bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico‐ureteric reflux after renal transplantation
Authors: Pichler Renate , Buttazzoni Alexander , Rehder Peter , Bartsch Georg , Steiner Hannes , Oswald Josef 
Published: November 2010

Study Type – Therapy (case series)Level of Evidence 4 What’s known on the subject? and What does the study add? Vesicoureteral reflux (VUR) after renal transplantation may cause recurrent urinary tract infections (UTIs) and loss of renal function with consecutive risk of progressive graft damage. There are only a few series on the therapeutic success of dextranomer/hyaluronic acid copolymer treatment by transurethral injection. We assessed whether transurethral endoscopic therapy is an alternative strategy treating VUR in this special patient collective and we found out that this surgical method is a minimally invasive and efficient procedure with reflux resolution rate of approximately 60% after one and 79% after two injections with significant reduction of postoperative UTIs on short‐term follow up.OBJECTIVE• To evaluate the success of endoscopic dextranomer/hyaluronic acid copolymer (DHAC) application in the treatment of patients with recurrent urinary tract infections (UTIs) and vesico‐ureteric reflux (VUR) into the transplanted graft after renal transplantation.PATIENTS AND METHODS• Between January 2008 and April 2009, 19 patients with recurrent UTIs presented VUR proven by voiding cystourethrography.• To correct VUR of the transplanted ureter, DHAC was injected endoscopically using hydrodistention technique.• Pre‐ and postoperative serum creatinine levels, the number of pre‐ and postoperative UTIs, postoperative complications and reflux resolution rate were recorded. The mean follow‐up was 6.5 months.RESULTS• The average number of UTIs was reduced significantly from 4.89 (range 2–14) to 1.31 (range 0–4) on pre‐ and postoperative follow‐up, respectively, of 6 months (P < 0.001). The success rate increased from 57.9% after the first injection to 78.9% after the second injection.• The remaining four patients with residual VUR received long‐term low dose antibiotic prophylaxis. In total, two (10.5%) patients developed increasing creatinine levels postoperatively as a result of distal ureteral obstruction, and temporary urinary drainage was necessary in both patients.CONCLUSIONS• DHAC appears to be an efficient and minimal invasive method for treating VUR after renal transplantation with respect to short‐term success.• Further investigation with a larger group of patients and longer follow‐up is needed to evaluate the prolonged effect, as well as any potential side effects.
Efficacy and Safety of Dapoxetine for the Treatment of Premature Ejaculation: Integrated Analysis of Results from Five Phase 3 Trials
Authors: McMahon Chris G. , Althof Stanley E. , Kaufman Joel M. , Buvat Jacques , Levine Stephen B. , Aquilina Joseph W. , Tesfaye Fisseha , Rothman Margaret , Rivas David A. , Porst Hartmut 
Published: November 2010

ABSTRACT

Introduction
Dapoxetine has been evaluated for the on-demand treatment of premature ejaculation (PE) in five phase 3 studies in various populations worldwide and has recently been approved in several countries.

Aim
To present integrated efficacy and safety data from phase 3 trials of dapoxetine.

Methods
Data were from five randomized, multicenter, double-blind, placebo-controlled studies conducted in over 25 countries. Men (N = 6,081) ≥18 years who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria for PE; four studies required a baseline intravaginal ejaculatory latency time (IELT) of ≤2 minutes. Dapoxetine 30 and 60 mg on demand (prn; 1–3 hours before intercourse) were evaluated for either 12 or 24 weeks in four studies; one study evaluated dapoxetine 60 mg daily (qd; included in safety assessments only) or prn for 9 weeks.

Main Outcome Measures
End points included stopwatch-measured IELT, Premature Ejaculation Profile (PEP) items, clinical global impression of change (CGIC) in PE, and adverse events (AEs).

