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Aim Aim of our study is to evaluate the performance of the ClearSight™ system (ClearCut Medical, Ltd.) in assessing surgical margins for DCIS and IBC in breast conserving surgery Material and Methods The ClearSight™ system utilizes a diffusion-weighted-imaging (DWI) protocol to create 2D surface maps showing T2*, a MR parameter related to the tissue's apparent diffusion coefficient (ADC), with a depth penetration of 1.5mm. ADC is a highly accurate differentiator for irregular versus normal tissue. From November 2017 a prospective, blinded post marketing study (N=63), evaluating the performance of the ClearSight™ system has been conducted in the Breast Centre at the Agaplesion Markus Krankenhaus, Frankfurt, Germany. After standard evaluation with ultrasound and/or X-ray, the specimens were scanned with the ClearSight™ system, and results were compared with the final histopathology results on a margin per margin bases, applying a simple T2* threshold to flag irregular tissue. Results Breast specimens' margins from 60 patients were analyzed. Pursuant to the breast conserving surgery (BCS), 348 margins were scanned by the ClearSight™ system. A rigid T2* threshold comparison with the pathology findings resulted in a sensitivity of 80% and specificity of 84%. Accuracy for invasive and in-situ cancers was found to be similar for tissues scanned within one hour after excision. After that sensitivity for DCIS started to drop and was found to be 56% after 2 hours. Further accuracy improvements can be achieved if the reading physician is free to apply an intuitive diffusion map interpretation rather than adhere to a fixed threshold. Conclusion The data suggest that ClearSightTM can reduce excision rates by a robust 80% if the excised breast tissue is scanned within one hour. Tissue drying impacts sensitivity for DCIS negatively. Free map interpretation leads to better results than a fixed threshold. Citation Format: Thill M, Kelling K, van Haasteren V, Traub L, Nölke J, Szwarcfiter I, Shapiro M, Schon A, Aulmann S. Successful intraoperative margin assessment in DCIS and invasive breast cancer with diffuison-weighted MRI using the Clearsight™ system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-23.

Background Low dose methotrexate toxicity rarely occurs, but may present with severe complications, such as pancytopenia, hepatotoxicity, mucositis, and pneumonitis. Known risk factors for methotrexate toxicity include dosing errors, metabolic syndrome, hypoalbuminemia, renal dysfunction, lack of folate supplementation, and the concomitant use of drugs that interfere with methotrexate metabolism. Vitamin B12 deficiency leads to megaloblastic anemia and may cause pancytopenia, but its role in methotrexate toxicity has not been described. Case presentation We present a case of a patient with rheumatoid arthritis who was admitted with febrile neutropenia, pancytopenia, and severe mucositis, likely secondary to low dose methotrexate toxicity. She had multiple factors that potentially contributed to the development of toxicity, including concurrent sulfasalazine use for rheumatoid arthritis. An evaluation of the patient’s macrocytic anemia revealed pernicious anemia. The patient’s illness resolved with cessation of methotrexate and sulfasalazine, leucovorin treatment and vitamin B12 repletion. Conclusions This case illustrates the multiple factors that may potentially contribute to low dose methotrexate toxicity and highlights the importance of testing for vitamin B12 deficiency in rheumatoid arthritis patients with macrocytic anemia. Addressing all the modifiable factors that potentially contribute to low dose methotrexate toxicity may improve outcomes.

Equine strongyle parasites are considered ubiquitous in grazing equids across the world, and cyathostomin parasites are known pathogens causing well-described disease complexes in horses. Decades of intensive anthelmintic treatments have led to anthelmintic resistance in cyathostomins, and current recommendations are to lower treatment intensity and base control strategies on fecal egg count surveillance. Little is known about risk factors associated with strongyle parasite egg shedding patterns in the United States equine population, as the most recent national survey was conducted 20 years ago. The present study was carried out as part of the National Animal Health Monitoring Systems (NAHMS) Equine 2015-2016 study. The aims were to describe strongyle parasite egg shedding patterns in the United States equine population and identify risk factors associated with prevalence and egg count magnitude. Data were collected from equine operations in 28 states via questionnaires and fecal samples submitted to a parasitology research laboratory for fecal egg count analysis and the data gathered underwent comprehensive statistical analyses. Though region and season were related, overall, the summer months and the fall in the southeast tended to have the greatest odds of presence of strongyles eggs on a FEC. Generally, equids resident in the Western region (Arizona, California, Colorado, Montana, Oregon, and Wyoming) had significantly lower strongyle prevalence, no matter the season, as well as a markedly different distribution between strongyle egg shedding levels (p = 0.0005). Overall, egg counts were over-dispersed with about 27% of equids (95% Confidence Interval (CI): 20-34%) contributing 80% of the egg output. Pasture history was significantly associated with strongyle egg prevalence (p = 0.0003) and egg shedding levels (p = 0.0063) with daily access in the previous 30 days being associated with higher odds of presence and greater median egg count levels. Equid gender was significantly associated with strongylid presence (p = 0.0081) and egg count level (p = 0.0008), with male equids having significantly lower odds and median egg counts than female equids, and age was significantly negatively associated with strongylid prevalence (p 0.0001). Time since last deworming was significantly positively associated with prevalence of strongyle eggs, and this was dependent on the class of dewormer used (p = 0.0086), with equids treated with macrocyclic lactone class of drugs having lower odds of strongyle egg presence at 120 days since the last deworming. These data provide useful insights into strongylid egg shedding patterns in the United States equine population, and they can help refine parasite control recommendations depending on region, pasture access, and age distribution.

