Previous Level Of Performance Research Articles

Long-term follow-up of Norwegian horses affected with acquired equine polyneuropathy.

Acquired equine polyneuropathy (AEP), a neurological disease clinically characterised by knuckling of metatarsophalangeal joints, has been described in numerous Nordic horses during the last 20years. Although clinical recovery has been reported, large-scale data on long-term follow-up of survivors have been lacking. To describe long-term survival of AEP affected horses registered in Norway, with a focus on athletic performance and possible residual clinical signs connected to the disease. A retrospective cohort study. The study includes 143 horses recorded with AEP in Norway from 2000 to 2012, with the follow-up period continuing until 2015. Participating owners of survivors completed a standardised questionnaire, providing information on disease and convalescence, management, performance-level and possible residual clinical signs. To investigate the follow-up of survivors, we performed 2 multivariable linear regression models. The follow-up time of survivors was 1.0-14.5years (median 5.3, interquartile range 2.5-7.2). Fifty-seven horses survived and all but 3 horses returned to previous or higher level of performance. However, possible disease-related residual clinical signs were reported in 14/57 horses. Forty-nine of the survivors were in athletic use at time of contact. The majority of survivors were categorised with low severity-grades at time of diagnosis and the initial grade was significantly associated with time to resumed training. Only 3 horses had experienced relapse/new attack during the follow-up period. Athletic performance was judged by owners, which renders a possible source of bias. Although AEP is a potential fatal disease, most survivors will recover and return to minimum previous level of athletic performance. Some horses display residual clinical signs, but often without negative effect on performance and relapse of disease is rare.

Long-term follow-up on recovery, return to use and sporting activity: a retrospective study of 236 operated colic horses in Finland (2006\u20132012)

BackgroundSurgical treatment of colic is expensive and complications may occur. Information on the prognosis and the use of the horse after surgery for colic is important for surgeons and owners. Current literature on return to athletic function after celiotomy is limited. The present study reviewed surgical cases of the Veterinary Teaching Hospital, Helsinki, Finland for 2006–2012. The aim was to follow the population of horses of different breeds for surgical findings, postsurgical complications, long-term recovery and prognosis. The findings and their influence on survival, return to previous or intended use and performance were assessed.ResultsMost of the operated horses (82.6%; 195/236) recovered from anesthesia and 74.9% (146/195) were discharged. The total follow-up time was 8 years and 10 months and the median survival time 79.2 months. Age of the horse, location of the abdominal lesion (small vs. large intestine), incidence of postoperative colic, surgical site infection, incisional hernia or convalescence time after surgery, did not significantly affect the probability of performing in the previous or intended discipline after the surgery. A majority of the discharged horses (83.7%) was able to perform in the previous or intended discipline and 78.5% regained their former or higher level of performance. Operated horses had 0.18 colic episodes per horse-year during the long-term follow-up. The incidence of colic was 20.0% within the first year after surgery. Horses operated for large intestinal colic were 3.3-fold more prone to suffer postoperative colic than horses operated for small intestinal colic. The majority of the owners (96.3%) were satisfied with the veterinary care and nearly all (98.5%) evaluated the recovery after the colic surgery to be satisfactory or above.ConclusionsIf the horse survives to discharge, prognosis for long-term survival and return to previous level of sporting activity and performance was good after colic surgery in a population of horses of different breeds. None of the factors studied were found to decrease the probability of performing in the same or intended discipline after surgery. The majority of horses were able to return to their previous activity and perform satisfactorily for several years after surgery.

Collateral ligament reconstruction in two horses following traumatic avulsion fracture using a knotless suture anchor construct

SummaryThis case report describes a technique for repair of medial collateral ligament avulsions in two horses. Both horses sustained traumatic injuries resulting in avulsion fractures at the origin of their medial tarsal and carpal collateral ligaments. This report describes the use of a knotless suture anchor to mechanically reconstruct medial collateral ligament avulsion injuries in two horses. The first horse, a 9‐year‐old Hannovarian Warmblood gelding presented for an acute nonweightbearing lameness in the right hindlimb. The injury was localised to the medial malleolus of the tibia and an avulsion fracture of the origin of the short medial collateral ligament of the tibiotarsal joint with disruption of the ligament was found on radiographs and ultrasound. The horse was taken to surgery and a reconstruction of the short medial collateral ligament was performed with a modified single row construct using a biocompatible, multistrand, long chain ultra‐high molecular weight polyethylene braided composite suture tape (2 mm Fibertape) and a single knotless suture anchor (5.5 × 19.1 mm PEEK SwivelLock C). The second horse, a 5‐year‐old Thoroughbred gelding presented for an acute nonweightbearing lameness in the left forelimb. The injury was localised to the medial styloid process of the radius and an avulsion fracture of the origin of the medial collateral ligament of the antebrachial carpal joint was found on radiographs and ultrasound. The horse was taken to surgery and a similar reconstruction procedure was performed to the collateral ligament. Both horses were recovered in a Robert Jones bandage without the use of casts or splints and recovered without incident. Both horses are sound and returned to previous level of athletic performance at 18 months and 8 months, respectively.

