The efficacy of injecting a distillate of the pitcher plant (Sarraceniaceae) adjacent to the palmar digital nerves of horses to ameliorate lameness caused by digital pain

This study aimed to determine the efficacy of instilling extract of the pitcher plant around the palmar digital nerves of horses to ameliorate digit pain causing lameness. Five mixed breed horses were recruited. Horses were determined to be lame because of pain in the distal portion of one or both thoracic limbs by a positive response to a basisesamoid nerve block using 2%^mepivacaine hydrochloride. Gait was evaluated pre- and post-nerve block at 30 min, 3, 7,14 and 21 days. At the 3-week evaluation, the basisesamoid nerve block was repeated using the extract, and the gait was evaluated at similar times. Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system. The basisesamoid nerve block significantly ameliorated lameness at 30 min when gait was evaluated, but it had no significant effect on lameness after this time. The product containing extract of the pitcher plant had no significant effect on lameness when administered as a basisesamoid nerve block at any time. Extract of the pitcher plant administered adjacent to the medial and lateral palmar digital nerves (i.e., a basisesamoid nerve block) had no efficacy in ameliorating lameness in the distal portion of one or both thoracic limbs. Extract of the pitcher plant likely has no value for treating horses for chronic pain when administered as a regional nerve block.

Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial

BACKGROUND

The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations.

PATIENTS AND METHODS

Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration).

RESULTS

In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1^stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2^ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform).

CONCLUSIONS

PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.

Mismatch repair deficiency, chemotherapy and survival for resectable gastric cancer: an observational study from the German staR cohort and a meta-analysis

PURPOSE

In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings.

METHODS

Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis.

RESULTS

MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI 0.13-3.37, P = 0.63) and 1.44 (95% CI 0.66-3.13, P = 0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI 0.14-0.91, P = 0.03), whereas those with MMRp had a HR of 1.18 (95% CI 0.89-1.58, P = 0.26).

CONCLUSION

Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.

‘THEY ASKED ME TO JOIN; I JOINED:’ LESSONS FOR SENIOR CENTERS ON SUPPORTING PHYSICAL ACTIVITY

Among older adults, physical activity (PA) remains a foundation for maintaining and improving health. However, over 25% of adults aged ≥ 50 engage in no physical activity outside of work hours (CDC 2016). PA does correlate with senior center participation but little is known about the social factors that contribute to sustaining senior center PA routines. We report on findings from qualitative interviews conducted with Black older adults (Nf22) on the “story” of their senior center involvement, particularly their PA participation. Interviews were recorded and transcribed verbatim; co-authors independently conducted a line-by-line analysis to identify themes. They then reconciled and sorted themes. Four themes provided insights on participants’ PA engagement: 1) Retirement as opportunity; 2) Invitation and welcome; 3) Physician messaging; and 4) Sense of community. Participants strongly connected retirement with the opportunity to engage in regular PA; work and family obligations previously prevented PA in daily life. Participants also linked trying new PA programs to the senior center’s culture of extending one-to-one invitations. Physician messaging specifically “to exercise” provided additional validation for prioritizing senior center PA within daily schedules. Finally, a sense of community, of being missed if not attending, provided further incentive to sustain PA routines. These findings provide guidance and simple lessons that senior centers can employ to encourage participation in their PA programming. The themes may also inform the design of survey research examining patterns of PA among older adults.

