Shaping a Future for Library and CME through Partnerships.

The purpose of this article is to highlight the value of a partnership between library services and continuing medical education (CME) teams. Examples of a successful partnership between library services and CME within a health system will be shown. Through team collaboration, library and CME services provide quick access to educational resources and activities which benefit the delivery of optimal health care.

Intraoperative optical coherence tomography for soft tissue sarcoma differentiation and margin identification.

BACKGROUND AND OBJECTIVE: Sarcomas are rare but highly aggressive tumors, and local recurrence after surgical excision can occur in up to 50% cases. Therefore, there is a strong clinical need for accurate tissue differentiation and margin assessment to reduce incomplete resection and local recurrence. The purpose of this study was to investigate the use of optical coherence tomography (OCT) and a novel image texture-based processing algorithm to differentiate sarcoma from muscle and adipose tissue. STUDY DESIGN AND METHODS: In this study, tumor margin delineation in 19 feline and canine veterinary patients was achieved with intraoperative OCT to help validate tumor resection. While differentiation of lower-scattering adipose tissue from higher-scattering muscle and tumor tissue was relatively straightforward, it was more challenging to distinguish between dense highly scattering muscle and tumor tissue types based on scattering intensity and microstructural features alone. To improve tissue-type differentiation in a more objective and automated manner, three descriptive statistical metrics, namely the coefficient of variation (CV), standard deviation (STD), and Range, were implemented in a custom algorithm applied to the OCT images. RESULTS: Over 22,800 OCT images were collected intraoperatively from over 38 sites on 19 ex vivo tissue specimens removed during sarcoma surgeries. Following the generation of an initial set of OCT images correlated with standard hematoxylin and eosin-stained histopathology, over 760 images were subsequently used for automated analysis. Using texture-based image processing metrics, OCT images of sarcoma, muscle, and adipose tissue were all found to be statistically different from one another (P ≤ 0.001). CONCLUSION: These results demonstrate the potential of using intraoperative OCT, along with an automated tissue differentiation algorithm, as a guidance tool for soft tissue sarcoma margin delineation in the operating room. Lasers Surg. Med. 49:240-248, 2017. © 2017 Wiley Periodicals, Inc.

Histopathologic findings and survival outcomes of dogs undergoing liver lobectomy as treatment for spontaneous hemoabdomen secondary to a ruptured liver mass: retrospective analysis of 200 cases (2012-2020).

OBJECTIVE: To describe the distribution of histopathologic diagnoses in a large population of dogs undergoing surgical treatment for spontaneous hemoperitoneum secondary to a ruptured liver mass. Additionally, to describe survival outcomes and assess for prognostic factors for overall survival time in this population. ANIMALS: 200 client-owned dogs with spontaneous hemoperitoneum resulting from a liver mass. PROCEDURES: Medical records from 19 veterinary referral hospitals were reviewed. Data collected included signalment, clinical signs, blood work, radiographic and ultrasonographic findings, surgical methods, intraoperative and postoperative complications, outcomes, and histopathologic findings. Follow-up information was obtained by contacting the referring veterinarian or owner. RESULTS: Well-differentiated hepatocellular carcinoma, benign masses, hemangiosarcoma, and other malignant tumors accounted for 36% (72/200), 27.5% (55/200), 25.5% (51/200), and 11% (22/200) of cases, respectively. Overall survival time for all dogs was 356 days and for the above categories was 897 days, 905 days, 45 days, and 109 days, respectively. Prognostic factors for survival included diagnosis, increased ALT, anemia, and whether a transfusion was received. Overall survival time in dogs with increased ALT was 644 versus 63 days with normal values. CLINICAL RELEVANCE: The majority of dogs (63.5%) were diagnosed with well-differentiated hepatocellular carcinoma or a benign process, resulting in favorable long-term survival. The distribution of histopathology for ruptured liver masses resulting in hemoperitoneum has not been previously reported and may be useful for client discussions prior to surgery.

Evaluating optical coherence tomography for surgical margin assessment of canine mammary tumours.

