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Animals use a variety of complex signaling mechanisms to convey an array of information that can be detected by conspecifics and heterospecifics. Receivers of those signals perceive that information and use it to direct their subsequent actions. Thus, communication such as that which occurs between senders and receivers of vocal communication signals can be a powerful model in which to investigate the neural basis of sensory perception and action initiation that underlie decision-making. In this study, we investigated how female songbirds perceive the quality of acoustic signals (songs) performed by males and use that information to express preference for one song among many possible alternatives. We use behavioral measurement of song preference before and after lesion-induced alteration of activity in an auditory processing area (caudal nidopallium, NC) for which we have previously described its interconnections with other auditory areas and downstream reward pathways. Our findings reveal that inactivating NC does not change a female’s ability or willingness to perform behavioral indicators of mate choice, nor does it change their ability to identify the songs of individual males. However, lesioning NC does induce a decrease in the strength of song preference for specific males more than others. That decrease does not result in a complete elimination of preference, as female preferences for specific males are still evident but not as strongly expressed after lesioning of NC. Taken together, these data indicate that NC plays a role in a female’s strength of preference in song evaluation and mate choice, and activity in NC is an important facet of mate choice.

The fifth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was held on May 17, 2022. The theme of this year’s summit was ‘Academic-Community Partnerships: Change Agents for Advancing Health Equity.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity, and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, and individuals involved in talent acquisition and development, such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States as well as from Saudi Arabia. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows, and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse, encompassing disparities in relation to maternal and child health (MCH), immigrant health, cancers, vaccination uptakes, and COVID-19 infections. Various solutions were ardently presented to address these disparities, including community engagement and partnerships, improvement in health literacy, and the development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research, and cultural competence as they relate to minority health issues and social determinants of health. The year’s summit was a great success! Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have attempted to stop the spread of blood-borne pathogens by issuing several recommendations and regulations. However, unless healthcare workers comply with these standards, they are not effective. In the anesthesia care environment, the anesthetist is responsible for ensuring that the equipment is clean, and disinfected, before use. We studied the prevalence of visible and occult blood on 6 types of anesthesia and monitoring equipment identified as ready for use in 28 operating suites, in 2 facilities.The sample consisted of 336 observations of the 6 types of equipment. The equipment was inspected for visible blood and then tested for occult blood using a 3-stage phenolphthalein test. Of the 336 observations, 110 (32.7%), were positive for occult blood with only 6 showing visible blood. The presence of blood on this equipment may be in direct violation of the OSHA Bloodborne Pathogen Standard and the infection control guidelines of the American Association of Nurse Anesthetists. Furthermore, the presence of blood on this equipment may increase the risk for nosocomial and occupational exposure to viral and bacterial pathogens. Recommendations were mode to decrease the risks from this contamination by redesigning equipment, increasing the use of disposable equipment, and ensuring compliance with effective infection control practices. [ABSTRACT FROM AUTHOR]

In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection.

The purpose of this investigation was to evaluate the effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures. Forty-four adults scheduled for head and neck procedures were randomly assigned into 2 groups for this single-blind investigation. Anxiety and baseline pain levels were documented preoperatively. Both groups received 28 minutes of privacy, during which subjects in the experimental group listened to a guided imagery compact disk (CD), but control group patients received no intervention. Data were collected on pain and narcotic consumption at 7- and 2-hour postoperative intervals. In addition, discharge times from the postoperative anesthesia care unit (PACU) and the ambulatory procedure unit and patient satisfaction scores were collected. The change in anxiety levels decreased significantly in the guided imagery group (P = .002). At 2 hours, the guided imagery group reported significantly less pain (P = .041). In addition, length of stay in PACU in the guided imagery group was an average of 9 minutes less than in the control group (P = .055). The use of guided imagery in the ambulatory surgery setting can significantly reduce preoperative anxiety, which can result in less postoperative pain and earlier PACU discharge times. [ABSTRACT FROM AUTHOR]

This report documents complications in false pilchard Harengula clupeola and scad Decapterus macarellus associated with a salinomycin (60 mg kg-1) and amprolium (100 mg kg-1) gel feed treatment, along with prolonged temperature increase, for an Enteromyxum leei outbreak in a salt water, mixed species, public aquarium exhibit. Shortly after administration, a mass mortality event ensued where hundreds of false pilchards and a few scad died. Medicated gel feed was noted within the gastrointestinal tracts of all affected fish. Microscopic lesions consistently involved myodegeneration and necrosis of the gastric muscularis layer and myocardium. Salinomycin was detected in multiple tissues while amprolium was largely limited to the stomach. Based upon the clinical, pathological, and toxicologic findings, the mortality event was attributed to salinomycin toxicity. False pilchards and scad were the only species affected, suggesting a species-specific sensitivity.

Cold stress is the leading cause of mortality in West Indian manatees Trichechus manatus in the northcentral Gulf of Mexico. This report describes an adult male manatee that stranded alive with signs of cold stress in Alabama (USA) waters in January 2022 and died during the rescue intervention. Postmortem examination and histopathologic review revealed multiple contributors to death. While the animal had evidence of cold stress syndrome, there was aortic stenosis and concentric left ventricular hypertrophy as well as an esophageal foreign body (plastic bag). Main findings from blood analysis indicated systemic inflammation and possible disseminated intravascular coagulation. Histopathologic findings from the cardiovascular system included aortic fibromuscular dysplasia, mitral and tricuspid valve endocardiosis, left ventricular myocardial hypertrophy, and right myocardial atrophy. A cause of the cardiovascular findings was not determined. This report is the first to document a case of cold stress syndrome complicated by aortic stenosis and esophageal occlusion in this species.

