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Background: Retinitis pigmentosa is a group of hereditary retinal diseases characterized by the degeneration of rod and cone photoreceptors. It commonly results in night blindness followed by tunnel vision and central vision reduction. The classic triad of clinical signs includes pigmented bone spicules, waxy disc pallor, and arterial attenuation. Unilateral retinitis pigmentosa is rare and can be supported with ancillary testing including genetic and laboratory studies to rule out differential diagnoses. Case Report: A 68-year-old Hispanic female was referred to the low vision rehabilitation clinic due to progressive vision loss in the left eye (OS) that began 15 years ago. The vision was normal in the right eye (OD). Additionally, she suffered from hearing loss in the right ear since age 3. Examination revealed abnormal visual acuity, visual field, fundus appearance, optical coherence tomography, and electrodiagnostic test results in the OS only. Laboratory studies ruled out various infectious, autoimmune, traumatic, and toxic drug etiologies. Genetic testing revealed novel mutations in genes associated with retinitis pigmentosa. Conclusion: The genetic testing results along with the clinical examination and electrodiagnostic evaluation supports the diagnosis of unilateral retinitis pigmentosa.

Visual Abstract, Highlights • In ADHF, elevated CVP opposes thoracic duct lymph flow and impairs decongestion of the interstitial space. • The use of a novel device for reducing CVP at the outflow of the thoracic duct was shown to be safe, well-tolerated, and effectively reduced EVLW, in an animal model of acute-on-chronic ischemic HF. • Similar results were observed when translating this therapy to a human case study. • Additional human studies to confirm these findings may establish device-based direct interstitial decongestion as a new treatment for ADHF., Summary Removal of excess fluid in acute decompensated heart failure (ADHF) targets the intravascular space, whereas most fluid resides in the interstitial space. The authors evaluated an approach to interstitial decongestion using a device to enhance lymph flow. The device was deployed in sheep with induced heart failure (HF) and acute volume overload to create a low-pressure zone at the thoracic duct outlet. Treatment decreased extravascular lung water (EVLW) volume (mL/kg) (-32% ± 9%, P = 0.029) compared to controls (+46% ± 9%, P = 0.003). Device-mediated thoracic duct decompression effectively reduced EVLW. Human studies may establish device-based interstitial decongestion as a new ADHF treatment.

This study focuses on the comparative and quantitative analysis of the epidemiologic trends and aspects of severe fever with thrombocytopenia syndrome (SFTS) outbreaks between Korea and Japan from 2013 to 2017. The following factors were analyzed; cumulative incidence rate (CIR), cases-fatality rate (CFR), and the epidemic aspects, including cases related to gender, male-to-female morbidity ratio (MFMR), age, seasonal, and geographical distributions. We observed 607 SFTS cases with CIR in Korea during the period 2013 to 2017 were as 0.24 per 100,000 populations and with a 127 fatal-cases (F.C.s), corresponding to a CFR of 20.9%, respectively. During the same period in Japan, 319 SFTS cases with a CIR of 0.05 and with 60 F.C.s to a CFR of 18.8% observed. When compared, the CIR of SFTS in Korea was significantly higher than in Japan (P

Objectives: Because of its multifaceted cardioprotective effects, remote ischemic pre-conditioning (RIPC) was examined as a strategy to attenuate doxorubicin (DOX) cardiotoxicity. Background: The use of DOX is limited by dose-dependent cardiotoxicity and heart failure. Oxidative stress, mitochondrial dysfunction, inflammation, and autophagy modulation have been proposed as mediators of DOX cardiotoxicity. Methods: After baseline echocardiography, adult male CD1 mice were randomized to either sham or RIPC protocol (3 cycles of 5 min femoral artery occlusion followed by 5 min reperfusion) 1 h before receiving DOX (20 mg/kg, intraperitoneal). The mice were observed primarily for survival over 85 days (86 mice). An additional cohort of 50 mice was randomized to either sham or RIPC 1 h before DOX treatment and was followed for 25 days, at which time cardiac fibrosis, apoptosis, and mitochondrial oxidative phosphorylation were assessed, as well as the expression profiles of apoptosis and autophagy markers. Results: Survival was significantly improved in the RIPC cohort compared with the sham cohort (p = 0.007). DOX-induced cardiac fibrosis and apoptosis were significantly attenuated with RIPC compared with sham (p < 0.05 and p < 0.001, respectively). Although no mitochondrial dysfunction was detected at 25 days, there was a significant increase in autophagy markers with DOX that was attenuated with RIPC. Moreover, DOX caused a 49% decline in cardiac BCL2/BAX expression, which was restored with RIPC (p < 0.05 vs. DOX). DOX also resulted in a 17% reduction in left ventricular mass at 25 days, which was prevented with RIPC (p < 0.01), despite the lack of significant changes in left ventricular ejection fraction. Conclusions: Our preclinical results suggested that RIPC before DOX administration might be a promising approach for attenuating DOX cardiotoxicity.

