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1.
J Vet Intern Med ; 36(3): 1113-1118, 2022 May.
Article in English | MEDLINE | ID: mdl-35485176

ABSTRACT

BACKGROUND: Board certification relies on passing the American College of Veterinary Internal Medicine (ACVIM) general examination. Pass rates might depend on properties of residency training programs (RTP). HYPOTHESIS: We hypothesized that <4 weeks of dedicated study time, lack of board preparation lectures, status as a re-taker, and private practice RTP would result in lower pass rates of the ACVIM general examination. SUBJECTS: Two hundred forty-eight ACVIM general examinees. METHODS: Cross-sectional study. Examinees were surveyed using a Qualtrics survey over a 3-year period. Factors included: study weeks, on-call duty, board preparation lectures, academic or private practice program, and status as a re-taker. RESULTS: First-attempt examinees were more likely to pass (P < .0001, OR 5.12, 95% CI [2.53, 10.52]). For first-attempt examinees, on-call duty during study weeks resulted in a lower pass rate (P = .002, OR 0.31, 95% CI [0.16, 0.67]). General didactic and specific board-preparation lectures resulted in higher pass rates (P = .003, OR 3.08, 95% CI [1.44, 6.61]; P = .02, OR 3.04, 95% CI [1.20, 7.68]). Diplomate-led board-preparation lectures resulted in higher pass rates than resident-led (P = .007, OR 10.67, 95% CI [1.75, 64.91]). Using a mixed effect logistic model, predicted pass rates were highest with both lack of on-call duty and presence of didactic lectures (predicted pass rate 95%, 95% CI [0.87, 0.98]). CONCLUSIONS AND CLINICAL IMPORTANCE: To optimize pass rates, RTP should provide study time without on-call duty. Provision of didactic lectures and specific board-preparation lectures by diplomates assist in candidate preparation.


Subject(s)
Educational Measurement , Internship and Residency , Animals , Certification , Cross-Sectional Studies , Humans , Physical Examination , United States
3.
Front Mol Biosci ; 8: 611367, 2021.
Article in English | MEDLINE | ID: mdl-33869275

ABSTRACT

The blood-brain barrier (BBB) hinders the distribution of therapeutics intended for treatment of neuroinflammation (NI) of the central nervous system. A twelve-amino acid peptide that transcytoses the BBB, termed MTfp, was chemically conjugated to siRNA to create a novel peptide-oligonucleotide conjugate (POC), directed to downregulate NOX4, a gene thought responsible for oxidative stress in ischemic stroke. The MTfp-NOX4 POC has the ability to cross the intact BBB and knockdown NOX4 expression in the brain. Following induction of ischemic stroke, animals pretreated with the POC exhibited significantly smaller infarcts; accompanied by increased protection against neurological deterioration and improved recovery. The data demonstrates that the MTfp can act as a nanomule to facilitate BBB transcytosis of siRNAs; where the NOX-4 specific siRNA moiety can elicit effective therapeutic knockdown of a gene responsible for oxidative stress in the central nervous system. This study is the first to conclusively demonstrate both siRNA-carrier delivery and therapeutic efficacy in any CNS disease model where the BBB remains intact and thus offers new avenues for potential treatments of oxidative stress underlying neuroinflammation in a variety of neuropathologies that are currently refractory to existing therapies.

