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OBJECTIVE: To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol. ANIMALS: 105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between january 2019 and March 2020. PROCEDURES: Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes. RESULTS: 2 of 105 (1.9%) dogs regurgitated, I of 105 0.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (2 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (2 4) for both regurgitation and aspiration pneumonia. CONCLUSIONS AND CLINICAL RELEVANCE: The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Technology use in type 1 diabetes (T1D) is impacted by socioeconomic status (SES). This analysis explored relationships between SES, glycemic outcomes, and technology use. RESEARCH DESIGN AND METHODS: A cross-sectional analysis of HbA1c data from 2,822 Australian youth with T1D was undertaken. Residential postcodes were used to assign SES based on the Index of Relative Socio-Economic Disadvantage (IRSD). Linear regression models were used to evaluate associations among IRSD quintile, HbA1c, and management regimen. RESULTS: Insulin pump therapy, continuous glucose monitoring, and their concurrent use were associated with lower mean HbA1c across all IRSD quintiles (P < 0.001). There was no interaction between technology use and IRSD quintile on HbA1c (P = 0.624), reflecting a similar association of lower HbA1c with technology use across all IRSD quintiles. CONCLUSIONS: Technology use was associated with lower HbA1c across all socioeconomic backgrounds. Socioeconomic disadvantage does not preclude glycemic benefits of diabetes technologies, highlighting the need to remove barriers to technology access. [ABSTRACT FROM AUTHOR]

Background: Effective treatment options for inoperable, metastatic, or recurrent canine pheochromocytomas are lacking. In humans, specific germline mutations exist that drive the development of pheochromocytomas. Pharmaceutical blockade of these abnormalities with small molecule inhibitors are an effective treatment strategy. Similar mutations may exist in the dog, and thus, treatment with similar small molecule inhibitors may provide a survival advantage. The purpose of this study was to assess the role of toceranib phosphate in the treatment of inoperable, metastatic, or recurrent canine pheochromocytomas. Results: Retrospectively, medical records of dogs that had a diagnosis or suspect diagnosis of a pheochromocytoma were reviewed for information regarding response to toceranib phosphate and overall outcome. Five dogs were identified that fit the inclusion criteria. All five experienced clinical benefit (1 partial response, 4 stable disease). Progression-free interval (PFI) for the dog with the partial response was 61 weeks. PFI for the two dogs with stable measurable disease were 36 weeks and 28 weeks. PFI in the two dogs with stable metastatic disease were at least 11 weeks and 18 weeks. Conclusions: Based on this limited series of dogs, the results suggest that toceranib may have biological activity in dogs with primary and metastatic pheochromocytomas. Larger studies are needed to define the use and response to toceranib in dogs with gross, microscopic, and metastatic pheochromocytoma. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus (GDV) in dogs. ANIMALS 41 client-owned dogs with confirmed GDV from 2012 through 2016. PROCEDURES Medical record data were collected regarding patient signalment, diagnostic test results, gastric lavage findings, surgical findings, and short-term survival status. For all dogs, gastric decompression was performed by orogastric ingmail. tubation and gastric lavage in the same anesthetic episode. If this stage was successful, subsequent corrective surgery (laparotomy and gastropexy) was delayed and performed in a second anesthetic episode. RESULTS 6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis. Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs. The mortality rate for delayedsurgery patients was 9% (3/35). Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate. Intraoperative identification of gastric necrosis was associated with nonsurvival. Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate. CONCLUSIONS AND CLINICAL RELEVANCE The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine whether serum total thyroxine (TT4) concentration at admission to an Intensive care unit (ICU) was associated with mortality rate and duration of hospitalization for critically III dogs. ANIMALS 166 client-owned dogs that were hospitalized in the ICU of a private veterinary practice from January 2013 through December 2016 and for which serum TT4 concentration had been measured at admission. PROCEDURES Medical records were reviewed to collect data regarding patient signalment, concurrent illnesses, medications, reason for hospitalization, outcome (death, euthanasia, or survival to hospital discharge), duration of hospitalization, and initial serum TT4 concentration. RESULTS Mean age of the 166 dogs was 8.6 years (range, I to 16 years). Overall mortality rate was 15.7%, with 26 dogs failing to survive to hospital discharge. Of these 26 dogs, 7 died and 19 were euthanized. No significant association was identified between serum TT4 concentration at admission and survival to discharge (yes or no) or duration of hospitalization. Age was significantly associated with survival to discharge, with older dogs less likely to survive than younger dogs. Duration of hospitalization was also associated with survival to discharge, with longer hospital stays associated with a lower likelihood of survival to discharge. CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that serum TT4 concentration at admission to an ICU had no prognostic value in this population of critically ill dogs. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rate and complications associated with inducing emesis in dogs that have ingested foreign material. Design: Retrospective case series, 2010–2014. Setting: Private practice and referral center. Animals: Sixty‐one client‐owned dogs that had emesis induced for the treatment of ingestion of foreign material. Interventions: None. Measurements and Main Results: Emesis was successfully induced in 59 of 61 (97%) dogs administered an emetic. Of those 59 dogs, 46 (78%) produced the foreign body. There were no complications reported in any of the dogs in which emesis was successfully induced. Dogs in which emesis was successfully induced were likely to produce the foreign body (P = 0.01). Conclusion: Based on the results of this study, emesis appears to be a safe and effective means for the removal of certain gastric foreign bodies in dogs. [ABSTRACT FROM AUTHOR]

