Computed tomographic angiography of a presumed acquired transhepatic portosystemic shunt in a miniature horse filly.

A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary differential diagnosis was a portosystemic shunt (PSS). Three-phase computed tomographic angiography findings were consistent with a transhepatic portosystemic shunt. Percutaneous liver biopsy confirmed severe diffuse hepatic changes, most likely due to chronic pyrrolizidine alkaloid toxicosis, and medical management was elected. Based on an extensive literature review, this is the first report of a transhepatic portosystemic collateral vessel in a horse. Computed tomographic angiography is feasible and useful for the diagnosis of PSS in miniature horses.

A biobehavioral examination of emotional eating in adolescents: Evaluating the role of acute cortisol stress reactivity in the context of a multi-method assessment of eating in response to stress.

Stress is linked to emotional eating among adolescents, which in turn increases risk for overweight/obesity (OW/OB) development and continuation. There is a lack of research disentangling chronic and acute stress as predictors of adolescent emotional eating. Further, there is a corresponding need to understand the effects of acute physiological stress reactivity within the context of adolescent emotional eating. The primary aim of this study was to examine the impact of cortisol stress reactivity on emotional eating in adolescents, above and beyond the effects of perceived chronic stress. The impact of subjective stress reactivity was also explored. Adolescents' (N = 49) intake of highly palatable snack foods was measured on separate control and stress-induction (following the Trier Social Stress Test for Children) days. A multi-method approach was used to assess objective (caloric intake) and subjective (self-report) emotional eating. Results indicated that greater cortisol reactivity, but not subjective stress reactivity, predicted subjective emotional eating, beyond the impact of chronic stress. Neither chronic stress nor subjective or objective stress reactivity predicted objective emotional eating following stress-induction. Findings point to the role of chronic stress and cortisol reactivity as risks for greater perceived emotional eating among adolescents, while elucidating differences between perceived and objective emotional eating. Future research should explore how chronic versus acute stress differentially contribute to adolescent weight management.

Computed tomographic features of an axillary liposarcoma with hepatic metastasis.

A geriatric dog presented for lethargy, dyspnea, and urinary incontinence. Thoracic radiographs demonstrated a large, mixed fat, and soft tissue opaque axillary mass and a pulmonary mass. Computed tomography (CT) further characterized these masses and revealed innumerable fat-attenuating hepatic masses and cranial mediastinal lymphadenopathy. Histopathology of the axillary and hepatic masses confirmed grade two primary axillary liposarcoma with hepatic metastasis. Cytology of the pulmonary mass was consistent with a pulmonary carcinoma. This is the first published CT description of fat-attenuating metastatic hepatic liposarcoma in a dog.

Rapid brain MRI protocols result in comparable differential diagnoses versus a full brain protocol in most canine and feline cases.

Evaluation of brain disease in veterinary patients uses a wide variety of MRI sequences. A shortened protocol that maintains consistency of interpretation would reduce radiologist reporting time, patient anesthetic time, and client cost. The aims of this retrospective, methods comparison, observer agreement study were to evaluate whether abbreviated MRI protocols alter differential diagnoses and recommendations compared to our institution's standard protocol; evaluate interobserver agreement on standard brain MRIs; and assess whether differential diagnoses change after postcontrast images. Normal and pathologic canine and feline brain MRIs were retrieved from hospital archives. Three protocols were created from each: a 5-sequence noncontrast enhanced Fast Brain Protocol 1 (FBP1); a 6-sequence contrast-enhanced Fast Brain Protocol 2 (FBP2); and an 11-sequence standard brain protocol (SBP). Three blinded veterinary radiologists interpreted FBP images for 98 cases (1 reader/case) and SBP images for 20 cases (3 readers/case). A fourth observer compared these interpretations to the original MRI reports (OMR). Overall agreement between FBPs and OMR was good (k = 0.75) and comparable to interobserver agreement for multiple reviews of SBP cases. Postcontrast images substantially altered conclusions in 17/97 cases (17.5%), as well as improved interobserver agreement compared to noncontrast studies. The conclusions reached with shortened brain protocols were comparable to those of a full brain study. The findings supported the use of a 6-sequence brain MRI protocol (sagittal T2-weighted [T2w] TSE; transverse T2w turbo spin echo fluid-attenuated inversion recovery, T2*-weighted gradient recalled echo, T1-weighted spin echo, and diffusion weighted imaging/apparent diffusion coefficient; and postcontrast transverse T1-weighted spin echo) for dogs and cats with suspected intracranial disease.

