Reverse coronal deformity: use of robotic total knee arthroplasty for identification and correction.

BACKGROUND: Despite continued advances in techniques and implant designs, a population of patients who are dissatisfied after total knee arthroplasty (TKA) remains. During robotic-assisted arthroplasty, real-time intraoperative assessment of patient knee alignment is performed. Here, we assess the prevalence of an under-appreciated deformity, reverse coronal deformity (RCD), and the benefits of utilizing robotic-assisted knee arthroplasty to help correct this dynamic deformity. METHODS: A retrospective study evaluating patients undergoing robotic-assisted cruciate-retaining TKA was performed. Intraoperative measurements were obtained using tibial and femoral arrays to assess coronal plane deformity at full extension and at 90° flexion. RCD was defined as ≥ 2° varus in knee extension that reversed to ≥ 2° valgus in flexion, or vice-versa. Coronal plane deformity was then reassessed after robotic-assisted bony resection and implant placement. RESULTS: Of 204 patients that underwent TKA, 16 patients (7.8%) were found to have RCD, with 14 patients (87.5%) transitioning from varus in extension to valgus in flexion. The average coronal deformity was 7.75°, with a maximum of 12°. These improved to an average coronal change of 0.93° post-TKA. Final medial and lateral gaps were all balanced to within 1° in extension and flexion. Another 34 patients (16.7%) had ≥ 5° change in coronal plane deformity from extension to flexion (average 6.39°), however, did not experience a reversal of their coronal deformity. Outcomes were assessed with KOOS Jr. scores postoperatively. CONCLUSION: Computer and robotic assistance were utilized to demonstrate the prevalence of RCD. We also demonstrated accurate identification and successfully balancing of RCD utilizing robotic-assisted TKA. An increased awareness of these dynamic deformities could aid surgeons in proper gap balancing even in the absence of navigation and robotic-assisted surgery.

Effects of central and peripheral administration of an acute-phase protein, α-1-acid-glycoprotein, on feed intake and rectal temperature in sheep.

In rodents, an acute-phase protein, α-1-acid-glycoprotein (AGP), was shown to provide a link between inflammation and suppression of feed intake by acting as a leptin receptor agonist. The objective of this study was to determine the effects of AGP on feed intake and rectal temperature in sheep. Ewes were ovariectomized, implanted with a cannula into a lateral ventricle of the brain, and kept indoors in individual pens. Feed intake and rectal temperature were determined for sheep in all experiments. In the first experiment, ewes (n = 4) received 1 of 4 treatments [0 (control), 0.012 (low), 0.06 (medium), or 0.30 (high) mg/kg BW AGP] into the lateral ventricle (ICV). All sheep received all treatments in a Latin square design balanced for carryover effects with 10 d between treatments. In the second experiment, ewes (n = 10) received 1 of 2 treatments (0 and 3 mg/kg BW of AGP) intravenously (IV) in a completely randomized design. In the third experiment, ewes (n = 19) received peripheral treatments (IV) of an antipyretic [0 (control) or 2.2 mg/kg BW flunixin meglumine (FLU)] 30 min before receiving central AGP [0 (control) or 0.3 mg/kg BW of AGP] in a completely randomized design. All data were analyzed using a mixed model analysis of variance and tested for effects of treatment, time, and the interaction of treatment and time. Cumulative 48-h feed intake after administration of treatments was also determined. In the first experiment, there was no effect of ICV treatment (P = 0.37) on feed intake rate or on cumulative feed intake (P = 0.31). There was an effect of ICV treatment (P = 0.002) on rectal temperatures, which were greater (P < 0.05) after the high dose of centrally administered AGP. In the second experiment, there was no effect of AGP administration IV on feed intake rate (P = 0.98), on cumulative feed intake (P = 0.41) or on rectal temperature (P = 0.71). In the third experiment, there was an effect of central AGP treatment (P < 0.0001) and an interaction of central AGP and time (P < 0.0001) on rectal temperature, whereas FLU had no effect (P = 0.93), demonstrating that AGP increased rectal temperatures regardless of antipyretic treatment. These results indicate that central AGP increases rectal temperature in sheep by pathways that do not involve prostaglandins. Further research is needed to determine whether AGP may be an important integrator of energy balance and inflammation.

Factors associated with seroprevalence of bovine anaplasmosis in Mississippi, USA.