Over the course of an approximately 11-month period, an outdoor, freshwater, mixed species, recirculating, display system at a public aquarium experienced intermittent mortalities of channel catfish ( Ictalurus punctatus ) and blue catfish ( I. furcatus) . Catfish acutely presented for abnormal buoyancy, coelomic distention, and protein-rich coelomic effusion. Gross lesions typically involved massive coelomic distension with protein-rich effusion, generalized edema, and gastric hemorrhage and edema. Microscopically, primary lesions included renal tubular necrosis, gastric edema with mucosal hemorrhages, and generalized edema. Aerobic culture and virus isolation could not recover a consistent infectious agent. Intracoelomic injection of coelomic effusion and aspirated retrobulbar fluid from a catfish into naïve zebrafish (bioassay) produced peracute mortality in 3 of 4 fish and nervous signs in the fourth compared with 2 saline-injected control zebrafish that had - no mortality or clinical signs. Kidney tissue and coelomic effusion were submitted for gas chromatography tandem mass spectrometry by multiple reaction monitoring against laboratory standards, which detected the presence of multiple pyrethroid toxins, including bioallethrin, bifenthrin, trans-permethrin, phenothrin, and deltamethrin. Detection of multiple pyrethroids presumably reflects multiple exposures with several products. As such, the contributions of each pyrethroid toward clinical presentation, lesion development, and disease pathogenesis cannot be determined, but they are suspected to have collectively resulted in disrupted osmoregulation and fluid overload due to renal injury. Pesticide-induced toxicoses involving aquarium fish are rarely reported with this being the first description of pyrethroid-induced lesions and mortality in public aquarium-held fish., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bayesian inference and decision analysis can be used to identify the most probable differential diagnosis and use those probabilities to identify the best choice of diagnostic or treatment among several alternatives. In this retrospective case analysis, we surveyed three experts on the prior probability of several differential diagnoses, given the signalment and history of a ferret presenting for lethargy and anorexia, and the conditional probability of different clinical findings (physical, bloodwork, imaging, etc.), given a diagnosis. Using these data and utility estimates provided by other clinicians, we constructed a decision tree to retrospectively identify the optimal treatment choice between exploratory laparotomy and medical management. We identified medical management as the optimal choice, in contrast to the original clinical team which performed an exploratory laparotomy. We discuss the potential cognitive biases of the original clinical team. We also discuss the strengths, e.g., shared decision making, and limitations of a Bayesian decision analysis in the veterinary clinic. Bayesian decision analysis can be a useful tool for retrospective case analysis and prospective decision making, especially for deciding on invasive interventions or end-of-life care. The dissimilarity of expert-derived probability estimates makes Bayesian decision analysis somewhat challenging to apply, particularly in wide-ranging specialties like zoological medicine.

One challenge in avian embryology is establishing a standard developmental timetable, primarily because eggs incubated for identical durations can vary in developmental progress, even within the same species. For remedy, avian development is classified into distinct stages based on the formation of key morphological structures. Developmental stages exist for a few galliform species, but the literature is lacking a description of normal stages for California valley quail (Callipepla californica). Thus, the objective of this study was to stage and document the morphological and structural development of California valley quail. Over two laying seasons, 390 eggs were incubated at 37.8֯ C in 60% RH for ≤23 days. Eggs were opened every ≤6 hours to document embryonic development, including, blastoderm diameter, anterior angle of nostril to beak tip, and lengths of wing, tarsus, third toe, total beak, total foot, and embryo. California valley quail embryos were staged and compared to domestic chicken (Gallus gallus domesticus), the staging standard for galliformes, as well as Japanese quail (Coturnix japonica), blue-breasted quail (Synoicus chinensis) and northern bobwhite quail (Colinus virginianus). This study produced the first description of the 43 normal stages of development for California valley quail. Compared with other galliformes, the California valley quail has a different number of stages and displays developmental heterochrony in stages 1-24, and morphological and developmental differences in stages 25-hatch. The observed differences emphasize the importance of staging individual avian species instead of relying on poultry animal models or close relatives for developmental reference. This is extremely important in species-specific embryological studies that evaluate critical windows of development or evaluate the impacts of environmental change on avian development. This study also suggests that staging frequencies of ≤6 hours and egg transport protocols should be standardized for future staging studies., Competing Interests: The authors have declared that no competing interests exist.

Iguanas are the most endangered family of reptiles, with 77% categorised as threatened or near threatened. Further, Cyclura is the most endangered reptile genus, with all 12 species considered threatened. Therefore, it is vital that we develop assisted reproductive technologies for Cyclura spp. to enhance their conservation efforts. The goals of this study were to collect semen, and to measure testicle size and testosterone concentrations in Grand Cayman rock iguana hybrids (Cyclura lewisi ×nubila (CLN)) and rhinoceros rock iguanas (Cyclura cornuta (CC)). A prospective longitudinal study was performed in 9.0 CLN and 9.0 CC during their reproductive season in southern Florida (February-July). Serial testicle ultrasound measurements and plasma testosterone concentrations were collected monthly. Testicle measurements (length (L), width (W), height (H)) were collected and testicle volume (V ) was estimated using the equation V =0.52(LW 2 ). There were significant differences in testicle L, W, H and V for both species. Testicle size peaked for CLN and CC in April and May respectively. Plasma testosterone concentrations increased from baseline during February, March and April in CLN and in March, April and May in CC. Ultrasound testicle measurements could be used to predict when to collect semen in these seasonally monocyclic iguanas.

Biodiversity loss is the greatest environmental problem threatening ecosystem, animal, and human health. Anthropogenic induced changes to climate, habitat, disease, species distributions, poaching, and unsustainable trade have accelerated extinction rates in all vertebrates, including reptiles. Preventing reptile extinctions will require humans to acknowledge these losses and develop ex situ and in situ plans to preserve them. Assisted reproductive technologies (ART) are management tools used to protect numerous vertebrate taxa; however, progress in developing ART for reptiles has lagged. Creating functional and sustainable reptile ART will strengthen our conservation capacity by capturing genetic material from select individuals to overcome natural or manmade boundaries. Utilising short-term gamete storage and genome resource banking, in conjunction with timed artificial insemination (AI) or ex ovo incubation, could lead to profound advances in reptile conservation, mitigating the loss of reptile biodiversity. In this article, we review ART reptile research completed since the 1970s. Topics include AI, hormonal control of reproduction, gamete collection, gamete storage, and genome resource banking. Additionally, we review the potential application of advanced reproductive methodologies, including in vitro /ex ovo fertilisation, intracytoplasmic sperm injection, cloning (somatic cell nuclear transfer), and genetic editing.

