Veterinary medicine for horses encompasses the study and application of medical practices to diagnose, treat, and prevent diseases in equine species. This field involves a comprehensive understanding of equine anatomy, physiology, pathology, and pharmacology. Veterinary practitioners employ a range of diagnostic tools and therapeutic interventions to address health issues in horses, including lameness, gastrointestinal disorders, respiratory conditions, and infectious diseases. Preventative care, such as vaccination and deworming programs, is also a significant aspect of equine veterinary medicine. This page gathers peer-reviewed research studies and scholarly articles that explore various aspects of veterinary medicine as it pertains to horses, including advancements in diagnostic techniques, treatment protocols, and preventive health strategies.
Lopes-Pereira CM, Harun M, Schmidtova D, Timane I, Mabasso M, Otto F, Bogin E.Adapting the concept of "bed-side" patient analysis, the Boehringer-Mannheim Reflotron was evaluated for its possible use in veterinary medicine under outdoor-field conditions. Horse blood was analysed with the Cobas Bio analyzer, and indoor and outdoor analyses were also performed with the Reflotron. All values showed close agreement with no significant differences. Good correlation coefficients (r values around 0.9000) were also seen between all methods used. The Reflotron was operated under outdoor-field conditions by using, whenever available, an on-farm electricity source, or a gas operat...
Atwill ER, Mohammed HO, Lopez JW, McCulloch CE, Dubovi EJ.To locate counties within New York state with a high seroprevalence among the equine population, to determine host, management, and environmental factors that were associated with seropositivity to Ehrlichia risticii, and to determine evidence for arthropod- or helminth-mediated transmission of E risticii to horses. Methods: Cross-sectional study. Methods: A random sample of 3,000 of the 39,000 equine operations in New York state was selected, and 2,587 horses from 511 operations were tested. Methods: Blood samples were collected from horses and tested for seropositivity, using the indirect fl...
Boersema JH, Eysker M, Maas J, van der Aar WM.The reappearance of strongyle eggs in faeces after treatment with ivermectin or pyrantel embonate was investigated in 22 foals, 36 yearlings, and 45 adult horses on five Dutch horse farms. The results confirmed earlier studies which showed an egg reappearance period of 9 and 6 weeks after ivermectin and pyrantel treatment, respectively. There were no differences between the egg reappearance periods of foals, yearlings, and adult horses. The mean egg counts of the yearlings were, however, consistently higher than the mean egg counts of the adult horses and foals in both ivermectin- and pyrantel...
West HJ.In horses with hepatic necrosis, lipidosis, neoplasia and cirrhosis, progression of the disease was studied by serial measurements of total serum bile acid concentrations and of plasma glutamate dehydrogenase (GD) and gamma glutamyl transferase (gamma GT) and by liver biopsy. Plasma ammonia concentrations were significantly elevated compared to clinically normal horses, but such changes were not always accompanied by a decline in plasma urea concentration. A fall in plasma glucose concentration carried a guarded prognosis. These were all invaluable aids in early diagnosis and throughout the di...
Tietje S, Becker M, Böckenhoff G.The rapid development of software and technology now allows a large amount of diagnostic information to be obtained from a computed tomographic examination. This imaging technique can also be usefully applied to the horse, given appropriate premises and a custom built table for accurate positioning. Computed tomography of the skull has considerable advantages over other techniques, as structures are viewed without superimposition. Fifteen cases are used to demonstrate how through high image quality (precise detail, reduction in artefacts) and objective measurement of density, various pathologi...
Riemersma DJ, van den Bogert AJ, Jansen MO, Schamhardt HC.Strains in the tendons of the m. flexor digitalis superficialis (superficial digital flexor, SDFT) and m. flexor digitalis profundus (deep digital flexor, DDFT) tendons, the accessory ligament of the deep digital flexor muscle (inferior check ligament, ICL) and the m. interosseus medius (suspensory ligament, SL) of 5 ponies were recorded at the walk and trot using mercury-in-silastic strain gauges (MISS), on a hard surface (brick pavement) and on sand. The horses were shod with normal, flat shoes. On pavement, strain in the SDFT, DDFT and SL increased significantly from the walk (2.19%, 1.15% ...
