Simini Surgery Review: Equine Edition

Simini Podcasts

Smart. Fast. Equine Surgical Insights. The Simini Surgery Review: Equine Edition distills the latest equine-focused surgical research into clear, actionable takeaways for busy practitioners. Each episode pulls from top-tier veterinary journals — like Veterinary Surgery and VCOT — and delivers focused summaries, critical analysis, and real-world application tips in a concise, conversational format. Hosted by equine clinicians, for equine clinicians, we cut through the academic jargon to highlight what actually matters in your practice: New surgical techniques and toolsImaging innovations and orthopedic advancesPost-op strategies and infection controlEvidence-based updates that refine your clinical decision-makingWhether you’re between cases or on the road, these fast-track deep dives help you stay sharp, current, and clinically confident. 📬 Produced by Simini — committed to advancing surgical performance and antimicrobial stewardship in equine practice.

  1. Aug 3

    Veterinary Surgery Deep Dive: Equine Ortho — July 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the July 2026 issue (Issue 5) of Veterinary Surgery, where three studies challenge common assumptions about infection control, fracture fixation, and athletic prognosis after arthroscopic surgery.  From questioning whether high-volume arthroscopic lavage can truly eradicate septic arthritis, to comparing fixation strategies for proximal sesamoid fractures, and evaluating the long-term racing performance of Standardbreds following arthroscopic removal of femoropatellar OCD lesions, these papers reinforce the importance of evidence-based surgical decision-making. In this episode: ✅ Friedlund et al. investigated whether 20 liters of arthroscopic lavage alone could eliminate bacteria from experimentally induced septic arthritis in horses. Despite the large lavage volume, all Staphylococcus aureus joints and half of the Escherichia coli joints remained culture-positive 24 hours later, demonstrating that mechanical lavage alone is insufficient to eradicate infection. The findings reinforce that septic arthritis requires an aggressive multimodal treatment strategy, combining arthroscopic lavage with systemic and local antimicrobial therapy, rather than relying on fluid volume alone.  ✅ O'Brien et al. compared the bone screw fastener (BSF) with traditional 4.5-mm cortical screws in an ex vivo model of mid-body proximal sesamoid bone fracture repair. Although the newer BSF implant offered no biomechanical advantage over conventional cortical screws, the study demonstrated a clear benefit of two-screw fixation, increasing construct yield strength from approximately 1,500 N to over 2,100 N, regardless of implant type. The authors also identified significantly greater fracture gap displacement along the abaxial cortex, highlighting the importance of controlling rotational forces when repairing these challenging fractures.  ✅ Rhodes et al. evaluated the racing performance of 45 Standardbred horses following arthroscopic removal of femoropatellar osteochondrosis dissecans (OCD) lesions and compared them with 196 unaffected paternal half-siblings. Although treated horses recorded slightly fewer starts during their three-year-old season, lesion grade did not significantly affect the likelihood of racing, and there were no meaningful differences in race wins or earnings compared with unaffected controls. Even horses with bilateral or concurrent OCD lesions achieved excellent long-term performance, supporting early arthroscopic intervention before intensive training begins.  Together, these studies demonstrate that successful orthopedic outcomes depend not on assumptions, but on understanding the biological and biomechanical realities behind every surgical decision. 🎓 Journal Articles Discussed Friedlund et al. — The Effect of Arthroscopic Lavage Volume on Bacterial Culture of Egress Fluid in Experimentally Induced Septic ArthritisO'Brien et al. — Biomechanical Comparison of the Bone Screw Fastener to Conventional Cortical Buttress Screws for Repair of Mid-Body Proximal Sesamoid Bone FracturesRhodes et al. — Outcome of Standardbred Racehorses Following Femoropatellar Arthroscopy for Osteochondrosis Dissecans📚 From the July 2026 Issue (Issue 5) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  2. Jul 16

