Management of a stingray barb laceration and suspect envenomation in a dog.

This case report describes the successful management of a stingray laceration and suspected envenomation using a combination of opioid analgesia, heat compression, antimicrobial therapy, surgical debridement and closure. Stingray envenomation in the dog is a rare clinical presentation and is yet to be documented in the Australian veterinary literature. Envenomation can be markedly painful and may cause swelling and local tissue necrosis. No consensus on treatment guidelines has been published. Diagnostics and treatments performed are outlined with recommendations on a management plan for future cases.

Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHOC-ED investigators.

PURPOSE: Point-of-care ultrasonography (POCUS) is an established tool in the management of hypotensive patients in the emergency department (ED). We compared the diagnostic accuracy of a POCUS protocol versus standard assessment without POCUS in patients with undifferentiated hypotension. METHODS: This was an international, multicenter randomized controlled trial included three EDs in North America and three in South Africa from September 2012 to December 2016. Hypotensive patients were randomized to early POCUS protocol plus standard care (POCUS group) or standard care without POCUS (control group). Initial and secondary diagnoses were recorded at 0 and 60 min. The main outcome was measures of diagnostic accuracy of a POCUS protocol in differentiating between cardiogenic and non-cardiogenic shock. Secondary outcomes were diagnostic performance for shock sub-types, as well as changes in perceived category of shock and overall diagnosis. RESULTS: Follow-up was completed for 270 of 273 patients. For cardiogenic shock, the POCUS-based diagnostic approach (POCUS) performed similarly to the non-POCUS approach (control) for specificity [95.5% (89.9-98.5) vs.93.8% (87.7-97.5)]; positive likelihood ratio (17.92 vs 14.80); negative likelihood ratio (0.21 vs 0.09) and diagnostic odds ratio (85.6 vs 166.57), with a similar overall diagnostic accuracy between the two approaches [93.7% (88-97.2) vs 93.6% (87.8-97.2)]. Diagnostic performance measures were similar across sub-categories of shock. CONCLUSION: This is the first randomized controlled trial to compare diagnostic performance of a POCUS protocol to standard care without POCUS in undifferentiated hypotensive ED patients. POCUS performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test; however, performance did not differ meaningfully from standard assessment.

RéSUMé: OBJECTIF: L'échographie au point d'intervention (POCUS) est un outil bien établi dans la gestion des patients hypotendus dans le service des urgences. Nous avons comparé la précision diagnostique d'un protocole POCUS par rapport à une évaluation standard sans POCUS chez des patients présentant une hypotension indifférenciée. MéTHODES: Il s'agissait d'un essai contrôlé randomisé international multicentrique incluant 3 services d'urgence en Amérique du Nord et 3 en Afrique du Sud de septembre 2012 à décembre 2016. Les patients hypotenseurs ont été répartis par randomisation selon le protocole POCUS précoce plus les soins standard (groupe POCUS) ou les soins standard sans POCUS (groupe témoin). Les diagnostics initiaux et secondaires ont été enregistrés à 0 et 60 minutes. Le principal résultat était la mesure de la précision diagnostique d'un protocole POCUS pour différencier le choc cardiogénique du choc non cardiogénique. Les résultats secondaires étaient la performance diagnostique pour les sous-types de chocs, ainsi que les changements dans la perception de la catégorie de choc et du diagnostic global. RéSULTATS: Le suivi a été complété pour 270 des 273 patients. Pour le choc cardiogénique, l'approche diagnostique basée sur le POCUS (POCUS) a donné des résultats similaires à l'approche non-POCUS (Contrôle) pour la spécificité (95,5 % (89,9­98,5) vs 93,8 % (87,7­97,5)) ; Rapport de vraisemblance positif (17,92 vs 14,80) ; Le rapport de vraisemblance négatif (0,21 vs 0,09) et le rapport de cotes diagnostiques (85,6 vs 166,57), avec une précision diagnostique globale similaire entre les deux approches (93,7 % (88­97,2) vs 93,6 % (87,8­97,2). Les mesures de performance diagnostique étaient similaires dans toutes les sous-catégories de choc. CONCLUSION: Il s'agit du premier essai contrôlé randomisé visant à comparer la performance diagnostique d'un protocole POCUS aux soins standard sans POCUS chez des patients hypotendus indifférenciés aux urgences. La POCUS a donné de bons résultats diagnostiques chez les patients hypotendus indifférenciés, surtout en tant que test de référence ; cependant, les performances ne diffèrent pas de manière significative de l'évaluation standard.

