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Background Creatine kinase (CK) and aspartate aminotransferase (AST) activity can be increased with myositis associated with Toxoplasma and Neospora infection in dogs. Hypothesis/Objectives Serum activity of CK and AST can be used as a rapid screen for predicting positive serology in meningoencephalitis caused by Toxoplasma gondii or Neospora caninum in dogs compared to dogs with noninfectious meningoencephalitis. Animals Eighty dogs with meningoencephalitis based on magnetic resonance imaging and cerebrospinal fluid analysis. Methods Retrospective case‐control study. Serological cutoffs (≥1:800 immunofluorescence for Neospora and ≥1:400 IgG or ≥1:64 IgM or both for Toxoplasma) categorized dogs as infected (n = 21, all neosporosis) or noninfected (n = 59). Activities of CK and AST between infected and noninfected groups were compared using a Mann‐Whitney U test and receiver operating characteristic curve analysis. Results No dogs were diagnosed with toxoplasmosis. Serum CK and AST activities were significantly increased (P 99%. An AST cutoff of 57 U/L had 94.44% sensitivity and 85.71% specificity with an estimated negative predicative value of 99%. Conclusions and Clinical Importance High serum CK and AST activity can increase suspicion for neosporosis while awaiting serological tests for dogs with meningoencephalitis.

Background Implantable vagus nerve stimulation (VNS) devices can be used to treat epilepsy in dogs. Adverse effects and short-term complications associated with delivering suggested therapeutic electrical stimulation (>1.5 mA) are not well-described. Objectives To compare complications and adverse effects observed with standard and rapid protocols of current increase. Animals Sixteen client-owned dogs with idiopathic epilepsy. Methods Nonrandomized, nonblinded prospective cohort study. Surgical complications, stimulation-related adverse effects, modifications to stimulator settings, number of hospital visits, and time to reach 1.5 mA stimulation current without intolerable adverse effects were described in dogs receiving current increases every 1 to 3 weeks (slow ramping) and dogs receiving current increases every 8 to 12 hours (fast ramping). Results Self-resolving surgery site seromas formed in 6 dogs. No other surgical complications were observed. Fourteen dogs reached 1.5 mA. Coughing (11/14 dogs; 5 slow, 6 fast ramping) was the most common adverse effect. Intolerable coughing that limited current increases despite changing other stimulus parameters occurred in 6/7 of the fast-ramping group and in none of the slow-ramping group. Median time to 1.5 mA was 72 days (range, 28-98) in the slow-ramping group and 77 days (range, 3-152) in the fast-ramping group. Median number of clinic visits was 6 for the slow-ramping group (range, 5-6) and 3 for the fast-ramping group (range, 1-7). Conclusions and clinical importance Coughing is a common adverse effect of VNS in dogs and generally is well tolerated, particularly if current is increased slowly and other stimulation parameters are adapted for effect.

Background:\ud \ud Although thoracic hemivertebra can cause neurological signs, they occur commonly in neurologically normal dogs.\ud Objectives:\ud \ud To evaluate whether computed tomography (CT) findings and factors associated with signalment can be used to differentiate between dogs with and without neurological signs associated with hemivertebra.\ud Animals:\ud \ud One hundred sixty dogs with ≥1 hemivertebrae were retrospectively studied. This group consisted of 40 dogs with clinical signs caused by hemivertebra and 40 French Bulldogs, 40 Pugs, and 40 English Bulldogs that underwent CT for reasons unrelated to neurological disease.\ud Methods:\ud \ud All dogs underwent CT and affected dogs also underwent magnetic resonance imaging. All CT studies were randomly evaluated by an observer blinded to signalment and clinical status. The following variables were evaluated: presence, number, location, and subtype of hemivertebra; presence of vertebral subluxation; severity of vertebral canal stenosis; presence, location, and severity of kyphosis, and number of vertebrae involved in the kyphotic segment. Statistical modeling was performed to identify factors associated with clinical status.\ud Results:\ud \ud Pug breed (odds ration [OR], 10.8; P = .01), more severe kyphosis (OR, 1.1 per grade increase; P

The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.