    Veterinary Surgery Deep Dive: Equine Ortho — May 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the May 2026 issue (Issue 4) of Veterinary Surgery, where two studies examine how timing and surgical technique can dramatically influence long-term orthopedic outcomes.  One study follows nearly 150 Standardbred foals during their first year of life to determine when tarsal osteochondrosis lesions are capable of healing naturally—and when surgery becomes inevitable. The second evaluates diode laser-facilitated ankylosis for distal tarsal osteoarthritis, identifying the surgical technique that best restores athletic performance while minimizing repeat procedures. In this episode: ✅ McCoy et al. conducted a prospective longitudinal study of 148 Standardbred foals, obtaining serial radiographs every two months from 2 to 12 months of age to evaluate the natural progression of tarsal osteochondrosis (OC). The authors found that 84.5% of lesions that ultimately resolved did so by six months of age, while none of the lesions that progressed to osteochondrosis dissecans (OCD) with fragment separation healed spontaneously. Once a fragment detached, spontaneous healing dropped to 0%, making surgical removal the only effective treatment. Interestingly, gait (trotting versus pacing) had no influence on lesion development or healing, while one farm that housed weanlings instead of allowing pasture turnout demonstrated no radiographic improvement after six months, highlighting the potential importance of exercise and environmental management during skeletal development. The study provides surgeons with a clear decision point: monitor stable OC lesions, but proceed with surgery promptly once fragment separation occurs.  ✅ Sanchez-Arjona et al. reviewed 64 horses treated with diode laser-facilitated ankylosis (DLF) for distal tarsal osteoarthritis over a ten-year period. Overall, 83% of horses experienced clinical improvement, while 64% returned to their previous level of athletic performance. Although three surgical techniques produced similar return-to-work rates, the addition of cuboidal bone fenestration dramatically reduced the need for repeat surgery. Horses treated with laser alone required reintervention in 20.8% of cases, whereas no horses receiving laser combined with cuboidal bone fenestration required a second procedure. By addressing both the joint surface and underlying subchondral bone pathology, fenestration appears to provide more durable long-term results while minimizing recurrent lameness.  Together, these studies demonstrate that successful orthopedic surgery depends on intervening at precisely the right moment and selecting techniques that address the underlying disease—not simply its visible manifestations. 🎓 Journal Articles Discussed McCoy et al. — Natural progression of tarsal osteochondrosis in Standardbred pacers and trottersSanchez-Arjona et al. — Outcomes of diode laser-facilitated ankylosis of the distal tarsal joints in horses: A retrospective study of 64 cases📚 From the May 2026 Issue (Issue 4) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  3. Jul 15

    Veterinary Surgery Deep Dive: Equine Soft Tissue— April 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the soft tissue research from the April 2026 issue (Issue 3) of Veterinary Surgery, where two studies emphasize that successful surgery extends well beyond the operating room. Together, they demonstrate how better postoperative interpretation and systematic quality improvement can dramatically improve patient outcomes.  One study redefines how surgeons should interpret peritoneal fluid following exploratory laparotomy, while the second shows how simple protocol changes across an entire hospital can nearly eliminate surgical site infections after equine abdominal surgery. In this episode: ✅ Granello et al. performed a prospective cohort study evaluating postoperative peritoneal fluid changes in 26 horses undergoing exploratory laparotomy for naturally occurring gastrointestinal disease. Serial abdominocentesis performed at 24, 72, and 168 hours demonstrated that although systemic lactate normalized within 24 hours, peritoneal lactate, total protein, and nucleated cell counts remained markedly elevated for up to seven days, regardless of whether the original lesion was strangulating or non-strangulating. These findings indicate that postoperative surgical manipulation itself produces a prolonged inflammatory response within the peritoneal cavity, making serial trends far more valuable than single measurements when deciding whether a horse requires repeat surgical intervention.  ✅ López-Cruz et al. evaluated the impact of a comprehensive hospital-wide quality improvement initiative after postoperative surgical site infection (SSI) rates following exploratory celiotomy unexpectedly increased to 29%. Using a structured root-cause analysis (fishbone diagram), the team identified multiple opportunities for process improvement, including separate personnel for sheath and abdominal preparation, two-step skin preparation with detergent followed by chlorhexidine, single-use clipper blades, standardized closure protocols, and application of medical-grade Manuka honey to the linea alba. Following implementation, SSI rates fell dramatically from 29% to just 2.3%, overall wound complications declined to 6.8%, and no horses required euthanasia because of postoperative surgical site complications. The study highlights how meticulous protocol refinement and team consistency can transform surgical outcomes without requiring expensive new technology.  Together, these studies reinforce a powerful lesson in equine soft tissue surgery: excellent outcomes depend not only on performing surgery well, but also on interpreting recovery appropriately and continually improving every step of the perioperative process. 🎓 Journal Articles Discussed Granello et al. — Serial postoperative peritoneal fluid analyses in horses with naturally-occurring strangulating and non-strangulating gastrointestinal lesionsLópez-Cruz et al. — Application of a framework to mitigate the risk of surgical site infection after exploratory celiotomy in horses: A retrospective study📚 From the April 2026 Issue (Issue 3) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  4. Jul 14