Johnson GC, Miller MA, Floss JL, Turk JR.The histologic and immunochemical characteristics of benign vascular tumors excised from the skin of seven young horses were evaluated. The patients were male horses of various breeds and were 16 months of age or younger at the time of presentation. Six tumors occurred on the extremities, and one was removed from the lip. Histologically, most tumors consisted of cellular nodules of varying compactness with few to many blood-filled lumina. Nodular growth separated preexisting adnexa and subcutaneous collagen. Some tumors contained or consisted predominantly of loosely packed arrays of ramifying...
Vatistas NJ, Snyder JR, Wilson WD, Drake C, Hildebrand S.Sixty-seven foals age < 150 days underwent a ventral celiotomy for colic. Of the 67 foals, 51 foals (82%) recovered from anaesthesia and 42 (63%) were subsequently released from the hospital. Three (6%) of the 51 foals were subjected to a repeat celiotomy. Long term follow-up was available on 36 foals. Twenty-nine (57%) of the 51 foals recovered from anaesthesia, were alive at least 2 years following surgery. Adhesions were identified in 8 (17%) of the foals which recovered from general anaesthesia but were subsequently subjected to euthanasia due to recurrent colic. Strangulating lesions were...
Moore RM, Hance SR, Hardy J, Moore BR, Embertson RM, Constable PD.Colonic luminal pressure (median, range) measured during ventral midline celiotomy in 69 horses with strangulating obstruction (SO) of the large colon (SO; > or = 270 degrees large colon volvulus; 27 cm H2O: 2 to 80 cm H2O) was greater (P = .0023) than that measured in 37 horses with nonstrangulating obstruction (NSO) of the large colon (NSO; < or = 180 degrees volvulus or a nonstrangulating displacement; 18 cm H2O; 6 to 46 cm H2O). Sixty-five percent (45 of 69) of horses with SO and all horses with NSO survived. Survival analysis was restricted to 59 horses with large-colon SO that survived t...
Theoret CL, Barber SM, Moyana T, Townsend HG, Archer JF.The reparative ability of equine synovium was determined by gross, histological, and ultrastructural examination. The functional potential of the synovium was estimated by examination of synovial cell organelles with transmission electron microscopy. Results from rested and exercised horses were compared to determine the effect of exercise on synovial healing. The response of synovectomized joint to exercise was evaluated with a standardized lameness examination and by gross, histological, and histochemical observations of the articular cartilage. A 7-mm diameter motorized synovial resector wa...
Tyler CM, Hodgson DR, Rose RJ.The VO2(max) in racehorses is approximately double that of elite human athletes and the rate of increase in VO2 at the onset of high intensity exercise is much greater than in man. The kinetics of gas exchange are affected by a warm-up prior to exercise in humans, there being a greater aerobic contribution to high intensity exercise after warm-up. Our hypothesis was that a warm-up would increase aerobic energy delivery in racehorses during high intensity exercise. Thirteen fit Standardbred racehorses ran to fatigue at 115% of VO2(max) on a treadmill at 10% slope. Prior to acceleration, horses ...
Holcombe SJ, Beard WL, Hinchcliff KW.To investigate the effect of a mask and pneumotachograph on ventilation, respiratory frequency, and tracheal and nasopharyngeal pressures in horses running on a treadmill. Methods: Six horses ran at 50, 75, and 100% of the speed that resulted in maximum oxygen consumption, with and without a mask and pneumotachograph. Tracheal and pharyngeal inspiratory and expiratory pressures, respiratory frequency, and arterial blood gases were measured. Methods: Six Standardbred horses. Methods: Oxygen consumption was measured during an incremental exercise test to determine the speed that resulted in maxi...
Whitehair KJ, Steffey EP, Woliner MJ, Willits NH.To study the effects of inhalation anesthetic agents on the response of horses to 3 hours of hypoxemia. Methods: Controlled crossover study. Methods: Five healthy adult horses. Methods: Horses were anesthetized twice: once with halothane, and once with isoflurane in O2. Anesthetized horses were positioned in left lateral recumbency. Constant conditions for the study began at 2 hours of anesthesia. A constant agent dose of 1.2 minimum alveolar concentration, PaO2 of 50 +/- 5 mm of Hg, and PaCO2 of 45 +/- 5 mm of Hg were maintained for 3 hours. Circulatory measurements were made at 0.5, 1, 2, an...