Objectives: \ud A previous single-country pilot study indicated serum anti-GM2 and anti-GA1 anti-glycolipid antibodies as potential biomarkers for acute canine polyradiculoneuritis. This study aims to validate these findings in a large geographically heterogenous cohort.\ud \ud Materials and Methods: \ud Sera from 175 dogs clinically diagnosed with acute canine polyradiculoneuritis, 112 dogs with other peripheral nerve, cranial nerve or neuromuscular disorders and 226 neurologically normal dogs were screened for anti-glycolipid antibodies against 11 common glycolipid targets to determine the immunoglobulin G anti-glycolipid antibodies with the highest combined sensitivity and specificity for acute canine polyradiculoneuritis.\ud \ud Results: \ud Anti-GM2 anti-glycolipid antibodies reached the highest combined sensitivity and specificity (sensitivity: 65.1%, 95% confidence interval 57.6 to 72.2%; specificity: 90.2%, 95% confidence interval 83.1 to 95.0%), followed by anti-GalNAc-GD1a anti-glycolipid antibodies (sensitivity: 61.7%, 95% confidence interval 54.1 to 68.9%; specificity: 89.3%, 95% confidence interval 82.0 to 94.3%) and these anti-glycolipid antibodies were frequently present concomitantly. Anti-GA1 anti-glycolipid antibodies were detected in both acute canine polyradiculoneuritis and control animals. Both for anti-GM2 and anti-GalNAc-GD1a anti-glycolipid antibodies, sex was found a significantly associated factor with a female to male odds ratio of 2.55 (P=0.0096) and 3.00 (P=0.0198), respectively. Anti-GalNAc-GD1a anti-glycolipid antibodies were more commonly observed in dogs unable to walk (odds ratio 4.56; P=0.0076).\ud \ud Clinical Significance: \ud Anti-GM2 and anti-GalNAc-GD1a immunoglobulin G anti-glycolipid antibodies represent serum biomarkers for acute canine polyradiculoneuritis.

Once decompressive surgery has been elected, the approach that maximizes the likelihood of gaining access to the herniated material for complete removal should be chosen. In most cases, a procedure that optimizes access to the ventrolateral aspect of the spinal cord will be advantageous but it is important to tailor the details of the surgical procedure to suit individual patients. Decompressive surgery for chronic (type II) herniations will frequently demand a ventral approach with partial corpectomy.

Objectives To determine if dogs with acute polyradiculoneuritis have lower serum 25-hydroxy vitamin D3 concentration compared to a control group of dogs with idiopathic epilepsy. Materials and Methods Retrospective case–control study of 21 dogs with acute canine polyradiculoneuritis and 21 control dogs with idiopathic epilepsy matched for year and season of presentation from a referral hospital population in the UK. Serum concentration of 25-hydroxy vitamin D3 was compared between groups using Student's t-test. Results Dogs with acute canine polyradiculoneuritis had significantly lower (P=0·033) serum 25-hydroxy vitamin D3 concentration (87·1?nmol/L ±55·4?nmol/L) compared to a control group with idiopathic epilepsy (113?nmol/L ±66·3?nmol/L). Clinical Significance The cause and clinical significance of the altered vitamin D status in dogs with acute polyradiculoneuritis are not clear and require further investigation. Our findings pave the way for improved understanding of acute canine polyradiculoneuritis and, potentially, improved clinical management, if a causal role for 25-hydroxy vitamin D3 is defined

Objectives To investigate whether the development of acute canine polyradiculoneuritis is associated with various putative risk factors. Materials and Methods Retrospective case–control study with conditional logistic regression analysis from a referral hospital population in the UK where controls were matched for year of presentation. Results Forty-three cases were identified with acute canine polyradiculoneuritis and 86 controls were selected. Jack Russell terriers and West Highland white terriers were found to have a significantly greater odds of developing acute canine polyradiculoneuritis compared to a mixed baseline group of dogs. The odds of developing acute canine polyradiculoneuritis were greater in the autumn and winter compared to spring. Vaccination, rural/urban habitation, sex, neuter status and age were not associated with development of acute canine polyradiculoneuritis in our population of dogs. Clinical Significance Breed and season were associated with development of acute canine polyradiculoneuritis. However, this is a small sample and so this observation needs confirmation in further studies and other factors may also be involved. Nevertheless, these findings may be important in further understanding the aetiopathogenesis of this condition.

Background Development of management strategies for lumbosacral stenosis in dogs is hampered by the lack of objective diagnostic criteria and outcome measures. Objective To explore the suitability of electrodiagnostic tests as ancillary diagnostic aids, inclusion criteria, or outcome measures. Sample population Sixty‐one client‐owned dogs with clinical signs of lumbosacral foraminal stenosis. Methods A blinded, cross‐sectional cohort study. Fifty‐one dogs exhibiting apparent lumbosacral pain or pelvic limb lameness with no detected orthopedic cause had blinded review of magnetic resonance imaging (MRI), allowing classification as affected with foraminal stenosis (25 dogs), unaffected (20 dogs), or another diagnosis (6 dogs). The presence of electromyographic changes and tibial neurography variables were compared between groups. Results Cord dorsum potential onset latency, F‐wave onset latency (both corrected for limb length), and F‐ratio were increased in dogs with lumbosacral foraminal stenosis versus those without, although there was overlap of the values between groups. The proportion of dogs with electromyographic changes was not significantly greater in MRI‐affected dogs. Conclusion Electrophysiological testing is a useful ancillary test, either to provide stricter inclusion criteria and outcome measures or to aid clinical decision‐making in equivocal cases.

