Low-density lipoprotein cholesterol goal attainment in patients with clinical evidence of familial hypercholesterolemia and elevated Lp(a).

BACKGROUND: Although potent lipid-lowering therapies are available, patients commonly fall short of recommended low-density lipoprotein cholesterol (LDL-C) levels. The aim of this study was to examine the relationship between familial hypercholesterolemia (FH) and elevated lipoprotein(a) [Lp(a)] and LDL-C goal attainment, as well as the prevalence and severity of coronary artery disease (CAD). Moreover, we characterized patients failing to meet recommended LDL-C goals. METHODS: We performed a cross-sectional analysis in a cohort of patients undergoing cardiac catheterization. Clinical FH was determined by the Dutch Clinical Lipid Network Score, and Lp(a) ≥ 50 mg/dL (≈ 107 nmol/L) was considered elevated. RESULTS: A total of 838 participants were included. Overall, the prevalence of CAD was 72%, and 62% received lipid-lowering treatment. The prevalence of clinical FH (probable and definite FH) was 4%, and 19% had elevated Lp(a) levels. With 35%, LDL-C goal attainment was generally poor. Among the participants with clinical FH, none reached their LDL-C target. Among patients with elevated Lp(a), LDL-C target achievement was only 28%. The prevalence and severity of CAD were higher in participants with clinical FH (86% prevalence) and elevated Lp(a) (80% prevalence). CONCLUSION: Most participants failed to meet their individual LDL-C goals according to the ESC 2016 and 2019 guidelines. In particular, high-risk patients with clinical FH or elevated Lp(a) rarely met their target for LDL-C. The identification of these patients and more intense treatment approaches are crucial for the improvement of CAD primary and secondary prevention.

Impact of general anesthesia on rotational thromboelastometry (ROTEM) parameters and standard plasmatic coagulation tests in healthy Beagle dogs.

OBJECTIVE: To assess the influence of general anesthesia on rotational thromboelastometry (ROTEM) and standard coagulation testing in healthy dogs. STUDY DESIGN: Prospective experimental study. ANIMALS: 10 healthy Beagle dogs. METHODS: Dogs were administered methadone (0.2 mg/kg) intramuscularly. Anesthesia was co-induced intravenously 30 min later with midazolam (0.1 mg/kg) and propofol to effect, and maintained with sevoflurane. Crystalloids were administered at 5 ml/kg/h. Blood was sampled by direct venipuncture before induction (T0) and 3.5 h later (T3.5) and ROTEM parameters (ExTEM, InTEM, FibTEM, ApTEM), standard plasmatic coagulation tests (prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen concentration), hematology, ionized calcium, triglycerides, pH, lactate and body temperature were compared over time with Students t - test or Wilcoxon matched pairs signed-rank tests. RESULTS: The following variables dropped significantly between T0 and T3.5: body temperature (p < 0.0001), hematocrit (p < 0.0001), platelet count (p < 0.01), pH (p < 0.01), triglycerides (p < 0.01), fibrinogen concentration (p < 0.01), ExTEM, FibTEM (p < 0.01) and ApTEM (p < 0.05) clotting times. Lactate concentration (p < 0.01), aPTT (p < 0.05) and FibTEM maximum clot firmness increased (p < 0.05). No changes were noted in ionized calcium, PT and InTEM values. CONCLUSION AND CLINICAL RELEVANCE: General anesthesia with concurrent hemodilution and hypothermia induced significant but clinically irrelevant changes in coagulation variables measured at 37 °Celsius. Blood samples from anaesthetized animals can be used for determination of coagulation status in dogs.

Cardiac-gated, phase contrast magnetic resonance angiography is a reliable and reproducible technique for quantifying blood flow in canine major cranial abdominal vessels.

