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Topic:Clinical Pathology

Clinical pathology in horses involves the study and analysis of biological samples to diagnose and monitor diseases and health conditions. This discipline encompasses various laboratory tests and procedures that assess the physiological and biochemical status of equines. Common analyses include hematology, biochemistry, urinalysis, and cytology, each providing insights into different aspects of equine health. Hematology evaluates blood components, such as red and white blood cells and platelets, to identify conditions like anemia or infection. Biochemistry tests measure enzymes, electrolytes, and metabolites to assess organ function and metabolic status. Urinalysis examines urine samples for indicators of renal function and systemic diseases. Cytology involves the microscopic examination of cells from tissues or fluids to detect abnormalities. This page aggregates peer-reviewed research studies and scholarly articles that explore the methodologies, applications, and diagnostic value of clinical pathology in equine medicine.
Assessment of clinical and microbiota responses to fecal microbial transplantation in adult horses with diarrhea.
PloS one    January 14, 2021   Volume 16, Issue 1 e0244381 doi: 10.1371/journal.pone.0244381
McKinney CA, Bedenice D, Pacheco AP, Oliveira BCM, Paradis MR, Mazan M, Widmer G.Fecal microbial transplantation (FMT) is empirically implemented in horses with colitis to facilitate resolution of diarrhea. The purpose of this study was to assess FMT as a clinical treatment and modulator of fecal microbiota in hospitalized horses with colitis. A total of 22 horses with moderate to severe diarrhea, consistent with a diagnosis of colitis, were enrolled at two referral hospitals (L1: n = 12; L2: n = 10). FMT was performed in all 12 patients on 3 consecutive days at L1, while treatment at L2 consisted of standard care without FMT. Manure was collected once daily for 4 days fro...
Evaluation of Overground Endoscopy Findings in Colombian Criollo Paso Horses.
Journal of equine veterinary science    January 12, 2021   Volume 99 103374 doi: 10.1016/j.jevs.2021.103374
Joó K, Duque Betancourt D, Vasquez Marin T, Parra Moyano LA.The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < ...
Relationship between atrial fibrillatory rate based on analysis of a modified base-apex surface electrocardiogram analysis and the results of transvenous electrical cardioversion in horses with spontaneous atrial fibrillation.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    January 11, 2021   Volume 34 73-79 doi: 10.1016/j.jvc.2021.01.001
Van Steenkiste G, Carlson J, Decloedt A, Vera L, Buhl R, Platonov PG, van Loon G.To compare the atrial fibrillatory rate (AFR) derived from a local right atrial intracardiac recording (RA-FR) and from a single-lead surface electrocardiogram (ECG) during atrial fibrillation (AF) and to evaluate the correlation with transvenous electrical cardioversion (TVEC) threshold (in Joules), number of shocks and cardioversion success rate in horses. Methods: ECGs and clinical records of horses with AF treated by TVEC. Horses were included if a simultaneous recording of the right atrial intracardiac electrogram and a modified base-apex ECG were available. Methods: Clinical records of h...
Feasibility, indications, and radiographically confirmed diagnoses of standing extremity cone beam computed tomography in the horse.
Veterinary surgery : VS    January 9, 2021   Volume 50, Issue 2 365-374 doi: 10.1111/vsu.13560
Pauwels FE, Van der Vekens E, Christan Y, Koch C, Schweizer D.To report on the feasibility, indications, and diagnostic yield of cone beam computed tomography (CBCT) of horses' extremities performed under standing sedation. Methods: Retrospective clinical case series. Methods: Fifty-nine CBCT examinations in 58 horses. Methods: Examinations were categorized for indications for CBCT dependent on a suspicion, presence, or absence of a diagnosis prior to CBCT. The number of acquisitions per examination, total time for the examination, diagnostic score of each acquisition (diagnostic, diagnostic-compromised, nondiagnostic), and additional diagnostic informat...
The influence of clinical severity and topical antimicrobial treatment on bacteriological culture and the microbiota of equine pastern dermatitis.