Background Chemotherapy-induced alopecia (CIA) is able to affect a patient's self-image and confidence negatively. A decade ago scalp cooling failed to avoid chemotherapy- induced hairloss in women who underwent chemotherapy as only thermal packs were used. The DigniCap® scalp cooling system consists of a silicon cap that includes two sensor controlled cooling cycles. These cycles regulate the scalp temperature to lead to a continuous vasoconstriction in the scalp. Thus, it is indicated to reduce the likelihood of CIA. Reduced temperature results in a reduced blood flow to the scalp area so that less chemotherapy reaches the hair cells. Therefore, these are not exposed to the full dose of chemotherapy and may be able to survive the treatment. The purpose of this study was to evaluate the effectiveness and adverse events of DigniCap® scalp cooling system. Patients and Methods Since October 2015, 48 of 60 planned breast cancer patients undergoing chemotherapy were prospectively included in a unicentric cohort study in the certified breast cancer center at AGAPLESION Markus Hospital, Frankfurt, Germany. The average age of the women was 52.7 years (range 33 – 76). The chemotherapy regimen included 4x EC q3w -> 12x paclitaxel q1w (60.4%), 4x TC q3w (8.3%), 6x carboplatin plus paclitaxel q3w (8.3%), 6x docetaxel, carboplatin, trastuzumab (TCbH) q3w + pertuzumab (4.1%), 4x nab-paclitaxel m 3 q4 (2.1%), 4x paclitaxel q2w -> 4x EC q2w (2.1%), 18x paclitaxel q1w (2.1%), 18x paclitaxel q1w plus myocet q1w (2.1%), eribulin d1, 8 q3 (2.1%), 4x EC q3w -> 12x paclitaxel q1w plus trastuzumab plus pertuzumab (2.1%), 6x carboplatin plus paclitaxel q3w plus bevacizumab (2.1%), 4x nab-paclitaxel3 q4 plus bevacizumab (2.1%), 4x nab-paclitaxel 3 q4 -> 4x EC q3w (2.1%). Our aim was to quantify the grade of alopecia, satisfaction and side effects of the scalp cooling system. Alopecia quantification was done by a standardized questionnaire and photo documentation. Final results of the whole cohort of 60 patients will be presented at SABCS 2017. Results The interim analysis showed a success rate of complete hair loss avoidance of 8.0%. Hair loss of less than 20% was documented in 60.0% (29 patients). In 19/ 48 patients (39.6%) adverse reactions caused by the DigniCap® Scalp Cooling System, like headache (12.5%) or CIA (27.1%) were reported. Conclusion Our evaluation shows that DigniCap® Scalp Cooling Systemhas a minimal rate of adverse events (39.6%) and reduces the likelihood of chemotherapy-induced alopecia (< 20% hair loss)effectively by 60.0%, even in anthracycline-based regimen. Citation Format: Traub L, Brandi C, Khandan F, Thill M. Effectiveness and adverse events of DigniCap® scalp cooling system [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-07.

The widespread occurrence of anthelmintic resistance in equine parasites across the world has led to recommendations of fecal egg count-based parasite programs to reduce treatment intensity and thereby delay further development of resistance as much as possible. The most recent study describing equine parasite control in the United States was conducted 20 years ago, and little is known about current strategies employed. This study was part of the National Animal Health Monitoring Systems (NAHMS) Equine 2015 Study, and aimed to describe equine parasite control strategies in the U.S. and evaluate to which extent respondents were in compliance with current guidelines. The study was carried out in 28 states, representing 70.9% of all equine operations with at least five equids present. Two questionnaires were administered, either by mail or delivered in person by veterinary medical officers. Participants provided specific details of their operation and were asked questions about strategies for anthelmintic therapy and diagnostic testing. A total of 380 operations provided data regarding their parasite control practices. Most respondents dewormed 2–3 times a year with ivermectin being the most commonly used anthelmintic. About 22% of respondents used fecal egg counts (FEC) in some form, with less than 10% using them on a regular basis. Less than 5% made use of fecal egg count reduction tests (FECRT). These results suggest little change since the last nationwide survey was conducted in 1998, as the majority of respondents did not report using FECs. This is in stark contrast to recent European surveys, where 50–60% of respondents were using FECs routinely. However, the anthelmintic treatment intensity appears to have been lowered compared to 1998. Taken together, these results suggest a continuing need for education and outreach regarding sustainable parasite control.

PURPOSE: In vitro fertilization with trophectoderm embryo biopsy and pre-implantation genetic screening with comprehensive chromosomal screening (PGS-CCS) for aneuploidy is becoming increasingly more popular. Embryos are cryopreserved and implanted in a subsequent frozen thawed embryo transfer cycle (FET). No studies have investigated differences in pregnancy outcomes by timing of trophectoderm biopsy relative to stages of blastocyst development. METHODS: Retrospective study of all patients (n = 363) at a single IVF center between January 1, 2013 and December 31, 2016 undergoing single embryo transfer with PGS-CCS where embryos were cryopreserved with subsequent FET. Embryo expansion and grading was assessed both at the time of biopsy and transfer. Pregnancy rates were analyzed by embryo expansion and embryo grading. RESULTS: Implantation, clinical pregnancy, and live birth rates improved significantly with increased embryo expansion at the time of embryo biopsy (P

