Subcutaneous fat sclerosis in a domestic short-hair cat.

The authors describe a case of presumptive feline subcutaneous fat sclerosis, a condition reported only once previously (in 1987) and diagnosed with postmortem examination. We describe radiographic, computed tomography scan and histopathological findings, and partial response to oral methylprednisolone and Vitamin E.

Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models.

BACKGROUND: The optimal strategy for identification of hemodynamically stable patients with acute pulmonary embolism (PE) at risk for death and clinical deterioration remains undefined. OBJECTIVES: We aimed at assessing the performances of currently available models/scores for identifying hemodynamically stable patients with acute, symptomatic PE at risk of death and clinical deterioration. METHODS: Prospective multicentre cohort study including patients with acute PE (COPE, NCT03631810). Primary study outcome was in-hospital death within 30 days or clinical deterioration. Other outcomes were in-hospital death, death and PE-related death all at 30 days. We calculated positive and negative predictive values, c-statistics of ESC-2014, ESC-2019, PEITHO, Bova, TELOS, FAST and NEWS2 for the study outcomes. RESULTS: In 5,036 hemodynamically stable patients with acute PE, positive predictive values for the evaluated models/scores were all below 10%, except for TELOS and NEWS2; negative predictive values were above 98% for all the models/scores, except for FAST and NEWS-2. ESC-2014 and TELOS had good performances for in-hospital death or clinical deterioration (c-statistic 0.700 and 0.722, respectively), in-hospital death (c-statistic 0.713 and 0.723, respectively) and PE-related death (c-statistic 0.712 and 0.777, respectively); PEITHO, Bova and NEWS2 also had good performances for PE-related death (c-statistic 0.738, 0.741 and 0.742, respectively). CONCLUSION: In hemodynamically stable patients with acute PE, the accuracy for identification of hemodynamically stable patients at risk for death and clinical deterioration varies across the available models/scores; TELOS seems to have the best performances. These data can inform management studies and clinical practice.

The role of climatic variables on nest evolution in tanagers.

Avian nests are fundamental structures in avian reproduction and face strong selective forces. Climatic conditions are likely to have shaped the evolution of specific nest traits, but evidence is scarce at a macroevolutionary level. The Thraupidae family (commonly known as tanagers) is an ideal clade to understand the link between nest architecture and climate because it presents wide variation in nest traits. To understand whether climatic variables have played a role in the diversification of nest traits among species in this family, we measured nests from 49 species using museum collections. We observed that dome-nesting species are present in dryer and hotter environments, in line with previous findings suggesting that domed nests are a specialisation for arid conditions. We also found evidence that nests with thicker walls are present in locations with lower precipitation and that solar radiation can influence the shape of domed nests; birds tend to build shorter and narrower domes in areas with high levels of solar radiation. Open nest architecture is also potentially influenced by wind speed, with longer and deeper nests in areas characterised by strong winds. Our results support the hypothesis that different climatic variables can drive the evolution of specific aspects of nest architecture and contribute to the diversity of nest shapes we currently observe. However, climatic variables account only for a small fraction of the observed structural variation, leaving a significant portion still unexplained.

BRAF mutations and survival with surgery for colorectal liver metastases: A systematic review and meta-analysis.

INTRODUCTION: Mutations in the BRAF gene (BRAFmut) are associated with an unfavorable prognosis in patients with metastatic colorectal cancer (CRC). The aim of this meta-analysis was to evaluate the prognosis of colorectal cancer (CRC) patients with liver metastases and the potential benefits of liver resection in patients with BRAFmut CRC. MATERIAL AND METHODS: A systematic search of PubMed, Cochrane Central Controlled Trials, and Embase databases was conducted on May 31, 2023. The inclusion criteria were as follows:1) reporting of outcomes in patients with BRAFmut CRC who underwent surgery for liver metastases and/or comparison of outcomes between those who underwent and those who did not undergo resection; 2) reporting of survival information as hazard ratios (HR); and 3) publication in English. RESULTS: 34 studies were included. Median follow up was 48 months for prognostic BRAF status meta-analysis. BRAFmut status showed a significantly increased risk of mortality (hazard ratio [HR] = 2.56, 95% confidence interval [CI] 2.04-3.22; P < 0.01) and relapse (HR = 1.97, 95% CI 1.44-2.71; P < 0.01). Resection of liver metastases was associated with a survival benefit (median follow up 46 months). The HR for survival was 0.44 (95% confidence interval [CI] 0.33-0.59; P < 0.01) in favor of surgery. CONCLUSIONS: and Relevance: Our analysis indeed confirms that BRAF mutation is associated with poor survival outcomes after liver resection of CRC metastases. However, upon quantitatively assessing the survival benefit of surgical intervention in patients with BRAF-mutated CRC liver metastases, we identified a significant 56% reduction in the risk of death.