MERGING AN AGE FRIENDLY UNIVERSITY WITH AN AGE FRIENDLY HEALTH CARE SYSTEM: CASE STUDY FINDINGS

Age Friendly Health Systems (AFHSs) and Age Friendly Universities (AFUs) are distinct entities in the “Age Friendly” ecosystem. While Age Friendly entities function independently, they typically exist in close proximity (e.g., universities and community hospitals); yet they remain isolated in their Age Friendly efforts. We report on a collaboration between a mid-Atlantic Age Friendly University and a new AFHS using case study methodology. Our goal is to inform and inspire key stakeholders responsible for creating innovative healthy aging communities. The collaboration began with a shared stakeholder team who articulated focus areas and overlapping goals. A charter document was developed articulating commitments and responsibilities. Using a Quality Improvement (QI) approach, projects targeted the hospital’s older patient needs that linked to the AFHS 4 M’s of Matters, Medications, Mobility, and Mentation. University graduate students and faculty volunteered to teach and mentor hospital staff on the QI projects: 1) Get to Know Me Boards filled by staff caring for hospitalized older adults (Matters); 2) Medical Intensive Care Unit discharge opioid medication deprescribing (Medication); 3) UMove Mobility Screening addressing functional status (Mobility); 4) UB-2 Delirium Screening (Mentation). Data collection across projects demonstrated proof-of-concept and identified implementation challenges around communication, screening, data entry, and data extraction from electronic medical records. During Covid-19 pandemic, the collaboration allowed QI projects to conduct multiple Plan-Do-Check-Act cycles while contributing to the Age Friendly goals of both organizations. Partnerships between academic institutions and hospitals foster development of evidence- based healthy aging communities and provide opportunities for continuing education and research.

Comparison of 2% mepivacaine and a solution of 2% lidocaine/epinephrine administered for median and ulnar nerve blocks in horses with naturally occurring forelimb lameness

OBJECTIVE

To compare a 2% lidocaine solution containing 5 μg/ml (1:200 000) epinephrine with 2% mepivacaine for reducing lameness in horses after use in proximal nerve blocks.

STUDY DESIGN

Experimental randomized crossover.

ANIMALS

Six adult horses with naturally occurring forelimb lameness.

METHODS

Horses were evaluated using an inertial gait sensor system. Lameness was measured as a vector sum (VS). Following baseline lameness examination, median and ulnar nerve blocks were performed with lidocaine/epinephrine (0.5 mg epinephrine added to 50 ml of 2% lidocaine immediately prior to administration) or an equal volume of 2% mepivacaine. Horses were trotted at 5 min and then at 30 min intervals for 150 min. After 24 h, nerve blocks were repeated using the other local anesthetic. Data were evaluated using linear models.

RESULTS

The reduction in the VS did not differ after nerve blocks with lidocaine/epinephrine or mepivacaine (P = .791). Mean time to VS <8.5 mm (n = 5) was 5 and 9.6 min for lidocaine/epinephrine and mepivacaine, respectively. For one horse, VS was not reduced to <8.5 mm with either treatment (this horse had the highest VS before treatments were administered). The decrease in VS to <8.5 mm lasted for 150 min in both treatment groups.

CONCLUSION

The outcomes of the median and ulnar nerve blocks performed with 2% lidocaine with epinephrine did not differ from blocks performed with 2% mepivacaine.

CLINICAL RELEVANCE

Two percent lidocaine with epinephrine may serve as an adequate replacement for proximal nerve blocks when mepivacaine is unavailable.

Making the Case for Advancing Age Inclusivity

How do you present the most effective case for promoting age-inclusivity to your campus leadership? Educational institutions differ in their missions and resources; and these factors affect their readiness to becoming more age-inclusive. This presentation suggests that the best approaches are tailored to intentionally and robustly advance your institution’s values, mission, and strategic plan as demonstrated through your proposed age-inclusivity initiative. We review the persuasive arguments for increasing the focus on age-inclusivity in higher education, including securing increasing external research and development funding, supporting employees and alums exploration of encore careers, attracting more students in light of demographic shifts, contributions to overall campus diversity, etc. Identifying the most compelling arguments for particular institutions, consistent with their missions, is connected to the various resources in the AFU toolkit. Finally, we show examples from a range of institutions who successfully made their cases for embracing age inclusivity and have not looked back.

Now What? Maintaining Momentum after Achieving Designation as an Age-Friendly University

The Age-Friendly University (AFU) designation in higher education recognizes the institution’s commitment to a culture of age-inclusivity across programs and policies. While AFU institutions are embracing the demographic shifts in higher education and society at-large, effectively responding to the needs and desires of an increasingly older population requires ongoing acceptance and support from campus leaders to maintain momentum and stay relevant within a dynamic field. This session will describe the intentional and systematic approach utilized by an AFU steering committee to build interest in and develop meaningful collaborations in multiple domains across campus, including at the level of the president. Our initiatives focus on five themes that align with the 10 age-friendly university principles: support for workforce development, broadening community engagement, expanding engagement in aging research and dissemination, addressing barriers related to aging and our physical environment, and facilitating age-friendly efforts across our state. We will present our experiences in expanding awareness of and support for the AFU movement on our campus and share a model for institutions seeking ideas for sustainability of their own initiatives.