Anecdotally, Veterinary Feed Directive prescriptions in the southeastern United States (U.S.) are written most often for treatment and prevention of bovine anaplasmosis (BA) but seroprevalence estimates and factors associated with this disease are currently unavailable in Mississippi (MS). Bovine anaplasmosis, a tick-borne disease of cattle caused by Anaplasma marginale, remains an economically important disease in U.S. The lack of recent seroprevalence of BA throughout the U.S. makes accurate assessment of production losses incurred by the cattle industry in the U.S. difficult, if not impossible to estimate. This study was aimed at determining the seroprevalence of and factors associated with BA in MS. Data were obtained from an active survey of 207 beef cows slaughtered between May 2013 and December, 2014 as well as from reviewing 5182 Veterinary Diagnostic Laboratories (VDLs) records of specimens from MS submitted for BA testing between 2002 and 2018. From the active surveillance, the overall observed apparent seroprevalence of BA in MS with cELISA was 28.99% (95% CI: 23.23 - 35.50%) while the estimated true seroprevalence was 29.02% (22.74 - 36.07%). However, from the laboratory records, the overall apparent period seroprevalence of BA in MS between 2002 and 2018 irrespective of diagnostic assay used was 16.72% (15.73 - 17.76%) and yearly increase in the diagnosis of BA followed a significant trend (P < 0.0001). With cELISA, the apparent seroprevalence of BA was 22.11% (20.78 - 23.49%) and the estimated true seroprevalence was 21.62% (20.18 - 23.11%). However, with CFT, the apparent seroprevalence of BA was 13.50% (10.75 - 16.81%) and the estimated true seroprevalence was 47.90% (36.30 - 61.87%). Factors associated with positive BA results were age, cattle type, and quarter of the year the specimens were submitted. The odds of the outcome were 22 as high in adults, 27 times as high in beef cattle, and 2 times as high between October to December in comparisons to juveniles, dairy cattle, and between April to June, respectively. Cattle population in the counties was not associated with positive BA results. Current records from the VDLs appear to accurately estimate the seroprevalence of BA in MS and thus serves as a reliable surveillance tool BA in the state. Because the burden of BA appears to be distributed throughout the state, future prevention and control measures for BA should focus on the identified putative risk factors and be intensified throughout MS.

Seroprevalence of bovine Anaplasmosis in Georgia.

Anecdotally, Veterinary Feed Directive prescriptions in many states in the southeastern United States (U.S.) are written most often for treatment and prevention of bovine anaplasmosis (BA). This tick-borne disease of cattle caused by Anaplasma marginale remains an economically important disease in U.S. However, there are no prevalence estimates of this disease in Georgia (GA). Thus, this study was aimed at determining the seroprevalence of BA in GA. In an active cull beef cow screening for BA, 293 beef cows were sampled from one cattle auction barn and one slaughterhouse between May 2013 and September 2014. These cows originated from 6 of 159 counties in GA. The top 3 counties sampled were Gordon (241 samples), Carroll (25 samples), and Emanuel (12 samples). Of the 293 sampled beef cows, 13 were positive and 280 were negative for BA. Hence, with competitive ELISA, the overall observed apparent seroprevalence of BA in GA was 4.44% (95% CI: 2.61-7.44%) while the estimated true seroprevalence was 2.62% (95% CI: 5.2-5.87%). The top 2 prevalent counties were Carroll and Gordon with apparent seroprevalence of 8% (95% CI: 2.22-24.97) and 4.78% (95% CI: 2.69-8.36), respectively and estimated true seroprevalence of 6.45% (95% CI: 0-25.37) and 2.99% (95% CI: 0.54-6.89), respectively. Although not significant, counties with specimen submissions for BA testing had a greater cattle population and number of cattle farms than counties without specimen submissions. Nevertheless, future prevention and control measures for BA should out of caution target counties with ≥5000 total cattle heads.

Factors associated with seroprevalence of bovine anaplasmosis in Texas.