Dermoscopic features of benign sebaceous proliferations in dogs: Description, assessment and inter-observer agreement.

BACKGROUND: Dermoscopy is a useful, noninvasive technique also used to assess sebaceous lesions in humans. Sebaceous hyperplasia, sebaceous adenoma and sebaceous epithelioma are common cutaneous lesions in dogs; however, their dermoscopic features have not been investigated. HYPOTHESIS/OBJECTIVES: The objectives of this study are to describe the dermoscopic features of canine sebaceous lesions and to assess the interobserver agreement on dermoscopic parameters. ANIMALS: Thirty-four lesions excised from 17 client-owned dogs, histologically confirmed as sebaceous proliferations, were included in this study. MATERIALS AND METHODS: Sebaceous lesions were evaluated in vivo at ×10 magnification with a handheld dermoscope. Each dermoscopic image was assessed independently by two ECVD board-certified veterinary referral clinicians and an ECVD resident. RESULTS: Thirty sebaceous hyperplasias, two sebaceous adenomas and two sebaceous epitheliomas were included. Dermoscopically, most lesions (91%) had single or multiple, well-defined, white-yellowish structures composed of grouped ovoid areas (clods). Irregular linear and, less commonly, arborising vessels were detected at the periphery of the yellow lobular-like structures in 93% of sebaceous hyperplasias and in 50% of neoplastic lesions. Erosions were seen in 6% of sebaceous hyperplasias and 50% of neoplastic lesions. Good interobserver agreement was found for white/yellowish clods (k = 0.75), yellow scales (k = 0.83), brown/grey dots (k = 0.80), erosions (k = 0.82) and red/brownish scales/crusts (k = 0.75). There was moderate agreement for fissures (k = 0.48) and vascular pattern (k = 0.51-0.53). CONCLUSIONS AND CLINICAL RELEVANCE: Dermoscopy represents a useful technique to assess sebaceous gland proliferations in dogs, as it is in humans.

Alteration of the temporal association between courtship audio and visual components affects female sexual response.

Some multimodal signals-that is, occurring in more than one sensory modality-appear to carry additional information which is not present when component signals are presented separately. To understand the function of male ring dove's (Streptopelia risoria) multimodal courtship, we used audiovisual playback of male displays to investigate female response to stimuli differing in their audiovisual timing. From natural courtship recordings, we created a shifted stimulus where audio was shifted relative to video by a fixed value and a jittered stimulus, where each call was moved randomly along the visual channel. We presented 3 groups of females with the same stimulus type, that is, control, shifted, and jittered, for 7 days. We recorded their behavior and assessed pre- and post-test blood estradiol concentration. We found that playback exposure increased estradiol levels, confirming that this technique can be efficiently used to study doves' sexual communication. Additionally, chasing behavior (indicating sexual stimulation) increased over experimental days only in the control condition, suggesting a role of multimodal timing on female response. This stresses the importance of signal configuration in multimodal communication, as additional information is likely to be contained in the temporal association between modalities.

Deconstructing the flight paths of hippocampal-lesioned homing pigeons as they navigate near home offers insight into spatial perception and memory without a hippocampus.

The aim of this study was to exploit detailed analyses of GPS-recorded tracks to better characterise the impact of hippocampal (HF) lesion on spatial memory and perception in the context of homing pigeon navigation when reliant on familiar landscape features near the home loft following repeated releases from the same three locations. As reported previously, following HF lesion, a low spatio-temporal resolution analysis revealed that homing pigeons fly less direct paths home once near the loft. We now further show that 1) HF-lesioned pigeons are less likely to display fidelity to a particular flight path home when released from the same locations multiple times, 2) intact pigeons are more likely to exploit leading-line landscape features, e.g., a road or the border of a woodlot, in developing flight-path fidelity and 3) even when flying a straight path HF-lesioned homing pigeons are more likely to display relatively rapid, oscillatory heading changes as if casting about for sensory, presumably visual information. The flight behaviour differences between the intact and HF-lesioned pigeons persisted across the four releases from the three locations, although the differences became smaller with increasing experience. Taken together, the GPS-track data offer a detailed characterisation of the effects of HF lesion on landscape-based, homing pigeon navigation, offering new insight into the role of the hippocampal formation in supporting memory-related, e.g., fidelity to a familiar route home, and perhaps perceptual-related, e.g., oscillating headings, navigational processes.

