Review of guidelines for functional claw trimming and therapeutic approach to claw horn lesions in cattle.

Lameness is one of the most pressing health and welfare problems in cattle, especially on dairy farms. The most common cause of lameness is claw pathology, often due to lack of appropriate functional claw trimming. Functional claw trimming restores the physiological shape of the claws and distributes weight properly between the claws and over the claw weight-bearing surface. It also allows closer examination of the claws for early signs of pathology. The methods of functional claw trimming described in the previous century are still applicable today, considering some recent findings on the subject. It is essential not to over-trim the claws and to maintain strict hygiene of the trimming tools. Claw horn pathology in the early stages is usually treated effectively by therapeutic claw trimming alone. The stoic nature of cattle and their natural tendency to hide pain often result in delayed treatment of claw diseases, leading to more advanced stages of disease/pathology associated with higher-grade lameness. This situation often leads to the development of neuropathic pain and hyperalgesia requiring multimodal treatment. Because claw horn diseases are multifactorial, veterinarians and others involved in animal management must be familiar with the preventive measures available to improve claw health in a cattle herd. Further research to improve claw horn quality and effectively control/prevent claw infections without polluting the environment or negatively affecting worker and animal health is still needed. This article reviews the latest knowledge on functional claw trimming and treatment of the most common claw horn diseases in cattle.

Medicines associated with folate-homocysteine-methionine pathway disruption.

Folate is vital for cell development and growth. It is involved in one-carbon transfer reactions essential for the synthesis of purines and pyrimidines. It also acts in conjunction with cobalamin (vitamin B12) as a fundamental cofactor in the remethylation cycle that converts homocysteine to methionine. A deficiency in folate or vitamin B12 can lead to elevated homocysteine level, which has been identified as an independent risk factor in several health-related conditions. Adequate folate levels are essential in women of childbearing age and in pregnant women, and folate deficiency is associated with several congenital malformations. Low folate levels can be caused by dietary deficiencies, a genetic predisposition or treatment with medicines that affect folate concentration. Women who are pregnant or of child-bearing age commonly use medicines, so it is important to identify the basic biochemical mechanisms by which medicines interfere with the folate-homocysteine-methionine pathway. This review focuses on prescription medicines associated with folate disruption. It also summarizes their undesirable/toxic effects. Recommendations regarding folate supplementation during medical therapy are also reviewed.

Addition of a fracture risk assessment to a coordinator's role improved treatment rates within 6 months of screening in a fragility fracture screening program.

We evaluated the impact of a more intensive version of an existing post-fracture coordinator-based fracture prevention program and found that the addition of a full-risk assessment improved treatment rates. These findings provide additional support for more intensive programs aimed at reducing the risk of re-fractures. INTRODUCTION: Evidence-based guidelines support coordinator-based programs to improve post-fracture osteoporosis guideline uptake, with more intensive programs including bone mineral density (BMD) testing and/or treatment being associated with better patient outcomes. The purpose of this study was to evaluate the impact of a more intensive version (BMD "fast track") of an existing provincial coordinator-based program. METHODS: We compared two versions of the program that screened treatment naïve fragility fracture patients (>50 years). Cases came from the BMD fast track program that included full fracture risk assessment and communication of relevant guidelines to the primary care provider (PCP). Matched controls were selected from the usual care program matching according to age, sex, fracture type, and date. Two matching techniques were used: traditional (hard) matching (TM) and propensity score matching (PS). The outcomes were treatment initiation with bone sparing medication, BMD testing rate, and the rate of returning to discuss the test results with a PCP. RESULTS: The program improvements led to a significant improvement in treatment initiation within 6 months from 16 % (controls based on PS) or 21 % (controls based on TM) to 32 % (cases). Ninety percent of patients in the BMD fast track program returned to their PCP to discuss bone health in the cases versus 60 % of the controls (for TM and PS). BMD testing occurred in 96 % of cases compared to the 66 (TM) or 65 % (PS) of the matched controls. CONCLUSIONS: Addition of a full-risk assessment to a coordinator-based program significantly improved treatment rates within 6 months of screening.