Colloidal-electrochemical fabrication strategies for functional composites of linear polyethylenimine.

Colloidal-electrochemical fabrication strategies have been developed for the deposition of linear polyethylenimine (LPEI) composite materials. Electrophoretic deposition (EPD) allowed for the fabrication of composite films containing Mn3O4 and ZnO nanoparticles, as well as advanced flame retardant materials, such as halloysite nanotubes and memory-type Al-Mg-Zr complex hydroxide (AMZ) in the matrix of the water-insoluble LPEI. A liquid-liquid extraction method has been designed for the agglomerate-free processing of AMZ particles. Efficient extraction was achieved using decylphosphonic acid as an extractor. A conceptually new polymer complex (PC)-EPD method has been developed, which is based on the use of LPEI-metal ion complexes. Proof-of-concept studies involved the fabrication of LPEI-Ni(OH)2 and LPEI-MnOx nanocomposites. The composites showed valuable flame retardant and charge-storage properties. The analysis of basic EPD and PC-EPD mechanisms as well as complexing properties of LPEI has driven the development of new strategies for the fabrication of organic composites. Hemoglobin was used as a model protein for the fabrication of composite films. Another important finding was the fabrication of composites, containing cyclodextrin, which is a unique carrier of various functional organic molecules. EPD and PC-EPD are versatile methods, which allow for the deposition of novel LPEI based composites containing various functional materials.

New developments in liquid-liquid extraction, surface modification and agglomerate-free processing of inorganic particles.

This review describes new methods for the particle extraction through liquid-liquid interface (PELLI). The discovery of new surface modification techniques, advanced extractors and new adsorption mechanisms enabled novel applications of PELLI in nanotechnology of metals, quantum dots, oxides and hydroxides. Colloidal and interface chemistry of PELLI is emerging as a new area of technological and scientific interest. The progress achieved in the understanding of particle behavior and interactions at the liquid-liquid interface, phase transfer and interface reactions allowed for the development of new extraction mechanisms. An important breakthrough was the development of surface modification techniques for extraction of functional oxides. Especially important is the possibility of particle transfer from the synthesis medium to the device processing medium, which facilitates agglomerate-free processing of functional nanoparticles. Multifunctional extractor molecules were discovered and used as capping and reducing agents for particle synthesis or dispersing and charging agents for colloidal processing. The progress achieved in the development of extractors and extraction mechanisms has driven the advances in the surface modification and functionalization of materials. New PELLI techniques were used for the development of advanced materials and devices for optical, photovoltaic, energy storage, electronic, biomedical, sensor and other applications.

Application of octanohydroxamic acid for liquid-liquid extraction of manganese oxides and fabrication of supercapacitor electrodes.

MnO2 and Mn3O4 particles were prepared by wet chemical methods and efficiently dispersed and mixed with multiwalled carbon nanotubes (MWCNT) for the fabrication of composite MnO2-MWCNT and Mn3O4-MWCNT electrodes for electrochemical supercapacitors (ES). The problem of particle agglomeration was addressed by particle extraction through a liquid-liquid interface (PELLI) using octanohydroxamic acid (OHA) as a new extractor. OHA exhibited remarkable adsorption on particles due to a bidentate bonding mechanism. The use of OHA broadened the application of PELLI technology, because it allowed good extraction of particles from an aqueous phase at high pH. Moreover, OHA allowed efficient extraction by strong adsorption on particles not only at the liquid-liquid interface, but also in the bulk of an aqueous phase. Building on the advantages offered by the PELLI method and OHA as an extractor we found that Mn3O4-MWCNT electrodes exhibited a remarkably high capacitance of 4.2F cm-2. Another major finding was that capacitance of Mn3O4-MWCNT electrodes was higher than that of MnO2-MWCNT electrodes at active mass of 33 mg cm-2. This finding showed processing advantages of PELLI and paved the way for applications of novel colloidal and surface modification strategies for the development of advanced ES. A conceptually new approach has been proposed based on the use of hydroxamic acids as capping agents for synthesis and extractor molecules for PELLI.