Blood flow changes in cranial abdominal vessels are important contributing factors for canine hepatic disease. This prospective, experimental, pilot study aimed to evaluate cardiac-gated, phase contrast magnetic resonance angiography (PCMRA) as a method for characterizing blood flow in canine major cranial abdominal vessels. Eleven, healthy, adult beagle dogs were sampled. Cardiac-gated, phase contrast magnetic resonance angiography of the cranial abdomen was performed in each dog and blood flow was independently measured in each of the major cranial abdominal vessels by three observers, with two observers recording blood flow values once and one observer recording blood flow values three times. Each dog then underwent ultrasonographic examination of the liver with fine needle aspirations and biopsies submitted to cytologic and histologic examination. The mean absolute stroke volume and velocity were respectively 9.6 ± 1.9 ml and -11.1 ± 1.1 cm/s for the cranial abdominal aorta, 2.1 ± 0.6 ml and -6.6 ± 1.9 cm/s for the celiac artery, and 2.3 ± 1.0 ml and -7.9 ± 3.1 cm/s for the cranial mesenteric artery. The mean absolute stroke volume and velocity were respectively 6.7 ± 1.3 ml and 3.9 ± 0.9 cm/s for the caudal vena cava and 2.6 ± 0.9 ml and 3.2 ± 1.2 cm/s for the portal vein. Intraobserver reliability was excellent (intraclass correlation coefficient > 0.9). Interobserver reproducibility was also excellent (intraclass correlation coefficient 0.89-0.99). Results of liver ultrasonography, cytology, and histopathology were unremarkable. Findings indicated that cardiac-gated, phase contrast magnetic resonance angiography is a feasible technique for quantifying blood blow in canine major cranial abdominal vessels. Blood flow values from this sample of healthy beagles can be used as background for future studies on canine hepatic disease.

Non-invasive quantification of hepatic fat content in healthy dogs by using proton magnetic resonance spectroscopy and dual gradient echo magnetic resonance imaging.

The objective of the present study was to describe two non-invasive methods for fat quantification in normal canine liver by using magnetic resonance imaging (MRI) and spectroscopy. Eleven adult beagle dogs were anesthetized and underwent magnetic resonance examination of the cranial abdomen by performing morphologic, modified Dixon (mDixon) dual gradient echo sequence, and proton magnetic resonance spectroscopy (1H MRS) imaging. In addition, ultrasonographic liver examination was performed, fine-needle liver aspirates and liver biopsies were obtained, and hepatic triglyceride content was assayed. Ultrasonographic, cytologic, and histologic examination results were unremarkable in all cases. The median hepatic fat fraction calculated was 2.1% (range, 1.3%-5.5%) using mDixon, 0.3% (range, 0.1%-1.0%) using 1H MRS, and 1.6% (range 1.0%-2.5%) based on triglyceride content. The hepatic fat fractions calculated using mDixon and 1H MRS imaging were highly correlated to that based on triglyceride content. A weak correlation between mDixon and 1H MRS imaging was detected. The results show that hepatic fat content can be estimated using non-invasive techniques (mDixon or 1H MRS) in healthy dogs. Further studies are warranted to evaluate the use of these techniques in dogs with varying hepatic fat content and different hepatic disorders.

[Local anaesthesia in ruminants]. / Lokalanästhesien beim Wiederkäuer.

The use of local anaesthesia in ruminants allows many surgical procedures to be conducted free of pain, efficiently and inexpensively in the field. Local anaesthesia combined with sedation and immobilisation of the animal can replace general anaesthesia for many procedures (e. g. castration, claw amputation). The level of difficulty differs among various local anaesthetic techniques: local infiltration of tissue or anaesthesia of the cornual nerve are easily performed, whereas local anaesthesia of the eye, regional anaesthesia in limbs or anaesthesia for umbilical surgery are more difficult to carry out. This article presents an illustrated overview of the most common local anaesthetic procedures in cattle as well as in small ruminants and serves as a practical guide for veterinarians in the field. In principle, these techniques can likewise be applied in other ruminants or artiodactyls.

Acetabular Version Increases After Closure of the Triradiate Cartilage Complex.

