Neutering is associated with developing hemangiosarcoma in dogs in the Veterinary Medical Database: An age and time-period matched case-control study (1964-2003).

The hypothesis that neutered dogs in the Veterinary Medical Database (VMDB) are at increased risk for developing hemangiosarcoma (HSA) was tested. Dogs (n = 5736) were diagnosed with HSA from a population of 2 106 324 dogs in the VMDB from 1964 to 2003. A case-control design matched on age and time period was created for general, cardiac, and splenic HSAs. A logistic regression analysis was performed including breed. Spayed females had an odds ratio (OR) of 1.59 for splenic, 1.47 for cardiac, and 1.72 for HSA in general. Castrated males had an OR of 1.26 for splenic and 1.14 for HSA in general compared to intact males. Controlled for historical time period and patient age, VMDB data support that neutering is associated with development of splenic HSA and HSA in general in both male and female dogs, but not cardiac HSA with an apparently lower than previously described magnitude of association. Key clinical message: This case-control design confirms an association between neutering and development of HSA and splenic HSA, but not cardiac HSA, in both male and female dogs. By controlling for time period at diagnosis, the bias of recent early neuter practices is eliminated, suggesting early neuter is not a principal driver of this effect.

La stérilisation est associée avec le développement d'hémangiosarcome chez les chiens dans le Veterinary Medical Database : une étude cas-témoin jumelant l'âge et la période de temps (1964­2003). L'hypothèse dans le Veterinary Medical Database (VNDB) selon laquelle les chiens stérilisés sont plus à risque de développer un hémangiosarcome (HSA) a été testée. Des chiens (n = 5736) ont été diagnostiqués avec un HSA à partir d'une population de 2 106 324 chiens dans le VMDB de 1964 à 2003. Un design cas-témoin apparié sur l'âge et la période de temps fut créé pour des HSAs en général, cardiaques et spléniques. Une analyse de régression logistique fut effectuée incluant la race. Les femelles stérilisées avaient un ratio de cotes (OR) de 1,59 pour un HSA splénique, de 1,47 pour HSA cardiaque et de 1,72 pour un HSA en général. Les mâles castrés avaient un OR de 1,26 pour les HSA splénique et de 1,14 pour les HSA généraux comparativement aux mâles entiers. En contrôlant pour la période de temps et l'âge du patient, les données du VMDB soutiennent le fait que la stérilisation est associée avec le développement de HSA splénique et d'HSA en général autant chez les chiens que chez les chiennes, mais pas les HSA cardiaques avec un degré d'association moindre que décrit antérieurement.Message clinique clé :Cette étude cas-témoin confirme une association entre la stérilisation et le développement d'HSA et d'HSA splénique, mais pas d'HSA cardiaque, autant chez le mâle que chez la femelle. En contrôlant pour la période de temps au moment du diagnostic, le biais pour la pratique récente de stérilisation tôt dans la vie de l'animal est éliminé, ce qui suggère que la stérilisation hâtive n'est pas un déterminant principal de cet effet.(Traduit par Dr Serge Messier).

Effect of Chaplaincy Visits in an Elder Care Setting: A Pilot Analysis of Existing Data.

Religion is a consistent, positive predictor of health in older adults. Studies focused on religion and spirituality as a coping mechanism find significant positive effects on the lives of older adults. This study investigated how an older person's living situation influences his or her access to spiritual and religious resources and, consequently, his or her health. Utilizing existing data, this pilot project examined the relationship between visits from a chaplain and the mood, pain level, functional ability, and/or discharge status of elders residing in the rehabilitation unit of one long-term care facility. Samples of patients who did and did not have chaplaincy visits were matched based on their level of frailty. Analytic comparisons revealed no significantly different outcomes in terms of mood, pain level, functional ability, or discharge status for patients visited by a chaplain. The outcomes suggest future hypotheses and offer a model for outcomes-based chaplaincy research.

Physiological and psychosocial factors in spiritual needs attainment for community-dwelling older adults.