Background: The melanocortin 4 antagonist TCMCB07 is safe and effective in reversing cachexia caused by sepsis or cancer in rodents. The safety and pharmacokinetics of TCMCB07 are demonstrated in healthy beagle dogs. Hypothesis/Objectives: The objectives of this study were to investigate the safety, peak plasma concentrations, and potential for efficacy of TCMCB07 in pet dogs with naturally occurring cachexia over a 4‐week time period. Animals: Fourteen dogs with cachexia of any underlying cause, except cancer of the oral cavity or gastrointestinal tract, were eligible for enrollment with informed client consent. Methods: This study was a prospective, 1‐armed open‐label trial. Physical examination, complete blood count, chemistry panel, and owner‐assessed quality of life surveys were checked at weeks 1, 2, and 4. Due to potential for bradycardia and hypotension, Holter monitoring and blood pressure evaluations were scheduled at pre‐enrollment and week 4. Results: Fourteen dogs completed the trial. Significant changes detected included increased mean body weight (18.6‐19.5 kg, P <.02), increased body condition score (median Tufts 5‐point thin dog scale score P <.004 and WSAVA muscle condition score P <.02) and increased mean blood urea nitrogen (21.79‐30.43 mg dL−1, P <.004). On quality of life surveys, pet owners perceived their dog appeared to be panting less (P <.002) and that the general health improved (P <.03). Four dogs had a change in coat pigmentation. The peak plasma concentration of TCMCB07 in cachectic dogs was similar to that in healthy beagle dogs. Conclusions and Clinical Importance: TCMCB07 was safe and has potential efficacy in pet dogs with cachexia. [ABSTRACT FROM AUTHOR]

Aim: To determine low‐density lipoprotein cholesterol (LDL‐C) screening frequency and levels, and factors associated with elevated LDL‐C, in Australasian youth with type 1 diabetes (T1D). Methods: Data were extracted from the Australasian Diabetes Data Network (ADDN), a prospective clinical quality registry, on all T1D healthcare visits attended by young people aged 16–25 years (with T1D duration of >1 year) between January 2011 and December 2020. The primary outcomes were elevated LDL‐C > 2.6 mmol/L (100 mg/dL) and threshold for treatment: >3.4 mmol/L (130 mg/dL), according to consensus guidelines. Multivariable Generalised Estimated Equations (GEE) were used to examine factors associated with elevated LDL‐C across all visits. Results: A cohort of 6338 young people (52.6% men) were identified, of whom 1603 (25.3%) had ≥1 LDL‐C measurement documented. At last measurement, mean age, age at T1D diagnosis and T1D duration were 18.3 ± 2.4, 8.8 ± 4.5 and 8.9 ± 4.8 years, respectively. LDL‐C was elevated in 737 (46.0%) and at the treatment threshold in 250 (15.6%). In multivariable GEE elevated LDL‐C continuously was associated with older age (OR = 0.07; 0.01–0.13, p = 0.02), female sex (OR = 0.31; 0.18–0.43; p < 0.001), higher HbA1c (OR = 0.04; 0.01–0.08; p = 0.01) and having an elevated BMI (OR = 0.17, 0.06–0.39, p < 0.001). Conclusions: LDL‐C screening and levels are suboptimal in this cohort, increasing future cardiovascular complication risk. There is an urgent need to understand how healthcare services can support improved screening and management of dyslipidaemia in this population. [ABSTRACT FROM AUTHOR]

