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Topic:Veterinary Medicine

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.
Limited association between stallion-like behavior and hormonal indicators of testicular remnants in geldings.
Journal of equine veterinary science    June 7, 2024   Volume 139 105104 doi: 10.1016/j.jevs.2024.105104
Omyla K, Conley A, Varner D, Dini P.Persistent stallion-like behavior is a common sign of cryptorchidism in supposed geldings. The presence of testicular tissue can be evaluated by analyzing hormones such as testosterone and anti-Müllerian hormone (AMH). Here, we used hormonal analysis to investigate relationships between the likely presence of testicular tissue and stallion-like behavior in samples submitted from presumptive geldings (n = 1,202), retrospectively. Most geldings with stallion-like behaviors had serum concentrations of testosterone (851/1,056; 80.6 %) and AMH (682/877; 77.8 %) below the laboratory reference range...
First molecular characterization of Burkholderia mallei strains isolated from horses in Mongolia. Ichikawa Y, Borjigin L, Enkhtuul B, Khurtsbaatar O, Aoshima K, Kobayashi A, Batbaatar V, Kimura T.Glanders, a highly contagious and often fatal disease affecting equids, is caused by Burkholderia mallei. Although sporadic cases of equine glanders have recently been documented in Mongolia, genome sequencing and molecular studies of the bacteria within this region are lacking. This study provided the first molecular characterization of B. mallei isolated from four native Mongolian horses from two different provinces in 2019 and 2022 by applying whole-genome sequencing with two SNP types (previously developed genotyping with 15 SNP markers that provide global coverage of the B. mallei populat...
Measurement of Trace Elements (Zinc, Copper, Magnesium, and Iron) in the Saliva of Horses: Validation Data and Changes in Equine Gastric Ulcer Syndrome (EGUS).
Animals : an open access journal from MDPI    June 7, 2024   Volume 14, Issue 12 doi: 10.3390/ani14121724
Muñoz-Prieto A, Cerón JJ, Tecles F, Cuervo MM, Contreras-Aguilar MD, Ayala I, Oí«š-Guillén A, Pardo-Marín L, Hansen S.The objective of this study was to evaluate the possible use of spectrophotometric assays for the measurement of trace elements, including Zinc (Zn), Copper (Cu), Magnesium (Mg), and iron (Fe) in the saliva of horses and study their possible changes in equine gastric ulcer syndrome (EGUS). EGUS is a highly prevalent disease, with a current high incidence due to the increase in intensive management conditions. There are two EGUS diseases: equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), which can appear individually or together. For this purpose, automated spe...
Piezoelectric device use in sinus osteotomy for equines is feasible but may extend time to accomplish frontonasal bone flap.
American journal of veterinary research    June 7, 2024   Volume 85, Issue 8 ajvr.24.01.0021 doi: 10.2460/ajvr.24.01.0021
Donard LA, Vinardell T, Boussauw B, Pollaris E.Sinus osteotomy is currently performed in equine surgery with conventional surgical methods, such as trephines and oscillating bone saw, leading to subsequent trauma to the bone during cutting. Piezoelectric devices are now used in maxillofacial surgery in humans as a standard tool as it is less traumatic than the oscillating bone saw and shortens the healing period. The aim of this study was to show that the piezoelectric device can be used for equine sinus surgery, compare its use with the oscillating bone saw, and describe the outcome of cases involving osteotomy performed with a piezoelect...
A multicentric intermediate-size B-cell lymphoma with epitheliotropism in a Freiberger mare.
Veterinary dermatology    June 7, 2024   Volume 35, Issue 5 573-577 doi: 10.1111/vde.13270
Veiga IB, Affolter VK, Moore PF, Maia-Nussbaumer PJ, Gerber V, Unger L, Dettwiler M.This report describes a multicentric intermediate-size B-cell lymphoma with epitheliotropism in a Freiberger mare affecting multiple mucous membranes, skin and internal organs. The clonal neoplastic B-cell population was accompanied by numerous reactive polyclonal small T cells. Differential diagnoses for these unusual findings are discussed. 本报告描述了一种多中心性中等大小B细胞淋巴瘤, 其在弗雷伯格母马中具有驱上皮性, 影响多处粘膜、皮肤和内脏。克隆性肿瘤B细胞群伴有大量反应性多克隆小T细胞。就这些异常发现对鉴别诊...
