Prospective comparison of prostatic aspirate culture and cystocentesis urine culture for detection of bacterial infection in dogs with prostatic neoplasia.

OBJECTIVE: The purpose of this study was to determine whether prostatic aspirate culture is a superior method to detect infection compared to culture of urine collected by cystocentesis in dogs with prostatic neoplasia. MATERIALS AND METHODS: A prospective study was conducted and dogs with suspected or confirmed prostatic neoplasia were enrolled. Urinalysis was done and culture and antimicrobial susceptibility testing was performed on paired urine and prostatic aspirate samples collected at a single timepoint. RESULTS: Ten dogs with prostatic neoplasia were enrolled. All dogs had one or more clinical sign consistent with lower urinary tract disease. One dog (10%) had a positive urine culture, but negative prostatic aspirate culture, one dog (10%) had a positive prostatic aspirate culture, but negative urine culture, and one dog (10%) had both positive urine and prostatic aspirate cultures. Using prostatic aspirate culture as the reference standard, urine culture had a sensitivity for detecting infection of 87.5% (95% confidence interval 52.9 to 99.4) and specificity of 50% (92.6 to 97.4) in this population of dogs. CLINICAL SIGNIFICANCE: Positive cultures were uncommon with both culture collection methods. Study results did not identify prostatic aspirate culture to be a more sensitive method of detecting prostatic infection than urine culture collected by cystocentesis in these dogs with prostatic neoplasia.

Assessment of Canine Pancreas-Specific Lipase and Outcomes in Dogs with Hemodialysis-Dependent Acute Kidney Injury.

BACKGROUND: Renal replacement therapies can be life-saving for dogs with severe acute kidney injury (AKI), however, comorbidities including pancreatitis might affect outcome. HYPOTHESIS/OBJECTIVES: To investigate the prevalence of pancreas-specific lipase (Spec cPL) measurements consistent with pancreatitis (≥400 µg/L) in dogs undergoing intermittent hemodialysis (IHD) for treatment of AKI and to determine whether there were associations between 30-days outcomes and Spec cPL measurements. ANIMALS: Fifty-three client-owned dogs presented to teaching hospitals between November 2008 and September 2016 that underwent IHD. METHODS: Retrospective medical record review from dogs that received IHD for management of AKI and also had a Spec cPL measurement. Association between survival, dialysis-dependency, and Spec cPL measurements was assessed. RESULTS: Forty of 53 (76%) dogs were alive at 30-days and 33/53(62%) had a Spec cPL result ≥400 µg/L. Spec cPL was not significantly different either between surviving (635.5 µg/L, range 29-1,001) and nonsurviving dogs (860 µg/L, range 56-1,001; P = 0.75) or between dialysis-dependent (1,001 µg/L, range 177-1,001) and nondialysis-dependent dogs (520 µg/L, range 29-1,001; P = 0.08). Spec cPL ≥400 µg/L was not significantly associated either with survival (P = 0.74) or dialysis-dependency (P = 0.33). CONCLUSIONS AND CLINICAL IMPORTANCE: Results revealed a high prevalence of Spec cPL ≥400 µg/L in dogs with AKI treated with IHD. No significant associations between Spec cPL and survival or dialysis-dependency in dogs with AKI at 30 days were identified in the current study, however, the latter could be due to lack of power in this study.

Leaching losses from Kenyan maize cropland receiving different rates of nitrogen fertilizer.

Meeting food security requirements in sub-Saharan Africa (SSA) will require increasing fertilizer use to improve crop yields, however excess fertilization can cause environmental and public health problems in surface and groundwater. Determining the threshold of reasonable fertilizer application in SSA requires an understanding of flow dynamics and nutrient transport in under-studied, tropical soils experiencing seasonal rainfall. We estimated leaching flux in Yala, Kenya on a maize field that received from 0 to 200 kg ha-1 of nitrogen (N) fertilizer. Soil pore water concentration measurements during two growing seasons were coupled with results from a numerical fluid flow model to calculate the daily flux of nitrate-nitrogen (NO3 --N). Modeled NO3 --N losses to below 200 cm for 1 year ranged from 40 kg N ha-1 year-1 in the 75 kg N ha-1 year-1 treatment to 81 kg N ha-1 year-1 in the 200 kg N ha-1 treatment. The highest soil pore water NO3 --N concentrations and NO3 --N leaching fluxes occurred on the highest N application plots, however there was a poor correlation between N application rate and NO3 --N leaching for the remaining N application rates. The drought in the second study year resulted in higher pore water NO3 --N concentrations, while NO3 --N leaching was disproportionately smaller than the decrease in precipitation. The lack of a strong correlation between NO3 --N leaching and N application rate, and a large decrease in flux between 120 and 200 cm suggest processes that influence NO3 --N retention in soils below 200 cm will ultimately control NO3 --N leaching at the watershed scale.-the daily flux of nitrate-nitrogen (NO3 --N). The lack of a strong correlation between NO3 --N leaching and N application rate, and a large decrease in flux between 120 and 200 cm suggest processes that influence NO3 --N retention in soils below 200 cm will ultimately control NO3 --N leaching at the watershed scale.

