Post operative synovial sepsis following endoscopic surgery: Increased risk associated with the carpal sheath.

REASONS FOR PERFORMING STUDY: The overall rate of sepsis following endoscopic surgery of synovial structures has not previously been documented. Clinical observation has led to the conjecture that tendon sheaths, in particular the carpal flexor tendon sheath, are more prone to post operative synovial sepsis than other synovial structures. OBJECTIVES: To document and investigate the rate of post operative synovial sepsis following elective endoscopic surgery. STUDY DESIGN: Retrospective case series. METHODS: The medical records of horses that underwent arthroscopy, tenoscopy or bursoscopy at Donnington Grove Veterinary Surgery between January 1999 and July 2012 were reviewed. The signalment, anatomical structure involved, use of electrosurgery, tourniquet or motorised resector, presence of a fracture, whether surgery was performed with the horse standing or under general anaesthesia and the number of structures examined were recorded. Multivariable logistic regression was used to test the association between the selected variables and synovial sepsis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Level of significance was P<0.05. RESULTS: There were 1670 horses that underwent endoscopic surgery of 3159 synovial structures: 2517 joints, 583 tendon sheaths and 59 bursae. There were 16 cases of post operative sepsis in 16 horses; therefore, the infection rate was one per 100 horses or 5 per 1000 procedures. Carpal sheath tenoscopy was associated with an OR of developing post operative synovial sepsis of 14.9 (95% CI 4.8-45.9, P<0.001) compared to other synovial structures. Tendon sheath endoscopy had an OR of developing post operative synovial sepsis of 5.21 (95% CI 1.24-21.91, P<0.02) compared to other synovial structures. CONCLUSION: Surgeons should be aware that tendon sheaths and the carpal sheath in particular appear to have higher odds of developing sepsis following endoscopic surgery.

Comparison of conventional and alternative arthroscopic approaches to the palmar/plantar pouch of the equine distal interphalangeal joint.

REASONS FOR PERFORMING THE STUDY: The conventional arthroscopic approach to the palmar/plantar aspect of the distal interphalangeal joint (DIPJ) may result in the inadvertent penetration of the digital flexor tendon sheath (DFTS) and the navicular bursa (NB). This iatrogenic communication would be undesirable subsequent to arthroscopic lavage of a septic DIPJ. HYPOTHESIS: A lateral/medial approach to the palmar/plantar aspect of the DIPJ will result in a significantly lower rate of inadvertent penetration of the DFTS and NB, whilst still providing adequate intra-articular evaluation. METHODS: The conventional palmar/plantar approach or a novel lateral/medial approach to the DIPJ was performed on cadaver fore- and hindlimbs (30 limbs/approach). Subsequently, India ink was injected into the dorsal pouch of the DIPJ, and the DFTS (n = 60) and NB (n = 20) were examined for the presence/absence of ink. In addition, observations of the number of attempts made to access the joint, evidence of iatrogenic intra-articular trauma and occurrence of incomplete visualisation of the palmar/plantar pouch were recorded. RESULTS: With the conventional approach, DFTS penetration was noted in 18/30 (60%) of the limbs, compared to 1/30 (3.3%) with the lateral/medial approach (P≤0.001). NB penetration was seen in 5/10 limbs with the palmar/plantar approach compared to 0/10 with the lateral/medial approach (P = 0.01). No significant differences were found between the approaches in the number of attempts made to access the joint, the incidence of iatrogenic intra-articular trauma, or the occurrence of incomplete visibility of the palmar/plantar pouch. CONCLUSIONS: The novel lateral/medial approach to the DIPJ significantly decreases the risk of inadvertent penetration of the DFTS and NB. POTENTIAL RELEVANCE: The novel lateral/medial approach to the DIPJ is an effective technique to gain access to the palmar/plantar pouches, and is particularly advantageous for arthroscopic lavage of a septic DIPJ.

An investigation of the relationship between race performance and superficial digital flexor tendonitis in the Thoroughbred racehorse.