BACKGROUND: Although the etiology of primary femoroacetabular impingement (FAI) is considered developmental, the underlying pathogenic mechanisms remain poorly understood. In particular, research identifying etiologic factors associated with pincer FAI is limited. Knowledge of the physiologic growth patterns of the acetabulum during skeletal maturation might allow conclusions on deviations from normal development that could contribute to pincer-related pathomorphologies. QUESTIONS/PURPOSES: In a population of healthy children, we asked if there were any differences related to skeletal maturation with regard to (1) acetabular version; (2) acetabular depth/width ratio; and (3) femoral head coverage in the same children as assessed by MRIs obtained 1 year apart. METHODS: We prospectively compared 129 MRIs in 65 asymptomatic volunteers without a known hip disorder from a mixed primary/high school population (mean age, 12.7 years; range, 7-16 years). All participants underwent two MRI examinations separated by a minimum interval of 1 year. Based on the status of the triradiate cartilage complex (open versus closed [TCC]), all hips were allocated to the following groups: "open-open" = open TCC at both MRIs (n = 45 hips [22 bilateral]); "open-closed" = open TCC at initial and closed TCC at followup MRI (n = 26 hips [13 bilateral]); and "closed-closed" group = closed TCC at both MRIs (n = 58 hips [29 bilateral]). We assessed acetabular version in the axial plane at five different locations (5, 10, 15, 20 mm below the acetabular dome and at the level of the femoral head) as well as three-dimensional (3-D) acetabular depth/width ratio and 3-D femoral head coverage on six radial MRI sequences oriented circumferentially around the femoral neck axis. Using analysis of variance for multigroup comparisons with Bonferroni adjustment for pairwise comparisons, we compared the results between the initial and followup MRI examinations and among the three groups. RESULTS: Acetabular version was increased in hips of the "open-closed" group at the followup MRI compared with the initial MRI at 5 mm (-6 ± 4.6 [95% confidence interval {CI}, -7.6 to -3.6] versus -1 ± 5.0 [95% CI, -3.3 to 0.7]; p < 0.001), 10 mm (0 ± 4.0 [95% CI, -1.6 to 2.1] versus 7 ± 4.6 [95% CI, 4.4-8.7]; p < 0.001), and 15 mm (8 ± 5.0 [95% CI, 6.1-10.2] versus 15 ± 4.6 [95% CI, 13.3-17.4]; p < 0.001) below the acetabular dome. Acetabular version did not change between the initial and followup MRI in the "open-open" and "closed-closed" groups. Independently of the groups, acetabular version was increased in all hips with a fused TCC compared with hips with an open TCC (mean difference measured at 5 mm below the acetabular dome at initial MRI examination: 2° ± 5.9° [95% CI, 0.2°-3.4°] versus -9° ± 4.4° [95% CI, -9.9° to -7.8°]; p < 0.001; at followup MRI examination: 1° ± 5.7° [95% CI, 0.1°-2.7°] versus -9° ± 3.8° [95% CI, -10° to -7.6°]; p < 0.001). Both acetabular depth/width ratio and femoral head coverage did not differ among the groups or between the initial and followup MRI examinations within each group. CONCLUSIONS: Although acetabular depth/width ratio and femoral head coverage remain relatively constant, acetabular version increases with advancing skeletal maturity. There seems to be a relatively narrow timeframe near physeal closure of the TCC within which acetabular orientation changes to more pronounced anteversion. Further studies with greater numbers and longer followup periods are required to support these findings and determine whether such version changes may contribute to pincer-type pathomorphologies. LEVEL OF EVIDENCE: Level II, prospective study.

Perfusion- and diffusion-weighted magnetic resonance imaging of the liver of healthy dogs.

OBJECTIVE To describe the perfusion and diffusion characteristics of the liver in healthy dogs as determined by morphological, perfusion-weighted, and diffusion-weighted MRI. ANIMALS 11 healthy adult Beagles. PROCEDURES Each dog was anesthetized and underwent morphological, perfusion-weighted, and diffusion-weighted MRI of the cranial aspect of the abdomen. On the MRI images, a region of interest (ROI) was established for each of 6 structures (aorta, caudal vena cava, portal vein, hepatic parenchyma, splenic parenchyma, and skeletal [epaxial] muscle). The signal intensity was determined, and a time-intensity curve was generated for each ROI. The apparent diffusion coefficient (ADC) was calculated for the hepatic and splenic parenchyma in diffusion-weighted MRI images, and the normalized ADC for the liver was calculated as the ratio of the ADC for the hepatic parenchyma to the ADC for the splenic parenchyma. Dogs also underwent abdominal ultrasonography, and ultrasound-guided fine-needle aspirate samples and biopsy specimens were obtained from the liver for cytologic and histologic examination. RESULTS Cytologic and histologic results suggested that the liver was clinically normal in all dogs. Perfusion-weighted MRI parameters varied among the 6 ROIs. The mean ± SD ADC of the hepatic parenchyma was 0.84 × 10(-3) mm(2)/s ± 0.17 × 10(-3) mm(2)/s, and the mean normalized ADC for the liver was 1.8 ± 0.4. CONCLUSIONS AND CLINICAL RELEVANCE Results provided preliminary baseline information about the diffusion and perfusion characteristics of the liver in healthy dogs. Additional studies on dogs of various breeds with and without hepatopathies are necessary to validate and refine these findings.

