Amikacin in 30% poloxamer 407 is a versatile local therapy with method of application and outcome documented in 29 dogs.

OBJECTIVE: To report the clinical use, adverse events, and outcomes after using amikacin in 30% poloxamer 407 (amikacin-P407) during open wound management or in a closed wound application in dogs. ANIMALS: 29 client-owned dogs. METHODS: Medical records from January 2017 to August 2023 from a single hospital were reviewed for dogs that received amikacin-P407 in an open or closed wound application. Information reviewed included signalment, nature of wound and/or surgical site infection (SSI), bacterial cultures, amikacin dose, gel volume, route of administration, estimated wound surface area, biochemistry parameters, urine casts, wound progression, and general clinical outcome. RESULTS: Amikacin-P407 was applied during open wound care (10 dogs), via injection (5 dogs), and at time of wound closure (13 dogs) and was used both in open and closed wound management (1 dog). Wounds were associated with SSIs in 18 of 30 sites. Multidrug resistance was noted in 21 of 30 preapplication cultures. Median amikacin dose was 14.5 mg/kg (range, 3 to 59.5 mg/kg), median total volume was 5.0 mL (range, 1 to 12 mL), and median tissue surface area was 6.6 cm2 (range, 1.6 to 36 cm2), for a local wound dose of 62.5 mg/cm2 (range, 6.9 to 214.3 mg/cm2). No short-term adverse local or systemic effects were noted in any wounds or dogs. No dehiscence was seen in 17 of 19 closed sites. CLINICAL RELEVANCE: The results of this case series suggested that Amikacin-P407 can be applied in a variety of ways with no adverse effects. Amikacin-P407 may be considered in open wound management or in a closed setting for infected wounds and SSIs.

Antibacterial activity of silver nanoparticles against Escherichia coli and methicillin-resistant Staphylococcus pseudintermedius is affected by incorporation into carriers for sustained release.

OBJECTIVE: To establish the lowest effective dose of commercially available nanoparticulate silver (AgNP) for antibacterial activity against Escherichia coli (E coli) and methicillin-resistant Staphylococcus pseudintermedius (MRSP), in vitro, and to establish the effect of incorporating AgNP into carriers for sustained release on this antibacterial activity. SAMPLES: Silver nanoparticle dispersion (0.02 mg/mL) composed of citrate-stabilized, spherical, 10 nm diameter nanoparticles in aqueous buffer. PROCEDURES: E coli and MRSP were treated with 0.01 mg/mL AgNP. The highest concentration of bacteria where growth was inhibited by AgNP was selected for treatment with 0.01 mg/mL AgNP incorporated 3 carriers for sustained release: calcium sulfate hemihydrate (CSH) beads, poloxamer 407 gel, and gelatin sponge, respectively. The antibacterial activity of AgNP and AgNP incorporated into carriers for sustained release was compared with a mixed linear effects model. RESULTS: AgNP inhibited bacterial growth at a concentration of 101 for MRSP and 103 for E coli. For MRSP, the treatment group was associated with bacterial growth (P < .001) while the concentration of bacteria and time were not (P = .292 and P = .289, respectively). For E coli, the treatment group and concentration of bacteria were associated with bacterial growth (P < .001 and = .029, respectively) while time was not (P = .095). Poloxamer 407 gel exerted standalone antibacterial activity against both species of bacteria; sponge and CSH beads did not. CLINICAL RELEVANCE: AgNP has antibacterial activity against E coli and MRSP, which can be reduced when incorporated into carriers for sustained release. Poloxamer 407 gel alone and combined with AgNP exerts antibacterial activity against E coli and MRSP.

Platinum measurements in Dulbecco's phosphate-buffered saline are lower than in plasma and can be sampled with ultrafiltration probes in vitro.