OBJECTIVE: To investigate if administration of an additional dose of gonadotropins concomitantly to human chorionic gonadotropin (hCG) trigger increases pregnancy rates in patients undergoing intrauterine insemination (IUI) with controlled ovarian hyperstimulation (COH). STUDY DESIGN: This is a retrospective cohort study of all gonadotropin-IUI cycles performed by a single physician in a private practice between January 2012 and September 2013. Control cycles were those in which follicle-stimulating hormone (FSH) was discontinued prior to the day of hCG trigger shot, and study cycles received continuous FSH including the day of hCG trigger shot. A total of 423 cycles from 239 patients were included; 275 (65.5%) were control cycles (137 patients), and 146 (34.7%) were study cycles (102 patients). RESULTS: Pregnancy rates were comparable in both control and study groups (15.27% vs. 15.07%, respectively, p=0.956). There was a 42% increase in multiple gestations in the study group; however, the difference was not statistically significant (p=0.155). Upon multivariate logistic regression, male factor infertility was the only variable that was associated with pregnancy outcomes. CONCLUSION: Continuous administration of FSH including the day of hCG trigger in patients undergoing COH with IUI does not seem to increase pregnancy rates. Our suggested protocol might be beneficial in patients with poor ovarian response.

Equine strongyle parasites are ubiquitous in grazing equids across the world. Anthelmintic resistance is widely developed in cyathostomin populations, but very few surveys have evaluated anthelmintic efficacy in equine populations in the United States, and most of these are over 15 years old. The present study was carried out as part of the National Animal Health Monitoring Systems (NAHMS) Equine 2015-2016 study. The aims were to investigate anthelmintic treatment efficacy by means of the fecal egg count reduction test (FECRT) and identify parameters associated with decreased efficacy. Data were collected from equine operations in 28 states via questionnaires and fecal samples submitted for fecal egg count analysis. Participants were instructed to collect samples from six equids at the day of anthelmintic treatments and 14 days later, and they were asked to include an empty syringe with a legible label of the anthelmintic product used in the shipment. Overall, dewormer treatment was effective for 76.3% of operations (84.6% of animals). Macrocyclic lactone use was effective for 88.7% of operations (95.0% of animals) while pyrimidine/benzimidazole use was effective for 21.4% of operations (43.5% of animals). Univariate analysis revealed that overall, macrocyclic lactones exhibited significantly higher efficacy than the pyrimidine and benzimidazole drug classes (p 0.0001). There were no statistically significant differences observed between geographic regions (West, South Central, North East, and Southeast). Body weight (p = 0.0355), amount of anthelmintic administered (p = 0.0119), and operation size (p = 0.0162) were statistically associated with anthelmintic efficacy, while anthelmintic treatment frequency in the previous 12 months was not (p = 0.7081). Multiple, mixed-effect logistic regression revealed that anthelmintic drug class (p 0.0001) was the most impactful factor in predicting anthelmintic efficacy, after accounting for operation size, region and clustering of equids at the operation level. Pasture rotation (p = 0.0129) also demonstrated a significant effect using this model. These data document widespread occurrence of reduced anthelmintic efficacy of benzimidazole and pyrimidine products against strongyle infections in equids in the United States. Anthelmintic efficacy patterns were relatively uniform between the four studied regions, and some epidemiological factors were identified to be associated with anthelmintic efficacy against strongyle infections. This information can be useful in devising sustainable parasite control strategies in the future.

Vesicular stomatitis (VS) is caused by a contagious rhabdovirus that affects horses, cattle, and swine. Clinical signs of vesicular stomatitis virus (VSV) infection in pigs and cattle are indistinguishable from foot-and-mouth disease (FMD), a foreign animal disease and reportable disease in the United States (Rodriguez et al., 2000). A VS epidemic occurred in the Rocky Mountain region in 2014-15. A study was conducted in Colorado to evaluate horse- and management-level factors associated with VS. For a horse to be considered a clinical VS horse, there were two requirements. First, clinical VS horses had to have clinical signs consistent with VS, including one or more of the following: vesicles, ulcers, erosions or crusting on the muzzle, nares, lips, oral or nasal mucosa, ears, ventrum, udder or penile sheath, or coronary band lesions. Second, clinical VS horses had to have laboratory confirmation of VSV exposure via virus isolation from lesions or a positive complement fixation test performed on sera. All non-clinical horses residing on VSV-affected premises enrolled in the study were evaluated for exposure (i.e., seroconversion) to VSV. Overall, management and housing data were collected from 334 horses on 48 premises in Colorado. Approximately one-third (31.4%) of enrolled horses were clinical cases and two-thirds (68.6%) were controls. Three premises-matched logistic regression models were constructed in SAS using backward elimination (P-value < 0.05) after univariate screening of a priori-selected variables (P-value < 0.20). Model outcomes included differences in characteristics and management of 1) clinical and nonclinical horses, 2) exposed and unexposed horses, and 3) exposed nonclinical and unexposed nonclinical horses. Overall, factors most strongly associated with risk of being a VS clinical horse were access to pasture (P-value = 0.002), and pregnancy status (P-value = 0.001). Factors most strongly associated with VSV exposure among horses were access to pasture (P-value = 0.003) and lack of any insect control (P-value = 0.001). The only factor associated with VSV-exposed nonclinical horses compared with unexposed VSV horses was contact with clinical horses (P-value = 0.013). There were no associations identified regarding clinical horses compared with exposed nonclinical horses. With regard to severity of lesions (severe vs. moderate or mild), no variables met the criteria for inclusion in the multivariable model. Results of this study provide evidence that pasture access and fly control are important factors associated with VSV exposure.