Magnetic resonance imaging anatomy of the rabbit brain at 3 T.

BACKGROUND: Rabbits are widely accepted as an animal model in neuroscience research. They also represent very popular pet animals, and, in selected clinical cases with neurological signs, magnetic resonance imaging (MRI) may be indicated for imaging the rabbit brain. Literature on the normal MRI anatomy of the rabbit brain and associated structures as well as related reference values is sparse. Therefore, it was the purpose of this study to generate an MRI atlas of the normal rabbit brain including the pituitary gland, the cranial nerves and major vessels by the use of a 3 T magnet. RESULTS: Based on transverse, dorsal and sagittal T2-weighted (T2w) and pre- and post-contrast 3D T1-weighted (T1w) sequences, 60 intracranial structures were identified and labeled. Typical features of a lissencephalic brain type were described. In the 5 investigated rabbits, on T1w images a crescent-shaped hyperintense area caudodorsally in the pituitary gland most likely corresponded to a part of the neurohypophysis. The optic, trigeminal, and in part, the facial, vestibulocochlear and trochlear nerves were identified. Mild contrast enhancement of the trigeminal nerve was present in all rabbits. Absolute and relative size of the pituitary gland, midline area of the cranial and caudal cranial fossa and height of the tel- and diencephalon, 3rd and 4th ventricles were also determined. CONCLUSIONS: These data established normal MRI appearance and measurements of the rabbit brain. Results provide reference for research studies in rabbits and, in rare instances, clinical cases in veterinary medicine.

Comparison of the effects of propofol or alfaxalone for anaesthesia induction and maintenance on respiration in cats.

OBJECTIVE: To compare the effects of propofol and alfaxalone on respiration in cats. STUDY DESIGN: Randomized, 'blinded', prospective clinical trial. ANIMALS: Twenty cats undergoing ovariohysterectomy. METHODS: After premedication with medetomidine 0.01 mg kg(-1) intramuscularly and meloxicam 0.3 mg kg(-1) subcutaneously, the cats were assigned randomly into two groups: group A (n = 10) were administered alfaxalone 5 mg kg(-1)  minute(-1) followed by 10 mg kg(-1)  hour(-1) intravenously (IV) and group P (n = 10) were administered propofol 6 mg kg(-1 ) minute(-1) followed by 12 mg kg(-1) hour(-1) IV for induction and maintenance of anaesthesia, respectively. After endotracheal intubation, the tube was connected to a non-rebreathing system delivering 100% oxygen. The anaesthetic maintenance drug rate was adjusted (± 0.5 mg kg(-1) hour(-1) ) every 5 minutes according to a scoring sheet based on physiologic variables and clinical signs. If apnoea > 30 seconds, end-tidal carbon dioxide (Pe'CO2 ) > 7.3 kPa (55 mmHg) or arterial haemoglobin oxygen saturation (SpO2 ) < 90% occurred, manual ventilation was provided. Methadone was administered postoperatively. Data were analyzed using independent-samples t-tests, Fisher's exact test, linear mixed-effects models and binomial test. RESULTS: Manual ventilation was required in two and eight of the cats in group A and P, respectively (p = 0.02). Two cats in both groups showed apnoea. Pe'CO2  > 7.3 kPa was recorded in zero versus four and SpO2  < 90% in zero versus six cats in groups A and P respectively. Induction and maintenance dose rates (mean ± SD) were 11.6 ± 0.3 mg kg(-1) and 10.7 ± 0.8 mg kg(-1)  hour(-1) for alfaxalone and 11.7 ± 2.7 mg kg(-1) and 12.4 ± 0.5 mg kg(-1) hour(-1) for propofol. CONCLUSION AND CLINICAL RELEVANCE: Alfaxalone had less adverse influence on respiration than propofol in cats premedicated with medetomidine. Alfaxalone might be better than propofol for induction and maintenance of anaesthesia when artificial ventilation cannot be provided.