Veterinary dermatology    January 8, 2021   Volume 32, Issue 2 173-e41 doi: 10.1111/vde.12912
Sangiorgio DB, Hilty M, Kaiser-Thom S, Epper PG, Ramseyer AA, Overesch G, Gerber VM.Equine pastern dermatitis (EPD) is a common dermatological problem in horses, yet its aetiology and pathogenesis are poorly understood. Objective: This study aimed to investigate the effects of lesion severity and topical antimicrobial treatment on bacterial flora of EPD-affected skin. Methods: Sixteen horses with EPD were investigated. Methods: An observational study was conducted by assigning a clinical severity score ranging from 0 (macroscopically nonlesional) to 21 (severe), and sampling the most and least severely affected limbs of 16 horses (32 limbs) for bacteriological culture and 16S...
The imbalance of the Th17/Treg axis following equine ascending placental infection.
Journal of reproductive immunology    January 7, 2021   Volume 144 103268 doi: 10.1016/j.jri.2020.103268
Fedorka CE, El-Sheikh Ali H, Walker OF, Scoggin KE, Dini P, Loux SC, Troedsson MHT, Ball BA.Ascending placentitis is a leading cause of abortion in the horse, but adaptive immune response to this disease is unknown. To evaluate this, sub-acute placentitis was experimentally-induced via trans-cervical inoculation of S. zooepidemicus, and endometrium and chorioallantois was collected 8 days later (n = 6 inoculated/n = 6 control). The expression of transcripts relating to Th1, Th2, Th17, and Treg maturation was assessed via RNASeq. IHC of transcription factors relating to each subtype in the same tissues (Th1: TBX21, Th2: GATA3, Th17: IRF4, Treg: FOXp3). An immunoassay was utili...
Chronic Collateral Sesamoidean Desmopathy in Draft Horses: Magnetic Resonance Imaging and Histopathological Findings.
Journal of equine veterinary science    January 7, 2021   Volume 98 103362 doi: 10.1016/j.jevs.2020.103362
Abu-Seida AM, Elemmawy YM.Desmopathy of the collateral sesamoidean ligament (CSL) is an unusual disorder in draft horses. This study records the magnetic resonance imaging (MRI) features of chronic CSL desmopathy in eight draft horses and confirms these features by histopathology. The recorded chronic CSL desmopathy has usually affected the forelimbs (100%) and commonly bilateral (62.5%). All horses showed positive proximal digital nerve block, positive front digital flexion test, and negative interphalangeal extension test. Radiography revealed no osseous abnormalities in all feet. MRI features of chronic CSL desmopat...
Effectiveness of a digital interactive multimedia tutorial for preparing veterinary students to perform ultrasonography in horses.
Journal of the American Veterinary Medical Association    January 7, 2021   Volume 258, Issue 2 165-169 doi: 10.2460/javma.258.2.165
Navas de Solis C, Gilmour LJ, Coleman MC, Watts AE, Bevevino KE, Glass KG, Hardy J, Chaney KP.To determine the effectiveness of a digital interactive multimedia tutorial (DIMT) for preparing veterinary students to perform ultrasonography in horses. Methods: 42 third-year veterinary students. Methods: Students were randomly assigned to 3 instructional methods: independent study (ie, 45 minutes to read a highlighted textbook chapter), lecture (ie, 45-minute lecture by a faculty member), or digital interactive multimedia tutorial (DIMT; ie, 45-minute narrated, interactive module). Written and practical tests were administered after each instruction session. For the practical test, each st...
Clinical and diagnostic findings, treatment, and short- and long-term survival in horses with peritonitis: 72 cases (2007-2017).
Veterinary surgery : VS    January 7, 2021   Volume 50, Issue 2 323-335 doi: 10.1111/vsu.13564
Arndt S, Kilcoyne I, Vaughan B, Dechant JE.To identify etiology, clinical findings, diagnostic results, treatment, and short- and long-term survival and to report factors associated with nonsurvival and survival in horses with peritonitis. Methods: Retrospective study. Methods: Horses (n = 72). Methods: Medical records at William R. Pritchard Veterinary Medical Teaching Hospital from 2007-2017 were reviewed for horses diagnosed with peritonitis. The essential inclusion criterion was a peritoneal nucleated cell count of ≥25 000 cells/μL. Gastrointestinal rupture and cases in which peritonitis occurred after abdominal surgery or cas...
