An implantable magnetic drive mechanism for non-invasive arteriovenous conduit blood flow control

OBJECTIVE

Hemodialysis patients usually receive an arteriovenous fistula (AVF) in the arm as vascular access conduit to allow dialysis 2-3 times a week. This AVF introduces the high flow necessary for dialysis, but over time the ever-present supraphysiological flow is the leading cause of complications. This study aims to develop an implantable device able to non-invasively remove the high flow outside dialysis sessions.

METHODS

The developed prototype features a magnetic ring allowing external coupling and torque transmission to non-invasively control an AVF valve. Mock-up devices were implanted into arm and sheep cadavers to test sizes and locations. The transmission torque, output force, and valve closure are measured for different representative skin thicknesses.

RESULTS

The prototype was placed successfully into arm and sheep cadavers. In the prototype, a maximum output force of 78.9±4.2 N, 46.7±1.9 N, 25.6±0.7 N, 13.5±0.6 N and 6.3±0.4 N could be achieved non-invasively through skin thicknesses of 1-5 mm respectively. The fistula was fully collapsible in every measurement through skin thickness up to the required 4 mm.

CONCLUSION

The prototype satisfies the design requirements. It is fully implantable and allows closure and control of an AVF through non-invasive torque transmission. In vivo studies are pivotal in assessing functionality and understanding systemic effects.

SIGNIFICANCE

A method is introduced to transfer large amounts of energy to a medical implant for actuation of a mechanical valve trough a closed surface. This system allows non-invasive control of an AVF to reduce complications related to the permanent high flow in conventional AVFs.

Question-based development of high-risk medical devices: A proposal for a structured design and review process

INTRODUCTION

The recent introduction of the European Medical Device Regulation poses stricter legislation for manufacturers developing medical devices in the EU. Many devices have been placed into a higher risk category, thus requiring more data before market approval, and a much larger focus has been placed on safety. For implantable and Class III devices, the highest risk class, clinical evidence is a necessity. However, the requirements of clinical study design and developmental outcomes are only described in general terms due to the diversity of devices.

METHODS

A structured approach to determining the requirements for the clinical development of high-risk medical devices is introduced, utilizing the question-based development framework, which is already used for pharmaceutical drug development. An example of a novel implantable device for haemodialysis demonstrates how to set up a relevant target product profile defining the device requirements and criteria. The framework can be used in the medical device design phase to define specific questions to be answered during the ensuing clinical development, based upon five general questions, specified by the question-based framework.

RESULTS

The result is a clear and evaluable overview of requirements and methodologies to verify and track these requirements in the clinical development phase. Development organizations will be guided to the optimal route, also to abandon projects destined for failure early on to minimize development risks.

CONCLUSION

The framework could facilitate communication with funding agencies, regulators and clinicians, while highlighting remaining 'known unknowns' that require answering in the post-market phase after sufficient benefit is established relative to the risks.

Second-Generation Atroposelective Synthesis of KRAS G12C Covalent Inhibitor GDC-6036

A chromatography-free asymmetric synthesis of GDC-6036 (1) was achieved via a highly atroposelective Negishi coupling of aminopyridine 5 and quinazoline 6b catalyzed by 0.5 mol % [Pd(cin)Cl]₂ and 1 mol % (R,R)-Chiraphite to afford the key intermediate (R_a)-3. An alkoxylation of (R_a)-3 with (S)-N-methylprolinol (4) and a global deprotection generates the penultimate heterobiaryl intermediate 2. A controlled acrylamide installation by stepwise acylation/sulfone elimination and final adipate salt formation and crystallization delivered high-purity GDC-6036 (1).

Phosphoramidates as Steering Elements for Highly Selective Access to Complementary Imidazo[1,2-a]pyrimidine Isomers

We report that selective N-phosphorylation of aminoimidazoles results in a key steering element that controls isomeric selectivity in the condensation of β-ethoxy acrylamides and aminoimidazoles to furnish imidazo[1,2-a]pyrimidines. We identified conditions that provide highly selective (99:1) phosphorylation at the endo- or exocyclic nitrogen. Either the 2-amino or 4-amino isomer of the (benzo)imidazo[1,2-a]pyrimidine products could be isolated in 64-95% yield. Mass spectrometric analysis and computational studies give insight into the mechanism of this exceptionally selective transformation.

Pd-Catalyzed C-N Coupling Reactions Facilitated by Organic Bases: Mechanistic Investigation Leads to Enhanced Reactivity in the Arylation of Weakly Binding Amines

The ability to use soluble organic amine bases in Pd-catalyzed C-N cross-coupling reactions has provided a long-awaited solution to the many issues associated with employing traditional, heterogeneous reaction conditions. However, little is known about the precise function of these bases in the catalytic cycle and about the effect of variations in base structure on catalyst reactivity. We used ¹⁹F NMR to analyze the kinetic behavior of C-N coupling reactions facilitated by different organic bases. In the case of aniline coupling reactions employing DBU, the resting state was a DBU-bound oxidative addition complex, LPd(DBU)(Ar)X, and the reaction was found to be inhibited by base. In general, however, depending on the binding properties of the chosen organic base, increased concentration of the base can have a positive or negative influence on the reaction rate. Furthermore, the electronic nature of the aryl triflate employed in the reaction directly affects the reaction rate. The fastest reaction rates were observed with electronically neutral aryl triflates, while the slowest were observed with highly electron-rich and -deficient substrates. We propose a model in which the turnover-limiting step of the catalytic cycle depends on the relative nucleophilicity of the base compared to that of the amine. This hypothesis guided the discovery of new reaction conditions for the coupling of weakly binding amines, including secondary aryl amines, which were unreactive nucleophiles in our original protocol.

