Canine thyroid carcinoma prognosis following the utilisation of computed tomography assisted staging.

BACKGROUND: Metastatic disease is frequently present at the time of diagnosis of canine thyroid carcinoma; however, utilisation of computed tomography (CT) alone for staging pre-treatment has been rarely reported in the veterinary literature. METHODS: The aims of this retrospective study were to stage affected dogs using CT findings of the cervical and thoracic regions, combined with histopathology/cytology results, in order to assess whether metastatic disease/WHO staging was of prognostic significance. RESULTS: Fifty-eight dogs were included in the study. Classification of cases into WHO stages I, II, III and IV were 10%, 50%, 9% and 31%, respectively. No statistically significant effect of WHO stage classification on overall survival/follow-up time was found (P = .576). Surgery resulted in a statistically significant increase in overall survival/follow-up time (P < .01). There was no statistically significant effect on overall survival/follow-up time in dogs that received medical therapy, either as sole therapy or as an adjunctive post-surgery (P = .198). CONCLUSION: In summary, this study documents the metastatic rate of canine thyroid carcinoma using CT for staging pre-treatment. Staging utilising CT revealed a higher distant metastatic rate in dogs with thyroid carcinoma when compared to historical studies using different imaging techniques. As long-term outcomes are possible for cases with advanced disease, surgical intervention could still be considered.

Uncovering undiagnosed liver disease: prevalence and opportunity for intervention in a population attending colonoscopy.

OBJECTIVE: Due to high rates of obesity and alcohol consumption, the prevalence of fatty liver disease is increasing. There is no widely adopted approach to proactively screen for liver disease in the community. We aimed to assess the burden of potentially undiagnosed liver disease in individuals attending for colonoscopy to develop a pathway to identify and manage individuals with undiagnosed liver disease. DESIGN: The OSCAR Study was a cross-sectional study recruiting patients attending for colonoscopy. Patients' metabolic and liver risk factors were measured. The prevalence of undiagnosed significant fatty liver disease was measured using the Fatty Liver Index (FLI) and Fibrosis-4 score (FIB-4). RESULTS: 1429 patients (mean age 59±14 years; 48.8% men) were recruited. 73.3% were overweight/obese, 12.7% had diabetes and 17.9% had metabolic syndrome. 19% were consuming more than recommenced alcohol levels (<14 units/week) and 41% had an AUDIT-C score ≥5. After excluding those with known liver disease, 43.2% of the cohort had a high FLI (high likelihood of fatty liver). 5.3% of these had a high FIB-4 score (>2.67, high probability of advanced fibrosis) and 90% of these were previously undiagnosed. 818 patients had a predicted 10-year cardiovascular event risk of ≥10%, however only 377 (46.1%) were on statin therapy. CONCLUSION: High levels of obesity, metabolic dysfunction and undiagnosed fatty liver disease were found in individuals attending for colonoscopy. Clinical encounters in the endoscopy unit may represent an opportunity to risk assess for liver and metabolic disease and provide an environment to develop targeted interventions.

Geo-epidemiology and environmental co-variate mapping of primary biliary cholangitis and primary sclerosing cholangitis.

BACKGROUND & AIMS: Autoimmune liver disease (AILD) is thought to result from a complex interplay between genetics and the environment. Studies to date have focussed on primary biliary cholangitis (PBC) and demonstrated higher disease prevalence in more urban, polluted, and socially deprived areas. This study utilises a large cohort of patients with PBC and primary sclerosing cholangitis (PSC) to investigate potential environmental contributors to disease and to explore whether the geo-epidemiology of PBC and PSC are disease-specific or pertain to cholestatic AILD in general. METHODS: All adult patients with PBC and PSC in a tightly defined geographical area within the UK were identified. Point- and area-based analyses and structural equation modelling (SEM) were used to investigate for disease clustering and examine for relationships between prevalence, distribution of environmental contaminants, and socio-economic status. RESULTS: We identified 2,150 patients with PBC and 472 with PSC. Significant spatial clustering was seen for each disease. A high prevalence of PBC was found in urban, post-industrial areas with a strong coal-mining heritage and increased environmental cadmium levels, whereas a high PSC prevalence was found in rural areas and inversely associated with social deprivation. CONCLUSIONS: This study demonstrates spatial clustering of PBC and PSC and adds to our understanding of potential environmental co-variates for both diseases. Disease clustering, within the same geographical area but over different scales, is confirmed for each disease with distinct risk profiles identified and associations with separate putative environmental factors and socio-economic status. This suggests that different triggers and alternative pathways determine phenotypic expression of autoimmunity in the affected population. Co-variate analysis points towards the existence of specific disease triggers. LAY SUMMARY: This study looked for potential environmental triggers in patients with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) living in the north-east of England and north Cumbria. We found that PBC was more common in urban areas with a history of coal mining and high levels of cadmium whereas PSC was more common in rural areas with lower levels of social deprivation.

Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device.