Objective: To measure plasma and tissue activities of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase (AST), creatine kinase, and γ-glutamyltransferase in 2 snake species., Animals: 6 banded water snakes (Nerodia fasciata) and 6 diamondback water snakes (Nerodia rhombifer)., Procedures: Blood was collected via the ventral tail vein to measure plasma enzyme activities. Animals were then euthanized, and samples of 9 tissues were collected from each snake: skeletal muscle, cardiac muscle, liver, spleen, lung, kidney, testicle, pancreas, and gallbladder. Tissues were frozen for 30 days, then homogenized and processed. Supernatants were collected and analyzed within 24 hours of processing. A linear mixed model was used to determine differences in enzyme activity between tissues and species and assess interactions between tissues and species., Results: Activities of all enzymes were found to differ significantly among tissues. There were also significant differences between species for all enzyme activities, except AST activity. The kidney had the highest alanine aminotransferase and γ-glutamyltransferase activities. Alkaline phosphatase activity was significantly highest in liver and kidney tissues than in other tissue. Creatine kinase activity was highest in skeletal muscle, followed by cardiac muscle and kidney. AST activity was present in all tissues evaluated, but was highest in liver, kidney, and cardiac muscle in both species., Clinical Relevance: Results reinforced the importance of characterizing the origin of tissue enzymes in reptiles to improve our understanding of biochemistry results and highlighted the differences that can exist in tissue enzyme activities between closely related species.

Background: Reliable biomarkers for monitoring disease progression and management in dogs with acute pancreatitis have not been described., Objective: To determine if serum concentrations of canine pancreatic lipase immunoreactivity (cPLI) and C-reactive protein (CRP) can be used as biomarkers for disease progression in hospitalized dogs with acute pancreatitis., Animals: Thirteen hospitalized dogs with acute pancreatitis diagnosed based on clinical signs, serum cPLI concentrations, and imaging findings were enrolled., Methods: Serum cPLI and CRP concentrations were determined before and then daily during hospital management and 1 week after hospital discharge. Modified canine activity index (MCAI) and canine acute pancreatitis clinical severity index (CAPCSI) scores were calculated daily for each patient while hospitalized., Results: The MCAI scores (P = .03) but not CAPCSI scores (P = .31) were significantly different between dogs that survived to discharge (n = 11) and those that did not (n = 2). Serum cPLI concentration was positively correlated with MCAI (rho = 0.42; P = .01). Serum CRP concentration also was positively correlated with the MCAI (rho = 0.42, P = .01)., Conclusions: Serum cPLI and possibly CRP could be used as objective biomarkers for clinical changes in hospitalized dogs with acute pancreatitis. Additional studies involving larger numbers of dogs would be warranted to evaluate the broader impact of these findings., (© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Reptiles are highly susceptible to anthropogenic activities as a result of their narrow geographical ranges and habitat specialization, making them a conservation concern. Geckos represent one of the mega-diverse reptile lineages under pressure; however, limited assisted reproductive technologies currently exist for these animals. Exogenous pregnant mare serum gonadotropin (PMSG) has been found to exhibit follicle stimulating hormone-like action and has been routinely used to alter reproductive hormones of vertebrates in assisted reproductive protocols. The purpose of this study was to determine the effects of serial injections of 20 IU and 50 IU PMSG on circulating testosterone concentrations, testicular dynamics, and semen production in a model species of gecko. Twenty-four captive-bred, adult, male leopard geckos ( Eublepharis macularius ) were divided into three treatment groups and administered a once-weekly injection of either PMSG or saline for a total of nine weeks. Ultrasonographic testicular measurements, electrostimulation for semen collection, and venipuncture were performed on days 0, 21, 42, and 63. Right unilateral orchidectomies and epididymectomies were performed in all animals on day 63; tissues were submitted for histopathology. PMSG treated geckos had significantly higher testicular volumes and weights, spermatozoa motility, and spermatozoa concentrations compared with controls. However, there were no significant differences in testosterone concentrations by treatment or time. Under the conditions outlined, PMSG is effective at stimulating spermatogenesis and increasing testicular size, but not effective at increasing testosterone concentrations in the leopard gecko between October-December in the Northern hemisphere.

The aim of this study of serpentovirus infection in captive snakes was to assess the susceptibility of different types of snakes to infection and disease, to survey viral genetic diversity, and to evaluate management practices that may limit infection and disease. Antemortem oral swabs were collected from 639 snakes from 12 US collections, including 62 species, 28 genera, and 6 families: Pythonidae ( N = 414 snakes; pythons were overrepresented in the sample population), Boidae (79), Colubridae (116), Lamprophiidae (4), Elapidae (12), and Viperidae (14). Infection was more common in pythons (38%; 95% CI: 33.1-42.4%), and in boas (10%; 95% CI: 5.2-18.7%) than in colubrids (0.9%, 95% CI: <0.01-4.7%); infection was not detected in other snake families (lamprophiids 0/4, 95% CI: 0-49%; elapids 0/12, 95% CI: 0-24.2%; and vipers 0/14, 95% CI: 0-21.5%), but more of these snakes need to be tested to confirm these findings. Clinical signs of respiratory disease were common in infected pythons (85 of 144). Respiratory signs were only observed in 1 of 8 infected boas and were absent in the single infected colubrid. Divergent serpentoviruses were detected in pythons, boas, and colubrids, suggesting that different serpentoviruses might vary in their ability to infect snakes of different families. Older snakes were more likely to be infected than younger snakes ( p -value < 0.001) but males and females were equally likely to be infected (female prevalence: 23.4%, 95% CI 18.7-28.9%; male prevalence: 23.5%, 95% CI 18-30.1%; p -value = 0.144). Neither age ( p -value = 0.32) nor sex ( p -value = 0.06) was statistically associated with disease severity. Longitudinal sampling of pythons in a single collection over 28 months revealed serpentovirus infection is persistent, and viral clearance was not observed. In this collection, infection was associated with significantly increased rates of mortality ( p -value = 0.001) with death of 75% of infected pythons and no uninfected pythons over this period. Offspring of infected parents were followed: vertical transmission either does not occur or occurs with a much lower efficiency than horizontal transmission. Overall, these findings confirm that serpentoviruses pose a significant threat to the health of captive python populations and can cause infection in boa and colubrid species., (Copyright © 2019 Hoon-Hanks, Ossiboff, Bartolini, Fogelson, Perry, Stöhr, Cross, Wellehan, Jacobson, Dubovi and Stenglein.)

