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Background: Surgical treatment of congenital heart defects affecting the right ventricular outflow tract (RVOT) often requires complex reconstruction and multiple reoperations due to structural degeneration and lack of growth of currently available materials. Hence, alternative approaches for RVOT reconstruction, which meet the requirements of biocompatibility and long-term durability of an ideal scaffold, are needed. Through this full scale pre-clinical study, we demonstrated the growth capacity of a Wharton’s Jelly derived mesenchymal stromal cells (WJ-MSC) tissue engineered vascular graft used in reconstructing the main pulmonary artery in piglets, providing proof of biocompatibility and efficacy.Methods: Sixteen four-week-old Landrace pigs were randomized to undergo supravalvar Main Pulmonary Artery (MPA) replacement with either unseeded or WJ-MSCs-seeded Small Intestinal Submucosa-derived grafts. Animals were followed up for 6 months by clinical examinations and cardiac imaging. At termination, sections of MPAs were assessed by macroscopic inspection, histology and fluorescent immunohistochemistry.Results: Data collected at 6 months follow up showed no sign of graft thrombosis or calcification. The explanted main pulmonary arteries demonstrated a significantly higher degree of cellular organization and elastin content in the WJ-MSCs seeded grafts compared to the acellular counterparts. Transthoracic echocardiography and cardiovascular magnetic resonance confirmed the superior growth and remodelling of the WJ-MSCs seeded conduit compared to the unseeded.Conclusion: Our findings indicate that the addition of WJ-MSCs to the acellular scaffold can upgrade the material, converting it into a biologically active tissue, with the potential to grow, repair and remodel the RVOT.

Cardioplegic cardioprotection strategies used during paediatric open-heart surgery remain suboptimal. Sildenafil, a phosphodiesterase 5 (PDE-5) inhibitor, has been shown to be cardioprotective against ischemia/reperfusion injury in a variety of experimental models and this study therefore tested the efficacy of supplementation of cardioplegia with sildenafil in a piglet model of cardiopulmonary bypass and arrest, using both cold and warm cardioplegia protocols. Piglets were anaesthetized and placed on coronary pulmonary bypass (CPB), the aorta cross-clamped and the hearts arrested for 60 min with cardioplegia with or without sildenafil (10 nM). Twenty minutes after removal of cross clamp (reperfusion), attempts were made to wean the pigs from CPB. Termination was carried out after 60 min reperfusion. Throughout the protocol blood and left ventricular tissue samples were taken for analysis of selected metabolites (using HPLC) and troponin I. In both the cold and warm cardioplegia protocols there was evidence that sildenafil supplementation resulted in faster recovery of ATP levels, improved energy charge (a measure of metabolic flux) and altered release of hypoxanthine and inosine, two purine catabolites. There was no effect on troponin release within the studied short timeframe. In conclusion, sildenafil supplementation of cardioplegia resulted in improved cardiac energetics in a translational animal model of paediatric CPB surgery.

Abstract Background Canine intrarenal cystic lesions (ICLs) are infrequently reported in the veterinary literature. Several treatment options have been described including cyst fenestration (partial nephrectomy/deroofing) +/− omentalization, sclerotherapy using alcohol as a sclerosing agent, percutaneous cyst drainage (PCD), and ureteronephrectomy. Information regarding presenting clinical signs, physical examination findings, histologic diagnosis and outcomes of dogs with ICLs treated by different methods is limited. Medical records of 11 institutions were retrospectively reviewed to identify dogs that underwent PCD, sclerotherapy, surgical deroofing +/− omentalization, or ureteronephrectomy for management of ICLs from 2004 to 2021. Six weeks postoperative/post-procedural follow-up was required. Cases suspected to represent malignancy on preoperative imaging were excluded. The study objective was to provide information regarding perioperative characteristics, complications, and outcomes of dogs undergoing treatment of ICLs. Results Eighteen dogs were included, with 24 ICLs treated. Ten had bilateral. There were 15 males and 3 females, with crossbreeds predominating. PCD, sclerotherapy, deroofing and ureteronephrectomy were performed in 5 (5 ICLs treated), 7 (11 ICLs), 6 (6), and 7 (7) dogs, respectively, with 5 dogs undergoing > 1 treatment. Seven dogs experienced 8 complications, with requirement for additional intervention commonest. PCD, sclerotherapy and deroofing resulted in ICL resolution in 0/5, 3/11 and 3/6 treated ICLs, respectively. Histopathology identified renal cysts (RCs) in 7/13 dogs with histopathology available and neoplasia in 6/13 (4 malignant, 2 benign). Of 5 dogs diagnosed histopathologically with neoplasia, cytology of cystic fluid failed to identify neoplastic cells. Among 7 dogs with histologically confirmed RCs, 4 had concurrent ICLs in ipsilateral/contralateral kidney, compared with 2/6 dogs with histologically confirmed neoplasia. Conclusions Benign and neoplastic ICLs were approximately equally common and cystic fluid cytology failed to differentiate the 2. Among renal-sparing treatments, deroofing most commonly resulted in ICL resolution. Presence of concurrent ICLs in ipsilateral/contralateral kidney does not appear reliable in differentiating benign from malignant ICLs.