REASONS FOR PERFORMING STUDY: There is limited information regarding the number of races and the period for evaluation of outcome which is critical for assessment of SDF tendonitis treatments. OBJECTIVE: To evaluate the re-injury rate and racing performance of Thoroughbred racehorses that sustain SDF tendonitis in relation to matched controls in terms of number of races post treatment and maximum racing performance ratings before and after injury. STUDY DESIGN: Clinical records and racing histories of 401 racehorses with a first occurrence of SDF tendonitis diagnosed by ultrasonography. Controls were of the same age, sex and were horses training in the same establishment at the time of injury as the case horses and where the trainer reported that the horse had not had a previous SDF tendon injury or treatment. RESULTS: Eighty percent of both case and control horses returned to racing after the date of injury, and the re-injury proportion within 3 years of treatment was 53%. The difference in Racing Post Rating((max)) (RPR((max))) and the Racing Post Rating in the race immediately before the treatment date was significantly smaller in case horses (mean = 9.6 lbs; range = 0-75) compared to control horses (mean = 17.0 lbs; range = 0-79). No significant decrease in RPR((max)) was noted post injury. No difference between case and control horses was found for return to racing and racing 3 times, but control horses were significantly more likely to compete 5 races post treatment date than case horses. CONCLUSION AND CLINICAL RELEVANCE: Injury was associated with an individual's pre-injury maximum performance level and return to racing and completion of 3 races are not useful indicator of the outcome of horses with SDF tendonitis. The assessment of the outcome of horses with an SDF injury in a population of racehorses using the number of races post injury requires a minimum of 5 races post injury to be a useful indicator. Further, a re-injury proportion in a population of horses in training for 3 years post treatment.

Habitat use affects morphological diversification in dragon lizards.

Habitat use may lead to variation in diversity among evolutionary lineages because habitats differ in the variety of ways they allow for species to make a living. Here, we show that structural habitats contribute to differential diversification of limb and body form in dragon lizards (Agamidae). Based on phylogenetic analysis and ancestral state reconstructions for 90 species, we find that multiple lineages have independently adopted each of four habitat use types: rock-dwelling, terrestriality, semi-arboreality and arboreality. Given these reconstructions, we fit models of evolution to species' morphological trait values and find that rock-dwelling and arboreality limit diversification relative to terrestriality and semi-arboreality. Models preferred by Akaike information criterion infer slower rates of size and shape evolution in lineages inferred to occupy rocks and trees, and model-averaged rate estimates are slowest for these habitat types. These results suggest that ground-dwelling facilitates ecomorphological differentiation and that use of trees or rocks impedes diversification.

The evolution of agriculture in beetles (Curculionidae: Scolytinae and Platypodinae).

Beetles in the weevil subfamilies Scolytinae and Platypodinae are unusual in that they burrow as adults inside trees for feeding and oviposition. Some of these beetles are known as ambrosia beetles for their obligate mutualisms with asexual fungi--known as ambrosia fungi--that are derived from plant pathogens in the ascomycete group known as the ophiostomatoid fungi. Other beetles in these subfamilies are known as bark beetles and are associated with free-living, pathogenic ophiostomatoid fungi that facilitate beetle attack of phloem of trees with resin defenses. Using DNA sequences from six genes, including both copies of the nuclear gene encoding enolase, we performed a molecular phylogenetic study of bark and ambrosia beetles across these two subfamilies to establish the rate and direction of changes in life histories and their consequences for diversification. The ambrosia beetle habits have evolved repeatedly and are unreversed. The subfamily Platypodinae is derived from within the Scolytinae, near the tribe Scolytini. Comparison of the molecular branch lengths of ambrosia beetles and ambrosia fungi reveals a strong correlation, which a fungal molecular clock suggests spans 60 to 21 million years. Bark beetles have shifted from ancestral association with conifers to angiosperms and back again several times. Each shift to angiosperms is associated with elevated diversity, whereas the reverse shifts to conifers are associated with lowered diversity. The unusual habit of adult burrowing likely facilitated the diversification of these beetle-fungus associations, enabling them to use the biomass-rich resource that trees represent and set the stage for at least one origin of eusociality.

Effect of nitroblue tetrazolium on NO synthase and motor function of opossum esophagus.