OBJECTIVE: To compare the influence of fluid on carboplatin elution, and assess the feasibility of ultrafiltration (UF) probe sampling. SAMPLE: 20 samples of 5 mg carboplatin in 1.0 mL 30% poloxamer 407 eluting in Dulbecco's phosphate-buffered saline (DPBS) or canine plasma and 6 samples of UF probe sampling in 0.01 mg/mL carboplatin in DPBS or plasma. METHODS: Carboplatin-gel specimens in dialysis tubing (12- to 14-kDa pores) were placed in 100 mL of DPBS or canine plasma (37 °C and 600 rpm stirring) in a nonlidded and lidded experiment. Samples were collected in decreasing frequency for 96 hours. The 0.01-mg/mL carboplatin solutions in DPBS and plasma were sampled 6 times by UF probe (30-kDa pores) or direct aspiration. Platinum was measured using inductively coupled plasma mass spectrometry. RESULTS: High fluid evaporation was noted in the nonlidded but not the lidded experiment. A burst release was seen in plasma (first 2 hours) and DPBS (first 5 hours) with the highest hourly increase in the first hour in both DPBS (6,040 ppb/h) and plasma (2,612 ppb/h), with no further increase after the first 22 hours. Platinum content in the specimens was higher at 96 hours than the surrounding fluid. Higher platinum concentrations were measured by both direct and UF probe sampling in DPBS than in plasma. CLINICAL RELEVANCE: Platinum concentrations measured in DPBS were higher than in plasma, but elution patterns were similar. Ultrafiltration probes can be used to sample platinum in vitro and could be used in vivo to measure local unbound Pt tissue concentrations in local chemotherapy delivery.

Sea squirt-inspired bio-derived tissue sealants.

Sea squirts' or tunicates' bodies are composed of cellulose nanofibers and gallol- functionalized proteins. These sea creatures are known to heal their injuries under seawater by forming crosslinks between gallols and functional groups from other proteins in their bodies. Inspired by their wound healing mechanism, herein, we have developed a tissue sealant using zein (a plant-based protein) and tannic acid (gallol-containing polyphenol). Except for fibrin- based sealants, most commercial surgical adhesives, and sealants available today are derived from petroleum products that compromise their biodegradability. They often have complicated and multi-step synthesis processes that ultimately affect their affordability. To overcome this challenge, we ensured that these sea squirt-inspired tissue sealants are bio-based, easily synthesized, and low-cost. The sealants were studied on their own and with a food-grade enzyme transglutaminase. The adhesion performances of the sealants were found to be higher than physiological pressures in seven out of nine different tissue substrates studied here. Their performance was also better than or on par with the FDA-approved fibrin sealant Tisseel. Ex vivo models demonstrate instant sealing of leaking wounds in less than a minute. The sealants were not only cytocompatible but also showed complete wound healing on par with sutures and Tisseel when applied in vivo on skin incisions in rats. Overall, these sea squirt-inspired bio-based sealants show great potential to replace currently available wound closure methods.

Review of local extravascular delivery systems for chemotherapeutic agents in small animals and horses.

Background: Tumors of various sizes and locations can create a treatment dilemma in achieving adequate surgical margins when sufficient free tissue is not available for closure. Extravascular local adjunctive chemotherapy has been investigated clinically to aid in achieving local tumor control in animals with naturally occurring neoplastic disease. Local chemotherapy can be an alternative primary or a local adjunctive treatment. Objectives and procedures: This is a summary of relevant findings of in vitro and in vivo studies on local chemotherapeutic delivery through carrier media, together with a summary of outcomes of clinical use of local delivery of chemotherapeutic agents in small animals and Equidae. Literature from 1990 to 2022 was evaluated via searches of PubMed, Google Scholar, and CAB Abstracts databases for studies of local extravascular delivery of chemotherapeutic agents and chemotherapeutic-impregnated delivery systems in research and clinical settings in veterinary medicine. Results: Chemotherapeutic-impregnated calcium sulfate hemihydrate beads with carboplatin are currently favored for extravascular delivery and are associated with minimal wound complications. The ideal delivery system may vary depending on the chemotherapeutic agent used, commercial availability, targeted tumor type, and location. Conclusion and clinical relevance: Future investigations might focus on the required dose, the rate of sustained release, and enhancing nodal uptake.

