Analyze Diet

Topic:Disease Treatment

Disease treatment in horses encompasses a range of medical interventions and management strategies aimed at addressing various health conditions affecting equine species. These treatments can include pharmacological approaches, such as the administration of antibiotics, anti-inflammatory drugs, and antiparasitic medications, as well as non-pharmacological methods like physical therapy, dietary adjustments, and surgical procedures. The selection of appropriate treatments depends on the specific disease, its severity, and the individual needs of the horse. This topic brings together peer-reviewed research studies and scholarly articles that explore the efficacy, safety, and advancements in therapeutic options for equine diseases, providing insights into best practices and emerging trends in equine veterinary medicine.
Immune Relevant Models for Ocular Inflammatory Diseases.
ILAR journal    February 24, 2018   Volume 59, Issue 3 352-362 doi: 10.1093/ilar/ily002
Gilger BC.Ocular inflammatory diseases, such as dry eye and uveitis, are common, painful, difficult to treat, and may result in vision loss or blindness. Ocular side effects from the use of antiinflammatory drugs (such as corticosteroids or nonsteroidal antiinflammatories) to treat ocular inflammation have prompted development of more specific and safer medications to treat inflammatory and immune-mediated diseases of the eye. To assess the efficacy and safety of these new therapeutics, appropriate immune-relevant animal models of ocular inflammation are needed. Both induced and naturally-occurring mode...
Clinical effect of corticosteroids in asthma-affected horses: A quantitative synthesis.
Equine veterinary journal    February 23, 2018   Volume 50, Issue 5 594-601 doi: 10.1111/evj.12815
There are limited findings from low-powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma. Objective: To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference (MID), expressed as the Minimally Clinically Detectable Difference (MCDD). Methods: Pair-wise and network meta-analysis. Methods: Literature searches for stud...
Lipidomic analysis of immune activation in equine leptospirosis and Leptospira-vaccinated horses.
PloS one    February 23, 2018   Volume 13, Issue 2 e0193424 doi: 10.1371/journal.pone.0193424
Wood PL, Steinman M, Erol E, Carter C, Christmann U, Verma A.Currently available diagnostic assays for leptospirosis cannot differentiate vaccine from infection serum antibody. Several leptospiral proteins that are upregulated during infection have been described, but their utility as a diagnostic marker is still unclear. In this study, we undertook a lipidomics approach to determine if there are any differences in the serum lipid profiles of horses naturally infected with pathogenic Leptospira spp. and horses vaccinated against a commercially available bacterin. Utilizing a high-resolution mass spectrometry serum lipidomics analytical platform, we demo...
10th Annual European College of Equine Internal Medicine Congress: 2-4 November, 2017.
Journal of veterinary internal medicine    February 22, 2018   Volume 32, Issue 2 867-878 doi: 10.1111/jvim.15044
No abstract available
Effect of a syringe aspiration technique versus a mechanical suction technique and use of N-butylscopolammonium bromide on the quantity and quality of bronchoalveolar lavage fluid samples obtained from horses with the summer pasture endophenotype of equine asthma.
American journal of veterinary research    February 22, 2018   Volume 79, Issue 3 348-355 doi: 10.2460/ajvr.79.3.348
Bowser JE, Costa LRR, Rodil AU, Lopp CT, Johnson ME, Wills RW, Swiderski CE.OBJECTIVE To evaluate the effect of 2 bronchoalveolar lavage (BAL) sampling techniques and the use of N-butylscopolammonium bromide (NBB) on the quantity and quality of BAL fluid (BALF) samples obtained from horses with the summer pasture endophenotype of equine asthma. ANIMALS 8 horses with the summer pasture endophenotype of equine asthma. PROCEDURES BAL was performed bilaterally (right and left lung sites) with a flexible videoendoscope passed through the left or right nasal passage. During lavage of the first lung site, a BALF sample was collected by means of either gentle syringe aspirati...
Re-evaluation of the regulation of omeprazole in racehorses: An evidence-based approach.