Investigation into antemortem semen collection methods in reptiles is required to counteract anthropogenic induced reptile biodiversity loss and to further develop assisted reproductive technologies in reptiles. The purpose of this study was to evaluate whether repeated electroejaculation under anesthesia could be done safely in the veiled chameleon ( Chamaeleo calyptratus ). Electroejaculation under anesthesia (alfaxalone 15 mg/kg intravenously) was performed once weekly over a 4-wk period in 12 Chamaeleo calyptratus . External vent appearance and cloacoscopy was performed prior to and after electroejaculation to assess the effect of the electroejaculation on the external and internal anatomy. Hematological and chemistry values were evaluated prior to the study and afterwards. Semen collection was successful in 50% of the electroejaculation events. Cloacoscopy images scores were significantly higher between the pre- and postelectroejaculation events for each week. No significant difference was observed between study week 1 prior to electroejaculation and study week 4 after electroejaculation in vent external morphology ( P = 0.157), and internal cloacal scoring ( P = 0.058). A significant increase in the white blood cell counts ( P = 0.015), absolute heterophil counts ( P = 0.02), absolute monocyte counts ( P = 0.003), and albumin ( P = 0.038) was observed between the pre- and postejaculation sampling periods. Aspartate aminotransferase ( P = 0.001) and potassium ( P = 0.036) decreased significantly between the pre- and postsampling periods. Vent image scores were significantly higher ( P = 0.046) between the pre- and postsampling images collected during week 1; however, there were no significant differences noted between pre- and postsample images for weeks 2 ( P = 0.063), 3( P = 0.083), or 4 ( P = 0.083). Serial electroejaculation procedures under alfaxalone anesthesia can be performed safely in veiled chameleons. Although changes were observed in the complete blood count and biochemistry results, these changes were determined to not be clinically significant. The results of this study demonstrate that antemortem assisted reproductive techniques such as electroejaculation can be safely used repeatedly.

The objective of this study was to compare surface, esophageal, and cloacal temperatures in awake iguanas, chameleons, and snakes at two different ambient temperatures and in alligators at one ambient temperature. Surface, esophageal, and cloacal temperatures were measured in all animals twice, with exception of the alligators, where temperatures were taken once. The first set of temperature readings was done at lower environmental temperature. An analysis of variance (ANOVA) with a mixed-effect model was used to analyze the temperature difference between esophageal and cloacal temperature against each other, and against surface temperature. Significance was set at P < 0.05. In all animals, surface, esophageal, and cloacal temperatures increased significantly ( P < 0.0001) with increased ambient temperature. Esophageal and cloacal temperature were not significantly different from each other in iguanas and chameleons at lower environmental temperature or in snakes and chameleons at high ambient temperature. In snakes, esophageal temperature 26.1 ± 1.6°C was significantly higher than cloacal temperature 25.2 ± 0.9°C ( P = 0.0016) at lower ambient temperature. In alligators no difference between esophageal and cloacal temperature was observed at the given ambient temperature. Surface temperature was significantly lower than esophageal and cloacal temperature in all species investigated, except iguanas at lower ambient temperature. The results of this study suggest that in healthy awake iguanas and chameleons at any ambient temperature and in snakes at high ambient temperature, cloacal temperatures are reflective of esophageal temperature in the species evaluated. In alligators, rectal temperature reflected esophageal temperature at the given ambient temperature. Surface temperature in contrast was underestimating esophageal temperature in all species investigated., (Copyright 2019 by American Association of Zoo Veterinarians.)

The expansion of native mass spectrometry (MS) methods for both academic and industrial applications has created a substantial need for analysis of large native MS datasets. Existing software tools are poorly suited for high-throughput deconvolution of native electrospray mass spectra from intact proteins and protein complexes. The UniDec Bayesian deconvolution algorithm is uniquely well suited for high-throughput analysis due to its speed and robustness but was previously tailored towards individual spectra. Here, we optimized UniDec for deconvolution, analysis, and visualization of large data sets. This new module, MetaUniDec, centers around a hierarchical data format 5 (HDF5) format for storing datasets that significantly improves speed, portability, and file size. It also includes code optimizations to improve speed and a new graphical user interface for visualization, interaction, and analysis of data. To demonstrate the utility of MetaUniDec, we applied the software to analyze automated collision voltage ramps with a small bacterial heme protein and large lipoprotein nanodiscs. Upon increasing collisional activation, bacterial heme-nitric oxide/oxygen binding (H-NOX) protein shows a discrete loss of bound heme, and nanodiscs show a continuous loss of lipids and charge. By using MetaUniDec to track changes in peak area or mass as a function of collision voltage, we explore the energetic profile of collisional activation in an ultra-high mass range Orbitrap mass spectrometer. Graphical abstract ᅟ.