4.
J Vet Intern Med ; 35(2): 853-859, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33534961

ABSTRACT

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmaceutical associated with gastroduodenal ulceration and perforation. The prevalence of gastrointestinal (GI) injury associated with chronic use of NSAIDs in dogs is unknown. OBJECTIVE/HYPOTHESIS: To determine the prevalence of GI mucosal erosions in dogs receiving chronic treatment with NSAIDs. We hypothesized that dogs receiving NSAIDs would have more GI mucosal erosions and longer GI transit time than a control population. ANIMALS: Fourteen client-owned medium- and large-breed dogs receiving an NSAID for at least 30 days and 11 client-owned control dogs undergoing video capsule endoscopy (VCE) for evaluation of chronic GI disease. METHODS: Dogs were prospectively recruited after determining no clinically relevant comorbidities were present and VCE was performed. The GI transit time and the presence of mucosal lesions were recorded. RESULTS: Twelve dogs receiving NSAIDs and 11 retrospectively evaluated control dogs were included. The NSAIDs administered included carprofen (9 dogs), meloxicam (2 dogs), and firocoxib (1 dog) for a median of 6 months. Ten (83.3%; 95% confidence interval; 51.6%-97.9%) NSAID-treated dogs had GI erosions. Erosions were seen with all 3 NSAIDs in at least 1 dog. Three of 11 control dogs had gastric erosions. Dogs receiving NSAIDs had more erosions detected (P = .004). CONCLUSIONS AND CLINICAL RELEVANCE: Subclinical GI erosions are more common in dogs receiving chronic treatment with NSAIDs than in control dogs with chronic GI disease, suggesting that NSAIDs be used with caution, particularly in dogs with comorbidities predisposing them to GI ulceration.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal , Pharmaceutical Preparations , Animals , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Dogs , Meloxicam , Prevalence , Retrospective Studies
5.
J Am Vet Med Assoc ; 258(2): 186-191, 2021 Jan 15.
Article in English | MEDLINE | ID: mdl-33405984

ABSTRACT

CASE DESCRIPTION: As a result of vehicular trauma, a 3-year-old neutered male domestic shorthair cat sustained luxation of the sacrocaudal joint and a urethral tear. CLINICAL FINDINGS: Retrograde contrast urethrocystography revealed a urethral tear at the level of the ischiatic tuberosity. Conservative treatment for 7 days with a urethral catheter was unsuccessful. TREATMENT AND OUTCOME: An approach for a perineal urethrostomy was performed and revealed a large urethral tear (4 mm in length in a craniocaudal orientation and encompassing approx 50% of the urethral circumference) proximal to the bulbourethral glands. Urethroplasty was performed with a graft of a rectangular section of single-layer porcine small intestinal submucosa. Perineal urethrostomy was then completed routinely, and a urethral catheter was left in place for 5 days. Two days after removal of the urethral catheter, stranguria was noted. Retrograde contrast urethrocystography revealed a urethral stricture. Balloon dilation of the urethral stricture was performed, and the cat's stranguria improved. Ten weeks following balloon dilation, the cat developed hematuria, and a urinary tract infection and urethral stricture were diagnosed. Balloon dilation was repeated with instillation of triamcinolone solution at the stricture site. Eighteen months later (approx 21 months after the initial surgery), the cat was urinating normally. CLINICAL RELEVANCE: The outcome for the cat of this report indicated that porcine small intestinal submucosa may be used to successfully augment urethroplasty for treatment of traumatic urethral tears in cats. Urethral balloon dilation with triamcinolone instillation may be used to treat postoperative urethral strictures.


Subject(s)
Cat Diseases , Swine Diseases , Urethral Stricture , Animals , Cat Diseases/surgery , Catheterization/veterinary , Cats , Dilatation/veterinary , Male , Swine , Treatment Outcome , Urethra/surgery , Urethral Stricture/surgery , Urethral Stricture/veterinary , Urologic Surgical Procedures/veterinary
6.
J Vet Med Educ ; 47(1): 106-116, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31009293

ABSTRACT

Competency in flexible endoscopy is a major goal of small animal internal medicine residency training programs. Hands-on laboratories to teach entry-level skills have traditionally used anesthetized laboratory dogs (live dog laboratory [LDL]). Virtual-reality endoscopy trainers (VRET) are used for this purpose in human medicine with the clear benefits of avoiding live animal use, decreasing trainee stress, and allowing repeated, independent training sessions. However, there are currently no commercially available veterinary endoscopy simulators. The purpose of the study was to determine whether a human VRET can be a reasonable alternative to a LDL for teaching early veterinary endoscopy skills. Twelve veterinarians with limited or no endoscopy experience underwent training with a VRET (n = 6) or a LDL (n = 6), performed two recorded esophagogastroduodenoscopies (EGD) on anesthetized dogs for evaluation purposes (outcomes laboratory), and then underwent training with the alternative method. Participants completed questionnaires before any training and following each training session. No significant differences were found between training methods based on: measured parameters from the outcomes laboratory, including duration of time to perform EGD; evaluators' assessment of skills; and, assessment of skills through blinded review of the esophageal portion of EGD recordings. The VRET was less stressful for participants than the LDL (p = .02). All participants found that the VRET was a useful and acceptable alternative to the LDL for training of early endoscopy skills. Based on this limited study, VRET can serve as a reasonable alternative to LDL for teaching endoscopy skills to veterinarians.