Fabrication of Mn3O4-carbon nanotube composites with high areal capacitance using cationic and anionic dispersants.

Mn3O4-multiwalled carbon nanotube (MWCNT) electrodes for supercapacitors with high active mass loadings have been fabricated with the goal of achieving a high area normalized capacitance (CS) and enhanced capacitance retention at high charge-discharge rates. Poly(4-styrenesulfonic acid-co-maleic acid) sodium salt P(SSA-MA) was used as a charging and dispersing agent for the fabrication of Mn3O4. The unique bonding properties of the MA monomers allowed efficient P(SSA-MA) adsorption on Mn3O4, whereas SSA monomers imparted a negative charge. Cationic ethyl violet (EV) and pyronin Y (PY) dyes were used for dispersion and charging of MWCNT. Good dispersion of the individual components and their electrostatic heterocoagulation facilitated efficient mixing, which allowed enhanced capacitive behavior at mass loadings of 28.4 mg cm-2, which meet requirements for practical applications. The highest capacitance of 2.8 F cm-2 was obtained at a scan rate of 2 mV s-1 for the composites, prepared using PY. However, the composites, prepared using EV showed better capacitance retention of 88% in the scan rate range of 2-100 mV s-1 and the capacitance of 2.1 F cm-2 was obtained at a scan rate of 100 mV s-1. The composites showed activation behavior during cycling, which resulted in a capacitance increase and electrical resistance reduction. The results of this investigation showed that Mn3O4-MWCNT composites, prepared by new colloidal methods are promising materials for practical applications in electrochemical supercapacitors.

Hepatic IGF1 DNA methylation is influenced by gender but not by intrauterine growth restriction in the young lamb.

Intrauterine growth restriction (IUGR) and postnatal catch-up growth confer an increased risk of adult-onset disease. Overnourishment of adolescent ewes generates IUGR in ∼ 50% of lambs, which subsequently exhibit increased fractional growth rates. We investigated putative epigenetic changes underlying this early postnatal phenotype by quantifying gene-specific methylation at cytosine:guanine (CpG) dinucleotides. Hepatic DNA/RNA was extracted from IUGR [eight male (M)/nine female (F)] and normal birth weight (12 M/9 F) lambs. Polymerase chain reaction was performed using primers targeting CpG islands in 10 genes: insulin, growth hormone, insulin-like growth factor (IGF)1, IGF2, H19, insulin receptor, growth hormone receptor, IGF receptors 1 and 2, and the glucocorticoid receptor. Using pyrosequencing, methylation status was determined by quantifying cytosine:thymine ratios at 57 CpG sites. Messenger RNA (mRNA) expression of IGF system genes and plasma IGF1/insulin were determined. DNA methylation was independent of IUGR status but sexual dimorphism in IGF1 methylation was evident (MF (both P<0.001). IGF1 mRNA expression correlated negatively with IGF1 methylation (r=-0.507, P=0.002) and positively with plasma IGF1 (r=0.884, P<0.001). Carcass and empty body weights were greater in males (P=0.002-0.014) and this gender difference in early body conformation was mirrored by sexual dimorphism in hepatic IGF1 DNA methylation, mRNA expression and plasma IGF1 concentrations.

Orexigenic Gene Expression in Late Gestation Ovine Foetal Hypothalamus is Sensitive to Maternal Undernutrition and Realimentation.