OBJECTIVE To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur. ANIMALS 50 client-owned dogs. PROCEDURES Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog’s quality of life. RESULTS Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog’s long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved. CLINICAL RELEVANCE Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.

Approximately 800, 000 surgical repairs are performed annually in the U.S. for debilitating injuries to ligaments and tendons of the foot, ankle, knee, wrist, elbow and shoulder, presenting a significant healthcare burden. To overcome current treatment shortcomings and advance the treatment of tendon and ligament injuries, we have developed a novel electrospun Tissue ENgineered Device (TEND), comprised of type I collagen and poly(D,L-lactide) (PDLLA) solubilized in a benign solvent, dimethyl sulfoxide (DMSO). TEND fiber alignment, diameter and porosity were engineered to enhance cell infiltration leading to promote tissue integration and functional remodeling while providing biomechanical stability. TEND rapidly adsorbs blood and platelet-rich-plasma (PRP), and gradually releases growth factors over two weeks. TEND further supported cellular alignment and upregulation of tenogenic genes from clinically relevant human stem cells within three days of culture. TEND implanted in a rabbit Achilles tendon injury model showed new in situ tissue generation, maturation, and remodeling of dense, regularly oriented connective tissue in vivo. In all, TEND’s organized microfibers, biological fluid and cell compatibility, strength and biocompatiblility make significant progress towards clinically translating electrospun collagen-based medical devices for improving the clinical outcomes of tendon injuries.

Food allergy is defined as a pruritic dermatitis which is indicated by allergic reactions to food components. Due to its excessive incidence of clinical signs it is necessary to determine the correct diagnosis, provide sufficient control and long term management to achieve comfortable way of life for an animal. In case of very intensive pruritus there are usually used in common medicine glucocorticoids, antihistamincs and inhibitors of Janus kinase but there are also other alternatives such as bioresonance, homeopathy, phytotherapy, acupuncture, etc. that have also very beneficial and curative effect in case of food allergy. Diagnostics and therapy by bioresonance are alternative methods used in modern medicine that was discovered as a combination of quantum physics and Traditional Chinese Medicine. We can use it for various types of acute and chronic diseases without any invasive intervention into the body. There have been positive results in the diagnosis and treatment of allergies in dogs, which are nowadays constantly increased, and that have been one of the most common causes of dermatological and gastrointestinal diseases.

Supplemental Digital Content is available in the text., IMPORTANCE: Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population. OBJECTIVES: To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults. DESIGN, SETTINGS, AND PARTICIPANTS: A retrospective cohort study of the Society of Critical Care Medicine’s Viral Infection and Respiratory Illness Universal Study registry. Patients 18–40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis. MAIN OUTCOMES AND MEASURES: Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality. RESULTS: Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27–37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% (n = 996), and 34.3% (n = 1,376) were admitted to the ICU. Older age (p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2–2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1–2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors. CONCLUSIONS: Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019.

In some educational contexts, it has been shown that interleaved presentation (i.e. alternating different tasks/skills) results in better learning than blocked presentation (i.e. practising one task/skill at a time). However, this interleaving effect has been studied in a limited range of contexts. Here, we examined whether blocked versus interleaved presentation influenced vocabulary learning in 56 children aged from 6 to 10 years old. We devised a novel online game involving two tasks. The first was a vocabulary learning task, in which children matched spoken words to images of novel animals. The second was a comprehension task, where the children arranged objects to match the spatial relations described in a spoken sentence. Stimuli were presented in a between-subjects design, such that trials from each task either occurred in blocks of 10 or were fully interleaved. Our analysis revealed vocabulary learning in both conditions, but the rate of learning did not differ for participants assigned to the blocked vs interleaved conditions. We did not, however, use posttest assessment means, so we cannot rule out any benefit of interleaving that may emerge after the initial learning phase.

Funding Acknowledgements Type of funding sources: None. Background. Nowadays frequently deployed invasive catheter ablation therapy in patients with symptomatic atrial fibrillation (AF) is unfortunately associated with distress such as preoperative anxiety. Improving preoperative patient information may lower anxiety towards AF ablation procedures. Purpose. To evaluate whether a lifelike 360˚ virtual reality (VR) patient information video decreases anxiety levels and improves patient preparation towards AF ablation as compared to standard preoperative patient information. Methods. Consecutive patients planned for AF ablation were recruited from the outpatient AF clinic and were randomized into two groups: the control group and the intervention group (VR group). The control group received standard preoperative information through oral counselling and information leaflets, the VR group received the standard information as well as a short dedicated 360˚ VR video (via in-hospital VR headset and disposable cardboard VR glasses for home use). Online questionnaires (aimed at information provision, anxiety and procedural experience) were administered both pre- and post-ablation. Results. A total of 103 patients (39.8% female, age 64 [58-71] years) were included in the analysis. The VR group (n = 58) reported to be clearly better informed about catheterization laboratory environment (78% vs. 73%) and the course of the procedure (82% vs. 78%), indicated fewer concerns about the procedure (47% vs. 55%) and were eager to learn even more (82% vs. 74%) as compared to controls (n = 45). However, there was no significant difference in the anxiety scores between the VR group and controls (10 [8-12] vs. 10 [8-14], p = 0.548). Home use of the video was satisfactory and resulted in discussion with relatives. Patient overall satisfaction was higher in VR group as compared to controls (84% vs. 81%). Conclusions. This study shows that a dedicated 360˚ VR video reduces concerns but does not reduce anxiety scores. Though, it easily improves procedural knowledge, patient information and patient satisfaction. Especially in times of remote patient care, this new way of informing patients may be of added value.

