Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus

Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

Physiological and metabolic alterations induced by commercial neonicotinoid formulations in Daphnia magna

Neonicotinoid insecticides are widely used agents in agriculture to control a broad range of insect pests. Although use of neonicotinoid pesticides has resulted in the widespread contamination of surface waters, sublethal toxicity data of these products in relation to non-target aquatic biota are still poor. Therefore, the objective of this study was to assess the effects of two neonicotinoid pesticides with widespread use on the basic physiological functions: the thoracic limb activity and heart rate of Daphnia magna, and to screen for their potential to affect the cytochrome P450 monooxygenase system of daphnids. The considered pesticides were the acetamiprid- and thiacloprid based products Mospilan 20 SG and Calypso 480 SC. The dose-dependent variation in the three biological endpoints considered were assessed following 24h exposures. The two neonicotinoid formulations elicited significant depression on the thoracic limb activity and heart rate of daphnids at doses close to the 48h-EC50 of the products, a response mainly attributable to the overall drop in the general health status of the organisms. The dose related variation in the ECOD activity of daphnids exposed to the selected neonicotinoid formulations followed a biphasic pattern, with starting effective doses for Mospilan 20 SG of 6.3 mg L-1 (= 1/20 of 48h-EC50 for Daphnia neonates), and for Calypso 480 SC of 0.034 mg L-1 (= 1/4000 of 48h-EC50). Maximal ECOD activity (2.2 fold increase vs. controls) was induced by Mospilan 20 SG in daphnids exposed to 114 mg L-1 product (= 48h-EC20), and by Calypso 480 SC (1.8 fold increase) at 5.2 mg L-1 dose (= 1/20 of 48h-EC50). The results outlined significant alterations in the physiological traits considered at concentrations below the immobility thresholds (48h-EC50) of the products used as benchmarks to rate their toxicity risks to aquatic biota. Therefore, we think our findings might deserve consideration in the environmental risk evaluation of these products.

Longitudinal gradient in the Camptocercus lilljeborgi Schoedler, 1862 species group (Cladocera: Anomopoda: Chydoridae)

A detailed study of morphology of the rare phytophilous cladoceran Camptocercus lilljeborgi Schoedler, 1862 revealed that populations from Eastern Siberia and Far East of Russia belong to a new species. C. smirnovi sp. nov. differs from C. lilljeborgi in body shape, morphology of ventral margin of valves, morphology of postabdomen, and length of IDL seta 1 of the thoracic limb I. C. lilljeborgi s. str. is distributed in Europe and Western Siberia, therefore, the lilljeborgi-group provides an example of the western-eastern differentiation in Northern Eurasia. Some characters of taxa from the lilljeborgi-group are convergently similar to the characters of the species of genus Graptoleberis Sars, 1862; both groups are adapted to a snail-like crawling on the surface of water macrophytes.

Intelligent Interpretation of Veterinary Musculoskeletal X-rays Trained with Human Thoracic Limb X-rays

Deep learning (DL) using convolutional neural networks (CNNs) is being widely applied to assist in the interpretation of medical images in modern healthcare but there is a paucity of ‘artificial intelligence’ being currently applied to veterinary medicine. Most veterinary musculoskeletal (MSK) x-ray imaging is done in a community setting and there has not been the development of large image repositories that are available in human healthcare. Domestic animals – cats and dogs – however, have similar skeletal anatomies to humans. Hence, we hypothesized that annotated human MSK x-rays (Xs) could perhaps be used as a surrogate for the lack of adequate veterinary data to develop an automated system to help interpret veterinary MSK Xs. We refer to this as ‘intelligent interpretation of Veterinary Musculoskeletal Xs (iiVetMSK-Xs). Our iiVetMSK-Xs has an x-ray classifier built on EfficientNet and a lesion localizer built on gradient-weight class activation mapping (Grad-CAM). We used the human Musculoskeletal Radiograph (MURA) dataset (40,005 thoracic limb Xs) and a small veterinary x-ray dataset (500 thoracic and pelvic limb Xs from 141 cats and dogs) downloaded from online case repositories. Our results show that using the human thoracic limb Xs and the veterinary dataset to train a CNN improved diagnostic accuracy threefold. We suggest that our iiVetMSK-Xs is an important first step in developing automated image interpretation for veterinary imaging.