Rezai A, Underwood JL, Jalali GR, Mathias S, Allen WR, Mowbray JF.Recurrent spontaneous abortion occurs in 1 in 500 random matings and usually results in abortion of all pregnancies. If absence of antibody to a paternally derived antigen caused abortion, the woman would be expected to make antibody to the other paternal antigen and abort only half her pregnancies. Methods: Microvesicles were prepared from equine placentae. Acid-eluted IgG antibody was eluted from the polymorphic R80K antigen and used to type the residual R80K antigen on vesicles or on peripheral blood leucocytes. Results: In several equine sibships all the half-sibs had the same paternal R80...
Riemersma DJ, van den Bogert AJ, Jansen MO, Schamhardt HC.Strains in the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), accessory ligament of the deep digital flexor muscle (inferior check ligament [ICL]) and the interosseus medius muscle (suspensory ligament [SL]) in the right forelimb of 5 ponies were measured using mercury-in-silastic strain gauges a few hours after implantation. Tendon strains were recorded at the walk with normal flat shoes, egg-bar shoes, a 7 degrees increased hoof angle accomplished by application of a heel-wedge and a 7 degrees decreased hoof angle using a toe-wedge, consecutively. Ground reactio...
Wardrop KJ, Baszler TV, Reilich E, Crawford TB.Morphometric evaluation of bone marrow core biopsies was used to determine megakaryocyte (MK) numbers and MK size in nine foals with equine infectious anemia virus (EIAV)-induced thrombocytopenia. Both immunocompetent normal foals and foals with severe combined immunodeficiency (SCID) were used. Platelet counts were made three times weekly following viral infection. Bone marrow core biopsies were taken from the ilium of each foal prior to experimental infection, immediately after the onset of thrombocytopenia, and at necropsy. All foals developed thrombocytopenia by 23 days postinfection. The ...
Persson SG, Funkquist P, Nyman G.The purposes of this study were to elucidate the influences of age and sex on the mass specific blood volume parameters: total blood volume (TBV/BW, ml/kg), plasma volume (PV/ BW, ml/kg), total red cell volume (CV/BW, ml/kg) and maximal packed cell volume (PCV, l/l, i.e. after total mobilisation of the splenic red cell reservoir) and to establish reference values for these in normally performing Standardbred trotting race horses. In total 205 horses were studied. They were all, according to their owners and/or trainers, performing satisfactorily in racing or training for shortly impending raci...
Jarvis GE, Evans RJ.Endotoxin has previously been shown to induce platelet aggregation in equine heparinised whole blood. This study aimed to determine whether platelet-activating factor or products of cyclo-oxygenase metabolism (thromboxane A2 or prostaglandins) were important in mediating the response of platelets to endotoxin. The effects of the following drugs on endotoxin-induced aggregation were investigated: aspirin, flunixin meglumine and carprofen (non-steroidal anti-inflammatory drugs); CV-3988 and WEB2086 (platelet-activating factor receptor antagonists); quinacrine (phospholipase A2 inhibitor). The ef...
Valberg SJ, Geyer C, Sorum SA, Cardinet GH.To trace pedigrees from affected horses, identify likely contributing founder horses, and determine the conditional probability of founder genotypes. Methods: Muscle biopsy records from the Neuromuscular Disease Laboratory at the University of California-Davis and the University of Minnesota were searched to identify horses with a polysaccharide storage myopathy and exercise intolerance/rhabdomyolysis. Pedigrees containing 5 to 6 generations were obtained where possible. Methods: 13 Quarter Horses, 4 American Paint Horses, 3 Appaloosas, and 3 Quarter Horse crossbreds (16 mares, 4 geldings, and...
Lloyd DR, Rose RJ, Duffield AM, Suann CJ.The combination of large doses of sodium bicarbonate and the potent narcotic, etorphine, has reportedly been given to racehorses in attempts to improve their performance and also to "mask" the presence of etorphine in urine samples. The increased urinary output and pH associated with sodium bicarbonate (approximately 500 g) administration may reduce the urinary concentration of etorphine, making it more difficult to detect. Our experiment was designed to examine the effects of this combination. Six Thoroughbred horses were used in a latin-square design with three horse pairs and three treatmen...