    Veterinary Surgery Deep Dive: Equine Ortho — April 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the April 2026 issue (Issue 3) of Veterinary Surgery, where two studies examine how precision—both in pain management and implant design—can improve orthopedic outcomes in horses.  One study investigates a novel method for targeted forelimb analgesia using cervical epidural catheterization, while the second evaluates whether polyaxial locking plate technology can provide greater flexibility and stability during fetlock arthrodesis. In this episode: ✅ Edwards et al. evaluated an ultrasound-guided cervical epidural catheter placed at the C1–C2 intervertebral space to deliver detomidine and morphine for horses with experimentally induced forelimb pain. In a crossover study involving five horses with carpal synovitis, four of five horses demonstrated greater than 50% improvement in lameness within two hours of treatment. The catheter remained functional for more than 10 days, supporting its feasibility for prolonged analgesia. However, despite localized drug delivery, horses still developed systemic effects including sedation, ataxia, and tachycardia, likely due to cranial migration of medication within the epidural space. The study demonstrates that cervical epidural catheterization is both technically safe and clinically effective, while highlighting the need for refined dosing strategies to minimize neurologic side effects.  ✅ Kadik et al. compared a traditional 5.5-mm locking compression plate (LCP) with a polyaxial non-contact bridging (NCB) locking plate system for equine fetlock arthrodesis using an ex vivo biomechanical model. During cyclic fatigue testing, the NCB construct demonstrated less than half the displacement of the standard LCP (0.22 mm versus 0.56 mm), indicating significantly greater construct stiffness during simulated postoperative loading. Although both systems exhibited similar ultimate failure strength, the polyaxial plate allowed 30 degrees of variable screw angulation, enabling surgeons to optimize screw placement in comminuted fractures or irregular bone while preserving construct stability. The findings suggest that polyaxial technology may offer meaningful advantages in complex arthrodesis cases by combining mechanical strength with greater intraoperative flexibility.  Together, these studies demonstrate that modern orthopedic innovation extends beyond stronger implants—it also includes delivering therapy more precisely and adapting surgical technology to the unique challenges of equine anatomy. 🎓 Journal Articles Discussed Edwards et al. — Cervical epidural catheter for administration of detomidine and morphine in a model of carpal synovitis in the horseKadik et al. — An ex vivo comparison of mono-versus polyaxial locking compression plates for metacarpophalangeal joint arthrodesis in the horse📚 From the April 2026 Issue (Issue 3) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  5. Jul 13