Examen des systèmes d'administration extravasculaire locaux d'agents chimiothérapeutiques chez les petits animaux et les chevaux. Contexte: Des tumeurs de tailles et emplacements différents peuvent créer un dilemme thérapeutique pour obtenir des marges chirurgicales adéquates lorsqu'il n'y a pas suffisamment de tissu libre disponible pour la fermeture. La chimiothérapie d'appoint extravasculaire locale a été étudiée cliniquement pour aider à obtenir une limitation locale de la tumeur chez les animaux atteints d'une maladie néoplasique naturelle. La chimiothérapie locale peut être une alternative primaire ou un traitement local d'appoint. Objectifs et procédures: Il s'agit d'un résumé des résultats pertinents d'études in vitro et in vivo sur l'administration locale de chimiothérapie par le biais de transporteurs, ainsi que d'un résumé des résultats de l'utilisation clinique de l'administration locale d'agents chimiothérapeutiques chez les petits animaux et les équidés. La littérature de 1990 à 2022 a été évaluée via des recherches dans les bases de données PubMed, Google Scholar et CAB Abstracts pour des études sur l'administration extravasculaire locale d'agents chimiothérapeutiques et de systèmes d'administration chimiothérapeutiques imprégnés dans des contextes de recherche et cliniques en médecine vétérinaire. Résultats: Les billes de sulfate de calcium hémihydratée chimiothérapeutique imprégnées de carboplatine sont actuellement privilégiées pour l'administration extravasculaire et sont associées à des complications minimes des plaies. Le système d'administration idéal peut varier en fonction de l'agent chimiothérapeutique utilisé, de la disponibilité commerciale, du type de tumeur ciblé et de l'emplacement. Conclusion et pertinence clinique: Les recherches futures pourraient se concentrer sur la dose requise, le taux de libération prolongée et l'amélioration de l'absorption nodale.(Traduit par Dr Serge Messier).

Effects of storage up to 1 year on the in vitro antimicrobial activity of preformulated antibiotic-impregnated calcium sulfate beads.

OBJECTIVE: To compare antimicrobial activity as demonstrated by the zone of inhibition (ZOI) produced by antibiotic-impregnated calcium sulfate (CaSO4 ) beads after storage for 0, 3, 6, 9, and 12 months. STUDY DESIGN: Controlled laboratory study. SAMPLE POPULATION: Three-millimeter diameter CaSO4 beads impregnated with vancomycin (125 mg/mL), or amikacin (250 mg/mL), or without antibiotic (control). METHODS: Calcium sulfate beads were created at the onset of the study. Individual beads were separated in sterile containers and stored in a closed cabinet at room temperature and humidity for 0, 3, 6, 9, or 12 months until testing. The ZOI against methicillin-resistant Staphylococcus pseudintermedius, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa was recorded with serial replating on a fresh lawn of bacteria every 24 h until beads failed to produce a ZOI. The ZOIs and their changes were compared with mixed-effects linear models. Eluted concentrations of vancomycin measured with high-performance liquid chromatography were reported. RESULTS: At 24 h, ZOIs were comparable regardless of time since formulation, except vancomycin against P. aeruginosa, which failed to generate a ZOI. The daily changes of ZOI and duration of activity of antibiotics did not vary between storage length (p > .05). There was no consistent change in eluted drug concentration between storage length of beads. CONCLUSION: Light protected storage at room temperature for up to 12 months did not impair the in vitro activity of antibiotic-impregnated CaSO4 beads, as demonstrated through ZOIs. CLINICAL SIGNIFICANCE: When stored correctly, antibiotic-impregnated CaSO4 beads can be used at least up to 12 months after formulation.

A narrative review of occupational scheduling that impacts fatigue and recovery relevant to veterinarian well-being.

Background: Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor. Objectives and procedures: This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors. Results: Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians. Conclusion and clinical relevance: Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.