Applicability of commercial clinical chemistry test kits for horse serum.
BMC research notes    January 7, 2021   Volume 14, Issue 1 13 doi: 10.1186/s13104-020-05434-2
Megerssa YC, Gari FR, Woldemariyam FT.Validation of a test method is critical for confirming that the test can generate accurate and precise data. Although commercial biochemical test kits exist there are no specific and validated commercial clinical chemistry test kits designed for horses. The aim of this study was to validate commercial clinical chemistry test kits designed for a human serum for use in horses. Results: Blood samples were collected from 29 apparently healthy adult male horses and pooled serum was prepared. Validation comprises replication and recovery experiments. Total observable error (TE), sigma (σ) metrics, ...
Effects of Intravenous Flunixin Meglumine, Phenylbutazone, and Acupuncture on Ocular Pain Scores in the Horse: A Pilot Study.
Journal of equine veterinary science    January 6, 2021   Volume 98 103375 doi: 10.1016/j.jevs.2021.103375
Makra Z, Csereklye N, Riera MM, McMullen RJ, Veres-Nyéki K.In this controlled, blinded, randomized block pilot study, the main objective was to evaluate the effectiveness of intravenous flunixin meglumine, phenylbutazone, and acupuncture on ocular pain relief using a multifactorial pain scale in the horse. Four experimental horses underwent corneal epithelial debridement in four sessions, when a randomly selected treatment or a control was used. All horses were pain scored before corneal wounding, then at 18 time points, when 11 parameters were allocated. Differences in the area under the curve of pain scores between the treatment groups were analyzed...
Evaluation of a novel ambulatory electrocardiogram monitor (the Carnation Ambulatory Monitor) for use in horses.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    January 6, 2021   Volume 34 16-28 doi: 10.1016/j.jvc.2020.12.005
Keen JA, O'Connor SA.Short-term electrocardiogram (ECG) examinations of horses may not detect paroxysmal arrhythmias. Twenty-four hour Holter equipment can be unwieldy and inconvenient for long-term use. This study evaluated a novel long-term ECG patch recorder, the Carnation Ambulatory Monitor (CAM) in horses, determining ideal placement, practicality, durability and performance. Methods: Twenty-one adult mixed-breed horses. Methods: Prospective observational study. Three horses had ECG patches fitted at selected sites (phase 1); the two most promising sites were used for further wear testing (phase 2) and the b...
Nonclassified Lymphoma as a Cause of Radial Nerve Paralysis in a Horse.
Journal of equine veterinary science    January 6, 2021   Volume 98 103371 doi: 10.1016/j.jevs.2021.103371
Barba M, Groover ES, Bailey J, Cole R, Christopherson P, Cattley R.A 4-year-old American Quarter Horse gelding was evaluated for acute non-weight-bearing lameness of the right thoracic limb with swelling in the right shoulder region. Physical examination revealed radial nerve paralysis of unknown etiology. The primary differential diagnosis was musculoskeletal trauma. Ultrasonography of the right shoulder region identified a heterogeneous mass that extended from the point of the shoulder to the thoracic inlet. Cytologic analysis of fluid collected by fine needle aspirate of the mass was consistent with large cell lymphoma. Based on the cytological findings, l...
Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases).
The Canadian veterinary journal = La revue veterinaire canadienne    January 5, 2021   Volume 62, Issue 1 22-26 
Merchan A, Barrett EJ, Rodgerson DH.A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months. Key clinical message: Hand-assisted recumbent laparoscopy...
MMP-9 Concentration in Peritoneal Fluid Is a Valuable Biomarker Associated with Endotoxemia in Equine Colic.