Results
Average IELT (mean [standard deviation], geometric mean [standard error]) increased from baseline (across groups, 0.9 [0.49] minutes, 0.8 [1.01] minutes) to a significantly greater extent with dapoxetine 30 (3.1 [3.91] minutes, 2.0 [1.03] minutes) and 60 mg (3.6 [3.85] minutes, 2.3 [1.03] minutes) vs. placebo (1.9 [2.43] minutes, 1.3 [1.02] minutes; P &lt; 0.001 for all) at week 12 (geometric mean fold increase, 2.5, 3.0, and 1.6, respectively). All PEP items and CGIC improved significantly with both doses of dapoxetine vs. placebo (P &lt; 0.001 for all). The most common AEs included nausea, dizziness, and headache, and evaluation of validated instruments demonstrated no anxiety, akathisia, suicidality, or changes in mood with dapoxetine use and no discontinuation syndrome following abrupt withdrawal.

Conclusions
In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.
HMOs and Managed Care: Implications for Rural Physician Manpower Planning*
Authors: Weiner Jonathan P. 
Published: November 2010

ABSTRACT: American health care is changing dramatically. Health maintenance organizations (HMOs) and other managed care plans are central to this change. Today, the majority of Americans living in metropolitan areas receive their care from these types of plans. The goal of this article is two‐fold. First, it will discuss the potential implications of HMOs and managed care for physician needs and supply in rural regions. Second, it will derive insight into alternative approaches for meeting rural health manpower needs by analyzing HMO staffing patterns.As HMOs and other managed care plans expand, rural physicians, their practices, and their patients will almost certainly be affected. As described in this paper, most of these effects are likely to be positive.The staffing patterns used by HMOs provide an interesting point of comparison for those responsible for rural health manpower planning and resource development. HMOs appear to meet the needs of their enrollees with significantly fewer providers than are available nationally or suggested by the federal standards. Moreover, HMOs make greater use of nonphysician providers such as nurse practitioners and physician assistants.
Influence of girth strap placement and panel flocking material on the saddle pressure pattern during riding of horses
Authors: BYSTRÖM A. , STALFELT A. , EGENVALL A. , VON PEINEN K. , MORGAN K. , ROEPSTORFF L. 
Published: November 2010

SummaryReasons for performing study: Saddle fit is well recognised as an important factor for the health and performance of riding horses. However, only few studies have addressed general effects of different saddle construction details within a group of horses.Objective: To assess the influence of girth strap placement, traditional vs. v‐system, and panel flocking material, wool vs. synthetic foam, on the saddle pressure pattern during riding.Methods: Six horses were ridden by 3 riders in sitting and rising trot and sitting canter. Saddle pressure was measured with 3 different saddle variants: 1) wool flocked panels and traditional girthing (baseline); 2) wool flocked panels and v‐system girthing; and 3) foam filled panels and traditional girthing. From the pressure data, a number of descriptive variables were extracted. These were analysed using ANCOVA models with horse, rider, saddle, seat (sitting/rising, trot only) and speed as independent variables.Results: With foam filled panels stride maximum pressures under the hind part of the saddle increased by 7–12% and the area under the saddle with a stride mean pressure >11 kPa increased by 114 cm2 in trot and 127 cm2 in canter. With v‐system girthing, the latter variable also increased, but only by 53 and 38 cm2 in trot and canter, respectively. In addition, stride maximum pressures under the front part of the saddle tended to increase (≤9%).Conclusions: Both flocking material and girthing have a significant influence on the saddle pressure and should thus be considered in saddle fitting. Wool seems a better flocking material than foam of the type used in the current study. For girthing, traditional placement seems equally good if not better than the v‐system. However, further studies are needed to show if these results are valid for a larger population of riding horses.
Oxygen consumption and gait variables of Arabian endurance horses measured during a field exercise test
Authors: COTTIN F. , METAYER N. , GOACHET A. G. , JULLIAND V. , SLAWINSKI J. , BILLAT V. , BARREY E. 
Published: November 2010