Intracranial neoplasia is commonly diagnosed in dogs and can be treated by a variety of methods, but formal comparisons of treatment efficacy are currently unavailable. This review was undertaken to summarize the current state of knowledge regarding outcome after the treatment of intracranial masses in dogs, with the aim of defining optimal recommendations for owners. This review summarizes data from 794 cases in 22 previously published reports and follows PRISMA guidelines for systematic review. A Pubmed search was used to identify suitable articles. These then were analyzed for quality and interstudy variability of inclusion and exclusion criteria and the outcome data extracted for summary in graphs and tables. There was a high degree of heterogeneity among studies with respect to inclusion and exclusion criteria, definition of survival periods, and cases lost to follow-up making comparisons among modalities troublesome. There is a need for standardized design and reporting of outcomes of treatment for brain tumors in dogs. The available data do not support lomustine as an effective treatment, but also do not show a clear difference in outcome between radiotherapy and surgery for those cases in which the choice is available.

Background: Limited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4-S3 segments. Previous research suggests that L4-S3 SCI does not have a worse prognosis than T3-L3 SCI. Hypothesis/Objectives: To elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4-S3 SCI and compare prognosis to T3-L3 SCI. Animals/Methods: A retrospective study on 61 nonambulatory dogs with L4-S3 SCI, matched to dogs with T3-L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or Results: Fewer L4-S3 dogs regained continence compared to T3-L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4-S3 SCI dogs, fewer dogs regained continence with loss of CPP (P < .001), LMN incontinence (P = .004), and noncompressive lesions (P = .006). Negative prognostic factors for regaining ambulation included absent CPP (P < .001) and large nonchondrodystrophic breed (P = .022). Conclusions and Clinical Importance: Dogs with L4-S3 SCI have a poorer short-term prognosis than do dogs with T3-L3 SCI. Dogs with L4-S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small-breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision-making in L4-S3 SCI.

Background The importance of Chiari-like malformation (CM) in the generation of clinical signs or the formation of syringomyelia in dogs is incompletely understood, partly because the prevalence of various CM definitions in unaffected dogs is unknown. Hypothesis/Objectives The aims were: to estimate the prevalence of CM in dogs asymptomatic for CM or syringomyelia, according to 3 currently used definitions; and, to investigate the effect of brachycephaly and head position during magnetic resonance (MR) imaging on estimates of the prevalence of CM. Animals One ninety-nine client-owned dogs without apparent signs of CM or syringomyelia. Methods Blinded, retrospective analysis. Archived MR images were analyzed for evidence of cerebellar indentation and impaction into or herniation through the foramen magnum. Logistic regression analysis was used to investigate the relationship of CM diagnosis with head position and the cranial index (a measure of brachycephaly). Results In 185 non-Cavalier King Charles Spaniel (CKCS) dogs, indentation was identified in 44% (95% CI, 47–51%) and impaction in 22% (95% CI, 16–28%). No asymptomatic, non-CKCS dogs showed herniation. Regression analysis showed a significant increase in the odds of indentation and impaction in an extended head position and as the cranial index increased (became more brachycephalic). Conclusions and Clinical Importance The high prevalence of cerebellar indentation and impaction suggests that they may be normal anatomical variations and therefore unsuitable as definitions of CM. We suggest that future research into CM in dogs should define cases and controls more strictly so that overlap between normal and abnormal animals is minimized.

An association between degenerative changes in the lumbosacral region of the vertebral column and clinical signs of pain and pelvic limb dysfunction has long been recognized in dogs and has become known as degenerative lumbosacral stenosis syndrome. Over the past two decades, methods of imaging this condition have advanced greatly, but definitive criteria for a reliable diagnosis using physical examination, imaging and electrodiagnostics remain elusive. Available treatment options have changed little over more than 30 years but, more importantly, there is a lack of comparative studies and little progress has been made in providing evidence-based recommendations for the treatment of affected dogs. This review provides an overview of the changes in diagnosis, understanding and treatment of lumbosacral disease in dogs over the past 30 years. Approaches to address the unanswered questions regarding treatment choice are also proposed.