Development and validation of an owner-assessed Visual Analog Scale for feline pruritus severity scoring (VAScat).

BACKGROUND: Assessment of the severity of pruritus is difficult in cats, because they manifest discomfort by increased licking, increased scratching or both. HYPOTHESIS/OBJECTIVES: Our objective was to develop and validate a feline-specific pruritus scale (VAScat). METHODS: The scale was designed as a double Visual Analog Scale (VAS), one VAS for licking and one for scratching, with severity and behavioural descriptors. The highest score (VAS-max) on either VAS was taken as the pruritus score for each cat. Owners of 153 cats with skin diseases and of 108 healthy cats scored their pet's pruritus using the VAScat. Ninety-six of 153 cats with skin diseases also were re-evaluated after four to eight weeks of treatment. RESULTS: Pearson's correlation value between VAS-licking and VAS-scratching scores was r = 0.26 (p < 0.01), and Cronbach's alpha was 0.41. Both indexes indicated that the two scales measure different manifestations of pruritus and supported the use of a dual assessing system. Comparison with a numerical pruritus severity scale (0, absent; 1, mild; 2, moderate; 3, severe) suggested that VAS-licking and VAS-scratching scales taken alone are unsuitable for measuring absent to mild pruritus (grades 0-1), while VAS-max is (p = 0.001). VAS-licking, VAS-scratching and VAS-max all were suitable to assess higher levels of pruritus (grades 2-3, p < 0.01). The VAScat was able to measure pruritus improvement following therapy, as post-treatment scores were significantly decreased compared to pre-treatment ones (p < 0.0001). CONCLUSIONS AND CLINICAL IMPORTANCE: The VAScat proved to be a useful tool to assess pruritus in cats and for monitoring the response to treatment for pruritus.

CONTEXTE: L'évaluation de la gravité du prurit est difficile chez les chats, car ils manifestent une gêne par un léchage accru et/ou un grattage accru. Hypothèses/Objectifs : Notre objectif était de développer et de valider une échelle de prurit spécifique au félin (EVAcat). Méthodes : L'échelle a été conçue comme une double échelle visuelle analogique (EVA), une EVA pour le léchage et une pour le grattage, avec des descripteurs de gravité et de comportement. Le score le plus élevé (VAS-max) sur l'un ou l'autre VAS a été pris comme score de prurit pour chaque chat. Les propriétaires de 153 chats atteints de maladies de la peau et de 108 chats en bonne santé ont noté le prurit de leur animal à l'aide du VAScat. Quatre-vingt-seize des 153 chats atteints de maladies de peau ont également été réévalués après quatre à huit semaines de traitement. Résultats : La valeur de corrélation de Pearson entre les scores de léchage VAS et de grattage VAS était de r = 0,26 (p < 0,01) et l'alpha de Cronbach était de 0,41. Les deux indices ont indiqué que les deux échelles mesurent différentes manifestations de prurit et ont soutenu l'utilisation d'un système d'évaluation double. La comparaison avec une échelle numérique de sévérité du prurit (0, absent ; 1, léger ; 2, modéré ; 3, sévère) a suggéré que les échelles EVA de léchage et de grattage prises seules ne conviennent pas pour mesurer le prurit absent à léger (grades 0-1), tandis que VAS-max l'est (p = 0,001). Le léchage VAS, le grattage VAS et le VAS-max étaient tous appropriés pour évaluer des niveaux plus élevés de prurit (grades 2-3, p < 0,01). Le VAScat a pu mesurer l'amélioration du prurit après le traitement, car les scores post-traitement ont été significativement diminués par rapport à ceux avant traitement (p < 0,0001). Conclusions et importance clinique : Le VAScat s'est avéré être un outil utile pour évaluer le prurit chez le chat et pour surveiller la réponse au traitement du prurit.