Household income and loss of control eating in adolescence: Examining the role of food insecurity.

Loss of control (LOC) eating is prevalent among adolescents and has been related to significant mental and physical health concerns. A growing body of research suggests that youth from lower income households are at risk for LOC eating. Food insecurity is an understudied contextual factor that may compound the risk for LOC eating in adolescents from low-income backgrounds. The present study sought to: 1) clarify the association between food insecurity and LOC eating among adolescents; and 2) examine whether household food insecurity moderated the association between income-to-needs and LOC eating. As part of a laboratory-based study, adolescents ages 12-17 (N = 60; 33% from low-income households; 53.3% female) completed the Eating Disorder Examination-Questionnaire to measure LOC eating. Parents reported the household food insecurity status and household income, used to calculate income-to-needs ratio. Higher household food insecurity was positively associated with adolescent LOC eating (b = 0.662, t(59) = 5.09, p < .01), after controlling for adolescent BMI percentile, race, ethnicity, biological sex, and age. Food insecurity significantly moderated the association between income-to-needs and LOC eating, ΔF(1,56) = 11.99, p < .01, with the interaction effect explaining an additional 12% of variance. Specifically, lower household income-to-needs was associated with greater LOC eating among adolescents at higher levels of household food insecurity. This finding expands upon prior work by highlighting specific socioeconomic factors that place youth from low-income backgrounds at even greater risk for negative health outcomes. Future research is needed to understand potential ways to intervene for adolescents to prevent future LOC eating in the context of food insecurity.

Biological sex and glucoregulation modulate postprandial cognition following dairy milk and fruit juice in healthy school-age children.

Objectives: Recent work suggests potential postprandial benefits for cognition and on-task behavior in children, depending on the macronutrients consumed, as well as individual differences such as sex and glucoregulation. We examined the effects of 1% milk versus apple juice on cognition and on-task behavior among healthy school-age children, predicting that milk would promote better performance and a greater presence of on-task behavior compared to juice. We also examined how sex and glucoregulation influenced cognition and behavior following each beverage.Methods: Eighty-four English-speaking children ages 8-12 (45 female, 39 male) attended two 0800 testing sessions after fasting overnight in a crossover design. Participant sessions were counterbalanced to include 237 mL of 1% milk or apple juice. Behavioral measures and complex attentional and executive function tasks were assessed at baseline, 30, 90, and 120 min post-ingestion. Outcomes were analyzed using repeated measures mixed models.Results: Participants with fasting glucose levels above 89.91 mg/dL responded more quickly in an inhibitory control paradigm following milk. Females performed faster on a vigilance task, but less accurately in a working memory paradigm after milk versus juice. No effects were found for on-task behavior.Discussion: Results demonstrated modulatory effects of glucoregulation and sex on postprandial cognition. Milk may improve cognitive performance in school-aged children with higher fasting glucose, and may be the optimal choice for speed among females, whereas juice may be better for accuracy. Future work should utilize designs incorporating glucoregulation and sex, and consider additional biological variables to better understand postprandial cognition and behavior in children.

MMP14 is a novel target of PTH signaling in osteocytes that controls resorption by regulating soluble RANKL production.