Few published articles have compared initial hCG values across all different types of ART cycles, including cycles with fresh or frozen embryo transfer. No articles have compared initial hCG values in cycles utilizing preimplantation genetic screening (PGS). The purpose of this study is to compare initial hCG values after fresh embryo transfer, frozen embryo transfer, and after PGS. This was a single-center retrospective cohort study at an academically affiliated private IVF center. All fresh and frozen embryo transfers between January 2013 and December 31, 2015 were included. We compared mean initial serum hCG values 14 days after oocyte retrieval for fresh cycles and 9 days after frozen embryo transfer. We examined cycles of single embryo transfer (SET) and double embryo transfer (DET). Two hundred elven IVF (fresh embryo transfer), 128 FET (frozen embryo transfer cycles, no PGS), and 111 PGS cycles (ovarian stimulation with embryo cryopreservation, PGS, and frozen transfer in a subsequent estrogen-primed cycle) with initial positive hCG values were analyzed. In patients achieving a positive hCG after SET, initial hCG values were higher after PGS compared to FET (182.4 versus 124.0 mIU/mL, p = 0.02) and IVF (182.4 versus 87.1 mIU/mL, p

Background Equine injury and disease cause two types of costs for those financially responsible for treating and caring for the infected horse(s); direct costs of treating the horse and indirect cost of lost use of the horse for a period of time to the user of the horse (daily horse use). Indirect costs are more difficult to estimate but pose significant financial implications for equine-owners/caregivers. Additionally, there exists a gap in existing research regarding the valuation of infectious treatment options in horses. Objective To estimate the value a US horse-owner/caregiver places on daily horse use and describe respondents' willingness-to-pay for various attributes of equine treatment options. Study design Online questionnaire survey. Methods An online questionnaire was provided to equine-owners and caretakers, and owner demographic, horse care and horse use information from respondents were requested. Additionally, respondents were presented with hypothetical disease treatment options with the following attributes: daily dosage, number of days of rest required, route of administration and out-of-pocket cost to the owner/caretaker through a choice experiment. Data were analysed using a rank-ordered logit analysis and willingness-to-pay estimates for daily use and treatment options were calculated. Results Results suggest that the average horse-owner with an uninsured and insured horse is willing to pay $12.07 (95% confidence interval: -$15.01, -$9.69) and $17.95 (95% confidence interval: -$25.30, -$11.20) per day to reduce lost use days required (due to need for rest) respectively. Respondents showed preferences for oral administration over treatments requiring i.m. injections. Main limitations As this study employed an online survey it was subjected to self-selection bias and a sample size calculation was not performed. Conclusions Veterinarians and pharmaceutical companies may use these results when promoting various treatment options to horse-owners/caregivers and in product development. Additionally, promotion efforts may be targeted towards equine-owners with higher daily use values (owners with insured horses).

SummaryReasons for performing study Systemic administration of ceftiofur crystalline free acid (CCFA) may be a potential treatment for infectious endometritis caused by Streptococcus equi ssp. zooepidemicus (S. zooepidemicus) and other susceptible bacterial organisms in the mare. Objective To determine if i.m. administration of CCFA at the label dose will exceed the minimum inhibitory concentration (MIC) of S. zooepidemicus in the endometrium following single administration and multiple administration protocols. Study design Experimental pharmacokinetic study. Methods Three mares (Group 1) were administered a single i.m. dose of CCFA (6.6 mg/kg bwt) and blood and endometrial biopsies were collected at selected intervals for 144 h. Six additional mares (Groups 2 and 3) received CCFA at times 0, 4, 11 and 18 days, and were sampled at predetermined times for 25 or 49 days, respectively. Plasma and tissue samples were analysed by high-pressure liquid chromatography with tandem mass spectrometry for desfuroylceftiofur acetamide concentration, which is a direct measure of all ceftofur and ceftiofur metabolites in the sample. Results A mean plasma desfuroylceftiofur acetamide concentration of 0.367 ± 0.0162 μg/ml (mean ± s.e.) was detected at 96 h following administration. Mean endometrial tissue concentration was 0.510 ± 0.0418 μg/g at 96 h and exceeded the MIC for S. zooepidemicus (0.25 μg/ml) throughout the 144 h monitoring period for Group 1. Mares in Groups 2 and 3, given multiple doses of CCFA, maintained plasma concentrations above the MIC for S. zooepidemicus for 25 days. Endometrial tissue levels remained above the MIC at most data collection points for 25 days. Conclusions Ceftiofur crystalline free acid reaches appropriate endometrial tissue values to exceed the MIC of S. zooepidemicus, a common cause of bacterial endometritis. Therefore, CCFA should be effective in the treatment of equine bacterial endometritis caused by S. zooepidemicus and other susceptible bacterial pathogens in the mare.

Case Description—A 7-year-old Quarter Horse gelding used for unsanctioned racing was examined because of fever and anorexia. Clinical Findings—Physical examination revealed fever, tachycardia, and tachypnea. Results of a CBC indicated anemia and mild thrombocytopenia. Results of microscopic examination of a blood smear indicated piroplasms in erythrocytes, consistent with Babesia spp. Regulatory authorities were contacted, and results of serologic testing at the National Veterinary Services Laboratories confirmed acute Babesia equi infection. Treatment and Outcome—Equids on the home premises of the index horse were placed under quarantine. Those equids were tested for piroplasmosis, and 6 of 63 horses had positive results for B equi. Another horse that had previously been housed on the index premises also had positive results for B equi. Competent tick vectors for piroplasmosis organisms were not identified. All 8 horses with piroplasmosis were Quarter Horses that participated in unsanctioned racing and were trained by the same person. Two of the horses were illegally removed from the index premises; these 2 horses and the other horse with piroplasmosis that was previously housed on the index premises could not be found. The other 5 horses with piroplasmosis were euthanized. Investigators concluded that transmission of B equi among horses was most likely iatrogenic. Clinical Relevance—The United States has been considered piroplasmosis free. However, veterinarians should consider piroplasmosis in horses with signalments and clinical signs similar to those of the index horse of this report. Regulatory authorities should be contacted regarding horses in which piroplasmosis is suspected.