Introducción- la evaluación de la severidad del prurito es difícil en gatos, porque manifiestan malestar lamiéndose o rascándose más o ambos a la vez. Hipótesis/Objetivos- Nuestro objetivo fue desarrollar y validar una escala de prurito específica para felinos (VAScat). Métodos- La escala fue diseñada como una doble Escala Visual Análoga (EVAS), una VAS para lamido y otras para rascado, con descriptores de severidad y comportamiento. La puntuación más alta (VAS-max) en cualquiera de las VAS se tomó como la puntuación de prurito para cada gato. Los propietarios de 153 gatos con enfermedades de la piel y de 108 gatos sanos calificaron el prurito de sus mascotas con el VAScat. Noventa y seis de 153 gatos con enfermedades de la piel también fueron reevaluados después de cuatro a ocho semanas de tratamiento. Resultados- el valor de correlación de Pearson entre las puntuaciones de VAS-lamerse y VAS-rascarse fue r = 0,26 (p < 0,01), y el alfa de Cronbach fue 0,41. Ambos índices indicaron que las dos escalas miden diferentes manifestaciones de prurito y apoyaron el uso de un sistema de evaluación dual. La comparación con una escala numérica de gravedad del prurito (0, ausente; 1, leve; 2, moderado; 3, severo) sugirió que las escalas VAS-lamerse y VAS-rascarse tomadas solas no son adecuadas para medir el prurito ausente o leve (grados 0-1) , mientras que VAS-max sí que lo es (p = 0,001). VAS-lamerse, VAS-rascarse y VAS-max fueron adecuados para evaluar niveles más altos de prurito (grados 2-3, p < 0,01). El VAScat pudo medir la mejora del prurito después de la terapia, ya que las puntuaciones posteriores al tratamiento se redujeron significativamente en comparación con las anteriores al tratamiento (p < 0,0001). Conclusiones e importancia clínica- El VAScat demostró ser una herramienta útil para evaluar el prurito en gatos y para monitorizar la respuesta al tratamiento del prurito.

Contexto - A avaliação da gravidade do prurido em gatos é difícil, pois eles manifestam desconforto pelo aumento da lambedura, coçam-se mais ou os dois. Hipótese/Objetivos: Nosso objetivo foi desenvolver e validar uma escala de prurido específica para felinos (VAScat). Métodos - A escala foi desenvolvida como uma escala analógica visual (VAS) dupla, uma VAS para lambedura e uma para coceira, com descrição de gravidade e de comportamento. O escore mais alto (VAS-max) em ambas as VAS foi considerado o escore de prurido para cada gato. Donos de 153 gatos com doença de pele e de 108 gatos saudáveis classificaram o prurido dos seus animais utilizando o VAScat. Noventa e seis de 153 gatos com doenças de pele também foram reavaliados após quatro de oito semanas de tratamento. Resultados - O valor de correlação de Pearson entre os escores de VAS-lambedura e o VAS-coceira foi r = 0,26 (p < 0,01), e o alfa de Cronbach foi 0,41. Ambos os índices indicaram que as duas escalas de mensuraram manifestações diferentes de prurido e confirmaram a necessidade do uso de um sistema duplo de avaliação. A comparação com uma escala numérica de gravidade de prurido (0, ausente; 1, leve; 2, moderado; 3, grave) sugeriu que as escalas VAS-lambedura e VAS-coceira isoladamente são ineficazes para a mensuração de prurido ausente a leve (notas 0-1), enquanto o VAS-max é adequado para tal (p = 0,001). VAS-lambedura, VAS-coceira e VAS-max são todas eficazes para avaliar graus de prurido mais altos (notas 2-3, p < 0.01). A VAScat foi capaz de mensurar a melhora do prurido após o tratamento, os escores pós-tratamento foram significativamente menores comparados aos pré-tratamento (p < 0.0001). Conclusões e importância clínica - O VAScat provou ser uma ferramenta útil para avaliar o prurido em gatos e para o monitoramento da resposta ao tratamento para prurido.

Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and Steatosis or Steatohepatitis.