    Veterinary Surgery Deep Dive: Equine Soft Tissue — February 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the soft tissue research from the February 2026 issue (Issue 2) of Veterinary Surgery, where two studies demonstrate how thoughtful surgical decision-making can improve both immediate postoperative outcomes and long-term quality of life.  One study introduces a modified stapled jejunostomy technique designed to eliminate a common mechanical weakness of traditional intestinal anastomoses, while the second provides reassuring evidence that life-saving surgery for large colon volvulus does not have to end a Thoroughbred broodmare's reproductive career. In this episode: ✅ Freeman et al. introduced a modified stapled (MS) jejunostomy technique that creates a wide, triangular stapled stoma while eliminating the traditional oversewn blind jejunal end. Unlike conventional side-to-side stapled anastomoses, which leave a blind pouch that may serve as a lead point for impaction or intussusception, the modified technique creates a more direct flow path using a single application of a GIA-100 stapler. In an experimental study of six healthy horses, the authors demonstrated that operative time and final stoma size were comparable to traditional methods while removing an important structural risk factor. The resulting spatulated geometry may also compensate for localized loss of circular muscle fibers by improving passive intestinal flow through the anastomosis.  ✅ Knudsen et al. performed a 17-year retrospective study evaluating reproductive outcomes in 29 Thoroughbred broodmares following either large colon resection (LCR) or colopexy for recurrent large colon volvulus. Despite the greater surgical complexity of LCR, mares undergoing resection achieved a 60.5% live foal rate per mare served, while the colopexy group achieved 68.2%—both comparable to the national Thoroughbred breeding average of 64.3%. Although fewer LCR mares produced foals during the first breeding season after surgery, this appeared to reflect postoperative recovery and missed breeding opportunities rather than permanent reductions in fertility. The findings support selecting the surgical procedure based entirely on tissue viability and anatomical considerations without compromising long-term reproductive expectations.  Together, these studies reinforce an important principle of equine soft tissue surgery: small technical refinements during surgery and evidence-based decision-making afterward can profoundly influence both surgical success and the patient's long-term quality of life. 🎓 Journal Articles Discussed Freeman et al. — Modified stapled jejunocecostomy in horsesKnudsen et al. — Reproductive success in Thoroughbred broodmares post large colon resection or colopexy📚 From the February 2026 Issue (Issue 2) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  6. Jul 10

    Veterinary Surgery Deep Dive: Equine Ortho — February 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the February 2026 issue (Issue 2) of Veterinary Surgery, where three studies showcase how refinements in equine tenoscopic surgery are expanding what surgeons can accomplish through minimally invasive techniques. Together, they highlight a common goal: improving surgical access while preserving critical anatomy and optimizing long-term athletic outcomes.  From preserving tendon blood supply during manica flexoria resection, to a new tenoscopic treatment for proximal digital annular ligament desmitis, and the development of a medial portal for carpal flexor tendon sheath surgery, these papers demonstrate how thoughtful surgical innovation continues to improve patient care. In this episode: ✅ Racine et al. presented a refined two-portal tenoscopic technique for resection of torn proximal manica flexoria (MF) while preserving the mesotendons (MTs) of the deep digital flexor tendon. Using a four-step approach—including a novel Kocher-Ochsner clamp twisting technique to detach the remaining areolar tissue—the authors successfully preserved the mesotendons while minimizing iatrogenic trauma. Among 30 horses, 96.4% achieved successful tendon sheath healing, and 75% returned to their previous or higher level of athletic performance. By maintaining the extrinsic vascular supply of the deep digital flexor tendon, this modified approach may improve long-term tendon healing while reducing surgical morbidity.  ✅ Wood et al. described a tenoscopically guided proximal digital annular ligament (PDAL) desmotomy for horses with proximal digital annular ligament desmitis. After validating the technique in 10 cadaver limbs, the procedure was successfully performed in five clinical cases, with four horses returning to their previous level of exercise following surgery. The study also demonstrates that pathologic thickening of the PDAL actually facilitates surgical identification during tenoscopy, while emphasizing the importance of performing a palmar or plantar annular ligament desmotomy first to improve instrument maneuverability and protect the superficial digital flexor tendon.  ✅ Woods et al. investigated the feasibility of creating a medial tenoscopic portal into the equine carpal flexor tendon sheath using contrast-enhanced CT and cadaver specimens. The authors identified a reproducible portal location approximately 5 mm proximal and 32 mm caudal to the distal medial radial physis, providing 120–140° of instrument triangulation when combined with the standard lateral portal. Although superficial flexor carpi radialis tendon impingement occurred during early testing, careful blunt dissection and transillumination from the lateral portal allowed safe placement while preserving major neurovascular structures. The technique offers surgeons improved visualization and access to previously difficult-to-reach lesions within the carpal sheath.  Together, these studies demonstrate that the future of equine tenoscopy lies not in larger incisions, but in smarter portal placement, preservation of normal anatomy, and continual refinement of minimally invasive surgical techniques. 🎓 Journal Articles Discussed Racine et al. — Four-step tenoscopic technique to resect a torn proximal manica flexoria while sparing the mesotendons of the deep digital flexor tendon in 30 horsesWood et al. — Tenoscopically guided proximal digital annular ligament desmotomy for the treatment of proximal digital annular ligament desmitisWoods et al. — Feasibility of a medial tenoscopic portal in the equine carpal flexor tendon sheath in cadavers📚 From the February 2026 Issue (Issue 2) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  7. Jul 9

