Thyroid and renal function in cats following low-dose radioiodine (111Mbq) therapy.

OBJECTIVES: To describe the effect of low-dose (111MBq) radioiodine therapy on thyroid and renal function in hyperthyroid cats over a 12-month follow-up period. MATERIALS AND METHODS: Client-owned hyperthyroid cats underwent low-dose radioiodine therapy and were followed-up for 12 months. Immediately before radioiodine treatment, and at 1, 6 and 12 months afterwards, total thyroxine, thyroid stimulating hormone, serum creatinine and glomerular filtration rate were measured. RESULTS: Fifteen of the 24 (63%) cats achieved euthyroidism following low-dose radioiodine treatment. The incidence of overt hypothyroidism was six of 24 (25%) cats. Of the six cats developing overt hypothyroidism, three had decreased renal function, with decreased glomerular filtration rate preceding azotaemia in two of these individuals. Transient overt or subclinical hypothyroidism before restoration of euthyroidism was not observed. CLINICAL SIGNIFICANCE: Low-dose radioiodine is effective treatment for hyperthyroidism in most cats but overt hypothyroidism may develop in some. Concurrent early decline in renal function may only be detected by measuring glomerular filtration rate rather than serum creatinine in some cats. Monitoring following radioiodine treatment should include total thyroxine and thyroid stimulating hormone and measurement of glomerular filtration rate should be considered in non-azotaemic cats.

Prevalence of FoxP3+ Cells Does Not Correlate With Ki67 Expression in Canine Diffuse Large B-cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of canine lymphoma and survival times are currently <1 year. Manipulation of the tumour microenvironment, of which the regulatory T cell (Treg) is a principal player, represents a potentially exciting way to curb the rapid proliferation of neoplastic cells. Tregs, characterized by the stable expression of the transcription factor FoxP3, suppress innate and adaptive arms of the immune response and represent a potential therapeutic target within neoplastic lymph nodes. This retrospective study explored the hypothesis that Tregs promote the proliferation of neoplastic large B cells, employing immunohistochemistry to assess both FoxP3 and Ki67 expression within canine lymph nodes. Fifty-seven biopsy samples of canine nodal DLBCL were examined. There were significantly fewer FoxP3+ cells in lymph nodes effaced by DLBCL than in reactive lymph nodes (27 versus 369 cells/mm2; Mann-Whitney U = 16, P = 0.011). There was no relationship between the number of intratumoural FoxP3+ cells and neoplastic cell proliferation (Spearman's rank r = 0.058, P = 0.670, 95% confidence interval). The results of this study show that FoxP3+ cells are reduced in lymph nodes effaced by DLBCL and that this change is unrelated to the expression of Ki67. This study also describes a robust digital method to standardize cell counts and facilitate future comparative studies.

Prevalence of FoxP3(+) Cells in Canine Tumours and Lymph Nodes Correlates Positively with Glucose Transporter 1 Expression.

Hypoxia and regulatory T cells (Tregs) in tumours are both known to be negative prognostic factors in cancer, and this study demonstrated a correlation between the two factors in canine neoplasia. Samples of 57 canine tumours and 29 canine lymph nodes categorized as tumour-draining, with or without metastasis, or reactive and not tumour-associated, were examined. Sequential sections were labelled by immunohistochemistry for glucose transporter 1 (Glut1) and FoxP3 as markers of hypoxia and Tregs, respectively. Up to 21 regions of interest (ROI) were selected in each section in a representative pattern and were assigned a semiquantitative score based on Glut1 labelling. The number of FoxP3(+) cells within each ROI was counted. A generalized estimating equation with negative binomial log link function was used to determine an association between Glut1 expression and FoxP3(+) cell count. Higher Glut1 immunoreactivity was correlated with significantly higher numbers of FoxP3(+) cells in the total tumour sample pool and total lymph node sample pool. Analysis of various subcategories of tumours and lymph nodes showed that this correlation was also present within samples characterized as malignant, haemopoietic mesenchymal tumours, non-haemopoietic mesenchymal tumours, epithelial tumours, lymphoma, lymph nodes containing metastases and reactive lymph nodes. These results indicate that hypoxia in canine tumours may result in an increased infiltration by Tregs.

