Methods for Decreasing Preweaning Mortality in a Fragile Mouse Model of Hypomorphic Collagen VII Deficiency.

Preweaning mortality is a widespread problem in laboratory mouse breeding, particularly in the case of fragile mouse models. While numerous studies explore alternative care methods to increase the survivability of common mouse strains, there remains a paucity of research into the care of mice with fragile health conditions that result from induced or natural genetic mutations. In this study, standard husbandry practices were enhanced by the addition of a softened diet, a nutritionally fortified dietary supplement, soft bedding, gentle handling techniques, decreased handling, lengthened weaning age, and dam productivity tracking. This alternative care plan was shown to increase the survival of a fragile recessive dystrophic epidermolysis bullosa mouse model, and some aspects could be used in developing a care plan for other fragile mouse strains.

Behavioral and Physiologic Effects of Dirty Bedding Exposure in Female ICR Mice.

Exposure of sentinel mice to dirty bedding is commonly used in health monitoring programs to screen colonies for clinical and subclinical disease. Despite the potential stressors present in dirty bedding, including but not limited to microorganisms, pheromones, and ammonia, it is unknown whether sentinel mice exposed to soiled bedding experience stress. In this study, select behavioral and physiologic changes associated with stress were assessed in female ICR mice exposed to dirty bedding. Behavioral parameters included evaluation in the home cage and selected behavioral tests; physiologic measurements included neutrophil:lymphocyte ratio and weight. Mice in the acute group were exposed for 24 h whereas mice in the chronic group were exposed for 4 wk. Mice in the chronic group exposed to dirty bedding weighed less at days 21 and 28 than did control mice. Chronic mice exposed to dirty bedding also exhibited decreased net weight gain over the entire study period as compared with control mice. No significant differences were detected in the other behavioral and physiologic parameters measured. These results indicate that dirty bedding exposure may affect sentinel mice, but further investigation is needed to determine the specific mechanism(s) behind the weight difference.

Effects of Repeated Intraperitoneal Injection of Pharmaceutical-grade and Nonpharmaceutical-grade Corn Oil in Female C57BL/6J Mice.

Due to potential adverse effects on animal wellbeing, the use of nonpharmaceutical-grade substances in animal research must be scientifically justified in cases where a pharmaceutical-grade version of the substance exists. This requirement applies to all substances, including vehicles used to solubilize experimental drugs. To date, no studies have evaluated the direct effect of the pharmaceutical classification of a compound on animal wellbeing. In this study, we evaluated intraperitoneal administration of pharmaceutical-grade corn oil, nonpharmaceutical-grade corn oil, and saline in female C57BL/6J mice. Compounds were administered every 48 h for a total of 4 injections. Mice were evaluated clinically by using body weight, body condition score, visual assessment score, CBC, and serum chemistries. Animals were euthanized at 24 h and 14 d after the final injection. Inflammation of the peritoneal wall and mesenteric fat was assessed microscopically by using a semiquantitative scoring system. Saline-dosed groups had lower pathology scores at both time points. At day 21, pharmaceutical-grade corn oil had a significantly higher pathology score compared with nonpharmaceutical-grade corn oil. No other significant differences between the corn oil groups were observed. The use of nonpharmaceutical grade corn oil did not result in adverse clinical consequences and is presumed safe to use for intraperitoneal injection in mice. Differences in inflammation between the 2 groups suggest that the use of either pharmaceutical-grade or nonpharmaceutical-grade corn oil should be consistent within a study.

Esophageal Intramural Diverticula: Multiple and Single.

More than 50 years ago, two investigators described a rare case of multiple esophageal diverticula, which they named esophageal intramural pseudodiverticulosis (EIPD). To this day, the pathogenesis of this condition remains obscure. Several coexisting conditions, such as strictures, esophageal dysmotility, or infection, require medical treatment. We present two typical cases of EIPD and one case of a rare single esophageal intramural diverticulum.

Use of endotracheal tubes with subglottic secretion drainage reduces ventilator-associated pneumonia in trauma patients.