BACKGROUND AND AIMS: Hepatic steatosis of nonalcoholic etiology (nonalcoholic fatty liver disease; NAFLD) is an emergent condition that may lead to hepatic cirrhosis and finally to liver cancer. We evaluate the risk of developing hepatocellular carcinoma (HCC) and quantify the prognosis in terms of recurrence (DFS) as well as HCC-specific and overall survival (CSS and OS) of patients with and without NAFLD. METHODS: We searched published articles that evaluated the risk and outcomes of HCC in patients with steatosis/steatohepatitis from inception to July 2021 were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Prospective cohort, case-control, or retrospective studies were selected that were published in English and provided incidence and survival rates of HCC patients with NAFLD. A random-effects model was created to estimate the pooled effect size. The primary outcome of interest was HCC incidence. The secondary endpoints were DFS, CSS, and OS. RESULTS: In total, 948 217 patients with NAFLD were analyzed, from n = 103 observational studies. NAFLD significantly increased the risk of HCC (HR = 1.88 [95% CI, 1.46-2.42]; P < .01] but not risk of recurrence (HR = 0.99 [95% CI, 0.85-1.15]; P = .9) or overall mortality (HR = 1.04 [95% CI, 0.88-1.24]; P = 0.64). Conversely, NAFLD increased HCC-related mortality risk (HR = 2.16 [95% CI, 0.85-5.5]; P = .1). Risk of HCC was increased in Western countries but not in Asian countries. CONCLUSIONS: Patients with NAFLD have an increased risk of HCC as compared to patients without NAFLD. NAFLD also increases liver cancer (HCC) mortality. These results justify applying general measures to patients with proven NAFLD and monitoring patients with NASH and fibrosis.

Prevalence of Listeria monocytogenes and Salmonella spp. in Different Ready to Eat Foods from Large Retailers and Canteens over a 2-Year Period in Northern Italy.

This study aims to give an overview of the prevalence of Listeria monocytogenes and Salmonella spp. in 9727 samples (2996 for L. monocytogenes and 6731 for Salmonella spp.) from different categories of ready-to-eat (RTE) foods, collected over 2 years from 28 large retailers and 148 canteens in the regions of northern Italy. The RTE samples were classified into two groups according to the preparation methods: (i) multi-ingredient preparations consisting of fully cooked food ready for immediate consumption, or with minimal further handling before consumption (Group A), and (ii) multi-ingredient preparations consisting of cooked and uncooked food, or preparations consisting of only raw ingredients (Group B). L. monocytogenes and Salmonella spp. were investigated in both of these categories. The overall prevalence of L. monocytogenes and Salmonella spp. was 0.13% and 0.07%, respectively. More specifically, L. monocytogenes was found in 0.04% of 2442 analysed RTE food samples belonging to group A and in 0.54% of 554 samples belonging to group B. Furthermore, 0.03% of 5367 RTE food samples from group A and 0.21% of 1364 samples from group B tested positive for Salmonella spp. In conclusion, the results obtained in this study can provide a significant contribution to L. monocytogenes and Salmonella spp. risk analysis in RTE foods.

Ear tip ulcerative dermatitis treated with oclacitinib in 25 dogs: a retrospective case series.

BACKGROUND: Ear tip ulcerative dermatitis (ETUD) is an uncommon clinical reaction pattern in canine dermatology. The lesions are suggestive of vascular damage which may be caused by inflammatory or noninflammatory diseases, and often are idiopathic. Therapeutic options for ETUD include topical glucocorticoids or tacrolimus, pentoxifylline, vitamin E, doxycycline, tetracycline and niacinamide, sulfonamides, glucocorticoids, ciclosporin and surgical correction. HYPOTHESIS/OBJECTIVES: The aims of this retrospective case series were to describe the clinical features and report response to treatment with oclacitinib in dogs with idiopathic, chronic ETUD. ANIMALS: Twenty-five privately owned dogs with unilateral or bilateral ETUD. METHODS AND MATERIALS: Cases of ETUD which were poorly responsive to conventional therapy and subsequently treated with oclacitinib, are summarised. All cases were tested for leishmaniosis by serological examination [indirect fluorescent antibody test (IFAT) or enzyme-linked immunosorbent assay (ELISA)]. Histopathological examination was performed in two cases. RESULTS: Serological results were negative for leishmaniosis in all dogs. Histopathological changes consistent with proliferative thrombovascular necrosis of the pinnae were documented in two cases. Oclacitinib, used at the standard dose range recommended for the treatment of canine atopic dermatitis, effectively resolved ETUD in 22 of 25 dogs within one to three months. Several of the dogs required prolonged use of twice daily dosing. CONCLUSIONS AND CLINICAL RELEVANCE: Oclacitinib should be included among the therapeutic options for ETUD, once infectious diseases have been ruled out.

GPS-profiling of retrograde navigational impairments associated with hippocampal lesion in homing pigeons.