Monoclonal antibodies for equine CD25 improve detection of regulatory T cells in horses.
Veterinary immunology and immunopathology    June 6, 2024   Volume 274 110790 doi: 10.1016/j.vetimm.2024.110790
Wagner B, Babasyan S, Wilford S, Robbin MG, de Mestre AM.CD25, the interleukin-2 receptor α-chain, is expressed on cell surfaces of different immune cells and is commonly used for phenotyping of regulatory T cells (Tregs). CD25 has essential roles in the maintenance of hemostasis and immune tolerance and Treg cell involvement has been shown in human diseases and murine models for allergy, autoimmunity, cancer, chronic inflammation, and many others. In horses, a cross-reactive anti-human CD25 antibody has previously been used for characterizing Tregs. Here, we developed monoclonal antibodies (mAbs) to equine CD25 and compared their staining pattern ...
Ultrasound biomicroscopic imaging parameters associated with outcome in equine infectious ulcerative keratitis and stromal abscesses.
Journal of the American Veterinary Medical Association    June 6, 2024   Volume 262, Issue S2 S57-S64 doi: 10.2460/javma.24.02.0097
Collins EN, Barr EM, Westermeyer H, Gilger BC, Oh A.To determine the predictive value of corneal ultrasound biomicroscopy (UBM) findings for the outcome of equine corneal disease. Methods: 46 horses with a clinical diagnosis of either infectious ulcerative keratitis or stromal abscess. Methods: Corneal UBM (VevoMD; UHF70; VisualSonics) of horses with infectious corneal disease presenting to the North Carolina State University Equine Ophthalmology Service from 2019 to 2023 were evaluated. Size and depth of lesion, presence of Descemet membrane disruption (DMD), corneal thickness, and aqueous humor cell counts (AHCC) were assessed. Comparisons of...
Heart rate and heart rate variability in horses undergoing hot and cold shoeing.
PloS one    June 6, 2024   Volume 19, Issue 6 e0305031 doi: 10.1371/journal.pone.0305031
Huangsaksri O, Wonghanchao T, Sanigavatee K, Poochipakorn C, Chanda M.Heart rate variability (HRV) is a frequently used indicator of autonomic responses to various stimuli in horses. This study aimed to investigate HRV variables in horses undergoing cold (n = 25) or hot (n = 26) shoeing. Multiple HRV variables were measured and compared between horses undergoing cold and hot shoeing, including the time domain, frequency domain, and nonlinear variables pre-shoeing, during shoeing, and at 30-minute intervals for 120 minutes post-shoeing. The shoeing method interacted with time to change the HRV variables standard deviation of RR intervals (SDNN), root mean square ...
Advances in equine reproduction.
Equine veterinary journal    June 5, 2024   Volume 56, Issue 4 644-649 doi: 10.1111/evj.14102
Stout TAE, Crabtree JR, Cuervo-Arango J.No abstract available
Enhancing prosthesis stability at the cricoid cartilage in equine laryngoplasty using 3-D-printed laryngeal clamps: An ex vivo model study.
Veterinary surgery : VS    June 5, 2024   doi: 10.1111/vsu.14115
Grzeskowiak R, Schumacher J, Omidi O, Bowers K, Cassone LMC, Abedi R, Hespel AM, Mulon PY, Anderson DE.To assess a three-dimensional (3-D)-printed laryngeal clamp (LC) designed to enhance the anchoring of laryngeal prostheses at the cricoid cartilage. Methods: Ex vivo biomechanical study. Methods: A total of 22 equine larynges. Methods: Two experimental groups included larynges with standard prosthetic laryngoplasty (PL; n = 10) and larynges with prosthetic laryngoplasty modified with laryngeal clamps (PLLC; n = 10). All constructs underwent 3000 cycles of tension loading and a single tension to failure. Recorded biomechanical parameters included maximum load, actuator displacement, a...