Nitric oxide mediates neuromuscular events in the opossum esophagus. The NADPH diaphorase stain is used to localize nitric oxide synthase-containing enteric neurons. Cells stain by the NADPH diaphorase technique because they reduce nitroblue tetrazolium to the visible formazan. The effects of nitroblue tetrazolium on neuromuscular function and nitric oxide synthase of esophageal muscle were studied. The NADPH diaphorase stain was performed. Nitroblue tetrazolium inhibited lower esophageal sphincter relaxation, abolished the latency gradient of the off response, and inhibited nitric oxide synthase. The NADPH diaphorase technique stained myenteric plexus nerve cell bodies and nerve processes. Nitroblue tetrazolium is not a nonspecific muscle or nerve toxin, as nerve-mediated cholinergic responses, responses to exogenous nitric oxide, and responses to myogenic stimulation were maintained after nitroblue tetrazolium abolished the off response and lower esophageal sphincter relaxation. Nitroblue tetrazolium inhibits nitric oxide-mediated events and nitric oxide synthase. It stains neurons in the esophageal myenteric plexus.

Nitric oxide modulates a calcium-activated potassium current in muscle cells from opossum esophagus.

Nitric oxide mediates nerve-induced hyperpolarization of circular smooth muscle of the esophagus. Two mechanisms are proposed to explain this hyperpolarization: an increase in K+ current or a decrease in Cl- current. These studies test the hypothesis that nitric oxide increases a K+ current in esophageal smooth muscle. Three outward K+ currents are present in circular smooth muscle cells from the opossum esophagus. One current is a Ca(2+)-activated K+ current (IKCa2+). This current is inhibited by charybdotoxin. Whole cell currents were recorded from isolated opossum esophageal smooth muscle cells using the whole cell patch-clamp technique. These studies showed that IKCa2+ is activated at potentials more positive than -30 mV. Bath application of S-nitroso-L-cysteine increased IKCa2+ by 50% above control levels throughout the entire activation range of potentials. The enhanced current was reversible on washout. Either charybdotoxin, an inhibitor of IKCa2+, or (R)-p-8-(4-chloropenylthio)-guanosine 3',5'-cyclic monophosphorothioate, an inhibitor of protein kinase G, antagonized the increase in outward current induced by S-nitroso-L-cysteine. These data suggest that nitric oxide activates IKCa2+ via the guanosine 3',5'-cyclic monophosphate-protein kinase G signal transduction pathway.

The management of patients with acute myocardial infarction after successful reperfusion with streptokinase.

Intracoronary streptokinase administration has been an effective procedure for establishing reperfusion of an evolving myocardial infarction by lysing the thrombus that is usually responsible for the infarction. After reperfusion is accomplished, appropriate management of the patient must be planned to provide the best chance for assuring continued vessel patency, and appropriate management of the patient's residual coronary artery disease also must be considered. In selected patients, percutaneous transluminal coronary angioplasty of the residual coronary lesion has been performed successfully immediately following reperfusion with streptokinase. Early coronary artery bypass graft surgery has been performed with good results in other patients. The appropriate management of the patient with acute myocardial infarction is still evolving, and only with additional study and experience will the "best" approach in the management of these patients be defined.

Vitamin A metabolism: alpha-tocopherol modulates tissue retinol levels in vivo, and retinyl palmitate hydrolysis in vitro.

The steady-state concentrations of retinol in rat tissues varied as a function of dietary alpha-tocopherol. The liver, kidney, and intestinal retinol concentrations increased in animals fed an alpha-tocopherol-deficient diet despite a decrease (liver) or no change (kidney and intestine) in the concentrations of total vitamin A. In contrast, in lung the concentrations of both retinol and total vitamin A decreased. alpha-Tocopherol inhibited retinyl palmitate hydrolase in vitro in liver, kidney, and intestine; had minimal effect on the testes hydrolase; and stimulated the lung hydrolase. Fifty percent inhibition of the liver hydrolase was provided by an alpha-tocopherol concentration (100 microM), close to that reported in livers of rats fed a purified diet, constituted with moderately low amounts of alpha-tocopheryl acetate. Phylloquinone (vitamin K1) inhibited the retinyl palmitate hydrolase in vitro in all tissues tested, and was about fivefold more potent than alpha-tocopherol. The effects of phylloquinone and alpha-tocopherol on the liver hydrolase were additive, not synergistic. The antioxidant N,N'-diphenyl-p-phenylenediamine, the most effective synthetic vitamin E substitute known, had little effect on the hydrolase. These data show that alpha-tocopherol effects vitamin A metabolism in several tissues, and suggest that it may be a physiological effector of tissue retinol homeostasis.