Malignant hyperthermia (MH) crises may induce morbidity or death in MH-susceptible (MHS) individuals. The only sensitive method of determining susceptibility is the caffeine-halothane contracture test, requiring muscle biopsy. Early research on MH demonstrated an abnormal response to catecholamines in MHS individuals. The purpose of this study was to determine whether MHS B lymphocytes would demonstrate an increased sensitivity to norepinephrine as indicated by an adrenergic augmentation of intracellular calcium ion (Ca 2+ ) accumulation, to possibly develop a less invasive laboratory assay for determining MH susceptibility. The fluorescent Ca 2+ indicator dye fura-2 acetoxymethyl was used to identify Ca 2+ flux within Epstein-Barr virus- immortalized MH-negative (MHN) and MHS B cells exposed to the RyR1 agonist 4-chloro-m-cresol (4-CmC) before and after administration of 1 μM of norepinephrine. In the presence of 4-CmC and norepinephrine, the area under the curve dose responses were significantly elevated in MHS B cells compared with MHN B cells (F[1,10] = 27.37; P < .01). Epstein-Barr virus-immortalized B cells from MHS humans displayed an increased sensitivity to norepinephrine compared with those from MHN individuals. These data suggest that an abnormal response to exogenous norepinephrine could potentially be used to develop a diagnostic laboratory assay to determine MH susceptibility., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)

Reptiles have the anatomic and physiologic structures needed to detect and perceive pain. Reptiles are capable of demonstrating painful behaviors. Most of the available literature indicates pure μ-opioid receptor agonists are best to provide analgesia in reptiles. Multimodal analgesia should be practiced with every reptile patient when pain is anticipated. Further research is needed using different pain models to evaluate analgesic efficacy across reptile orders., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Evidence-based medicine allows veterinarians to practice high-quality medicine, because the basis for all decision making is quantitative, objective, and reproducible. Case reports and case series are limited in their scope and application. Cross-sectional studies, likewise, cannot provide answers to specific variable testing with a temporal application. It is essential for the reptile specialty to expand into case-control studies, cohort studies, and experimental/intervention studies. Unfortunately, much of the reptile literature remains limited to descriptive studies. This article reviews current evidence-based topics in reptile medicine and shares how everyone practicing in the field can contribute to improving this specialty., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Chelonian reproductive medicine is an extremely important facet to ensuring captive populations for the pet trade and conservation efforts around the globe. This article covers basic chelonian reproductive anatomy and physiology, natural history, behavior, and sexing chelonians, in addition to discussing reproductive disorders that are commonly seen by veterinarians. Reproductive disorders covered include infertility, dystocia, follicular stasis, egg yolk coelomitis, phallus prolapse, and reproductive neoplasia. It is hoped that this information will allow clinicians to recognize, understand, and successfully treat reproductive disorders in chelonians, thus providing the best available care for our chelonian patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Chronic noncancer pain (CNCP) in military and veteran populations mirrors the experience of chronic pain in America; however, these two populations have unique characteristics and comorbid conditions such as traumatic brain injuries, postconcussive syndrome, posttraumatic stress disorder, and behavioral health disorders that complicate the diagnosis and treatment of chronic pain. Military members and veterans may also be stigmatized about their conditions and experience problems with integration back into healthy lifestyles and society as a whole following deployments and after military service. The military and veteran health care systems have made chronic pain a priority and have made substantial strides in addressing this condition through advances in practice, education, research, and health policy. Despite this progress, significant challenges remain in responding to the wide-spread problem of chronic pain. The purpose of this article is to: (a) examine the state of CNCP in military and veteran populations; (b) discuss progress made in pain practice, education, research, and health policy; and (c) examine research, evidence-based practice guidelines, and expert consensus reports that are foundational to advancing pain care and improving health for military service members and veterans with CNCP. In addition, recommendations are proposed to address this widespread health problem through the expanded use of advanced practice registered nurses, the implementation of models of care, and use of national resources to educate health care providers, support practice, and promote effective pain care., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To examine the longitudinal association between physical performance and risk of dementia in individuals aged 90 and older without dementia., Design: Population-based longitudinal study., Settings: The 90+ Study, Laguna Woods, California., Participants: Men n = 176 and women n = 402 without dementia from The 90+ Study (n = 578, mean age 93.3). At baseline, 54% of participants were cognitively normal, and 46% had cognitive impairment, no dementia., Measurements: Physical performance measures (4-m walk, 5 chair stands, handgrip, standing balance) were scored from 0 (unable to perform) to 4 (best performance). The outcome was dementia, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Hazard ratios (HRs) for dementia in relation to baseline physical performance were estimated using Cox regression after adjustment for potential confounders. HRs and P-values for the overall Wald chi-square are reported to show the magnitude of each physical performance measure and the strength of the association between each measure and incident dementia., Results: Poor physical performance in most measures was associated with greater risk of incident dementia over a mean follow-up of 2.6 years (range 0.6-9.0 years). After controlling for potential confounders, standing balance had the strongest association with incident dementia (HRs = 1.9-2.5, overall P = .02), followed by 4-m walk (HRs = 1.1-1.8, overall P = .04) and handgrip (HRs = 1.0-2.0, overall P = .03). The association with five chair stands was not significant. In a subanalysis limited to cognitively normal participants, HRs were attenuated, but most remained in the same direction., Conclusion: Poor physical performance is associated with risk of developing dementia over an average 2.6-year follow-up in the oldest-old, indicating that poor physical performance may be an early sign of late-age dementia., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Three koalas (Phascolarctos cinereus) presented with moderate to severe interproximal space accumulation with Eucalyptus spp. at the San Diego Zoo. Premise trimodal composite was used to create dental onlay bridge-like prostheses to eliminate open, enlarged interproximal spaces. The prostheses prevented further leaf material accumulation within the interproximal spaces and consequently reduced periodontal disease. Aesthetically, the prosthesis replicates normal tooth coloration and appearance and wears at a similar rate to surrounding teeth. Prosthetic repair or replacement may be required, so periodic examination every 3-6 mo is recommended.

Early research in malignant hyperthermia (MH) focused on the autonomic nervous system (ANS) as a primary trigger of the syndrome. This hypothesis was based on the initial signs and symptoms of MH such as tachycardia, cardiac arrhythmias, hypertension, and signs of increased metabolism in patients who developed MH. Supporting these early links between MH and the ANS were case reports from anesthesia providers who reported that patients who subsequently developed MH after a nontriggering previous anesthetic had appeared unusually stressed prior to the surgical procedure in which they triggered. There is no disagreement in the scientific community that a primary disorder in MH lies in the inability to control myoplasmic calcium levels in skeletal muscles. However, considering the variability in genetic and clinical presentation, the timing of intraoperative triggering, and the unexplained phenomenon of nonanesthetic triggering, the identification of cofactors in MH triggering remains paramount. A careful review of existing research supports the hypothesis that the autonomic nervous system plays a significant role as a cofactor in the triggering and progression of an MH episode. If a differentiation can be made and a link can be demonstrated between abnormalities in receptor sensitivity for or release, reuptake, or metabolism of catecholamines in malignant hyperthermia susceptible individuals, we may be able to use these as additional markers/predictors of disease.