Adverse nutritional effects on developing foetal hypothalamic appetitive pathways may contribute to programmed hyperphagia and obesity in intra-uterine growth-restricted, low birth weight offspring. In the present study, for the first time, hypothalamic gene expression for primary orexigenic and anorexigenic genes was examined in late gestation ovine foetuses (130 days; term=145 days) whose mothers were undernourished (UN) or well-nourished (C) throughout pregnancy, or transferred from UN to C on day 90 (UN-C). Pregnancies resulted from singleton embryo transfer into adolescent growing ewes. Body weight, carcass fat content and perirenal adipose tissue (PAT) mass were all lower for UN (n=9) than C (n=7) and intermediate for UN-C foetuses (n=6), with no effect of sex. PAT leptin gene expression (by the reverse transcriptase-polymerase chain reaction) was lower in UN than C and UN-C groups, and lower in males than females. Gene expression (by in situ hybridisation with radiolabelled riboprobes) in the arcuate nucleus was greater in UN than C foetuses for neuropeptide Y (NPY), agouti-related peptide (AGRP) and leptin receptor (OBRb) but not different for pro-opiomelanocortin and cocaine- and amphetamine-regulated transcript. Gene expression in UN-C foetuses was intermediate for NPY and AGRP and not different from C foetuses for OBRb. Gene expression for NPY, AGRP and OBRb correlated negatively with foetal carcass fat content and with PAT leptin gene expression across all groups. Males had greater mRNA expression for AGRP than females, with NPY and OBRb showing similar trends. Therefore, maternal undernutrition throughout pregnancy increased orexigenic gene expression in the late gestation foetal hypothalamus, and expression levels were largely normalised by improved maternal nutrition in the last third of pregnancy. These findings may have implications for avoiding or correcting prenatal programming of postnatal hyperphagia and obesity.

Neural correlates of motion processing through echolocation, source hearing, and vision in blind echolocation experts and sighted echolocation novices.

We have shown in previous research (Thaler L, Arnott SR, Goodale MA. PLoS One 6: e20162, 2011) that motion processing through echolocation activates temporal-occipital cortex in blind echolocation experts. Here we investigated how neural substrates of echo-motion are related to neural substrates of auditory source-motion and visual-motion. Three blind echolocation experts and twelve sighted echolocation novices underwent functional MRI scanning while they listened to binaural recordings of moving or stationary echolocation or auditory source sounds located either in left or right space. Sighted participants' brain activity was also measured while they viewed moving or stationary visual stimuli. For each of the three modalities separately (echo, source, vision), we then identified motion-sensitive areas in temporal-occipital cortex and in the planum temporale. We then used a region of interest (ROI) analysis to investigate cross-modal responses, as well as laterality effects. In both sighted novices and blind experts, we found that temporal-occipital source-motion ROIs did not respond to echo-motion, and echo-motion ROIs did not respond to source-motion. This double-dissociation was absent in planum temporale ROIs. Furthermore, temporal-occipital echo-motion ROIs in blind, but not sighted, participants showed evidence for contralateral motion preference. Temporal-occipital source-motion ROIs did not show evidence for contralateral preference in either blind or sighted participants. Our data suggest a functional segregation of processing of auditory source-motion and echo-motion in human temporal-occipital cortex. Furthermore, the data suggest that the echo-motion response in blind experts may represent a reorganization rather than exaggeration of response observed in sighted novices. There is the possibility that this reorganization involves the recruitment of "visual" cortical areas.

Impact of birth weight and gender on early postnatal hypothalamic energy balance regulatory gene expression in the young lamb.

Intra-uterine growth restriction (IUGR) is involved in developmental metabolic programming and here we test the hypothesis that IUGR affects the developing hypothalamic energy balance regulatory pathways in a sex-specific manner. This experiment investigated early postnatal hypothalamic gene expression for six primary leptin- and insulin-sensitive neuropeptides and receptors in male and female IUGR (n = 8 and 9, respectively) and normal (N) birth weight lambs (n = 8 per gender) gestated and suckled by overnourished mothers. IUGR lambs were smaller at birth, had increased fractional growth rates (FGR), lower final body weight (11 weeks) and similar body fat content compared with N lambs, while males had higher final body weight and insulinemia but lower body fat and leptinemia than females. In situ hybridization revealed greater gene expression in the hypothalamic arcuate nucleus at 11 weeks for anorexigenic genes in females and orexigenic genes in males, with no effect of IUGR. Leptinemia correlated with gene expression for neuropeptide Y (NPY, negatively) in both sexes and pro-opiomelanocortin (POMC, positively) in females but with leptin receptor (negatively) only in males. Current FGR for girth correlated negatively with gene expression for NPY in males and POMC in females. Neither IUGR nor gender affected suckling activity (proxy for appetite) assessed at 3 weeks, but final NPY gene expression correlated with suckling weight gain in males. This study has revealed no effect of IUGR on early postnatal hypothalamic energy balance gene expression but a major effect of gender associated with major sex differences in adiposity and leptinemia.