Social media influencer marketing to build a counter-narrative for promoting sexuality education

Background

A recent cross sectional community readiness assessment carried out in Islamabad, Pakistan indicated that the community is at the denial or resistant stage for implementing school-based sexuality education in Pakistan. The resistance was attributed to lack of awareness and prevalent misconceptions regarding sexuality education. This study aims at qualitatively exploring strategies for targeting misconceptions and increase awareness regarding sexuality education with stakeholder involvement.

Methods

35 in-depth interviews and a focus group discussion was conducted to discuss the results of the readiness assessment comprising of community members, researchers, NGO representatives, and social media influencers. Discussion guide included topics on engagement strategies, intervention modes of delivery, target audience, misconceptions, community support, and optimizing sexuality education in local context. Qualitative content analysis was conducted for analyzing the data.

Results

Results indicate that current community support is usually passive in nature and digital or social media platforms are mostly used to talk about sexuality education. Participants believed social media can be used as a platform for disseminating information by involving social media influencers with careful narrative building around sexuality for rebranding the topic, as talking about sexuality is seen as a taboo in the society. Targeting misconceptions through counter narratives and scientific evidence was considered as a way forward for increasing community acceptability and readiness. Violence, staying safe, and age appropriateness were identified as some of the key features of sexuality education that need to be highlighted for garnering community support.

Conclusions

For promoting sexuality education in Pakistan, it is essential to tackle resistance by sensitizing the community and digital social media platforms offer an opportunity to do this through influencer marketing.

Key messages

Digital and social media offer an opportunity for promoting sexuality education in conservative settings like Pakistan. Social media influencer marketing might be useful in building counter narrative and for community engagement.

The Age-Friendly University Umbrella: New Synergies for Gerontology Programs, Aging Centers, and Health Systems

Higher education has a tentative relationship with gerontology programs and research centers. Despite demographic shifts, academic gerontology serves a modest student body and attracts limited research/scholarly interest. Our new Age Friendly University (AFU) designation served to motivate our university leaders and faculty to re-imagine how aging issues are fundamental to our mission framed by: 1) Interdisciplinarity; 2) Intergenerational relations; and 3) Inclusiveness of the life course. Additionally, the AFU initiative energized the relationships among our health professions schools, academic departments, and research center to collaborate on grant opportunities. Our AFU also started collaborating with a local health system seeking Age Friendly Health System status. Finally, our AFU designation raised visibility with our three local county governments who had just received Age Friendly Community status. Our AFU efforts have served as an inclusive umbrella to attract new, interested partners in our shared effort to improve the lives of older adults. Part of a symposium sponsored by Directors of Aging Centers Interest Group.

A concept for a magnetic particle imaging scanner with Halbach arrays

Magnetic particle imaging (MPI) is a new medical imaging technique visualizing the concentration distribution of superparamagnetic nanoparticles used as tracer material. MPI is not yet in clinical routine, since one of the challenges is the upscaling of scanners. Typically, the magnetic fields of MPI scanners are generated electromagnetically, resulting in an immense power consumption but providing high flexibility in terms of adjusting the field strengths and very fast image acquisition rates. Permanent magnets provide high flux densities and do not need any power supply. However, the flux density is not adjustable, and a mechanical movement is slow compared to electromagnetically varying fields. The MPI scanner concept proposed here uses permanent magnets and provides high flexibility, with the possibility to choose between fast overview scanning and detailed image acquisition. By mechanical rotation of magnetic rings in Halbach array configuration, it is possible to adjust the field or gradient strengths. The latter allows for determining the spatial resolution and the size of the field of view. A continuous mechanical rotation defines the coarseness of the scanning trajectory and image acquisition rate. This concept provides a comparable flexibility, as an alternating magnetic field and an adjustable field gradient can be applied as known from electromagnetically driven MPI systems, and therefore yields high potential for an enlarged system. We present the idea of an arrangement of Halbach arrays and how to calculate the generated magnetic fields. Simulations for an exemplary geometry are provided to show the potential of the proposed setup.