Un examen narratif des horaires de travail qui ont un impact sur la fatigue et la récupération en rapport avec le bien-être des vétérinaires. Mise en contexte: L'insuffisance de sommeil est une affection mondiale avec de graves implications pour la santé mentale et physique. Les facteurs liés à l'emploi jouent un rôle important dans la détermination des habitudes de sommeil. Les travailleurs de la santé sont particulièrement sensibles à l'insuffisance de sommeil liée au travail et au repos inadéquat en général. Il y a peu de publications sur les pratiques de sommeil chez les vétérinaires, et la reconnaissance globale des impacts d'un repos inadéquat au sein de la profession vétérinaire est faible. Objectifs et procédures: Cette revue décrit les facteurs professionnels affectant la quantité suffisante de repos et de la récupération, passe en revue la littérature spécifique aux vétérinaires ainsi que celle adjacente pertinente concernant les habitudes de sommeil, et discute des solutions potentielles pour traiter les horaires professionnels contribuant à l'insuffisance de sommeil et au repos inadéquat. Des bases de données en ligne ont été consultées pour extraire la littérature contemporaine relative au sommeil, au repos insuffisant et aux facteurs liés à l'emploi, en mettant l'accent sur la médecine vétérinaire et d'autres secteurs de la santé. Résultats: Les facteurs liés à l'emploi entraînant un repos insuffisant chez les travailleurs de la santé comprennent les charges de travail excessives, les journées de travail prolongées, les jours cumulés d'heures de travail pénibles et les gardes après les heures normales de travail. Ces facteurs sont répandus au sein de la profession vétérinaire et peuvent contribuer à un repos insuffisant généralisé et aux impacts négatifs qui en résultent sur la santé et le bien-être des vétérinaires. Conclusion et pertinence clinique: Une quantité et une qualité de sommeil suffisantes sont essentielles à la santé physique et mentale et sont négativement affectées par de nombreux aspects de la profession vétérinaire. L'examen critique des stratégies actuelles utilisées dans la pratique clinique est essentiel pour promouvoir l'épanouissement professionnel, la santé et le bien-être des vétérinaires.(Traduit par Dr Serge Messier).

Veterinarian burnout demographics and organizational impacts: a narrative review.

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors.

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

A narrative review of the pathophysiology and impacts of insufficient and disrupted sleep.

Background: Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue. Objectives and procedures: This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years. Results: The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health. Conclusion and clinical relevance: Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health.

Un examen narratif de la physiopathologie et des impacts d'un sommeil insuffisant et perturbé. Contexte: Malgré les ramifications importantes d'un manque de sommeil sur la santé mentale et physique et le bien-être général, de nombreuses personnes ignorent ce qui constitue un sommeil suffisant ou l'étendue à court et à long terme des effets du manque de sommeil, y compris ceux qui peuvent ne pas être perçus comme de la fatigue. Objectifs et procédures: Cette revue décrit la physiologie du sommeil, définit des normes de santé, passe en revue la physiopathologie et les risques pour la santé de l'insuffisance de sommeil aiguë et chronique et propose des concepts pour améliorer l'hygiène individuelle du sommeil. Des bases de données en ligne ont été consultées pour extraire la littérature relative au sommeil, à l'insuffisance de sommeil, à la fatigue et à la santé, en mettant l'accent sur la littérature publiée au cours des 5 années précédentes. Résultats: Les effets néfastes de la perte de sommeil aiguë et chronique varient dans leur portée et leur impact. Les individus obtiennent souvent une quantité de sommeil inférieure aux normes, un problème mal reconnu par les individus et la société. Ce manque de reconnaissance perpétue une culture dans laquelle l'insuffisance de sommeil est acceptée, entraînant des impacts négatifs graves et substantiels sur la santé mentale et physique. Conclusion et pertinence clinique: La gestion du sommeil est l'un des aspects les plus fondamentaux et les plus imprévisibles de la santé personnelle. Améliorer la prise de conscience des rôles physiologiques importants du sommeil, des habitudes de sommeil saines et des conséquences d'un sommeil insuffisant est essentiel pour promouvoir le bien-être général et la santé mentale et physique.(Traduit par Dr Serge Messier).

Postoperative injectable opioid use and incidence of surgical site complications after use of liposomal bupivacaine in canine gastrointestinal foreign body surgery.