Parathyroid hormone (PTH) affects the skeleton by acting on osteocytes (Ots) in bone through yet unclear mechanisms. We report that matrix metalloproteinase 14 (MMP14) expression/activity are increased in bones from mice with genetic constitutive activation (ca) of the PTH receptor 1 (PTH1R) in Ots (caPTH1ROt) and in bones from mice exposed to elevated PTH levels but not in mice lacking [conditional knockout (cKO)] the PTH1R in Ots (cKOPTH1ROt). Furthermore, PTH upregulates MMP14 in human bone cultures and in Ot-enriched bones from floxed control mice but not from cKOPTH1ROt mice. MMP14 activity increases soluble receptor activator of NF-κΒ ligand production, which in turn, stimulates osteoclast differentiation and resorption. Pharmacologic inhibition of MMP14 activity reduced the high bone remodeling exhibited by caPTH1ROt mice or induced by chronic PTH elevation and decreased bone resorption but allowed full stimulation of bone formation induced by PTH injections, thereby potentiating bone gain. Thus, MMP14 is a new member of the intricate gene network activated in Ots by PTH1R signaling that can be targeted to adjust the skeletal responses to PTH in favor of bone preservation.-Delgado-Calle, J., Hancock, B., Likine, E. F., Sato, A. Y., McAndrews, K., Sanudo, C., Bruzzaniti, A., Riancho, J. A., Tonra, J. R., Bellido, T. MMP14 is a novel target of PTH signaling in osteocytes that controls resorption by regulating soluble RANKL production.

Familial influences on the use of controlling feeding practices with adolescents.

Little is known about what factors influence a caregiver to use controlling feeding practices with adolescents. The present study examines potential predictors (e.g., parent and child eating, parent and child weight, and the home environment) of the use of controlling feeding practices among adolescents, an age group that has not received much attention. Parents (N = 54, M age = 43.63 years, SD = 6.42; 94.4% female) of adolescents ages 12-17 (N = 54, M age = 13.94 years, SD = 1.75; 43.6% female) completed measures assessing their child feeding practices, eating patterns and the home environment. Adolescents completed measures of their eating patterns. Regression analyses were used to determine the most salient predictors of controlling child feeding practices, specifically restriction of food intake and pressure to eat. After controlling for adolescent age, parental dietary restraint was significantly associated with restriction and accounted for 15.2% of the variance in the use of restriction, F (1, 51) = 10.4, p<.01. Adolescent emotional eating and income-to-needs ratio were significantly associated with use of pressure above and beyond adolescent age and accounted for 29.1% of the variance in the use of pressure, F (2, 48) = 10.2, p<.001. This study suggests that future research should include factors from different levels of influence, such as child, parent and home environment. As understanding of these influences grows, efforts can be made to target specific contributors within intervention settings to address potential adverse outcomes associated with controlling feeding practices.

Maternal Depressive Symptoms Mediate the Association between Socio-economic Status and Adolescent Weight Outcomes: A Longitudinal Analysis.

Introduction The prevalence of pediatric obesity is an issue in the United States, in which approximately one-third of children and adolescents are overweight or obese. Youth living in low socioeconomic (SES) households are at an increased risk for developing obesity; yet, research is needed to understand the mechanisms that might better explain the relationship between SES and obesity risk. Maternal depression presents a potential mechanism by which SES might predict a later risk for obesity in pediatric populations. Methods The present study used a national dataset from the National Institute of Child Health and Human Development-Study of Early Child Care and Youth Development (NICHD-SECCYD) to examine whether maternal depressive symptoms (at an age of 9 years) mediated the association between early SES (the income-to-needs ratio measured at an age of 1 month) and adolescent weight outcomes [Body Mass Index z-scores (zBMI) for age and sex, at an age of 15 years]. Results The results suggested that greater maternal depressive symptoms helped to explain a significant amount of the variance of lower SES predicting poorer weight outcomes in adolescents. Discussion These findings illustrate the role of maternal depressive symptoms in explaining how SES predicts adolescent weight outcomes. Implications are discussed, and future research is needed to identify women from lower SES households who are experiencing depressive symptoms to provide support and initiate points of early intervention to address relevant health outcomes in youths.

GLUCOCORTICOID EXCESS IN BONE AND MUSCLE.

Glucocorticoids (GC), produced and released by the adrenal glands, regulate numerous physiological processes in a wide range of tissues. Because of their profound immunosuppressive and anti-inflammatory actions, GC are extensively used for the treatment of immune and inflammatory conditions, the management of organ transplantation, and as a component of chemotherapy regimens for cancers. However, both pathologic endogenous elevation and long-term use of exogenous GC are associated with severe adverse effects. In particular, excess GC has devastating effects on the musculoskeletal system. GC increase bone resorption and decrease formation leading to bone loss, microarchitectural deterioration and fracture. GC also induce loss of muscle mass and strength leading to an increased incidence of falls. The combined effects on bone and muscle account for the increased fracture risk with GC. This review summarizes the advance in knowledge in the last two decades about the mechanisms of action of GC in bone and muscle and the attempts to interfere with the damaging actions of GC in these tissues with the goal of developing more effective therapeutic strategies.