Comparison of speed of onset and analgesic effect of 2% mepivacaine hydrochloride deposited within or outside the neurovascular bundle at the level of the proximal sesamoid bones in horses with naturally occurring forefoot-related lameness

OBJECTIVE

To compare the speed of onset and analgesic effect of mepivacaine deposited within or immediately outside the neurovascular bundle at the base of the proximal sesamoid bones in horses.

ANIMALS

6 horses with naturally occurring forefoot-related lameness.

PROCEDURES

In a crossover study design, horses were randomly assigned to receive 1 of 2 treatments first, with the second treatment administered 3 to 7 days later. Trotting gait was analyzed with an inertial sensor-based motion analysis system immediately before treatment to determine degree of lameness. Afterward, ultrasound guidance was used to inject 2% mepivacaine hydrochloride around the palmar digital nerves of the affected forelimb at the level of the base of the proximal sesamoid bones either within the subcircumneural space or outside the circumneural sheath. After injection, gait was reevaluated at 5-minute intervals for 45 minutes.

RESULTS

Mepivacaine deposition outside the circumneural sheath did not resolve lameness in any horse; for 3 horses, the mean time to 70% reduction of initial vertical head movement was 13.3 minutes, and the remaining 3 horses had no such reduction at any point. Mepivacaine deposition within the subcircumneural space resulted in a mean time to 70% reduction of initial vertical head movement of 6.7 minutes and mean time to resolution of lameness of 21.7 minutes.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that when peripheral nerves of horses lie within a sheath, local anesthetic solution should be deposited within the sheath for an effective nerve block. If local anesthetic solution is deposited outside the sheath, the nerve block may yield erroneous results.

Statins, diabetes mellitus and prognosis of amyotrophic lateral sclerosis: data from 501 patients of a population-based registry in southwest Germany

BACKGROUND AND PURPOSE

A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS.

METHODS

In all, 501 patients (mean age 65.2 ± 10.9 years; 58.5% male) from the ALS Registry Swabia recruited between October 2010 and April 2016 were included in this prospective cohort study. Data were collected using a standardized questionnaire.

RESULTS

Statin use (n = 65) was not associated with overall survival (P = 0.62). Age of ALS onset in patients with DM was 4.2 years later (95% confidence interval 1.3-7.2 years) than in patients without DM (P < 0.01). The overall survival of patients with high body mass index at study entry (>27.0 kg/m² , upper quartile, n = 127) was prolonged by more than 5 months compared to patients with low body mass index (<22.0 kg/m² , lower quartile, n = 123; P = 0.04).

CONCLUSIONS

This study supports the view that statin use is not associated with overall survival of ALS patients, suggesting that statins are not harmful and should not be discontinued in ALS. Furthermore, the delayed onset of ALS in patients with DM may mirror the potentially protective metabolic profile associated with type 2 DM. Consistently, this study provides further evidence that high body mass index is a positive prognostic factor in ALS.

The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

The current international COVID‐19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air‐purifying respirators and powered air‐purifying respirators during simulated difficult airway scenarios. Twenty‐five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered respirator group; however, noise levels were perceived to be significantly lower than in the standard respirator group. We conclude that standard and powered respirators do not significantly prolong simulated advanced intubation procedures.

Effect of 3% chloroprocaine hydrochloride when used for median and ulnar regional nerve blocks in lame horses

OBJECTIVE

To assess onset of analgesia for 3% chloroprocaine hydrochloride and 2% mepivacaine hydrochloride when used for median and ulnar nerve blocks in lame horses.

ANIMALS

6 naturally lame horses.