OBJECTIVE: To compare postoperative analgesic use and postoperative complications between dogs that received liposomal bupivacaine (LB) during surgical gastrointestinal foreign body (GIFB) removal and those that did not. STUDY DESIGN: Retrospective study. ANIMALS: Two hundred five dogs. METHODS: Medical records for all dogs with GIFB removal at the Purdue University Veterinary Hospital between May 2017 and August 2021 were searched. Incomplete records and dogs with less than 2 weeks' veterinary follow up were excluded. Data collected included: patient information, time until surgery, intraoperative findings, surgical data (including perforation at time of surgery, linear vs. solid, enterotomy vs. enterectomy), use of LB (including time and manner of administration), time to extubation after surgery, in-hospital postoperative analgesic use and duration, and postoperative complications. Fentanyl was noted as used/not used, quantified as mean hourly rate over 12 h intervals. All analyses were performed using commercial statistical software with p < .05 as the significance level. RESULTS: Dogs that received LB were heavier (n = 65, median 28.5 kg) than those that did not (n = 140, median 24.4 kg) (p = .005). Postoperative fentanyl use (p < .05 between 13 and 72 h) and hourly rates (p < .05 between 13 and 48 h) were less, and postoperative time in the intensive care unit (ICU) (p < .001) and hospital were shorter (p < .001) in dogs receiving LB. Postoperative wound complications were seen in 7/65 dogs (10.8%, 95% CI = 4.4-21.0%) with LB and 4/140 (2.9%, 95% CI = 0.8-7.2%) without LB (p = .039). CONCLUSION: Use of LB was associated with reduced postoperative analgesic use, and shortened ICU and hospital stay but also with wound complications. CLINICAL SIGNIFICANCE: Caution should be used when using LB in (clean) contaminated surgeries.

Debridement and primary closure of a mesenteric duodenal perforation in a dog.

A 7-year-old male mixed intact breed dog was presented with a 6-day history of lethargy and anorexia. A linear foreign body was diagnosed and an exploratory laparotomy performed. The foreign body was pushed orad and removed via gastrotomy. Two mesenteric duodenal perforations were found: one at the level of the common bile duct and a second at the duodenal flexure. Both lesions were debrided and primarily closed in a simple interrupted appositional pattern. A gastrostomy tube and closed suction drain were placed routinely. The dog recovered without complications and ate voluntarily the first day postoperatively. The drain and gastrostomy tube were removed without incident at 4 and 15 days, respectively. Five months postoperatively the dog was reported to be clinically normal. Debridement and primary closure may represent an alternative to more extensive surgery with rerouting for duodenal perforations in select cases.

Influence of 4 drain configurations on fluid dispersal and retrieval in an instillation model.

OBJECTIVE: To describe and compare the pattern of fluid dispersal and retrieval in a novel instillation therapy system. STUDY DESIGN: In vitro experimental study. METHODS: A 10 cm2 square model was constructed using plastic sheeting secured to plexiglass, with a wound infusion catheter and Jackson-Pratt (JP) active suction drain positioned in 4 configurations: parallel, perpendicular, diagonal, and opposite. Fluid was instilled using the wound infusion catheter, allowed to dwell for 10 min, and retrieved using the JP drain. Two surface area calculations were made using imaging software: coloration with diluted methylene blue (MB) on photos, and filling with diluted contrast on fluoroscopic images. Fluid retrieval was recorded. Statistical analysis was performed using a mixed-effects linear model (p < .05). RESULTS: Configuration influenced fluid dispersion within the model (p = .0001); the diagonal configuration had the greatest surface area coverage (mean ± SD; 94.5 ± 2.4%) and the parallel configuration had the lowest surface area coverage (60.2 ± 2.9%). A dwell period increased fluid dispersal by an average of 4.0 ± 0.8% (p < .0001). Fluid retrieval exceeded 16.7 ± 1.5 mL (83.5 ± 7.5% volume instilled) for all configurations and was 0.5 ± 0.1 mL (2.5 ± 0.5% volume instilled) greater for MB than contrast agent (p < .0001). CONCLUSION: Perpendicular or diagonal configurations and low-viscosity fluid maximized fluid dispersion and retrieval. CLINICAL SIGNIFICANCE: Wound instillation therapy involves delivering lavage fluid or medications to a closed wound space. This is feasible using a wound-infusion catheter and active suction drain. Configuration should be considered to optimize fluid dispersal and retrieval when planning instillation therapy.

A narrative review of the impact of work hours and insufficient rest on job performance.

OBJECTIVE: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN: Narrative review. METHODS: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

In vitro elution of silver nanoparticles from three carrier media.

