Prognostic factors and outcome in cats with thymic epithelial tumours: 64 cases (1999-2021).

OBJECTIVES: To describe the clinical presentation, treatment and outcomes of cats diagnosed with thymic epithelial tumours and to determine prognostic factors for survival and recurrence. MATERIALS AND METHODS: Clinical records of cats diagnosed with a thymic epithelial tumour between 1999 and 2021 at three referral institutions were retrospectively reviewed. RESULTS: Sixty-four cats were included. Paraneoplastic syndromes were present in nine cats and metastatic disease was seen in two cats, one at diagnosis and one at the time of recurrence. Median tumour diameter was 6 cm (range, 2 to 15) and a cystic appearance was described on imaging in 25 cats. Surgical excision was attempted in 54 cats with a perioperative mortality rate of 11%. Median survival time for cats surviving to hospital discharge was 897 days (range, 21 to 3322). The 1-, 2- and 5-year survival rates for surgically treated thymic epithelial tumour were 86%, 70% and 66%, respectively. Survival was longer for cats with Masaoka-Koga stage I and II tumours compared to stages III and IV (1366 days versus 454 days; P=0.002). Masaoka-Koga stage was the only significant prognostic factor detected on multi-variable analysis, with stage III and IV tumours associated with increased risk of death (hazard ratio: 5.67, 95% confidence interval: 1.29 to 24.91, P=.021). Tumour recurrence occurred in 11 cats at a median of 564 days (range, 93 to 1095); no significant prognostic factors for recurrence were identified. CLINICAL SIGNIFICANCE: Cats with thymic epithelial tumours had a good long-term prognosis following surgery. Tumour recurrence can occur late in the disease course and ongoing monitoring should therefore be considered. Masaoka-Koga stage may influence survival time and could be used to predict outcome.

Changing patterns of referral into a family history clinic and detection of ovarian cancer: a retrospective 10-year review.

This study examines whether a change in the criteria for genetic testing for ovarian cancer risk changed the nature of referrals into our Familial Cancer service. This is a retrospective review of 273 women who underwent risk reducing surgery (RRS). The primary outcome was to establish whether there was an increase in women having RRS with a confirmed genetic mutation. Secondary outcomes included the incidence of occult cancer and of subsequent primary peritoneal cancer. The results showed an increase in women being offered RRS based on genetic diagnosis; 91% versus 32% before the criteria change. Four occult malignancies (1.5%) and two peritoneal cancers (0.7%) were noted.We have demonstrated a change in the nature of referrals to the familial cancer service from perceived risk to genetic diagnosis. We can now counsel women more accurately. With a defined risk we are enabling them to make an informed decision regarding risk reduction.

Molecular pathology in the cancer clinic - where are we now and where are we headed?

Molecular pathology is a developing sub-microscopic discipline of pathology that studies the effects of molecular variations and mutations on disease processes. The ultimate goal of molecular pathology in cancer is to predict risk, facilitate diagnosis and improve prognostication based on a complete understanding of the biological impact of specific molecular variations, mutations and dysregulations. This knowledge will provide the basis for customised cancer treatment, so-called precision medicine. Rapid developments in genomics have placed this field at the forefront of clinical molecular pathology and there are already a number of well-established genetic tests available for clinical use including PCR of antigen receptor rearrangement and KIT mutational analysis. Moving beyond tests assessing a single gene, there are significant research efforts utilising genomics to predict cancer risk, forecast aggressive behaviour and identify druggable mutations and therapeutic biomarkers. Researchers are also investigating the use of circulating cells and nucleic acid for clinically useful low morbidity genomic assessments. If we are to realise the full potential of molecular pathology and precision medicine there are a number of challenges to overcome. These include developing our understanding of the underlying biology (in particular intra-tumoural heterogeneity), methodological standardisation of assays, provision of adequate infrastructure and production of novel therapeutics backed by high-quality clinical data supporting the precision medicine approach. The era of molecular pathology holds the potential to revolutionise veterinary cancer care, but its impact on clinical practice will depend upon the extent to which the inherent challenges can be overcome.

Mange Caused by a Novel Micnemidocoptes Mite in a Golden Eagle ( Aquila chrysaetos ).