Equine respiratory viral infections cause significant worldwide disease and economic loss. Common causes include equine influenza virus (EIV) and equine herpesviruses-1 and -4 (EHV-1 and -4), and risk of exposure to these agents may be highest in young horses commingling at sales and competitive events. A surveillance study was conducted at two horse shows and two Thoroughbred sales to determine whether horses shed EHV-1, EHV-4, or EIV on arrival, or 2-4 days later, and whether shedding was associated with identifiable risk factors. Real-time polymerase chain reaction assays were used to detect EHV-1, EHV-4, and EIV nucleic acid in nasal swabs obtained from 369 horses at the four events. In response to evidence of clinical disease, 82 additional horses were sampled at two farms providing horses for one of the sales. On arrival at the events, shedding of EHV-1 was detected in 3.3%, EHV-4 in 1.1%, and EIV in 0.8% of horses. EHV-1 was detected at low levels, and EHV-1 and EHV-4 detection was not associated with clinical disease. EIV was detected only in horses at a Thoroughbred sale, in association with an outbreak of respiratory disease traced back to regional farms. On arrival at events, horses younger than 2 years had a significantly greater risk of shedding EHV-1 compared with older horses; no other significant risk factors associated with viral shedding were identified. Thus, there is a risk of exposure to EIV, EHV-1, and EHV-4 at equine events, and horses and events should be managed to mitigate this risk.

Hintergrund: Die Zytostatika-induzierte Alopezie (ZIA) bedeutet fur viele Frauen eine psychische Belastung mit Beeintrachtigung des Korper- und Selbstwertgefuhls. Eine kontrollierte Kopfhautkuhlung verursacht durch lokale Vasokonstriktion eine reduzierte Zytostatika-Aufnahme und Aktivitat an den Haarwurzeln. Das DigniCap® System (SYSMEX) zeigte in Studien Erfolgsraten von 81%, wobei differente Erfolgskriterien zugrunde lagen. Patienten und Methoden: Seit Oktober 2015 erhielten 12 Mammakarzinom-Patientinnen in der Klinik fur Gynakologie und Geburtshilfe des Agaplesion Markus Krankenhauses ihre Chemotherapie simultan zur Kopfhautkuhlung mittels DigniCap®. Folgende Chemotherapie-Regime wurden appliziert: 4 × EC → 12 × Paclitaxel (N = 7), 4 × Paclitaxel → 4 × EC (N = 1), 4 × EC (N = 1), 18 × Paclitaxel Mono (N = 1), 4 × Nab-Palitaxel Mono (N = 1), 18 × Paclitaxel plus Myocet (N = 1). Die Effektivitat und die Nebenwirkungen von DigniCap® wurde mithilfe von standardisierten Fragebogen und Fotodokumentation evaluiert. Ausgewertet wurden sowohl die subjektive Einschatzung der Patientinnen hinsichtlich Vertraglichkeit sowie ausbleibender Alopezie, als auch die objektive Fotodokumentation. Zielsetzung der Studie: Ziel der Studie ist es die Effektivitat und Nebenwirkungen des DigniCap® Systems zur Vermeidung von Zytostatika induzierter Alopezie zu untersuchen. Ergebnisse: Bis dato blieb bei 50% der Patientinnen eine Zytostatika induzierte Alopezie komplett aus, so dass die Therapie mit DigniCap® als erfolgreich bewertet werden kann (N = 6). Drei Patientinnen dokumentierten einen geringen Haarverlust von < 20% (N = 3; 25%). Drei Patientinnen brachen die Therapie, aufgrund fehlender Wirksamkeit (N = 1; 8,3%) oder kuhlungsbedingter Nebenwirkungen fruhzeitig ab (N = 2; 16,7%). Zusammenfassung: Die bisherige Auswertung zeigt die Effektivitat des DigniCap® Systems zur Vermeidung einer ZIA (75%). In nur einem Fall trat eine komplette Alopezie auf (8,3%). In 16,7% traten Kopfschmerzen als Nebenwirkung auf.

This study is the first report estimating, on a national basis, the use of various biosecurity practices, singly and in combination, on U.S. equine operations. Use of biosecurity practices is described for operations by risk level, based on reported exposure of resident horses to outside horses during the previous 12 months. In addition, the association between use of various biosecurity practices and use of antibiotics to treat infectious disease in both adult equids and foals is reported. The comparison of these study findings with previously reported data in the literature is limited by the fact that few estimates of biosecurity practice use on equine operations have been reported and none has been published on a national basis beyond those in the National Animal Health Monitoring System (NAHMS) equine reports. A total of 78.5% of operations had some risk of exposure of resident horses to outside horses between summer 2004 and the time of the interview in summer 2005. For the majority of biosecurity practices, there was a significant (p0.05) difference between different exposure risk levels in the percentage of operations using the practice. A higher percentage of high- and medium-risk operations implemented a combination of 4 or more biosecurity practices compared to low-risk operations. There was less use of antibiotics to treat infectious disease in adult horses on operations that required those who visit the operation to use separate equipment, change clothes/overalls, disinfect boots and equipment, or park vehicles away from animals than on those that did not. None of the other biosecurity practices were associated with use of antibiotics in adult horses and none of the biosecurity practices included in this study was associated with use of antibiotics in foals. For adults the use of antibiotics for infectious disease increased with decreasing herd size; this trend was reversed for antibiotic use in foals. The effect of exposure risk level was different for adults and foals. For adults, antibiotic use was lower for operations at higher risk; for foals, antibiotic use was higher for operations at higher risk.