Breaking the Base Barrier: An Electron-Deficient Palladium Catalyst Enables the Use of a Common Soluble Base in C-N Coupling

Due to the low intrinsic acidity of amines, palladium-catalyzed C-N cross-coupling has been plagued continuously by the necessity to employ strong, inorganic, or insoluble bases. To surmount the many practical obstacles associated with these reagents, we utilized a commercially available dialkyl triarylmonophosphine-supported palladium catalyst that facilitates a broad range of C-N coupling reactions in the presence of weak, soluble bases. The mild and general reaction conditions show extraordinary tolerance for even highly base-sensitive functional groups. Additionally, insightful heteronuclear NMR studies using 15N-labeled amine complexes provide evidence for the key acidifying effect of the cationic palladium center.

Oxidatively Initiated NHC-Catalyzed Enantioselective Synthesis of 3,4-Disubstituted Cyclopentanones from Enals

An unprecedented N-heterocyclic carbene (NHC)-catalyzed annulation of enals to form 3,4-disubstituted cyclopentanones has been discovered. Aryl enals undergo dimerization in the presence of a single-electron oxidant to form C2 symmetric cyclopentanones. A cross-reaction has also been developed, allowing for the synthesis of differentially substituted cyclopentanones. Mechanistically, the reaction is thought to proceed through radical intermediates, further establishing the synthetic utility of this class of reactivity.

Head and neck response of a finite element anthropomorphic test device and human body model during a simulated rotary-wing aircraft impact

A finite element (FE) simulation environment has been developed to investigate aviator head and neck response during a simulated rotary-wing aircraft impact using both an FE anthropomorphic test device (ATD) and an FE human body model. The head and neck response of the ATD simulation was successfully validated against an experimental sled test. The majority of the head and neck transducer time histories received a CORrelation and analysis (CORA) rating of 0.7 or higher, indicating good overall correlation. The human body model simulation produced a more biofidelic head and neck response than the ATD experimental test and simulation, including change in neck curvature. While only the upper and lower neck loading can be measured in the ATD, the shear force, axial force, and bending moment were reported for each level of the cervical spine in the human body model using a novel technique involving cross sections. This loading distribution provides further insight into the biomechanical response of the neck during a rotary-wing aircraft impact.

Enantioselective N-heterocyclic carbene-catalyzed β-hydroxylation of enals using nitroarenes: an atom transfer reaction that proceeds via single electron transfer

A novel oxidative N-heterocyclic carbene-catalyzed reaction pathway has been discovered. Alkyl and aryl enals undergo β-hydroxylation via oxygen atom transfer from electron-deficient nitrobenzenes, followed by trapping of the resultant acyl azolium by the solvent. The proposed mechanism involves a single electron transfer event to initiate the reaction followed by radical recombination. This represents a profound mechanistic departure from the established two-electron disconnects in NHC catalysis.

Effects of cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile collision

BACKGROUND CONTEXT

Whereas arthrodesis is the most common surgical intervention for the treatment of symptomatic cervical degenerative disc disease, arthroplasty has become increasingly more popular over the past decade. Although literature exists comparing the effects of anterior cervical discectomy and fusion and cervical total disc replacement (CTDR) on neck kinematics and loading, the vast majority of these studies apply only quasi-static, noninjurious loading conditions to a segment of the cervical spine.

PURPOSE

The objective of this study was to investigate the effects of arthrodesis and arthroplasty on biomechanical neck response during a simulated frontal automobile collision with air bag deployment.

STUDY DESIGN

This study used a full-body, 50th percentile seated male finite element (FE) model to evaluate neck response during a dynamic impact event. The cervical spine was modified to simulate either an arthrodesis or arthroplasty procedure at C5-C6.

METHODS

Five simulations of a belted driver, subjected to a 13.3 m/s ΔV frontal impact with air bag deployment, were run in LS-DYNA with the Global Human Body Models Consortium full-body FE model. The first simulation used the original model, with no modifications to the neck, whereas the remaining four were modified to represent either interbody arthrodesis or arthroplasty of C5-C6. Cross-sectional forces and moments at the C5 and C6 cervical levels of the neck, along with interbody and facet forces between C5 and C6, were reported.

RESULTS

Adjacent-level, cross-sectional neck loading was maintained in all simulations without exceeding any established injury thresholds. Interbody compression was greatest for the CTDRs, and interbody tension occurred only in the fused and nonmodified spines. Some interbody separation occurred between the superior and inferior components of the CTDRs during flexion-induced tension of the cervical spine, increasing the facet loads.

CONCLUSIONS

This study evaluated the effects of C5-C6 cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile impact. Although cervical arthrodesis and arthroplasty at C5-C6 did not appear to significantly alter the adjacent-level, cross-sectional neck responses during a simulated frontal automobile impact, key differences were noted in the interbody and facet loading.