Aim: Hypertension increases complication risk in type 1 diabetes (T1D). We examined blood pressure (BP) in adolescents and young adults with T1D from the Australasian Diabetes Data Network, a prospective clinical diabetes registry in Australia and New Zealand. Methods: This was a longitudinal study of prospectively collected registry data. Inclusion criteria: T1D (duration ≥ 1 year) and age 16–25 years at last visit (2011–2020). Hypertension was defined as (on ≥ 3 occasions) systolic BP and/or diastolic BP > 95th percentile for age < 18 years, and systolic BP > 130 and/or diastolic BP > 80 mmHg for age ≥ 18 years. Multivariable Generalised Estimating Equations were used to examine demographic and clinical factors associated with BP in the hypertensive range across all visits. Results: Data from 6338 young people (male 52.6%) attending 24 participating centres across 36,655 T1D healthcare visits were included; 2812 (44.4%) had BP recorded at last visit. Across all visits, 19.4% of youth aged < 18 years and 21.7% of those aged ≥ 18 years met criteria for hypertension. In both age groups, BP in the hypertensive range was associated with male sex, injection (vs. pump) therapy, higher HbA1c, and higher body mass index. Conclusions: There is a high proportion of adolescents and young adults reported with BP persistently in hypertensive ranges. Findings flag the additive contribution of hypertension to the well-established body of evidence indicating a need to review healthcare models for adolescents and young adults with T1D. [ABSTRACT FROM AUTHOR]

Protein kinase C (PKC) is an extensive isozyme family that plays critical roles in cell growth regulation and differentiation and in specialized physiological processes such as neurotransmission. The regulation of PKC isozymes is complex not only due to the existence of isozyme-selective regulatory mechanisms but also due to the fact that multiple regulatory mechanisms may contribute to the governance of the function of a given isozyme. Most PKC isozymes require trans-phosphorylation by phosphoinositide-dependent kinase-1 (PDK1) to become catalytically competent and stimulation by lipid cofactors (in some cases in conjunction with Ca2+) to be activated. At least two PKC isozymes, d and q, can be proteolytically converted in cells to lipid-independent activated forms that participate in cell signaling. In addition, evidence is now emerging that oxidative stimuli may induce PKC activation in cells under certain conditions via tyrosine phosphorylation of the isozymes, and that under other conditions the oxidants may inactivate PKC isozymes by oxidative modification of Cys residues in the catalytic domain. Isozyme-selective binding proteins that direct the localization of PKC isozymes offer yet another level of regulatory control over PKC signaling. [ABSTRACT FROM AUTHOR]

One of the primary objectives of the Oncology Pathology Working Group (OPWG) is for oncologists and pathologists to collaboratively generate consensus documents to standardize aspects of and provide guidelines for veterinary oncologic pathology. Consensus is established through review of relevant peer‐reviewed literature relative to a subgroup's particular focus. In this article, the authors provide a critical review of the current literature for the diagnosis of, and histopathologic prognostication for, canine cutaneous and oral/lip melanocytic neoplasms, suggest guidelines for reporting, provide recommendations for clinical interpretation, and discuss future directions. This document represents the opinions of the working group and the authors and does not constitute a formal endorsement by the American College of Veterinary Pathologists, American College of Veterinary Internal Medicine or the Veterinary Cancer Society. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA1c. RESEARCH DESIGN AND METHODS: Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect models related variables to HbA1c. RESULTS: DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (interquartile range 3.2, 9.4) years of follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI 0.11,0.28; [+2.5 mmol/mol, 95% CI 1.4,3.6]; P < 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c (−0.28%, 95% CI −0.31, −0.25; [−3.1 mmol/mol, 95% CI −3.4, −2.8]; P < 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA1c. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI 1.15, 1.59; [+15.0 mmol/mol, 95% CI 12.6, 17.4]; P < 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52; [+4.7 mmol/mol, 95% CI 3.4, 5.6]; P < 0.001). CONCLUSIONS: Severe, but not mild or moderate, DKA at diagnosis was associated with a marginally higher HbA1c over time, an effect that was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher long-term HbA1c. [ABSTRACT FROM AUTHOR]

Background: Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self‐management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. Research Design and Methods: Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were individuals with T1D aged 16–25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. Results: Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol); only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B = 0.20; 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B = 0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B = −0.33, −0.45 to −0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B = −0.49, −0.59 to 0.40, p < 0.001). Conclusions: This Australasian study demonstrates widespread and persistent sub‐optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population. [ABSTRACT FROM AUTHOR]