OBJECTIVE: To determine and compare the rate, pattern, and completeness of silver nanoparticle (AgNP) elution in vitro over 7 days from 3 carrier media in PBSS. SAMPLE: AgNPs in calcium sulfate hemihydrate (CSH) beads, poloxamer 407 gel, and a gelatin sponge. PROCEDURES: Three carrier media were used to create constructs containing AgNPs (8,500 ng). All constructs were submerged in PBSS and stored at 38°C for 7 days. Samples were collected after 2, 6, 12, 18, 24, 36, 48, 72, 96, 120, 144, and 168 hours, and AgNP concentration was measured with inductively coupled plasma mass spectrometry. Constructs were tested in quadruplicate. RESULTS: Sustained release of AgNPs was seen from all constructs for a minimum of 72 hours. Release from all constructs was incomplete, with an initial burst during the first 24 hours followed by a time-dependent decrease in elution rate for up to 168 hours. A mixed-effects model showed a significant difference in AgNP release over time (P < .001) and among media (P < .001). AgNP-gel constructs released the largest quantity of AgNPs (8,401.02 ng [98.84%]), followed by AgNP-sponge constructs (1,503.45 ng [17.69%]). Release from AgNP-CSH bead constructs was 87.824 ng (1.03%), with no additional release after 72 hours. CLINICAL RELEVANCE: Sustained release of AgNPs is possible in vitro, but efficacy against bacterial infections needs to be investigated prior to clinical use.

Influence of musical preferences and intraoperative questions on suturing speed.

OBJECTIVE: To determine the effect of music and surgeon-directed questions on suturing speed. STUDY DESIGN: Randomized observational study. SAMPLE POPULATION: Fifty-five faculty veterinarians, residents, interns, and fourth-year veterinary students. METHODS: Experience, gender, and favorable and unfavorable music choices were self-declared by participants. Each person performed four timed suture trials, which required them to complete a simple 10 cm continuous suture pattern on a model. The initial trial served as practice and did not include music or questions. The order of the three remaining trials was randomized, and consisted of one trial each with favorable music, unfavorable music, and required the participant to answer 2 questions. Trial duration was compared using a mixed effects linear model. Influence of gender and experience on participants' categorical responses to 2 different questions was evaluated using a Pearson χ2 test and Fisher's exact test, respectively. Stratified analysis was used to evaluate further the effect of experience and gender. RESULTS: Question trials were on average 8.1 s longer than favorable music trials (P = .008), with no notable difference found between unfavorable and favorable music or unfavorable music and question trials. Experience (P = .021) and gender (P = .033) influenced participants' response to question 1 but not question 2 (P = .267 and P = .839, respectively). CONCLUSION: Listening to favorable music, rather than answering questions, may result in decreased closure times. This influence was greater for less experienced individuals and less experienced male veterinarians and veterinary students. CLINICAL SIGNIFICANCE: The absence of questions may increase suturing speed, particularly for minimally experienced surgeons or when instruction is taking place in a surgical laboratory setting.

Pharmacokinetic and safety assessment of carboplatin-impregnated calcium sulfate hemihydrate beads in eight rats.

OBJECTIVE: Evaluate local tissue toxicity and plasma platinum (Pt) in vivo after subcutaneous implantation of carboplatin-impregnated calcium sulfate hemihydrate (CI-CSH) beads. STUDY DESIGN: In vivo experimental study. ANIMALS: Eight male Sprague-Dawley rats. METHODS: CI-CSH beads were implanted subcutaneously (5 mg carboplatin/rat; 13.5 mg/kg carboplatin; 7.08 mg/kg Pt; 1.18 mg/m2 Pt) in eight rats (d0). Wound healing (daily), radiographic bead dissolution (weekly), systemic Pt uptake (plasma-Pt), local tissue Pt (d28), and histologic changes compared to nonincised and incised catheterization sites (d28) were assessed. Blood and tissue samples were analyzed by inductively coupled plasma mass spectrometry for Pt, and pharmacokinetic analysis was performed using noncompartmental methods. RESULTS: One rat died at d10, the remainder survived until d28. No wound complications were seen. The CI-CSH implantation site had higher histopathology scores than the other sites for necrosis (p = .013) and fibrosis (p = .013). Beads decreased in density radiographically (d0 to d28) (p = .062). Peak plasma-Pt concentration was 225.78 ng/ml at 12 h, and decreased over time, but Pt was still detectable on d28. The elimination half-life was 5.03 ± 1.13 days. Only 1.69% of implanted Pt remained in the beads at d28. CONCLUSIONS: CI-CSH beads incited microscopic mild inflammation but wound healing was not impaired. Pt was absorbed systemically and the release from the beads was near complete at d28. CLINICAL SIGNIFICANCE: Piled CI-CSH bead implantation is well tolerated in rats with similar elution profile as previously described. Beads were radiographically visible at d28. Minimal Pt was detected systemically suggesting Pt release does not match bead dissolution.

Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele.

OBJECTIVE: To determine the influence of normograde (NG) versus retrograde (RG) catheterization of the cystic duct and common bile duct (CBD) in dogs with gallbladder mucoceles (GBM) treated with open cholecystectomy. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n = 117) with GBM. METHODS: Medical records were reviewed for signalment, history, clinical laboratory and diagnostic imaging findings, details of surgery including catheterization method, complications, and outcome. Long-term follow-up data were obtained by telephone or electronic communication. Relationships between catheterization method and clinical variables and outcome were evaluated. RESULTS: Dogs catheterized RG were more likely to experience any postoperative complication (p = .0004) including persistence of gastrointestinal signs (p = .0003). Survival to discharge and long-term survival did not differ by group (p = .23 and p = .49). Total bilirubin (TB) decreased by 70.3% after NG catheterization compared to 39.1% after RG catheterization (p = .03) and increased in 14.9% dogs catheterized NG and 38.0% dogs catheterized RG (p = .004). The presence of a diplomate surgeon at surgery resulted in decreased incidences of any perioperative or postoperative complication (p = .003 and p = .05). CONCLUSION: Retrograde catheterization was associated with more postoperative concerns than NG catheterization, but similar survival times. Surgery should be performed by diplomates experienced in biliary surgery to minimize complications. CLINICAL SIGNIFICANCE: Although both NG and RG techniques to catheterize the cystic duct and CBD are options for treatment of GBM with low mortality, results of this study provide some evidence to recommend NG over RG catheterization.

Local Administration of Carboplatin in Poloxamer 407 After an Ulnar Osteosarcoma Removal in a Dog.

An 8 yr old male castrated hound presented for a left distal ulnar osteosarcoma. Staging (computed tomography and nuclear scintigraphy) did not reveal any metastases. A limb-sparing ulnectomy with local adjunctive carboplatin in a poloxamer copolymer gel (poloxamer 407) was performed. The patient recovered without complications after surgery. No wound healing complications or adverse effects occurred after local use of carboplatin in poloxamer 407. The local recurrence-free interval was 296 days from surgery, and the survival time was 445 days from initial diagnosis. This is the first report in the veterinary literature of using poloxamer 407 as a carrier for local delivery of chemotherapeutic drugs in a clinical patient.

Repeatability of in vitro carboplatin elution from carboplatin-impregnated calcium sulfate hemihydrate beads made in a clinic setting.

OBJECTIVE: To evaluate the intra-lot and inter-lot consistency and total carboplatin elution over 25 days from carboplatin-impregnated calcium sulfate hemihydrate (C-I CSH) beads manufactured in a clinic setting. STUDY DESIGN: In vitro elution study. METHODS: Two volumes of carboplatin were mixed with CSH to yield 4 mg and 8 mg C-I CSH doses. Two lots of beads were made for each concentration and split into five doses (n = 10 per concentration). Beads hardened in molds and were placed in a covered six-well plate, submerged in phosphate-buffered saline, and incubated with samples collected at 12 time points (0, 6, 12, and 24 hours and 2, 3, 5, 7, 10, 14, 18, and 25 days). The amount of carboplatin in each sample was evaluated by high-performance liquid chromatography/mass spectrometry. Correction for carboplatin degradation and dilution was applied, and eluted carboplatin was calculated. Intra-lot and inter-lot coefficient of variation (CV) was calculated for each concentration. RESULTS: The intra-lot CV ranged between 7.9% and 23.1%, and the inter-lot CV ranged from 3.5% to 10.3%, with improvement noted in each successive lot of beads. Mean peak eluted carboplatin was 2.45 ± 0.43 mg (61%) and 3.68 ± 0.41 mg (45.9%) for the 4-mg and 8-mg C-I CSH beads, respectively, with both occurring at the 12-hour timepoint. CONCLUSION: Progressive improvement in variability with successive lots of beads indicated a learning curve with bead manufacturing with a low variation both within and between lots of C-I CSH beads. CLINICAL SIGNIFICANCE: On-site mixing of carboplatin with commercial CSH bead powder leads to a low variation of carboplatin per bead dose.