Objectives:. Coronavirus disease 2019 continues to spread worldwide with high levels of morbidity and mortality. We performed anticoronavirus immunoglobulin G profiling of critically ill coronavirus disease 2019 patients to better define their underlying humoral response. Design:. Blood was collected at predetermined ICU days to measure immunoglobulin G with a research multiplex assay against four severe acute respiratory syndrome coronavirus 2 proteins/subunits and against all six additionally known human coronaviruses. Setting:. Tertiary care ICU and academic laboratory. Subjects:. ICU patients suspected of being infected with severe acute respiratory syndrome coronavirus 2 had blood collected until either polymerase chain reaction testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative) or until death or discharge if the patient tested polymerase chain reaction positive (coronavirus disease 2019 positive). Interventions:. None MEASUREMENTS AND MAIN RESULTS:. Age- and sex-matched healthy controls and ICU patients who were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well-balanced with the exception that coronavirus disease 2019 positive patients had greater body mass indexes, presented with bilateral pneumonias more frequently, and suffered lower Pao2:Fio2 ratios, when compared with coronavirus disease 2019 negative patients (p < 0.05). Mortality rate for coronavirus disease 2019 positive patients was 50%. On ICU days 1–3, anti–severe acute respiratory syndrome coronavirus 2 immunoglobulin G was significantly elevated in coronavirus disease 2019 positive patients, as compared to both healthy control subjects and coronavirus disease 2019 negative patients (p < 0.001). Weak severe acute respiratory syndrome coronavirus immunoglobulin G serologic responses were also detected, but not other coronavirus subtypes. The four anti–severe acute respiratory syndrome coronavirus 2 immunoglobulin G were maximal by ICU day 3, with all four anti–severe acute respiratory syndrome coronavirus 2 immunoglobulin G providing excellent diagnostic potential (severe acute respiratory syndrome coronavirus 2 Spike 1 protein immunoglobulin G, area under the curve 1.0, p < 0.0005; severe acute respiratory syndrome coronavirus receptor binding domain immunoglobulin G, area under the curve, 0.93–1.0; p ≤ 0.0001; severe acute respiratory syndrome coronavirus 2 Spike proteins immunoglobulin G, area under the curve, 1.0; p < 0.0001; severe acute respiratory syndrome coronavirus 2 Nucleocapsid protein immunoglobulin G area under the curve, 0.90–0.95; p ≤ 0.0003). Anti–severe acute respiratory syndrome coronavirus 2 immunoglobulin G increased and/or plateaued over 10 ICU days. Conclusions:. Critically ill coronavirus disease 2019 patients exhibited anti–severe acute respiratory syndrome coronavirus 2 immunoglobulin G, whereas serologic responses to non–severe acute respiratory syndrome coronavirus 2 antigens were weak or absent. Detection of human coronavirus immunoglobulin G against the different immunogenic structural proteins/subunits with multiplex assays may be useful for pathogen identification, patient cohorting, and guiding convalescent plasma therapy.