Objectives To evaluate whether screening tests used to identify infectious and neoplastic triggers for immune-mediated haemolytic anaemia, in particular a complete blood count and differential, serum biochemistry profile, urine analysis (including culture), abdominal ultrasound and thoracic radiographs, can identify triggers for steroid-responsive meningitis-arteritis. Methods Retrospective descriptive review. Results Twenty-one steroid-responsive meningitis-arteritis cases were identified in which all screening tests had been performed. All cases had changes in complete blood count (including neutrophilia, monocytosis, lymphocytosis, eosinopenia or anaemia); 19 had changes in biochemistry (including hypoalbuminaemia, hyperglobulinaemia, increased alkaline phosphatase activity, hyperphosphataemia, increased total calcium concentration, hypercholesterolaemia, hyperkalaemia, increased urea concentration and increased alanine aminotransferase activity); two cases had an elevated urine protein to creatinine ratio but none had positive urine culture results; no cases had abnormalities on orthogonal radiographs of the thorax; four cases had abnormalities identified on abdominal ultrasound, which following cytological examination suggested inflammation in the absence of pathological organisms. Clinical Significance Screening tests used to identify infectious and neoplastic triggers in immune-mediated haemolytic anaemia did not isolate triggers for steroid-responsive meningitis-arteritis in the population of dogs under investigation.

Aim The aim of this study is to compare the high-frequency pressure amplitude (oscillatory change in pressure (ΔP)) and tidal volume (high-frequency tidal volume at the airway opening (VTHF)) delivered by the Drager VN500 (Dragerwerk Ag & Co., Lubeck, Germany) and the Sensormedics 3100 (SM3100; CareFusion, San Diego, CA, USA) through a range of oscillatory frequencies. Methods In this benchtop study, high-frequency oscillations were applied to an infant test lung at unrestricted set amplitudes. Pressure and flow were measured as a function of frequency, incremented by 1 Hz from 5 to 15 Hz. Measurements were repeated for a range of ventilator settings, and lung resistive and compliance states. Results The VN500, but not the SM3100, demonstrated an exponential decrease in airway opening ΔP as frequency increased. The difference between the SM3100- and VN500-delivered VTHF became greater with each frequency increment. At 15 Hz, VN500 VTHF was 49% of SM3100 VTHF. Conclusions The VN500 demonstrates a frequency-related reduction in ΔP not observed in the SM3100. Clinicians need to be aware of these differences in performance characteristics.

Part 1 of this How to… concentrated on gathering information by observing the patient. Part 2 is about the hands-on neurological examination.

The first part of this How to… covers observation and the localization of the lesion in the neurological system.

OBJECTIVE To determine the effectiveness of manual bladder expression in paraplegic dogs by comparing urine volumes measured by use of intermittent catheterization and ultrasonography. ANIMALS 36 paraplegic dogs. PROCEDURES 93 measurements of bladder volume were collected for the 36 dogs. Residual urine volume was determined by use of intermittent urethral catheterization and estimated by use of ultrasonography. RESULTS Manual bladder expression voided a mean of 49% of urine from the bladder in this population of dogs. There was no correlation (R2, 0.06) between the effectiveness of manual bladder expression and body weight. Ultrasonographic estimation of bladder volume had good correlation (R2, 0.62) with bladder volume determined by use of intermittent bladder catheterization, but clinically unacceptable variation for predicting actual bladder volume (mean difference, 22 mL; 95% confidence interval, −96 to 139 mL). CONCLUSIONS AND CLINICAL RELEVANCE Manual bladder expression was ineffective at completely emptying urine from the bladder of paraplegic dogs, but the effectiveness of the procedure was not affected by body weight. Manual bladder expression would likely be a useful procedure to prevent increases in pressure within the bladder. Ultrasonographic estimation of bladder volume could be a useful predictor of actual bladder volume, but it was susceptible to wide variations among dogs, and results should therefore be interpreted with caution.

Objective—To determine the effects of syringomyelia on electromyography (EMG) findings, somatosensory-evoked potentials (SEPs), and transcranial magnetic motor-evoked potentials (TMMEPs) in Cavalier King Charles Spaniels (CKCSs). Animals—27 client-owned CKCSs that underwent prebreeding magnetic resonance imaging screening or investigation of clinical signs consistent with syringomyelia. Procedures—In dogs with (n = 11) and without (16) magnetic resonance imaging-confirmed syringomyelia, the median nerve in each thoracic limb was stimulated and SEPs were recorded over the C1 vertebra; onset latency and latency and amplitude of the largest negative (N1) and positive (P1) peaks were measured. The TMMEPs were recorded bilaterally from the extensor carpi radialis and tibialis cranialis muscles; onset latencies in all 4 limbs were measured. Bilateral systematic needle EMG examination was performed on the cervical epaxial musculature, and the number of sites with spontaneous activity was recorded. Results—In dogs with syringomyelia, amplitudes of N1 and P1 and the amplitude difference between P1 and N1 were significantly smaller than those recorded for dogs without syringomyelia (approx 2-fold difference). No difference in SEP latencies, TMMEP latencies, or the proportion of dogs with > 2 sites of spontaneous activity detected during EMG examination was detected between groups. Conclusions and Clinical Relevance—Results indicated that SEP amplitude at the C1 vertebra was a more sensitive measure of spinal cord function in CKCSs with syringomyelia, compared with results of EMG or TMMEP assessment. Measurement of SEP amplitude may have use as an objective assessment of the evolution and treatment of this disease.