Orsini JA, Park MI, Spencer PA.Concentrations of amikacin in endometrial tissue and plasma were studied in mares in estrus after intrauterine infusion of 1.0 or 2.0 g once a day for 3 consecutive d, and after 9.7 or 14.5 mg/kg body weight (BW) had been injected intramuscularly once a day for 3 consecutive d to determine concentrations of amikacin sulfate in plasma and endometrial tissues, and whether parenteral administration provides any advantages over intramuscular infusion. No amikacin was detected in serum at the 1.0 g dose. At the infusion dose of 2.0 g once a day, very low levels of serum amikacin were detected at 1 ...
Mätz-Rensing K, Drommer W, Kaup FJ, Gerhards H.Ten horses with partial or total retinal detachment were investigated using light and electron microscopy (TEM, SEM). Several lesions were observed and compared with normal retinal morphology. Three weeks after the initial retinal detachment, hypertrophy of the pigment epithelium with transformation of the apical microvilli could be observed. The lesions were accompanied by progressive degeneration and atrophy of the sensory retina, starting at the photoreceptor outer segments. Hypertrophy of Müller cells was a concomitant finding. Retinal detachment represents a sequel either to inflammatory...
Suzuki T, Kachi T.The adrenal medulla is a typical paraganglion, having the same origin as the sympathetic ganglia, and contains at least two types of parenchymal cells: chromaffin cells and supporting cells. We previously reported that the extent of cellular association of chromaffin cells with supporting cells was remarkably higher in noradrenaline (NA)-than in adrenaline (A)-cell regions in the adrenal medullae of the rat and pig. Methods: Cryostat sections of adrenal medullae of nine mammalian species fixed with Zamboni fluid for 24 h were immunostained by ABC methods using antisera to S-100 protein and PNM...
Watson ED, Thomson SR.The density and distribution of MHC Class II positive cells and subpopulations of lymphocytes were studied in the endometrium of genitally normal mares and mares susceptible to endometritis. In genitally normal mares, more MHC Class II positive cells were present in the epithelium and stratum compactum during oestrus than dioestrus. Significantly more CD4+ and CD8+ lymphocytes were present in the stratum compactum than in the stratum spongiosum. CD4+ lymphocytes were present in greater numbers than CD8+ lymphocytes in the stratum compactum but approximately equal numbers were present in the st...
Koch DW, Easley JT, Nelson BB, Delcambre JJ, McCready EG, Hackett ES.Auditory tube diverticula, also known as guttural pouches, are naturally occurring dilations of the auditory tube in horses that communicate with the nasopharynx through a small ostium. Infection and select other conditions can result in inflammation and narrowing of the nasopharyngeal ostium, which prevents drainage of fluid or egress of air and can lead to persistent infection or guttural pouch tympany. Auditory tube diverticulotomy allows continuous egress from the auditory tube diverticula and is a feature of disease treatment in horses, in which medical treatment alone is not successful. ...
Bailey MT, Christman SA, Wheaton JE, Troedsson MH, O'Brien TD, Ababneh MM, Santschi E.The aim of this study was to examine inhibin production in granulosa-theca cell tumours (GTCT). The experimental aims were: (i) to determine GTCT cell types that produce inhibin alpha- and betaA-subunits; (ii) to determine whether alpha- and betaA-subunit forms differ in GTCT fluid and normal equine follicular fluid (eFF); and (iii) to determine whether dimeric inhibin (alpha betaA) is present in GTCT plasma and tumour fluid. Plasma, tumour fluid and tumour tissue were collected from mares (n=6) with GTCT. Plasma and eFF were collected during the follicular phase from mares (n=4) undergoing no...
Winter J, Kershaw O, Schmitz R, Gehlen H.Equine leukaemic lymphoma is a rare disease of the haematopoetic tissue. It results from neoplastic degradation of B- and T-lymphocytes and their occurrence in the blood. Clinical signs are often unspecific and include chronic weight loss, ventral oedema at the thorax and abdomen and regional lymphadenopathy. Horses are often presented late in the course of the disease and therapy is rarely successful. This review summarizes the clinical pathologic findings of equine leukaemic lymphoma and the findings of laboratory testing and other diagnostic measures, and presents treatment options describe...