Rapid Construction of (-)-Paroxetine and (-)-Femoxetine via N-Heterocyclic Carbene Catalyzed Homoenolate Addition to Nitroalkenes

A concise enantioselective synthesis of (-)-paroxetine (Paxil) and (-)-femoxetine has been achieved. Key to these syntheses is a N-heterocyclic carbene catalyzed homoenolate addition to a nitroalkene followed by in situ reduction of the nitro-group to rapidly access δ-lactams.

Asymmetric N-heterocyclic carbene catalyzed addition of enals to nitroalkenes: controlling stereochemistry via the homoenolate reactivity pathway to access δ-lactams

An asymmetric intermolecular reaction between enals and nitroalkenes to yield δ-nitroesters has been developed, catalyzed by a novel chiral N-heterocyclic carbene. Key to this work was the development of a catalyst that favors the δ-nitroester pathway over the established Stetter pathway. The reaction proceeds in high stereoselectivity and affords the previously unreported syn diastereomer. We also report an operationally facile two-step, one-pot procedure for the synthesis of δ-lactams.

Prevention of ischaemia-induced small intestinal adhesions in foals

REASONS FOR PERFORMING STUDY

Treatments addressing variously theorised pathophysiological mechanisms of small intestinal adhesions have been reported. This study applied those classes of treatments to the most clinically relevant aetiology of post operative adhesions.

HYPOTHESIS

Treatments addressing the pathophysiology of ischaemia-reperfusion induced adhesions would accordingly reduce the incidence of adhesions from this model.

METHODS

Four classes of treatments were administered for 72 h to 16 foals subjected to complete ischaemia followed by reperfusion to create peritoneal adhesions. These groups were: 1) FPG group--flunixin meglumine (1.1 mg/kg bwt i.v., divided q.i.d.), potassium penicillin G (22,000 iu/kg bwt i.v., q.i.d.) and gentamicin (2.2 mg/kg bwt i.v., t.i.d.); 2) HEP group--heparin (80 iu/kg bwt subcut., b.i.d.); 3) DMSO group--dimethylsulphoxide (DMSO) (20 mg/kg bwt [diluted in 500 ml normal saline] i.v., b.i.d.); and 4) SCMC group--sodium carboxymethylcellulose (500 ml 3% sterile solution intraperitoneally, administered only at the beginning of surgery).

RESULTS

Post operative intestinal obstruction did not occur in any foal. After 10 days, necropsy revealed bowel-to-bowel adhesions in none of the FPG or DMSO groups, in 2/4 of the SCMC group, in 3/4 of the HEP group and 5/6 foals subjected to the procedure without treatment (UIR group).

CONCLUSIONS

Inhibition of the inflammation associated with ischaemia and reperfusion in foals treated with FPG or DMSO decreased small intestinal adhesions in foals.

POTENTIAL RELEVANCE

Although anti-inflammatory therapy was shown to eliminate bowel-bowel adhesions in this controlled study, it must be remembered that clinical cases are without control. These therapies are advised to improve the result but are unlikely to eliminate the problem.

Use of web-based data collection to evaluate analgesic administration and the decision for surgery in horses with colic

REASONS FOR PERFORMING STUDY

There is no current veterinary information with regard to data entry on a website. We therefore completed a prospective study on use of analgesics in relation to the need for abdominal surgery using a web-based survey instrument.

OBJECTIVES

To establish an internet-based data entry system that could be used to record prospective data on horses with colic.

HYPOTHESIS

Failure of horses to respond to the initial administration of an analgesic is an indicator of the need for abdominal surgery.

METHODS

A survey was developed to determine if the response to administration of an analgesic during a veterinarian's first examination of a horse with colic was related to the need for surgery. Veterinarians were contacted via AAEP and ECN listservs requesting submission of cases using a log-in system at a data entry website. The survey was completed by submission of a data entry page.

RESULTS

Twenty-seven veterinarians submitted details of 119 cases of colic, 28 of which required surgery. The need for surgery was significantly associated with moderate or severe pain observed during the first examination compared to mild or no pain, and with constant pain or return of pain after administration of one or more analgesics and the need to administer a second analgesic treatment. Abnormal findings on rectal examination were not associated with the need for surgery, whereas total absence or decrease of intestinal sounds was significantly related to the odds that surgery was needed. The web-based data collection was successful in collecting all data points on the survey for each case.

CONCLUSIONS

This study reinforced veterinarians' use of response to therapy as a way to determine the need for abdominal surgery.

POTENTIAL RELEVANCE

When a specific diagnosis has not been made, lack of response or resumption of colic after analgesic administration should be considered as an indicator of the need for surgery. Web-based collection of data allows veterinary practitioners to participate in clinical research by providing prospective data.

Investigating the effects of anaerobic and aerobic post-treatment on quality and stability of organic fraction of municipal solid waste as soil amendment

The use of OFMSW for biogas and compost production is considered as a sustainable strategy in saving valuable landfill space while producing valuable product for soil application. This study examines the effects of anaerobic and aerobic post-treatment of OFMSW on the stability of anaerobic digestate and compost and soil quality using seed germination tests. Anaerobic digestion of OFMSW was carried out for fifteen days after which the residual anaerobic digestate was subjected to aerobic post-treatment for seventy days. Seed germination tests showed that fresh feedstock and digestates collected during anaerobic digestion and during the early stages of aerobic post-treatment were phytotoxic. However, phytotoxic effects were not observed in soils amended with the fully stabilised anaerobic digestate compost, ADC. It was also found that seed germination increases with dilution and incubation time, suggesting that lower soil application rates and longer lag periods between soil application of ADC and planting can reduce the amount of biodegradable organics in the ADC, thus enhancing the benefits of ADC as soil amendment.