BACKGROUND: Patients sustaining traumatic injuries have a higher incidence of ventilator-associated pneumonia (VAP) compared with other critically ill patient populations. Previous studies of patients with predominantly medical diagnoses and use of endotracheal tubes allowing subglottic secretion drainage (ETT-SSD) have shown significant reduction in VAP rates. We hypothesized that the use of ETT-SSD would reduce VAP in trauma patients. METHODS: A retrospective review from 2010 to 2014 of adult trauma patients orotracheally intubated for more than 48 hours was performed at a Level 1 trauma center. Patients were compared based on standard endotracheal tube (ETT) versus ETT-SSD for the primary outcome VAP per 1,000 ventilator days. The diagnosis of VAP was made by quantitative bronchoalveolar lavage cultures as defined by Centers for Disease Control and Prevention criteria. Patients with ETT-SSD were matched to patients with ETT based on age group, sex, mechanism of injury, head and chest Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS). RESULTS: Of 1,135 patients included in the study, 667 patients had ETT and 468 had ETT-SSD. Groups did not differ by demographics, mechanism of injury, Glasgow Coma Scale (GCS) score, alcohol intoxication, or ISS. Patients with ETT-SSD had significantly higher head AIS score but lower chest AIS score. In matched cohorts, ETT-SSD had a lower VAP rate (5.7 vs. 9.3 for ETT, p = 0.03), decreased ventilator days (12 vs. 14, p = 0.04), and decreased intensive care unit length of stay (13 days vs. 16 days, p = 0.003). CONCLUSION: After controlling for confounding factors, ETT-SSD decreased VAP rate, ventilator days, and intensive care unit length of stay in trauma patients. In this high-risk patient population, we recommend routine use of ETT-SSD to decrease VAP. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Novel method of delivery of continuous positive airway pressure for apnea testing during brain death evaluation.

BACKGROUND: There are several methods for apnea testing for the evaluation of neurological death, including oxygen via T-piece, oxygen cannula inserted into the endotracheal tube, and continuous positive airway pressure (CPAP). Lung suitability for transplantation is determined in part by the partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2; P:F) ratio. We hypothesized that delivery of CPAP during apnea testing using a novel method would improve post-test P:F ratios. METHODS: A retrospective review was performed at a level I trauma center for all patients undergoing apnea testing from 2010 to 2016. The CPAP system used a flow-inflating bag and was made available in 2012. It was used at the discretion of the clinician. Patients were classified as having an apnea test by CPAP or by non-CPAP method (T-piece, oxygen cannula in endotracheal tube, etc). The two groups were compared for baseline characteristics and the primary outcome of postapnea test P:F ratio. RESULTS: During the study period, 145 patients underwent apnea testing; 67 patients by the CPAP method and 78 by non-CPAP method. There were no significant differences in demographics, mechanism of brain injury, pneumonia rate, smoking status, or antibiotic usage between the two groups. The pretest P:F ratio was similar between groups, but the CPAP group had significantly higher post-test P:F ratio (304 vs 250, p=0.02). There were no reported complications arising from CPAP use. CONCLUSIONS: We describe a novel method of delivering CPAP by a flow-inflating bag during examination for brain death. This method led to improved oxygenation, P:F ratios, and may decrease barotrauma. The flow-inflating bag was inexpensive, easily implemented, and without adverse effects. Multicentered, prospective trials are needed to elicit significant benefit in lung donation and transplantation. LEVEL OF EVIDENCE: Level IV, diagnostic tests.

Criteria for excision of suspected fibroadenomas of the breast.

BACKGROUND: Fibroadenomas are benign breast tumors; however, more aggressive lesions may mimic or arise within fibroadenomas. We sought to define criteria identifying patients who should undergo surgical excision. METHODS: Patients with a preoperative diagnosis of fibroadenoma, who underwent surgical excision between 2002 and 2011, were retrospectively reviewed. Patients with final pathologic diagnosis of fibroadenoma were compared with those with non-fibroadenoma pathology. RESULTS: Of the 723 patients, 681 (94%) had fibroadenomas on final pathology. The incidence of non-fibroadenoma pathology was 6% (42 patients) and included benign phylloides (23), malignant phylloides (2), atypical ductal hyperplasia (1), intraductal papilloma (5), and other benign pathology (11). No cases of adenocarcinoma were identified. Non-fibroadenoma pathology was associated with age >35, immobile or poorly circumscribed mass, size >2.5 cm, and biopsy not definitive for fibroadenoma. CONCLUSION: Patients with age >35 years, immobile or poorly circumscribed mass, size >2.5 cm, or biopsy not definitive for fibroadenoma should undergo surgical excision.

In the wake of politics: the political and economic construction of fisheries biology, 1860-1970.