The aim of this study was to compare the effectiveness of the "muffin test" (MT) with that of the oral glucose tolerance test (OGTT) in diagnosing impaired glucose tolerance (IGT).This is a cross-sectional study in a single academic institution. The participants were 73 women aged 42 to 58 years, less than 36 months after menopause, recruited for the Kronos Early Estrogen Prevention Study Trial. After a 10-hour fasting blood draw, the participants were provided a muffin and a beverage. Two-hour glucose levels were assessed. A subset underwent metabolic testing consisting of an OGTT (n = 12) and a mixed-meal tolerance test (n = 10). The main outcome measures were the prevalence of IGT and 2-hour glucose measurements after each testing method.Two-hour glucose levels were linearly related to fasting values by multivariable linear regression. This association was exaggerated in overweight (body mass index, 25 kg/m2) women (coefficient, 1.43; P0.001). Two-hour OGTT and MT glucose levels were comparable (P0.05); 2-hour glucose levels after OGTT were slightly lower than after the mixed-meal tolerance test (P0.05).The prevalence of IGT was 11% (8 of 73). Fasting plasma glucose alone would have missed 63% of cases (five of eight cases). The MT demonstrated 100% sensitivity and specificity for diagnosing IGT compared with the gold standard OGTT. This small pilot study should be confirmed in a larger prospective group of participants.

Infrared thermography (IRT) is a passive, remote, and noninvasive method of measuring surface temperatures. Select surface locations, such as the eye, could indicate body temperature. To investigate whether thermographic eye temperatures were associated with body temperatures and could be used to detect febrile ponies, we measured IRT eye temperatures, rectal temperatures, and implanted thermal microchip temperatures from 24 male ponies daily for 3 consecutive days. Information regarding distance of the pony from the IRT device, presence of direct sunlight during the measurement period, and ambient temperature were also collected. A multivariate linear regression analysis indicated that 60.41% of the variance in IRT was accounted for by rectal temperature, sunlight, and distance between the camera and the pony, with rectal temperature being the major contributor to variance (46.23%). Using a rectal temperature of >38.6°C (101.5°F) as the indicator of febrile status, sensitivity and specificity of the IRT device used to detect the febrile ponies were found to be 74.6% and 92.3%, respectively, when using the maximum IRT eye temperature per pony per day. In conclusion, IRT eye temperature could be a preliminary screening tool to determine whether a more time-consuming, labor–intensive, and invasive method (e.g., rectal temperature) is warranted for fever validation.

Objective—To develop a questionnaire for self-assessment of biosecurity practices at equine boarding facilities and to evaluate infectious disease control practices in these facilities in Colorado. Design—Cross-sectional study. Sample Population—64 equine boarding facilities in Colorado. Procedures—Survey questions were rated according to importance for prevention and containment of equine infectious diseases. Point values (range, 0 to 20) were assigned for possible responses, with greater values given for optimal infection control methods. Questionnaires were mailed to equine boarding facilities in Colorado advertised on the World Wide Web. Survey responses were compared with assessments made by a member of the research team during visits to 30 randomly selected facilities. Agreement among results was analyzed via a kappa test and rated as poor, fair, moderate, substantial, or nearly perfect. Results—Survey responses were received for 64 of 163 (39%) equine boarding facilities. Scores ranged from 106 to 402 points (maximum possible score, 418). Most facilities received better scores for movement and housing of equids than for other sections of the survey. Respondents at 24 of 48 (50%) facilities that routinely received new equids reported isolation of new arrivals. Agreement between self-assessment by survey respondents and evaluation by a member of the research team was determined to be fair to substantial. Conclusions and Clinical Relevance—Most equine boarding facilities have opportunities to improve measures for prevention or containment of contagious diseases (eg, isolation of newly arrived equids and use of written health management protocols). Most self-assessments of infection control practices were accurate.

Reproductive aging coincides with endocrine changes that are not solely reproductive in nature and culminates in hypergonadotropic hypogonadism and amenorrhea. These changes are identifiable biochemically regardless of clinical manifestations. Changes in the hypothalamic-pituitary-ovarian axis are associated with changes in other hormonal axes, specifically the adrenal androgen and the somatotropic axis. A large body of literature indicates that reproductive aging is associated with a decline in the somatotropic axis. The interactions between reproductive aging and changes in the adrenal androgen axis are more complex and complicated by age-related declines in the adrenal axis early in the reproductive years. These changes may play an important role in overall health maintenance. Attempts to ameliorate hormonal declines with exogenous hormonal therapy have produced mixed results. Finally, the age-specific timing as well as the rapidity of the changes that occur with reproductive aging seems to have important consequences on metabolism, cardiovascular risk, cognition, bone density, and even mortality.