Best practice for the pharmacological management of hyperthyroid cats with antithyroid drugs.

Pharmacological management of feline hyperthyroidism offers a practical treatment option for many hyperthyroid cats. Two drugs have been licensed for cats in the last decade: methimazole and its pro-drug carbimazole. On the basis of current evidence and available tablet sizes, starting doses of 2·5 mg methimazole twice a day and 10 to 15 mg once a day for the sustained release formulation of carbimazole are recommended. These doses should then be titrated to effect in order to obtain circulating total thyroxine (TT4) concentrations in the lower half of the reference interval. Treated cases should be monitored for side-effects, especially during the first months of treatment. Some side-effects may require discontinuation of treatment. At each monitoring visit, clinical condition and quality of life should also be evaluated, with special attention to possible development of azotaemia, hypertension and iatrogenic hypothyroidism. When euthyroidism has been achieved, monitoring visits are recommended after 1 month, 3 months and biannually thereafter. Cats with pre-existing azotaemia have shorter survival times. However, development of mild azotaemia during the initial course of treatment, unless associated with hypothyroidism, does not appear to decrease survival time. The long-term effects of chronic medical management require further study.

A comprehensive pathological survey of duodenal biopsies from dogs with diet-responsive chronic enteropathy.

BACKGROUND: The detailed pathological phenotype of diet-responsive chronic enteropathy (CE) and its modulation with dietary therapy remain poorly characterized. HYPOTHESIS/OBJECTIVES: Key mucosal lesions of diet-responsive CE resolve with dietary therapy. METHODS: This was a prospective observational study of 20 dogs with diet-responsive CE. Endoscopic duodenal biopsies collected before and 6 weeks after the start of a dietary trial were assessed by means of qualitative and quantitative histopathological, immunohistochemical, and ultrastructural criteria. Control duodenal biopsies were obtained from 10 healthy Beagle dogs on 1 occasion. RESULTS: Compared with control dogs, the CE dogs had higher villus stunting scores and higher overall WSAVA scores, a lower villus height-to-width ratio, and higher lamina propria density of eosinophils. The CE dogs also had ultrastructural lesions of the mitochondria and brush border. In common with other studies in which the disease and control populations are not matched for breed, age, sex, and environment, these comparisons should be interpreted with caution. Comparing biopsies collected at presentation and 6 weeks after starting the dietary trial, mean lamina propria mononuclear cell score and lamina propria densities of eosinophils and mononuclear cells decreased. Dietary therapy also improved ultrastructural lesions of the mitochondria and brush border, eliciting a decrease in intermicrovillar space and an increase in microvillus height. CONCLUSIONS AND CLINICAL IMPORTANCE: In dogs with diet-responsive CE, the remission of clinical signs with dietary therapy is associated with subtle decreases in lamina propria density of eosinophils and mononuclear cells, and resolution of ultrastructural lesions of the enterocyte.

Supporting cancer patients in Jamaica--a needs assessment survey.

OBJECTIVE: Global cancer incidence is rising rapidly particularly in the developing world where a majority of people present with advanced disease. In the English-speaking Caribbean, there is very little published data on the needs of cancer patients, their caregivers or those of allied health professionals. The research team sought to redress this balance by undertaking a needs assessment survey in the South Eastern Health Region of Jamaica to identify unmet needs and to make recommendations for improved service delivery. METHODS: A mixed methods, cross-sectional study design was used involving formal and semi-formal interviews and focus group discussions. RESULTS: The study results indicated that there were significant barriers to accessing healthcare. These included prohibitive costs of diagnosis and treatment, a mistrust of and poor communication with doctors, compounded by people's fears, belief in folk wisdom and lack of knowledge about cancer. Recommendations offered by the study participants focussed on a community-based model of support to address the multiple needs of people facing life-limiting illness and their caregivers. Healthcare practitioners recommended the development of specific policies, targeting, in particular improved drug availability and palliative care education in order to guide development of appropriate services for the large numbers of cancer patients in need. CONCLUSION: A multiplicity of unmet needs was identified by cancer patients, their caregivers and allied health professionals. Recommendations by study participants and the authors echoed the guidelines as set out by the World Health Organization (WHO) in its 1990 Public Health Model for the integration of palliative care into existing healthcare systems.