Mediators of inflammation    January 5, 2021   Volume 2021 9501478 doi: 10.1155/2021/9501478
Barton AK, Richter IG, Ahrens T, Merle R, Alalwani A, Lilge S, Purschke K, Barnewitz D, Gehlen H.The purpose of the study was to compare the results of sepsis scoring (clinical examination and clinical pathology) to the concentrations of matrix-metalloproteinases (MMPs) -2, -8, and -9; tissue-inhibitor of metalloproteinases (TIMPs) -1 and -2; and inflammatory chemokines interleukin (IL) 1β and tumor-necrosis-factor-alpha (TNF-α) in plasma and peritoneal fluid of equine colic patients. A modified sepsis scoring including general condition, heart and respiratory rate, rectal temperature, mucous membranes, white blood cell count (WBC), and ionized calcium was applied in 47 horses presented...
Navicular Syndrome-related changes to collagen proportion of different cross-sections of the flexor tendons in equine distal forelimb.
Research in veterinary science    January 5, 2021   Volume 135 106-112 doi: 10.1016/j.rvsc.2021.01.002
Salinas P, Lira-Velásquez D, Bongiorno A, Sandoval C.The aim of this study was to quantify the distribution of aligned and non-aligned collagen in cross-sections of the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) in different levels of the distal forelimb of equines diagnosed with NS (Navicular Syndrome). Sixty equine forelimbs were collected. Was compared two groups (NA, Not affected vs. NS-group) by t-Student. Diagnosis of NS was based on clinical and lameness examination, diagnostic analgesia and radiological findings. The proportion of aligned and non-aligned collagens at 2 levels for the SDFT and 3 levels ...
Skin Diseases in Donkeys and Mules-An Update.
Animals : an open access journal from MDPI    December 31, 2020   Volume 11, Issue 1 65 doi: 10.3390/ani11010065
Lima TS, Silva RAF, Pereira RMF, Soares KL, Santos NTA, Sousa MS, Mendonça FS, Lucena RB.The skin of donkeys and mules represents a promising source of income; however, cultural, productive, and infectious factors can directly interfere with the quality of the integumentary tissue and well-being of these species. The objective of this study is to present a literature review on equine dermatopathies. This literature review included scientific articles related to equine medicine and breeding according to pre-established search terms and expressions published in recently articles. The evaluation of the clinical and pathological behavior of dermatopathies implies the use of control st...
The Effect of Uterine Lavage on Soluble CD14, Chemokine Ligand 2, and Interleukin 10 Levels in Mares With Postpartum Metritis.
Journal of equine veterinary science    December 30, 2020   Volume 98 103365 doi: 10.1016/j.jevs.2020.103365
Tukia E, Wagner B, Vainio K, Mönki J, Kareskoski M.Postpartum metritis in mares is a life-threatening condition associated with severe clinical signs due to endotoxemia, and it is often followed by complications such as laminitis. Repeated large-volume uterine lavages are commonly recommended as a part of the treatment protocol to remove endotoxin-laden contents from the uterus. It has, however, also been suggested that lavages may increase the uptake of endotoxin into the circulation, leading to a deterioration of clinical signs. Endotoxemia is associated with the release of a multitude of inflammatory mediators regulating the immune response...
Comparison of four peribulbar anaesthetic techniques: a preliminary study in equine cadavers.
Veterinary anaesthesia and analgesia    December 29, 2020   Volume 48, Issue 3 442-450 doi: 10.1016/j.vaa.2020.10.009
Rabbogliatti V, De Zani D, Zani DD, Di Cesare F, Brioschi FA, Gioeni D, Crivellari B, Ravasio G.To compare the peribulbar injectate distribution and probability of regional anaesthesia of four peribulbar anaesthetic techniques in equine cadavers. Methods: Prospective experimental cadaver study. Methods: A total of 12 isolated equine cadaver heads and 24 eyes. Methods: The 24 orbits underwent one of four injection techniques (six orbits each) with a mixture (1:4) of contrast medium and saline (CM): 20 mL ventrolateral peribulbar injection (V-20), 20 mL dorsolateral peribulbar injection (D-20), combined ventrolateral and dorsolateral peribulbar injections 10 mL each (VD-20) or 20 mL each (...
Computed tomographic assessment of brain tissue disruption and skull damage in equine cadaveric heads caused by various firearm-ammunition combinations applied as potential gunshot methods for euthanasia of horses.