The effect of systemic acetazolamide administration on intraocular pressure in healthy horses-A preliminary study.
Veterinary ophthalmology    June 5, 2024   Volume 28, Issue 1 66-72 doi: 10.1111/vop.13240
Shnaiderman-Torban A, Pe'er O, Gustafsson K, Tatz A, Brizi M, Soback S, Abu Ahmad W, Magen R, Ofri R, Kelmer G.In equine glaucoma, topical treatment with carbonic anhydrase inhibitors (CAIs) is recommended. Oral acetazolamide, a systemic CAI, is used in horses with hyperkalemic periodic paralysis. Information regarding its effect on equine intraocular pressure (IOP) is scarce. The aim of the study was to determine the effect of oral acetazolamide treatment on IOP in horses, in a case-control study. Methods: Ten healthy horses. Methods: Horses were treated with oral acetazolamide (4.4 mg/kg) BID for 1 week. Serum acetazolamide concentrations were determined by liquid chromatography/tandem mass spect...
Blebbistatin as a novel antiviral agent targeting equid herpesvirus type 8.
Frontiers in veterinary science    June 5, 2024   Volume 11 1390304 doi: 10.3389/fvets.2024.1390304
Li L, Cui X, Yu Y, Sun Q, Li W, Li Y, Li S, Chen L, Khan MZ, Wang C, Wang T.Equid herpesvirus type 8 (EqHV-8) poses a significant threat to equine health, leading to miscarriages and respiratory diseases in horses and donkeys, and results in substantial economic losses in the donkey industry. Currently, there are no effective drugs or vaccines available for EqHV-8 infection control. Unassigned: In this study, we investigated the and antiviral efficacy of Blebbistatin, a myosin II ATPase inhibitor, against EqHV-8. Unassigned: Our results demonstrated that Blebbistatin significantly inhibited EqHV-8 infection in Rabbit kidney (RK-13) and Madin-Darby Bovine Kidney (MDB...
Hematological and Biochemical Effects Associated with Prolonged Administration of the NSAID Firocoxib in Adult Healthy Horses.
Veterinary sciences    June 5, 2024   Volume 11, Issue 6 doi: 10.3390/vetsci11060256
Ignácio FS, Garcia LV, de Souza GG, Amatti LZ, de Barros LD, Bergfelt DR, Camargo GS, de Meira C, de Almeida BFM.Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most commonly used classes of drugs in both human and veterinary medicine. However, many clinical side effects have been observed, especially when treatment has been prolonged. While the anti-inflammatory efficacy and safety of repeated administration of firocoxib (Previcox®), which is a selective NSAID COX-2 inhibitor, has been evaluated for short-term use (one to fourteen days), its clinical relevance for longer-term use is not known. As a preliminary study, healthy, adult male and female horses (n = 7) were treated with fi...
Equine helminths: prevalence and associated risk factors in Gamo Gofa Zone, Ethiopia.
Journal of veterinary science    June 5, 2024   Volume 25, Issue 3 e41 doi: 10.4142/jvs.23291
Getahun YA, Tsalke BS, Buzuneh AW, Mejo MM, Habtewold WT.Equines are indispensable in reducing the huge burden on children and women and income generation. On the other hand, minimal attention is given to improving their health and welfare. Objective: This study examined the prevalence and associated risk factors of helminth parasites of equine in the Gamo Gofa Zone. Methods: A cross-sectional study was employed from June 2019 to March 2020. The study districts and were selected purposively based on agroecology whereas selection of study households and animals were performed based on simple random sampling techniques. Identification of nematode, tr...
Flow-controlled expiration ventilation using a piston ventilator: effects of expiration time and speed on respiratory and pulmonary mechanics with focus on hysteresis and compliance in healthy horses.