PROCEDURES

A crossover experiment was conducted. Horses were assigned to 1 of 2 treatment groups (3% chloroprocaine or 2% mepivacaine first). Median and ulnar nerve blocks were performed in the lame limb with the assigned treatment. Lameness was objectively evaluated before treatment administration and at various points for 120 minutes after treatment with a wireless inertial sensor-based motion analysis system. Following a 7-day washout period, horses then received the other treatment and lameness evaluations were repeated.

RESULTS

Median and ulnar nerve blocks performed with 3% chloroprocaine resulted in more consistent, rapid, and profound amelioration of lameness than did blocks performed with 2% mepivacaine. Lameness decreased more between 20 and 40 minutes after injection when 3% chloroprocaine was used than when 2% mepivacaine was used. Complete resolution of lameness was detected a mean of 9 minutes after injection when median and ulnar nerve blocks were performed with 3% chloroprocaine and a mean of 28 minutes after injection when performed with 2% mepivacaine.

CONCLUSIONS AND CLINICAL RELEVANCE

3% chloroprocaine had a more rapid onset and provided better analgesia for median and ulnar nerve blocks in horses with naturally occurring lameness, compared with 2% mepivacaine. These favorable properties suggest that 3% chloroprocaine would be useful for performance of median and ulnar regional nerve blocks during complicated lameness evaluations.

Castration of Dogs Using Local Anesthesia After Sedating With Xylazine and Subanesthetic Doses of Ketamine

Orchiectomy is performed in some species using only sedation and local anesthesia to decrease the expense of performing the procedure using general anesthesia. The objective of this study was to determine if dogs can be castrated safely and painlessly by using only sedation and local anesthesia. After dogs were sedated with intramuscularly administered xylazine (1 mg/kg) and subanesthetic ketamine (1 mg/kg), testes and skin were anesthetized with 2% lidocaine (6 mg/kg, total dose) buffered with sodium bicarbonate. Systolic, diastolic, and mean blood pressures; heart and respiratory rates; and movement scores were determined before and during surgery when manipulations were most likely to cause pain. No dog reacted substantially to injection of the combination of sedatives, and no dog reacted noticeably to injection of lidocaine. During surgery, the average heart rate was reduced from baseline by 40–60 beats per minute, and the average respiratory rate was reduced by ~10 breaths per minute. An overall reduction of arterial blood pressures was observed. All but one dog moved purposely in response to a toe pinch at the end of surgery. We found that sedating dogs intramuscularly with xylazine and a sub-anesthetic dose of ketamine and administering lidocaine at the incision site and intratesticularly allowed dogs to be castrated humanely and avoided the expense of general anesthesia and the need for hospitalization.

Ex vivo investigation of the effect of the transverse arytenoid ligament on abduction of the arytenoid cartilage when performing equine laryngoplasty

Aims: To investigate the effect of the transverse arytenoid ligament (TAL) on abduction of the arytenoid cartilage when performing laryngoplasty. Methods: Modified prosthetic laryngoplasty was performed on right and left sides of 13 cadaver larynges. Increasing force was sequentially applied to the left arytenoid cartilage at 3 N intervals from 0-24 N, when the force on the right arytenoid cartilage was either 0 or 24 N, before and after TAL transection. Digital photographs of the rostral aspect of the larynx were used to determine the left arytenoid abduction angles for these given force combinations and results compared before and after TAL transection. Longitudinal and transverse sections of the TAL from seven other equine larynges were also examined histologically. Results: Increasing force on the left arytenoid cartilage from 0-24 N produced a progressive increase in the angle of the left arytenoid cartilage (p < 0.001) and increasing force on the right arytenoid cartilage from 0-24 N reduced the angle of the left arytenoid cartilage (p < 0.001). Following transection of the TAL the mean angle of the left arytenoid increased from 36.7 (95% CI = 30.5-42.8)° to 38.4 (95% CI = 32.3-44.5)°. Histological examination showed that the TAL was not a discrete ligament between the arytenoid cartilages but was formed by the convergence of the ligament and the left and right arytenoideus transversus muscles. Conclusions: Transection of the TAL in ex vivo equine larynges enabled greater abduction of the left arytenoid cartilage for a given force. These results indicate that TAL transection in conjunction with prosthetic laryngoplasty may have value, but the efficacy and safety of TAL transection under load in vivo, and in horses clinically affected with recurrent laryngeal neuropathy must be evaluated. Abbreviations: F_max: Force needed to maximally abduct the left or right arytenoid; TAL: Transverse arytenoid ligament.