Objectives:. Coronavirus disease 2019 continues to spread rapidly with high mortality. We performed metabolomics profiling of critically ill coronavirus disease 2019 patients to understand better the underlying pathologic processes and pathways, and to identify potential diagnostic/prognostic biomarkers. Design:. Blood was collected at predetermined ICU days to measure the plasma concentrations of 162 metabolites using both direct injection-liquid chromatography-tandem mass spectrometry and proton nuclear magnetic resonance. Setting:. Tertiary-care ICU and academic laboratory. Subjects:. Patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had blood samples collected until either testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative) or until ICU day 10 if the patient tested positive (coronavirus disease 2019 positive). Interventions:. None. Measurements and Main Results:. Age- and sex-matched healthy controls and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well balanced with the exception that coronavirus disease 2019 positive patients suffered bilateral pneumonia more frequently than coronavirus disease 2019 negative patients. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Feature selection identified the top-performing metabolites for identifying coronavirus disease 2019 positive patients from healthy control subjects and was dominated by increased kynurenine and decreased arginine, sarcosine, and lysophosphatidylcholines. Arginine/kynurenine ratio alone provided 100% classification accuracy between coronavirus disease 2019 positive patients and healthy control subjects (p = 0.0002). When comparing the metabolomes between coronavirus disease 2019 positive and coronavirus disease 2019 negative patients, kynurenine was the dominant metabolite and the arginine/kynurenine ratio provided 98% classification accuracy (p = 0.005). Feature selection identified creatinine as the top metabolite for predicting coronavirus disease 2019-associated mortality on both ICU days 1 and 3, and both creatinine and creatinine/arginine ratio accurately predicted coronavirus disease 2019-associated death with 100% accuracy (p = 0.01). Conclusions:. Metabolomics profiling with feature classification easily distinguished both healthy control subjects and coronavirus disease 2019 negative patients from coronavirus disease 2019 positive patients. Arginine/kynurenine ratio accurately identified coronavirus disease 2019 status, whereas creatinine/arginine ratio accurately predicted coronavirus disease 2019-associated death. Administration of tryptophan (kynurenine precursor), arginine, sarcosine, and/or lysophosphatidylcholines may be considered as potential adjunctive therapies.

Supplemental Digital Content is available in the text., Objectives: Coronavirus disease 2019 patients admitted to the ICU have high mortality. The host response to coronavirus disease 2019 has only been partially elucidated, and prognostic biomarkers have not been identified. We performed targeted proteomics on critically ill coronavirus disease 2019 patients to better understand their pathophysiologic mediators and to identify potential outcome markers. Design: Blood was collected at predetermined ICU days for proximity extension assays to determine the plasma concentrations of 1,161 proteins. Setting: Tertiary care ICU and academic laboratory. Subjects: All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had blood samples collected until either testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative) or until ICU day 10 if the patient positive (coronavirus disease 2019 positive). Interventions: None. Measurements and Main Results: Age- and sex-matched healthy control subjects and ICU patients who were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well-balanced with the exception that coronavirus disease 2019 positive patients suffered bilateral pneumonia more frequently than coronavirus disease 2019 negative patients. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Feature selection identified the top performing proteins for identifying coronavirus disease 2019 positive ICU patients from both healthy control subjects and coronavirus disease 2019 negative ICU patients (classification accuracies 100%). The coronavirus disease 2019 proteome was dominated by interleukins and chemokines, as well as several membrane receptors linked to lymphocyte-associated microparticles and/or cell debris. Mortality was predicted for coronavirus disease 2019 positive patients based on plasma proteome profiling on both ICU day 1 (accuracy 92%) and ICU day 3 (accuracy 83%). Promising prognostic proteins were then narrowed down to six, each of which provided excellent classification performance for mortality when measured on ICU day 1 CMRF-35-like molecule, interleukin receptor-12 subunit B1, cluster of differentiation 83 [CD83], family with sequence similarity 3, insulin-like growth factor 1 receptor and opticin; area-under-the-curve =1.0; p = 0.007). Conclusions: Targeted proteomics with feature classification easily distinguished both healthy control subjects and coronavirus disease 2019 tested negative ICU patients from coronavirus disease 2019 tested positive ICU patients. Multiple proteins were identified that accurately predicted coronavirus disease 2019 tested positive patient mortality.

Supplemental Digital Content is available in the text., Objectives: Coronavirus disease 2019 is caused by the novel severe acute respiratory syndrome coronavirus 2 virus. Patients admitted to the ICU suffer from microvascular thrombosis, which may contribute to mortality. Our aim was to profile plasma thrombotic factors and endothelial injury markers in critically ill coronavirus disease 2019 ICU patients to help understand their thrombotic mechanisms. Design: Daily blood coagulation and thrombotic factor profiling with immunoassays and in vitro experiments on human pulmonary microvascular endothelial cells. Setting: Tertiary care ICU and academic laboratory. Subjects: All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had daily blood samples collected until testing was confirmed coronavirus disease 2019 negative on either ICU day 3 or ICU day 7 if the patient was coronavirus disease 2019 positive. Interventions: None. Measurement and Main Results: Age- and sex-matched healthy control subjects and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well balanced with the exception that coronavirus disease 2019 positive patients were more likely than coronavirus disease 2019 negative patients to suffer bilateral pneumonia. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Compared with healthy control subjects, coronavirus disease 2019 positive patients had higher plasma von Willebrand factor (p < 0.001) and glycocalyx-degradation products (chondroitin sulfate and syndecan-1; p < 0.01). When compared with coronavirus disease 2019 negative patients, coronavirus disease 2019 positive patients had persistently higher soluble P-selectin, hyaluronic acid, and syndecan-1 (p < 0.05), particularly on ICU day 3 and thereafter. Thrombosis profiling on ICU days 1–3 predicted coronavirus disease 2019 status with 85% accuracy and patient mortality with 86% accuracy. Surface hyaluronic acid removal from human pulmonary microvascular endothelial cells with hyaluronidase treatment resulted in depressed nitric oxide, an instigating mechanism for platelet adhesion to the microvascular endothelium. Conclusions: Thrombosis profiling identified endothelial activation and glycocalyx degradation in coronavirus disease 2019 positive patients. Our data suggest that medications to protect and/or restore the endothelial glycocalyx, as well as platelet inhibitors, should be considered for further study.