Subject(s)
Computer Simulation , Education, Veterinary , Endoscopy , Virtual Reality , Animals , Clinical Competence , Computer Simulation/standards , Dogs , Education, Veterinary/methods , Education, Veterinary/standards , Endoscopy/education , Endoscopy/veterinary , Humans , Surveys and Questionnaires
7.
J Vet Intern Med ; 33(5): 1964-1969, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31381197

ABSTRACT

BACKGROUND: Video capsule endoscopy (VCE) is a noninvasive imaging modality that can identify mucosal lesions not detected with traditional endoscopy or abdominal sonography. In people, VCE is used in diagnostic and management protocols of various gastrointestinal (GI) disorders, particularly in GI bleeding of obscure origin or unexplained iron deficiency anemia (IDA). OBJECTIVE: To evaluate the utility of VCE in the identification of mucosal lesions in dogs with evidence of GI hemorrhage. ANIMALS: Sixteen client-owned dogs that underwent VCE. METHODS: Retrospective case-control study. Medical records were reviewed to include dogs with microcytosis, low normal mean corpuscular volume, or clinical GI bleeding that received VCE. RESULTS: Median age of dogs was 8.7 years (range, 8 months to 15 years) with a median weight of 21.7 kg (range, 6.9-62.5 kg). Abdominal ultrasound (16), abdominal radiography (4), and abdominal CT (1) did not identify a cause for GI blood loss. Gastric mucosal lesions were identified by VCE in 15 of 16 dogs and small intestinal lesions in 12 of 14 dogs, with 2 capsules remaining in the stomach. Endoscopy was performed in 2 dogs before VCE; 1 dog had additional small intestinal lesions identified through the use of VCE. CONCLUSIONS AND CLINICAL IMPORTANCE: Video capsule endoscopy is a minimally invasive diagnostic tool that can identify GI lesions in dogs presenting with microcytosis with or without GI hemorrhage when ultrasonography is inconclusive; however, the majority of lesions identified would have been apparent with conventional endoscopy.


Subject(s)
Capsule Endoscopy/veterinary , Dog Diseases/diagnostic imaging , Erythrocyte Indices/veterinary , Gastrointestinal Hemorrhage/veterinary , Anemia, Iron-Deficiency/etiology , Animals , Capsule Endoscopy/methods , Case-Control Studies , Dogs , Female , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Tract/diagnostic imaging , Intestine, Small/diagnostic imaging , Male , Retrospective Studies
8.
Top Companion Anim Med ; 35: 47-52, 2019 Jun.
Article in English | MEDLINE | ID: mdl-31122688

ABSTRACT

The gut is the site of digestion and absorption as well as serving as an endocrine and immune organ. All of these functions may be affected by critical illness. This review will discuss secondary effects of critical illness on the gut in terms of gastrointestinal function that is clinically observable and discuss consequences of gut dysfunction with critical illness to patient outcome. Because there is little evidence-based medicine in the veterinary field, much of our understanding of gut dysfunction with critical illness comes from animal models or from the human medical field. We can extrapolate some of these conclusions and recommendations to companion animals, particularly in dogs, who have similar gastrointestinal physiology to people. Additionally, the evidence regarding gut dysfunction in veterinary patients will be explored. By recognizing signs of dysfunction early and taking preventative measures, we may be able to increase success with treatment of critical illnesses.