Optical coherence tomography (OCT) uses near-infrared light waves to generate real-time, high-resolution images on the microscopic scale similar to low power histopathology. Previous studies have demonstrated the use of OCT for real-time surgical margin assessment for human breast cancer. The use of OCT for canine mammary tumours (CMT) could allow intra-operative visualisation of residual tumour at the surgical margins. The purpose of this study was to assess OCT imaging for the detection of incomplete tumour resection following CMT surgery. We hypothesized that the OCT images would have comparable features to histopathological images of tissues at the surgical margins of CMT resections along with a high sensitivity of OCT detection of incomplete surgical excision of CMT. Thirty surgical specimens were obtained from nineteen client-owned dogs undergoing surgical resection of CMT. OCT image appearance and characteristics of adipose tissue, skin, mammary tissue and mammary tumour at the surgical margins were distinct and different. The OCT images of normal and abnormal tissues at the surgical margins were utilized to develop a dataset of OCT images for observer evaluation. The sensitivity and specificity for ex vivo images were 83.3% and 82.0% (observer 1) and 70.0% and 67.9% (observer 2). The sensitivity and specificity for in vivo images were 70.0% and 89.3% (observer 1) and 76.7% and 67.9% (observer 2). These results indicate a potential use of OCT for surgical margin assessment for CMT to optimize surgical intervention and clinical outcomes. Improved training and experience of observers may improve sensitivity and specificity.

Intra-operative imaging of surgical margins of canine soft tissue sarcoma using optical coherence tomography.

Optical coherence tomography (OCT) is a rapid non-invasive imaging technique that has shown high sensitivity for intra-operative surgical margin assessment in human breast cancer clinical trials. This promising technology has not been evaluated in veterinary medicine. The objective of this study was to correlate normal and abnormal histological features with OCT images for surgical margins from excised canine soft tissue sarcoma (STS) and to establish image evaluation criteria for identifying positive surgical margins. Fourteen client-owned dogs underwent surgical resection of a STS and OCT imaging of 2 to 4 areas of interest on the resected specimen were performed. Following imaging these areas were marked with surgical ink and trimmed for histopathology evaluation. Results showed that different tissue types had distinct characteristic appearances on OCT imaging. Adipose tissue exhibited a relatively low scattering and a honey-comb texture pattern. Skeletal muscle and sarcoma tissue were both dense and highly scattering. While sarcoma tissue was highly scattering, it did not have organized recognizable structure in contrast to muscle which showed clear fibre alignment patterns. In this investigation, we showed different tissue types had different and characteristic scattering and image texture appearances on OCT, which closely correlate with low-power histology images. Given the differentiation between tissue types the results support that OCT could be used to identify positive surgical margins immediately following resection of STS. Further research is needed to assess the diagnostic accuracy of this method for surgical margin assessment.

Complications and outcomes associated with unilateral thyroidectomy in dogs with naturally occurring thyroid tumors: 156 cases (2003-2015).

OBJECTIVE: To describe complications and outcomes of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors. ANIMALS: 156 dogs undergoing unilateral thyroidectomy for a naturally occurring thyroid tumor. PROCEDURES: Dogs that underwent a unilateral thyroidectomy in 2003 through 2015 were included in a multi-institutional retrospective study. For each dog, information gathered through evaluation of electronic and paper records included perioperative complications, short-term outcome (survival to discharge from the hospital vs nonsurvival), and long-term outcome (survival time). RESULTS: In the perioperative period, complications occurred in 31 of the 156 (19.9%) dogs; hemorrhage was the most common intraoperative complication (12 [7.7%] dogs). Five of 156 (3.2%) dogs received a blood transfusion; these 5 dogs were among the 12 dogs that had hemorrhage listed as an intraoperative complication. Immediately after surgery, the most common complication was aspiration pneumonia (5 [3.2%] dogs). One hundred fifty-three of 156 (98.1%) dogs that underwent unilateral thyroidectomy survived to discharge from the hospital. One hundred-thirteen dogs were lost to follow-up; from the available data, the median survival time was 911 days (95% confidence interval, 704 to 1,466 days). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that unilateral thyroidectomy in dogs with a naturally occurring thyroid tumor was associated with a perioperative mortality rate of 1.9% and a complication rate of 19.9% and that hemorrhage and aspiration pneumonia were the most common complications. Long-term survival of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors was not uncommon.

Genetic improvement of hip-extended scores in 3 breeds of guide dogs using estimated breeding values: Notable progress but more improvement is needed.