Emissions of microplastic fibers from microfiber fleece during domestic washing.

Microplastics are found in marine and freshwater environments; however, their specific sources are not yet well understood. Understanding sources will be of key importance in efforts to reduce emissions into the environment. We examined the emissions of microfibers from domestic washing of a new microfiber polyester fleece textile. Analyzing released fibers collected with a 200 µm filter during 10 mild, successive washing cycles showed that emission initially decreased and then stabilized at approx. 0.0012 wt%. This value is our estimation for the long-term release of fibers during each washing. Use of detergent and softener did not significantly influence emission. Release of fibers during tumble drying was approx. 3.5 times higher than during washing.

Pattern electroretinography of larger stimulus field size and spectral-domain optical coherence tomography in patients with Stargardt disease.

AIMS: To investigate the importance of a larger stimulus field for pattern electroretinography (PERG) in evaluating macular function in Stargardt disease, and to determine the relationship between PERG and spectral-domain optical coherence tomography (SD-OCT). METHODS: In this prospective cross-sectional study, PERG from standard (12 degrees x 16 degrees ) and larger (24 degrees x 32 degrees ) stimulus fields and SD-OCT were recorded in 18 patients with genetically confirmed Stargardt disease, and in 18 control subjects. RESULTS: A PERG P50 response to the larger stimulus field was detectable in 86% of eyes, with a mean P50 amplitude of 2.3 microV, compared with 22% and 1.0 muV for the standard stimulus field. The specificity and sensitivity of PERG to the standard stimulus field were greater than for the larger field. For both PERG P50 and N95, the differences in their amplitudes between the standard and larger stimulus fields correlated significantly with visual acuity and SD-OCT parameters. CONCLUSION: The higher sensitivity and specificity of PERG to the standard stimulus field provide detection of early maculopathy in Stargardt disease, while PERG with the larger stimulus field allows for longer follow-up. The PERG amplitude for the larger stimulus field correlated with severity of transverse photoreceptor loss in SD-OCT. These methods are complementary for evaluation of progression of photoreceptor damage in patients with Stargardt disease.

Mapping of central visual function by microperimetry and autofluorescence in patients with Best's vitelliform dystrophy.

PURPOSE: To evaluate retinal sensitivity and fixation patterns in patients with Best's dystrophy by microperimetry (MP) and to correlate the results with static perimetry and retinal morphology seen by autofluorescence (AF). METHODS: Central 10 degrees visual fields in 11 patients with Best's dystrophy (VA: 0.5+/-0.38) were recorded by the Octopus M2 TOP program and by MP (MP1, Nidek Technologies). AF was recorded by HRA (Heidelberg Engineering). RESULTS: High correlation (R=0.75, -0.76, -0.48) was found between static perimetry (MS, MD and CLV indices) and MP. Based on MP and AF results, three groups of patients were formed. Patients in the first two groups fixated inside the central nonuniform hypo- and hyperfluorescent AF ring area, next to relative (Group 1) or absolute scotoma (Group 2). Inner parts of the retina close to the fovea were most affected, whereas regions closer to the periphery of the 10 degrees visual field showed near normal function. As the disease progressed, there was an evident shift of fixation to preferential retinal locus (PRL) in eight eyes with visual acuity 0.2 or less (Group 3). Fixation shift was superior in four eyes, temporal in two eyes, and nasal in two eyes. CONCLUSION: MP enabled a highly sensitive topographic monitoring of retinal function, showing central or pericentral fixation in the early stages, until loss of central function, in eyes with VA 0.2 or less, caused evident shift of fixation to PRL. PRL was never situated inside the central uniform hypofluorescent area, but corresponded with the hyperfluorescent ring seen with AF imaging.

How low can they go? Potential for reduction in work injury rates.

BACKGROUND: There is a considerable variability in occupational injury rates across companies, even within the same industry. The aim of this study was to estimate how many injuries could be prevented if all firms could achieve the performance of their better peers. METHOD: Data were obtained from the Workplace Safety & Insurance Board of Ontario on all insured firms in the province. Within rate groups (firms in the same type of business) the number of injuries expected if all firms had a lost time injury rate at the 25th percentile of the distribution for the rate group were estimated. The total number of injuries were compared with the expected number, after adjusting for firm size and type of injury. RESULTS: Overall, using the 25th percentile as a benchmark, 42% of lost time injuries in Ontario could be prevented. DISCUSSION: There is considerable potential for prevention of work injuries based on currently achieved, non-optimal benchmarks.