The avian hippocampal formation (HF) is homologous to the mammalian hippocampus and plays a central role in the control of spatial cognition. In homing pigeons, HF supports navigation by familiar landmarks and landscape features. However, what has remained relatively unexplored is the importance of HF for the retention of previously acquired spatial information. For example, to date, no systematic GPS-tracking studies on the retention of HF-dependent navigational memory in homing pigeons have been performed. Therefore, the current study was designed to compare the pre- and post-surgical navigational performance of sham-lesioned control and HF-lesioned pigeons tracked from three different sites located in different directions with respect to home. The pre- and post-surgical comparison of the pigeons' flight paths near the release sites and before reaching the area surrounding the home loft (4 km radius from the loft) revealed that the control and HF-lesioned pigeons displayed similarly successful retention. By contrast, the HF-lesioned pigeons displayed dramatically and consistently impaired retention in navigating to their home loft during the terminal phase of the homing flight near home, i.e., where navigation is supported by memory for landmark and landscape features. The data demonstrate that HF lesions lead to a dramatic loss of pre-surgically acquired landmark and landscape navigational information while sparing those mechanisms associated with navigation from locations distant from home.

Gamma Knife Radiosurgery for Treatment of Brain Metastases during the COVID-19 Outbreak.

INTRODUCTION: The WHO declared 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a public health emergency of international concern. The National and Regional Health System has been reorganized, and many oncological patients died during this period or had to interrupt their therapies. This study summarizes a single-centre experience, during the COVID-19 period in Italy, in the treatment of brain metastases with Gamma Knife stereotactic radiosurgery (GKRS). METHODS: We retrospectively analysed our series of patients with brain metastases who underwent GKRS at the Niguarda Hospital from February 24 to April 24, 2020. RESULTS: We treated 30 patients with 66 brain metastases. A total of 22 patients came from home and 8 patients were admitted to the emergency room for urgent neurological symptoms. Duration of stay was limited to 0-1 day in 17 patients. We chose to treat a cluster of 9 patients, whose greater lesion exceeded 10 cm3, with 2-stage modality GKRS to minimize tumour recurrence and radiation necrosis. CONCLUSION: Due to the COVID-19 pandemic, the whole world is at a critical crossroads about the use of health care resources. During the COVID-19 outbreak, the deferral of diagnostic and therapeutic procedures and a work backlog in every medical specialty are the natural consequences of reservation of resources for COVID-19 patients. GKRS improved symptoms and reduced the need for open surgeries, allowing many patients to continue their therapeutic path and sparing beds in ICUs. Neurosurgeons have to take into account the availability of stereotactic radiosurgery to reduce hospital stay, conciliating safety for patients and operators with the request for health care coming from the oncological patients and their families.

Comparison of three therapeutic regimens for genotype-3 hepatitis C virus infection in a large real-life multicentre cohort.

BACKGROUND & AIMS: In the direct-acting antiviral era, treatment of genotype-3 HCV (HCV-GT3) is still challenging. Real-life comparisons between recommended regimens, sofosbuvir (SOF)+daclatasvir (DAC), SOF/velpatasvir (VEL), glecaprevir/pibrentasvir (GLE/PIB), are scarce. We aimed at filling this data gap. METHODS: Sustained virological response 12 weeks after treatment completion (SVR12) was assessed for all HCV-GT3 patients consecutively treated within the Lombardia web-based Navigatore HCV-Network; differences in SVR12 across regimens were evaluated by logistic regression. RESULTS: Of the 2082 subjects with HCV-GT3, 1544 were evaluable for comparisons between regimens: SOF + DAC (1023, 66.2%), SOF/VEL (369, 23.9%), GLE/PIB (152, 9.8%). Patients treated with former regimens were more frequently male, cirrhotic, HIV-positive, pretreated, used ribavirin in their regimen, and had lower baseline HCV-RNA. SVR12 was similar across groups: 94.8% in SOF + DAC, 97.6% in SOF/VEL, 96.7% in GLE/PIB (P = .065). At univariate analysis, SVR12 was associated with female gender (97.9% vs 94.8%, P = .007) and lower median pretreatment Log10 HCV-RNA (5.87 vs 6.20, P = .001). At multivariate logistic regression analysis, treatment with SOF/VEL was associated with a higher likelihood of SVR12 than SOF + DAC, but only in the absence of ribavirin (98% vs 90.3%). Female gender and lower pretreatment HCV-RNA were independently associated with SVR12. CONCLUSIONS: In a large real-life setting of HCV-GT3-infected patients with a high proportion of cirrhosis, the success rate was remarkable. The slight advantage of SOF/VEL on SOF + DAC was significant only without ribavirin. The current prescription shift towards novel regimens (ie SOF/VEL and GLE/PIB) in easier-to-treat patients allows ribavirin-free and shorter schedules without mining SVR12 in this <> genotype.