SummaryReasons for performing study: Arabian horses have morphological, muscular and metabolic features designed for endurance races. Their gas exchange and gait variables were therefore measured during a field exercise test. This study presents original respiratory and locomotor data recorded in endurance horses under field conditions.Hypothesis and objectives: Respiratory gas exchange ratio (RER) of Arabian horses at the speed required to win endurance races (18 km/h for 120–160 km) are <1 and running economy (RE) is also low in order to maintain exercise intensity using aerobic metabolism for long intervals. The purpose of this study was to measure oxygen consumption and gait variables in Arabian endurance horses running in the field in order to estimate RER and RE.Materials and methods: Five Arabian horses trained for endurance racing were test ridden at increasing speeds on the field. Their speed was recorded and controlled by the rider using a GPS logger. Each horse was equipped with a portable respiratory gas analyser, which measured breath‐by‐breath respiratory variables and heart rate. The gait variables were recorded using tri‐axial accelerometer data loggers and software for gait analysis. Descriptive statistics and linear regressions were used to analyse the speed related changes in each variable with P<0.05 taken as significant.Results: At a canter speed corresponding to endurance race winning speed (18 km/h), horses presented a VO2= 42 ± 9 ml/min/kg bwt, RER = 0.96 ± 0.10 and RE (= VO2/speed) = 134 ± 27 l/km/kg bwt. Linear relationships were observed between speed and VO2, HR and gait variables. Significant correlations were observed between VO2 and gait variables.Conclusions and potential relevance: The RER of 0.96 at winning endurance speed indicates that Arabian horses mainly use aerobic metabolism based on lipid oxidation and that RER may also be related to a good coordination between running speed, respiratory and gait parameters.
Kinematic characteristics of hoof landing in jumping horses at elite level
Authors: HERNLUND E. , EGENVALL A. , ROEPSTORFF L. 
Published: November 2010

SummaryReasons for performing study:Biomechanical events of the distal limb during the landing phase of a jump have been proposed to be risk factors for injury, indicating need for further characterisation of the landing and the hoof‐surface interaction. This is essential also for valid testing of arena surfaces when simulating actual conditions.Objectives:To investigate the hoof landing characteristics for different limbs of elite showjumping horses during the landing phase when jumping 1.30–1.50 m competition fences on 2 different arena surfaces.Materials and methods:A single, fixed high speed camera (1000 frames/s) was aimed at landing spots after different fences during 2 competitions. A total of 64 hoof landings were recorded on one sand and one turf surface (using studs on the turf). Hoof movements were tracked from calibrated video sequences. Landing velocities, landing angles, maximal vertical and horizontal deceleration and timing of maximal deceleration peaks were calculated and compared between leading/trailing fore‐/hindlimbs. All outcomes were analysed for limb, using generalised linear models and controlling for effects of surface and obstacle.Results:Landing speed differed among limbs (P<0.02 for all speeds and models). The leading hoof approached the ground more acutely angled to the horizontal plane than the trailing comparing fore‐ (P<0.001) and hindlimbs (0.05≥P>0.01), respectively. Differences in landing and braking kinematics were also found between surfaces and obstacles; however, these effects were hard to separate because of the nonexperimental design.Conclusions:The landing and braking characteristics of the hooves varied substantially between hind‐, fore‐, trailing and leading limbs. Developing mechanical testing devices for arena surfaces, this fairly wide range of biomechanical events must be considered, in order to simulate the horse‐surface interaction.
Relationship between saddle pressure measurements and clinical signs of saddle soreness at the withers
Authors: Von PEINEN K. , WIESTNER T. , Von RECHENBERG B. , WEISHAUPT M. A. 
Published: November 2010