Journal of veterinary pharmacology and therapeutics    February 22, 2018   Volume 41, Issue 3 469-475 doi: 10.1111/jvp.12491
Viljanto M, Hillyer L, Hincks P, Pearce C, Paine SW.Medication control and doping control have been established in horse racing to ensure the integrity of the sport and the welfare of the horses. This ensures that horses do not compete under the influence of any drugs, including omeprazole, a therapeutic medication used to treat equine gastric ulcer syndrome. In this study, pharmacokinetic data were produced in equine plasma and urine following an oral administration of 4 mg/kg of generic buffered formulation of omeprazole to six Thoroughbred horses in five daily doses to determine an appropriate screening limit and detection time in equine pl...
Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement.
Journal of veterinary internal medicine    February 22, 2018   Volume 32, Issue 2 617-632 doi: 10.1111/jvim.15042
Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL.Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and a...
Comparison of Analgesic Effects of a Constant Rate Infusion of Both Tramadol and Acetaminophen Versus those of Infusions of Each Individual Drug in Horses.
Journal of equine veterinary science    February 22, 2018   Volume 64 101-106 doi: 10.1016/j.jevs.2018.02.015
Tavanaeimanesh H, Azarnoosh A, Ashar FS, Dehghan MM, Mohebbi Z, Akbarinejad V, Corley K.The choice of analgesic agents for the horse is limited, and many have side effects that can restrict their use for chronic and prolonged pain. Little information has been published on tramadol and acetaminophen use in the horse. The study evaluated the analgesic effects of coadministration of tramadol and acetaminophen compared to those of each drug individually in a crossover study. The study was performed on six healthy horses each infused with the following over 1 hour: control (normal saline), tramadol, acetaminophen, or both (acetaminophen and tramadol infused together). Nociception (usi...
Time required to achieve maximum concentration of amikacin in synovial fluid of the distal interphalangeal joint after intravenous regional limb perfusion in horses.
American journal of veterinary research    February 22, 2018   Volume 79, Issue 3 282-286 doi: 10.2460/ajvr.79.3.282
Kilcoyne I, Nieto JE, Knych HK, Dechant JE.OBJECTIVE To determine the maximum concentration (Cmax) of amikacin and time to Cmax (Tmax) in the distal interphalangeal (DIP) joint in horses after IV regional limb perfusion (IVRLP) by use of the cephalic vein. ANIMALS 9 adult horses. PROCEDURES Horses were sedated and restrained in a standing position and then subjected to IVRLP (2 g of amikacin sulfate diluted to 60 mL with saline [0.9% NaCl] solution) by use of the cephalic vein. A pneumatic tourniquet was placed 10 cm proximal to the accessory carpal bone. Perfusate was instilled with a peristaltic pump over a 3-minute period. Synovial ...
Molecular Characterization of the Horn Fly Haematobia irritans Infesting Horses in Central Anatolia Region in Turkey.
Journal of equine veterinary science    February 21, 2018   Volume 64 49-54 doi: 10.1016/j.jevs.2018.02.004
Onder Z, Duzlu O, Yildirim A, Ciloglu A, Okur M, Inci A.This study reports intense horn fly infestations of horses raised in an important wetland ecosystem, Sultan Marshes in Central Anatolia, Turkey. In total, seven horses raised together were found to be harbored over 500 flies per site of each animal. Totally, 376 fly specimens were collected from the horses by using the nets and were subjected to the laboratory for species identification. All flies were morphologically identified as the adults of Haematobia irritans. Partial fragments of mitochondrial cytochrome oxidase I (mt-COI) gene from totally 50 isolates were amplified for sequence and ph...
Catheter-associated venous air embolism in hospitalized horses: 32 cases.
Journal of veterinary internal medicine    February 20, 2018   Volume 32, Issue 2 805-814 doi: 10.1111/jvim.15057
Parkinson NJ, McKenzie HC, Barton MH, Davis JL, Dunkel B, Johnson AL, MacDonald ES.Venous air embolism is a potentially life-threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown. Objective: Our objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses. Methods: Thirty-two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage. Methods: Multicenter retrospective study. Data extracted from...
New Treatment for Urethral Rent in Stallions.