A Young Man with Joints Effusion without Trauma: It is a Rheumatic Disease

The problem of swollen joints in athletes represents a typical risk following a sports injury, but this is not the only cause, although it is the most frequent one. Indeed inflammatory arthritis may also be a source of joint effusion. We report the case of a 21-year-old professional football player who suffered from pain and swelling in his joints after a mild sprain. He first underwent arthroscopy, followed by intra-articular steroid injections at a later stage. Despite that, his joints swelled again over the next few weeks. The patient was diagnosed as suffering from reactive arthritis (ReA) and treated with a conventional treatment. As the synovitis still persisted, he was finally treated with Etanercept (50 mg s.c. weekly) which resulted in a complete and quick resolution of arthritis, allowing the patient to return to his previous level of performance.

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

BackgroundRegenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry.ResultsCompared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively.ConclusionsA single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

Postoperative Rehabilitation and Return to Play After Anterior Cruciate Ligament Reconstruction

An anterior cruciate ligament (ACL) disruption of the knee can be a devastating injury to the athletes, as they are faced with possible reconstructive surgery and the extensive months of physical rehabilitation that follows. Within the first postoperative year, many athletes are unable to return to their previous level of athletic performance and some athletes are unable to return to play at all. Strength and Conditioning (S&C) Professionals utilize specific exercises and training principles to enhance an athlete’s athletic performance in the arena of competition. As a major component of the ACL rehabilitation process involves the implementation of exercises for the athlete to execute, these S&C exercises and training principles should also be a consideration for utilization by the rehabilitation professional during the ACL rehabilitation. These S&C exercises and training principles may not only assist in a desired return-to-play outcome, but would also familiarize or refamiliarize the athletes with the training program design that may be instituted during their off-season athletic performance-enhancement training.

Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomised open-label multicentre clinical trial in 80 lame horses.

Intra-articular (IA) injection of corticosteroids with or without hyaluronate (HA) has been used for decades in equine practice for treatment of noninfectious synovitis and osteoarthritis. However, to date, no large-scale randomised equine field trials have been reported that address the supposed superior clinical efficacy of the combination of corticosteroid + HA compared with IA injection of corticosteroid alone. To compare the clinical efficacy of IA triamcinolone acetonide (TA, 12 mg) compared with IA TA (12 mg) + high molecular weight HA (20 mg) in horses with clinical joint disease. Prospective, randomised, parallel, open label, multicentre clinical trial. Eighty client-owned horses from 13 clinics were included. Lameness and effusion scores were assessed at baseline and 3 weeks after IA treatment. A standardised telephone questionnaire was completed between the owner and consulting veterinarian at 3 months. The primary outcome parameter was clinical success rate, defined as ≥2 grades lameness reduction (on a 0-5 scale) at 3 weeks. Chi-square statistics and binary logistic regression were used to analyse data on an intention-to-treat basis for the 3 week outcome. The success rate of IA TA 3 weeks after treatment was 87.8%, while that of TA+HA was 64.1% (P = 0.01). Age >13 years was associated with a reduced success rate for the combination treatment (P = 0.004) at 3 weeks. At 3 months, half the horses in each group had returned to their previous level of performance. The combination of TA with HA was associated with a lower short-term clinical success rate and a similar medium-term outcome compared with IA TA, with only half of the horses performing at their previous level of exercise after 3 months regardless of treatment group allocation.