Subject(s)
Critical Illness/therapy , Gastrointestinal Diseases/veterinary , Animals , Cat Diseases/diagnosis , Cat Diseases/therapy , Cats , Dog Diseases/diagnosis , Dog Diseases/therapy , Dogs , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Gastrointestinal Tract/physiopathology , Humans
9.
J Vet Intern Med ; 32(6): 2069-2073, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30325062

ABSTRACT

BACKGROUND: Sino-nasal aspergillosis is a common nasal disease in dogs. Recommended treatment protocols typically involve trephination of the frontal sinuses or the use of an antifungal solution instilled into the frontal sinus under anesthesia, both of which have associated morbidity and complications. OBJECTIVES: To assess a minimally-invasive topical treatment protocol for sino-nasal aspergillosis in dogs. ANIMALS: Twelve client-owned dogs diagnosed with sino-nasal aspergillosis that completed recommended treatment. METHODS: Medical records were retrospectively reviewed to identify dogs with sino-nasal aspergillosis that received treatment. Fungal plaques were manually debrided and irrigated via frontal sinuscopy in 12 dogs that then were treated topically with 1% topical clotrimazole cream. Irrigation and topical medication application was achieved using a catheter placed retrograde directly into the frontal sinuses using the Seldinger technique over a guidewire, thereby avoiding the need for frontal sinus trephination. Invasion into the calvarium was recorded before treatment but was not considered a criterion for exclusion. Debridement and cream deposition was repeated every 2 weeks as needed until negative culture and histopathologic findings were obtained. RESULTS: All dogs were cured (negative results for Aspergillus on endoscopy, fungal culture, and histopathology) with a median of 2 treatments. Treatments were well tolerated, with minimal adverse effects reported. Three dogs had evidence of erosion into the calvarium on computed tomography imaging. CONCLUSIONS AND CLINICAL IMPORTANCE: This protocol appears to be an effective and well-tolerated minimally invasive treatment for sino-nasal aspergillosis, including in dogs with erosion into the calvarium. Only mild adverse effects were noted.


Subject(s)
Antifungal Agents/therapeutic use , Aspergillosis/veterinary , Dog Diseases/microbiology , Nose Diseases/veterinary , Administration, Intranasal/veterinary , Animals , Antifungal Agents/administration & dosage , Aspergillosis/drug therapy , Dog Diseases/drug therapy , Dogs , Female , Frontal Sinusitis/drug therapy , Frontal Sinusitis/microbiology , Frontal Sinusitis/veterinary , Male , Nose Diseases/drug therapy , Nose Diseases/microbiology , Retrospective Studies
10.
J Vet Intern Med ; 32(2): 670-678, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29460464

ABSTRACT

BACKGROUND: Sucralfate is a gastroprotectant with no known systemic effects. The efficacy of sucralfate for prevention and treatment of stress-related mucosal diseases (SRMD) in dogs is unknown. HYPOTHESIS/OBJECTIVES: To develop a canine ex vivo model of SRMD and to determine the effect of sucralfate on mucosal barrier function in this model. ANIMALS: Gastric antral mucosa was collected immediately postmortem from 29 random-source apparently healthy dogs euthanized at a local animal control facility. METHODS: Randomized experimental trial. Sucralfate (100 mg/mL) was applied to ex vivo canine gastric mucosa concurrent with and after acid injury. Barrier function was assessed by measurement of transepithelial electrical resistance (TER) and radiolabeled mannitol flux. RESULTS: Application of acidified Ringers solution to the mucosal side of gastric antrum caused a reduction in gastric barrier function, and washout of acidified Ringers solution allowed recovery of barrier function (TER: 34.0 ± 2.8% of control at maximum injury, 71.3 ± 5.5% at recovery, P < .001). Sucralfate application at the time of injury or after injury significantly hastened recovery of barrier function (TER: 118.0 ± 15.2% of control at maximum injury, P < .001 and 111.0 ± 15.5% at recovery, P = .35). CONCLUSIONS AND CLINICAL IMPORTANCE: Sucralfate appeared effective at restoring defects in gastric barrier function induced by acid and accelerating repair of tissues subjected to acid in this model, suggesting that sucralfate could have utility for the treatment and prevention of SRMD in dogs.