The Concentration of Metronidazole in the Distal Interphalangeal Joint following Intravenous Regional Limb Perfusion via the Cephalic Vein in Standing Horses

Objective The aim of this study was to determine the concentration of metronidazole in the distal interphalangeal joint (DIPJ) of the thoracic limb after administering metronidazole to standing horses by intravenous regional limb perfusion (IVRLP). Methods Eleven healthy horses had a wide rubber tourniquet applied to the proximal aspect of the antebrachium for 0.5 hours and 500 mg of metronidazole diluted in physiologic saline solution to a total volume of 108 mL was administered by cephalic IVRLP. Synovial fluid samples were collected from the DIPJ before perfusion and at 0.25, 0.5, 2, 12 and 24 hours. Blood samples were obtained at the same time points for serum analysis. Concentrations of metronidazole were determined by liquid chromatography/tandem mass spectrometry. Results Four horses were excluded due to low synovial fluid concentrations and not completing the full tourniquet application time. The C max in the synovial fluid was 327 ± 208 µg/mL, and the t max was 26 ± 7 minutes. Only the concentrations of metronidazole at time points 0.25 and 0.5 hours were significantly different (p < 0.001) from synovial concentration before perfusion. The serum C max was 1.78 ± 0.93 µg/mL, and the t max was 76 ± 52min. Conclusion Metronidazole administered by IVRLP reached high concentrations in the synovial fluid at 0.5 hours. However, the concentrations rapidly decreased below the minimum inhibitory concentration of potential target pathogens. Effectiveness of metronidazole administered by IVRLP as a sole therapy against anaerobic infections of synovial structures of the distal limb cannot be determined by a pharmacokinetic study. However, the present study serves as the basis for future carefully planned clinical trials.

Effect of Sedation on the Neurological Examination of the Patellar and Withdrawal Reflexes in Healthy Dogs

Introduction: Pain, temperament, fear, and anxiety can prevent safe and accurate evaluation of common neurologic reflexes in dogs. When sedation is used it is unknown how the neurological examination, and specifically patellar and withdrawal reflexes are affected, and, if present, how long any effect might last. The purpose of this study is to investigate the effect of sedation on the evaluation of select common limb spinal reflexes in healthy dogs.Material and Methods: Fourteen healthy dogs with normal neurologic exams were included. After placing joint landmarks, patellar reflex and pelvic and thoracic limb withdrawal reflexes were tested. Joint angles were measured, obtaining reflex angle endpoints, change in angle, and change in time to reflex completion. These measurements were recorded at different time points: prior to sedation (awake timepoint), 15 and 30 min following administration of standardized sedation protocol of dexmedetomidine and butorphanol, and 15 and 30 min following administration of a standardized reversal agent, atipamazole.Results: For patellar reflex, the stifle end angle increased from 91.5 to 108.55 degrees (p &lt; 0.0001) 15 min following sedation, and remained increased at 104.5 degrees (p &lt; 0.0001) 30 min following sedation. Stifle change in angle increased from 9.6 to 24.4 degrees (p &lt; 0.0001) 15 min following sedation, and remained increased at 20.85 degrees (p &lt; 0.0001) and 11 degrees (p = 0.012) at 30 min sedation and 15 min reversal. Tarsal joint in pelvic withdrawal and elbow in thoracic withdrawal reflexes did not differ in at any timepoint of sedation or reversal when compared with the awake timepoint, for end angle or change in angle. The increases in end angle and change in angle for patellar reflex generated a change in time for patellar reflex from 0.12 s (awake) to 0.129 s (15 min sedation) which was statistically significant (p = 0.041). Change in time did not differ for pelvic withdrawal or thoracic withdrawal.Discussion/Conclusions: Reflexes were elicited in all dogs under sedation. Sedation does not affect the evaluation of the withdrawal reflex on any limb but improves the visualization of the patellar reflex in this group of neurologically normal dogs.

Humeral fracture repair using a robust fixation in an adult Giant Anteater (Myrmecophaga tridactyla): case report

ABSTRACT The treatment of fractures from the thoracic limb in giant anteaters is extremely challenging. Unfamiliar and peculiar anatomical characteristics, robust musculature and the imminent need for an early return to limb function highlight such challenges. The objective of this report was to describe the successful use of anatomical osteosynthesis with a robust locking compression plate in a humeral fracture of an adult giant anteater. The patient was rescued on the highway after being run over and presented for treatment at the Veterinary Teaching Hospital. Surgical stabilization was performed using a craniomedial approach to the humerus, using a customized broad 3.5mm locking compression plate. The patient presented early limb support at 24 hours postoperatively. Radiographic monitoring was performed at 30, 60 and 90 days postoperatively, and bone healing was observed without any complications. It is concluded that the treatment of humerus fractures in giant anteaters requires robust fixation. The use of a reinforced locking compression plate system proved to be effective and adequate to the mechanical load that an adult individual of this species needs for early use of the thoracic limb and, at the same time, efficient in controlling interfragmentary movement, which allowed fracture consolidation.