American journal of veterinary research    June 5, 2024   Volume 85, Issue 8 ajvr.24.02.0036 doi: 10.2460/ajvr.24.02.0036
Douglas HF, Brandly J, Hopster K.To investigate the effects of FLow-controlled EXpiration (FLEX) ventilation expiration time and speed on respiratory and pulmonary mechanics in anesthetized horses in dorsal recumbency. Methods: 6 healthy adult research horses. Methods: In this randomized crossover experimental study, horses were anesthetized 3 times and were ventilated each time for 60 minutes using conventional volume-controlled ventilation (VCV), linear emptying of the lung over 50% of the expiratory time (FLEX50), or linear emptying of the lung over 100% of the expiratory time (FLEX100) in a randomized order. The primary o...
Cytotoxicity of local anaesthetics and protective effects of platelet rich plasma on equine tenocytes: An in vitro study.
Veterinary journal (London, England : 1997)    June 5, 2024   Volume 306 106159 doi: 10.1016/j.tvjl.2024.106159
Local anaesthetics (LAs) can have detrimental effects on rat, bovine, canine, and human tendon tissues and cells. Currently, there has been no available data on the impact of these drugs on equine tenocytes. Even if LA injection for managing painful tendon conditions in horses is limited, it is usually used via intra-articular, intrasynovial, perineural, and intrathecal as well as for lameness examinations. In this in vitro study, the cytotoxic effects of LAs, including lidocaine, mepivacaine, and bupivacaine on equine tenocytes, in the presence and absence of platelet rich plasma (PRP), were ...
Clinical Approach to Immune-Mediated Hemolytic Anemia and Thrombocytopenia.
The Veterinary clinics of North America. Equine practice    June 4, 2024   S0749-0739(24)00032-4 doi: 10.1016/j.cveq.2024.04.006
Easton-Jones CA.Primary immune mediated hemolytic anemia (IMHA) and thrombocytopenia (IMTP) are rare in horses with the conditions more commonly occurring secondary to underlying disease. Several case reports have suggested a link between neoplasia and immune-mediated destruction of platelets and red blood cells. Diagnostic investigations should therefore focus on identifying possible underlying causes such as infections and neoplasia. Immunosuppressive therapy with corticosteroids and azathioprine is the mainstay of treatment but should be used cautiously in cases where underlying infection has not been excl...
Mechanical Properties and Failure Mode of Proximal Screw Fixation Technique Using Locking Compression Plate for Proximal Interphalangeal Arthrodesis in Horses: An Ex Vivo Study.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    June 4, 2024   doi: 10.1055/s-0044-1787680
de Souza AF, Pereira CAM, Costa C, Fürst A, Kümmerle JM, De Zoppa ALV. The aim of this study was to measure the mechanical properties and failure mode of an model of proximal interphalangeal arthrodesis in horses with different methods of proximal screw fixation using a locking compression plate. Methods:  Pastern joint arthrodesis with a 3-hole 4.5-mm narrow locking compression plate was performed on 20 forelimbs of equine cadavers, randomized into four groups based on the fixation method and type of proximal screw used: unicortical cortex, bicortical cortex, unicortical locking, bicortical locking. Single-cycle axial compression testing was conducted unti...
Tropical grass digestibility assessed by the mobile bag and in vitro methods in horses.
Journal of equine veterinary science    June 4, 2024   105112 doi: 10.1016/j.jevs.2024.105112
Silva AH, Lucena JEC, Taran FMP, Cunha DS, Almeida JAT, Lima RS, Dias WS, Santiago JM.This study aimed to compare the digestibility of tropical grasses by horses by the in vivo method using mobile nylon bags with the in vitro digestibility method using horse feces as a source of inoculum. Five horses were used in a 2 × 5 factorial design with randomized blocks featuring two methods (in vivo and in vitro) and five grasses: Tifton 85 hay (Cynodon spp.), sixweeks threeawn grass (Aristida adsencionis, Linn), Alexandergrass (Brachiaria plantaginea (Link) Hitchc.), capim-de-raiz (Chloris orthonoton, Doell), and Sabi grass (Urochloa mosambicensis). No difference (P>0.05) was foun...
A fresh look at the SarcoFluor antibody test for the detection of specific antibodies to Sarcocystis neurona for the diagnosis of equine protozoal myeloencephalitis.