Comparison of a computed tomographic pulmonary trunk to aorta diameter ratio with echocardiographic indices of pulmonary hypertension in dogs.

There are limited criteria for the detection of pulmonary hypertension in dogs undergoing computed tomography (CT) for pulmonary disease. This retrospective analytical exploratory study compared a CT pulmonary trunk to aorta ratio with echocardiographic estimates of pulmonary hypertension. Dogs having both a contrast thoracic CT and echocardiogram were selected and maximal pulmonary trunk and descending aorta diameters were measured by two observers on a single transverse CT image. Computed tomographic diameter ratios were compared with the echocardiographic parameters of tricuspid regurgitation gradient, right ventricular acceleration time-to-ejection time ratio, pulmonary insufficiency gradient, and pulmonary artery to aorta diameter. A total of 78 dogs were sampled, with 44 dogs having one or more finding suggestive of pulmonary hypertension. A moderate positive correlation was shown between tricuspid regurgitation gradient and CT pulmonary trunk to aorta ratio (r = 0.61, P-value < 0.0001). Mean CT pulmonary trunk to aorta ratio of dogs with moderate (P = 0.0132) and severe (P < 0.0003) pulmonary hypertension were significantly higher than normal dogs. There was no significant difference in mean CT pulmonary trunk to aorta ratio between normal and mild pulmonary hypertension dogs (P = 0.4244). The intraclass correlation coefficient (0.72) showed good reproducibility of the ratio. Findings indicated that CT pulmonary trunk to aorta ratio is a reproducible and potentially useful method to predict moderate and severe pulmonary hypertension in dogs, but not mild pulmonary hypertension. In dogs undergoing thoracic CT for pulmonary disease, an increased ratio should prompt follow up echocardiography.

Pulmonary vasculature in dogs assessed by three-dimensional fractal analysis and chemometrics.

Fractal analysis of canine pulmonary vessels could allow quantification of their space-filling properties. Aims of this prospective, analytical, cross-sectional study were to describe methods for reconstructing three dimensional pulmonary arterial vascular trees from computed tomographic pulmonary angiogram, applying fractal analyses of these vascular trees in dogs with and without diseases that are known to predispose to thromboembolism, and testing the hypothesis that diseased dogs would have a different fractal dimension than healthy dogs. A total of 34 dogs were sampled. Based on computed tomographic pulmonary angiograms findings, dogs were divided in three groups: diseased with pulmonary thromboembolism (n = 7), diseased but without pulmonary thromboembolism (n = 21), and healthy (n = 6). An observer who was aware of group status created three-dimensional pulmonary artery vascular trees for each dog using a semiautomated segmentation technique. Vascular three-dimensional reconstructions were then evaluated using fractal analysis. Fractal dimensions were analyzed, by group, using analysis of variance and principal component analysis. Fractal dimensions were significantly different among the three groups taken together (P = 0.001), but not between the diseased dogs alone (P = 0.203). The principal component analysis showed a tendency of separation between healthy control and diseased groups, but not between groups of dogs with and without pulmonary thromboembolism. Findings indicated that computed tomographic pulmonary angiogram images can be used to reconstruct three-dimensional pulmonary arterial vascular trees in dogs and that fractal analysis of these three-dimensional vascular trees is a feasible method for quantifying the spatial relationships of pulmonary arteries. These methods could be applied in further research studies on pulmonary and vascular diseases in dogs.

Adolescent weight control: an intervention targeting parent communication and modeling compared with minimal parental involvement.