Occurrence of the home disadvantage in professional ice hockey was examined by analyzing shootout data from 2005 through 2008. Results indicated that teams involved in shootouts playing at their home arenas did not lose significantly more games at home than on the road. Results did not support the hypotheses that emphasize the roles of physical contact and diffusion of responsibility in accounting for past failures to find the home disadvantage in professional ice hockey.

Study Design: Controlled laboratory study., Objectives: To measure the architectural properties of rat supraspinatus muscle after a complete detachment of its distal tendon., Methods: Supraspinatus muscles were released from the left humerus of 29 Sprague-Dawley rats (mass, 400-450 g), and the animals were returned to cage activity for 2 weeks (n=12), 4 weeks (n=9), or 9 weeks (n=8), before euthanasia. Measurements of muscle mass, pennation angle, fiber bundle length (sarcomere number), and sarcomere length permitted calculation of normalized fiber length, serial sarcomere number, and physiological cross-sectional area., Results: Coronal oblique sections of the supraspinatus confirmed surgical transection of the supraspinatus muscle at 2 weeks, with reattachment by 4 weeks. Muscle mass and length were significantly lower in released muscles at 2 weeks, 4 weeks, and 9 weeks. Sarcomere lengths in released muscles were significantly shorter at 2 weeks but not different by 4 weeks. Sarcomere number was significantly reduced at 2 and 4 weeks, but returned to control values by 9 weeks. The opposing effects of smaller mass and shorter fibers produced significantly smaller physiological cross-sectional area at 2 weeks, but physiological cross-sectional area returned to control levels by 4 weeks., Conclusions: Release of the supraspinatus muscle produced early radial and longitudinal atrophy of the muscle. The functional implications of these adaptations would be most profound at early time points (particularly relevant for rehabilitation), when the muscle remains smaller in cross-sectional area and, due to reduced sarcomere number, would be forced to operate over a wider range of the length-tension curve and at higher velocities, all adaptations resulting in compromised force-generating capacity. These data are relevant to physical therapy because they provide tissue-level insights into impaired muscle and shoulder function following rotator cuff injury.

Background: Chronic rotator cuff tears are often associated with pain or poor function. In a rat with only a detached supraspinatus tendon, the tendon heals spontaneously which is inconsistent with how tears are believed to heal in humans., Questions/purposes: We therefore asked whether a combined supraspinatus and infraspinatus detachment in the rat would fail to heal and result in a chronic injury in the supraspinatus tendon., Methods: We acutely detached the supraspinatus and infraspinatus tendons in a rat model. At 4, 8, and 16 weeks post-detachment, biomechanical testing, collagen organization, and histological grading were evaluated for the detached supraspinatus and infraspinatus tendons and compared to controls., Results: In the detached supraspinatus tendon, area and percent relaxation were increased at all time points while the modulus and stiffness were similar to those of controls at 4 and 8 weeks. Collagen disorganization increased at late time points while cellularity increased and cells were more rounded in shape. In the detached infraspinatus tendon, area and percent relaxation were also increased at late time points. However, the modulus values initially decreased followed by an increase in both modulus and stiffness at 16 weeks compared to control. In the detached infraspinatus, we also observed a decrease in collagen organization at all time points and increased cellularity and a more rounded cell shape., Conclusions: Due to the ongoing changes in mechanics, collagen organization and histology in the detached supraspinatus tendon compared to control animals at 16 weeks, this model may be useful for understanding the human chronic tendon tear., Clinical Relevance: This rat rotator cuff chronic model can be used to test hypotheses regarding injury and repair mechanisms that cannot be addressed in human patients or in cadaveric studies.

Hypothesis: This study examined the effect of multiple rotator cuff tendon tears on shoulder function in an animal model., Materials and Methods: Forty-eight Sprague-Dawley rats were divided into uninjured control, supraspinatus tendon detachment, supraspinatus+infraspinatus tendon detachment, or supraspinatus+subscapularis tendon detachment groups. Functional assessment was determined through ambulatory parameters (paw and stride measures) and range of motion prior to tendon detachment and at various time points after tendon detachment., Results: Ambulatory parameters and total range of motion, representing measures of shoulder function, were significantly altered with rotator cuff tears. The addition of a second torn rotator cuff tendon (infraspinatus or subscapularis)had further detrimental effects on animal shoulder function compared to uninjured control., Discussion: This study demonstrated functional changes in a rat rotator cuff model. Many of the permanent functional changes were likely present because the required motion used for those actions can no longer be performed. For parameters that were transient, compensation with another limb or subsidence of pain may have occurred., Conclusion: The findings in this study are consistent with the alterations in shoulder function observed with rotator cuff and other shoulder injuries in the human. Future studies using this model can begin to examine the root of the functional differences, whether it is pain, mechanical deficiency, or a combination of both, which cannot be fully studied clinically [corrected].

Rotator cuff tears are disabling conditions that result in changes in joint loading and functional deficiencies. Clinically, damage to the long-head of the biceps tendon has been found in conjunction with rotator cuff tears, and this damage is thought to increase with increasing tear size. Despite its importance, controversy exists regarding the optimal treatment for the biceps. An animal model of this condition would allow for controlled studies to investigate the etiology of this problem and potential treatment strategies. We created rotator cuff tears in the rat model by detaching single (supraspinatus) and multiple (supraspinatus + infraspinatus or supraspinatus + subscapularis) rotator cuff tendons and measured the mechanical properties along the length of the long-head of the biceps tendon 4 and 8 weeks following injury. Cross-sectional area of the biceps was increased in the presence of a single rotator cuff tendon tear (by approximately 150%), with a greater increase in the presence of a multiple rotator cuff tendon tear (by up to 220%). Modulus values decreased as much as 43 and 56% with one and two tendon tears, respectively. Also, multiple tendon tear conditions involving the infraspinatus in addition to the supraspinatus affected the biceps tendon more than those involving the subscapularis and supraspinatus. Finally, biceps tendon mechanical properties worsened over time in multiple rotator cuff tendon tears. Therefore, the rat model correlates well with clinical findings of biceps tendon pathology in the presence of rotator cuff tears, and can be used to evaluate etiology and treatment modalities., ((c) 2008 Orthopaedic Research Society.)