Minimum infusion rate of alfaxalone for total intravenous anaesthesia after sedation with acepromazine or medetomidine in cats undergoing ovariohysterectomy.

OBJECTIVE: To determine the induction doses, then minimum infusion rates of alfaxalone for total intravenous anaesthesia (TIVA), and subsequent, cardiopulmonary effects, recovery characteristics and alfaxalone plasma concentrations in cats undergoing ovariohysterectomy after premedication with butorphanol-acepromazine or butorphanol-medetomidine. STUDY DESIGN: Prospective randomized blinded clinical study. ANIMALS: Twenty-eight healthy cats. METHODS: Cats undergoing ovariohysterectomy were assigned into two groups: together with butorphanol [0.2 mg kg(-1) intramuscularly (IM)], group AA (n = 14) received acepromazine (0.1 mg kg(-1) IM) and group MA (n = 14) medetomidine (20 µg kg(-1) IM). Anaesthesia was induced with alfaxalone to effect [0.2 mg kg(-1) intravenously (IV) every 20 seconds], initially maintained with 8 mg kg(-1)  hour(-1) alfaxalone IV and infusion adjusted (±0.5 mg kg(-1)  hour(-1) ) every five  minutes according to alterations in heart rate (HR), respiratory rate (fR ), Doppler blood pressure (DBP) and presence of palpebral reflex. Additional alfaxalone boli were administered IV if cats moved/swallowed (0.5 mg kg(-1) ) or if fR >40 breaths minute(-1) (0.25 mg kg(-1) ). Venous blood samples were obtained to determine plasma alfaxalone concentrations. Meloxicam (0.2 mg kg(-1) IV) was administered postoperatively. Data were analysed using linear mixed models, Chi-squared, Fishers exact and t-tests. RESULTS: Alfaxalone anaesthesia induction dose (mean ± SD), was lower in group MA (1.87 ± 0.5; group AA: 2.57 ± 0.41 mg kg(-1) ). No cats became apnoeic. Intraoperative bolus requirements and TIVA rates (group AA: 11.62 ± 1.37, group MA: 10.76 ± 0.96 mg kg(-1)  hour(-1) ) did not differ significantly between groups. Plasma concentrations ranged between 0.69 and 10.76 µg mL(-1) . In group MA, fR , end-tidal carbon dioxide, temperature and DBP were significantly higher and HR lower. CONCLUSION AND CLINICAL RELEVANCE: Alfaxalone TIVA in cats after medetomidine or acepromazine sedation provided suitable anaesthesia with no need for ventilatory support. After these premedications, the authors recommend initial alfaxalone TIVA rates of 10 mg kg(-1)  hour(-1) .

Alfaxalone or ketamine-medetomidine in cats undergoing ovariohysterectomy: a comparison of intra-operative parameters and post-operative pain.

OBJECTIVE: To compare post-operative pain in cats after alfaxalone or ketamine- medetomidine anaesthesia for ovariohysterectomy (OHE) and physiologic parameters during and after surgery. STUDY DESIGN: Prospective 'blinded' randomized clinical study. ANIMALS: Twenty-one healthy cats. METHODS: Cats were assigned randomly into two groups: Group A, anaesthesia was induced and maintained with alfaxalone [5 mg kg(-1) intravenously (IV) followed by boli (2 mg kg(-1) IV); Group MK, induction with ketamine (5 mg kg(-1) IV) after medetomidine (30 µg kg(-1) intramuscularly (IM)], and maintenance with ketamine (2 mg kg(-1) IV). Meloxicam (0.2 mg kg(-1) IV) was administered after surgery. Basic physiological data were collected. At time T = -2, 0, 0.5, 1, 2, 4, 6, 8, 12, 16, 20, and 24 hours post-operatively pain was assessed by three methods, a composite pain scale (CPS; 0-24 points), a visual analogue scale (VAS 0-100 mm), and a mechanical wound threshold (MWT) device. Butorphanol (0.2 mg kg(-1) IM) was administered if CPS was scored ≥13. Data were analyzed using a general linear model, Kruskal-Wallis analyses, Bonferroni-Dunn test, unpaired t-test and Fisher's exact test as relevant. Significance was set at p < 0.05. RESULTS: VASs were significantly higher at 0.5, 1, 2, 4, and 20 hours in group A; MWT values were significantly higher at 8 and 12 hours in group MK. Post-operative MWT decreased significantly compared to baseline in both groups. There was no difference in CPS at any time point. Five cats required rescue analgesia (four in A; one in MK). CONCLUSION AND CLINICAL RELEVANCE: Anaesthesia with ketamine-medetomidine was found to provide better post-surgical analgesia than alfaxalone in cats undergoing OHE; however, primary hyperalgesia developed in both groups. Alfaxalone is suitable for induction and maintenance of anaesthesia in cats undergoing OHE, but administration of additional sedative and analgesic drugs is highly recommended.