A second-year, female golden eagle ( Aquila chrysaetos ) was live trapped in northern California because of severe feather loss and crusting of the skin on the head and legs. On physical examination, the bird was lethargic, dehydrated, and thin, with severe feather loss and diffuse hyperemia and crusting on the head, ventral wings, ventrum, dorsum, and pelvic limbs. Mites morphologically similar to Micnemidocoptes derooi were identified with scanning electron microscopy. The eagle was treated with ivermectin (0.4 mg/kg) once weekly for 7 weeks, as well as pyrethrin, meloxicam, ceftiofur crystalline free acid, and voriconazole. Although the eagle's condition improved, and live mites or eggs were not evident on skin scrapings at the time of completion of ivermectin treatment, evidence of dead mites and mite feces were present after the last dose of ivermectin. Two additional doses of ivermectin and 2 doses of topical selamectin (23 mg/kg) were administered 2 and 4 weeks apart, respectively. No mite eggs, feces, or adults were evident after treatment was completed. A second golden eagle found in the same region was also affected with this mite but died soon after presentation. This is the first report, to our knowledge, of successful treatment, as well as treatment with selamectin, of mites consistent with Micnemidocoptes species in any raptorial species.

Study design and interpretation of mammalian carnivore density estimates.

Ecological theory and wildlife management often depend on reliable comparison and interpretation of population density estimates. A synthesis of 1,772 mammalian carnivore population estimates (713 unique to reference, species, site, and size of study area) from 74 species revealed global patterns among aspects of study and interpretive design that undermine the reliability and usefulness of density comparisons. The spatial extent of the study area could explain most of the variation in density, probably because study areas are typically delineated around population clusters. We related the scale-defined density estimates (regression residuals) to 28 other variables measured from the published literature, but none provided convincing biological explanation of the variation in density. Many aspects of study and interpretive design were possibly ill-suited to identifying the factor(s) influencing density. Study attributes and findings were reported inconsistently, and were subject to ideological motivations. Descriptions of vegetation were most difficult to relate to density. More intensive sampling and estimation methods produced above-average density estimates, but the differences were slight and the evidence lacking for concluding whether these more intensive methods were also more accurate. The first underlying factor extracted from principle-components analysis described the growing recognition of population declines and range reductions among large-bodied carnivores, which has also influenced study design. Another factor described an increasing trend for density to be compared and extrapolated to larger areas, but without adjusting for the effect of scale. To understand the factors influencing carnivore distribution and abundance, sampling and reporting methods (e.g., site description with maps) will need to represent the available pool of species, locations, and ecological conditions at larger-than-conventional spatial and temporal scales.

Occupational exposure of nonsmoking nightclub musicians to environmental tobacco smoke.

This study assessed environmental tobacco smoke (ETS) exposures of nonsmoking musicians in nightclub environments using total suspended particulate (TSP), the ultraviolet absorbing fraction of TSP (UVPM), gaseous nicotine, saliva nicotine, saliva cotinine, and perceived smokiness as exposure/dose indicators. Measured exposures were as high or higher than those of other occupational groups studied. TSP ranged from 110 to 1714 micrograms/m3 (mean 502, SD 390 micrograms/m3). UVPM (mean 221, SD 95 micrograms/m3) was associated with gaseous and saliva nicotine concentrations. Paired-sample variation was much higher for TSP than for UVPM. Correlation of TSP with UVPM, gaseous nicotine, and saliva nicotine was poor. Paired-sample gaseous nicotine results were similar, with exposures of 28.0 to 50.0 micrograms/m3 (mean 37.1, SD 6.9 micrograms/m3), and were high compared with previous studies. These results suggested that nightclub musicians may be exposed to higher concentrations of ETS than some other occupational groups. Saliva nicotine results were consistent with those previously reported with regard to the range of values, large variation observed, and increase in saliva nicotine levels observable after only a few hours of exposure. Saliva nicotine results could not be correlated with other measures of exposure and did not appear to be a reliable biological indicator of absorbed dose. Saliva cotinine levels were comparable to other occupational groups studied, but were lower than previous findings for bartenders and waitresses. Levels ranged from 1.7 to 5.0 ng/mL (mean 3.4, SD 0.9 ng/mL), and increased with number of exposures during the workweek, but did not correlate with other ETS indicators.

Scaling population density and spatial pattern for terrestrial, mammalian carnivores.