Lingual Squamous Cell Carcinoma in Two Horses

Squamous cell carcinoma (SCC) is one of the most common malignant neoplasms in horses, but lingual SCC has seldom been reported. On separate occasions, a 12-year-old American Quarter Horse mare and an 18-year-old American Saddlebred stallion were presented to the Auburn University Large Animal Teaching Hospital for evaluation of weight loss, dysphagia, and ptyalism. Evaluation of each horse included physical examination, skull radiographs, oral examination, complete blood count and serum biochemistry profile, endoscopic evaluation of the mouth, and biopsy of tissue from a lesion found on the tongue. Histopathologic assessment of tissue harvested from the lingual lesions led to a diagnosis of SCC in each case. The diagnosis prompted euthanasia for one horse, but radiation therapy appeared to delay the progression of the lesion in the other horse.

Performance comparison of 159 Thoroughbred racehorses and matched cohorts before and after desmotomy of the interspinous ligament

Racehorses may perform poorly because of impinging dorsal spinous processes (DSPs) of the thoracolumbar vertebrae. No study has looked objectively at the long-term outcome of racehorses undergoing desmotomy of the interspinous ligament as a treatment for horses with poor performance caused by impinging DSPs. The aim of this study was to examine objectively, by using pre-operative and post-operative racing records, the effectiveness of desmotomy of the interspinous ligament (DISL) in improving the performance of racehorses with impinging DSPs. Medical records of all horses undergoing desmotomy of one or more interspinous ligaments at a referral equine hospital, between February 2015 and September 2016, were reviewed. The study was confined to Thoroughbred racehorses with sufficient historical information and racetrack data to allow their racing performances be compared to that of matched controls. Matched controls were of the same age, sex, and racing type and were trained at the same time by the same trainer as those undergoing desmotomy. The time to follow-up was at least 12 months. Of the 6545 horses presented for poor performance or lameness during the study period, 236 horses (3.6%) underwent desmotomy of one or more interspinous ligaments, and of these, 159 met the inclusion criteria. Horses undergoing desmotomy had significantly better improvement in racing performance than did matched controls. Eight horses developed unilateral neurogenic atrophy of epaxial musculature. DISL between impinging DSPs can improve the performance of racehorses experiencing from poor performance caused by pain resulting from the impinging processes.

Buffering mepivacaine with sodium bicarbonate speeds and potentiates analgesia of median and ulnar nerve blocks performed on horses

The objective of this study was to determine if buffering mepivacaine HCL (mepHCl) with sodium bicarbonate (NaHCO₃) would significantly decrease the time to onset of analgesia when performing median and ulnar nerve blocks in naturally lame horses. Median and ulnar nerve blocks were performed on the naturally lame limb of nine horses during two separate study periods, with a minimum washout period of three days between study periods. Nerve blocks were performed by administering mepHCl alone or mepHCl mixed with NaHCO₃ (nine parts 2 per cent mepHCl to one part 8.4 per cent NaHCO₃). Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system (Lameness Locator) prior to the high regional nerve block and every five minutes following administration of the nerve block for 75 min. Resolution of lameness occurred earlier and was more profound for horses administered median and ulnar nerve blocks performed with mepHCl and NaHCO₃ than when these nerve blocks were performed using only mepHCl.