Nunn FG, Pirie RS, McGorum B, Wernery U, Poxton IR.Serum from 12 horses suffering from chronic grass sickness (CGS) were assayed for IgG antibodies against botulinum neurotoxins C and D (BoNT/C and BoNT/D) and to a surface antigen extract of a neurotoxin negative strain of Clostridium botulinum type C. Collectively, the six surviving CGS cases demonstrated significantly higher initial IgG levels (P=0.05) against surface antigens than the six that were subsequently euthanased. The surviving animals also demonstrated higher initial IgG levels against the BoNT/C but not reaching significance (P=0.06). The two groups demonstrated no difference bet...
Ramsay WN.The non-haem iron concentration was estimated in post-mortem liver samples from 51 horses (age range 1-25 years). Two were normal and 49 had been suffering from conditions that were not expected to have had long-term effects on iron metabolism. Muscle samples (splenius and biceps femoris) from 23 of these horses were also analysed. There was a highly significant age-related increase in the non-haem iron concentration in the liver (r = 0.635, p < 0.001), but not in the muscles, in which the iron concentration was much lower than in the liver.
Reynolds BL, Stedham MA, Lawrence JM, Heltsley JR.A space-occupying intracranial mass was diagnosed in a horse. The clinical findings included blindness, circling to the right, apprehension, anorexia, weight loss, and leaning against the stall. On ophthalmoscopic examination, the most striking observation was complete bilateral devascularization of the retinas. The horse was euthanatized and necropsied. Necroscopy revealed the mass to occupy the olfactory and frontal areas of the left hemisphere of the brain and part of the left frontal sinus. Microscopically, the mass was an adenocarcinoma and probably arose from the lining epithelium of the...
Otten N, Marti E, Söderström C, Amtmann E, Burger D, Gerber H, Lazary S.A xanthate compound with antiviral and antitumoural activities, tricyclodecan-9-yl-xanthogenate (D609) in combination with the potassium salt of the lauric acid (KC12) and, in a further investigation, the above-mentioned substances together with recombinant human TNF alpha (rh-TNF alpha), were tested on equine sarcoid tumours for therapeutic efficacy. A pilot investigation on 5 healthy horses showed that the compounds were well-tolerated; apart from a local, temporary oedema at the injection site, no other clinical symptoms were observed after subcutaneous administration of volumes from 0.1 to...
Kahn SK, Cywes-Bentley C, Blodgett GP, Canaday NM, Turner-Garcia CE, Vinacur M, Cortez-Ramirez SC, Sutter PJ, Meyer SC, Bordin AI, Vlock DR, Pier GB....The efficacy of transfusion with hyperimmune plasma (HIP) for preventing pneumonia caused by Rhodococcus equi remains ill-defined. Quarter Horse foals at 2 large breeding farms were randomly assigned to be transfused with 2 L of HIP from adult donors hyperimmunized either with R. equi (RE HIP) or a conjugate vaccine eliciting antibody to the surface polysaccharide β-1→6-poly-N-acetyl glucosamine (PNAG HIP) within 24 hours of birth. Antibody activities against PNAG and the rhodococcal virulence-associated protein A (VapA), and to deposition of complement component 1q (C՛1q) onto PNAG were d...
Verwilghen D, Ponthier J, Van Galen G, Salciccia A, Sandersen C, Serteyn D, Grulke S.Radial extracorporeal shockwave therapy (ESWT) is widely used in equine practice for the treatment of orthopedic problems. However, its original use as a lithotripsy device in human and canine urology led us to postulate that it could be used as an alternative to the surgical treatment of urethral calculi in horses. Objective: Radial ESWT can easily and safely fragment calculi in the distal urethra of the horse. Methods: Two postmortem cases and 1 live case of obstructive urinary disease admitted at the Veterinary Teaching Hospital of Liege. Methods: A radial shockwave device was directly appl...
Geurden T, Smith ER, Vercruysse J, Yazwinski T, Rehbein S, Nielsen MK.This reflection paper complements the WAAVP (World Association for the Advancement of Veterinary Parasitology) general anthelmintic efficacy guideline, which outlines the general principles of anthelmintic efficacy evaluation across all animal host species. It provides background to the recommendations made in the WAAVP general anthelmintic efficacy guideline, with insights into the discussions leading to specific recommendations in the general guideline or the absence thereof. Furthermore, this paper discusses recent technological advancements with potential value to the evaluation of anthelm...