Veterinary parasitology    June 3, 2024   Volume 330 110219 doi: 10.1016/j.vetpar.2024.110219
Pandit PS, Smith WA, Finno CJ, Aleman M, Conrad PA, Packham A, Plancarte M, Woolard K, Marsh A, Pusterla N.Equine protozoal myeloencephalitis (EPM) is a challenging disease to diagnose in horses with neurological signs. To optimize contemporary diagnostic testing, including the use of serum:CSF antibody ratios, the SarcoFluor antibody test for Sarcocystis neurona requires revalidation. The SarcoFluor, a previously validated immunofluorescent antibody test (IFAT) for the detection of antibodies specific to S. neurona in serum and cerebrospinal fluid (CSF) of naturally infected horses was analyzed using recent data and considering a serum:CSF antibody ratio threshold. Utilization of serum and CSF pho...
Primary phenotypic features associated with caudal neck pathology in warmblood horses.
Journal of veterinary internal medicine    June 3, 2024   doi: 10.1111/jvim.17125
Dyson S, Zheng S, Aleman M.Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Objective: Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. Methods: A total of 223 Warmblood horses. Methods: Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. Th...
Equus Caballus Papillomavirus Type 7 is A Rare Cause Of Equine Penile Squamous Cell Carcinomas.
Veterinary journal (London, England : 1997)    June 3, 2024   106155 doi: 10.1016/j.tvjl.2024.106155
Munday JS, Knight CG, Bodaan CJ, Codaccioni C, Hardcastle MR.Penile squamous cell carcinomas (SCCs) are common, potentially life-threatening neoplasms of horses. They are well-recognized to be caused by Equus caballus papillomavirus (EcPV) type 2, although EcPV2 cannot be detected in all cases. A 23-year-old standardbred gelding developed multiple penile in situ and invasive SCCs that contained histological evidence of PV infection. By using both consensus and specific PCR primers, these lesions were found to contain EcPV7 DNA, but not DNA from EcPV2 or any other PV type. To determine how frequently EcPV7 is present in equine penile SCCs, specific prime...
Spatiotemporal pattern and suitable areas analysis of equine influenza in global scale (2005-2022).
Frontiers in veterinary science    June 3, 2024   Volume 11 1395327 doi: 10.3389/fvets.2024.1395327
Ding J, Wang Y, Liang J, He Z, Zhai C, He Y, Xu J, Lei L, Mu J, Zheng M, Liu B, Shi M.Equine influenza (EI) is a severe infectious disease that causes huge economic losses to the horse industry. Spatial epidemiology technology can explore the spatiotemporal distribution characteristics and occurrence risks of infectious diseases, it has played an important role in the prevention and control of major infectious diseases in humans and animals. For the first time, this study conducted a systematic analysis of the spatiotemporal distribution of EI using SaTScan software and investigated the important environmental variables and suitable areas for EI occurrence using the Maxent mode...
Effects of conditioning on the left ventricular function of young purebred Arabian horses.
PloS one    June 3, 2024   Volume 19, Issue 6 e0304724 doi: 10.1371/journal.pone.0304724
Ramos GV, Santos MM, Gava FN, de Lacerda-Neto JC.The effects of conditioning on cardiac function in young horses is still unknown. For this reason, this study evaluated the left ventricular (LV) function of young horses by echocardiography after six weeks of conditioning. Fourteen untrained young purebred Arabian horses were evaluated at rest and after a stress test (ST) before and after a six-week conditioning program. There was an increase in V4 (p < 0.001) after conditioning, as well as a reduction in both heart rate (HR) at rest and peak HR during the ST (p < 0.001). There was also a reduction in internal diameter, along with an in...
Predicted efficacy and tolerance of different dosage regimens of benzylpenicillin in horses based on a pharmacokinetic study with three IM formulations and one IV formulation.