Urinary Neutrophil Gelatinase-associated Lipocalin as a Marker for Identification of Acute Kidney Injury and Recovery in Dogs with Gentamicin-induced Nephrotoxicity.

BACKGROUND: Acute kidney injury (AKI) is associated with high mortality rates in dogs, which may be a consequence of late recognition using traditional diagnostic tests. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein-induced during kidney injury that may identify AKI earlier than traditional tests. OBJECTIVES/HYPOTHESIS: To evaluate urinary NGAL (uNGAL) and uNGAL-to-urinary creatinine ratio (UNCR) as early markers of kidney injury and recovery in an AKI model in dogs. It was hypothesized that these markers would document AKI earlier than serum creatinine concentration. ANIMALS: Five purpose-bred dogs. METHODS: Prospective study. Acute kidney injury, defined as a > 50% increase in serum creatinine concentration above baseline, was induced in dogs by gentamicin administration (8-10 mg/kg SC q8h). Blood and urine collected for biochemical analyses and uNGAL and urinary creatinine concentrations, respectively, during AKI induction and recovery. RESULTS: Acute kidney injury was diagnosed significantly earlier based on a 7-fold increase in UNCR compared to a > 50% increase in serum creatinine concentration (day 8; range, 2-10 mg/dl vs day 16; range, 14-19 mg/dl; P = .009). During recovery, the initial decrease in UNCR preceded the decrease in serum creatinine concentration by a median of 2 days. The uNGAL changes paralleled UNCR changes, but the increase in uNGAL was triphasic; the initial peak occurred earlier than UNCR (median, day 11 versus median, day 19). CONCLUSIONS AND CLINICAL IMPORTANCE: The UNCR was early marker of gentamicin-induced AKI and its decrease documented onset of renal recovery. Additional studies are needed to validate this marker in dogs with naturally occurring renal injury.

Evaluation of Canine Pancreas-Specific Lipase Activity, Lipase Activity, and Trypsin-Like Immunoreactivity in an Experimental Model of Acute Kidney Injury in Dogs.

BACKGROUND: Diagnosis of pancreatitis in dogs is complicated by extrapancreatic disorders that can alter the results of laboratory tests. Extrapancreatic disorders can also affect the diagnosis of exocrine pancreatic insufficiency (EPI). The effects of acute kidney injury (AKI) on pancreas-specific lipase activity (Spec cPL(®) Test), serum lipase activity and trypsin-like immunoreactivity (TLI) in dogs have not been evaluated. HYPOTHESIS/OBJECTIVES: Serum Spec cPL, lipase activity, and TLI concentrations will increase secondary to decreased kidney function. ANIMALS: Five purpose-bred dogs. METHODS: Experimental prospective study. Gentamicin was used to induce AKI in 5 purpose-bred dogs. Serum samples were collected for measurement of creatinine, Spec cPL, lipase activity and TLI over 60 days, during both induction of, and recovery from, AKI. RESULTS: All dogs developed and recovered from AKI. Six of 52 (12%) serum Spec cPL concentrations were increased (2 in the equivocal zone and 4 consistent with pancreatitis) in 2 of 5 (40%) dogs. Two of 51 (4%) serum lipase activity values were increased in 2 of 5 dogs. Serum TLI was increased above the reference range in 17 of 50 (34%) samples in 3 of 5 dogs. For all biomarkers, there was no consistent correlation with increases in serum creatinine concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: Decreased renal excretion during experimental AKI did not cause consistent and correlated increases in serum Spec cPL, lipase activity, or TLI in this cohort of dogs.

Evaluation of neutrophil gelatinase-associated lipocalin as a marker of kidney injury in dogs.