Supplemental Digital Content is available in the text., Objectives: Coronavirus disease 2019 is caused by severe acute respiratory syndrome-coronavirus-2 infection to which there is no community immunity. Patients admitted to ICUs have high mortality, with only supportive therapies available. Our aim was to profile plasma inflammatory analytes to help understand the host response to coronavirus disease 2019. Design: Daily blood inflammation profiling with immunoassays. Setting: Tertiary care ICU and academic laboratory. Subjects: All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome-coronavirus-2, using standardized hospital screening methodologies, had daily blood samples collected until either testing was confirmed negative on ICU day 3 (coronavirus disease 2019 negative), or until ICU day 7 if the patient was positive (coronavirus disease 2019 positive). Interventions: None. Measurements and Main Results: Age- and sex-matched healthy controls and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well-balanced with the exception that coronavirus disease 2019 positive patients were more likely than coronavirus disease 2019 negative patients to suffer bilateral pneumonia. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. We measured 57 inflammatory analytes and then analyzed with both conventional statistics and machine learning. Twenty inflammatory analytes were different between coronavirus disease 2019 positive patients and healthy controls (p < 0.01). Compared with coronavirus disease 2019 negative patients, coronavirus disease 2019 positive patients had 17 elevated inflammatory analytes on one or more of their ICU days 1–3 (p < 0.01), with feature classification identifying the top six analytes between cohorts as tumor necrosis factor, granzyme B, heat shock protein 70, interleukin-18, interferon-gamma-inducible protein 10, and elastase 2. While tumor necrosis factor, granzyme B, heat shock protein 70, and interleukin-18 were elevated for all seven ICU days, interferon-gamma-inducible protein 10 transiently elevated on ICU days 2 and 3 and elastase 2 increased over ICU days 2–7. Inflammation profiling predicted coronavirus disease 2019 status with 98% accuracy, whereas elevated heat shock protein 70 was strongly associated with mortality. Conclusions: While many inflammatory analytes were elevated in coronavirus disease 2019 positive ICU patients, relative to healthy controls, the top six analytes distinguishing coronavirus disease 2019 positive ICU patients from coronavirus disease 2019 negative ICU patients were tumor necrosis factor, granzyme B, heat shock protein 70, interleukin-18, interferon-gamma-inducible protein 10, and elastase 2.

Reconstructing large bone defects caused by severe trauma or resection of tumors remains a challenge for orthopedic and plastic surgeons. Free flaps comprised of a muscle flap with fibula bone and its vascularized bed can be transplanted to the reconstruction site to achieve healing. However, this transplantation technique adds morbidity, and requires extensive microsurgery and sculpting of the bone tissue to adapt the graft to both the vasculature and the anatomy of the bone defect. The aim of the current study is to evaluate an alternative approach consisting of the in situ production of a pre-vascularized synthetic bone graft and its subsequent transplantation to a critical-sized bone defect. 3D printed chambers containing biphasic calcium phosphate (BCP) granules, perfused by a local vascular pedicle, with or without the addition of stromal vascular fraction (SVF), were subcutaneously implanted into New Zealand White female rabbits. The SVF was prepared extemporaneously from autologous adipose tissue, while the vascular pedicle was isolated from the inguinal site. Chambers filled with BCP alone served as controls. After 8 weeks, the constructs containing a vascular pedicle exhibited abundant neovascularization, with significant numbers of blood vessels sprouting from the pedicle, which was further enhanced by the addition of SVF. These pre-vascularized synthetic bone grafts were then transplanted into 15 mm critical-sized segmental ulnar defects for a further 8 weeks. Micro-CT and decalcified histology revealed that pre-vascularization of synthetic bone grafts led to significantly enhanced bone regeneration. This pre-clinical study demonstrates the feasibility and efficacy of in situ production of pre-vascularized synthetic bone grafts for regenerating large bone defects, and will address an important clinical need.

We reviewed 11 cases of superficial chronic ulcerative dermatitis (SCUD) in psittacine birds that presented to an exotic animal practice over an 8-year period. African grey parrots ( Psittacus erithacus) were overrepresented, accounting for 55% of SCUD-affected birds. All affected birds were hand-reared pets and bonded strongly to their owners. In all cases, fungal culture results were negative. The most commonly cultured bacteria were Enterobacter cloacae (27%), followed by Escherichia coli, and Staphylococcus aureus (both 18%). An underlying cause of behavioral self-mutilation with secondary infection of dermatitis lesions by opportunistic bacteria was suspected in 10 of 11 cases. The axillae were the most common anatomic sites affected (45%). In two cases, more than one site was affected concurrently. Mean age of birds affected was 11.4 years. Two birds had suffered from SCUD previously, with 1 bird having suffered from 3 previous episodes and was euthanized as a result. All birds were treated with systemic antibiotics, topical antibacterial preparations, and systemic nonsteroidal anti-inflammatory drugs. A neck collar was applied in all cases. Median time to clinical resolution was 2 months (range, 1-21 months). Excluding the bird that was euthanized, all birds showed a positive response to treatment.