Development of numerical models for injury biomechanics research: a review of 50 years of publications in the Stapp Car Crash Conference

Numerical analyses frequently accompany experimental investigations that study injury biomechanics and improvements in automotive safety. Limited by computational speed, earlier mathematical models tended to simplify the system under study so that a set of differential equations could be written and solved. Advances in computing technology and analysis software have enabled the development of many sophisticated models that have the potential to provide a more comprehensive understanding of human impact response, injury mechanisms, and tolerance. In this article, 50 years of publications on numerical modeling published in the Stapp Car Crash Conference Proceedings and Journal were reviewed. These models were based on: (a) author-developed equations and software, (b) public and commercially available programs to solve rigid body dynamic models (such as MVMA2D, CAL3D or ATB, and MADYMO), and (c) finite element models. A clear trend that can be observed is the increasing use of the finite element method for model development. A review of these modeling papers clearly indicates the progression of the state-of-the-art in computational methods and technologies in injury biomechanics.

Motion Analysis of the Mandible during Low-Speed, Rear-End Impacts using High-Speed X-rays

There has been much debate over "whiplash"-induced temporomandibular joint (TMJ) dysfunction following low-speed, rear-end automobile collisions. While several authors have reported TMJ injury based on case studies post collision, there has been little biomechanical evidence showing that rear-end impact was the primary cause of such injury. The purpose of this study was to measure the relative translation between the upper and lower incisors in cadavers subjected to low-speed, rearend impacts. High-speed x-ray images used for this analysis were reported previously for the analysis of cadaveric cervical spine kinematics during low-speed, rear-end impacts. The cadavers were positioned at various seatback angles and body postures, producing an overall picture of various seating scenarios. Of the 38 tests conducted using 10 cadavers, there were seven tests from three cadavers in which the positions of the upper and lower incisors could be tracked with precision using imageprocessing software. The relative protrusion, retrusion, and mouth opening were computed from these seven sets of data, providing a better understanding of TMJ motion. Based on this limited data, the average maximum protrusion, retrusion and mouth opening were 1.6+/-1.8, 1.1+/-0.7, and 1.2+/-1.2 mm, respectively. These values appear to fall within normal physiological limits experienced during daily activities such as mastication. It is concluded that low-speed, rear-end automobile collisions do not appear to create the motion required to initiate injury to the TMJ.

Evaluation of Carolina Rinse solution as a treatment for ischaemia reperfusion of the equine jejunum

REASONS FOR PERFORMING STUDY

Ileus and peritoneal adhesions are the most common complications following surgery for small intestinal obstruction. Carolina Rinse (CR) has been shown to decrease reperfusion injury in intestine and other organs.

HYPOTHESIS

CR decreases intestinal inflammation and subsequent scarring associated with reperfusion injury.

METHODS

CR was infused intra-arterially and applied topically just prior to reperfusion in jejunum exposed to experimental ischemia. Vascular permeability, neutrophil accumulation and serosal scarring were compared in treated and untreated intestine.

RESULTS

CR maintained a normal osmotic reflection coefficient and decreased migration of neutrophils into the serosa during reperfusion. After 10 days, treated intestine was normal in appearance with a trend toward less serosal scarring and fibroblast proliferation. There was a significant decrease in fibroplasia at biopsy sites in treated intestine.

CONCLUSIONS

Arterial perfusion combined with topical application of CR during jejunal ischaemia decreases immediate reperfusion injury and limits post operative scarring.

POTENTIAL RELEVANCE

CR should be used as a local perfusate rather than a systemic treatment; it may best be applied topically and intraluminally to avoid damaging mesenteric arteries. CR should be considered an adjunct treatment as part of overall surgical management and post operative care.

Treatment of ischaemic jejunum with topical and intraluminal Carolina Rinse

Carolina Rinse Solution (CRS) was applied topically and intraluminally to ischaemic (Group 1; n = 5) and distended equine jejunum (Group 2; n = 5). Mesenteric blood flow, ORC (osmotic reflection coefficient), wet weight to dry weight ratios (WW/DW), serosal thickness, and neutrophil accumulation in the serosa were measured. After 60 min ischaemia followed by reperfusion (Group 1), mesenteric blood flow remained greater than baseline values. The mean ORC was similar to that previously reported in normal bowel or ischaemic intestine treated with CRS by arterial perfusion. The ORC after distention and decompression (Group 2) increased and was similar to that previously reported in a comparable untreated experimental model. The WW/DW after both ischaemia and distention increased compared to specimens collected from noninstrumented jejunum proximal to the experimental segments in the same horses. There was no difference in neutrophil numbers in the serosa of either ischaemic or distended intestine compared to the noninstrumented proximal jejunum. CRS-treated ischaemic intestine maintained microvascular permeability similar to that reported for normal intestine whereas treated distended intestine did not. Combined topical and intraluminal application of CRS to ischaemic intestine may reduce complications due to acute inflammation during reperfusion.