PURPOSE AND HYPOTHESIS: Correct femoral component rotation at knee arthroplasty influences patellar tracking and may determine function at extremes of movement. Additionally, such malrotation may deleteriously influence flexion/extension gap geometry and soft tissue balancing kinematics. Little is known about the effect of subtle rotational change upon load transfer across the tibiofemoral articulation. Our null hypothesis was that femoral component rotation would not influence load across this joint in predictable manner. METHODS: A cadaveric study was performed to examine load transfer using the orthosensor device, respecting laxity patterns in 6° of motion, to examine load across the medial and lateral compartments across a full arc of motion. Mixed-effect modelling allowed for quantification of the effect upon load with internal and external femoral component rotation in relation to a datum in a modern single-radius cruciate-retaining primary knee design. RESULTS: No significant change in maximal laxity was found between different femoral rotational states. Internal rotation of the femoral component resulted in significant increase in medial compartment load transfer for knee flexion including and beyond 60°. External rotation of the femoral component within the limits studied did not influence tibiofemoral load transfer. CONCLUSIONS: Internal rotation of the femoral component will adversely influence medial compartment load transfer and could lead to premature polyethylene wear on the medial side.

Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation.

OBJECTIVES: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking. DESIGN: Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation. SETTING: Eight acute NHS hospital trusts and 12 local authority areas in North East England. PARTICIPANTS: 37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy. INTERVENTIONS: A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol. MAIN OUTCOME MEASURES: Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting. RESULTS: After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter. CONCLUSIONS: The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

Length of stay and its impact upon functional outcomes following lower limb arthroplasty.

PURPOSE: The aim was to investigate the interplay between patient characteristics and (1) length of hospital stay and (2) one-year patient-reported outcome following total knee and hip arthroplasty. METHODS: Event (survival) analysis and structural equation modelling were performed for 1001 patients undergoing knee (n = 566) and hip (n = 435) arthroplasty in a single institution. RESULTS: Age, body mass index and co-morbidities were independent predictors of length of stay in both event analysis and structural equation modelling. These patient characteristics and type of arthroplasty had both small direct and indirect effects on patient-reported outcome measures at one year. Length of stay had a small effect (<2 %) in SF-36 scores at one year. CONCLUSION: Predictors that influence length of stay also impact on one-year post-operative outcome and therefore should be taken into account during patient selection and discharge planning. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study.

BACKGROUND: Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows. METHODS: Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex. RESULTS: Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1(st) (7.4 µg/m(3)) to the 25(th) (17.2 µg/m(3)), 50(th) (33.8 µg/m(3)), 75(th) (108.3 µg/m(3)), and 90(th) (180.8 µg/m(3)) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage. CONCLUSIONS: The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.

PAH contamination in shellfish: modelling to estimate exposure.

Polycyclic aromatic hydrocarbons (PAH) are known carcinogens and are abundant in the environment and foodstuffs. Currently the majority of PAH research focuses on benzo[a]pyrene (BaP), although a much greater range of PAH are known to have detrimental effects to human health. Monitoring a large number of PAH is expensive, time consuming and analytically demanding, yet there is currently no clear basis for determining which PAH should be monitored to give an indication of overall exposure. A thorough statistical examination of the relationships between different PAH in different foodstuffs has not previously been carried out. Using a test dataset of homogenised edible flesh from shellfish samples as a case study a modelling process using principal components analysis regression is proposed to determine which PAH subset (from a total of 27 monitored PAH) should be assessed as indicators for general PAH exposure. Multivariate ordination and clustering show that PAH concentrations of compounds of similar chemical structure can be highly correlated in the samples, e.g. the five ringed isomers PAHs benzo[b]fluoranthene, benzo[j]fluoranthene and benzo[k]fluoranthene. The model selection process determined which subsets of PAH can be used to predict the presence and abundance of other PAHs in shellfish samples. Models were more accurate in predicating PAHs concentrations of PAH where concentrations were measured above the limit of detection (LoD). PAH with values below the LoD were harder to predict accurately. The current analysis highlights that laboratories should focus on the following PAHs BaP, benzo[a]anthracene, benzo[g,h,i]perylene, phenanthrene, benzo[g,h,i]fluoranthene, chrysene, benzo[k]fluoranthene, benzo[b]fluoranthene and fluoranthene when analysing shellfish samples. Focussing monitoring on this group of PAH may give a better indication of overall PAH content of samples that the summed PAH indicator methods currently adopted.

Intraocular extramedullary plasmacytoma in a cat.

An 8-year-old, castrated male Domestic Short-haired cat was referred for evaluation of a possible intraocular neoplasm following previous ocular trauma. The eye was blind, and uveitis and an iridal mass were noted on examination. An enucleation was performed and the mandibular lymph node excised. Histopathologic examination revealed neoplastic proliferation of plasma cells in the iris and lymph node. No other evidence of disseminated disease was detected. This is the first case reported of an intraocular extramedullary plasmacytoma in the cat. The variation in clinical manifestations and potential association with multiple myeloma are not known at this time. Disseminated metastasis from a primary plasmacytoma of the uveal tract could also involve the bone marrow and be indistinguishable from multiple myeloma. Early enucleation, as in trauma-associated sarcomas, may be indicated to prevent metastasis. Periodic systemic evaluation for evidence of multiple myeloma should be performed.