SummaryThis case report describes the diagnosis and management of primary femoral nerve sheath tumours in two dogs. Both of the tumours were localised by electromyography (EMG) and magnetic resonance imaging (MRI), and were then surgically resected using a novel approach to the iliopsoas muscle via osteotomy of the ventral ilial wing. This approach should be considered when attempting surgical treatment of conditions affecting the iliopsoas muscle or the femoral nerve because it provides excellent exposure of these structures.

The scaling of turbulent kinetic energy (TKE) and its vertical component (VKE) in the upper ocean boundary layer, forced by realistic wind stress and surface waves including the effects of Langmuir circulations, is investigated using large-eddy simulations (LESs). The interaction of waves and turbulence is modeled by the Craik–Leibovich vortex force. Horizontally uniform surface stress τ0 and Stokes drift profiles uS(z) are specified from the 10-m wind speed U10 and the surface wave age CP/U10, where CP is the spectral peak phase speed, using an empirical surface wave spectra and an associated wave age–dependent neutral drag coefficient CD. Wave-breaking effects are not otherwise included. Mixed layer depths HML vary from 30 to 120 m, with 0.6 ≤ CP/U10 ≤ 1.2 and 8 m s−1 < U10 < 70 m s−1, thereby addressing most possible oceanic conditions where TKE production is dominated by wind and wave forcing. The mixed layer–averaged “bulk” VKE 〈w2〉/u*2 is equally sensitive to the nondimensional Stokes e-folding depth D*S/HML and to the turbulent Langmuir number Lat = u*/US, where u* = |τ0|/ρw in water density ρw and US = |uS|z=0. Use of a D*S scale-equivalent monochromatic wave does not accurately reproduce the results using a full-surface wave spectrum with the same e-folding depth. The bulk VKE for both monochromatic and broadband spectra is accurately predicted using a surface layer (SL) Langmuir number LaSL = u*/〈uS〉SL, where 〈uS〉SL is the average Stokes drift in a surface layer 0 > z > − 0.2HML relative to that near the bottom of the mixed layer. In the wave-dominated limit LaSL → 0, turbulent vertical velocity scales as wrms ∼ u*La−2/3SL. The mean profile (z) of VKE is characterized by a subsurface peak, the depth of which increases with D*S/HML to a maximum near 0.22HML as its relative magnitude /〈w2〉 decreases. Modestly accurate scalings for these variations are presented. The magnitude of the crosswind velocity convergence scales differently from VKE. These results predict that for pure wind seas and HML ≅ 50 m, 〈w2〉/u*2 varies from less than 1 for young waves at U10 = 10 m s−1 to about 2 for mature seas at winds greater than U10 = 30 m s−1. Preliminary comparisons with Lagrangian float data account for invariance in 〈w2〉/u*2 measurements as resulting from an inverse relationship between U10 and CP/U10 in observed regimes.

Objective To clarify the role of sports and exercise physicians as medical assessors. Methods Group discussion between senior doctors at a previous annual conference of the Australasian College of Sports Physicians, followed by further discussion between the authors. Clarification of the key requirements of insurers, and formulation of practical advice for those performing this work. Results Our expertise in performing medical assessments for the purpose of fitness to play sport is a transferable skill. It can also be used to provide medical assessments for injured workers. Our expertise in rehabilitation is also of value to insurers and other interested parties. Conclusion The work is both challenging and rewarding, and can provide additional variety in the working week.

BackgroundSteroid-responsive meningitis-arteritis (SRMA) is an inflammatory disease of dogs that is suspected to be immune-mediated. The development of other immune-mediated diseases has been linked to vaccinations, time of the year, geographic location, sex, neuter status, and breed.Hypothesis/ObjectivesTo identify if the development of SRMA is associated with time of year, vaccination, geographic location, sex, neuter status, and breed.AnimalsSixty SRMA cases and 180 controls, all ≤24 months of age and matched for year of presentation, from a referral hospital population in the United Kingdom.MethodsRetrospective case-control study with unconditional logistic regression analysis.ResultsBeagles (P = .001), Border Collies (P = .001), Boxers (P = .032), Jack Russell Terriers (P = .001), Weimaraners (P = .048), and Whippets (P Conclusions and Clinical ImportanceOnly breed increased the odds of developing SRMA. It would be prudent to investigate the genetics of the identified breeds to help elucidate the etiopathogenesis of SRMA.