Subject(s)
Anti-Ulcer Agents/pharmacology , Dog Diseases/drug therapy , Dog Diseases/prevention & control , Gastric Mucosa/drug effects , Sucralfate/pharmacology , Animals , Anti-Ulcer Agents/administration & dosage , Dog Diseases/chemically induced , Dogs , Gastric Mucosa/pathology , Hydrogen-Ion Concentration , In Vitro Techniques , Isotonic Solutions , Ringer's Solution , Stomach Ulcer/chemically induced , Stomach Ulcer/drug therapy , Stomach Ulcer/prevention & control , Stomach Ulcer/veterinary , Sucralfate/administration & dosage
11.
Top Companion Anim Med ; 32(2): 55-57, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28992904

ABSTRACT

An 8-year-old, entire, male British Bulldog was referred for a week-long history of severe stranguria and dysuria. A prostatic wash was diagnostic of prostatic carcinoma. A transluminal urethral stent was placed in the proximal urethra, which resulted in resolution of the urinary obstruction, however, the dog developed severe urinary incontinence after the procedure. Cystoscopically-guided submucosal collagen injections were performed immediately proximal to the os penis. The dog's incontinence resolved with a single collagen injection for the 10-month follow-up period.


Subject(s)
Collagen/administration & dosage , Dog Diseases/therapy , Urethral Stricture/veterinary , Urinary Incontinence/veterinary , Animals , Carcinoma/veterinary , Dogs , Injections/veterinary , Male , Prostatic Neoplasms/veterinary , Stents/adverse effects , Stents/veterinary , Treatment Outcome , Urethra/surgery , Urethral Stricture/surgery , Urinary Incontinence/surgery , Urinary Incontinence/therapy
12.
Biomed Microdevices ; 18(5): 75, 2016 10.
Article in English | MEDLINE | ID: mdl-27492638

ABSTRACT

We present in-vivo study related to the use of our implantable RF telemetry system for pressure-volume (PV) cardiac monitoring in a animal subject. We implant a commercial MEMS PV sensor into the subject's heart left-ventricle (LV), while the telemetry system is implanted outside of the heart and connected to the sensor with a 7-microwires tether. The RF telemetry system is suitable for commercial application in medium sized subjects, its total volume of 2.475cm(3) and a weight of 4.0g. Our designed system is 58 % smaller in volume, 44 % in weight and has a 55 % reduction in sampling power over the last reported research in PV telemetry. In-vivo data was captured in both an acute and a freely moving setting over a 24 hour period. We experimentally demonstrated viability of the methodology that includes the surgical procedure and real-time monitoring of the in-vivo data in a freely moving subject. Further improvements in catheter design will improve the data quality and safety of the subject. This real-time implantable technology allows for researchers to quantify cardiac pathologies by extracting real-time pressure-volume loops, wirelessly from within freely moving subjects.


Subject(s)
Heart Ventricles , Pressure , Telemetry/instrumentation , Animals , Calibration , Movement , Phantoms, Imaging , Prostheses and Implants , Swine , Time Factors , Wireless Technology
13.
Sci Rep ; 6: 30434, 2016 07 26.
Article in English | MEDLINE | ID: mdl-27457421

ABSTRACT

Transforming growth factor alpha (TGFα) is a growth factor involved in osteoarthritis (OA). TGFα induces an OA-like phenotype in articular chondrocytes, by inhibiting matrix synthesis and promoting catabolic factor expression. To better understand TGFα's potential as a therapeutic target, we employed two in vivo OA models: (1) post-traumatic and (2) aging related OA. Ten-week old and six-month old male Tgfa null mice and their heterozygous (control) littermates underwent destabilization of the medial meniscus (DMM) surgery. Disease progression was assessed histologically using the Osteoarthritis Research Society International (OARSI) scoring system. As well, spontaneous disease progression was analyzed in eighteen-month-old Tgfa null and heterozygous mice. Ten-week old Tgfa null mice were protected from OA progression at both seven and fourteen weeks post-surgery. No protection was seen however in six-month old null mice after DMM surgery, and no differences were observed between genotypes in the aging model. Thus, young Tgfa null mice are protected from OA progression in the DMM model, while older mice are not. In addition, Tgfa null mice are equally susceptible to spontaneous OA development during aging. Thus, TGFα might be a valuable therapeutic target in some post-traumatic forms of OA, however its role in idiopathic disease is less clear.


