Survey of canine use and safety of isoxazoline parasiticides.

A veterinarian and pet owner survey (Project Jake) examined the use and safety of isoxazoline parasiticides given to dogs. Data were received during August 1-31, 2018 from a total of 2,751 survey responses. Forty-two percent (1,157) reported no flea treatment or adverse events (AE), while 58% (1594) had been treated with some parasiticide for flea control, and of those that received a parasiticide, the majority, or 83% (1,325), received an isooxazoline. When any flea treatment was given, AE were reported for 66.6% of respondents, with no apparent AE noted for 36.1%. Project Jake findings were compared to a retrospective analysis of publicly available Food and Drug Administration (FDA) and European Medicines Agency (EMA) reported AE. The number of total AE reported to FDA and EMA were comparable, although a 7 to 10 times higher occurrence of death and seizures was reported from the EMA or from outside the United States (US). Serious AE responses for death, seizures and neurological effects reported in our survey were higher than the FDA but moderately lower than the EMA reports. These sizable global data sets combined with this pre- and post-parasiticide administration survey indicated that isoxazoline neurotoxicity was not flea- and tick-specific. Post-marketing serious AE were much higher than in Investigational New Drug (IND) submissions. Although the labels have recently been updated, dogs, cats and their caregivers remain impacted by their use. These aggregate data reports support the need for continued cross-species studies and critical review of product labelling by regulatory agencies and manufacturers.

Aquaporin-1 Expression in Herniated Human Lumbar Intervertebral Discs.

STUDY DESIGN: Case series. OBJECTIVE: Intervertebral disc (IVD) degeneration is the cause of spondylosis. The pathogenesis is poorly understood, but disc dehydration often plays a role. In this study, we aim to identify and quantify aquaporin-1 (AQP1) in ex vivo human degenerated IVDs obtained intraoperatively and to investigate the relationship between AQP1 levels and magnetic resonance imaging (MRI) T2 intensity of the disc. METHODS: Ex vivo samples of nucleus pulposus (NP) tissue from lumbar IVDs were obtained from 18 consecutive patients who underwent surgery for disc herniation at L4/5 and L5/S1 level. Immunohistochemistry was performed to determine the presence of AQP1 expression, and this was quantified by Western blot analysis. AQP1 expression was compared to preoperative IVD signal intensity on T2-weighted MRI. RESULTS: NP tissue was obtained from 18 patients (9 for L4/5 level and 9 for L5/S1 level). AQP1 expression was detected in all samples by Western blot and immunohistochemistry. AQP1 expression had a linear correlation with the preoperative IVD signal intensity on T2-weighted MRI at L4/5 level (R2 = 0.90) and at L5/S1 level (R2 = 0.92). AQP1 expression was 52.2 ± 59.0 at L5/S1 level and 15.9 ± 20.6 at L4/5 (P = .10). CONCLUSIONS: Our results show that AQP1 can be detected in IVD obtained from live human subjects. Increased AQP1 expression is associated with greater disc hydration as measured by signal intensity on T2-weighted MRI. AQP1 may have a role in the dehydration associated with disc degeneration.

Postorthopedic Surgery Joint Replacement Surgery Venous Thromboembolism Prophylaxis.

Elective total hip or knee arthroplasty places patients at risk for venous thromboembolism (VTE). As our understanding of the pathophysiology of VTE after joint arthroplasty has increased, pharmacologic strategies have been developed to target different aspects of the coagulation cascade. Various approaches have been used as risk reduction strategies. In 2011 and 2014 the Food and Drug Administration approved rivaroxaban and apixaban as new oral antithrombotic agents. Although controversies remain with regard to the ideal VTE pharmacoprophylactic agent, this class of novel oral anticoagulants has been demonstrated to be safe and to be more effective than enoxaparin.

Utilization of a novel digital measurement tool for quantitative assessment of upper extremity motor dexterity: a controlled pilot study.