Bovine anaplasmosis (BA), caused by Anaplasma marginale, is an economically important tick-borne disease of cattle in the United States (U.S.) and worldwide. Anecdotally, Veterinary Feed Directive prescriptions in the southeastern U.S. are written mostly for treatment/prevention of BA. However, there are no recent temporal seroprevalence estimates of BA in Texas (TX). Thus, this study was aimed at determining the seroprevalence of and factors associated with BA in TX. Data were obtained from an active slaughter survey (n = 215) performed between August and December 2014 as well as from reviewing Texas A&M Veterinary Medical Diagnostic Laboratories (TVMDLs) records of specimens submitted for BA testing from January 2002 to June 2012 (n = 15,460). Irrespective of the assay used, the overall apparent seroprevalence of BA in TX between 2002 and 2012 was 15.91% (95% CI: 15.34 - 16.50%) and the yearly increase in seroprevalence followed a significant trend (P < .0001). With cELISA, the apparent seroprevalence of BA was 13.49% (95% CI: 9.56 - 18.7%) and 13.02% (95% CI: 9.74 - 17.18%) for the slaughter survey and TVMDLs records between October and December 2011, respectively. Whereas the estimated true seroprevalence for the same period was 12.35% (95% CI: 8.04 - 18.05%) and 12.78% (95% CI: 9.19 - 17.30%), respectively. Factors associated with positive BA results were age, breed, diagnostic assay used, year and quarter of the year the specimens were submitted. The odds of the outcome were 1.5 times as high when cattle were adults (vs juvenile). In comparison to other breeds, the odds of the outcome were 11.57, 7.16, and 2.5 times higher in Hereford, Angus, and mixed breeds, respectively. When compared to 2003, the odds of the diagnosis of BA was approximately 2 times as high in 2010 but 3 times as high in 2002, 2005, and 2011 and approximately 4 times as high in 2006 and 2007. In comparison to the duration from October to December, the odds of the outcome were approximately 1.5 as high from January to March and from July to September durations. Counties with specimen submissions for BA testing had a significantly greater cattle population (p = .0061) and number of cattle farms (p < .001) than counties without specimen submissions. Subsequent prevention and control measures for BA should target these factors and should prioritize on counties with higher cattle population in the eastern part of TX. Furthermore, TVMDLs records appear sufficient for the surveillance of BA in TX.

Factors associated with Seroprevalence of Anaplasma marginale in Kentucky cattle.

Bovine anaplasmosis (BA) is tick-borne disease of cattle caused by Anaplasma marginale and it remains an economically important disease in the United States (U.S.). We have anecdotal information that Veterinary Feed Directive prescriptions in Kentucky (KY) are written most often for treatment and prevention of BA. However, there are no recent prevalence estimates of this disease in KY. Thus, this study was aimed at determining the seroprevalence of and factors associated with BA in KY. Data were obtained from an active slaughter survey (n = 232) performed between May and July 2013 as well as from reviewing The University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) records of specimens submitted for BA testing from 2002-2012 (n = 2,573). With competitive ELISA, the apparent prevalence of BA in KY was 10.78% (95% CI: 7.41-15.42%) and 11.58% (95% CI: 10.31-12.98%) for the slaughter survey and laboratory records, respectively. Whereas the estimated true prevalence was 9.44% (95% CI: 5.65-14.48%) and 10.3% (95% CI: 8.92-11.8%), respectively. From the laboratory records, factors associated with positive BA results were age, breed, whether specimens were submitted singularly or as a group, year and quarter of the year the specimens were submitted. The odds of the outcome were 5 times as high when cattle were adults (vs juvenile) and almost 4 times as high when specimens were submitted singularly (vs group). In comparison to Holstein breed, the odds of the outcome were 3.5 and 2.5 times higher in Angus and mixed breeds, respectively. The odds of a diagnosis of BA varied in an undulating pattern by year of sample submission. When compared to 2011, the odds of a diagnosis of BA was approximately 3 times as high in 2005, 2008, and 2009 and approximately 5 times as high in 2004, 2006, and 2012. In comparison to the duration from January to March, the odds of the outcome were almost 20 times as high from July to September but 10 times as high from October to December durations. Counties with specimen submissions for BA testing had a significantly greater cattle population and number of cattle farms than counties without specimen submissions. Future prevention and control measures for BA should target these factors and should be weighted more on counties with higher cattle population. Furthermore, current records from the UKVDL appear sufficient for the surveillance of BA in KY.

Kisspeptin receptor agonist (FTM080) increased plasma concentrations of luteinizing hormone in anestrous ewes.