Journal of equine veterinary science    February 20, 2018   Volume 64 89-95 doi: 10.1016/j.jevs.2018.02.014
Sancler-Silva YFR, Silva-Junior ER, Fedorka CE, Scheeren VFC, Cavalero TS, Papa PM, Alvarenga MA, Dell'Aqua JA, Papa FO.The aim of this report is to describe a new methodology to successfully treat stallions diagnosed with urethral rent. Four stallions of ages ranging from 7 to 12 years (median 9) with hemospermia were admitted for clinical evaluation, breeding soundness examination, and urethroscopy for inspection of the urethra and vesicular glands. Once the presence of urethral rent was identified and/or other sources of hemorrhage were excluded, a topical treatment was performed with 4% Policresulen solution (Albocresil). The treatment was carried out by infusing 100 mL of the solution into the lumen of t...
Effect of sotalol on heart rate, QT interval, and atrial fibrillation cycle length in horses with atrial fibrillation.
Journal of veterinary internal medicine    February 20, 2018   Volume 32, Issue 2 815-821 doi: 10.1111/jvim.15055
Decloedt A, Broux B, De Clercq D, Deprez P, Van Steenkiste G, Vera L, Ven S, van Loon G.Based on its pharmacokinetic profile and electrophysiological effects in healthy horses, sotalol potentially could be used as a long-term PO antiarrhythmic drug in horses. Objective: To evaluate the effect of sotalol on heart rate (HR), QT interval, atrial fibrillatory rate, and success of cardioversion in horses with naturally occurring chronic atrial fibrillation (AF). Methods: Twenty-eight horses referred for transvenous electrical cardioversion of AF were treated with 2 mg/kg sotalol PO q12h for 3 days before cardioversion, and 13 horses underwent the same protocol without sotalol administ...
A Novel Surgical Methodology for Dual Cannula Placement of the Ileum and Cecum in Equids: Assessment of Postoperative Management and Clinical Outcome.
Journal of equine veterinary science    February 17, 2018   Volume 64 41-48 doi: 10.1016/j.jevs.2018.02.008
Williams TL, Mochal-King C, Rude BJ, Weed BC, Nicodemus MC.Cecal and ileal cannulations have previously been used to determine equine digestibility and define gastrointestinal physiology. However, research has been limited to specific portions of the equine digestive tract lacking utilization of dual cannulations. The purpose of this study was to develop and implement surgical and preoperative and postoperative procedures for cannulation of dual sections, ileum and cecum, of the equine digestive tract including development of recommendations for addressing postsurgery complications. A total of 8 ponies went through surgical procedures for the placemen...
Effects of Feeding Frequency Using a Commercial Automated Feeding Device on Gastric Ulceration in Exercised Quarter Horses.
Journal of equine veterinary science    February 16, 2018   Volume 64 96-100 doi: 10.1016/j.jevs.2018.02.005
Bass L, Swain E, Santos H, Hess T, Black J.The objective of this study was to evaluate two feeding regimens: traditional grain feeding (twice a day, traditional fed [TF]) compared with horses fed with an automated feeder programmed to deliver grain in 20 equal aliquots (fractioned fed [FF]) and its effects on gastric ulceration, body weight, and body condition score (BCS). Thirty-one Quarter Horses were maintained in individual stalls during the 60-day experimental period and worked at moderate exercise intensity. Gastroscopies were performed before grain adaptation at 0, 30, and 60 days. Weight and BCS were evaluated biweekly. There ...
Genetic and subunit vaccines based on the stem domain of the equine influenza hemagglutinin provide homosubtypic protection against heterologous strains.
Vaccine    February 15, 2018   Volume 36, Issue 12 1592-1598 doi: 10.1016/j.vaccine.2018.02.019
Ibañez LI, Caldevilla CA, Paredes Rojas Y, Mattion N.H3N8 influenza virus strains have been associated with infectious disease in equine populations throughout the world. Although current vaccines for equine influenza stimulate a protective humoral immune response against the surface glycoproteins, disease in vaccinated horses has been frequently reported, probably due to poor induction of cross-reactive antibodies against non-matching strains. This work describes the performance of a recombinant protein vaccine expressed in prokaryotic cells (ΔHAp) and of a genetic vaccine (ΔHAe), both based on the conserved stem region of influenza hemagglut...