Reasons for performing study: Arterial blood gas analysis is widely accepted as a diagnostic tool to assess respiratory function in neonates. To the authors' knowledge, there are no published reports of arterial blood gas parameters in normal neonatal foals at altitude. Objective: To provide information on arterial blood gas parameters of normal foals born at 1500 m elevation (Fort Collins, Colorado) in the first 48 h post partum. Hypothesis: Foals born at 1500 m will have lower P a O 2 and P a CO 2 than foals born at sea level due to low inspired oxygen and compensatory hyperventilation occurring at altitude. Methods: Sixteen foals were studied. Arterial blood gas analysis was performed within 1 h of foaling and subsequent samples were evaluated at 3, 6, 12, 24 and 48 h post partum. Data were compared to those previously reported in healthy foals born near sea level. Results: Mean P a O 2 was 53.0 mmHg (7.06 kPa) within 1 h of foaling, rising to 67.5 mmHg (9.00 kPa) at 48 h post partum. P a CO 2 was 44.1 mmHg (5.88 kPa) within one hour of foaling, falling to 38.3 mmHg (5.11 kPa) at 48 h. Both P a O 2 and P a CO 2 were significantly lower in foals born at 1500 m elevation than those near sea level at several time points during the first 48 h. Conclusions and potential relevance: Foals at 1500 m elevation undergo hypobaric hypoxia and compensatory hyperventilation in the first 48 h. Altitude specific normal arterial blood values are an important reference for veterinarians providing critical care to equine neonates.

Summary The equine practitioner is in a position to make day-to-day decisions regarding antimicrobial drug (AMD) use for their patients as well as to educate their clients regarding judicious use. General guidelines regarding judicious use of AMDs in equine patients have been developed by the American Association of Equine Practitioners. Detailed guidelines for AMD use in specific equine diseases supported by clinical trials and results of surveillance studies focused on resistance among equine bacterial pathogens are lacking. Studies that could lead to detailed and justifiable use recommendations would allow the equine practitioner to make more informed decisions regarding when to use AMDs, which drugs should be used and how they should be used (e.g. dose, route and duration).

Objective—To compare temperature readings from an implantable percutaneous thermal sensing microchip with temperature readings from a digital rectal thermometer, to identify factors that affect microchip readings, and to estimate the sensitivity and specificity of the microchip for fever detection. Design—Prospective study. Animals—52 Welsh pony foals that were 6 to 10 months old and 30 Quarter Horses that were 2 years old. Procedures—Data were collected in summer, winter, and fall in groups 1 (n = 23 ponies), 2 (29 ponies), and 3 (30 Quarter Horses), respectively. Temperature readings from a digital rectal thermometer and a percutaneous thermal sensing microchip as well as ambient temperature were recorded daily for 17, 23, and 19 days in groups 1 through 3, respectively. Effects of ambient temperature and rectal temperature on thermal sensor readings were estimated. Sensitivity and specificity of the thermal sensor for detection of fever (rectal temperature, ≥ 38.9°C [102°F]) were estimated separately for data collection at ambient temperatures ≤ 15.6°C (60°F) and > 15.6°C. Results—Mean ambient temperatures were 29.0°C (84.2°F), −2.7°C (27.1°F), and 10.4°C (50.8°F) for groups 1 through 3, respectively. Thermal sensor readings varied with ambient temperature and rectal temperature. Rectal temperatures ranged from 36.2° to 41.7°C (97.2° to 107°F), whereas thermal sensor temperature readings ranged from 23.9° (75°F) to 42.2°C (75° to 108°F). Sensitivity for fever detection was 87.4%, 53.3%, and 58.3% in groups 1 to 3, respectively. Conclusions and Clinical Relevance—The thermal sensor appeared to have potential use for initial screening of body temperature in equids at ambient temperatures > 15.6°C.

Objective—To determine the adsorptive capability of di-tri-octahedral smectite (DTOS) on Clostridium perfringens alpha, beta, and beta-2 exotoxins and equine colostral antibodies. Sample Population—3 C perfringens exotoxins and 9 colostral samples. Procedures—Alpha, beta, and beta-2 exotoxins were individually co-incubated with serial dilutions of DTOS or bismuth subsalicylate, and the amount of toxin remaining after incubation was determined via toxin-specific ELISAs. Colostral samples from healthy mares were individually co-incubated with serial dilutions of DTOS, and colostral IgG concentrations were determined via single radial immunodiffusion assay. Results—Di-tri-octahedral smectite decreased the amount of each C perfringens exotoxin in co-incubated samples in a dose-dependent manner and was more effective than bismuth subsalicylate at reducing exotoxins in vitro. Decreases in the concentration of IgG were detected in samples of colostrum that were combined with DTOS at 1:4 through 1:16 dilutions, whereas no significant decrease was evident with DTOS at the 1:32 dilution. Conclusions and Clinical Relevance—Di-tri-octahedral smectite effectively adsorbed C perfringens exotoxins in vitro and had a dose-dependent effect on the availability of equine colostral antibodies. Results suggested that DTOS may be an appropriate adjunctive treatment in the management of neonatal clostridiosis in horses. In vivo studies are necessary to fully assess the clinical efficacy of DTOS treatment.