A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.

OBJECTIVE: To compare patellar tendon sonographic findings in active, currently asymptomatic, elite athletes with those in nonathletic controls. DESIGN: Cross-sectional cohort study with convenience control sample. SETTING: The Victorian Institute of Sport Tendon Study Group, an institutional elite athlete study group in Australia. PATIENTS AND PARTICIPANTS: Two hundred elite male and female athletes from the sports of basketball, cricket, netball, and Australian rules football. Forty athletes who had current symptoms of jumper's knee were excluded from analysis, leaving 320 subject tendons in athletes who were currently asymptomatic. Twenty-seven nonathletic individuals served as controls. MAIN OUTCOME MEASURE: Sonographic patellar tendon appearance. We measured the dimensions of subject tendons and noted the presence or absence of hypoechoic regions and tendon calcification. Dimensions of hypoechoic regions were measured, and approximate cross-sectional areas were calculated. Chi-squared analysis was used to test the prevalence of hypoechoic regions in subjects and controls and men and women. RESULTS: In currently asymptomatic subjects, hypoechoic regions were more prevalent in athlete tendons (22%) than in controls (4%), in male subject tendons (30%) than in female subjects (14%), and in basketball players (32%) than in other athletes (9%) (all p < 0.01). Bilateral tendon abnormalities were equally prevalent in men and women but more prevalent in basketball players (15%) than in other athletes (3%) (p < 0.05). Sonographic hypoechoic regions were present in 35 of 250 (14%) patellar tendons in athletes who had never had anterior knee pain. CONCLUSIONS: Patellar tendon sonographic hypoechoic areas were present in asymptomatic patellar tendons of a proportion of elite athletes but rarely present in controls. This has implications for clinicians managing athletes with anterior knee pain.

Symptoms of jumper's knee (patellar tendinosis) are not easily quantified and this may explain why there are no evidence-based guidelines for managing the condition. A simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management. Thus we devised and tested the Victorian Institute of Sport Assessment (VISA) questionnaire. The brief questionnaire assesses (i) symptoms, (ii) simple tests of function and (iii) ability to play sport. Six of the eight questions are scored on a visual analogue scale from 0–10 with 10 representing optimal health. The maximal VISA score for an asymptomatic, fully performing individual is 100 points and the theoretical minimum is 0 points. We found the VISA scale to have excellent short-term test-retest, and inter-tester reliability (both, r>0.95) as well as good short-term (one week) stability (r=0.87). Mean (SD) of the VISA scores ranged from 95 (8) points in asymptomatic control subjects to 55 (12) points in patients who presented to a sports medicine clinic with jumper's knee and 22 (17) points in patients before surgery for chronic jumper's knee. Six- and twelve-months after surgery VISA scores returned to 49 (15) and 75 (17) points respectively, mirroring clinical recovery. We conclude that the VISA score is a reliable index of the severity of jumper's knee that has potential to aid clinicians and researchers.

The differences in performance of early generation high-frequency oscillators have been attributed to their distinct pressure and flow waveforms. Recently, five new oscillators have been commercially released. The objective of this study was to characterize the pressure and flow waveforms of eight commercially available oscillators.In vitro benchtop study.Tertiary pediatric teaching hospital.Eight oscillators were evaluated using a test lung; mean airway pressure 10 and 20 cm H2O; frequencies 5, 10, and 15 Hz; pressure amplitude 30 cm H2O (or equivalent); compliance 1.0 mL/cm H2O; and endotracheal tube 3.5 mm. Ventilators tested were Sensormedics 3100A and B (Carefusion), SLE5000 (SLE), Fabian (Acutronic), Leonie+ (Heinen+Löwenstein), Sophie (Stephan), and VN500 and Babylog 8000 (Dräger).Pressure (airway opening, at oscillator and within the test lung) and airway opening flow waveforms were recorded. Airway opening waveforms were characterized by type (square or sine) and by determining power spectral density analysis. The Sensormedics A and B and the SLE5000 delivered square waves; all other oscillators generated sine waves. Sensormedics, the SLE5000, and the Sophie had a characteristic inspiratory slope (incisura). The pressure waveform within the test lung was a sine wave for all oscillators. Oscillators with square waves or an inspiratory incisura exhibited the highest number of nonfundamental frequency components on power spectral density analysis, suggesting more complex harmonic waveforms with potentially greater transmissive power to the lungs. At frequencies of 5 and 10 Hz, all ventilators, except Babylog 8000, generated airway pressure amplitudes greater than 28.6 cm H2O and tidal volumes greater than 6 mL at the airway opening.Current high-frequency oscillators deliver different waveforms. As these may result in variable clinical performance, operators should be aware that these differences exist.