SummaryReasons for performing the study: Similar to human decubitus ulcers, local high pressure points from ill‐fitting saddles induce perfusion disturbances of different degrees resulting in tissue hypoxia and alteration in sweat production.Objective: To relate the different clinical manifestations of saddle sores to the magnitude of saddle pressures at the location of the withers.Methods: Sixteen horses with dry spots after exercise (Group A) and 7 cases presented with acute clinical signs of saddle pressure in the withers area (Group B) were compared with a control group of 16 sound horses with well fitting saddles (Group C). All horses underwent a saddle pressure measurement at walk, trot and canter. Mean and maximal pressures in the area of interest were compared between groups within each gait.Results: Mean pressures differed significantly between groups in all 3 gaits. Maximal pressure differed between groups at trot; at walk and canter, however, the only significant difference was between Group C and Groups A and B, respectively, (P>0.05). Mean and maximal pressures at walk in Group A were 15.3 and 30.6 kPa, in Group B 24.0 and 38.9 kPa and in Group C 7.8 and 13.4 kPa, respectively; at trot in Group A 18.1 and 43.4 kPa, in Group B 29.7 and 53.3 kPa and in Group C 9.8 and 21.0 kPa, respectively; and at canter in Group A 21.4 and 48.9 kPa, in Group B 28.6 and 56.0 kPa and in Group C 10.9 and 24.7 kPa, respectively.Conclusion: The study shows that there is a distinguishable difference between the 3 groups regarding the mean pressure value, in all gaits.
The effect of treadmill speed and gradient on equine hindlimb muscle activity
Authors: CROOK T. C. , WILSON A. , HODSON‐TOLE E. 
Published: November 2010

SummaryReasons for performing study: Locomotion requires successful negotiation of different terrains, but we currently know little of how the musculoskeletal system adapts to cope with positive and negative slopes.Objective: To compare the effects of treadmill speed and gradient on equine hindlimb muscle mean electromyographic (EMG) intensity.Methods: Surface EMG recorded the activity of gluteus medius (GM), biceps femoris (BF), vastus lateralis (VL), gastrocnemius lateralis (GL) and extensor digitorum longus (EDL) in 6 horses at walk (1.4–1.6 m/s) and trot (2.6–3 m/s) on 3 different treadmill gradients (0, 10% and −10%). Significant differences in mean EMG intensity and kinematic data were determined using Friedman and Wilcoxon signed rank tests (P<0.05).Results: Increasing velocity increased the mean EMG intensity of GM, BF and GL regardless of gradient. Treadmill incline increased the mean EMG intensity for all muscles at the walk and that of GM at trot. Treadmill decline reduced the mean EMG intensity of GM at both the walk and the trot and that of BF at the walk, but not the trot. The mean EMG intensity of EDL, VL and GL remained similar at both gaits when compared to the horizontal.Conclusions: The hip retractors are the primary muscles responsible for powering equine locomotion in response to increasing workload.Potential relevance: A better understanding of the effects of speed and gradient on the functional activity of the horses' locomotor muscles will enable the development of more effective training programmes pre‐ and post injury.
Differences in the metabolic properties ofgluteus mediusand superficial digital flexor muscles and the effect of water treadmill training in the horse
Authors: BORGIA L. A. , VALBERG S. J. , ESSEN‐GUSTAVSSON B. 
Published: November 2010

SummaryReasons for performing study:Flexor tendon injury may be due to flexor muscle fatigue, contributing to fetlock joint hyperextension and tendon damage. A water treadmill provides resistance training on flexor tendon muscles, which might reduce the risk of tendon injury.Objective:To determine the effect of water treadmill training on the properties of the gluteal and superficial digital flexor (SDF) muscles and on cardiocirculatory response to a standardised exercise test.Methods:Five healthy unfit horses were trained on a water treadmill for 5 days/week for 4 weeks, starting with 5 min/day increasing to 20 min/day. Before and after the water treadmill training, an incremental SET was performed on a land treadmill to determine velocity at a heart rate 200 beats/min (V200) and resting gluteal and SDF muscle biopsies were obtained for biochemical analyses.Results:There was no measurable difference in resting concentrations of gluteal or SDF muscle glycogen, lactate, ATP or glucose‐6‐phosphate (G6P), or activities of citrate synthase (CS), 3‐hydroxyacyl CoA dehydrogenase (HAD) and lactate dehydrogenase (LDH) after training and no change in V200, Lactate, glycogen, G6P and ATP concentrations were 50% lower andtype 1fibres 30% higher in SDF compared to gluteal muscles. CS and HAD activities were similar between SDF and gluteal, while LDH was lower in the SDF muscle.Conclusions:A more strenuous water treadmill conditioning protocol may be needed to induce a training effect in gluteal and SDF muscle and heart rate response. The low substrate concentrations and oxidative capacity of SDF may predispose this muscle to catastrophic fatigue during maximal exercise.
Investigation of the incidence and type of injuries associated with high‐speed treadmill exercise testing
Authors: FRANKLIN S. H. , BARAKZAI S. Z. , COUROUCÉ‐MALBLANC A. , DIXON P. , NANKERVIS K. J. , PERKINS J. D. , ROBERTS C. A. , VANERCK‐WESTERGREN E. , ALLEN K. J. 
Published: November 2010