BACKGROUND: Spiritual well-being enhances older persons' health status. Factors that optimize their spiritual well-being are not well-established. OBJECTIVE: To describe spiritual needs attainment and identify factors associated with such attainment among community-dwelling older persons. DESIGN: Cross-sectional. SETTING: Sixty-five U.S. continuing care retirement communities or independent housing facilities. SUBJECTS: 4077 persons entering the facilities between January 1, 2007 and November 30, 2016. METHODS: Standardized Community Health Assessment and Wellness Survey instruments were used to determine the proportion of subjects reporting their spiritual needs were met. Multivariate logistic regression identified characteristics independently associated with this outcome. RESULTS: Among the 4077 subjects (mean age 81.6 ±â€¯7.5; male, 28.8%; and White race, 70.7%), 93.4% stated their spiritual needs were met. Factors independently associated with a greater likelihood of spiritual needs attainment were: satisfaction with life (adjusted odds ratio (AOR) 2.81, 95% confidence interval (CI) 2.00, 3.96; p < 0.001), feeling valued (AOR 2.51, 95% CI 1.61, 3.92; p < 0.001), strong and supportive family relationship (AOR 1.99, 95% CI 1.20, 3.29; p = 0.008), sufficient sleep (AOR 1.59, 95% CI 1.15, 2.19; p = 0.005), no pain (AOR 1.35, 95% CI 1.01, 1.82; p = 0.046), and having someone to talk to about death among those interested in doing so (AOR 0.39, 95% CI 0.29, 0.54; p < 0.001). CONCLUSIONS: The majority of community-dwelling older persons reported their spiritual needs were met. Adequate sleep, pain relief, and having a person with whom to discuss death are potentially modifiable factors that may promote spiritual needs attainment in this population, which in turn, may improve their health outcomes.

Gum arabic-coated radioactive gold nanoparticles cause no short-term local or systemic toxicity in the clinically relevant canine model of prostate cancer.

INTRODUCTION: Gum arabic-coated radioactive gold nanoparticles (GA-(198)AuNPs) offer several advantages over traditional brachytherapy in the treatment of prostate cancer, including homogenous dose distribution and higher dose-rate irradiation. Our objective was to determine the short-term safety profile of GA-(198)AuNPs injected intralesionally. We proposed that a single treatment of GA-(198)AuNPs would be safe with minimal-to-no evidence of systemic or local toxicity. METHODS: Nine dogs with spontaneously occurring prostatic cancer were treated. Injections were performed with ultrasound or computerized tomography guidance. Complete blood counts, chemistry panels, and urinalyses were performed at weekly intervals for 1 month and imaging was repeated 4 weeks postinjection. Planar scintigraphic images were obtained within 30 minutes of injection. RESULTS: No statistically significant difference was found in any hematologic or biochemical parameter studied, nor was any evidence of tumor swelling or abscessation found in eight dogs with repeat imaging; one dog died secondary to urethral obstruction 12 days following injection. At 30 minutes postinjection, an average of 53% of injected dose in seven dogs was retained in the prostate, with loss of remaining activity in the bladder and urethra; no systemic uptake was detected. CONCLUSION: GA-(198)AuNP therapy had no short-term toxicity in the treatment of prostatic cancer. While therapeutic agent was found in the prostate immediately following injection, some loss of agent was detected in the bladder and urethra. Localization of radioactivity within the prostate was lower than anticipated and likely due to normal vestigial prostatic ducts. Therefore, further study of retention, dosimetry, long-term toxicity, and efficacy of this treatment is warranted prior to Phase I trials in men.

Effects of two training curricula on basic laparoscopic skills and surgical performance among veterinarians.

OBJECTIVE: To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training. DESIGN: Evaluation study. SAMPLE POPULATION: 17 veterinarians at 1 institution. PROCEDURES: Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B). RESULTS: Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores. CONCLUSIONS AND CLINICAL RELEVANCE: MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.

Improving disposition outcomes for patients in a geriatric skilled nursing facility.

OBJECTIVES: To evaluate an intervention to improve discharge disposition from a skilled nursing unit (SNU). DESIGN: Historical control comparison of discharge disposition before and after implementation. SETTING: Fifty-bed SNU. PARTICIPANTS: All patients admitted from acute care hospitals to a SNU between June 2008 and May 2010. INTERVENTION: Physician admission procedures were standardized using a template, patients with three or more hospital admissions over the prior 6 months received palliative care consultations, and multidisciplinary root-cause analysis conferences for patients transferred back to the hospital acutely were conducted bimonthly to identify problems and improve processes of care. MEASUREMENTS: Patients' discharge disposition (i.e., acute care, long-term care, home, or death) before and after implementation were compared. RESULTS: Discharge dispositions were determined for all 1,725 patients admitted during the study; 862 patients before (June-May 2008) and 863 during (June 2009-May 2010) the intervention. Discharge dispositions were significantly differently distributed across the two periods (P=.03). Readmission to acute care declined (from 16.5% to 13.3%, a nearly 20% decline). Multivariable logistic regression, controlling for age, sex, and case-mix index and adjusting for clustering due to repeated admissions of individual patients, suggests that, during the intervention period, patients were more likely than during the baseline period to die on the unit in accordance with their wishes than to be transferred out to the hospital (odds ratio=2.45, 95% confidence interval=1.09-5.5). CONCLUSION: Interventions such as the ones implemented can lead to fewer hospital transfers for SNUs.