Diagnostics and Treatments in Chronic Diarrhea and Weight Loss in Horses.
The Veterinary clinics of North America. Equine practice    February 14, 2018   Volume 34, Issue 1 69-80 doi: 10.1016/j.cveq.2017.11.011
Oliver-Espinosa O.Chronic diarrhea in the horse is defined as diarrhea present for more than several days with little if any improvement. The diagnosis and treatment of horses with chronic diarrhea usually present a great challenge to the clinician. There are many limitations to treatment of these patients given the limited numbers in which a final diagnosis can be achieved. The lack of knowledge of the alterations of horse microbiota during chronic diarrhea and the multiplicity of causes also make treatment challenging. A poor prognosis is often attached to chronic diarrhea, particularly in cases with neoplasi...
Plasma and peritoneal fluid concentrations of ceftriaxone after intravenous and intraperitoneal administration in horses.
Veterinary journal (London, England : 1997)    February 14, 2018   Volume 234 72-76 doi: 10.1016/j.tvjl.2018.02.006
Alonso JM, Peccinini RG, Campos ML, Nitta TY, Akutagawa TYM, Crescencio AP, Alves ALG, Rodrigues CA, Watanabe MJ, Hussni CA.Intraperitoneal (IP) use of antimicrobial agents may lead to therapeutic effects with better clinical results than intravenous (IV) administration. The aim of this study was to compare plasma and peritoneal fluid concentrations of ceftriaxone after IP and IV administration in horses, and to evaluate possible adverse effects. One group of five horses received 25mg/kg ceftriaxone diluted in 1L saline solution by IP catheter once daily for 5 days, while a second group of five horses received 25mg/kg ceftriaxone diluted in 250mL saline solution by IV injection once daily for 5days and 1L saline so...
Enteral/Parenteral Nutrition in Foals and Adult Horses Practical Guidelines for the Practitioner.
The Veterinary clinics of North America. Equine practice    February 14, 2018   Volume 34, Issue 1 169-180 doi: 10.1016/j.cveq.2017.11.012
Carr EA.Nutritional support is an important adjunct to medical therapy in the sick, injured, or debilitated equine patient. What is not clear is the optimal route, composition, or amounts of support. The enteral route should be chosen whenever possible to maximize the benefits to the gastrointestinal tract and the patient as a whole. Complete or partial parenteral nutrition is most useful as a bridge during recovery and transition to enteral feeding in the horse. The reader is encouraged to consider nutritional support whether enteral or parenteral in any anorexic, chronically debilitated, or sick equ...
A retrospective report (2003-2013) of the complications associated with the use of a one-man (head and tail) rope recovery system in horses following general anaesthesia.
Irish veterinary journal    February 13, 2018   Volume 71 6 doi: 10.1186/s13620-018-0117-1
Niimura Del Barrio MC, David F, Hughes JML, Clifford D, Wilderjans H, Bennett R.The mortality rate of horses undergoing general anaesthesia is high when compared to humans or small animal patients. One of the most critical periods during equine anaesthesia is recovery, as the horse attempts to regain a standing position. This study was performed in a private equine practice in Belgium that uses a purpose-designed one-man (head and tail) rope recovery system to assist the horse during the standing process.The main purpose of the retrospective study was to report and analyse complications and the mortality rate in horses during recovery from anaesthesia using the described ...
Tenotomy of the semitendinosus muscle under standing sedation versus general anesthesia: Outcomes in 20 horses with fibrotic myopathy.