OBJECTIVE: Adolescent weight control interventions demonstrate variable findings, with inconsistent data regarding the appropriate role for parents. The current study examined the efficacy of a standard adolescent behavioral weight control (BWC) intervention that also targeted parent-adolescent communication and parental modeling of healthy behaviors (Standard Behavioral Treatment + Enhanced Parenting; SBT + EP) compared with a standard BWC intervention (SBT). METHODS: 49 obese adolescents (M age = 15.10; SD = 1.33; 76% female; 67.3% non-Hispanic White) and a caregiver were randomly assigned to SBT or SBT + EP. Adolescent and caregiver weight and height, parental modeling, and weight-related communication were obtained at baseline and end of the 16-week intervention. RESULTS: Significant decreases in adolescent weight and increases in parental self-monitoring were observed across both conditions. Analyses of covariance revealed a trend for greater reduction in weight and negative maternal commentary among SBT condition participants. CONCLUSIONS: Contrary to hypotheses, targeting parent-adolescent communication and parental modeling did not lead to better outcomes in adolescent weight control.

Diagnostic sensitivity of bone scintigraphy for equine stifle disorders.

Disorders of the stifle are a common cause of lameness in horses yet the accuracy of scintigraphy for diagnosis of stifle conditions is controversial. The aim of retrospective cross-sectional study was to determine the diagnostic sensitivity (Se) of bone scintigraphy in detecting stifle disease and to determine if two orthogonal scintigraphic images improve diagnostic Se. Horses that underwent scintigraphic examination during a two-year period were included. Horses were divided into two groups: group 1 (N = 23) had lameness that was localized to the stifle by intra-articular analgesia and group 2 (N = 182) had lameness that was localized to a different location. Scintigraphic studies (one image or two images) were independently and retrospectively analyzed by two radiologists (R1 and R2). Sensitivity, specificity (Sp) and predictive values (PV), and were calculated for each type of study (one image or two images) and for each radiologist (R1 or R2). The Se to detect stifle disorders varied between radiologists (29.2% and 20.8%). The Sp was 84.5% and 88.3%. When two images were evaluated a decrease in the positive PV for both readers occurred. The Cohen kappa coefficient (κ) between readers was poor when one image (0.084) or two images (0.117) were evaluated. Findings from this study indicated that bone-phase nuclear scintigraphy is reasonably specific but highly insensitive for detecting lameness originating from the stifle in a diverse population of both normal and affected horses. The addition of a caudal scintigraphic image acquisition did not improve diagnostic sensitivity.

Treatment adherence and facilitator characteristics in a community based pediatric weight control intervention.

BACKGROUND: There is a pressing need to develop effective and broadly accessible interventions to address pediatric obesity. An important dimension in translating interventions to community settings is evaluating the fidelity with which the intended treatment is delivered and the level of facilitator needed to deliver the intervention with efficacy. PURPOSE: The primary objectives of this study were to: 1) provide descriptive information regarding adherence to protocol and non-specific facilitator characteristics (e.g. interpersonal characteristics, group management skills) within the context of a community based pediatric weight control intervention delivered by paraprofessionals; and 2) examine the relationships among facilitator adherence and characteristics and rate of change in percent overweight demonstrated by youth over the course of the 24-week intervention. METHODS: The intervention was conducted between February and September of 2011. Children (6-16 years) and parents completed primary outcome measures at baseline, 12, and 24 weeks (i.e. end of treatment). A 2-part rating form was developed to assess facilitator adherence to weekly content and general provider characteristics at two different time points during the intervention. RESULTS: Youth participating in this study were on average 11.3 years old (SD = 2.8), with most being under the age of 13 years (74.2%). Over half were female (54.8%) and over two-thirds were White (68.4%). On average, facilitators adhered to 96.0% (SD = 5.2%) of the session content at Time 1 and 92.6% (SD = 6.8%) at Time 2. Higher Content Adherence at Time 1 and Time 2 were associated with greater loss in percent overweight. CONCLUSIONS: Our data suggest that paraprofessionals without prior expertise in pediatric weight control can be trained to successfully deliver an intervention that is evidence based and incorporates behavioral and educational components. These findings need to be considered in light of some limitations, including the fact that facilitator domains were assessed with a modification of a standardized tool and we did not obtain inter-rater reliability of observations. These limitations not withstanding, investing time in training facilitators to adhere to a given protocol is critical and may be of higher priority than focusing on more general facilitator characteristics.

Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents.