THE study by Kearsley-Fleet and others (2013), summarised on p 338 of this issue of Veterinary Record , examines the epidemiology of a large cohort of epileptic dogs obtained from first-opinion practice and provides useful information about the potential differences between cases seen in first- and second-opinion practice. Only 2.2 per cent of the dogs in their study underwent MRI scanning. As MRI is generally restricted to referral practices, this suggests that only a very small proportion of epileptic dogs in the UK are referred for investigation and, therefore, that studies on referred dogs with epilepsy sample only a small proportion of the canine population with epilepsy. It is tempting to assume that this may introduce some sampling bias into these studies and that those animals that are referred for investigation of their seizures will have a more severe phenotype and therefore worse outcomes. This sampling bias is problematic as it potentially reduces the external validity of these papers; that is, their findings may not be completely applicable to the general …

Case Description—A 2-year-old spayed female domestic shorthair cat was examined because of bilateral thoracic limb weakness of acute onset. Clinical Findings—Clinical signs included muscle atrophy, paresis, depressed spinal reflexes, hyperesthesia of the thoracic limbs, and reduced jaw muscle tone. Pelvic limb reflexes were normal. Results of a neurologic examination were suggestive of multifocal lesions involving both brachial plexuses and the trigeminal nerves. Abnormal nerve conduction across the brachial plexus and delayed late potentials were found on electrodiagnostic testing, and diffuse subclinical involvement of other regions of the peripheral nervous system was confirmed on the basis of abnormal electromyographic findings for the masticatory muscles and conduction block of the peroneal nerve. Treatment and Outcome—No specific treatments were given, and neurologic signs resolved within a month. A relapse occurred 2 months after the first episode, with clinical signs affecting both the pelvic and the thoracic limbs on this occasion. Again, the condition resolved without specific treatment, and 13 months after the initial episode, the cat reportedly was normal. Conclusions and Clinical Relevance—Findings suggested that brachial plexus neuropathy can be a multifocal disease in cats, even if clinically apparent neurologic deficits are initially subtle or absent, and that electrodiagnostic techniques can be used to identify subclinical involvement of the peripheral nerves.

Christine Thomas and Caroline Hahn 178 pages, paperback, £32.29. Saunders Elsevier. 2012. ISBN 978 0 70203 482 4 ![Graphic][1] THIS is an enjoyable and informative book. It is written by an associate professor of comparative physiology and anatomy (Christine Thomas) and a senior lecturer in clinical neuroscience (Caroline Hahn) who is an experienced clinical neurologist with particular expertise in large animal neurology. It is useful to compare it with others in the field. Currently, I feel that Miller's Anatomy of the Dog offers the best topographical neuroanatomical descriptions; DeLahunta and Glass Veterinary Neuroanatomy and Clinical Neurology integrates functional anatomy and its diseases excellently, while King's 1987 publication (Physiology and Clinical Anatomy of the Domestic Mammals, vol 1: The central nervous … [1]: /embed/inline-graphic-1.gif

Tendon disorders are a major problem for participants in competitive and recreational sports. To try to determine whether the histopathology underlying these conditions explains why they often prove recalcitrant to treatment, we reviewed studies of the histopathology of sports-related, symptomatic Achilles, patellar, extensor carpi radialis brevis and rotator cuff tendons. The literature indicates that healthy tendons appear glistening white to the naked eye and microscopy reveals a hierarchical arrangement of tightly packed, parallel bundles of collagen fibres that have a characteristic reflectivity under polarised light. Stainable ground substance (extracellular matrix) is absent and vasculature is inconspicuous. Tenocytes are generally inconspicuous and fibroblasts and myofibroblasts absent. In stark contrast, symptomatic tendons in athletes appear grey and amorphous to the naked eye and microscopy reveals discontinuous and disorganised collagen fibres that lack reflectivity under polarised light. This is associated with an increase in the amount of mucoid ground substance, which is confirmed with Alcian blue stain. At sites of maximal mucoid change, tenocytes, when present, are plump and chondroid in appearance (exaggerated fibrocartilaginous metaplasia). These changes are accompanied by the increasingly conspicuous presence of cells within the tendon tissue, most of which have a fibroblastic or myofibroblastic appearance (smooth muscle actin is demonstrated using an avidin biotin technique). Maximal cellular proliferation is accompanied by prominent capillary proliferation and a tendency for discontinuity of collagen fibres in this area. Often, there is an abrupt discontinuity of both vascular and myofibroblastic proliferation immediately adjacent to the area of greatest abnormality. The most significant feature is the absence of inflammatory cells. These observations confirm that the histopathological findings in athletes with overuse tendinopathies are consistent with those in tendinosis--a degenerative condition of unknown aetiology. This may have implications for the prognosis and timing of a return to sport after experiencing tendon symptoms. As the common overuse tendon conditions are rarely, if ever, caused by 'tendinitis', we suggest the term 'tendinopathy' be used to describe the common overuse tendon conditions. We conclude that effective treatment of athletes with tendinopathies must target the most common underlying histopathology, tendinosis, a noninflammatory condition.