BACKGROUND: The current methods of assessing motor function rely primarily on the clinician's judgment of the patient's physical examination and the patient's self-administered surveys. Recently, computerized handgrip tools have been designed as an objective method to quantify upper-extremity motor function. This pilot study explores the use of the MediSens handgrip as a potential clinical tool for objectively assessing the motor function of the hand. METHODS: Eleven patients with cervical spondylotic myelopathy (CSM) were followed for three months. Eighteen age-matched healthy participants were followed for two months. The neuromotor function and the patient-perceived motor function of these patients were assessed with the MediSens device and the Oswestry Disability Index respectively. The MediSens device utilized a target tracking test to investigate the neuromotor capacity of the participants. The mean absolute error (MAE) between the target curve and the curve tracing achieved by the participants was used as the assessment metric. The patients' adjusted MediSens MAE scores were then compared to the controls. The CSM patients were further classified as either "functional" or "nonfunctional" in order to validate the system's responsiveness. Finally, the correlation between the MediSens MAE score and the ODI score was investigated. RESULTS: The control participants had lower MediSens MAE scores of 8.09%±1.60%, while the cervical spinal disorder patients had greater MediSens MAE scores of 11.24%±6.29%. Following surgery, the functional CSM patients had an average MediSens MAE score of 7.13%±1.60%, while the nonfunctional CSM patients had an average score of 12.41%±6.32%. The MediSens MAE and the ODI scores showed a statistically significant correlation (r=-0.341, p<1.14×10⁻5). A Bland-Altman plot was then used to validate the agreement between the two scores. Furthermore, the percentage improvement of the the two scores after receiving the surgical intervention showed a significant correlation (r=-0.723, p<0.04). CONCLUSIONS: The MediSens handgrip device is capable of identifying patients with impaired motor function of the hand. The MediSens handgrip scores correlate with the ODI scores and may serve as an objective alternative for assessing motor function of the hand.

Surgical seroma formation following posterior cervical laminectomy and fusion without rhBMP-2: case report.

Seroma formation following posterior cervical laminectomy and fusion is now recognized as a rare but significant risk. Previous reports have attributed the development of postoperative seromas to the use of recombinant bone morphogenetic protein-2 (rhBMP-2). Here the authors present the case of a 78-year-old female with a history of osteoporosis who developed delayed postoperative neck and shoulder pain following posterior cervical laminectomy and fusion utilizing only autograft bone and demineralized bone matrix (DBM) allograft. Postoperative MRI demonstrated normal hardware placement and a large epidural fluid collection that extended from C-4 to C-6. The patient underwent decompression and drainage of her sterile postoperative seroma. To the authors' knowledge, no case of seroma formation with the use of DBM has been previously reported. This case suggests that although rhBMP-2 is involved in the majority of postoperative seroma developments, other osteoinductive agents such as DBM can contribute to the development of a symptomatic seroma. This report presents an illustrative case study and reviews the current understanding of the development of and treatment for cervical seroma following posterior cervical laminectomy and fusion.

Minimally invasive surgery for lumbar microdiscectomy.

Symptomatic disc herniation is a common indication for spinal operations. The open microscopic discectomy has been the traditional method of addressing this pathology, but minimally invasive techniques are increasingly popular. Potential advantages of the MIS microdiscectomy approach include decreased muscle and soft tissue disruption, shorter length of stay and decreased postoperative pain. Here we demonstrate an MIS microdiscectomy on a 24-year-old female with a left L-4 and L-5 radiculopathy secondary to a large L4-5 disc herniation. The video can be found here: http://youtu.be/aXyZ2FJMh2s.

Minimally invasive palliative resection of lumbar epidural metastasis.

Spinal metastatic lesions are the most common tumors encountered by spinal surgeons. As with procedures for degenerative disease, minimally invsive surgery techniques have been applied to minimize muscle and soft tissue destruction in procedures for tumor resection. Here, we present a 23-year-old female with radiculopathy and foot drop secondary to nerve root compression by epidural metastases from Ewing's sarcoma. This patient had a history of previous resection and instrumentation as well as multiple rounds of chemotherapy and radiation that failed to control her disease. The patient presented with three weeks of radicular pain and foot drop that was continuing to worsen at the time of her operation. The decision was therefore made to perform a palliative resection and decompression for relief of her progressive symptoms. In this video, we demonstrate a palliative tumor debulking and nerve root decompression utilizing an MIS approach. The video can be found here: http://youtu.be/tq4kbvKTebI.

Minimally invasive tubular surgery for transforaminal lumbar interbody fusion.