A laparoscopic surgical skills assessment tool for veterinarians.

Our aim in this study was to validate a test of laparoscopic surgical performance by determining the relation of scores from an objective structured assessment of technical skills performed in a canine abdominal model to experience and basic laparoscopic skills. The number of years the participants had performed rigid video-endoscopic procedures (VEP), using triangulation skills, correlated positively with both evaluators' total surgical performance scores for all three evaluation methods: global rating scale, visual analog scale (VAS) rating of overall performance, and operative component rating scale (OCRS). Experience of VEP without triangulation skills (i.e., flexible endoscopy, otoscopy) or video game experience did not correlate with surgical performance. A highly validated basic laparoscopic skills assessment (McGill University inanimate system for training and evaluation of laparoscopic skills, or MISTELS) score was strongly correlated with the VAS score for surgical performance and OCRS scores. Inter-rater reliability was high for the VAS and OCRS evaluation methods, and scores from the detailed OCRS method did not differ between evaluators. In conclusion, the surgical performance test correlated with VEP triangulation experience and basic laparoscopic skills. This type of test needs to be evaluated in a larger sample population including higher numbers of veterinary laparoscopic surgeons for further validation.

Comparison of systemic toxicities of 177Lu-DOTMP and 153Sm-EDTMP administered intravenously at equivalent skeletal doses to normal dogs.

UNLABELLED: Bone-seeking radiopharmaceuticals have been used to effectively treat cancer arising from and metastasizing to bone in humans and dogs. The rate of complete tumor control is low, and the geographic distribution of available compounds is limited by their half-lives. This experiment was done to evaluate in normal dogs the toxicity of (177)Lu-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonate ((177)Lu-DOTMP) used as a potential therapeutic radiopharmaceutical. METHODS: Four normal purpose-bred dogs were administered (177)Lu-DOTMP at a dose of 8.14 MBq/kg and monitored for 84 d for evidence of toxicity in the bone marrow and vital organs. RESULTS: No statistically significant alterations in the biochemical profile, white blood cell count, or platelet count were observed in any dog. Very mild decreases in the red cell count were seen on day 84. No microscopic evidence of toxicity was present at necropsy. CONCLUSION: The dogs receiving (177)Lu-DOTMP tolerated the administration and the effects of the compound without apparent clinical toxicity. The results of this experiment support the further evaluation in tumor-bearing dogs of (177)Lu-DOTMP as a potential therapy for metastatic bone cancer and primary bone tumors in humans and dogs.

Glucose lowering effects of inhaled insulin in healthy cats.

Inhaled medications have proven effective and well tolerated in cats, and inhaled insulin has been used successfully for the management of diabetes mellitus in humans. Thus, we hypothesize that delivery of aerosolized regular insulin can lower blood glucose in healthy cats. Five adult cats were administered aerosolized 0.9% saline (IS), regular insulin intravenously (IV) 0.5 U/kg, and aerosolized regular insulin 15 U/kg (I15) and 25 U/kg (I25) and blood glucose was evaluated. Mean blood glucose was significantly lower at 15, 30 and 45 min in the I25 and IV groups compared to baseline. Similarly, the IV and I25 groups had a significantly greater maximal percent change in blood glucose than the IS group. Significantly more cats developed severe hypoglycemia (<50 mg/dl; 2.7 mmol/l) in the IV and I25 groups than in the IS group. Results of this study demonstrate that aerosolized insulin can effectively lower blood glucose concentrations in healthy cats.

Effects of subanesthetic doses of ketamine on hemodynamic and immunologic variables in dogs with experimentally induced endotoxemia.