A case of successful pregnancy in a ewe with uterus didelphys.

Uterus didelphys is a rare congenital abnormality of the reproductive tract. Although it occurs in various species, there are no published reports describing pregnancy outcome in association with this abnormality. Herein we describe a case of successful unilateral singleton pregnancy in a ewe incidentally found to have uterus didelphys during the course of a biomedical research study. The pregnancy was established using assisted reproductive techniques and interrupted in late gestation, at which point the abnormality was identified. Serial ultrasound assessment of foetal biometry revealed a normal foetal growth trajectory. Despite a 45% reduction in placentome number, total placentome weight was near normal secondary to compensatory placentome growth and development. To our knowledge, this is the first detailed report of normal foetal growth in an animal with uterus didelphys and illustrates the ability of the ovine placenta to adapt to a reduced number of placentomes and maintain foetal nutrient supply.

Reflections on the Canadian MORE(OB) obstetrical risk management programme.

In, 2001, the Patient Safety Division of the Society of Obstetricians and Gynaecologists of Canada initiated and championed a new program to improve patient safety performance in Canadian hospital obstetric units. This new program was developed under the banner of Managing Obstetrical Risk Efficiently and called the MORE(OB) Programme The MORE(OB) Programme was first piloted in Canadian hospitals at the beginning of May 2002 and, by mid 2004, 33 pilot sites had been implemented. In autumn 2004, this program embarked on a national launch. In 2007, the Society of Obstetricians and Gynaecologists of Canada collaborated with the Healthcare Insurance Reciprocal of Canada to form Salus Global Corporation. The birth of this corporate entity embraced the support of rapid expansion of the program within and outside of Canada. This collaboration also enabled innovation and implementation of safety programs beyond the obstetric discipline.

Piezoresistance in silicon at uniaxial compressive stresses up to 3 GPa.

The room-temperature longitudinal piezoresistance of n-type and p-type crystalline silicon along selected crystal axes is investigated under uniaxial compressive stresses up to 3 GPa. While the conductance (G) of n-type silicon eventually saturates at ≈ 45% of its zero-stress value (G(0)) in accordance with the charge transfer model, in p-type material G/G(0) increases above a predicted limit of ≈ 4.5 without any significant saturation, even at 3 GPa. Calculation of G/G(0) using ab initio density functional theory reveals that neither G nor the mobility, when properly averaged over the hole distribution, saturate at stresses lower than 3 GPa. The lack of saturation has important consequences for strained-silicon technologies.

Decreasing maternal nutrient intake during the final third of pregnancy in previously overnourished adolescent sheep: effects on maternal nutrient partitioning and feto-placental development.

When pregnant adolescent sheep are overnourished during pregnancy normal nutrient partitioning priorities to the gravid uterus are altered, leading to impaired placental development and fetal growth restriction. We hypothesized that decreasing dietary intake in overnourished dams during the final third of gestation may reverse this inappropriate nutrient partitioning in favor of the fetus. Adolescent ewes were offered control (C; n = 12) or high (H; n = 20) dietary intakes to induce normal vs. compromised placental development. Ten ewes receiving the H intake were switched to a low intake at d90 of gestation (HL). Between d90 to 130, HL dams lost weight and adiposity, and metabolic hormones and glucose at d130 were less than H and similar to C. In spite of these maternal changes, at d130 fetal bodyweight was equivalent in HL and H groups and ∼20% less than in C. A greater degree of brain sparing was evident in HL fetuses and glucose and insulin concentrations were more perturbed than in H fetuses. Relative to C, placentome weight was reduced by 46 and 32% in H and HL and the fetal:placentome weight ratio was H > HL > C. Placental vascular morphology was largely unaffected by maternal diet during late gestation but mRNA expression of five angiogenic genes was up-regulated in the fetal cotyledon of HL pregnancies, commensurate with blood vessel remodeling. Nevertheless, overfeeding to promote maternal anabolic growth during adolescent pregnancy impairs feto-placental development that cannot be rescued by reducing maternal intake during the final third of gestation.