American journal of veterinary research    December 29, 2020   Volume 82, Issue 1 28-38 doi: 10.2460/ajvr.82.1.28
Lund JR, Ketover HR, Hetzel S, Waller K, Brounts SH.To evaluate with CT the characteristics of brain tissue disruption and skull damage in cadaveric heads of adult horses caused by each of 6 firearm-ammunition combinations applied at a novel anatomic aiming point. Methods: 53 equine cadaveric heads. Methods: Heads placed to simulate that of a standing horse were shot with 1 of 6 firearm-ammunition combinations applied at an aiming point along the external sagittal crest of the head where the 2 temporalis muscles form an inverted V. Firearm-ammunition combinations investigated included a .22-caliber long rifle pistol firing a 40-grain, plated le...
Ex vivo comparison of ultrasonographic intestinal wall layering with histology in horses: A feasibilty study. Bevevino KE, Edwards JF, Cohen ND, de Solis CN.Ultrasonography is increasingly being used as a clinical and research method for evaluating the gastrointestinal tract in horses, however published studies comparing ultrasonographic and histologic characteristics of equine intestinal wall layers are currently lacking. Objectives of this prospective, observational, methods comparison, case series study were to compare the layering pattern and thickness of the intestinal wall layers determined using ex vivo and in vivo ultrasonography with those determined using histology. For the ex vivo study, twelve horses were euthanized for reasons unrelat...
Retrospective analysis of lameness localisation in Western Performance Horses: A ten-year review.
Equine veterinary journal    December 26, 2020   Volume 53, Issue 6 1150-1158 doi: 10.1111/evj.13397
Johnson SA, Donnell JR, Donnell AD, Frisbie DD.Similar to other high-level athletic disciplines, the western performance horse experiences a variety of orthopaedic conditions as a result of rigorous sport-specific physical demands. While musculoskeletal injury rates have been quantified in other equine disciplines, these data are lacking for the western performance athlete. Objective: To identify the most common anatomical regions of lameness in western performance horses being evaluated at the nation's largest sanctioned shows over a 10-year study period. Methods: Retrospective review of clinical records. Methods: Records of diagnostic an...
Clinical implications of using adrenocorticotropic hormone diagnostic cutoffs or reference intervals to diagnose pituitary pars intermedia dysfunction in mature horses.
Journal of veterinary internal medicine    December 24, 2020   Volume 35, Issue 1 560-570 doi: 10.1111/jvim.16017
Horn R, Stewart AJ, Jackson KV, Dryburgh EL, Medina-Torres CE, Bertin FR.Diagnosis of pituitary pars intermedia dysfunction (PPID) is problematic because of large variations in ACTH concentrations. Objective: Compare the test characteristics of baseline and post-thyrotropin-releasing hormone (TRH) stimulation plasma ACTH concentrations in horses using diagnostic cutoff values (DCOVs) and reference intervals (RIs) and determine the clinical consequences of using each method. Methods: One hundred six mature horses: 72 control cases and 34 PPID cases. Methods: Prospective case-controlled study. Horses underwent monthly TRH stimulation tests. Diagnostic cutoff values w...
Clinical insights: Update on colic.
Equine veterinary journal    December 22, 2020   Volume 53, Issue 1 6-8 doi: 10.1111/evj.13347
Aitken MR.No abstract available
Assessment of platelet biology in equine patients with systemic inflammatory response syndrome. Ehrmann C, Engel J, Moritz A, Roscher K.In addition to maintaining hemostasis, platelets have an important role in modulating innate and adaptive immune responses. A low platelet count has been found to be a negative prognostic factor for survival in humans and horses with critical illnesses, such as sepsis or systemic inflammatory response syndrome (SIRS). Decreased platelet aggregation, caused by in vivo activation, has been found in human patients with severe sepsis. In our prospective controlled study, we assessed platelet biology in blood samples from 20 equine SIRS cases and 120 healthy control horses. Platelet variables such ...
Evaluation of a smartphone-based electrocardiogram device accuracy in field and in hospital conditions in horses.