Veterinary surgery : VS    February 13, 2018   Volume 47, Issue 3 350-356 doi: 10.1111/vsu.12767
Suarez-Fuentes DG, Tatarniuk DM, Caston SS, Kersh KD, Gillen AM, Hays AM.To compare outcomes after semitendinosus tenotomy performed under standing sedation versus general anesthesia. Methods: Retrospective case series. Methods: 20 horses with fibrotic myopathy of the semitendinosus muscle. Methods: Medical records (2002-2015) of horses undergoing tenotomy of the semitendinosus muscle for the treatment of fibrotic myopathy were reviewed. Signalment, history, affected muscles, restrain method, surgical procedures, and short-term outcome as well as complications were retrieved from records. Long-term outcome (gait and athletic function) was assessed at least 6 months...
Variations during ageing in the three-dimensional anatomical arrangement of fascicles within the equine superficial digital flexor tendon.
European cells & materials    February 13, 2018   Volume 35 87-102 doi: 10.22203/eCM.v035a07
Ali OJ, Comerford EJ, Clegg PD, Canty-Laird EG.BiTendons are constructed from collagenous fascicles separated by endotenon/interfascicular matrix (IFM). Tendons may be specialised for precision movement or to store energy during locomotion and for the latter the elasticity of the endotenon/IFM is particularly important. The equine superficial digital flexor tendon (SDFT) is a dedicated energy-storing tendon with a similar function to the human Achilles tendon. Classical anatomical descriptions portray fascicles as longitudinally arranged distinct anatomical structures. In the present study, using three-dimensional reconstruction from whole...
Mouldable, thermoplastic, glue-on frog-supportive shoes change hoof kinetics in normal and obese Shetland ponies.
Equine veterinary journal    February 12, 2018   Volume 50, Issue 5 684-689 doi: 10.1111/evj.12814
Sleutjens J, Serra Bragança FM, van Empelen MW, Ten Have RE, de Zwaan J, Roelfsema E, Oosterlinck M, Back W.Obesity and hyperinsulinaemia are frequently encountered in the equine population and risk factors for the development of laminitis. There are many options for hoof support that claim a beneficial effect, but often the scientific evidence is scarce. Objective: To quantify the effect of frog-supportive shoes on hoof kinetics in normal and obese ponies. Methods: Controlled in vivo trial. Methods: Ten Shetland mares (n = 10) with a normal (n = 5) or obese (n = 5) body condition were led over a dynamically calibrated pressure plate before (T0), immediately after (T1) and 72 h (T2) after ap...
Abnormal locomotor muscle recruitment activity is present in horses with shivering and Purkinje cell distal axonopathy.
Equine veterinary journal    February 12, 2018   Volume 50, Issue 5 636-643 doi: 10.1111/evj.12813
Aman JE, Valberg SJ, Elangovan N, Nicholson A, Lewis SS, Konczak J.Cerebellar Purkinje cell axonal degeneration has been identified in horses with shivering but its relationship with abnormal hindlimb movement has not been elucidated. Objective: To characterise surface electromyographic (sEMG) hindlimb muscle activity in horses with shivering, correlate with clinical scores and examine horses for Purkinje axonal degeneration. Methods: Descriptive controlled clinical study. Methods: The hindlimb of seven shivering and six control draught horses were clinically scored. Biceps femoris (BF), vastus lateralis (VL), tensor fasciae latae and extensor digitorum longu...
Chondrogenic Differentiation of Defined Equine Mesenchymal Stem Cells Derived from Umbilical Cord Blood for Use in Cartilage Repair Therapy.
International journal of molecular sciences    February 10, 2018   Volume 19, Issue 2 537 doi: 10.3390/ijms19020537
Desancé M, Contentin R, Bertoni L, Gomez-Leduc T, Branly T, Jacquet S, Betsch JM, Batho A, Legendre F, Audigié F, Galéra P, Demoor M.Cartilage engineering is a new strategy for the treatment of cartilage damage due to osteoarthritis or trauma in humans. Racehorses are exposed to the same type of cartilage damage and the anatomical, cellular, and biochemical properties of their cartilage are comparable to those of human cartilage, making the horse an excellent model for the development of cartilage engineering. Human mesenchymal stem cells (MSCs) differentiated into chondrocytes with chondrogenic factors in a biomaterial appears to be a promising therapeutic approach for direct implantation and cartilage repair. Here, we cha...
The relationships between faecal egg counts and gut microbial composition in UK Thoroughbreds infected by cyathostomins.