Kisspeptin receptor (KISS1R) agonists with increased half-life and similar efficacy to kisspeptin in vitro may provide beneficial applications in breeding management of many species. However, many of these agonists have not been tested in vivo. These studies were designed to test and compare the effects of a KISS1R agonist (FTM080) and kisspeptin on luteinizing hormone (LH) in vivo. In experiment 1 (pilot study), sheep were treated with FTM080 (500 pmol/kg BW) or sterile water (VEH) intravenosuly. Blood was collected every 15 min before (1 h) and after (1 h) treatment. In experiment 2, sheep were treated with KP-10 (human Metastin 45-54; 500 pmol/kg BW), one of three dosages of FTM080 (500 (FTM080:500), 2500 (FTM080:2500), or 5000 (FTM080:5000) pmol/kg BW), or VEH intravenously. Blood was collected every 15 min before (1 h) and after (4 h) treatment. In experiment 1, FTM080:500 increased (P < 0.05) plasma LH concentrations when compared to VEH. The area under the curve (AUC) of LH following FTM080:500 treatment was also increased (P < 0.05). In experiment 2, plasma LH concentrations increased (P < 0.05) following treatment with KP-10 and FTM080:5000 when compared to VEH and FTM080:500. The AUC of LH following KP-10 was greater than (P < 0.05) all other treatments and the AUC of LH following FTM080:5000 was greater than (P < 0.05) all treatments except KP-10. These data provide evidence to suggest that FTM080 stimulates the gonadotropic axis of ruminants in vivo. Any increased half-life and comparable efficacy of FTM080 to KP-10 in vitro does not appear to translate to in vivo in sheep.

Reproduction and beyond, kisspeptin in ruminants.

Kisspeptin (Kp) is synthesized in the arcuate nucleus and preoptic area of the hypothalamus and is a regulator of gonadotropin releasing hormone in the hypothalamus. In addition, Kp may regulate additional functions such as increased neuropeptide Y gene expression and reduced proopiomelanocortin (POMC) gene expression in sheep. Other studies have found a role for Kp to release growth hormone (GH), prolactin and luteinizing hormone (LH) from cattle, rat and monkey pituitary cells. Intravenous injection of Kp stimulated release LH, GH, prolactin and follicle stimulating hormone in some experiments in cattle and sheep, but other studies have failed to find an effect of peripheral injection of Kp on GH release. Recent studies indicate that Kp can stimulate GH release after intracerebroventricular injection in sheep at doses that do not release GH after intravenous injection. These studies suggest that Kp may have a role in regulation of both reproduction and metabolism in sheep. Since GH plays a role in luteal development, it is tempting to speculate that the ability of Kp to release GH and LH is related to normal control of reproduction.

Circular external fixation for treatment of distal humerus fractures: case report.

High-energy blasts can lead to complex intra-articular distal humerus fractures with extensive soft tissue loss, and treatment is fraught with complications. We describe 2 patients with such injuries treated successfully with the use of aggressive wound management followed by distal humerus fracture stabilization with a circular external fixator. We chose this circular external fixator over the Ilizarov frame because of our experience and success in the treatment of open tibia fractures with negligible malalignment and high union rate. This circular external fixator allows for indirect reduction of fracture fragments over time to improve final alignment with great control to fine-tune the reduction postoperatively. In our humerus cases, fracture union was achieved with good alignment and acceptable functional range of motion. Symptomatic heterotopic ossification did not develop despite the presence of multiple risk factors.

Posterior remodeling of medial clavicle causing superior vena cava impingement.

Injuries involving the sternoclavicular region resulting in posterior displacement of the medial clavicle are rare, and those that occur prior to fusion of the medial epiphyseal growth plate are more often a result of physis fracture, rather than sternoclavicular joint dislocation. Medial clavicular physis fractures initially are treated by closed reduction with the expectation of normal osseous repair and remodeling. We report a case of a previously fractured medial clavicle physis that abnormally remodeled, was reinjured, and resulted in posterior displacement with superior vena cava impingement and brachioplexopathy. Our case report describes the patient's initial injury and repair, the reinjury and discovery of abnormal remodeling, and the outcome of surgical intervention. We also include a review of recent literature on sternoclavicular joint injuries and treatment options. To our knowledge, this is the first reported case of an abnormally remodeled medial clavicle resulting in superior vena cava compression.

Interaction of estrogen and progesterone on kisspeptin-10-stimulated luteinizing hormone and growth hormone in ovariectomized cows.

BACKGROUND/AIMS: Growth hormone (GH) is necessary for optimal reproductive efficiency and its secretion is influenced by sex steroids. This study was designed to determine whether kisspeptin-10 (Kp10) could stimulate GH and if gonadal steroids enhance the GH response to Kp10 in cows. METHODS AND RESULTS: Intravenous injection of Kp10 at 100 or 200 pmol/kg body weight with or without treatment with estradiol cypionate and/or progesterone increased luteinizing hormone (p < 0.01) plasma concentrations. Plasma concentrations of GH were increased following Kp10 in cows treated with estradiol cypionate and/or progesterone (p < 0.05) but not in cows treated with Kp10 without gonadal steroids. CONCLUSIONS: These data suggest that reproductive steroids enhance the sensitivity of the somatotropic axis to physiologically relevant doses of Kp10, and support the possibility that Kp10 is an integrator of luteinizing hormone and GH release.