SummaryReasons for performing study:During the past 20 years, treadmill exercise testing has played an important role in both the study of equine exercise physiology and the investigation of poor athletic performance. However, it has been suggested that some trainers and veterinarians may be reluctant to refer horses for treadmill exercise testing because of fears that horses may be at increased risk of musculoskeletal injury during treadmill exercise.Objective:To investigate the incidence and types of injuries sustained by horses undergoing treadmill exercise.Methods:Data were collated from 9 centres in the UK, France and Belgium, and the prevalence and types of injury were established.Results:A total of 2305 records were reviewed, with 2258 horses performing treadmill exercise. There was an overall injury rate of 5.4%. However, the majority of injuries sustained were minor in nature (4.7%). Only 13 horses (0.6%) sustained major injuries in association with treadmill exercise. These included 5 cases of severe exercise‐induced myopathy, 4 fractures (of which 1 was catastrophic), 2 tendon injuries, 1 case with undiagnosed severe lameness and 1 with marked exacerbation of a previously diagnosed lameness. Two other major incidents were reported but were not directly associated with treadmill exercise (one had iliac thrombosis and one collapsed and died as a result of a pulmonary embolism).Conclusions:This study confirms that the majority of horses undergo treadmill exercise without incident. The majority of injuries that did occur were minor in nature and the incidence of major injuries was similar to that reported during competition elsewhere.Potential relevance:Treadmill exercise is a safe procedure and does not appear to pose an increased risk of injury in comparison with overground exercise.
Saddle pressure patterns of three different training saddles (normal tree, flexible tree, treeless) in Thoroughbred racehorses at trot and gallop
Authors: LATIF S. N. , Von PEINEN K. , WIESTNER T. , BITSCHNAU C. , RENK B. , WEISHAUPT M. A. 
Published: November 2010

SummaryReasons for performing study:To a large extent the success of a racehorse depends on effective and health preserving training methods. An important issue is the prevention of back pain. The influence of different types of training saddles (normal tree: SA, treeless: SB, flexible tree: SC) on the saddle pressure patterns in racehorses have not previously been investigated. It is commonly assumed that SAlimits the motion of the back especially in the lower thoracic region during gallop.Hypothesis:SAproduces higher pressures in the caudal part of the saddle at trot (rising trot), canter and gallop (both in a jockey seat) compared to SBand SC.Methods:Saddle pressures were measured in 8 racehorses ridden on a training track at trot (3.5 m/s), canter (6.4 m/s) and gallop (12.6 m/s). Each horse performed the protocol with each saddle. To analyse the pressure distribution over the horse's back the pressure picture was divided into thirds (TDfront, TDmid, TDhind). The stride‐mean loaded areas, forces and mean and peak pressures were determined.Results:At canter and gallop, all 3 saddles were mainly loaded in TDfront(>80% of the rider's weight), with a decreasing gradient to TDmidand TDhind(<3%), which was least pronounced in SC. At trot, the load was shifted towards TDmidand TDhind(10–15%, each). High peak pressures occurred in TDfrontat canter and gallop and in TDhindat trot.Conclusions:The type of tree had no influence on the pressure picture of the caudal third at gallop. The high peak pressures observed in TDhindat trot in all saddles may limit the activity of the horse's back, which is of particular importance since trot is an integral part of the daily work.