Minimum end-tidal sevoflurane concentration necessary to prevent movement during a constant rate infusion of morphine, or morphine plus dexmedetomidine in ponies.

OBJECTIVE: To compare the effects of a constant rate infusion (CRI) of dexmedetomidine and morphine to those of morphine alone on the minimum end-tidal sevoflurane concentration necessary to prevent movement (MACNM ) in ponies. STUDY DESIGN: Prospective, randomized, crossover, 'blinded', experimental study. ANIMALS: Five healthy adult gelding ponies were anaesthetized twice with a 3-week washout period. METHODS: After induction of anaesthesia with sevoflurane in oxygen (via nasotracheal tube), the ponies were positioned on a surgical table (T0), and anaesthesia was maintained with sevoflurane (Fe'SEVO 2.5%) in 55% oxygen. Monitoring included pulse oximetry, electrocardiography and measurement of anaesthetic gases, arterial blood pressure and body temperature. The ponies were mechanically ventilated and randomly allocated to receive IV treatment M [morphine 0.15 mg kg⁻¹ (T10-T15) followed by a CRI (0.1 mg kg⁻¹ hour⁻¹)] or treatment DM [dexmedetomidine 3.5 µg kg⁻¹ plus morphine 0.15 mg kg⁻¹ (T10-T15) followed by a CRI of dexmedetomidine 1.75 µg kg⁻¹ hour⁻¹ and morphine 0.1 mg kg⁻¹ hour⁻¹]. At T60, a stepwise MACNM determination was initiated using constant current electrical stimuli at the skin of the lateral pastern region. Triplicate MACNM estimations were obtained and then averaged in each pony. Wilcoxon signed-rank test was used to detect differences in MAC between treatments (α = 0.05). RESULTS: Sevoflurane-morphine MACNM values (median (range) and mean ± SD) were 2.56 (2.01-4.07) and 2.79 ± 0.73%. The addition of a continuous infusion of dexmedetomidine significantly reduced sevoflurane MACNM values to 0.89 (0.62-1.05) and 0.89 ± 0.22% (mean MACNM reduction 67 ± 11%). CONCLUSION AND CLINICAL RELEVANCE: Co-administration of dexmedetomidine and morphine CRIs significantly reduced the MACNM of sevoflurane compared with a CRI of morphine alone at the reported doses.

Novel avulsion pattern of the left principal bronchus with involvement of the carina and caudal thoracic trachea in a cat.

A 2-year-old, 4.5 kg, neutered male domestic shorthair cat was presented to the emergency service with dyspnoea, anorexia and apathetic behaviour. Thoracic radiographs showed typical signs for a thoracic trauma and a tracheal lesion in the region of the carina, consistent with pseudoairway formation. Computed tomography (CT) was performed in the conscious cat to avoid aggravation of air leakage associated with ventilation. The additional CT findings were consistent with a novel pattern of a traumatic avulsion of the left principal bronchus expanding into the carina and caudal thoracic trachea. Despite the complex avulsion pattern, successful treatment was achieved surgically by performing an end-to-end anastomosis via a fifth right intercostal lateral thoracotomy. The cat was ventilated with a feeding tube and jet ventilation throughout. The cat showed excellent recovery 6 months after surgery.