OBJECTIVE: To determine the effects of ketamine hydrochloride on hemodynamic and immunologic alterations associated with experimentally induced endotoxemia in dogs. ANIMALS: 9 mixed-breed dogs. PROCEDURES: In a crossover study, dogs were randomly allocated to receive ketamine (0.5 mg/kg, IV, followed by IV infusion at a rate of 0.12 mg/kg/h for 2.5 hours) or control solution (saline [0.9% NaCl] solution, 0.25 mL, IV, followed by IV infusion at a rate of 0.5 mL/h for 2.5 hours). Onset of infusion was time 0. At 30 minutes, lipopolysaccharide (LPS; 1 microg/kg, IV) was administered. Heart rate (HR), systolic arterial blood pressure (SAP), plasma tumor necrosis factor (TNF)-alpha activity, and a CBC were evaluated. RESULTS: Mean SAP was significantly reduced in dogs administered ketamine or saline solution at 2 and 2.5 hours, compared with values at time 0. However, there was no significant difference between treatments. At 1, 2, and 2.5 hours, dogs administered ketamine had a significantly lower HR than dogs administered saline solution. Although plasma TNF-alpha activity significantly increased, compared with values at time 0 for both groups, ketamine-treated dogs had significantly lower peak plasma TNF-alpha activity 1.5 hours after LPS administration. All dogs had significant leukopenia and neutropenia after LPS administration, with no differences detected between ketamine and saline solution treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of a subanesthetic dose of ketamine had immunomodulating effects in dogs with experimentally induced endotoxemia (namely, blunting of plasma TNF-alpha activity). However, it had little effect on hemodynamic stability and no effect on WBC counts.

Role of human HGFIN/nmb in breast cancer.

INTRODUCTION: HGFIN, previously identified as nmb, and its homolog osteoactivin are single transmembrane proteins that are expressed in differentiated immune cells. These proteins exhibit properties that could potentiate tumorigenesis or decrease invasiveness. These seemingly opposing roles of HGFIN suggest that this protein might be central to malignancies and might also behave as a tumor suppressor. Consistent with the reported roles for HGFIN is the fact that this gene is regulated by p53 through multiple binding sites in the 5' flanking region, and is expressed in osteoblasts. METHODS: This study used siRNA to knock-out HGFIN in non-tumorigenic breast cells and ectopically expressed HGFIN in breast cancer cells. In addition, in situ hybridization studies analyzed primary breast tissues from archived breast surgeries. Reporter gene assays studied the untranslated exon 1 of HGFIN. RESULTS: HGFIN expression led to reduced cell growth of breast cancer cells and reduced migration. At the molecular level, reporter gene analyses determined the untranslated exon 1 to be a negative regulator of the upstream enhancing effect. Ectopic expression of wild-type p53 in breast cancer cells that expressed endogenous mutant p53 resulted in increased HGFIN reporter gene activities. CONCLUSION: As the majority of cancer cells have mutations in p53, further studies on the relationship between p53 and HGFIN expression, and its role in tumor genesis and bone invasion, might uncover novel therapy targets for breast and other cancers. The results show a central role for p53 in HGFIN expression, which appears to determine the behavior of the cancer cells.

A population study of neutering status as a risk factor for canine prostate cancer.

BACKGROUND: Prostate cancer has been reported to occur more commonly in neutered than intact male dogs in several case series. This study was undertaken to evaluate risk of prostate cancer in a large population database. The hypothesis was that castration is a risk factor for prostate cancer in male companion dogs. METHODS: Data were derived from recorded visits to North American veterinary teaching hospitals. The Veterinary Medical Databases (VMDB) were queried to yield male dogs with urinary bladder transitional cell carcinoma (TCC), prostate adenocarcinoma (ACA), prostate TCC, prostate carcinoma (CA), and prostate tumors. A second query yielded all male dogs over the age of 4 years without a diagnosis of urinary tract cancer. These populations were compared to determine relative risks for developing each disease, singly and collectively, associated with neutering status. Odds ratios were calculated for breed as a risk factor. RESULTS: Neutered males had a significantly increased risk for each form of cancer. Neutered males had an odds ratio of 3.56 (3.02-4.21) for urinary bladder TCC, 8.00 (5.60-11.42) for prostate TCC, 2.12 (1.80-2.49) for prostate adenocarcinoma, 3.86 (3.13-4.16) for prostate carcinoma, and 2.84 (2.57-3.14) for all prostate cancers. Relative risks were highly similar when cases were limited to those with a histologically confirmed diagnosis. CONCLUSIONS: Breed predisposition suggests that genetic factors play a role in the development of prostate cancer. The risk associated with being neutered is highest for TCC, supporting previous work identifying the urothelium and ductular rather than acinar epithelium as the source of these tumors.