Supporting cancer patients in Jamaica: a needs assessment survey / Apoyo a los pacientes de cáncer en Jamaica: una encuesta para la evaluación de las necesidades

OBJECTIVE: Global cancer incidence is rising rapidly, particularly in the developing world where a majority of people present with advanced disease. In the English-speaking Caribbean, there is very little published data on the needs of cancer patients, their caregivers or those of allied health professionals. The research team sought to redress this balance by undertaking a needs assessment survey in the South Eastern Health Region of Jamaica to identify unmet needs and to make recommendations for improved service delivery. METHODS: A mixed methods, cross-sectional study design was used involving formal and semi-formal interviews and focus group discussions. RESULTS: The study results indicated that there were significant barriers to accessing healthcare. These included prohibitive costs of diagnosis and treatment, a mistrust of, and poor communication with doctors, compounded by people's fears, belief in folk wisdom and lack of knowledge about cancer. Recommendations offered by the study participants focussed on a community-based model of support to address the multiple needs of people facing life-limiting illness and their caregivers. Healthcare practitioners recommended the development of specific policies, targeting, in particular, improved drug availability and palliative care education in order to guide development of appropriate services for the large numbers of cancer patients in need. CONCLUSION: A multiplicity of unmet needs was identified by cancer patients, their caregivers and allied health professionals. Recommendations by study participants and the authors echoed the guidelines as set out by the World Health Organization (WHO) in its 1990 Public Health Model for the integration of palliative care into existing healthcare systems.

OBJETIVO: La incidencia de cáncer global está aumentado rápidamente, particularmente en el mundo en vías de desarrollo, dónde un gran número de personas se presentan con la enfermedad en estado avanzado. En el Caribe angloparlante, se ha publicado muy poca información sobre las necesidades de los pacientes de cáncer, sus cuidadores o los profesionales de salud asociados. El equipo de investigación buscó restablecer el equilibrio emprendiendo un estudio de evaluación de las necesidades en la Región de Salud Suroriental de Jamaica, para identificar las necesidades no satisfechas y hacer recomendaciones encaminadas a mejorar la prestación de servicios. MÉTODOS: Se empleo un diseño de estudio transversal con métodos mixtos, contentivo de entrevistas formales y semi-formales así como discusiones de grupos focales. RESULTADOS: Los resultados del estudio indicaron que había barreras considerables para el acceso a la atención a la salud. Estas comprendían costos prohibitivos para el diagnóstico y el tratamiento, desconfianza y pobre comunicación con los doctores, agravada por los miedos de la gente, la creencia en la sabiduría popular, y la falta de conocimientos sobre el cáncer. Las recomendaciones ofrecidas por los participantes en el estudio se centran en un modelo basado en la comunidad. Este modelo permite abordar las múltiples necesidades de las personas que enfrentan enfermedades limitantes de la vida, así como las necesidades de sus cuidadores. Los practicantes de cuidados de la salud recomendaron el desarrollo de políticas específicas, encaminadas especialmente a mejorar la disponibilidad de medicamentos y educación de cuidados paliativos para guiar el desarrollo de servicios apropiados para el gran número de pacientes necesitados, enfermos de cáncer. CONCLUSIÓN: Se identificaron una multiplicidad de necesidades no satisfechas, por parte de los pacientes de cáncer, sus cuidadores y profesionales de salud asociados. Las recomendaciones hechas por los participantes en el estudio y los autores, siguieron al pie de la letra los lineamientos trazados por la Organización Mundial de la Salud (OMS) en su Modelo de Salud Pública de 1990 para la integración del cuidado paliativo en los sistemas de cuidado de salud existentes.

K-shell photodetachment of Li(-): experiment and theory.

An experimental K-shell photodetachment study of Li(-) giving rise to doubly photoionized Li(+) ions has been carried out at the Advanced Light Source, using a collinear photon-ion beam apparatus. The experiment reveals dramatic structure, differing substantially both qualitatively and quantitatively from the corresponding processes above the 1s ionization threshold in Li and Li(+), as predicted by our enhanced R-matrix calculation. The experimental/theoretical comparison shows good agreement over some of the photon energy range, and also reveals some puzzling discrepancies.