Treatments to promote colonic hydration: enteral fluid therapy versus intravenous fluid therapy and magnesium sulphate

Although large intestine impactions are commonly treated with i.v. fluids combined with the osmotic laxative MgSO4, enteral fluids are less expensive and also appear to be efficacious for impactions. Therefore, this study was conducted to compare the systemic and gastrointestinal effects of enteral fluids with the changes produced by i.v. fluids combined with MgSO4. Four horses with a fistula in the right dorsal colon alternately received both treatments in 2 periods one week apart. Sixty litres of fluids were administered continuously (10 l/h) through a venous catheter or a nasogastric tube. Magnesium sulphate (1 g/kg bwt) was administered via nasogastric tube before i.v. fluid therapy. Two horses had mild abdominal discomfort at the end of enteral fluid therapy. Pollakiuria, hypostenuria, increased bodyweight, increased faecal and ingesta hydration, and decreased PCV, plasma protein and plasma magnesium were produced by both treatments. Abdominal distention and more pronounced changes in bodyweight and ingesta hydration were seen with enteral fluids. Intravenous fluids plus MgSO4 produced hypocalcaemia and more pronounced changes in plasma protein. These results indicate that enteral fluid therapy is more effective in promoting ingesta hydration and produces less pronounced systemic effects than i.v. fluid therapy plus MgSO4.

Parenteral nutrition for horses with gastrointestinal disease: a retrospective study of 79 cases

Parenteral nutrition is advocated for sick foals and horses, although there is no report which has critically evaluated its benefits in this species. Therefore, the hypothesis that parenteral nutrition (PN) is beneficial for horses with severe gastrointestinal disease was investigated in a retrospective study. Records from 79 treatment courses in horses with gastrointestinal disease were reviewed for the years 1992-2000. The fatality rate (48.1%) was attributed to the severity of the primary disease. Complications due to PN were recorded and hyperglycaemia was the most common complication associated with PN. The number of laparatomies, proportion of horses that received lipid emulsion and the daily cost were higher in nonsurvivors than in survivors. The length of PN course was longer in survivors, although glucose peak was observed later in nonsurvivors after initiation of PN. The content of vitamins in PN solution and plasma protein at the beginning of PN were higher for survivors, while the volume of plasma administered was significantly larger in nonsurvivors. In horses with inflammatory diseases, the rate of glucose infusion and the amount of vitamins administered were higher than in horses with nonstrangulated obstruction. The proportion of horses that received lipid emulsion was higher among those with nonstrangulated and strangulated obstruction than in the group with inflammatory conditions. Because of the diverse group of diseases and the variability in the clinical signs, evaluating the effect of PN on disease outcome was not possible. A prospective study to compare horses with similar clinical conditions treated and not treated with PN is needed to evaluate fully the benefits of PN, and to establish guidelines for patient selection for PN.

Estimate of the national incidence of and operation-level risk factors for colic among horses in the United States, spring 1998 to spring 1999

OBJECTIVE

To estimate the national incidence of, operation-level risk factors for, and annual economic impact of colic among horses in the United States during 1998 and 1999.

DESIGN

Epidemiologic survey.

ANIMALS

21,820 horses on 1,026 horse operations in 28 states.

PROCEDURES

Horses were monitored for colic for 1 year, and results were recorded in a log that was collected quarterly. Operation-level data were collected via 4 on-site personal interviews. Associations between colic and independent variables adjusted for size of operation were determined.

RESULTS

Annual national incidence of colic in the US horse population was estimated to be 4.2 colic events/100 horses per year. Case fatality rate was 11%, and 1.4% of colic events resulted in surgery. Annual cost of colic in the United States was estimated to be $115,300,000.

CONCLUSIONS AND CLINICAL RELEVANCE

The national impact of equine colic is substantial because of the high case fatality rate.

The effect of implanting gentamicin-impregnated polymethylmethacrylate beads in the tarsocrural joint of the horse

OBJECTIVE

To determine the effect of intra-articular gentamicin-impregnated polymethylmethacrylate (PMMA) beads inserted in the equine tarsocrural joint on the synovial fluid, synovial lining, and cartilage, and to determine the peak and sustainable gentamicin concentrations in synovial fluid and plasma.

STUDY DESIGN

Pharmacokinetic, cytologic, and histologic study of the effect of gentamicin-impregnated PMMA on normal equine tarsocrural joints.

ANIMALS

Five healthy adult horses.

METHODS

Gentamicin-impregnated PMMA bead strands (3 strands each of 40 beads, with each strand containing 100 mg gentamicin) were surgically inserted into one radiographically normal tarsocrural joint in 5 horses. Each horse had both joints flushed with 1 L of lactated Ringer's solution before bead administration. Synovial fluid total protein concentration, white blood cell (WBC) count, gentamicin concentration, synovial histology, cartilage integrity, and cartilage glycosaminoglycan (GAG) concentrations were determined.

RESULTS

Gentamicin concentration (mean +/- SEM peak concentration, 27.9 +/- 2.27 microg/mL) occurred in the first 24 hours and remained above 2 microg/mL for 9 days. Gentamicin concentrations in control joints and the plasma remained below detectable levels. The synovial fluid WBC count for treated joints was increased compared with control joints for 72 hours, but was similar at day 6. The synovial protein concentration in gentamicin-treated joints remained increased for 21 days. Synovium in treated joints had diffuse synovitis, whereas control joints had less fibrovascular proliferation. Superficial cartilage erosion was present in all treated joints. There was no difference in the GAG content of treated and control joint cartilage.