OBJECTIVE: To examine longitudinal bidirectional associations between changes in adolescents' weight status and psychosocial constructs. METHOD: 118 obese adolescents aged 13-16 years participated in a behavioral weight control intervention. Percent overweight (OW), fear of negative evaluation (FNE), and frequency of weight-related teasing (WRT) were collected at baseline, end of intervention, and 12 and 24 months post-randomization. 3 multivariate latent change score models were estimated to examine longitudinal cross-lagged associations between: (1) OW and FNE; (2) OW and WRT; and (3) FNE and WRT. RESULTS: Decreases in OW were prospectively associated with subsequent decreases in both FNE and WRT; however, changes in FNE and WRT were not prospectively associated with subsequent change in OW. Decreases in FNE were prospectively associated with subsequent decreases in WRT. CONCLUSION: Moderate weight loss in the context of a behavioral weight control intervention has positive long-term implications for obese adolescents' peer relations.

A Multi-Informant Assessment of Food Security in Adolescents: Discordance in Self-Report and Parent-Proxy Report.

Food insecurity is associated with a multitude of negative outcomes among adolescents. Despite adolescents' burgeoning autonomy, much of the research has relied on parent-proxy report, with few studies directly comparing adolescents' and parents' perceptions of adolescent food security. In the present study, parent-adolescent dyads (N = 144) completed questionnaires measuring perceptions of adolescent food security. Adolescents (12-17 years) completed the Child Food Security Survey Module. Parents completed the Household Food Security Survey Module. Dyads demonstrated discordant perceptions of adolescent food security on categorical- and item-levels of analysis. Further research is needed to elucidate explanations for these discrepancies using longitudinal designs.

Abaloparatide is more potent than teriparatide in restoring bone mass and strength in type 1 diabetic male mice.

This study investigated the efficacy of the two FDA-approved bone anabolic ligands of the parathyroid hormone receptor 1 (PTH1R), teriparatide or human parathyroid hormone 1-34 (PTH) and abaloparatide (ABL), to restoring skeletal health using a preclinical murine model of streptozotocin-induced T1-DM. Intermittent daily subcutaneous injections of equal molar doses (12 pmoles/g/day) of PTH (50 ng/g/day), ABL (47.5 ng/g/day), or vehicle, were administered for 28 days to 5-month-old C57Bl/6 J male mice with established T1-DM or control (C) mice. ABL was superior to PTH in increasing or restoring bone mass in control or T1-MD mice, respectively, which was associated with superior stimulation of trabecular and periosteal bone formation, upregulation of osteoclastic/osteoblastic gene expression, and increased circulating bone remodeling markers. Only ABL corrected the reduction in ultimate load, which is a measure of bone strength, induced by T1-DM, and it also increased energy to ultimate load. In addition, bones from T1-DM mice treated with PTH or ABL exhibited increased ultimate stress, a material index, compared to T1-DM mice administered with vehicle. And both PTH and ABL prevented the increased expression of the Wnt antagonist Sost/sclerostin displayed by T1-DM mice. Further, PTH and ABL increased to a similar extent the circulating bone resorption marker CTX and the bone formation marker P1NP in T1-DM after 2 weeks of treatment; however, only ABL sustained these increases after 4 weeks of treatment. We conclude that at equal molar doses, ABL is more effective than PTH in increasing bone mass and restoring the cortical and trabecular bone lost with T1-DM, due to higher and longer-lasting increases in bone remodeling.

Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention.

OBJECTIVE: The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95). METHOD: Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95. RESULTS: Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13). CONCLUSION: A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

Reactive histiocytosis of the orbit and posterior segment in a dog.

We present a case of reactive histiocytic disease involving the orbit, optic nerve, retina, and choroid in a Border Collie dog initially presenting for vision loss. Long-term partial return of vision has been achieved with systemic immunosuppression. Anterior segment and ocular surface manifestations of reactive histiocytic disease in dogs are relatively common. Posterior segment and orbital involvement, however, are minimally documented in the existing literature. To the authors' knowledge, this is the first report of disease confined to the orbit and posterior segment as well as the first report of vision loss as a presenting complaint for reactive histiocytic disease. Clinical, magnetic resonance imaging, cytologic, and histopathologic findings are reviewed.