BACKGROUND: Acute kidney injury (AKI) is a common and often fatal disorder in dogs. HYPOTHESIS: Urine neutrophil gelatinase-associated lipocalin (NGAL)/creatinine ratio is a sensitive and specific biomarker of AKI in dogs. ANIMALS: Ninety-four dogs. METHODS: Prospective study. Dogs were classified as follows: (1) healthy dogs, (2) dogs with lower urinary tract disorders, (3) dogs with chronic kidney disease (CKD), (4) dogs with azotemic International Renal Interest Society (IRIS) AKI Grades II-V, and (5) dogs with IRIS AKI Grade I (nonazotemic). Urinary NGAL was quantitated in each dog using an ELISA assay and concentrations were expressed as a ratio to urinary creatinine concentration from the same specimen, and designated the urinary NGAL/creatinine ratio (UNCR). RESULTS: There was a significant difference in UNCR among the study groups (P < .001). Both the azotemic and nonazotemic AKI groups had higher UNCR when compared with all other groups (P < .001 for all pairs). There was a statistically significant difference in UNCR between dogs diagnosed with CKD compared with dogs with lower urinary tract diseases (P = .005) as well as between dogs with CKD and healthy dogs (P = .001). Receiver operator characteristics (ROC) analysis of UNCR as an indicator of azotemic and nonazotemic AKI had an area under the ROC curve of 0.94 and 0.96, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: NGAL/creatinine ratio is a sensitive and specific marker of AKI. It can be used to screen patients at risk for AKI and can be utilized to diagnose milder forms of AKI potentially earlier in the course of the disease.

[Hypo- and hypernatremia]. / Hypo- und Hypernatriämie.

Hyponatremia is an electrolyte disorder that is defined by a serum sodium concentration of less than 135 mmol/L. Hyponatremia occurs at a high incidence. It is commonly associated with mild to moderate mental impairment. Hypoosmolar hyponatremia occurs in the setting of plasma volume deficiency ("hypovolemia", e. g. after gastrointestinal fluid loss), liver cirrhosis and cardiac failure ("hypervolemic" hyponatremia) and syndrome of inappropriate antidiuretic hormone secretion ("euvolemic" hyponatremia). Excessive antidiuretic hormone and continued fluid intake are the pathogenetic causes of these hyponatremias. Whereas hypovolemic hyponatremia is best corrected by isotonic saline, conventional proposals for euvolemic and hypervolemic hyponatremia consist of the following: fluid restriction, lithium carbonate, demeclocycline, urea and loop diuretic. None of these nonspecific treatments is entirely satisfactory. Recently a new class of pharmacological agents - orally available vasopressin antagonists, collectively called vaptans - have been described. A number of clinical trials using vaptans have been performed already. They showed vaptans to be effective, specific and safe in the treatment of euvolemic and hypervolemic hyponatremia. In Europe the vaptanes are currently certified exclusively for the treatment of euvolemic hyponatremia. Hypernatremia is caused by a relative deficit of free water and often occurs in elderly patients, who have an impaired thirst mechanism or are unable to ask for water. The cornerstone of treatment is administration of free water to correct the relative water deficit.

Role of rho-kinase in the regulation of vascular tone in hypertensive renal transplant recipients.

Activation of rho-kinase (ROK) is involved in the development of hypertension as it is a potent regulator of vascular smooth muscle cell (VSMC) contractility. Here we evaluated whether activation of ROK is present in hypertensive kidney transplant recipients (NTX). We tested the effect of the ROK-inhibitor fasudil on the regulation of forearm blood flow (FBF) in NTX and in healthy control subjects (CTL). In addition potential modulating effects of ROK-inhibition on local vascular nitric oxide (NO) release were studied. The effect of intra-arterial infusion of fasudil on FBF was studied by venous-occlusion plethysmography in NTX and CTL. To unmask the role of NO fasudil was infused with/without clamping of vascular NO in NTX and CTL. To unravel the basal NO-mediated tone the NO-synthase inhibitor l-NMMA was infused. Fasudil markedly but comparably increased FBF in NTX and CTL. The vascular response to fasudil was blunted during NO-clamp in CTL (104+/-18% vs. 244+/-48% for NO-clamp+fasudil vs. fasudil alone; baseline=0%, P<0.05) but not in NTX. The l-NMMA-induced vasoconstriction was impaired in NTX compared to CTL. In NTX and CTL basal vascular tone equally depends on ROK. Fasudil-induced vasodilatation is partly mediated by vascular NO in CTL but not in NTX. The greater NO-insensitive fasudil-induced increase in FBF in NTX suggests an increased ROK-mediated VSMC constrictor tone in these patients. Basal NO-mediated tone is attenuated in hypertensive NTX.