Abstract Objectives Analyze the mechanics of Finochietto-style retractors, including the responses of thoracic tissues during thoracotomy, with an emphasis on tissue trauma and means for its reduction. Methods Mechanical analyses of the retractor were performed, including analysis of deformation under load and kinematics of the crank mechanism. Thoracotomies in a porcine model were performed in anesthetized animals (7) and fresh cadavers (17) using an instrumented retractor. Results Mechanical analyses revealed that arm motion is a non-linear function of handle rotation, that deformation of the retractor under load concentrates force at one edge of the retractor blade, and that the retractor behaves like a spring, deforming under the load of retraction and continuing to force open the incision long after crank rotation stops. Experimental thoracotomies included retractions ranging from 50 to 112 mm over 30 to 370 s, generating maximum forces of 118 to 470 N (12–50 kgf). Tissue ruptures occurred in 12 of the 24 retractions. These ruptures all occurred at retraction distances wider than 30 mm and at forces greater than 122.5 N. Significant tissue ruptures were observed for nearly all retractions at higher retraction rates (exceeding ½ rotation of the crank per 10 s). Conclusions The Finochietto-style retractor can generate large forces and some aspects of its design increase the probability of tissue trauma.

Safe hydrogel delivery requires stiffness-matching with host tissues to avoid iatrogenic damage and reduce inflammatory reactions. Hydrogel-encapsulated cell delivery is a promising combinatorial approach to spinal cord injury therapy, but a lack of in vivo clinical spinal cord injury stiffness measurements is a barrier to their use in clinics. We demonstrate that ultrasound elastography – a non-invasive, clinically established tool – can be used to measure spinal cord stiffness intraoperatively in canines with spontaneous spinal cord injury. In line with recent experimental reports, our data show that injured spinal cord has lower stiffness than uninjured cord. We show that the stiffness of hydrogels encapsulating a clinically relevant transplant population (olfactory ensheathing cells) can also be measured by ultrasound elastography, enabling synthesis of hydrogels with comparable stiffness to canine spinal cord injury. We therefore demonstrate proof-of-principle of a novel approach to stiffness-matching hydrogel-olfactory ensheathing cell implants to ‘real-life’ spinal cord injury values; an approach applicable to multiple biomaterial implants for regenerative therapies.

PICO questionWhich sternotomy closure method (orthopaedic wire or suture) is recommended in large breed dogs undergoing a median sternotomy?Clinical bottom lineThe literature search revealed no clinical studies on large breed dogs comparing the clinical outcomes following either orthopaedic wire or suture sternotomy closure methods. Post-mortem studies on large breed dogs suggest that sutures are as suitable as orthopaedic wires for sternal closure with regards to their biomechanical properties. There is insufficient clinical evidence to make a recommendation that sutures be used in large breeds of dog.