Renal safety in 3264 HCV patients treated with DAA-based regimens: Results from a large Italian real-life study.

BACKGROUND: Sofosbuvir (SOF)-based regimens have been associated with renal function worsening in HCV patients with estimated glomerular filtration rate (eGFR) ≤ 45 ml/min, but further investigations are lacking. AIM: To assess renal safety in a large cohort of DAA-treated HCV patients with any chronic kidney disease (CKD). METHODS: All HCV patients treated with DAA in Lombardy (December 2014-November 2017) with available kidney function tests during and off-treatment were included. RESULTS: Among 3264 patients [65% males, 67% cirrhotics, eGFR 88 (9-264) ml/min], CKD stage was 3 in 9.5% and 4/5 in 0.7%. 79% and 73% patients received SOF and RBV, respectively. During DAA, eGFR declined in CKD-1 (p < 0.0001) and CKD-2 (p = 0.0002) patients, with corresponding rates of CKD stage reduction of 25% and 8%. Conversely, eGFR improved in lower CKD stages (p < 0.0001 in CKD-3a, p = 0.0007 in CKD-3b, p = 0.024 in CKD-4/5), with 33-45% rates of CKD improvement. Changes in eGFR and CKD distribution persisted at SVR. Baseline independent predictors of CKD worsening at EOT and SVR were age (p < 0.0001), higher baseline CKD stages (p < 0.0001) and AH (p = 0.010 and p < 0.0001, respectively). CONCLUSIONS: During DAA, eGFR significantly declined in patients with preserved renal function and improved in those with lower CKD stages, without reverting upon drug discontinuation.

Actividad física recreativa en niños y adolescentes: situación actual, indicaciones y beneficios / Recreational physical activity in children and adolescents: current situation, indications and benefits

Actividad física se considera a cualquier movimiento corporal producido por los músculos esqueléticos, con el consiguiente consumo de energía. Los niños que hacen actividad física logran beneficios en diversos aspectos: condición física, psicológica, social, desarrollo de hábitos saludables, mejora en la calidad de vida adulta. Esta actividad física debe ser voluntaria, desarrollada en los tiempos libres, y generar placer y alegría, lo que contribuirá a la salud física y psicológica. Favorece la creatividad y las relaciones sociales y de comunicación. Promueve la educación en hábitos saludables para la vida adulta. Según la Organización Mundial de la Salud la actividad física es un pilar para combatir el flagelo de la obesidad y el sobrepeso, y una herramienta para disminuir el sedentarismo mundial de aquí al 2030. (AU)

Physical activity is considered as any body movement produced by skeletal muscles, which consumes energy. Children who do physical activity achieve benefits in various aspects: physical, psychological, social condition, develop of healthy habits, improvement of quality in adult life. Physical activity must be voluntary, developed in leisure time, and shall generate pleasure and joy. This way physical activity contributes with physical and psychological health. It also promotes creativity as much as sociable and communicational relationships. At the same time, physical activity encourages, promotes the education in healthy habits for adult life. According to the World Health Organization, physical activity is a pillar to combat the scourge of obesity and the overweight. It is a tool to reduce world sedentary lifestyle by 2030. (AU)

Footpad peripheral ganglioneuroblastoma in a dog.

BACKGROUND: Peripheral neuroblastic tumours arising from primitive cells of the cranial and spinal ganglia and from sympathetic ganglion cells of the autonomic nervous system include, from most to least differentiated, ganglioneuroma, ganglioneuroblastoma and neuroblastoma. Canine ganglioneuroblastoma has been described in the mediastinum, nasal and oral cavities, as well as in the brain. OBJECTIVE: To describe the clinical and histopathological findings, treatment and follow-up of a primary cutaneous ganglioneuroblastoma affecting the footpad of a dog. ANIMAL: An 8-year-old male German shepherd dog, referred for left forelimb lameness and licking of the footpad, showed thickening of the footpad of digit V with a central nodular lesion. METHODS AND RESULTS: Histopathological and immunohistochemical examination on a surgical skin biopsy specimen showed an infiltrative and highly cellular neoplasm in the deep dermis. The neoplasm was composed of large polyhedral cells with abundant cytoplasm containing Nissl substance that reacted strongly with neuron-specific enolase and neuronal nuclei antigen, spindle cells with indistinct cell borders suggestive of Schwann cells, with a mild S-100 and GFAP immunoreactivity, and rare nests of neuroblasts. The owner agreed to digit amputation. Histologically, a neoplastic multinodular proliferation with morphological findings like those detected in the biopsy was observed, not extended to the surgical margins and without involvement of skeletal bone. No recurrence or metastasis was observed over a period of one year. CONCLUSIONS AND CLINICAL IMPORTANCE: To the best of the authors' knowledge, this is the first report of a primary cutaneous ganglioneuroblastoma in a dog. Ganglioneuroblastoma should be included in the differential diagnoses of canine footpad neoplastic diseases.