Deficiencies in Pitching Biomechanics in Baseball Players With a History of Superior Labrum Anterior-Posterior Repair

Background: Baseball pitchers who undergo superior labrum anterior-posterior (SLAP) repair often have trouble returning to their previous level of performance. While the reason is often assumed to be diminished shoulder range of motion or other mechanical changes, differences in pitching biomechanics between baseball pitchers with a history of SLAP repair and pitchers with no injury history have not been studied previously. Hypothesis: The primary hypothesis was that compared with the control group, the SLAP group would exhibit compromised shoulder range of motion (external rotation and horizontal abduction) and internal rotation torque during pitching. Study Design: Controlled laboratory study. Methods: Pitching biomechanics were compared retrospectively between a group of 13 collegiate and professional pitchers with a history of a SLAP tear and a control group of 52 pitchers with no history of surgery; groups were matched by age, height, weight, and pitch velocity. Data were collected with an automated 3-dimensional motion analysis system while participants threw fastballs from the windup. Biomechanics of the shoulder (horizontal abduction and external rotation), elbow (flexion, extension velocity, and flexion torque), and body (stride length, shoulder horizontal adduction, and forward trunk tilt) were compared between the 2 groups. For each variable, a Student t test was used at an α level of .05. Results: Pitchers in the SLAP group exhibited significantly less shoulder horizontal abduction (10.0° ± 13.2° vs 21.0° ± 11.7°, respectively; P = .013) and shoulder external rotation (168.3° ± 12.7° vs 178.3° ± 7.3°, respectively; P = .016) than those in the control group. In addition, players in the SLAP group pitched with a more upright trunk, demonstrated by a less forward trunk tilt at the instant of ball release (30.2° ± 6.3° vs 34.4° ± 6.6°, respectively; P = .048). Conclusion: Pitchers with a history of SLAP repair produce less shoulder horizontal abduction, shoulder external rotation, and forward trunk tilt during pitching than do pitchers with no history of injury. Clinical Relevance: To facilitate normal pitching mechanics, shoulder external rotation and horizontal abduction at 90° should be primary objectives in surgical repair and rehabilitation after SLAP repair. In addition, pitchers should work with their pitching coaches to ensure proper forward trunk tilt.

Outcome Following Surgical Treatment of 23 Cases of Primary Plantar/Palmar Annular Ligament Desmopathy: A Retrospective Study

Reasons for performing studyLittle exists in the literature regarding the outcome of endoscopically‐guided desmotomy of the palmar/plantar annular ligament (PAL) where injury to the PAL was the only diagnosis.ObjectivesTo report the return to previous level of exercise in horses treated with endoscopically guided PAL resection in which PAL injury was considered to be the primary condition.Study designRetrospective case series.MethodsMedical records of surgical cases at Donnington Grove Veterinary Surgery between 2005 and 2013 were reviewed. The inclusion criteria were cases that had undergone surgical transection of the palmar/plantar annular ligament under general anaesthesia and endoscopic guidance using a No. 12 scalpel blade where annular ligament injury was the only notable finding at surgery. Follow‐up was obtained by a telephone questionnaire.ResultsTwenty‐three horses were included in the study. Twenty horses were noted to have restriction to passage of the arthroscope within the digital flexor tendon sheath at the time of surgery. Following the initial 3‐month post operative rest period 21 horses were sound. Three horses did not return to their previous level of activity due to unrelated lameness issues and 2 returned to a lower level of competition due to owner preference. Of the remaining 18 horses, 16 returned to their previous level of athletic performance. Two horses had recurrent or persistent lameness associated with the residual PAL desmopathy.ConclusionsIn this case series surgical treatment of primary PAL injury carries a good prognosis (89% return to previous level of exercise) in contrast to a previously reported study (<50% of horses were able to return to athletic function) [1].Ethical animal research: Ethical committee approval not currently required by this congress: retrospective study of clinical records. Explicit owner informed consent for participation in this study was not stated. Sources of funding: None. Competing interests: None.

Chronic Posterior Sternoclavicular Joint Fracture Dislocations in Children and Young Adults

Posterior sternoclavicular joint (SCJ) fracture dislocations in children and young adults can be missed on initial examination or could fail closed treatment. We hypothesize that surgical interventions (open reduction and ligamentous reconstruction or medial clavicle resection depending on the clinical scenario) are safe treatment options in patients with symptomatic chronic posteriorly displaced SCJ injuries. A retrospective review was conducted of all patients younger than 25 years of age who underwent surgical treatment for chronic posteriorly displaced SCJ injuries at our institution from January 1, 1999 to December 31, 2011. Chronic injuries were defined as those presenting and/or treated at a minimum of 6 weeks from the causative injury. Indications for surgery included symptomatic posterior SCJ dislocations or posteriorly angulated physeal fractures that did not remodel and were refractory to nonoperative treatment. Subjective patient outcomes were obtained by mailed survey and telephone contact. Outcomes included a Disabilities of the Arm, Shoulder and Hand score, patient-rated levels of pain and/or disability, SCJ stability, and symptom improvement. Seven patients met the inclusion criteria and all patients reported postoperative improvement or complete resolution of pain at last clinical follow-up (mean, 13 mo). At average 5.5 years follow-up, all respondents (n=4) reported that their injury did not interfere with normal social activities or daily activities. No patients reported difficulty with employment; however, all patients reported mild difficulty with return to their level of athletic activity before SCJ fracture dislocation. Patients rated their level of pain or disability as 1.5 on a 10-point scale. Surgical intervention can reliably provide pain relief and facilitate successful return to activities including work in patients with symptomatic chronic posterior SCJ fracture dislocations. However, patients must be counseled that they may experience persistent symptoms with return to their previous level of sport performance. Therapeutic Study-Investigating the Results of Treatment: Level IV.