Frontiers in veterinary science    May 31, 2024   Volume 11 1409266 doi: 10.3389/fvets.2024.1409266
Ferran AA, Roques BB, Chapuis L, Kuroda T, Lacroix MZ, Toutain PL, Bousquet-Melou A, Lallemand EA.Benzylpenicillin (BP) is a first-line antibiotic in horses but there are discrepancies between manufacturers and literature recommendations regarding dosing regimen. Objectives of this study were to evaluate pharmacokinetics and local tolerance of four different formulations of BP in adult horses, and to suggest optimized dosing regimen according to the formulation. Unassigned: A cross-over design was used in 3 phases for the intramuscular injection of three different products: procaine BP alone, procaine BP/ benzathine BP combination or penethamate hydriodide were administered IM in the glute...
Jugular venous thrombosis as a risk factor for exercise-induced pulmonary hemorrhage in thoroughbred racehorses.
Open veterinary journal    May 31, 2024   Volume 14, Issue 5 1111-1116 doi: 10.5455/OVJ.2024.v14.i5.4
Shawaf T.Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low environmental temperature, and distance of the race have been studied in racehorses. Unassigned: The aim of this study was to study the relationship between EIPH and the presence of jugular vein thrombose in racehorses. Unassigned: Forty-eight thoroughbred racehorses randomly selected from animals with exercise intolerance due to respiratory disorders were enrolled in the present study. Clinical and tracheobronchoscopy examinations w...
Use of recombinant tissue plasminogen activator (rTPA) for treatment of fibrin in the anterior chamber of the horse.
Veterinary medicine and science    May 31, 2024   Volume 10, Issue 4 e1448 doi: 10.1002/vms3.1448
Pereira R, Bowen M, Rapezzano G, Redpath A, Pratt S, Hallowell G.Recombinant intracameral tissue plasminogen activator (rTPA) administration can aid clearance of fibrin from the anterior chamber. In this retrospective multicentre case series, the effect of intracameral rTPA administration to treat fibrin in the anterior chamber resulting from trauma or inflammatory ocular disease was evaluated. Clinical data from 30 treatments in 29 horses were obtained from medical records from 2003 to 2022. Association between time from onset of clinical signs and time for rTPA treatment to effect was studied with regression analysis. Twenty-seven horses (93.1%) had no pr...
Update on the equine grass sickness biobank, database and research project.
The Veterinary record    May 31, 2024   Volume 194, Issue 11 doi: 10.1002/vetr.4361
Wells B.Beth Wells, equine grass sickness project lead at the Moredun Research Institute, encourages vets to report any equine grass sickness cases they encounter and explains how case reports and samples are being used to support research into this complex disease.
A novel approach to ear pain in the horse: A case report.
Open veterinary journal    May 31, 2024   Volume 14, Issue 5 1309-1312 doi: 10.5455/OVJ.2024.v14.i5.26
Lardone E, Landi A, Franci P.During electrochemotherapy (ECT), a chemotherapeutic drug is injected into the tumor and then an electroporation is provided. In horses, ear manipulation may be very painful, and combining a loco-regional technique with sedation might be a good option to avoid anesthesia-related risks. A two-injection-point block of the internal and external pinna and acoustic meatus was described in horse cadavers, and it permitted complete stain of all three branches of the great auricular nerve (GAN), internal auricular nerve branch (IAB), lateral auricular branch (LAB), and caudal auricular nerve (CAN), su...
Effects of astaxanthin on gut microbiota of polo ponies during deconditioning and reconditioning periods.
Physiological reports    May 30, 2024   Volume 12, Issue 11 e16051 doi: 10.14814/phy2.16051
Kawaida MY, Maas KR, Moore TE, Reiter AS, Tillquist NM, Reed SA.To determine the effects of astaxanthin (ASTX) supplementation on the equine gut microbiota during a deconditioning-reconditioning cycle, 12 polo ponies were assigned to a control (CON; n = 6) or supplemented (ASTX; 75 mg ASTX daily orally; n = 6) group. All horses underwent a 16-week deconditioning period, with no forced exercise, followed by a 16-week reconditioning program where physical activity gradually increased. Fecal samples were obtained at the beginning of the study (Baseline), after deconditioning (PostDecon), after reconditioning (PostRecon), and 16 weeks after the ces...