Transforaminal lumbar interbody fusion (TLIF) was originally developed as a method for circumferential fusion via a single posterior approach and is now an extremely common procedure for the treatment of lumbar instability. More recently, minimally invasive techniques have been applied to this procedure with the goal of decreasing tissue disruption, blood loss and postoperative patient discomfort. Here we describe a minimally invasive tubular TLIF on a 60-year-old male with radiculopathy from an unstable L4-5 spondylolisthesis. The video can be found here: http://youtu.be/0BbxQiUmtRc.

Comparison of operating field sterility in open versus minimally invasive microdiscectomies of the lumbar spine.

BACKGROUND: Postoperative wound infection is a preventable risk that can lead to significant adverse outcomes and increased cost of care. Minimally invasive surgeries (MIS) have been found to have lower rates of postoperative infection compared with the traditional approach. To assess if the reported difference is related to intraoperative contamination or to other factors, we assessed the surgical field for sterility. METHODS: We compared 10 MIS versus 10 traditional microdiscectomies. Swabs of the operating field were obtained before and after the procedure from multiple sites in the operating room. Positive and negative controls were taken of the skin immediately before and after preparation of the incision site. All swabs were plated out on Columbia blood agar plates and grown for 48 hours. Colony counting was performed to determine growth. RESULTS: There was no statistically significant difference in the colony counts of swab sites in traditional microdiscectomies compared with MIS microdiscectomies. There was no significant contamination of the operating field using either approach. CONCLUSIONS: In this prospective study, we found that there was no significant difference in bacterial counts in swabs of operative sites in either traditional or MIS microdiscectomies, suggesting that the decreased rate of postoperative infection in the reported literature for MIS cases may be related to other factors, such as patient selection and/or postoperative care.

Minimally invasive surgical decompression for lumbar spinal metastases.

BACKGROUND: The risk of significant morbidity and mortality often outweighs the benefit of surgical resection as palliative treatment for patients with high systemic disease burden, poor cardiopulmonary status, and previous spinal surgeries. Minimally invasive surgical (MIS) approaches to decompressing metastatic epidural cord compression (MECC) can address these issues and thereby make palliation a feasible option for these patients. CASE DESCRIPTION: We present the cases of three consecutively collected patients with severe neurological compromise secondary to lumbar epidural metastases who underwent MIS decompression and achieved improved functional outcome and quality of life. The first patient is a 23-year-old female with metastatic Ewing's sarcoma who presented with 2 weeks of a right foot drop and radiculopathic pain. The next case is that of a 71-year-old male with metastatic prostate cancer who presented with significant radiculopathic L5-S1 pain and severe motor deficits in his lower extremities. The last case is that of a 73-year-old male with metastatic hepatocellular carcinoma who presented with worsening left leg weakness, paresthesia, and dysethesia. Postoperatively, each patient experienced significant improvement and almost complete enduring return of function, strength, and resolution of pain. CONCLUSION: We demonstrate that MIS approaches to spinal decompression as palliative treatment for metastatic disease is a viable treatment in patients with a focal symptomatic lesion and comes with the benefits of decreased surgical morbidity inherent to the minimally invasive approach as well as excellent functional outcomes.

One-step conversion of to its using salts for GC-MSdetection of bacterial endospores.

Methyl sulfate (MeSO4-) salts were explored as thermochemolysis-methylation (TCM) reagents for gas chromatographic (GC) analysis of dipicolinic acid (DPA) as its dimethyl ester (Me2DPA) from bacterial endospores. The reaction was carried out under non-pyrolytic conditions by inserting a small coiled wire filament coated with the sample and reagents directly inside a GC injection port at 290 °C. Above 10 : 1 methyl donor/DPA ratios, alkali metal salts of MeSO4- effected 80-90% conversion of DPA to Me2DPA, which was 10-20 times more active than the same amount of tetramethylammonium hydroxide (TMA-OH) at this temperature. A quaternary salt mixture consisting of 1 : 3 : 1 : 3 TMA+/Na+/OH-/MeSO4- methylated spore DPA with an average conversion of 86% (mean conversion by TMA-OH under the same conditions was 4%). Therefore, the sensitivity for detection of bacterial endospores was increased over 20-fold compared to that observed with the more commonly employed TMA-OH methylating reagent. The limit of detection by this method was 9 × 104 total spores. Mechanisms describing the observed behavior are proposed and discussed. This is the first use of MeSO4- as a TCM reagent for GC.