CONCLUSIONS

Short-term implantation of gentamicin (300 mg)-impregnated PMMA beads can provide therapeutic levels of gentamicin (>2 microg/mL) in the normal tarsocrural joint for 9 days; however, gentamicin-impregnated PMMA beads induce synovitis and superficial cartilage erosion.

CLINICAL RELEVANCE

Temporary intra-articular administration of antibiotic-impregnated PMMA may be an effective way to treat septic joints that require constant high concentrations of antibiotics.

Serosal injury in the equine jejunum and ascending colon after ischemia-reperfusion or intraluminal distention and decompression

OBJECTIVE

To document morphologic changes that occur in equine intestinal serosa after experimentally induced ischemia and subsequent reperfusion (jejunum, ascending colon) or after intraluminal distention and decompression (jejunum).

STUDY DESIGN

Morphologic effects of ischemia-reperfusion or intraluminal distention-decompression determined on the serosal layer of the equine jejunum. The large colon serosa was evaluated after ischemia-reperfusion injury.

ANIMALS OR SAMPLE POPULATION

Seven adult horses.

METHODS

After induction of general anesthesia and ventral median celiotomy, ischemia was created by arteriovenous (AVO) and lumen occlusion of a 20-cm segment of jejunum and ascending colon for 70 minutes, followed by a 60-minute reperfusion period. Intraluminal distention (25 cm H2O) was created in a second 20-cm jejunal segment and maintained within the abdomen for 120 minutes, followed by a 120-minute decompression period. Seromuscular biopsies were obtained upon entering the abdomen and after the ischemic and reperfusion periods, and after the distention and decompression periods along with corresponding control seromuscular biopsies. Samples were processed and examined by light microscopy, transmission electron, and scanning electron microscopy.

RESULTS

Ischemia and reperfusion, and intraluminal distention and decompression, resulted in severe morphologic changes in the seromuscular layer of equine jejunum. A similar period of ischemia-reperfusion caused minimal changes in the ascending colon serosa.

CONCLUSION

Adult equine jejunum sustains more serosal damage than the ascending colon after similar periods of ischemia-reperfusion injury. Intraluminal distention and subsequent decompression causes serosal damage in the equine jejunum.

CLINICAL RELEVANCE

The small intestine is more susceptible to seromuscular layer damage than the ascending colon.

Effects of intraluminal distention and decompression on microvascular permeability and hemodynamics of the equine jejunum

OBJECTIVE

To determine whether intraluminal distention and subsequent decompression of the equine jejunum affects intestinal blood flow, hemodynamics, and microvascular permeability.

ANIMALS

5 healthy adu t horses.

PROCEDURES

Horses were anesthestized and underwent exploratory laparotomy. Two jejunal segments were identified as sham-operated or instrumented segments. After baseline values were obtained, intraluminal distention was created in the experimental segment to induce an ntraluminal pressure of 18 cm H2O. After 120 minutes of distention, the intestine was decompressed for 120 minutes. Mesenteric blood flow, oxygen delivery, oxygen consumption, microvascular permeability, wet weight-to-dry weight ratio, neutrophil infiltration, and vascular resistance were determined and comparisons made among control, sham-operated, and experimental segments.

RESULTS

Mean jejunal blood flow was 21.4 ml/min per kg. There was a significant decrease in mesenteric bood flow to the distended intestine (13.4 ml/min per kg). Blood flow increased significantly during the decompression period (340% of baseline blood flow). Intraluminal distention and subsequent decompression resulted in a significant increase in microvascular permeability, as determined by the osmotic reflection coefficient. Oxygen delivery and oxygen content decreased significantly during the distention period and increased during decompression. Morphologic evaluation revealed a significant increase in edema and neutrophil infiltration after distention and decompression, compared with results for the sham-operated or control segments.

CONCLUSIONS AND CLINICAL RELEVANCE

Intraluminal distention and decompression of the equine jejunum results in low-flow ischemia and edema, which may contribute to adhesions and ileus in the postoperative period after surgery for obstructions of the small intestines.

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999)

OBJECTIVE

To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint.

DESIGN

Retrospective study.

ANIMALS

15 horses.

PROCEDURE

Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded.

RESULTS

Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.

Changes to water repellence of soil caused by the growth of white-rot fungi: studies using a novel microcosm system

A microcosm system is described which permits assessment of the progressive growth of filamentous fungi through soil. We report on its application to measure the effects of Coriolus versicolor and Phanerochaete chrysosporium upon the sorptivity and water repellence of a mineral soil, measured using a miniature infiltration device. Both fungal species caused moderate sub-critical repellence. Since the pore structure was unaffected, the repellence was probably due to hydrophobic substances of fungal origin. This is the first report of changes in soil repellence caused by the growth of potential xenobiotic bioremediating fungi. The potential consequences are discussed.