Nasal Planum Vasculopathy in a Scottish Terrier Dog Treated with Ciclosporin and Endonasal Stents.

A two-year-old, intact female Scottish Terrier presented with one-and-a-half-year history of erosive and ulcerative lesions affecting the nasal planum. Clinical appearance, history, histopathology, and response to therapy were suggestive of a rare vasculopathy of the nasal planum that has been previously described in Scottish Terrier dogs. In previously published reports, medical treatments of the disease had failed, leading to euthanasia of five dogs, while a short-term follow-up was available for one case that was controlled with prednisolone and ciclosporin. The dog reported herein was successfully treated with medical therapy consisting initially of a combination of ciclosporin and prednisolone and endonasal stents applied over the first six months. Stents were inserted in order to prevent abnormal scarring and nostril stenosis. More than one and a half years after diagnosis, the dog is still being administered ciclosporin once daily, breathes normally, and has an optimal quality of life.

Ciclosporin and the cat: Current understanding and review of clinical use.

Practical relevance: Ciclosporin (CsA) is a systemic immuno-modulatory drug widely used to treat immune-mediated diseases in humans and veterinary species. CsA was registered for use in cats in the USA and Europe in 2011, and is indicated for the treatment of chronic allergic dermatitis at a recommended daily dose of 7 mg/kg PO. AUDIENCE: This review will be of interest to all veterinarians working with cats, given the wide range of potential applications of CsA and its safety profile. Although the drug is currently only licensed to treat chronic allergic dermatitis in cats, a small number of reports describe its use in non-dermatological conditions. Evidence base: This article reviews the mechanism of action, pharmacokinetics, drug interactions, adverse effects and clinical use of CsA, both for the licensed indication and for off-label use in the feline patient. Information presented has been summarised from the existing literature on CsA, with specific interest in studies carried out in cats. For its licensed indication, chronic allergic dermatitis, evidence provided includes randomised, placebo or prednisolone-controlled studies (EBM grade I) and prospective or retrospective open trials.

Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study.

Sepsis is a rapidly evolving disease with a high mortality rate. The early identification of sepsis and the implementation of early evidence-based therapies have been recognized to improve outcome and decrease sepsis-related mortality. The aim of this study was to compare the accuracy of the standard diagnostic work-up of septic patients with an integrated approach using early point of care ultrasound (POCUS) to identify the source of infection and to speed up the time to diagnosis. We enrolled a consecutive sample of adult patients admitted to the ED who met the Surviving Sepsis Campaign (SSC) criteria for sepsis. For every patient, the emergency physician was asked to identify the septic source after the initial clinical assessment and after POCUS. Patients were then addressed to the standard predefined work-up. The impression at the initial clinical assessment and POCUS-implemented diagnosis was compared with the final diagnosis of the septic source, determined by independent review of the entire medical record after discharge. Two hundred consecutive patients entered the study. A final diagnosis of the septic source was obtained in 178 out of 200 patients (89 %). POCUS-implemented diagnosis had a sensitivity of 73 % (95 % CI 66-79 %), a specificity of 95 % (95 % CI 77-99 %), and an accuracy of 75 %. Clinical impression after the initial clinical assessment (T0) had a sensitivity of 48 % (CI 95 % 41-55 %) and a specificity of 86 % (CI 95 % 66-95 %). POCUS improved the sensitivity of the initial clinical impression by 25 %. POCUS-implemented diagnoses were always obtained within 10 min. Instead the septic source was identified within 1 h in only 21.9 % and within 3 h in 52.8 % with a standard work-up. POCUS-implemented diagnosis is an effective and reliable tool for the identification of septic source, and it is superior to the initial clinical evaluation alone. It is likely that a wider use of POCUS in an emergency setting will allow a faster diagnosis of the septic source, leading to more appropriate and prompt antimicrobial therapy and source control strategies.