Subject(s)
Osteoarthritis/prevention & control , Transforming Growth Factor alpha/deficiency , Aging/pathology , Animals , Collagen Type II/metabolism , Disease Models, Animal , Disease Progression , Epitopes/metabolism , Female , Heterozygote , Male , Matrix Metalloproteinase 13/metabolism , Menisci, Tibial/pathology , Mice, Inbred C57BL , Mice, Knockout , Transforming Growth Factor alpha/metabolism , Wounds and Injuries/pathology
14.
Vet Radiol Ultrasound ; 57(5): E54-7, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27144390

ABSTRACT

An 11-month-old female entire West Highland White Terrier presented for chronic diarrhea with acute deterioration in demeanor and progression to systemic inflammatory response syndrome. Transcutaneous abdominal ultrasonography identified colonic ulceration and secondary mucosal gas. Suspected hepatic portal vein gas and hepatic parenchyma gas were also visualized. The patient was stabilized and managed for ulcerative colitis. Based on endoscopic biopsies, the dog was diagnosed with severe, chronic, pyogranulomatous colitis. On repeat ultrasonographic evaluation the portal vein and hepatic gas had resolved but the patient deteriorated and was ultimately euthanized due to sepsis.


Subject(s)
Dog Diseases/diagnostic imaging , Embolism, Air/veterinary , Hepatic Veins/diagnostic imaging , Portal Vein/diagnostic imaging , Ultrasonography/veterinary , Animals , Diagnosis, Differential , Dogs , Embolism, Air/diagnostic imaging , Female
15.
J Dent Hyg ; 89(2): 119-31, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25883373

ABSTRACT

PURPOSE: This study examined the relationship between methamphetamine use and oral health status. METHODS: Using a cross-sectional design, data were collected in 1998 from 174 newly admitted prisoners in Iowa. Oral examinations identified dental caries and missing teeth, and personal interviews identified methamphetamine use and covariates. Descriptive statistics were used to summarize the data, and bivariate and multivariate linear regression analyses, including testing for interaction effects, were used to examine the effects of methamphetamine use on oral health status. RESULTS: Multivariate regression analyses for carious teeth and surfaces showed significant interaction effects: methamphetamine*race/ethnicity (carious teeth: p=0.039; surfaces: p=0.023) and methamphetamine*tooth brushing when on drugs (carious teeth: p=0.044; surfaces: p=0.035). Methamphetamine use had a significant effect on dental caries among Non-Whites and among those who brushed their teeth less than once a day when on drugs. Soda consumption (carious teeth: p=0.026; surfaces: p=0.030) and reason for last dental visit (carious teeth: p=0.025; surfaces: p=0.011) were also associated with caries. For missing teeth there was a significant methamphetamine*race/ethnicity interaction (p=0.028) among Whites who used methamphetamine compared to Whites who did not use methamphetamine. Age (p=0.0001) and reason for last dental visit (p=0.0001) were also associated with missing teeth. CONCLUSION: The effect of methamphetamine use on missing teeth was moderated by race/ethnicity,; while its effect on dental caries was moderated by race/ethnicity and tooth brushing when on drugs.


Subject(s)
Amphetamine-Related Disorders/epidemiology , Dental Caries/epidemiology , Methamphetamine/adverse effects , Tooth Loss/epidemiology , Adolescent , Adult , Amphetamine-Related Disorders/ethnology , Comorbidity , Cross-Sectional Studies , Dental Caries/ethnology , Female , Humans , Iowa/epidemiology , Male , Middle Aged , Prisoners , Tooth Loss/ethnology , Toothbrushing , Young Adult
16.
J Urol ; 193(5): 1669-75, 2015 May.
Article in English | MEDLINE | ID: mdl-25464003