Surgical repair of a diaphragmatic hernia in a racehorse

A 9-year-old Thoroughbred was evaluated for clinical signs of acute abdominal pain. During laparotomy, a rent in the diaphragm and herniation of the small intestine into the thoracic cavity were detected. Because edges of the rent were smooth and fibrous, which suggested the defect was chronic, the abdomen was closed without repairing the rent. After recurrence of clinical signs, a second laparotomy was performed, during which the intestines were found to have reherniated. The diaphragmatic rent was repaired, using a polypropylene mesh secured with stainless steel staples. The horse recovered and subsequently returned to racing and jumping. A diaphragmatic hernia should be suspected in horses that have moderate to severe signs of abdominal pain for which a definitive cause can not be identified. Thoracic ultrasonography or radiography can be used to confirm the hernia. Diaphragmatic hernias in horses can be successfully repaired using mesh implants secured with staples.

Cardiopulmonary changes associated with abdominal insufflation of carbon dioxide in mechanically ventilated, dorsally recumbent, halothane anaesthetised horses

The use of laparoscopy for the diagnosis or therapeutic management of abdominal disease in the horse has distinct advantages when it allows the horse to remain standing. However, distending the abdomen by insufflation of a biologically active gas in an anaesthetised horse may add to the physiological challenge of general anaesthesia and recumbency. The cardiopulmonary responses to abdominal insufflation with carbon dioxide (CO2) to 15 mmHg pressure were evaluated in 6 horses in dorsal recumbency anaesthetised with halothane in oxygen and subjected to laparoscopic colopexy. Vaporiser settings targeted a fractional expired halothane of 1.5 MAC and a clinically acceptable depth of anaesthesia. Pressure and rate controlled positive pressure ventilation was adjusted to an ETCO2 of 35 mmHg before abdominal insufflation and was not changed thereafter. Cardiopulmonary data were collected before, at 30 and 60 min during and 30 min after CO2 insufflation. ANOVA for repeated measures followed by Tukey's protected t test were used to determine differences. Partial pressure of oxygen and pH of arterial blood, tidal volume and systemic vascular resistance decreased during abdominal insufflation and laparoscopic surgery whereas mean arterial blood pressure, right atrial pressure, cardiac index, stroke index, partial pressure of CO2 in arterial blood and end tidal respiratory gases, and calculated physiological shunt increased significantly. Only systemic vascular resistance returned to the pre-insufflation level after desufflation. The hypercapnia, acidosis and apparent increase in cardiac work that accompany CO2 pneumoperitoneum for laparoscopic surgery could place the anaesthetised horse at additional risk of perioperative complications.

Laparoscopic colopexy in horses

OBJECTIVE

To describe a technique for laparoscopic colopexy in horses.

STUDY DESIGN

Description of a technique to perform laparoscopic colopexy in horses.

ANIMALS

Six healthy adult horses between 3 and 23 years of age and weighing between 440 and 636 kg.

METHODS

Horses were positioned in dorsal recumbency, and the abdomen was insufflated to an intraabdominal pressure of 15 mm Hg. A laparoscope portal was placed at the umbilicus, and instrument portals were placed cranial to the laparoscope and lateral to midline. The lateral taenia of the left ventral colon was laparoscopically identified and retracted with Babcock forceps to the peritoneal surface and sutured with two strands of size 2 monofilament nylon in a continuous pattern via laparoscopic observation. All horses were euthanatized 90 days after surgery, and the colopexy adhesion was examined histologically.

RESULTS

Laparoscopic colopexy was successful in all six horses. There were no intraoperative or postoperative complications. Initial abdominal insufflation to 15 mm Hg required an average of 38 L (range 32 to 46 L) of carbon dioxide and 9.8 minutes (range 9 to 11 minutes) to be completed. A total of 132 L of carbon dioxide (range 64 to 196 L) was needed for the entire procedure. The laparoscopic colopexy procedure required 95 minutes (range 60 to 142 minutes) to perform. Laparoscopic colopexy resulted in a firm, fibrous adhesion of the colon to the abdominal tunic. Microscopically the colopexy adhesion was mature fibrous tissue with no evidence of inflammation.

CONCLUSIONS

Laparoscopic colopexy can be successfully performed in horses with minimal abdominal invasion.

Prospective study of equine colic incidence and mortality

A prospective study of one year was conducted on 31 horse farms to obtain population based estimates of incidence, morbidity and mortality rates of equine colic. Farms with greater than 20 horses were enrolled by randomly selecting horse owners from 2 adjacent counties of Virginia and Maryland. Descriptive information for 1427 horses was collected at the initiation of the study and updated at 3 month intervals. Time on the farm during the study was tabulated for each horse. When colic was reported by the owner, investigators visited the farm to obtain information about the colic. The crude incidence density rate of colic was 10.6 colic cases/100 horse-years, based on 104 cases/358,991 horse-days. The median farm specific incidence density rate was 7 cases/100 horse-years, and the range for individual farms varied from 0 to 30 colic cases/100 horse-years. A specific diagnosis was not made for 84 (81%) of colic episodes. Seventy colic episodes (67%) were treated by a veterinarian. Drugs were used in 83 (80%) colic episodes, and 78 (75%) of colic cases were mild, requiring no treatment or resolving after only one treatment. Four horses required colic surgery. Fourteen (13%) horses had more than one episode of colic during the year. Mortality from all causes of death was 2.5 deaths/100 horse-years, mortality rate for colic was 0.7 deaths/100 horse-years. Proportional mortality rate of colic, 28%, was higher than for any other cause of death. Horses less than age 2 years or greater than age 10 years had lower incidence than horses age 2-10 years. No difference in colic risk between genders was identified. Arabian horses had the lowest and Thoroughbreds the highest breed specific incidence rates. Horses used for eventing, or in training had a statistically significant higher incidence rate of colic compared to mature horses with no use (pets, retired, on pasture with no stated purpose). Horses used for lessons or with no use had the lowest incidence rates.