    Veterinary Surgery Deep Dive: Equine Soft Tissue — January 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the soft tissue research from the January 2026 issue (Issue 1) of Veterinary Surgery, where two innovative studies focus on making equine upper airway surgery less invasive, mechanically stronger, and more effective over the long term.  One study introduces a standing, minimally invasive technique for prolonged treatment of guttural pouch disease, while the second evaluates new prosthetic laryngoplasty implant designs aimed at reducing the long-term failure that continues to challenge treatment of recurrent laryngeal neuropathy. In this episode: ✅ Lepage et al. described a novel technique for endoscopically assisted transcutaneous guttural pouch catheterization (TGPC) using a 20 French balloon catheter placed into the medial guttural pouch compartment of standing horses. Across 15 procedures, the authors achieved a 100% technical success rate without major arterial or nerve injury. The catheter remained in place for 4 to 17 days, allowing repeated lavage and prolonged local treatment of guttural pouch mycosis and empyema while avoiding the morbidity associated with open surgical approaches and general anesthesia. Minor complications were limited to superficial venous bleeding and temporary skin abrasions, with all catheter tracts healing rapidly following removal. The study demonstrates that prolonged standing access to the guttural pouch is both practical and safe, opening new possibilities for managing these anatomically challenging diseases.  ✅ Ysebaert et al. compared three prosthetic laryngoplasty constructs in an ex vivo biomechanical study of equine larynges. Traditional suture fixation was evaluated alongside a suture anchor and a novel tie bolt implant. While the suture anchor achieved equivalent arytenoid abduction using significantly less tension, the tie bolt demonstrated the greatest construct stiffness, the least cyclic elongation, and the highest ultimate failure load. Rather than failing through progressive suture cut-through of the arytenoid cartilage, the tie bolt distributed forces so effectively that failure occurred only after fracture of the cartilage itself. These findings suggest that optimizing implant mechanics may substantially improve long-term stability following prosthetic laryngoplasty for recurrent laryngeal neuropathy.  Together, these studies illustrate how innovation in equine soft tissue surgery increasingly centers on minimizing surgical morbidity while maximizing mechanical reliability and long-term patient outcomes. 🎓 Journal Articles Discussed Lepage et al. — Endoscopically assisted transcutaneous placement of a balloon catheter in the medial guttural pouch compartment of the horse: A surgical approach to local treatmentYsebaert et al. — Biomechanical testing of three constructs for prosthetic laryngoplasty in horses demonstrates advantages of differing metallic implants in the arytenoid cartilage📚 From the January 2026 Issue (Issue 1) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