OBJECTIVE:To (1) characterise the chemical and ultra-structural composition of ameroid constrictors, at a native state and during in vitro expansion and (2) determine the presence of irritant compounds at the surface or within the bulk of the constrictor. METHODS:Twelve sterile, commercially packaged ameroid constrictors (3 repeats of 3.5 mm, 5 mm, 6 mm and 7 mm internal diameter) were analysed by time-of-flight secondary ion mass spectrometry, Raman spectroscopy, attenuated total reflectance Fourier transform infrared spectroscopy and scanning electron microscopy. RESULTS:Ameroid constrictors have a composition commensurate with casein with little-to-no intra- or inter- constrictor variation. Microscopic analysis indicated that the topographical features of the constrictor surfaces were consistent between all constrictors. Following in vitro expansion there was a reproducible decrease in Ca+ ion content, little-to-no variation in secondary protein structure and morphological changes including the presence of surface aggregates present only at the inner surface of the ameroid constrictor. The potential irritant polydimethylsiloxane was found on the constrictor surface. A trace quantity of an ion fragment assigned as formaldehyde was detected; however, the extremely low level is thought highly unlikely to play a role as an inflammatory trigger clinically. DISCUSSION:There is a high degree of inter- and intra-constrictor homogeneity from different batches, and reproducible ultrastructural changes following in vitro expansion. Variations occur in both the surface chemistry and topography of the device during closure, which can potentially affect the biomaterial-host interface. Ameroid constrictor closure mechanism is likely involving calcium-mediated inter-protein interactions rather than the imbibition of water only.

BACKGROUND:T-tubules are invaginations of the sarcolemma that play a key role in excitation-contraction coupling in mammalian cardiac myocytes. Although t-tubules were generally considered to be effectively absent in atrial myocytes, recent studies on atrial cells from larger mammals suggest that t-tubules may be more numerous than previously supposed. However, the degree of heterogeneity between cardiomyocytes in the extent of the t-tubule network remains unclear. The aim of the present study was to investigate the t-tubule network of pig atrial myocytes in comparison with ventricular tissue. METHODS:Cardiac tissue was obtained from young female Landrace White pigs (45-75 kg, 5-6 months old). Cardiomyocytes were isolated by arterial perfusion with a collagenase-containing solution. Ca2+ transients were examined in field-stimulated isolated cells loaded with fluo-4-AM. Membranes of isolated cells were visualized using di-8-ANEPPS. T-tubules were visualized in fixed-frozen tissue sections stained with Alexa-Fluor 488-conjugated WGA. Binary images were obtained by application of a threshold and t-tubule density (TTD) calculated. A distance mapping approach was used to calculate half-distance to nearest t-tubule (HDTT). RESULTS & CONCLUSION:The spatio-temporal properties of the Ca2+ transient appeared to be consistent with the absence of functional t-tubules in isolated atrial myocytes. However, t-tubules could be identified in a sub-population of atrial cells in frozen sections. While all ventricular myocytes had TTD >3% (mean TTD = 6.94±0.395%, n = 24), this was true of just 5/22 atrial cells. Mean atrial TTD (2.35±0.457%, n = 22) was lower than ventricular TTD (P3% (1.65±0.06 μm, n = 5, P

4-Aminopyridine (4-AP) blocks voltage gated potassium channels, restoring conduction to demyelinated axons and improving function in demyelinating conditions, but its use is associated with adverse effects and benefit in spinal cord injury is limited. Derivatives of 4-AP have been developed to improve clinical efficacy while reducing toxicity. We compared the therapeutic effects of orally administered 4-AP and its t-butyl carbamate derivative (t-butyl) with placebo in dogs that had suffered an acute spinal cord injury that left them chronically paralyzed. Nineteen dogs were entered into the trial, conducted in two-week treatment blocks starting with placebo, followed by random assignment to 4-AP or t-butyl, a washout and then the opposite medication followed by placebo. Investigators and owners were blinded to treatment group. Primary outcome measures included open field gait score (OFS), and treadmill based stepping score and regularity index, with additional secondary measures also considered. Thirteen of 19 dogs completed the protocol. Two were euthanized due to unrelated heath problems, two developed side effects and two were unable to complete for unrelated reasons. Dogs showed significant improvement in supported stepping score (from 17.39 to 37.24% with 4-AP; 16.85 to 29.18% with t-butyl p