ABSTRACT

PURPOSE: We determine the safety and feasibility of magnetic resonance image guided transurethral ultrasound prostate ablation using active temperature feedback control in a preclinical canine model with 28-day followup. MATERIALS AND METHODS: After a long acclimatization period we performed ultrasound treatment in 8 subjects using the magnetic resonance image guided TULSA-PRO™ transurethral ultrasound prostate ablation system. Comprehensive examinations and observations were done before and throughout the 28-day followup, including assessment of clinically significant treatment related adverse events. In addition to gross pathology evaluation, extensive histopathological analysis was done to assess cell kill inside and outside the prostate. We evaluated prostate conformal heating by comparing the spatial difference between the treatment plan and the 55C isotherm measured on magnetic resonance imaging thermometry acquired during treatment. These findings were confirmed on contrast enhanced magnetic resonance imaging immediately after treatment and at 28 days. RESULTS: Clinically there were no adverse events in any of the 8 subjects throughout the 28-day followup. All subjects had normal urinary and bowel function. Gross necropsy and histology confirmed that the intended thermal cell kill was confined to the prostate. No surrounding tissue was damaged, including the rectum and the external urinary sphincter. Conformal heating was achieved with an average -0.9 mm accuracy and 0.9 mm precision. Contrast enhanced magnetic resonance imaging and histological analysis confirmed tissue ablation in targeted areas of the prostate. Urethral tissue was spared from thermal damage. CONCLUSIONS: Magnetic resonance image guided transurethral ultrasound is a safe, feasible procedure for accurate and precise conformal thermal ablation of prostate tissue, as demonstrated in a preclinical model with 28-day followup.


Subject(s)
Magnetic Resonance Imaging , Surgery, Computer-Assisted , Transurethral Resection of Prostate/methods , Animals , Dogs , Feasibility Studies , Follow-Up Studies , Male , Time Factors , Transurethral Resection of Prostate/adverse effects
18.
Can Vet J ; 54(8): 761-4, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24155476

ABSTRACT

Renal hematuria has limited treatment options. This report describes management of bilateral idiopathic renal hematuria in a dog with surgically assisted installation of 0.5% silver nitrate solution. Initial treatment resulted in freedom from clinical signs or recurrent anemia for 10 months; however, recurrence of bleeding following a nephrectomy resulted in euthanasia.


Gestion de l'hématurie rénale idiopathique bilatérale chez un chien à l'aide du nitrate d'argent. L'hématurie rénale offre des options de traitement limitées. Ce rapport décrit la gestion de l'hématurie rénale idiopathique bilatérale chez un chien à l'aide de l'installation assistée par chirurgie d'une solution de nitrate d'argent de 0,5 %. Le traitement initial a produit une disparition des signes cliniques ou de l'anémie récurrente pendant 10 mois. Cependant, la récurrence des saignements après une néphrectomie se sont traduits par l'euthanasie.(Traduit par Isabelle Vallières).


Subject(s)
Dog Diseases/drug therapy , Hematuria/veterinary , Kidney Diseases/veterinary , Sclerosing Solutions/therapeutic use , Silver Nitrate/therapeutic use , Animals , Dog Diseases/etiology , Dogs , Endoscopy/veterinary , Female , Hematuria/drug therapy , Hematuria/etiology , Kidney Diseases/complications , Kidney Diseases/drug therapy , Sclerosing Solutions/administration & dosage , Sclerotherapy/veterinary , Silver Nitrate/administration & dosage
19.
JAMA Pediatr ; 167(5): 422-8, 2013 May.
Article in English | MEDLINE | ID: mdl-23479000