Sample introduction in gas chromatography using a coiled wire filament.

A simple device for field sampling and concentration of analytes for subsequent introduction into an injection port for gas chromatographic (GC) analysis has been developed. It consists of a tiny, coiled platinum wire filament (CWF) that is attached to a retractable plunger wire, which fits inside a syringe needle housing. Sampling is accomplished by dipping the end of the CWF in a liquid sample, which is drawn into the wire coil by capillary action, and introducing it into the injection port either before or after allowing the solvent to evaporate. The CWF can be used with or without a nonvolatile chemical coating. A major advantage of this sampling device is that nonvolatile sample matrix components remain on the wire coil, reducing the required injection port and liner cleaning frequency and contamination of the head of the chromatographic column. The coil itself can be easily cleaned between analyses by rinsing and/or burning off residual material in a small flame. The sampling coil facilitates specifically designed chemical reactions in the injection port, such as thermochemolysis and methylation. Applications demonstrated in this work include: (1) direct introduction of samples with little or no pre-treatment, (2) simultaneous thermochemolysis and methylation of lipid-containing samples such as bacteria and bacterial endospores for analysis of biomarkers, and (3) solid phase micro-extraction (SPME) using temporary wire coatings. The CWF allowed for significant reduction in sample preparation time, in most cases to less than a few minutes. The peak shapes examined for polycyclic aromatic hydrocarbon analytes (PAHs) were significantly better (asymmetry factors <1.3) when using the CWF sampling technique compared to splitless and on-column injection techniques (asymmetry factors >1.3). Extraction efficiencies for SPME (especially for high boiling point components such as PAHs) improved by an average of 2.5 times when using the CWF compared to the performance of commercially available SPME fibers. Coiled wire filaments and GC injection port liners were used for more than 100 Bacillus endospore thermochemolysis methylation analyses without the need for cleaning or replacement.

Motion generated in the unstable lumbar spine during hospital bed transfers.

STUDY DESIGN: A parallel group design with repeated measures using a cadaver model was employed. OBJECTIVE: The purpose of this study was to evaluate and compare lumbar spine motion generated in the presence of spinal instabilities during common hospital moves using different transfer techniques. SUMMARY OF BACKGROUND DATA: Up to 25% of spinal cord injuries may occur during initial management of the patient with a compromised spinal column, when multiple transfers between diagnostic locations and operating, recovery and hospital rooms are often required. Few studies have compared methods of moving patients with lumbar spinal column injuries in hospital settings. METHODS: A global instability was created in 3 cadavers at L1 and sensors were attached to T12 and L2. A 3-dimensional electromagnetic tracking system (Liberty, Polhemus Inc) was used to measure flexion, lateral bending, and axial rotation while moving a cadaver from one bed to another to compare 2 transfer techniques used in hospitals: manual transfer and the On3, a motorized lateral transfer device (Hill-Rom, Batesville, IN). RESULTS: Significant increases in lumbar angulations (P<0.05 for all motions) were produced by manual transfers as compared with the On3 device. Manual transfers completed with 6 trained personnel produced 153% more flexion, 92% more axial rotation, and 177% more lateral bending than moves performed by 2 people with the On3 transfer device. CONCLUSIONS: The On3 device reduced motion in the patient with an unstable lumbar spine during hospital bed transfers with fewer personnel.

Intraosseous blood supply to the distal humerus.

PURPOSE: Nonunion of the distal humerus after fracture or osteotomy is uncommon but can present an important clinical problem. Vascular insufficiency of bone may be an important contributing factor. The purpose of this study was to describe the intraosseous vascular anatomy of the distal humerus. METHODS: Nine fresh-frozen upper extremity cadaver specimens were injected with India ink and Ward's blue latex solution. A modified Spalteholz technique was used to show the intraosseous vascular anatomy. RESULTS: The distal humeral diaphysis was supplied by a single nutrient artery. The lateral column was supplied predominately by posterior segmental vessels, whereas the medial column was supplied by anterior and posterior segmental vessels. The trochlea, olecranon fossa, and coronoid fossa were watershed areas. CONCLUSIONS: Our study shows the intraosseous vascular anatomy of the distal humerus is relatively consistent. There also appears to be a consistent trochlear vessel medially and small anterior perforating vessels in the lateral column that have not previously been described.