Aims: To compare Salmonella enterica serotype Infantis isolates obtained from patients or the environment of a veterinary teaching hospital over a period of 9 years following a nosocomial outbreak to determine whether isolates were epidemiologically related or represented unrelated introductions into the hospital environment. Methods and Results: Fifty-six S. Infantis isolates were compared based on their phenotypic (antimicrobial drug [AMD] susceptibility pattern) and genotypic (pulsed-field gel electrophoresis [PFGE] pattern and presence of integrons) characteristics. Epidemiologically unrelated S. Infantis isolates clustered separately from all but two of the hospital isolates, and several isolates from different years and various sources were indistinguishable from each other in cluster analysis of two-enzyme PFGE results. A high percentage of isolates (80·3%) were resistant to at least one AMD, with 67·8% showing resistance to >5 AMD. The majority (74·1%) of isolates tested contained type 1 integrons. Conclusion: Results strongly suggest that there was nosocomial transmission of S. Infantis during the initial outbreak, and that contamination arising from this outbreak persisted across years despite rigorous hygiene and biosecurity precautions and may have led to subsequent nosocomial infections. Significance and Impact of the Study: Evidence of persistence and transmission of Salmonella clones across years, even in the face of rigorous preventive measures, has important implications for other facilities that have experienced outbreaks of Salmonella infections.

Objective—To describe the prevalence of West Nile virus (WNV) infection and evaluate factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with WNV infection. Design—Retrospective case series. Sample Population—Laboratory submission forms from 1,104 equids tested for WNV in Colorado in 2003. Procedures—Submission forms accompanying samples submitted for detection of WNV via IgM capture ELISA were obtained from the Colorado state veterinarian and diagnostic laboratories performing the tests. Data on signalment, clinical signs, history of vaccination against WNV, and assay results were collected from laboratory submission forms. Equids with clinical signs compatible with WNV infection in which IgM capture ELISA results were positive were considered as case equids. Results—1,104 equids were tested for WNV; 1,017 (92.1%) had clinical signs compatible with WNV infection. Among equids with clinical signs compatible with WNV infection, the odds of testing positive for WNV via IgM capture ELISA were lower in males and in vaccinated equids and higher in equids with moderate and severe illness, compared with females, unvaccinated equids, and equids with mild illness. Conclusions and Clinical Relevance—Among equids with clinical signs compatible with WNV infection, vaccination against WNV, severity of clinical signs, duration of illness, and region in Colorado were associated with increased risk of having a positive IgM capture ELISA result.

The objective of this study was to investigate the perceived increase in resistance of Streptococcus equi subsp. zooepidemicus ( S. zooepidemicus) isolated from the lower respiratory tract of horses to trimethoprim–sulfamethoxazole (SXT). The recorded SXT-susceptibility results of 50 S. zooepidemicus isolates from the tracheal wash fluid of equine patients examined at Colorado State University Veterinary Teaching Hospital from each of 2 time periods (1987–1990 and 1997–2001) were compared and statistically analyzed using a cross-sectional study design. There was a statistically significant difference between the documented resistance of S. zooepidemicus isolated in the 1987–1990 time period (8%), using quantitative microbroth dilution, and the resistance reported for isolates from the 1997–2001 time period (42%), using Kirby–Bauer agar disk diffusion. Laboratory investigation revealed inadequate quality control of media and subsequent falsely reported resistance of S. zooepidemicus from 1997 to 2001 time period. This study demonstrates how minor deviations from prescribed laboratory-testing guidelines can have a major effect on antimicrobial susceptibility test results. The study also underscores the need for regular surveillance and monitoring of trends in antimicrobial susceptibility to detect and correct such problems. In addition, epidemiologists and others collecting data from laboratories should be cautioned to interact with the laboratory regarding interpretation of results of various testing methods to ensure accurate analysis and conclusions.

Accurate empathy, long argued to be important in psychotherapy, now is an object of social–cognitive research. Graduate–level psychology students viewed brief portions of a therapy session and inferred the thoughts and feelings of the client. Accuracy scores were the rated similarity of their inferences to the client's reported thoughts and feelings. Throughout the semester course in interviewing, experimental participants practiced such judgments with feedback, while controls did not. Both groups' accuracy increased from pre– to post-test on inferred feelings, in part because the post-test was easier. Nonetheless, experimental participants on the post-test had greater accuracy of inferred feelings than controls. Women were more accurate than men in inferences for thoughts at post-test. Implications for training and future research are discussed.

Objective—To compare neutralizing antibody response between horses vaccinated against West Nile virus (WNV) and horses that survived naturally occurring infection. Design—Cross-sectional observational study. Animals—187 horses vaccinated with a killed WNV vaccine and 37 horses with confirmed clinical WNV infection. Procedure—Serum was collected from vaccinated horses prior to and 4 to 6 weeks after completion of an initial vaccination series (2 doses) and 5 to 7 months later. Serum was collected from affected horses 4 to 6 weeks after laboratory diagnosis of infection and 5 to 7 months after the first sample was obtained. The IgM capture ELISA, plaque reduction neutralization test (PRNT), and microtiter virus neutralization test were used. Results—All affected horses had PRNT titers ≥ 1:100 at 4 to 6 weeks after onset of disease, and 90% (18/20) maintained this titer for 5 to 7 months. After the second vaccination, 67% of vaccinated horses had PRNT titers ≥ 1:100 and 14% had titers < 1:10. Five to 7 months later, 33% (28/84) of vaccinated horses had PRNT titers ≥ 1:100, whereas 29% (24/84) had titers < 1:10. Vaccinated and clinically affected horses' end point titers had decreased by 5 to 7 months after vaccination. Conclusions and Clinical Relevance—A portion of horses vaccinated against WNV may respond poorly. Vaccination every 6 months may be indicated in certain horses and in areas of high vector activity. Other preventative methods such as mosquito control are warranted to prevent WNV infection in horses. (J Am Vet Med Assoc 2005;226:240–245)