An 18-month-old domestic short hair male castrated cat presented with a history of fever of unknown origin of 1-year duration. Abdominal ultrasound revealed a mixed echogenicity mass. Cytological examination of the fluid obtained through fine needle aspiration was consistent with a retroperitoneal abscess. The cat underwent a midline celiotomy and the abscess was opened, lavaged, and omentalized. Antibiotics were also administered. Two months after surgery, the cat represented with a fluctuant swelling in the right flank region at the lumbodorsal triangle. Abdominal and mass ultrasound showed a mixed echogenicity swelling in the right flank. Under gas anesthesia, the swelling was surgically explored and a 0.4 cm long grass awn was found and removed. Telephone communication with the owners 6 months after surgery found the cat to be free of clinical signs.

We establish reference values of tear production by the phenol red thread test (PRTT) and intraocular pressure (IOP) by rebound tonometry in helmeted guinea fowl ( Numida meleagris ). Aqueous tear production and IOP were measured in 44 (22 males, 22 females) clinically normal captive helmeted guinea fowl. Birds were gently physically restrained in the sitting position without any pressure to the head or neck. In each bird, aqueous tear production was measured by placing phenol red threads in the superior conjunctival fornix, and IOP was measured by using a Tonovet rebound tonometer. Overall mean ± standard deviation (SD) values of PRTT and IOP of all eyes were 16.5 ± 1.3 mm/15 s (ranging from 14-18 mm/15 s) and 9.1 ± 0.9 mm Hg (ranging from 7-10 mm Hg), respectively. No significant differences were found in IOP or PRTT between males and females (P = .76; P = .83, respectively) or between the left and right eyes (P = .34 and .66, respectively) in the guinea fowl. Results of this study may be beneficial for the diagnosis and therapy of keratoconjunctivitis sicca, glaucoma, and uveitis in helmeted guinea fowl.

Objective To report the clinical use of a cavitron ultrasonic surgical aspirator (CUSA) for the resection of hepatic lesions in dogs. Study design Clinical prospective study. Animals Eleven client-owned dogs. Methods Dogs requiring a hepatic nodulectomy, segmentectomy, and/or a lobectomy (including complex lobectomies) were enrolled. The number and location of procedures, blood loss, duration of surgery, and short-term complications were recorded. Results Dogs underwent a mean of 2.3 ± 1.1 procedures. All masses were amenable to surgical excision regardless of their location and their relationship with major hepatic vessels. Dogs lost a median of 77 mL of blood (9.9-161), which corresponded to 4.3% of blood volume (0.8%-23.2%). The dog with the highest blood loss survived without requiring transfusion. The median duration of all CUSA procedures was 33.5 minutes (15-82). Short-term outcomes were assessed for the first 15 days, during which two complications were diagnosed. Cholangiohepatitis was diagnosed in one dog and resolved after medical management, and another dog developed necrotic pancreatitis and died. Conclusion Liver parenchyma-sparing nodulectomies and segmentectomies and liver lobectomies including complex lobectomies were achieved with a CUSA in all dogs. Clinical significance Use of a CUSA can be considered as an alternative for the removal of hepatic lesions in dogs.

Adrenal gland tumours are uncommon in dogs. However, advances in abdominal imaging have led to the diagnostic dilemma of incidental adrenal mass findings, so-called adrenal incidentaloma, in patients with unrelated clinical signs. When the maximum width of the adrenal gland exceeds 1.5 cm, the shape is lost and the gland is asymmetric compared with the contralateral gland, an adrenal neoplasia should be suspected. Among the primary adrenal gland tumours the most common are adrenocortical neoplasias, such as adenomas, carcinomas and pheochromocytomas. Since peri-, intra-, and postoperative treatment can vary, differentiation between adrenocortical tumours and pheochromocytomas should be attempted before planning the surgical treatment. Histopathological examination is always required to confirm diagnosis.