Dramatic dietary fat reduction is feasible for breast cancer patients: Results of the randomised study, WINS (UK) - stage 1.

INTRODUCTION: The influence of dietary fat on breast tumour growth(1) and, more recently, on treatment outcomes,(2,3) suggests an important role for dietary advice in the future health of breast cancer patients. The Women's Intervention Nutrition Study (UK) - Stage 1 assessed the feasibility of achieving and maintaining a ≥ 50% reduction in reported fat intake in postmenopausal, early stage breast cancer patients in the UK. METHOD: This study recruited patients in South-east England between 2000 and 2005. They were randomly allocated into two groups. Group 1 (n = 54), received specific dietary counselling to halve their reported fat intake and maintain this low fat intake. Group 2 (n = 53) received healthy eating advice only. Dietitian-led group sessions provided support for women in both groups over 2 years.(4) Validated four-day diaries were used to measure intake. Data analysis used Generalised Linear Model (GLM) for repeated measures and logistic regression. RESULTS: A significantly greater proportion of women in Group 1 reported a fat intake reduction of ≥ 50% at 3 months (p < .001) and 24 months (p < .001) than in Group 2. The size of the effect of active dietary counselling was 37% at 3 months (95%CI: 21-54%) and 35% at 24 months (95%CI: 17-53%). Mean fat intake was halved at 3 months and 24 months in Group 1 only. CONCLUSION: Demonstrating such feasibility is a key step towards defining diet's role in the secondary prevention of breast cancer.

Effects of altered glucose supply and adiposity on expression of hypothalamic energy balance regulatory genes in late gestation growth restricted ovine fetuses.

Intra-uterine growth restriction (IUGR) predisposes obesity in adulthood. This may be due to altered fetal nutrition causing sustained changes within the developing hypothalamic energy balance regulatory system. Using our established ovine model of IUGR, 130-day singleton fetuses (term=147 days) were obtained from growing adolescent mothers on control dietary intake (C), high intake (H) or H with growth hormone administration during either early (H+early GH) or late gestation (H+late GH) (n=6/group). GH increased maternal glycemia for the duration of treatment. H and H+early GH fetuses showed IUGR compared with C fetuses; body weight was partially restored in H+late GH fetuses, with 40% increased adiposity. In the fetal hypothalamic arcuate nucleus (ARC), cocaine- and amphetamine-regulated transcript mRNA (anorexigenic) was decreased in H fetuses and correlated across all groups with total fetal liver glycogen. Neuropeptide Y, agouti-related peptide (orexigenic) and proopiomelanocortin (anorexigenic) mRNAs were not different between groups. Insulin receptor mRNA in the ARC was increased in H, H+early GH and H+late GH fetuses and correlated negatively with fetal plasma insulin. Leptin receptor mRNA in the ARC correlated positively with fetal plasma leptin concentration and fetal fat content. Therefore, in IUGR fetuses, a key anorexigenic neuropeptide is sensitive to altered glucose supply and the hypothalamic leptin-signaling pathway is altered prenatally by increased adiposity and leptinemia. These changes could impact on postnatal energy balance regulation.

Effect of glyphosate-based herbicide on acetylcholinesterase activity in tadpoles, Hoplobatrachus rugulosus.

This study focused on the effects of a glyphosate-based herbicide on activity of the neuron enzyme, acetylcholinesterase (AchE), in the tadpole stage (stage 35-39) of the East Asian Bullfrog, Hoplobatrachus rugulosus. There were 4 herbicide concentration treatments consisting of glyphosate-based herbicide added at 21, 24, 27 and 30 microl to 1L de-chlorinated water in glass containers (10x15x20 cm). There were 4 replicates per treatment, each replicate using 20 tadpoles. The toxicity results were compared with tadpoles in distilled water as a control treatment. After 24, 48, 72 and 96 hours exposure to glyphosate-based herbicide concentrations, LC50 values of 25.21, 24.66, 24.16 and 23.63 microl/L, respectively, were recorded. AChE activities decreased significantly and markedly with herbicide concentration. Such inhibition of AChE activity by this glyphosate-based herbicide indicates the potential of such herbicides to disrupt ecological communities in water near where the herbicides are applied.