Objectives: The aim of this study was to determine closure-related complications and outcome after median sternotomy (MS) in cats. Methods: This was a retrospective, multicentric study. The medical records of cats undergoing MS from six referral hospitals were reviewed (2010–2020). Data retrieved included signalment, history, presenting complaints, surgery, patient outcomes and complications. Follow-up was performed via patient records and email/telephone contact with both owners and referring veterinarians. Descriptive statistics were performed. Results: Data on 36 cats were collected; four were excluded due to insufficient follow-up and six died less than 5 days after surgery. Twenty-six cats survived to discharge (survival rate 81%). Three cats had a full sternotomy (FS) performed and 23 cats a partial sternotomy (PS). Of the cats that underwent a PS, six included the manubrium (PSM) and three included the xyphoid process. For 14 cats, the length of sternotomy was unknown. Sternotomy closure was performed with suture in all cats. Two cats (7.7%) developed closure-related complications, both after PSM, during the long-term follow-up, one mild, slightly displaced sternal fracture and one severe, sternal dehiscence (without skin wound dehiscence) requiring revision surgery. No seroma, surgical site infection or wound dehiscence occurred. The most common reason for MS was the presence of a thoracic mass (17/26; 65%), with thymoma being the most common (11/17; 65%). Conclusions and relevance: MS has a low closure-related complication risk in cats when compared with dogs. Complications in cats present differently to what has been previously described in dogs. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to describe the indications for percutaneous pigtail catheter placement in cats requiring urine diversion, and to report the associated intra- and postoperative complications. Methods: The medical records of cats that underwent percutaneous pigtail catheter placement for urine diversion between January 2011 and May 2021 were retrospectively reviewed. Results: Twenty-five cats were included. Indications for pigtail catheter placement were medical management of obstructive urinary tract disease (n = 12), urinary tract damage after traumatic injury (n = 8) and neurological bladder dysfunction (n = 5). Catheters were in place for a median time of 8.28 days (range 3–27), and the duration of the catheter placement was not different between the medical, traumatic and neurological groups. Ten cats (40%) developed pigtail catheter complications including dislodgement, urine leakage, urinary tract infection and bladder rupture. The majority of complications were easily resolved and did not require surgical intervention. Conclusions and relevance: The results suggest that percutaneous pigtail catheter placement can facilitate urine diversion in both the emergency setting and in the long-term management of urine retention without many complications. [ABSTRACT FROM AUTHOR]

Balloon valvuloplasty is the treatment of choice for dogs with severe type A pulmonic stenosis (PS), but less successful for dogs with annular hypoplasia and unsuitable for supravalvular stenosis or cases with a circumpulmonary coronary malformation. We report outcomes and complications of the first 15 consecutive transvalvular pulmonic stent angioplasty procedures performed by a single center in dogs with PS. Fifteen dogs with naturally occurring PS were included in the study. Dogs underwent echocardiography before and four weeks after the procedure. Transvenous approaches were used to deploy a pre-mounted, balloon-expandable metallic stent in all cases. Of 15 dogs, all had annular hypoplasia, and in addition, supravalvular stenosis was diagnosed in 11 of 15 dogs, and three had R2A coronary malformation. All dogs survived to discharge. One dog died less than four weeks postoperatively (non-cardiac), but 14 of 15 dogs were re-examined at four weeks. Severity reduced in all cases; median pressure gradient reduced from 137 mmHg (range 81–202 mmHg) to 83 mmHg (range 31–155 mmHg). Clinical signs improved in all cases, and hematocrit reduced in all dogs with erythrocytosis. The median follow-up time was 280 days (range 95–896 days). Over one-year follow-up was available in six of fifteen dogs. Two dogs died because of refractory right-sided congestive heart failure signs: one at 10 months and one at 22 months postoperatively. Transvalvular pulmonic stent angioplasty technique was associated with an improvement in clinical signs and reduction in stenosis severity for all dogs in this population, including cases with supravalvular PS or circumpulmonary coronary malformation. [ABSTRACT FROM AUTHOR]

ABSTRACT The purpose of the study was to report the postoperative outcome, complications, and long-term follow-up of the use of a static hydraulic urethral sphincter for the management of urethral sphincter mechanism incompetence in female dogs. Medical records were reviewed to extract information on long-term (>365 days) outcome data. Telephone owner questionnaire was performed to assess postoperative urinary continence scores (scale 1–10, where 10 is complete continence) and the presence and frequency of complications. Twenty female dogs were included. Mean (±standard deviation) time to follow-up was 1,205.1 (±627.4) days. Median continence score/10 (range) was 3.5 (2–6) preoperatively, and 9.0 (7–10) at the last follow-up. Median continence score was significantly higher at all time points postoperatively compared with before surgery (P <.001). Complete continence was achieved in 90% of bitches. Minor complications occurred in 13 bitches and included dysuria (8), bacterial cystitis (8), longer urination time (10), incisional seroma (5), urinary retention (3), hematuria (2), and pain when urinating (2). Major complications occurred in one dog (static hydraulic urethral sphincter removed 28 mo after placement). Continence scores were sustainably improved in the long-term. Complications were mostly minor. Urinary tract infections were the most common but resolved with conventional antibiotic treatment. [ABSTRACT FROM AUTHOR]

