavage of ß-cyanoglucosides; the release of hydrogen cyanide is believed to produce food poisoning by consumption of certain crops as Cassava (Manihot esculenta Crantz). The production of hydrogen cyanide by some disruption of the plant wall is related to the content of two ß-cyanoglucosides (linamarin and lotaustralin) which are stored within the tuber. Some features about the mechanistic bases of these transformations have been published; nevertheless, there are still questions about the exact mechanism, such as the feasibility of a difference in the kinetics of cyanogenesis between both cyanoglucosides. In this work, we have performed a theoretical analysis using DFT and QTAIM theoretical frameworks to propose a feasible mechanism of the observed first step of the enzyme-catalyzed rupture of these glucosides; our results led us to explain the observed difference between linamarin and lotaustralin. Meanwhile, DFT studies suggest that there are no differences between local reactivity indexes of both glucosides; QTAIM topological analysis suggests two important intramolecular interactions which we found to fix the glucoside in such a way that suggests the linamarin as a more reactive system towards a nucleophilic attack, thus explaining the readiness to liberate hydrogen cyanide.

Tragedy of transition: hypertensive crisis in a young adult secondary to unilateral ureteropelvic junction obstruction following pyeloplasty as an adolescent.

A 25-year-old man with a history of left ureteropelvic junction (UPJ) obstruction that was corrected surgically at the age of 16 presented with a chief complaint of syncope. He was found to have severe hypertension with evidence of end organ damage on laboratory evaluation. His blood pressure was controlled with intravenous and oral antihypertensives with improvement in end organ dysfunction. Workup for secondary causes of hypertension implicated failed left-sided pyeloplasty with resultant hydronephrosis as the aetiology. The patient was transitioned to an oral antihypertensive regimen and discharged with urological surgery follow-up. Blood pressure control was maintained with oral antihypertensives and a low-salt diet; however, evidence of chronic kidney disease persisted. This case highlights the importance of close follow-up and adequate transition of care in patients with UPJ obstruction who transitioned to adulthood.

Effect of conformation of the distal portion of the femur and proximal portion of the tibia on the pathogenesis of cranial cruciate ligament disease in dogs.

OBJECTIVE: To evaluate mediolateral radiographic views of stifle joints to identify conformational differences between athletically sound dogs and dogs with cranial cruciate ligament disease (CCLD). SAMPLE POPULATION: Radiographic images of 50 stifle joints of 43 dogs with surgically confirmed CCLD and 50 stifle joints of 38 dogs without clinical signs of stifle joint disease. PROCEDURES: Mediolateral radiographic views of stifle joints were obtained, and long axes of the femur, tibia, and femoral condyles were measured. Angles between long axes of the femur and femoral condyle and between long axes of the femur and tibia were measured. Circles were drawn representing the joint surface of femoral condyles (circle 1), area of contact on the tibial plateau (circle 2), and femoral trochlea (circle 3). Radii of circles 1, 2 (line F), and 3 were measured. Distances between midpoints of circles 1 and 2 (line K) and between midpoint of circle 2 and most cranial aspect of the tibial tuberosity (line G) were measured. To evaluate differences in conformation that could lead to CCLD, quotients derived from measurements were created for comparison; angles were compared between dog groups. RESULTS: Significant differences were found in the quotients created by the lengths of lines G and F and lines G and K between dogs with and without CCLD. CONCLUSIONS AND CLINICAL RELEVANCE: No anatomic differences were detected in the distal portion of the femur between dogs with and without CCLD. Development of the tibial tuberosity and shape (convexity) of tibial condyles may be relevant in the pathogenesis of CCLD.

Astrocytes differentially respond to inflammatory autoimmune insults and imbalances of neural activity.

BACKGROUND: Neuronal activity intimately communicates with blood flow through the blood-brain barrier (BBB) in the central nervous system (CNS). Astrocyte endfeet cover more than 90% of brain capillaries and interact with synapses and nodes of Ranvier. The roles of astrocytes in neurovascular coupling in the CNS remain poorly understood. RESULTS: Here we show that astrocytes that are intrinsically different are activated by inflammatory autoimmune insults and alterations of neuronal activity. In the progression of experimental autoimmune encephalomyelitis (EAE), both fibrous and protoplasmic astrocytes were broadly and reversibly activated in the brain and spinal cord, indicated by marked upregulation of glial fibrillary acidic protein (GFAP) and other astrocytic proteins. In early and remitting EAE, upregulated GFAP and astrocytic endfoot water channel aquaporin 4 (AQP4) enclosed white matter lesions in spinal cord, whereas they markedly increased and formed bundles in exacerbated lesions in late EAE. In cerebellar cortex, upregulation of astrocytic proteins correlated with EAE severity. On the other hand, protoplasmic astrocytes were also markedly activated in the brains of ankyrin-G (AnkG) and Kv3.1 KO mice, where neuronal activities are altered. Massive astrocytes replaced degenerated Purkinje neurons in AnkG KO mice. In Kv3.1 KO mice, GFAP staining significantly increased in cerebellar cortex, where Kv3.1 is normally highly expressed, but displayed in a patchy pattern in parts of the hippocampus. CONCLUSIONS: Thus, astrocytes can detect changes in both blood and neurons, which supports their central role in neurovascular coupling. These studies contribute to the development of new strategies of neuroprotection and repair for various diseases, through activity-dependent regulation of neurovascular coupling.