CSF proteome analysis in clinically isolated syndrome (CIS): candidate markers for conversion to definite multiple sclerosis.

Cerebrospinal fluid (CSF) is a promising source of biomarkers in clinically isolated syndrome (CIS), which frequently presents as a first episode of multiple sclerosis (MS). Using the two-dimensional difference in gel electrophoresis (2-D DIGE), we compared CSF samples from patients with CIS that remained CIS (CIS-CIS, n=8) over a follow-up time of 2 years and from patients with CIS that developed definite MS of the relapsing-remitting subtype (CIS-RRMS, n=8) over the same period. Protein spots that showed significant differences between patients and controls were selected for further analysis by MALDI-TOF mass spectrometry. For validation of identified spots ELISA experiments were performed. We identified one protein that was upregulated in CIS-RRMS (serin peptidase inhibitor) and eight proteins (alpha-1-B-glycoprotein, Fetuin-A, apolipoprotein A4, haptoglobin, human Zinc-alpha-2-glycoprotein (ZAG), Retinol-binding protein, superoxid dismutase 1, transferrin) that were down-regulated in CIS-RRMS vs. CIS-CIS. For Fetuin-A, our findings could be confirmed by ELISA. The pathophysiological role as well as clinical relevance of these candidate proteins in CIS remains to be further clarified by future studies.

An investigation of the action of Neutral Protamine Hagedorn human analogue insulin in dogs with naturally occurring diabetes mellitus.

BACKGROUND: Neutral Protamine Hagedorn human analogue insulin (Humulin N) is commonly used for treatment of canine diabetes mellitus (DM). However, blood glucose and serum insulin concentrations in Humulin N-treated dogs with naturally occurring DM have not been reported. OBJECTIVE: To investigate blood glucose and serum insulin concentrations in the clinical setting of client-owned Humulin N-treated dogs with naturally occurring, well-regulated DM. ANIMALS: Ten client-owned dogs with naturally occurring, well-regulated DM. METHODS: In this clinical study, blood glucose and serum insulin concentrations were measured when dogs received food and insulin (T(0)), at approximately every half hour for the next 2 hours, and then approximately every 2 hours for an additional 8 hours. Insulin duration of action was defined as the number of hours from T(0) to the lowest blood glucose concentration and until blood glucose concentration returned to an interpolated value of 70% of basal blood glucose concentration (Glucose(b)). RESULTS: Mean percent of insulin-induced blood glucose suppression was 49.9 +/- 17.1% (median, 46%; range, 29-78%). Insulin duration of action ranged from 4 to 10 hours. Blood glucose concentration increased initially and returned to Glucose(b) within 0.6-2.2 hours after T(0) in 5 dogs. This initial blood glucose surge then was followed by blood glucose suppression in all 5 dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: These results suggest that Humulin N administered SC twice daily is an effective mode of treatment for dogs with naturally occurring DM. Postprandial hyperglycemia is present in some well-regulated diabetic dogs treated with Humulin N.

Brain abscess caused by Streptococcus pneumoniae with acute onset and rapid progressive symptoms.

Although the decline of the morbidity and mortality in recent years, brain abscess is still an important problem in neurocritical care medicine and remains a serious illness that can result in severe disability or even death, especially if misdiagnosed or managed improperly. We report a very rare case of a patient who developed a bacterial brain abscess in the posterior fossa with an atypical rapid progression of neurological symptoms. Furthermore, MRI demonstrated additional brain stem and left hemispheric lesions. Early onset broad antibiotic therapy, corticosteroid application and extensive intermediate care management was leading to a complete regression of the initially dramatic symptoms.

Biodegradable magnesium scaffolds: Part II: peri-implant bone remodeling.