Single-Center Study of 83 Horses with Suspensory Injuries Treated with Adipose-Derived Stem and Regenerative Cells

Adipose-derived stem and regenerative cells (ADRCs), concentrated from autologous fat tissue, have the ability to differentiate into various specific cell types including tenocytes. In this retrospective study, clinical data are presented from 83 horses with 176 suspensory ligament injuries, treated with ADRCs, given a strictly enforced standardized rehabilitation program, and followed up for at least one year after returning to work. Assessment for a successful outcome was return to full work (RFW) at a previous or higher level of performance for one year or more without re-injury. RFW numbers were 84.6% for horses with fore-limb ligament injuries and 82.1% for horses with hind-limb injuries. RFW outcomes were slightly better in cases with proximal suspensory ligament desmitis (86.7%) compared to horses with lesions of the body and branches. The ADRC injection procedure was well tolerated; no treatment-related adverse events, including injection flares, were detected in any of the 83 horses. The demonstrated long term stability of healed lesions strongly supports the therapeutic use of regenerative cells extracted from adipose tissue for treatment of acute and chronic, fore- and hind-limb suspensory ligament injuries in horses of various athletic sport disciplines.

Ability to Return to Play After Arthroscopic Shoulder Surgery in Professional Female Tennis Players

Ability to Return to Play After Arthroscopic Shoulder Surgery in Professional Female Tennis Players

Arthroscopic Shoulder Surgery in Female Professional Tennis Players

Objectives:Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players.Methods:The records of all female tennis players on the Women’s Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were ability and time to return to professional play, and if they were able to return to their previous level of function, as determined by singles ranking. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated.Results:During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean time to return to play was 6.7 months after surgery. However, only 25% (2 out of 8) players had achieved their pre-injury singles rank or better by 18 months post operatively. In total, three players returned to their pre-injury singles ranking, with their peak singles ranking being attained at a mean of 2.5 years post operatively.Conclusion:This study demonstrates that in professional female tennis players, a high return to play rate following arthroscopic shoulder surgery is also associated with a prolonged and often incomplete return to previous level of performance. Thus, counselling the patient to this fact is important to manage their expectations.

A Role for Dopamine-Mediated Learning in the Pathophysiology and Treatment of Parkinson’s Disease

Dopamine contributes to corticostriatal plasticity and motor learning. Dopamine denervation profoundly alters motor performance, as in Parkinson's disease (PD); however, the extent to which these symptoms reflect impaired motor learning is unknown. Here, we demonstrate a D2 receptor blockade-induced aberrant learning that impedes future motor performance when dopamine signaling is restored, an effect diminished by coadministration of adenosine antagonists during blockade. We hypothesize that an inappropriate corticostriatal potentiation in striatopallidal cells of the indirect pathway underlies aberrant learning. We demonstrate synaptic potentiation in striatopallidal neurons induced by D2 blockade and diminished by application of an adenosine antagonist, consistent with behavioral observations. A neurocomputational model of the basal ganglia recapitulates the behavioral pattern and further links aberrant learning to plasticity in the indirect pathway. Thus, D2-mediated aberrant learning may contribute to motor deficits in PD, suggesting new avenues for the development of therapeutics.

Systemic or intrasynovial medication as singular or as combination treatment in horses with (peri-)synovial pain

Records of lame horses (2004–2007) with (peri-)synovial pain of the metacarpophalangeal joint (MCPJ, n = 53), digital flexor tendon sheath (DFTS, n = 20), and distal interphalangeal joint (DIPJ, n...