ABSTRACT

IMPORTANCE: Pediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS). OBJECTIVE: To test the hypothesis that using OU-HOT for bronchiolitis would decrease LOS. DESIGN AND SETTING: Retrospective cohort study at Primary Children's Medical Center, Salt Lake City, Utah. PARTICIPANTS: Uncomplicated bronchiolitis patients younger than 2 years admitted during the winter seasons of 2005 through 2011. INTERVENTIONS: Implementation of a new bronchiolitis care process encouraging use of an OU-HOT protocol. MAIN OUTCOME MEASURES: Mean hospital LOS, discharge within 24 hours, emergency department (ED) bronchiolitis admission rates and ED revisit/readmission rates, and inflation-adjusted cost. RESULTS: A total of 692 patients with bronchiolitis from the 2010-2011 bronchiolitis season were compared with 725 patients from the 2009-2010 season. Implementation of an OU-HOT protocol was associated with a 22.1% decrease in mean LOS (63.3 hours vs 49.3 hours, P < .001). Although LOS decreased during all 6 winter seasons, linear regression and linear quantile regression analyses for the 2005-2011 LOS data demonstrated a significant acceleration in the LOS decrease for the 2010-2011 season after implementation of the OU-HOT protocol. Discharges within 24 hours increased from 20.0% to 38.4% (P < .001), with no difference in ED bronchiolitis admission or ED revisit/readmission rates. After implementation of the OU-HOT protocol, the total cost per admitted case decreased by 25.4% ($4800 vs $3582, P < .001). CONCLUSIONS AND RELEVANCE: Implementation of an OU-HOT protocol for patients with bronchiolitis safely reduces hospital LOS with significant cost savings. Although widespread implementation has the potential for dramatic cost savings nationally, further studies assessing overall health care use and cost, including the impact on families and outpatient practices, are needed.


Subject(s)
Bronchiolitis/therapy , Home Nursing , Observation , Oxygen Inhalation Therapy , Quality Improvement , Bronchiolitis/economics , Clinical Protocols , Cost-Benefit Analysis , Female , Health Care Costs , Hospitals, Pediatric , Humans , Infant , Length of Stay , Male , Retrospective Studies , Utah
20.
Am J Vet Res ; 73(5): 659-63, 2012 May.
Article in English | MEDLINE | ID: mdl-22533397

ABSTRACT

OBJECTIVE: To examine whether a zinc L-carnosine compound used for treatment of suspected gastric ulcers in dogs ameliorates acid-induced injury in canine gastric mucosa. SAMPLE: Gastric mucosa from 6 healthy dogs. PROCEDURES: Mucosa from the gastric antrum was harvested from 6 unadoptable shelter dogs immediately after euthanasia and mounted on Ussing chambers. The tissues were equilibrated for 30 minutes in neutral Ringer's solution prior to incubation with acidic Ringer's solution (HCl plus Ringer's solution [final pH, 1.5 to 2.5]), acidic Ringer's solution plus zinc L-carnosine compound, or zinc L-carnosine compound alone. Tissues were maintained for 180 minutes in Ussing chambers, during which permeability was assessed by measurement of transepithelial electrical resistance. After the 180-minute treatment period, tissues were removed from Ussing chambers and labeled with immunofluorescent anti-active caspase-3 antibody as an indicator of apoptosis. RESULTS: Permeability of the gastric mucosa was significantly increased in a time-dependent manner by addition of HCl, whereas control tissues maintained viability for the study period. Change in permeability was detected within the first 15 minutes after acid application and progressed over the subsequent 150 minutes. The zinc L-carnosine compound had no significant effect on this increase in permeability. Apoptosis was evident in acid-treated tissues but not in control tissues. The zinc L-carnosine compound did not protect against development of apoptosis. CONCLUSIONS AND CLINICAL RELEVANCE: Addition of HCl caused a dose-dependent increase in gastric permeability over time and apparent induction of apoptosis as determined on the basis of immunofluorescence. However, there was no significant protective effect of a zinc L-carnosine compound. Nonetheless, results suggested the utility of this method for further studies of canine gastric injury.


Subject(s)
Anti-Ulcer Agents/pharmacology , Carnosine/analogs & derivatives , Dog Diseases/drug therapy , Dog Diseases/prevention & control , Gastric Acid/chemistry , Gastric Mucosa/drug effects , Organometallic Compounds/administration & dosage , Stomach Ulcer/veterinary , Animals , Anti-Ulcer Agents/administration & dosage , Carnosine/administration & dosage , Caspase 3/chemistry , Dog Diseases/chemically induced , Dogs , Fluorescent Antibody Technique/veterinary , Gastric Mucosa/pathology , Hydrogen-Ion Concentration , In Vitro Techniques , Isotonic Solutions/chemistry , Ringer's Solution , Stomach Ulcer/chemically induced , Stomach Ulcer/drug therapy , Stomach Ulcer/prevention & control , Vitamin E/administration & dosage , Vitamin E/pharmacology , Zinc Compounds/administration & dosage
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