This case report describes a combination of congenital cardiopulmonary abnormalities found in a 1-year-old Labrador Retriever. To the authors' knowledge this combination of cardiopulmonary abnormalities has not been previously reported in veterinary medicine. Unilateral absence of the right pulmonary artery associated with unilateral right-sided aortopulmonary collaterals was observed. These aortopulmonary collaterals preserved the blood supply to the right lung lobes but led to left ventricular volume overload. There was also evidence of severe bullous lung disease in the right lung, which was suspected to be secondary to pulmonary sequestration as a result of the anomalous hemi-pulmonary circulation. The diagnosis of left-sided volume overload was achieved by radiography and echocardiography while the remainder of the findings was diagnosed on computed tomography angiography. The owner refused surgery for occlusion of the shunting vessels and therapy at standard doses of benazepril, spironolactone and pimobendan was initiated. In spite of the severe volume overload, the dog remained stable with static non-progressive clinical signs and stable echocardiographic findings at 1-year follow-up. The case report also acts as a reminder of the possible occurrence of unusual extra-cardiac shunts in the presence of an unexplained left ventricular volume overload. [ABSTRACT FROM AUTHOR]

Abstract: An 8 year old female spayed Boxer dog, diagnosed with concurrent vasovagal syncope and arrhythmogenic right ventricular cardiomyopathy, presented for routine evaluation approximately three months following epicardial pacemaker implantation. Routine device interrogation revealed intermittent loss of ventricular capture and intermittent failure to appropriately sense. Following evaluation of chronic impedance data, failure of the pacemaker lead–header interface or lead conductor fracture was suspected. Radiographic and pacemaker interrogator findings suggested incomplete lead insertion into the device header with intermittent loss of ventricular capture and variable pacemaker sensing. We hypothesize that either the presence of a loose or cross-threaded set screw or operator error at the time of device implantation may have caused this complication. This report details the diagnosis of mechanical failure of the lead–header interface, a complication not previously reported in a veterinary patient. [Copyright &y& Elsevier]

Objectives: To describe a novel atrial retractor and compare 2 methods of intraoperative left atrial retraction for minimally invasive mitral valve repair. Methods: Left atrial retraction was performed on 5 swine cadavers to evaluate performance (percent of mitral valve annulus accessible), complications encountered, ease of use, and surgical time for the minimally invasive atrial retractor and a HeartPort atrial retractor. Results: Estimated accessibilities were 93.0% (standard error = 3.2) and 92.7% (standard error = 3.3) for the HeartPort and minimally invasive atrial retractor retractors, respectively, with a difference of 0.3% (standard error = 2.2%, P = .8832, df = 34). Tissue damage occurred in 1 case for the minimally invasive atrial retractor and 2 cases for the HeartPort retractor. The mean surgical times for retractor placement and mitral valve annulus exposure were 107.4 and 39.2 seconds for the HeartPort and minimally invasive atrial retractor retractors, respectively, with a difference of 68.2 seconds (P = .0092, df = 4). Conclusions: The minimally invasive atrial retractor is a suitable alternative for atrial retraction compared with standard techniques of retraction. It provides comparable exposure of the mitral valve annulus, is less time consuming to place, provides subjectively more working volume within the left atrium, and has the advantage of minimal atriotomy incision length and customizable retraction. [Copyright &y& Elsevier]

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Presents a letter to the editor in response to the article "Laparoscopic Ovariohysterectomy in Nine Dogs," by Doctor Austin.