Edwards JF, Ruoff WW.Cecal rupture has been reported as a complication of tape-worm infestation or parturition in horses. Often it occurs with no apparent predisposing factors. Spontaneous rupture on the medial surface of the cecum occurred in 2 of 19 foals, 12 to 24 hours after gastric endoscopy. The sites of rupture were identical in both foals. Rupture occurred despite prior deworming, withholding of food and water before anesthesia, and care in induction of anesthesia and recovery. Surgeons should be aware of the potential of cecal rupture in horses anesthetized for elective surgery.
Aurich C, König N, Budik S.In mares, repeated embryo collection in successive oestrous cycles is necessary if a greater number of foals should be produced. We investigated effects of repeated embryo collection in fertile donor mares on embryo recovery rates. In addition, an influence of the individual mare and season on embryo recovery rates was studied. In nine mares, a total of 153 embryo collections were performed during 30 months (17 ± 2.2 embryo collections per mare). The overall embryo recovery rate was 64% and did not differ among mares. Between successive embryo collection procedures, recovery rate varied signi...
Duesterdieck-Zellmer KF, Moneta L, Ott JF, Larson MK, Gorman EM, Hunter B, Löhr CV, Payton ME, Morré JT, Maier CS.To determine effects of intraarticularly administered tiludronate on articular cartilage in vivo, eight healthy horses were injected once with tiludronate (low dose tiludronate [LDT] 0.017 mg, n = 4; high dose tiludronate [HDT] 50 mg, n = 4) into one middle carpal joint and with saline into the contralateral joint. Arthrocentesis of both middle carpal joints was performed pre-treatment, and 10 min, 24 h, 48 h, 7 and 14 days after treatment. Synovial nucleated cell counts and total solids, tiludronate, sulfated glycosaminoglycan (sGAG), chondroitin sulfate 846 epitope (CS-846, a measure of aggr...
McAleese SM, Brown JK, Macrae AI, Mackellar A, Huntley JF, Miller HR.The high-affinity receptor for IgE (FcepsilonRI) plays a central role in IgE-mediated allergic reactions. Cross-linking of FcepsilonRI by IgE-antigen complexes results in the activation of mast cells and basophils and is thought to contribute to the immunopathology of Heaves, a chronic obstructive pulmonary disease of horses. Recombinant protein corresponding to the extra-cellular portion of the FcepsilonRI alpha subunit, cloned and sequenced previously, was expressed using both mammalian cells and insect cells. The yield of expressed protein was considerably greater using insect cells and the...
Samuelson JP, Echeverria KO, Foreman JH, Fredrickson RL, Sauberli D, Whiteley HE.A 22-y-old Quarter Horse gelding was presented to the University of Illinois Veterinary Teaching Hospital for evaluation of increased heart rate and mild colic signs. Rectal examination revealed a large left perirenal mass. Abdominal ultrasonography further confirmed this finding. Thoracic ultrasonography indicated multifocal irregularities on the pleural surface suggestive of consolidation and possibly masses in the lungs. The animal was euthanized. Autopsy findings included a large, firm, expansile, gelatinous retroperitoneal mass that surrounded both kidneys, as well as nodules with similar...
Archer RM, Gordon SJ, Carslake HB, Collett MG.A 3-month-old female Warmblood foal was presented after displaying signs of colic with pyrexia for 5 days. Results: The foal continued to show signs of colic, frequently passed urine, and was pyrexic with an elevated white blood cell count. The umbilical stalk was thickened but there was no evidence of purulent material. Exploratory laparotomy revealed an enlarged left umbilical artery remnant tightly adhered to the bladder wall. The left umbilical artery continued to an aneurysm involving the distal aorta. The foal was subject to euthanasia and post-mortem examination confirmed a spherical ao...
Murakami K, Sentsui H, Shibahara T, Yokoyama T.Three horses were experimentally infected with equine infectious anemia virus (EIAV). All horses were febrile after inoculation with EIAV and then developed chronic symptoms with intermittent fever. The febrile period was characterized by a rise in body temperature with reduced PBL and erythrocyte counts. Flow cytometric analysis showed that the reduced number of lymphocytes was due to significant decreases in CD4+ and CD8+ T cells in the absence of any change in B cell number. At the end of the febrile period the body temperature began to recover and numbers of CD4+ and CD8+ T cells showed a ...