A large part of ecological theory has been developed with the assumption that intra- and inter-specific patterns of density and spatial distribution can be consistently and reliably compared, and that these patterns have represented populations across nonstudied landscapes. These assumptions are erroneous. We found that log10 population density estimates consistently decreased linearly with log10 spatial extent of study areas for species of terrestrial Carnivora. The size of the study area accounted for most of the variation in population estimates, and study areas increased with the female body mass of the study species. But study sites consistently had higher densities than can be expected for nonstudy sites, regardless of the size of the study area, because study sites are typically chosen based on a priori knowledge of high density. Inter-specific comparisons of density and distribution might provide more insight into community organization after intra-specific density estimates have been scaled by the study areas, and related to the nonstudied landscapes within each species' geographic range.

Spatial scaling of allometry for terrestrial, mammalian carnivores.

A regression slope of -0.75 between log10 density and log10 body mass is thought to express equivalence of energy conversion among species' populations of similar taxonomic and trophic status. Using larger sample sizes than the usual 1-3 density estimates per species, we estimated a regression slope of -0.71 for terrestrial mammalian carnivores. We investigated the sampling variation in this estimate, and those derived from smaller intra-specific subsets, using 1000-iteration bootstrap analyses to obtain 90% confidence intervals. As expected, these widened as random subsets were reduced in size, but always contained the postulated -0.75. However, log10 density also declined as 3/4 of the log10 spatial extent of study area, and study area accounted for virtually all of the variation in density that was previously thought due to body mass. We removed the effect of study area by using the species-specific regression models between density and study area to predict density at a common scale of 400 km2. These common-scale densities regressed against body mass with a slope of -0.16, but separated into body mass classes less than and greater than 11 kg, they produced slopes that were not significantly different from zero. We show that the allometry of density could be a case of circular logic, whereby body mass has influenced the investigator's choice of study area, and the resulting scale-dependent densities are related back to body mass. To test the allometry hypothesis, the effect of study area on density estimates needs to be removed. This requires conducting larger-scale studies of the smaller-bodied species so that all species compared are represented by an average study area that is near the common scale. Furthermore, study sites need to be selected and designed to represent more than the local detail in species' density.

Physician-executives past, present, and future.

The dramatic changes in the United States' health care system during the last decade have sparked increasing interest in physician-executives. These executives, skilled in both clinical medicine and health care management, can be found in hospitals, managed care organizations, group practices, and government institutions. This paper outlines the physician-executive's roles and the development process. The remarkable growth in the number of physician-executives is expected to continue as they demonstrate their abilities to help health care providers expand ambulatory services, facilitate provider-physician relationships and physician recruitment, and lend expertise in quality improvement and risk management issues.

The feasibility of mandatory HIV testing for health professionals and other special populations.

Infection with the human immunodeficiency virus (HIV) has become an increasingly important public health problem. Due to the profound increase in the incidence of the disease, testing has become an important tool in prevention efforts as well as treatment. In view of the dire prognosis associated with the diagnosis of HIV infection, there is a great deal of interest in mandatory HIV testing of special groups. Mandatory testing has been implemented for several groups such as the United States military. However, there are a number of issues to be considered before implementing a mandatory testing program. These include the predictive value and accuracy of the tests themselves, confidentiality and the social ramifications of breaches in confidentiality, the likelihood of forcing high risk persons underground to avoid testing, and the constitutionality of a mandatory testing policy. Since the discovery of the apparent transmission of HIV infection from a dentist to his patients, there has been increasing interest in a policy mandating the testing of health professionals. However, in view of the low risk of transmission to patients, it would be ill-advised to require HIV testing of health care workers. In general, the benefits of a mandatory testing policy do not outweigh the human and financial costs it would engender.

Patient demographic characteristics and housestaff performance in the care of patients with human immunodeficiency virus disease.

A retrospective review of the medical records of 45 patients with human immunodeficiency virus (HIV) disease was conducted in an Oklahoma internal medicine teaching clinic. Demographics of this patient population and house staff performance in the care of these patients was evaluated. The study population demographics were similar to national findings with the exception of lower documented homosexual/bisexual transmission among males and higher heterosexual transmission among females. Deficiencies in documentation were noted in the areas of route of acquisition, mental status, and functional level. In several instances patients who were candidates for zidovudine and/or Pneumocystis prophylaxis were not receiving these treatments. The quality of care could be enhanced through the use of HIV evaluation and treatment protocols as well as specially designed, HIV-specific medical records to improve data collection. These HIV-specific medical records can be found in the appendices.