From a bibliographic analysis and personal experiences, the authors present the advantages of the epidemiologic method in psychiatry. They point out its specificity and the methodological difficulties. Since the psychiatric practices are being deeply transformed, it becomes essential to know precisely the importance and the distribution of mental diseases in the population. It is not possible to image changing a care system trend without knowing the real needs of the population. The descriptive epidemiologic method contributes to this. The aim of analytic epidemiology is ever more important since it allows to spot the circumstances in which mental diseases appear and are developed, and to elaborate etiological hypotheses. Finally, this favors preventive approaches where evaluative epidemiology permits to measure the validity and effectiveness of programs which, like those elaborated for other social calamities (transmissible diseases, degenerative diseases), take place for studies in the field of mental health disorders.

The author opens the subject by questioning "why" and "how" to plan for mental health. Planification is a public health process. This process made modern countries able to develop health care policies in accordance to scientific progress. This allowed to stop the transmission of communicable diseases. Mental health disorders are one of the 4 public health priorities along with cardio-vascular diseases, cancers an consequences of accidents. New care methods have to be found in order to be adapted to recent needs. In many countries, mental health care have been and still are on the way to be modified. These major modifications will be illustrated by the French "sectorisation" which will be replaced in the context of complete reconversion of the French mental health care system. Two research streams will be proposed: research focused on the health care system which will enlight the different systems, their characteristics, activities and adequation; epidemiological studies in order to measure population needs in term of mental health, to clarify how mental health disorders appear and what sort of care are used by the persons. To illustrate these themas, the author will present his own experience. For more than 25 years he was operating on complex private mental health care system using the resources of an epidemiological unit in order to plan the development of this care system.

Changes in psychiatric practices derive from noticeable revision of conceptual framework and from the presence of different resources available to treat mental health problems. After an absolute priority given to the psychiatric hospital which in hand of an able doctor like Esquirol was certainly a splendid instrument of care, has followed the "Sector concept" (catchment area) which ideally insists on preventive and therapeutic measures directed toward the sick or presumably sick individual. But such evolutions are seldom linear and vicious genius tends to slow if not to reverse the process. The author retraces here the evolution of a psychiatric care system managed by himself for 25 years. Originally created by Sivadon in the context of relative freedom due to appurtenance to the private sector, this experience has been developed through addition of a variety of therapeutic structures to end up with a comprehensive System of social psychiatric deserving a catchment area. The author gives us his insights on the slowly made modifications to the functioning of this structure. He confirms the value of the catchment area framework but in the same time underlines his risks.

The author suggests an analysis of the evolution of psychiatry referring to space concepts, according to three stages. In the first one, the topographical space is represented by the asylum and the nosography, which both bound a closed field. The second stage represents the dynamical space of therapeutic institution which refers to the psycho-analytical and sociological concepts. The third stage opens a space of meaning; it refers to the concept of sector, to the process of deinstitutionalization and to the epidemiological field; it tries to surround some projects linked with the notions of mental health and prevention.

The authors, taking the opportunity of an epidemiological study, submit the results of 12 day hospitals functioning, having a similar administrative structure, receiving an homogeneous train of clients but distributed on different points of the national territory and having a different functional organization. They draw conclusions from it, on the day hospital definition, the interest of defining scientific evaluation systems, for a better assessment of the therapeutic functioning, the place and importance of this type of medical service for the evolution of actions in the field of mental health.

The authors report an experience on the assessment of mental illness prevalence rate in the socio-professional population of four French provinces. This analysis, preceded by a demographic study of the considered population, will be extended by an incidence of mental disorders research relative to constitute a cohort of patients which 3 years follow-up study will allowed to make a cost analysis (cost-effectiveness) of the chosen therapeutic ways and means.

From a long term study, the authors analyse the becoming of a 337 psychiatric patients cohort, treated in a day hospital. They examine particularly the correlations between the results (individual and institutional), the primary therapeutic objective and the means employed to reach it. The factor analysis of correspondence (Benzecri's method) permitted them to point out and classify some groups related to the therapeutic projects and their destiny. The relation between the length of stay (cost indicator), the means employed (mean indicator) and the results obtained (result indicator), requires a very thorough analysis to evaluate the possible determinants of health economy studies.

The authors report two epidemiologic surveys using the same methodology, in two areas, one in Tunisia (Governorship of Sousse), the other one in France (XVth Secteur des Yvelines). They define a prevalence rate and an annual incidence rate, in different socio-economic contexts and in inequally equipped areas.