OBJECTIVES: Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this. METHODS: A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over a nine year period was carried out. Subjects completed a questionnaire designed to collect details of sport participation, symptoms, and time out of sport. Ultrasonographic results were recorded from the radiologists' reports. Histopathological results were obtained for patients who had surgery. RESULTS: Forty eight subjects recalled that symptoms of jumper's knee began before the age of 20 years. Symptoms prevented 33 from participating in sport for more than six months, and 18 of these were sidelined for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation. CONCLUSIONS: Jumper's knee has the potential to be a debilitating condition for a sports person. About 33% of athletes presenting to a sports medicine clinic with jumper's knee were unable to return to sport for more than six months.

OBJECTIVE To compare patellar tendon sonographic findings at baseline and at follow-up in active female basketball players with and without symptoms of jumper's knee. We hypothesized that baseline sonographic morphology would not reliably predict prognosis and, in particular, that it would not predict the need for surgery. DESIGN Prospective longitudinal study with 12-month minimum follow-up. SETTING Institutional elite athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS AND PARTICIPANTS A total of 15 female elite basketball players with 23 sonographically abnormal tendons and 15 matched control basketball players with 23 sonographically normal tendons. MAIN OUTCOME MEASURES Sonographic patellar tendon appearance and clinical assessment of symptoms of jumper's knee at baseline and follow-up. Dimensions of abnormal regions were measured. RESULTS At baseline, the 23 subject tendons contained sonographic hypoechoic regions (six currently symptomatic, eight previously symptomatic only, and nine never symptomatic). At follow-up, the hypoechoic areas in seven tendons had resolved (and caused no symptoms), the hypoechoic areas in 11 tendons had remained essentially the same size (five were symptomatic), and the hypoechoic areas in five tendons had expanded (three symptomatic). At baseline, there were no differences between the mean +/- SD cross-sectional areas of the abnormalities in the tendons that subsequently resolved (15.9 +/- 10.1 mm2) and those that remained unchanged (39.3 +/- 25.8) or expanded (25.3 +/- 12.5). The presence of a baseline sonographic abnormality predicted symptoms of jumper's knee at follow-up (p < 0.05), but the presence of symptoms of jumper's knee at baseline also predicted symptoms at follow-up (p < 0.05). No subject or control missed any games or underwent surgical treatment. CONCLUSIONS Patellar tendon sonographic hypoechoic areas can resolve, remain unchanged, or expand in active sports-women without predicting symptoms of jumper's knee. Thus, symptoms were not directly related to sonographic tendon morphology. Sonographic hypoechoic regions ought not to constitute per se an indication for surgery.

To determine the histopathologic findings of patellar tendinosis ("jumper's knee") demonstrated with ultrasonography (US) and magnetic resonance (MR) imaging.Twenty-four athletes (28 knees) with jumper's knee (23 men, one women; mean age, 30.9 years) scheduled to undergo open tenotomy underwent US patellar tendon examination. Seventeen patients (19 knees) also underwent MR imaging. Tissue was obtained for histopathologic examination in all 28 cases. Eleven age-, height-, and weight-matched athletes (22 knees) without previous knee symptoms served as control subjects for the US examination. Control material for histopathologic examination was obtained in 20 cadavers (39 knees). Data were analyzed with standard statistical methods.MR imaging and US both revealed an abnormal zone at the proximal patellar tendon attachment. Histopathologic examination revealed mucoid degeneration in all tendons in patients and in 8% (three of 39) of tendons in cadavers (P.01).Jumper's knee is characterized by consistent changes at MR imaging, US, and histopathologic examination and is appropriately described as patellar tendinosis.

A twelve channel receiver array operating at 2.5 Gbit/s per channel, i.e. with an aggregate capacity of 30 Gbit/s, has been fabricated using silicon hybrid technology. The module, which is intended for use in rack-to-rack and board-to-board optical interconnects, has a typical sensitivity of /spl sim/-20 dBm in fibre at 1.3 /spl mu/m wavelength, and a channel-to-channel crosstalk penalty of