International journal for parasitology    February 9, 2018   Volume 48, Issue 6 403-412 doi: 10.1016/j.ijpara.2017.11.003
Peachey LE, Molena RA, Jenkins TP, Di Cesare A, Traversa D, Hodgkinson JE, Cantacessi C.A growing body of evidence, particularly in humans and rodents, supports the existence of a complex network of interactions occurring between gastrointestinal (GI) helminth parasites and the gut commensal bacteria, with substantial effects on both host immunity and metabolic potential. However, little is known of the fundamental biology of such interactions in other animal species; nonetheless, given the considerable economic losses associated with GI parasites, particularly in livestock and equines, as well as the global threat of emerging anthelmintic resistance, further explorations of the ...
Streptococcus equi Infections in Horses: Guidelines for Treatment, Control, and Prevention of Strangles-Revised Consensus Statement.
Journal of veterinary internal medicine    February 9, 2018   Volume 32, Issue 2 633-647 doi: 10.1111/jvim.15043
Boyle AG, Timoney JF, Newton JR, Hines MT, Waller AS, Buchanan BR.This consensus statement update reflects our current published knowledge and opinion about clinical signs, pathogenesis, epidemiology, treatment, complications, and control of strangles. This updated statement emphasizes varying presentations in the context of existing underlying immunity and carrier states of strangles in the transmission of disease. The statement redefines the "gold standard" for detection of possible infection and reviews the new technologies available in polymerase chain reaction diagnosis and serology and their use in outbreak control and prevention. We reiterate the impo...
Palmar annular ligament desmotomy in horses with the Arthrex-Centerline™ : An ex-vivo study.
Open veterinary journal    February 7, 2018   Volume 8, Issue 1 53-56 doi: 10.4314/ovj.v8i1.9
Lacitignola L, De Luca P, Imperante A, Tommasa SD, Crovace A.The aim of this study was to evaluate the use of a single-portal endoscopic desmotomy of the PAL with the use of Arthrex - Centerline™. Ten horse distal front limbs from horses free of PAL disease were prepared for tenoscopy of the digital flexor tendon sheath (DFTS). A dual-port endoscopic desmotomy with a hook knife was performed in 5 specimens (Group A) and single port Arthrex-Centerline™ Desmotomy was performed in another 5 specimens (Group B). The performing time, judgments of the surgeon, number of blade passages, and gross anatomy were evaluated. The performing time and surgeon judg...
Equid herpesvirus 8: Complete genome sequence and association with abortion in mares.
PloS one    February 7, 2018   Volume 13, Issue 2 e0192301 doi: 10.1371/journal.pone.0192301
Garvey M, Suárez NM, Kerr K, Hector R, Moloney-Quinn L, Arkins S, Davison AJ, Cullinane A.Equid herpesvirus 8 (EHV-8), formerly known as asinine herpesvirus 3, is an alphaherpesvirus that is closely related to equid herpesviruses 1 and 9 (EHV-1 and EHV-9). The pathogenesis of EHV-8 is relatively little studied and to date has only been associated with respiratory disease in donkeys in Australia and horses in China. A single EHV-8 genome sequence has been generated for strain Wh in China, but is apparently incomplete and contains frameshifts in two genes. In this study, the complete genome sequences of four EHV-8 strains isolated in Ireland between 2003 and 2015 were determined by I...
Probiotic Use in Equine Gastrointestinal Disease.
The Veterinary clinics of North America. Equine practice    February 7, 2018   Volume 34, Issue 1 13-24 doi: 10.1016/j.cveq.2017.11.004
Schoster A.Probiotics are commonly used in human and veterinary medicine due to their postulated positive effects on overall and specifically gastrointestinal health. Although some beneficial effects have been shown in several human diseases, a general beneficial effect of probiotics is currently not supported. In horses, well-designed studies to date are few, results are conflicting, and the effects of probiotics are questionable. Adverse effects are rare; however, intestinal adverse effects (diarrhea) have been reported in foals. Quality control of over-the-counter probiotics is not tightly regulated, ...