CLINICAL SIGNIFICANCE AND PROGNOSIS OF DEEP DIGITAL FLEXOR TENDINOPATHY ASSESSED OVER TIME USING MRI

Deep digital flexor (DDF) tendinopathy is one of the most frequent causes of foot lameness and the prognosis is guarded. The progress of lesion healing may be followed by magnetic resonance (MR) imaging to formulate a prognosis and to adapt the rehabilitation program. We assessed the correlation of outcome with total tendon damage and temporal resolution of MR abnormalities. Images from 34 horses with DDF tendinopathy that had undergone at least two low-field standing MR examinations of the foot (mean 2.5 ± 1.3 times) were reviewed. No horse having a T1-GRE hyperintense lesion over 30 mm in length or over 10% tendon cross-sectional area returned to its previous activity level. Horses with concomitant lesions had worse outcome than horses with DDF tendinopathy only (P = 0.005). In all horses including those with excellent outcome, the lesion persisted, even mildly, in T1-GRE and PD images. Horses with tendon lesion resolution on STIR-FSE and T2-FSE images on recheck examination had a better outcome (P = 0.0004 and P = 0.002, respectively), and all horses that returned to their previous level of performance had complete resolution of signal hyperintensity on the STIR-FSE sequence. Although rehabilitation remains multifactorial, characteristics of DDF tendinopathy and concomitant lesions on first and recheck MR examinations allow refining the prognosis.

Sportverletzungen und Überlastungsschäden des Ellenbogengelenks

Sports injuries of the elbow joint can be acute or can arise due to chronic overuse. Such overstress syndromes are common in overhead, throwing and racket sports activities. The present article introduces diagnostic algorithms developed from knowledge gained through motion analysis, clinical examination and further imaging. The diagnosis of the overtaxing syndromes mainly depends on these findings. Basically most of the disorders in the elbow joint can be treated conservatively. If this is not the case or if the conservative treatment does not succeed, arthroscopic techniques, ligament reconstruction or nerve decompression are the major alternatives. The prognosis for regaining elbow function and returning to the previous level of performance is generally good. The resulting therapy recommendations are summarised on the basis of the current highest grades of evidence.

Conservative management of a transverse fracture of the distal phalanx in a Quarter Horse

A 7-year-old Quarter Horse gelding was evaluated because of sudden onset of severe left forelimb lameness of 4 days' duration. Clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. Radiography revealed a transverse fracture of the distal phalanx of the left forelimb. The horse was treated conservatively with stall rest and stabilization of the hoof with fiberglass cast material and an elevated heel support. These treatments improved the lameness considerably. Over the following 4 months, the horse was exercised at an increasing level; external coaptation of the hoof was removed, and the horse was gradually shod in a flat shoe. At 6 months after injury, the horse had no signs of lameness when working at its previous performance level, but it was euthanized for reasons unrelated to orthopedic disease. Radiographically, the fracture was unapparent; however, results of magnetic resonance imaging and histologic examination of the cadaveric limb confirmed the presence of tissue changes consistent with a healing fracture. Conservative management of transverse fractures of the distal phalanx of a forelimb may be effective and enable affected horses to be returned to their intended use.

P-1408 - Prevalence and associated factors of stress, anxiety and depression among entering medical students

Many studies have shown that the prevalence of psychological distress among medical students during medical training is high. However, there are few studies explore on the psychological health of medical students prior to the medical training. To determine the prevalence and associated factors of entering medical students had significant stress, anxiety and depression symptoms prior to medical course. This study was an attempt to explore the psychological health aspects of entering medical students prior to medical training. A cross-sectional study was done on two cohorts of applicants to a medical school. A total of 839 applicants were invited to participate in the study. The DASS-21 was administered to them after they completed interviews to measure stress, anxiety and depression level. Moderate to extremely severe levels of stress, anxiety and depression were considered as significant levels. A total of 743 (92.2%) applicants took part in the study. Approximately 26 (3.6%) experienced stress, 400 (54.5%) experienced anxiety, and 14 (1.9%) experienced depression. Stress associated with entry qualification, previous academic performance, race, involvement in extra-curricular activities, and parent education levels. Anxiety associated with parent concern about religion education, entry qualification, extra-curricular activities, previous academic performance, race and mother education level. Depression associated with parent concern about friends, entry qualification, extra-curricular activities, previous academic performance and race. The prevalence of stress and depression among entering medical students was low prior to medical training. Its associated factors seem to be related to academic, parent and student personal backgrounds.

Desmitis of the medial tarsal collateral ligament in 7 horses

SummarySevere lameness, tarsocrural joint effusion and medially focused peritarsal swelling combined with focal pain on palpation are clinical signs suggestive of acute injury to the medial tarsal collateral ligament. Diagnosis can be made on physical examination and ultrasonographic findings; however, magnetic resonance imaging may provide more information especially with subtle injury. Acute exacerbation of the injury during the prolonged convalescence is common. The prognosis for medial tarsal collateral ligament desmitis appears good for survival but fair for return to previous levels of performance and requires prolonged periods of rest and a controlled exercise programme.