In this study, histomorphometrical parameters of the peri-implant bone remodeling around degrading open-porous scaffolds made of magnesium alloy AZ91D were investigated and compared with the peri-implant bone remodeling around an autologous bone transplant in the contralateral side in a rabbit model after 3 and 6 months. Osteoblast activity was displayed by collagen I (alpha 2) mRNA in situ hybridization. Major scaffold degradation was completed within 3 months after implantation showing no osteolysis around the scaffolds, both after 3 and 6 months. Enhanced formation of unmineralized extracellular matrix and an enhanced mineral apposition rate adjacent to the degrading magnesium scaffolds were accompanied by an increased osteoclastic bone surface, which resulted in higher bone mass and a tendency to a more mature trabecular bone structure around the magnesium scaffolds compared to the control. These results show that even fast-degrading magnesium scaffolds induce extended peri-implant bone remodeling with a good biocompatibility. In summary, this study shows that degrading magnesium scaffolds promote both bone formation and resorption in a rabbit model and are therefore very promising candidates for the development of novel implants in musculoskeletal surgery.

Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine.

BACKGROUND: Propofol is associated with a high incidence of injection pain in children, even if given together with lidocaine. A new lipid formulation of etomidate (Etomidate-Lipuro) has been found in adults to cause very little discomfort during i.v. injection. The aim of the present prospective, double-blind, randomized trial was to compare the incidence of injection pain during i.v. induction of anaesthesia between propofol with added lidocaine (previous standard) and this new etomidate formulation in paediatric patients. METHODS: A total of 110 paediatric patients, aged 2-16 years, scheduled for outpatient surgery were planned to be included in the study. The primary end point of the study was the incidence of injection pain during induction of anaesthesia as assessed by a four-point scale as described previously. The occurrence of myoclonic muscular activity was registered as a secondary end point (four-point scale). An interim analysis after 80 patients was requested by the Ethics' Committee. RESULTS: The study was stopped after the inclusion of 80 patients. A significantly lower incidence of injection pain was found in the Etomidate-Lipuro group as compared with the propofol-lidocaine group (5.0% vs 47.5%, P<0.001). The use of etomidate was associated with a significantly higher incidence of myoclonic activity compared with propofol-lidocaine (85.0% vs 15%, P<0.001). CONCLUSIONS: The use of a new lipid formulation of etomidate is associated with significantly less injection pain than propofol with added lidocaine in children. This finding may warrant a change in clinical practice in order to avoid unnecessary pain in children.

Quantification of doxorubicin in plasma--a comparative study of capillary and venous blood sampling.

Doxorubicin, an anthraquinone glycoside, is currently one of the clinically most important antineoplastic drugs. The aim of the present study was to identify potential concentration differences of doxorubicin in plasma from capillary and venous blood samples. Sixteen patients (seven females and nine males; median age: 37 years, range: 1-77 years) were included. The quantitative analysis of doxorubicin was carried out by reversed-phase liquid chromatography with fluorometric detection. The concentration of doxorubicin in capillary and venous samples were closely correlated (r=0.98; p<0.0001). The median plasma concentration ratio capillary/venous was 1.13 (95% confidence interval: 1.06-1.20) and not affected either by plasma drug concentration, age or the body mass index of the patient. The concentration ratio was significantly higher in males (median: 1.18) than in females (median: 1.01). The observed concentration differences of doxorubicin in plasma from capillary and venous samples are of minor importance only. Capillary blood sampling is recommended for use in pharmacokinetic studies of doxorubicin, especially in pediatric patients, in order to avoid sometimes traumatic venous blood sampling.

Color line search for illuminant estimation in real-world scenes.

The estimation of illuminant color is mandatory for many applications in the field of color image quantification. However, it is an unresolved problem if no additional heuristics or restrictive assumptions apply. Assuming uniformly colored and roundly shaped objects, Lee has presented a theory and a method for computing the scene-illuminant chromaticity from specular highlights [H. C. Lee, J. Opt. Soc. Am. A 3, 1694 (1986)]. However, Lee's method, called image path search, is less robust to noise and is limited in the handling of microtextured surfaces. We introduce a novel approach to estimate the color of a single illuminant for noisy and microtextured images, which frequently occur in real-world scenes. Using dichromatic regions of different colored surfaces, our approach, named color line search, reverses Lee's strategy of image path search. Reliable color lines are determined directly in the domain of the color diagrams by three steps. First, regions of interest are automatically detected around specular highlights, and local color diagrams are computed. Second, color lines are determined according to the dichromatic reflection model by Hough transform of the color diagrams. Third, a consistency check is applied by a corresponding path search in the image domain. Our method is evaluated on 40 natural images of fruit and vegetables. In comparison with those of Lee's method, accuracy and stability are substantially improved. In addition, the color line search approach can easily be extended to scenes of objects with macrotextured surfaces.