Effect of ambulation following 18F-fluorodeoxyglucose injection on standing positron emission tomography of the healthy equine digit.

OBJECTIVE: Measure 18F-FDG uptake in digital tissues of healthy horses subjected to different ambulatory conditions between the time of injection and positron emission tomography (PET) scan acquisition. ANIMALS: 8 healthy adult horses. METHODS: Horses were walked (AMB) or tied in stalls (NONAMB) immediately after injection with ∼1.5 MBq/kg 18F-FDG until scan acquisition using a randomized crossover design. Steps were quantified using accelerometers. Standardized uptake values (SUV; mean and maximum) in digital tissues including the dorsal lamellae (proximal, middle, and distal), quarter lamellae (medial and lateral), and coronary band were analyzed using a mixed-effects linear regression model. RESULTS: Mean (95% CI) step count for AMB (569[484-653]) was higher than NONAMB (88[24-152]) P = <.001. The SUVmax (but not SUVmean) was increased in AMB compared with NONAMB in the proximal (2.74[2.52-2.98] vs 2.42[2.05-2.78]; P = .04) and middle (2.74[2.37-3.11] vs 2.36[2.05-2.68]; P = .03) dorsal lamellae but was not different in the distal lamellae or coronary band. In the medial quarter lamellae, both SUVmax (2.53[1.58-3.48] vs 2.07[0.81-3.33]; P = .01) and SUVmean (1.90[1.55-2.25] vs 1.49[0.91-2.06]; P = .007) were increased in AMB compared with NONAMB. The medial quarter lamellae also had lower SUVmax (P = .002) and SUVmean (P = .04) compared with the lateral quarter and lower SUVmax compared with the mid-dorsal lamellae (P = .01). CLINICAL RELEVANCE: Lamellar 18F-FDG uptake was affected by ambulatory activity mostly in the medial quarter; however, this effect was relatively small and unlikely to interfere with clinical detection of laminitis.

Enhanced recovery after surgery (ERAS®) protocol adapted to the Brazilian reality: a prospective cohort study for thoracic patients.

BACKGROUND: In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM). METHODS: Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. RESULTS: PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. CONCLUSIONS: This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.