Two hip quality phenotypes-a hip-extended score assigned by a board certified radiologist and the PennHIP distraction index-were analyzed to estimate genetic parameters and to calculate estimated breeding values used for selecting replacement breeders. Radiographs obtained at 12-18 months of age were available on 5,201 German Shepherd Dogs, 4,987 Labrador Retrievers and 2,308 Golden Retrievers. Obtained by fitting a two-trait model using Bayesian techniques, estimates of heritability for the hip-extended score were 0.76, 0.72, and 0.41 in German Shepherd Dogs, Labrador Retrievers, and Golden Retrievers, respectively, while estimated heritabilities for distraction index were 0.60, 0.66 and 0.59, respectively. Genetic correlations between the two hip quality measures were -0.28 in German Shepherd Dogs, -0.21 in Labrador Retrievers, and -0.29 in Golden Retrievers. Genetic selection for improved hip quality based upon the hip extended score phenotype began in 1980. Among first generation puppies, 34% of 273 German Shepherd Dogs, 55% of 323 Labrador Retrievers, and 43% of 51 Golden Retrievers had an Excellent hip extended score. After 8 generations of selection, mostly based on estimated breeding values derived from the hip extended score, over 93% of 695 German Shepherd Dogs, 94% of 528 Labrador Retrievers, and 87% of 116 Golden Retrievers received an Excellent hip extended score. With respect to PennHIP distraction index values among these same dogs, median values were at or above 0.30 for all 3 breeds meaning that half or more of dogs possessing the Excellent hip-extended-score phenotype remained susceptible to developing the osteoarthritis of canine hip dysplasia. Genetic improvement of the hip-extended-view phenotype to its desired biological endpoint left a surprising proportion of dogs expressing sufficient joint laxity to place them in an osteoarthritis at-risk state as they age. Only by directly applying selection pressure to reduce distraction index was marked reduction in joint laxity noted.

Evaluation of information presented within mast cell tumour histopathology reports in the United States: 2012-2015.

For canine mast cell tumour (MCT), histopathology reports are one of the main factors considered in the decision-making process regarding need and type of adjunctive therapy. However, considerable variation exists in types of information reported, especially relating to surgical margins. The purpose of this study was to describe and evaluate how information is presented within canine MCT histopathology reports across the United States. The reports were collected from medical and surgical oncologists from 4 geographic regions of the USA: Midwest, Northeast, South and West. All reports were obtained between January 1st 2012 and May 1st 2015. Inclusion criteria required that the final diagnosis was MCT, a microscopic description was present, and it was not a scar revision. Three hundred and sixty-eight reports were collected from 26 contributors. While the majority of the reports contained a clinical history (85.9%), information for certain prognostic indicators such as location and mass size was lacking. Grading with both Patnaik and Kiupel systems were described in 76.5% of reports with a single system being used in 7.1% and 15.2% of reports, respectively. Subcutaneous MCT were assigned a grading scheme in 67.2% of reports with 33.3% stating appropriate limitations. Surgical margins were reported in 92% of the reports with 77.2% describing deep and lateral margins separately. Tissue composing the deep margin was only described in 10.9% of the reports. The present results indicate reporting of MCT has variability across pathologists with inconsistencies present in the reporting of clinical history, margin evaluation and subcutaneous MCT grading.

Effect of an intraoperative infusion of amino acids on body temperature, serum biochemistry, serum insulin and recovery variables in healthy dogs undergoing ovariohysterectomy.

Change in body temperature (BT), serum biochemistry and recovery variables were compared after infusion of amino acids (AA) or lactated Ringer's solution (LRS) in dogs undergoing ovariohysterectomy. Dogs received eight parts 10 per cent AA and two parts LRS (AA, n=10) or only LRS (CG, n=10) at 10 ml/kg/hour during 90 minutes of anaesthesia. BT was measured during anaesthesia and 60 minutes of recovery. Extubation time and shivering were noted. Serum samples were obtained before anaesthesia (T0), end of anaesthesia (T90) and 18 hours after (T18h). Friedman, Mann-Whitney, Kruskal-Wallis or Fisher's exact tests were used for analysis. A decrease in BT of -2.16 (-1.59 to -3.24)°C for group AA and -2.79 (-1.98 to -4.52)°C for group CG was different (P=0.02). Time to extubation was 5 (3-9) minutes for group AA and 9 (5-15) minutes for group CG and was different (P=0.01). Only 30 per cent of dogs in group AA and 100 per cent of dogs in group CG shivered during recovery (P=0.003). Glucose, insulin and blood urea nitrogen at T90 were higher than T0 and T18h for group AA. Dogs receiving intraoperative infusion of AA had a higher BT, extubated sooner and shivered less than control dogs at recovery from anaesthesia.

Canine Hip Dysplasia Screening Within the United States: Pennsylvania Hip Improvement Program and Orthopedic Foundation for Animals Hip/Elbow Database.

Canine hip dysplasia (CHD) is a complex, polygenic disease radiographically associated with hip subluxation and development of osteoarthritis. Screening programs have been established with the goal of hip improvement, with the most common in the United States being OFA hip scoring and the PennHIP method. When evaluating the single hip-extended view used by OFA versus the 3 radiographic views and associated distraction index (DI) used by PennHIP for CHD screening, the scientific evidence supports the use of the DI and PennHIP method. OFA scoring can be used to effect hip improvement, especially when incorporated into estimated breeding values.