An Objective Assessment of the Effect of Anesthetizing the Median Nerve on Lameness Caused by Pain in the Cubital Joint

The median nerve, along with the ulnar nerve, is often anesthetized when performing a lameness examination in horses. Because of the close proximity of the median nerve to the cubital joint, proximal migration of local anesthetic might ameliorate pain originating from the cubital joint. The objective of this study was to determine if a median nerve block will ameliorate lameness caused by pain in the cubital joint. A forelimb lameness was induced in six healthy horses by injecting 100 ng of recombinant equine interleukin 1 beta (IL-1β) into the cubital joint. The median nerve of the lame leg was anesthetized using 10 mL of 2% mepivacaine hydrochloride. A successful median nerve block was confirmed by loss of skin sensation at the medial aspect of the pastern and typical changes in thermographic images. Gait was assessed before and at 20, 40, and 60 minutes after the median nerve block using an inertial sensor-based motion analysis system (Lameness Locator; Equinosis LLC, Columbia, MO). A full-factorial repeated measures analysis of variance was used to compare treatment effect across time. IL-1β administration resulted in significant transient lameness in all horses (P < .0001). The median nerve block was successfully performed in all horses and did not result in significant improvement (P = .32) of lameness as quantified by the total differential head vector sum. This result has relevant clinical application as it suggests when performing a lameness examination, it is unlikely that blocking the median nerve with 10 mL of local anesthetic will ameliorate pain originating from the cubital joint.

Effect of the addition of epinephrine to a lidocaine solution on the efficacy and duration of palmar digital nerve blocks in horses with naturally occurring forefoot lameness

OBJECTIVE To determine whether addition of epinephrine to a lidocaine solution would prolong and potentiate the efficacy of a palmar digital nerve block (PDNB) in horses. ANIMALS 6 adult horses with naturally occurring forefoot lameness. PROCEDURES Initially, a PDNB with a 2% lidocaine solution was performed on the affected foot of each horse. Three days later, the PDNB was repeated with a 1% lidocaine solution or a 1% lidocaine solution containing epinephrine (dilution, 1:200,000). After another 3-day washout period, the PDNB was repeated with the treatment opposite that administered for the second PDNB. Gait was analyzed with a computerized lameness analysis system and heart rate and extent of skin sensation between the heel bulbs of the blocked foot were evaluated at predetermined times for 2 hours after each PDNB. RESULTS Efficacy and duration of the PDNB did not differ significantly between the 2% and 1% lidocaine treatments. The addition of epinephrine to the 1% lidocaine solution improved the efficacy and prolonged the duration of the PDNB. It also resulted in a positive correlation between skin desensitization and amelioration of lameness. Median heart rate remained unchanged throughout the observation period for all 3 treatments. No adverse effects associated with the PDNBs were observed. CONCLUSIONS AND CLINICAL RELEVANCE Addition of epinephrine (dilution, 1:200,000) to a 1% lidocaine solution improved the efficacy and prolonged the duration of a PDNB in horses with naturally occurring lameness and might be clinically useful for lameness evaluations and standing surgery of the forefoot of horses.

Arthrodesis of the Distal Interphalangeal Joint in a Horse Using Stainless Steel Baskets and Transarticular 4.5-mm Cortical Screws

The distal interphalangeal joint was successfully arthrodesed in a 7-monthold horse using two 13-mm stainless steel baskets that were packed with autogenous cancellous bone and held in place with transarticular 4.5-mm cortical screws. The baskets were placed midway between the extensor process of the distal phalanx and the collateral ligament on the corresponding side of the joint. The screws were directed from the abaxial side of the middle phalanx, axially and distally through the basket and across the joint space, into the distal phalanx. Bony fusion of the distal interphalangeal joint occurred through the region occupied by the baskets as well as through the central region of the joint. The horse was free of lameness at the walk in the operated limb from the fourth until the tenth postoperative month, at which time lameness recurred as a result of sepsis in the region of the lateral implant. An additional complication was the development of a carpus varus deformity in the contralateral forelimb, presumably as a result of stretching of the lateral collateral carpal ligaments from excessive weight-bearing coupled with an abnormal posture (tripod stance) during convalescence. The horse was euthanatized 10 months after the arthodesis procedure because of severe lameness associated with sepsis in the region of the lateral implant.

Arthrodesis of the distal interphalangeal joint can be accomplished by inserting perforated stainless steel baskets into the joint.

Modifications in the surgical approach to avoid complications of sepsis need to be made before this technique can be recommended for clinical application.

Although the horse did not survive long-term, presentation of this technique should prove useful to other investigators as they attempt to devise techniques to fuse the distal interphalangeal joint.