Correlating weather and trauma admissions at a level I trauma center.

BACKGROUND: Popular emergency room wisdom touts higher temperatures, snowfall, weekends, and evenings as variables that increase trauma admissions. This study analyzed the possible correlation between trauma admissions and specific weather variables, and between trauma admissions and time of day or season. METHODS: Trauma admission data from a Level I trauma center database from July 1, 1996 to January 31, 2002 was downloaded and linked with local weather data from the Archives of the National Oceanic and Atmospheric Administration website, and then analyzed. RESULTS: There were 8,269 trauma admissions over a total of 48,984 hours for an average of one admission every 6 hours. Daily high temperature and precipitation were valid predictors of trauma admission volume, with a 5.25% increase in hourly incidents for each 10-degree difference in temperature, and a 60% to 78% increase in the incident rate for each inch of precipitation in the previous 3 hours. CONCLUSIONS: Weather and seasonal variations affect admissions at a Level I trauma center. Data from this study could be useful for determining staffing requirements and resource allocation.

Evaluation of the prevalence and onset of lung lesions and their impact on growth of lambs.

OBJECTIVE: To determine the prevalence and temporal onset of lung lesions in lambs and the impact of lung lesions on growth of affected lambs. ANIMALS: 259 crossbred wether lambs from a single flock in the upper Midwestern United States. PROCEDURE: An observational study was conducted. Lambs born in the spring and fall were slaughtered at finished weight or at a predetermined time point. Lungs of each lamb were examined and classified as normal, moderate lesions (consolidation > 5% but < or = 50% of any lobe), or severe lesions (consolidation > 50% of any lobe). Data were examined to detect effects of prevalence or severity of lung lesions on growth and carcass traits. RESULTS: 57 of 89 (64%) spring-born lambs had lung lesions characterized by consolidation of lung tissue. A small number of lambs had pulmonary adhesions or active abscesses. In contrast, only 31 of 108 (29%) fall-born lambs had lung lesions. Severe lung lesions were associated with a significant reduction in average daily gain. Severe lung lesions were not detected until the middle of the finishing period and were associated with culture of Mannheimia haemolytica or Pasteurella multocida. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results indicates that the prevalence of severe lung lesions can be quite high in lambs. Severe lung lesions can lead to greatly decreased growth performance of lambs.

A role for agouti-related protein in appetite regulation in a species with continuous nutrient delivery.

Knowledge of specific neurotransmitters as well as the pathways and mechanisms regulating appetite in ruminants that continually graze, such as sheep, is incomplete. Although fundamentally agouti-related protein (AGRP) has a similar function across species to increase food intake, the regulation of AGRP may vary across grazing and intermittent feeders. To investigate the role of orexigenic peptides in the regulation of feed intake, we first extracted messenger RNA from sheep that were fasted for 3 days, which was then used for PCR followed by cloning and sequencing to demonstrate the presence of hypothalamic AGRP expression. Ovine AGRP was closely related to the bovine, but contained sequence differences with human and mouse AGRP. Analysis of genomic DNA also revealed a similar gene structure to other published species. Secondly, using dual-labeled immunohistochemistry, we determined that there was both increased AGRP immunoreactivity and increased abundance of c-Fos immunoreactivity in AGRP neurons in the arcuate nucleus of fasted sheep. Because AGRP neurons are activated by fasting, we hypothesized that AGRP would stimulate feeding in this ruminant species. Sheep fed ad libitum were injected intracerebroventricularly with concentrations of AGRP at 0.2 and 2.0 nmol/kg. AGRP at 2.0 nmol/kg significantly increased food intake at 4, 6 and 12 h (p < 0.05). A 4th study was done to investigate the interactions of AGRP and neuropeptide Y (NPY) on food intake over a 24-hour period. Intracerebroventricular injections of either AGRP or NPY significantly increased cumulative food intake over saline controls. When AGRP and NPY were injected in combination, food intake was increased over saline controls; however, AGRP did not potentiate the effects of NPY. These results demonstrate that AGRP stimulates food intake in sheep and highlights the important differences between this species and rodent models.