Although presumed, damage in the remaining (intact) rotator cuff tendons in the presence of an isolated supraspinatus tendon tear or multiple tendon tear has not been well studied. This study used an animal model of multiple rotator cuff tendon tears to investigate alterations in the remaining (intact) tendon mechanical properties at 4 and 8 weeks after injury. Twenty-four rats served as uninjured controls, whereas 72 were divided among 3 tendon detachment groups: supraspinatus tendon detachment, supraspinatus + infraspinatus tendon detachment, and supraspinatus + subscapularis tendon detachment. The remaining (intact) rotator cuff tendons had decreased mechanical properties in the presence of rotator cuff tears. The remaining (intact) subscapularis and infraspinatus tendon cross-sectional areas increased, whereas tendon modulus decreased after tears of both 1 and 2 tendons. The remaining (intact) tendon cross-sectional areas continued to increase with time after injury. These alterations could potentially lead to further tendon damage and tear progression.

Augmentation materials for rotator cuff tears, such as small intestine submucosa (SIS), have been used with the goal of improving outcome. Knowledge is limited on the use of SIS in animal models of acute and chronic rotator cuff tears. We hypothesized that the use of SIS in the surgical management of full thickness supraspinatus tears would improve histologic and biomechanical properties. Results show temporal improvements in several histologic parameters. Both acute and chronic injuries repaired with SIS have similar and increased mechanical properties respectively, compared to those repaired without SIS. In general, acute repairs with SIS were comparable to acute repairs without SIS. In chronic repairs, the use of SIS significantly reduced the cross sectional area of the healing tendon and increased the modulus. These results provide information on the use of SIS for rotator cuff repairs.

Within-patient HIV populations evolve rapidly because of a high mutation rate, short generation time, and strong positive selection pressures. Previous studies have identified "consistent patterns" of viral sequence evolution. Just before HIV infection progresses to AIDS, evolution seems to slow markedly, and the genetic diversity of the viral population drops. This evolutionary slowdown could be caused either by a reduction in the average viral replication rate or because selection pressures weaken with the collapse of the immune system. The former hypothesis (which we denote "cellular exhaustion") predicts a simultaneous reduction in both synonymous and nonsynonymous evolution, whereas the latter hypothesis (denoted "immune relaxation") predicts that only nonsynonymous evolution will slow. In this paper, we present a set of statistical procedures for distinguishing between these alternative hypotheses using DNA sequences sampled over the course of infection. The first component is a new method for estimating evolutionary rates that takes advantage of the temporal information in longitudinal DNA sequence samples. Second, we develop a set of probability models for the analysis of evolutionary rates in HIV populations in vivo. Application of these models to both synonymous and nonsynonymous evolution affords a comparison of the cellular-exhaustion and immune-relaxation hypotheses. We apply the procedures to longitudinal data sets in which sequences of the env gene were sampled over the entire course of infection. Our analyses (1) statistically confirm that an evolutionary slowdown occurs late in infection, (2) strongly support the immune-relaxation hypothesis, and (3) indicate that the cessation of nonsynonymous evolution is associated with disease progression.

Shoulder overuse injuries, especially those to the supraspinatus tendon of the rotator cuff, are common musculoskeletal disorders. Unfortunately, little is known about the disease etiology and pathogenesis. The objective of this study was to determine the levels of specific inflammatory and angiogenic markers in a rat supraspinatus tendon overuse injury model. We hypothesized that inflammation would not be present early in the overuse protocol. Conversely, we hypothesized that the overuse protocol would result in increased angiogenesis early. Increases in five-lipoxygenase activating protein, cyclooxygenase-2, vascular endothelial growth factor, and von Willebrand factor were evaluated by use of reverse transcription-polymerase chain reaction from 1 day through 16 weeks of treadmill running (overuse protocol). These results provide important information on the role of angiogenesis and inflammation in the disease process. Future studies will further evaluate the mechanisms of the disease process as well as potential targeted treatment modalities.

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood. A rat model was used to investigate the supraspinatus tendon organizational and mechanical property changes that occur with time post-injury to understand the natural injury response in the absence of repair. It was hypothesized that increased time post-injury would result in increased detrimental changes to tendon organizational and mechanical properties. Tendons were detached at the insertion on the humerus without repair and the quantitative organizational and mechanical properties were analyzed at 1, 2, 4, 8, and 16 weeks post-detachment. Tendon detachment resulted in a dramatic decrease in mechanical properties initially followed by a progressive increase with time. The quantitative collagen fiber orientation results provided corroborating support to the mechanical property data. Based on similarities in histology and mechanical properties to rotator cuff tears in humans, the animal model presented here is promising for future investigations of the tendon's natural injury response in the absence of repair.

Musculoskeletal soft tissue injuries from athletic activities are common in the rotator cuff tendons, lateral epicondyle of the elbow, the patella tendon, and the Achilles tendon. Despite the fact that the Achilles tendon is the largest and strongest tendon in the human body, it is frequently injured in the athletic setting. To study the etiology and pathogenesis of Achilles tendon injuries, our goal was to develop a model of Achilles tendon overuse by evaluating the Achilles tendons from animals subjected to the exercise protocol previously described as overuse for the supraspinatus tendon. We hypothesized that the same exercise protocol would produce injuries to the Achilles tendon as demonstrated by changes in the cross-sectional area and biomechanical properties. While a significant injury was induced into the supraspinatus tendon, we found no changes in the Achilles tendons of these exercised animals based on gross observation, geometric measurements, and mechanical testing analyses. Although surprising, there are many possible explanations for these findings including differences in potential injury mechanisms, functional capabilities of the differing tendons, and other factors.