Background Stent implantation is the treatment of choice for adolescents and adults with aortic coarctation (CoAo). Despite excellent short-term results, 20%–40% of the patients develop arterial hypertension later in life, which was attributed to inappropriate response of the aortic baroreceptors to increased stiffness of the ascending aorta (ASAO), either congenital or induced by CoAo repair. In particular, it has been hypothesized that stent itself may cause or sustain hypertension. Therefore, we aimed to study the hemodynamic and structural impact following stent implantation in the normal aorta of a growing animal. Methods Eight female sheep completed the study and a stent was implanted in four. Every 3 mo we measured blood pressure of the anterior and posterior limbs and left ventricular function by echocardiography. Twelve months later invasive pressure was measured under baseline and simulated stress conditions. Expression of genes indicating oxidative stress (OS), endothelial dysfunction (ED) and stiffness, as well as pathological examination were performed in ascending (ASAO) and descending aorta (DSAO). Results SOD1 and MMP9 gene expression were higher in ASAO of the stented animals, compared to DSAO and controls, while NOS3 was decreased. No differences were found in blood pressure and echocardiographic parameters. No histological differences were found in the aorta of the two groups of animals. Conclusions Stent does not affect central and peripheral hemodynamics, cardiac structure and function even in the long term. However, the finding of markers of OS and increased stiffness of ASAO, proximal to the stent, points to molecular mechanisms for increased cardiovascular risk of patients with stented CoAo.

A 14 mo old female neutered Doberman pinscher was evaluated for difficulty in rising, a wide based stance, pelvic limb gait abnormalities, and cervical pain of 2 mo duration. Neurologic examination revealed pelvic limb ataxia and cervical spinal hyperesthesia. Spinal reflexes and cranial nerve examination were normal. The pathology was localized to the C1-C5 or C6-T2 spinal cord segments. Computed tomography (CT) findings indicated bony proliferation of the caudal articular processes of C6 and the cranial articular processes of C7, resulting in bilateral dorsolateral spinal cord compression that was more pronounced on the left side. A limited dorsal laminectomy was performed at C6–C7. Due to progressive neurological deterioration, follow-up CT examination was performed 4 days postoperatively. At the level of the laminectomy defect, a subfacial seroma had developed, entering the spinal canal and causing significant spinal cord compression. Under ultrasonographic guidance a closed-suction wound catheter was placed. Drainage of the seroma successfully relieved its compressive effects on the spinal cord and the patient's neurological status improved. CT was a valuable tool in assessing spinal cord compression as a result of a postoperative subfascial seroma. Minimally invasive application of a wound catheter can be successfully used to manage this condition.

Objective: Compare the maximum concentration (Cmax), time to maximum concentration (Tmax), mean concentration, rate of return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC when epinephrine is administered by humerus intraosseous (HIO) compared to intravenous (IV) routes in both a hypovolemic and normovolemic cardiac arrest model. Design: Prospective, between subjects, randomized experimental study. Setting: TriService Facility. Subjects: Twenty-eight adult Yorkshire Swine were randomly assigned to four groups: HIO normovolemia; HIO hypovolemia; IV normovolemia; and IV hypovolemia. Intervention: Swine were anesthetized. The hypovolemic group was exsanguinated 31 percent of their blood volume. Subjects were placed into arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After another 2 minutes, 1 mg epinephrine was given by IV or HIO routes; blood samples were collected over 4 minutes. Hypovolemic groups received 500 mL of 5 percent albumin following blood sampling. CPR continued until ROSC or for 30 minutes. Main outcome measures: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, odds of ROSC. Results: Cmax was significantly higher, the Tmax, and the time to ROSC were significantly faster in the HIO normovolemic compared to the HIO hypovolemic group (p < 0.05). All seven in the HIO normovolemic group achieved ROSC compared to three of the HIO hypovolemic group. Odds of ROSC were 19.2 times greater in the HIO normovolemic compared the HIO hypovolemic group. Conclusion: The HIO is an effective route in a normovolemic model. However, the findings indicate that sufficient blood volume is essential for ROSC in a hypovolemic scenario.

Bandaging is a very common practice for veterinary nurses and when properly applied can provide optimal recovery for a variety of conditions such as cut pads, haemorrhage control and post-surgical interventions. Some care must be taken to assure proper bandaging skills in order to avoid redness, oedema, abrasions and other major complications

The aim of this study is to assess the effects of pregnancy and lactation on selected antioxidant profile in Aardi, goats.

‘…Whereas previous Congresses have been very good by all accounts, they have not adequately been all inclusive with respect to addressing a broad spectrum, co-equal recognition and exposure to both...

Cytopathology is a powerful non-invasive diagnostic technique, useful for the diagnosis of skin lesions in dogs. An accurate identification of the most common epithelial and mesenchymal neoplasms in dogs is considered of primary importance and may play a key role in the choice of the most appropriate therapeutic option.

Cytopathology is a diagnostic technique commonly used in veterinary and human medicine. It is based on the study of cells obtained from tissues or body secretions to identify diseases. This procedure is also used for the identification of skin disorders, both inflammatory and neoplastic. The aim of this article, the first in a four-part series, is to guide the clinician in the correct sampling and preparation of cytological samples.