Prader-Willi syndrome (PWS) is a rare genetic disorder characterised by neurodevelopmental delays, hyperphagia, difficulties with social communication and challenging behaviours. Individuals require intensive supervision from caregivers which may negatively affect caregiver quality of life. This study used data collected in the Australasian PWS Registry (n = 50, mean age 11.2 years) to evaluate associations between child behaviours and caregiver mental well-being. Symptoms of sleep-related breathing disorder, child depression and social difficulties were associated with poorer caregiver mental and physical well-being. Growth hormone therapy use was associated with better caregiver mental and physical well-being. Optimising management of problematic behaviours and sleep disturbances have the potential to support caregivers who are the most vital network of support for individuals affected by PWS. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate risk factors, clinical features, and prognostic indicators in guinea pigs with urolithiasis. ANIMALS 158 guinea pigs with urolithiasis. PROCEDURESMedical records of an exotics animal specialty service were searched, identifying guinea pigs with urolithiasis. Signalment, clinical data, and outcomes were recorded. Variables of interest were analyzed for statistical associations with outcome. RESULTS Overall, 54.4% (86/158) of animals survived to discharge. Median survival time was 177 days. Females (53.2%; 84/158) were more common than males (46.8%; 74/158). Males were presented younger (mean age, 3.64 years) than females (4.41 years). In 81 of 154 (52.5%) cases, animals were presented with primary urinary concerns, while 73 (47.5%) presented for nonurinary primary concerns. Females more commonly presented with distal urinary tract urolithiasis (63/84; 75%) but fared better overall with a longer median survival time (1,149 days) than males (59 days). Surgical intervention was not a risk factor for nonsurvival: however, increased age (> 4.1 years), male sex, anorexia, weight loss, and lower rectal temperature (< 37.2 00 on presentation were associated with nonsurvival. Reoccurrence was noted in 13.9% (22/158) of cases, at an average of 284 days. CLINICAL RELEVANCE Urolithiasis should always be considered a differential diagnosis forany unwell guinea pig. In particular, distal urinary tract urolithiasis should be considered in females. A poorer prognosis was associated with older, male guinea pigs, and those displaying anorexia, weight loss, and hypothermia. The need for surgical intervention should not confer a poorer outcome. Further studies are needed to determine specific risk factors and identify possible preventative measures. [ABSTRACT FROM AUTHOR]

Individuals with Prader-Willi syndrome (PWS) often have excessive daytime sleepiness and emotional/behavioral disturbances. The objective of this study was to examine whether daytime sleepiness was associated with these emotional/behavioral problems, independent of nighttime sleep-disordered breathing, or the duration of sleep. Caregivers of individuals with PWS (aged 3 to 25 years) completed the Pediatric Sleep Questionnaire (PSQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and the parent version of the Developmental Behavior Checklist (DBC-P). Sleep adequacy was adjusted for age by computing sleep duration against age-specific recommendations. The associations between ESS-CHAD and the total DBC and its subscale scores were evaluated by linear regression, adjusted for sleep-related breathing difficulties, sleep adequacy, and body mass index (BMI). There were 54 responses for individuals with PWS (including 22 males) aged 4.4–24.0 (mean 12.5) years. Daytime sleepiness predicted a substantial proportion of the variance in total DBC-P scores in the unadjusted model (28%; β = 0.028; p < 0.001) and when adjusted for sleep adequacy, BMI, and sleep-related breathing difficulties (29%; β = 0.023; p = 0.007). This relationship was not moderated by BMI Z-scores, but the relationship was more prominent for children younger than 12 years than for children older than 12 years. Conclusions: These findings provide preliminary novel evidence that daytime sleepiness may drive the expression of emotional/behavioral disturbances, and should be explored as a potential modifiable risk factor for these disturbances in PWS, particularly pre-adolescent children. What is Known: • Individuals with Prader-Willi syndrome (PWS) commonly experience excessive daytime sleepiness and exhibit emotional/behavioral disturbances. • In the typically developing population, sleepiness is associated with emotional/behavioral disturbances, independently of sleep-disordered breathing.. What is New: • This study found evidence for a direct link between daytime sleepiness and emotional/behavioral disturbances, independent of sleep-related breathing difficulties, sleep adequacy, and body mass index. • Excessive daytime sleepiness may be a modifiable risk factor for emotional/behavioral disturbances in PWS. [ABSTRACT FROM AUTHOR]