A population-based study of surgery for spinal metastases. Survival rates and complications.

The management of spinal metastases is palliative and aimed at improving quality of life at an acceptable risk. This population study uses administrative databases and measures survivorship and complication rates after surgery for spinal metastases. The effects of various potential predictor variables were evaluated. We identified 987 patients with a median survival for all types of cancer of 227 days. The one and three-month mortality was 9% and 29%, respectively. Increasing age, male gender and primary lung cancer were significant risk factors for death within 30 days of surgery. A preoperative neurological deficit contributed a 19% increase in mortality and a 71% increase in the risk of postoperative wound infection. We found an overall major complication rate of 27%. This information will provide patients, families and clinicians with objective data which will help in the choice of treatment and the understanding of the surgical risk and outcome.

Pattern ERG and psychophysical functions in Best's disease.

The aim of the study was to asses the neurosensory retinal function in 12 patients (24 eyes) with different stages of Best's disease, by determining how pattern and full field flash ERG responses were related to visual acuity, stage of disease and extent of visual field loss. All patients had typically abnormal EOG responses and normal full field-flash ERG responses. Patients were stratified in two groups according to visual acuity. In the first group 12 eyes with visual acuity better than 0.5, all amplitudes and latencies of PERG P50 and N95 responses were in the normal range. Small central scotoma was detected by static perimetry in four of these eyes. In the second group of 12 eyes with visual acuity 0.5 or less, PERG showed reduced both P50 and N95 amplitudes in five eyes, and N95 solely, in two eyes. All patients had central scotomas detected by static perimetry. Progression of the disease, seen in deterioration of visual acuity and progression of central visual field defects, corresponded well with reduction of both PERG P50 and N95 amplitudes. There was no correlation found between visual acuity and EOG responses. Our results show that in Best's distrophy, pattern ERG is getting abnormal with progression of the disease, indicating relative preservation of neurosensory retina in initial stages of the disease. In contrast to EOG - being abnormal in all the patients regardless of the stage of disease - and full field-flash ERG - being normal in most of the patients - PERG gives opportunity for electrophysiological determination of the progression of the disease.

Impact of menstrual phase on false-negative mammograms in the Canadian National Breast Screening Study.

BACKGROUND: The efficacy of breast carcinoma screening should be enhanced if false-negative mammography were reduced. Prospectively collected data from the Canadian National Breast Screening Study were used to examine whether menstrual cycle phase was associated with false-negative outcomes for mammographic screening. METHODS: Of 8887 women ages 40-44 years at the onset of screening, randomized to receive annual mammography and clinical breast examination, reporting menstruation no more than 28 days prior to their screening examination, and with a valid radiologic report, 1898 had never used oral contraceptives or replacement estrogen with or without progesterone. The remainder were past (6573) and current (416) estrogen users. Similar selection criteria were applied at subsequent screens. The distribution of false-negative and false-positive mammography in relation to true-negative and true-positive mammography was examined with respect to the follicular (Days 1 to 14) and luteal (Days 15-28) menstrual phases. RESULTS: Comparing luteal with follicular mammograms in 6989 patients who ever used estrogen, the unadjusted odds ratio (2-sided P-values) for false-negatives versus true-negatives was 2.16 (0.05) and the adjusted odds ratio was 1.47 (0.05). In 1898 never-users, parallel odds ratios for luteal false-negatives were 0.55 (1.0) and 0.74 (1.0), respectively. CONCLUSIONS: These results suggest that menstruating women who have used hormones may have an increased risk of false-negative results for screening mammograms performed in the luteal phase of the menstrual cycle. An increased risk of false-negative mammography might adversely affect screening efficacy. The impact of menstrual phase on mammographic interpretation, especially for women who ever used hormones, requires further investigation.