Specialized substance abuse treatment programs have been developed for women within the past two decades. This article presents the results of a secondary analysis of a regional database of drug abuse treatment programs that compared the characteristics of women-only (WO) and mixed-gender (MG) programs across three treatment modalities. In general, WO programs differed from MG programs in their policies regarding fees, sources of payment, special populations served, services offered, and treatment capacity, process, and duration. The differences in program characteristics reflect broader societal gender differences, including women's generally lower economic status and primary responsibility for child-rearing.

One hundred fifty-two self-identified lesbian and bisexual women participated in an exploratory study of lesbian health and high-risk sexual behaviors. These women were primarily White, middle class, and college educated. The relationship of alcohol and marijuana use to high-risk sexual behaviors and involvement in past or current abusive experiences was investigated. Having been involved in coercive sexual activities was related to some high-risk sexual activities and alcohol and marijuana use. The women in this sample were engaging in high-risk sexual activities, perhaps because of a lack of HIV-risk perception among lesbians in general, and in this sample in particular. These results demonstrate the need for HIV and safer-sex education even among highly educated women and awareness of the interrelationship between drug use and unsafe sexual activities.

A number of issues are relevant to the development and use of levo-alpha-acetylmethadol (LAAM) as a treatment alternative to methadone. A brief history of methadone maintenance treatment is provided and variants of standard methadone treatment are discussed. The history and current status of LAAm are discussed, as well as its advantages over methadone. In addition, relevant clinical, research, and policy issues are addressed. LAAm has advantages over methadone specifically with regard to thrice-weekly dosing, potential to reduce HIV/AIDS risk, possible cost savings, and possible improved clinic-community relations. The effective and cost-effective implementation of LAAM as a new treatment for opioid addiction requires attention to a number of issues: (1) LAAM as an HIV prevention measure through its potential risk-reduction effects, (2) the sue of LAAM with specific high-risk subgroups, (3) causes of differential rates of treatment dropout and their amenability to intervention, (4) the role fo patient choice in long-term maintenance treatment, (5) the impact of LAAM on clinic operations, (6) the potential for LAAM as a take-home medication, and (7) the costs of implementing and sustaining LAAM maintenance services.

We have studied the effect of i.v. anaesthesia with propofol in the emulsion (Intralipid) formulation on drug distribution and metabolism in six dogs using dual-route administration of propranolol as a model compound. Each dog was studied on two consecutive days: day 1 awake and day 2 during propofol anaesthesia (6 mg kg-1 followed by an infusion of 0.8 mg kg-1 min-1). Propofol anaesthesia was associated with reduced intrinsic clearance by 40% (P less than 0.05) but no significant difference in systemic clearance or hepatic plasma flow. Propofol produced marked changes in drug distribution; volume of distribution (Vss) of propranolol increased 54% from 82.5 (SEM 7.3) litre awake to 127.3 (27) litre during propofol anaesthesia (P less than 0.05). This change was accompanied by an increase (P less than 0.05) in the free fraction of propranolol from 8.5 (0.7) % in awake to 14.0 (0.7) % in propofol-anaesthetized dogs. The combination of the effects of both drug clearance and protein binding resulted in a 65% decrease in the intrinsic clearance of unbound drug (P less than 0.05). In contrast with the effects of propofol on drug distribution, infusion of Intralipid alone in another group of six dogs had no significant effects on drug distribution, protein binding or drug metabolism. We conclude that propofol is a modest inhibitor of drug metabolism, but has major effects on propranolol distribution, possibly by changing plasma protein binding.

Nicardipine, a new dihydropyridine calcium channel blocking agent, has been shown to be effective in the management of hypertension. The adrenergic response to intravenous nicardipine as measured by changes in plasma catecholamine concentrations in seven patients undergoing treatment of postoperative hypertension is reported. Postoperative hypertension was defined as a systolic blood pressure (SBP) greater than 140 mm Hg. Nicardipine or placebo was administered in doses of 10 mg/h, 12.5 mg/h, and 15.0 mg/h for 5 minutes, 5 minutes, and 15 minutes, respectively, to achieve a therapeutic response defined as a reduction of SBP of 15% or more. Once a therapeutic response occurred, patients entered a maintenance period when the study drug infusion rate was reduced to the equivalent of 3.0 mg/h, and the dose was adjusted by 1.0 to 2.5 mg/h every 15 minutes as needed to maintain blood pressure control. Patients who did not respond to the study drug had their treatment code broken and, if on placebo, received open-label nicardipine. Blood samples were taken for the measurement of plasma norepinephrine (NE) concentrations at baseline prior to nicardipine infusion, at the time of therapeutic response, during maintenance, and after discontinuation of nicardipine. There were no significant differences between the baseline heart rate prior to nicardipine infusion and at the time of therapeutic response, during maintenance, or after discontinuation of the infusion. Mean NE concentrations at baseline prior to nicardipine infusion were 589.3 +/- 140.1 pg/mL (normal range, 75 to 480 pg/mL). Thus, hypertensive patients in the recovery room have a high degree of background sympathetic stimulation. Nicardipine did not further increase plasma NE levels.(ABSTRACT TRUNCATED AT 250 WORDS)

The 16PF was administered in either Spanish or English to 546 Anglo- or Mexican-Americans separated into three ethnicity/test language groups: Anglos tested in English, Mexican-Americans tested in Spanish, and Mexican-Americans tested in English. Multivariate and univariate statistics revealed significant differences among the three groups. The largest number of scale differences was between Anglos and Mexican-Americans tested in Spanish. The second largest number of differences was found between the two Mexican-American groups, and the smallest number of differences was found between Anglos and Hispanics tested in English.

Most patients undergoing laparoscopic procedures experience no complications; however, a major complication rate of approximately 0.3% has been documented. Cardiomyopathy is also rare. A patient who underwent laparoscopy for oocyte retrieval during in vitro fertilization/embryo transfer developed congestive heart failure and pulmonary edema. A cardiomyopathy was diagnosed subsequently.