Prospective study of equine colic risk factors

A 1 year prospective study was conducted on 31 horse farms to identify risk factors for equine colic. Farms were randomly selected from a list from 2 adjacent counties of Virginia and Maryland, USA. The association between colic and farm or individual horse risk factors related to management, housing, pasture, use, nutrition, health and events was first examined by univariate statistical analysis. Individually significant (P < = 0.25 for farm factors, P < = 0.10 for horse factors) variables were used in a stepwise multivariable forward logistic regression to select explanatory factors (P < = 0.05). Analysis was conducted at 2 levels: farm and individual horse with farm specified as a random effects variable. No farm-level variables were significant. Significant horse-level variables included: age, odds ratio (OR) = 2.8 for horses age 2-10 years compared to < 2 years; history of previous colic, OR = 3.6 relative to no colic; changes in concentrate feeding during the year (1 per year, OR = 3.6, more than 1, OR = 2.2) relative to no changes; more than 1 change in hay feeding during the year, OR = 2.1 relative to no changes; feeding high levels of concentrate (> 2.5 kg/day dry matter, OR = 4.8, > 5 kg/day dry matter, OR = 6.3) relative to feeding no concentrate; and vaccination with monocytic ehrlichiosis vaccine during the study, OR = 2.0 relative to no vaccination. Feeding a whole grain with or without other concentrate components reduced risk, OR = 0.4, relative to feeding no whole grain. Results of the study suggest that diet and changes in diet are important risks for colic in a population of horses on farms.

Treatment of impaction colics

Impactions have been reported in the stomach and all segments of the intestine. Impactions predominately occur just oral to sites of intestinal narrowing or active pacemakers. The most common sites of impaction are in the ileum, the cecum, and the large colon pelvic flexure. The treatment of gastrointestinal impactions depends on the segment affected and the amount of bowel damage which has occurred from distension. Many impactions respond to appropriate administration of analgesics, cathartics, and oral or intravenous fluids. The prognosis for impactions treated medically is better than for those which require surgery.

Diseases and surgery of the cecum

The cecum is an important site of water and electrolyte absorption, as well as microbial digestion of soluble and insoluble carbohydrates. These functions of the cecum and ascending colon require that ingesta be mixed constantly and retained long enough to complete the digestion of cellulose. Parasites, changes in regional blood flow, diet, and various pharmacologic agents are associated with alterations in normal cecal motility patterns.

Signs of sympathetic denervation associated with a thoracic melanoma in a horse

Sympathetic denervation in a 20-year-old, gray, Thoroughbred-Percheron gelding was manifested by cutaneous hyperthermia and sweating over the right side of the body, demarcated by a line from the withers to the elbow and extending cranially. There was cutaneous hyperthermia over the right side of the head, but other signs of Horner's syndrome (sweating, ptosis, miosis, enophthalmos) were not present. The pattern of cutaneous hyperthermia and sweating was consistent with sympathetic denervation localized to the cervicothoracic ganglion, and thoracic radiographs revealed increased density in the craniodorsal thorax. Cytologic evaluation of a sample of pleural effusion revealed mesothelial cells containing melanin and cells suggestive of melanocytes or melanoblasts. Treatment with oral cimetidine and intrapleural cisplatin was not successful. A necropsy was not performed, but the clinical findings supported a diagnosis of thoracic melanoma involving the cervicothoracic ganglion.

Morphologic and quantitative evaluation of the myenteric plexuses and neurons in the large colon of horses

OBJECTIVE

To determine the number of myenteric plexuses and neurons in the large colon of clinically normal horses and whether the number was decreased in the large colon of horses with colon disease.

DESIGN

Prospective study.

SAMPLE POPULATION

Colon samples from 15 clinically normal horses and 31 horses with colon disease.

PROCEDURE

Samples were obtained, fixed, and stained with H&E. The number of myenteric plexuses and neurons and longitudinal muscle thickness were determined in each segment of colon for clinically normal horses. Counts for segments were compared with each other and with counts in the same segment from horses with colon disease.

RESULTS

Myenteric plexus and neuron densities and longitudinal muscle thickness in clinically normal horses were significantly greater in the pelvic flexure and left dorsal and transverse colons. Horses with chronic obstruction (> 24 hours' duration) or with previous obstruction had significantly lower neuron density in the pelvic flexure. Myenteric plexus density in horses with strangulating large colon torsion/volvulus was significantly less in the right ventral, right dorsal, and transverse colons, and neuron density in these horses was significantly less in all segments of colon, except the left ventral colon. Horses with colon strangulation that survived had significantly greater neuron density than horses with colon strangulation that died. Enteroglial cell numbers were increased in myenteric plexuses of horses with acute and chronic obstruction.

CLINICAL IMPLICATIONS

Myenteric plexus and neuron densities can be estimated by evaluating linear counts of H&E-stained colon samples. Enteroglial cells may increase in number in response to myenteric plexus inflammation, which may affect bowel function.