Veterinary record open    December 21, 2020   Volume 7, Issue 1 e000441 doi: 10.1136/vetreco-2020-000441
Alberti E, Stucchi L, Pesce V, Stancari G, Ferro E, Ferrucci F, Zucca E.Due to compactness and cheapness, smartphone ECG (sECG) could be very useful to equine practitioners. However, previous studies have evaluated the accuracy of sECG in hospitalised horses only. Different conditions in the field could influence the accuracy of the device. The aim of this study is to compare the accuracy of sECG in field and in hospital conditions. Methods: This is a prospective study. Paired standard base-apex ECG (stECG) and sECG were recorded in hospitalised horses and in subjects examined in field conditions. ECGs were analysed for heart rate and rhythm, presence/type of arrh...
Assessment of intrasynovial injection in horses by contrast-enhanced ultrasonography using air bubbles created by agitation of solution.
Equine veterinary journal    December 21, 2020   Volume 53, Issue 6 1159-1168 doi: 10.1111/evj.13388
Ogden NKE, Cullen MD, Stack JD.Accuracy of intrasynovial injections can be challenging to assess in a clinical setting in horses. Contrast-enhanced ultrasonography (CEUS) using injectate agitated with air has been used to determine the success rates of synovial injections in human rheumatology. Objective: To assess the diagnostic sensitivity and specificity of CEUS and to describe its clinical use. Methods: Cadaveric study followed by a prospective descriptive observational study. Methods: Part 1: CEUS was performed following injection of agitated methylene-blue solution targeting 13 different anatomical synovial structures...
Radiographic and Venographic Appearance of Healthy and Laminitic Feet in Amiata Donkeys.
Frontiers in veterinary science    December 21, 2020   Volume 7 601665 doi: 10.3389/fvets.2020.601665
Nocera I, Aliboni B, Ben David L, Gracia-Calvo LA, Sgorbini M, Citi S. Laminitis is a debilitating disorder resulting in irreversible anatomical changes in the feet of equids. Assessing specific anatomical features through radiography and venography provides diagnostic and prognostic information. The reference ranges are well-established in horses, but not in donkeys. It is also uncertain as to whether these ranges can be applied to every donkey breed. The present study characterizes the radiological and venographic hoof anatomy of healthy feet of Amiata donkeys and defines the changes associated with severe and mild laminitis. A total of 16 forefeet were evalu...
Microstructural properties of the proximal sesamoid bones of Thoroughbred racehorses in training.
Equine veterinary journal    December 21, 2020   Volume 53, Issue 6 1169-1177 doi: 10.1111/evj.13394
Ayodele BA, Hitchens PL, Wong ASM, Mackie EJ, Whitton RC.Proximal sesamoid bone fractures are common catastrophic injuries in racehorses. Understanding the response of proximal sesamoid bones to race training can inform fracture prevention strategies. Objective: To describe proximal sesamoid bone microstructure of racehorses and to investigate the associations between microstructure and racing histories. Methods: Cross-sectional. Methods: Proximal sesamoid bones from 63 Thoroughbred racehorses were imaged using micro-computed tomography. Bone volume fraction (BVTV) and bone material density (BMD) of the whole bone and four regions (apical, midbody d...
Pharmacokinetic and pharmacodynamic effects of 2 registered omeprazole preparations and varying dose rates in horses.
Journal of veterinary internal medicine    December 19, 2020   Volume 35, Issue 1 620-631 doi: 10.1111/jvim.15971
Wise JC, Hughes KJ, Edwards S, Jacobson GA, Narkowicz CK, Raidal SL.Omeprazole preparations vary in bioavailability in horses. Objective: To characterize the pharmacokinetics and pharmacodynamics of an existing enteric-coated oral omeprazole paste (REF) and a novel, in-feed, enteric-coated dry granule preparation (NOV). Methods: Twelve Standardbred/Thoroughbred mares free from clinical disease. Methods: A prospective, blinded randomized interventional study was trial, conducted in 3 parts: (a) bioavailability study, (b) dose titration study, and (c) comparative clinical pharmacodynamic study, each using a blocked crossover design. Results: Consistent with the ...
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