  8. Jul 8

    Veterinary Surgery Deep Dive: Equine Ortho & Soft Tissue — January 2026 Edition

    In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic and soft tissue research from the January 2026 issue (Issue 1) of Veterinary Surgery, where three innovative studies challenge long-standing approaches to some of the most difficult conditions in equine surgery. Together, they ask an important question: Can smarter surgical techniques improve outcomes while reducing patient risk?  From salvaging severe chronic laminitis, to performing subtotal nasal septum excision under standing sedation, and investigating a novel treatment for dorsal nasopharyngeal collapse, these studies highlight how careful biomechanical thinking and minimally invasive approaches continue to reshape equine surgery. In this episode: ✅ Hargitaiova et al. evaluated a modified high metacarpal deep digital flexor tenotomy combined with Steward Clog shoeing for horses with chronic, refractory laminitis. By transecting the deep digital flexor tendon proximal to the accessory ligament, the technique unloads the distal phalanx while preserving passive restraint of the distal interphalangeal joint. Among 15 horses and ponies (26 limbs), only one limb developed distal interphalangeal joint subluxation (4%), while long-term survival reached 43% in horses and 50% in ponies despite the severity of disease. The study demonstrates that preserving the accessory ligament, together with immediate orthotic support, can successfully realign the distal phalanx while minimizing joint instability in cases where traditional options have failed.  ✅ Brink et al. described a standing technique for subtotal nasal septum excision using sedation, regional anesthesia, and obstetrical wire transection. Among 12 horses, 11 returned to their intended athletic use, including racehorses, while surgeons reported less intraoperative hemorrhage than is typically encountered under general anesthesia. The paper emphasizes two key technical principles: meticulous ethmoidal nerve blockade to ensure patient comfort, and creating the caudal septal cut at an angle of 60 degrees or greater to prevent postoperative airway obstruction as the septal stump heals. The findings suggest that many complex sinonasal procedures may be safely performed standing, reducing anesthetic risk while maintaining excellent long-term outcomes.  ✅ Jeong et al. investigated transendoscopic laser fenestration of the dorsal pharyngeal recess as a treatment for dorsal nasopharyngeal collapse (NPC). Using an experimental model of bilateral glossopharyngeal neurectomy, the authors found that creating a permanent communication with the guttural pouches failed to improve respiratory performance. In fact, airflow diversion into the guttural pouches appeared to worsen inspiratory airflow in experimentally induced disease. Interestingly, a single horse with naturally occurring NPC demonstrated improved exercise performance following surgery, suggesting that although the technique is ineffective for severe neurogenic collapse, it may still warrant investigation in naturally occurring, less severe cases.  Together, these studies demonstrate that innovation in equine surgery is not simply about developing new procedures—it is about understanding biomechanics, respecting anatomy, and carefully validating new techniques before they become standard practice. 🎓 Journal Articles Discussed Hargitaiova et al. — High-metacarpal deep digital flexor tenotomy and Steward clog shoeing for managing chronic refractory laminitis: A retrospective clinical studyBrink et al. — Standing excision of the nasal septum of 12 horsesJeong et al. — Laser fenestration of the dorsal pharyngeal recess does not correct experimentally induced dorsal nasopharyngeal collapse in horses📚 From the January 2026 Issue (Issue 1) of Veterinary Surgery 🎁 Want to learn more about Simini Protect Lavage or request a sample? Learn More: www.simini.com Request a Sample: https://www.simini.com/evaluation-kit

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About

Smart. Fast. Equine Surgical Insights. The Simini Surgery Review: Equine Edition distills the latest equine-focused surgical research into clear, actionable takeaways for busy practitioners. Each episode pulls from top-tier veterinary journals — like Veterinary Surgery and VCOT — and delivers focused summaries, critical analysis, and real-world application tips in a concise, conversational format. Hosted by equine clinicians, for equine clinicians, we cut through the academic jargon to highlight what actually matters in your practice: New surgical techniques and toolsImaging innovations and orthopedic advancesPost-op strategies and infection controlEvidence-based updates that refine your clinical decision-makingWhether you’re between cases or on the road, these fast-track deep dives help you stay sharp, current, and clinically confident. 📬 Produced by Simini — committed to advancing surgical performance and antimicrobial stewardship in equine practice.

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