Anaesthetic death rate is higher in exotic patients than in dogs and cats. Unfamiliarity with monitoring and inability to intubate are frequently cited reasons for higher death rate. Ability to hide signs of illness, and fewer healthy, elective aneasthetic procedures likely influence death rate as well. Direct vascular support can be challenging. For some patients, small size or unique anatomic features present unique challenges. Sophisticated monitoring equipment (e.g. capnographs, blood pressure monitors) designed for canine/feline use must often be adapted for exotic patients, and is more likely to fail when used in exotic patients. For this reason, the anaesthetist must develop a plan for addressing equipment failure, and have a backup monitoring device ready, if applicable. Anecdotally, it appears that changes in respiratory and cardiovascular parameters may occur more rapidly than in canine and feline patients. While careful patient preparation and monitoring are important for any anaesthetic patient, particular attention to detail may help improve anaesthetic survival rate in exotic species.

Non-steroidal anti-inflammatory drugs are extensively used in veterinary practice for the management of both acute and chronic pain; however, while they are generally fairly effective analgesics, they have a spectrum of potential side effects ranging from mild to life threatening. This article will discuss the adverse effects that may occur with these drugs and the mechanisms by which they arise, and also describe the situations in which these agents should be avoided.

Obesity is one of the most common health problems in companion animals, with almost half of dogs and cats being overweight or obese. Veterinary nurses should be prepared that pet owners may not know or understand what optimal weight is in their pets, as well as the serious health consequences of obesity. The approach to a successful weight management programme includes assessing the pet, family, and environment, selecting an appropriate diet for each individual pet's needs and preferences, determining and initiating appropriate calorie restriction, incorporating physical activity if possible, and most importantly, tailoring the plan to the pet and pet owners to increase adherence. Understanding weight loss in the broader context of human–animal relationships allows veterinary staff to effectively develop and support successful treatment plans.

Non-steroidal anti-inflammatory drugs are extensively used in veterinary practice for the management of both acute and chronic pain. While they are generally fairly effective analgesics, they also have a spectrum of potential side effects ranging from mild to life threatening. This article — the first in a series of two — will discuss how the pharmacology of these agents produces their therapeutic effects, while the second article will expand on their side effects and contraindications.

During lethargic sheep or goat consultation, obstructive urolithiasis is a differential diagnosis to be specifically investigated and ruled out rather than a chance problem of occasional occurrence. The problem arises often as a primary dietary-induced disorder, but can also develop after an acute dehydrating illness, indigestion and even the result of direct urinary tract trauma. Complete obstruction is recognised much more commonly in the male than the female, although uroliths may form and cause inflammatory clinical signs in either sex. A history of stranguria, vocalisation, waxing and waning lethargy are regular historical complaints from the client. Stranguria is often misinterpreted as tenesmus or intestinal obstruction. Signalment, history, and physical examination are often sufficient for diagnosis, however some additional diagnostic tests such as ultrasound, bloodwork and abdominocentesis can assist in confirmation, therapeutic planning and prognosis. Multiple treatment options have been described for clinical cases, however, with the cost of individual treatment and limitations of success, prevention should always be part of overall case management.

With a growing number of anti-epileptic medications becoming available on the market, it is easy to loose track of how we should best treat our seizuring patients. This article provides an overview of the three first-line anti-epileptic medications, and guidelines for their safe use.

Veterinary nurses and clinicians should be familiar with common toxicants so that they can ask potential questions about the patient's history, including clinical signs and access to potentially toxic agents. This article outlines some of the toxicants commonly identified in small animal practice, including human medications, such as antidepressants, sleeping pills and paracetamol, household products, such as chocolate, grapes and antifreeze, and poisonous plants. Early diagnosis is essential to prompt immediate management.

Melorheostosis is a rare, benign connective tissue disorder affecting both bone and soft tissues. Its insidious and variable presentation makes it a challenging clinical diagnosis. We describe the case of a patient presenting with monomelic involvement including significant contractures of the left upper extremity. This case illustrates the functional morbidity associated with melorheostosis as well as its characteristic (i.e. radiographs with flowing hyperostosis) and more rare (i.e. local gigantism) findings. Crawford MD, Eward WC. What is the Diagnosis? The Duke Orthop J 2015;5(1):70-72.

Proton-Pump Inhibitors (PPIs) have changed the therapy of numerous upper gastrointestinal tract disorders; but their use is not without risk of adverse effects. Recent studies suggest more serious adverse events with chronic use of PPIs. Because of these risks, clinicians should reassess individual patient’s needs for chronic PPI therapy.

Plague is a well-known disease caused by Yersinia pestis, with the potential to cause significant morbidity and mortality in humans and major public health impacts. Many animal species are sensible to the disease and some play important epidemiological role in sylvatic and domestic cycles. Since ancient pandemics, the disease never disappeared and nowadays continues to represent a threat to humans and animals. Recent reports of antibiotic resistance and potential use in bioterrorism recall adequate awareness by human medicine and veterinary professionals.