As an environmentally focused, applied field science, fisheries biology has recently been marked by its failed promise to enable sustainable exploitation. Fisheries biology's origin through state support raises many questions. How did fisheries biologists get this support? Did political considerations and economic ideals fundamentally shape the science? Why has it been perceived as fundamentally conservation oriented? New evidence indicates the political basis for Thomas Henry Huxley's contention that the deep-sea fisheries were inexhaustible; this essay shows how his influence extended to recent neoliberal resource management solutions. It also explores how fisheries biology acquired the ideal of maximum sustained yield (MSY) via Progressive Era efficiency conservation and German scientific forestry; how American Cold War foreign policy made this ideal paradigmatic of mid to late twentieth-century fisheries biology; and how emerging bioeconomics in the 1950s imposed a troublesome misunderstanding of fisheries biology's earlier mission.

The effect of storage temperature on the accuracy of a cow-side test for ketosis.

The objective of this study was to assess the effect of storage conditions on the accuracy of a milk test strip for ketosis. Storage at 21 degrees C for up to 18 wk had little effect on accuracy for diagnosis and classification of subclinical ketosis.

The social ecology of changing pain management: do I have to cry?

OBJECTIVE: To improve acute pain management for children with systematic assessment and appropriate analgesia. DESIGN: An action research design was used; pre-post data were collected during a four-phase intervention. The intervention was a social ecological approach to changing pain assessment and prescription practices. SETTING: A university-affiliated public hospital in the greater Los Angeles area. PARTICIPANTS: An interdisciplinary team of clinicians and hospital administrators were engaged in implementing new pain management procedures for children with postoperative and procedural pain. INTERVENTIONS: We implemented the Poker Chip Tool as a standard pain assessment tool, changed policy to make morphine drug of choice for acute postoperative pain, provided extensive educational activities, and conducted weekly rounds with anesthesiologist/intensivist, nurses, pharmacist, and child life specialist. Role modeling by leaders was used to build skill in interdisciplinary collaboration for staff. We promoted the initiative as an activity of the medical center strategic plan. Efforts were linked to national shifts in pain management through guideline review and use of a visiting expert. OUTCOME MEASURES: Charts were audited for assessment of pain intensity. Doses dispensed by pharmacy were used as a proxy measure of analgesia administered to children to establish change in pattern of analgesic use. RESULTS: In Phase I: 54% of charts audited had documentation of pain intensity. This rate climbed to Phase II, 93% of the audited charts at full implementation and stabilized at 84% at the project conclusion. Record of doses of analgesia dispensed demonstrated a shift from reliance on meperidine to morphine and acetaminophen with codeine. The relative rates demonstrated a 100% increase in acetaminophen with codeine distributed from the beginning of the study to full implementation of the project (chi(2) = 9.01, df = 1, p < 0.002). The relative rate for meperidine demonstrated a 250% decrease (chi(2) = 12.26, df = 1, p < 0.0004), and the relative rate for morphine exhibited a 455% increase (chi(2) = 209.20, df = 1, p < 0.0001). By the final phase (IV: Evaluation), meperidine was only 1% of the analgesia dispensed. Morphine doses that were initially 35% climbed to 62% at the close of the study. Acetaminophen with codeine shifted correspondingly from 24% to 36%. Anecdotal reports suggested that skills in assessment and building collaboration generalized to other patient care situations. CONCLUSIONS: Using a social ecology approach that focused simultaneously on the environment (ward, medical center, and national scene) and relationships among the clinical team improved pain management practices. These changes took place over 2 years and were sustained 2 years after the intense intervention.

Spinal compression due to atlantal vertebral malformation in two African lions (Panthera leo).

Two young (14-mo-old and 6-mo-old), unrelated, male African lions (Panthera leo) were presented to the Veterinary Teaching Hospitals of Oklahoma State University and Kansas State University with progressive ambulatory difficulty. In both cases, limited neurologic evaluation demonstrated pelvic limb paresis and ataxia with conscious proprioceptive deficits. Spinal imaging showed nearly identical lesions in both cases. Radiography and myelography demonstrated cervical stenosis secondary to atlantal (C1) malformation producing a dorsoventral deformity of the laminar arch with atlantoaxial spinal cord compression between the ventrally displaced laminar arch of the atlas and the underlying odontoid process of C2. Computed tomography of the atlanto-axial junction confirmed cervical stenosis and cord compression, showing flattening of the spinal cord between the laminar arch of C1 and the dens of C2. Decompressive surgery consisting of dorsal laminectomy of C1 was performed. Each lion demonstrated progressive improvement of neurologic status to recovery of normal ambulation after surgical intervention. Neurologic disease in large captive felids is rare; atlanto-axial spondylomyelopathy has not been reported previously.