Computed tomography features for differentiating malignant and benign focal liver lesions in dogs: A meta-analysis.

Computed tomography (CT) is often performed to complement ultrasound following detection of focal liver lesions (FLL). There is no consensus in the literature regarding the CT features that might be helpful in the distinction between benign and malignant FLL. The aim of this meta-analysis was to identify, based on the available literature, the qualitative and quantitative CT features able to distinguish between benign and malignant FLL. Studies on the diagnostic accuracy of CT in characterising FLL were searched in MEDLINE, Web of Science, and Scopus databases. Pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), receiver operator curve (ROC) area, were calculated for qualitative features. DOR were used to determine which qualitative features were most informative to detect malignancy; quantitative features were selected/identified based on standardised mean difference (SMD). Well-defined margins, presence of a capsule, abnormal lymph nodes, and heterogeneity in the arterial, portal and delayed phase were classified as informative qualitative CT features. The pooled sensitivity ranged from 0.630 (abnormal lymph nodes) to 0.786 (well-defined margins), while pooled specificity ranged from 0.643 (well-defined margins) to 0.816 (heterogeneous in delayed phase). Maximum dimensions, ellipsoid volume, attenuation of the liver in the pre-contrast phase, and attenuation of the liver in the arterial, portal, and delayed phase were found to be informative quantitative CT features. Larger maximum dimensions and volume (positive SMD), and lower attenuation values (negative SMD) were more associated with malignancy. This meta-analysis provides the evidence base for the interpreting CT imaging in the characterization of FLL.

Use of deep learning to detect cardiomegaly on thoracic radiographs in dogs.

The purpose of this study was to develop a computer-aided detection (CAD) device based on convolutional neural networks (CNNs) to detect cardiomegaly from plain radiographs in dogs. Right lateral chest radiographs (n = 1465) were retrospectively selected from archives. The radiographs were classified as having a normal cardiac silhouette (No-vertebral heart scale [VHS]-Cardiomegaly) or an enlarged cardiac silhouette (VHS-Cardiomegaly) based on the breed-specific VHS. The database was divided into a training set (1153 images) and a test set (315 images). The diagnostic accuracy of four different CNN models in the detection of cardiomegaly was calculated using the test set. All tested models had an area under the curve >0.9, demonstrating high diagnostic accuracy. There was a statistically significant difference between Model C and the remainder models (Model A vs. Model C, P = 0.0298; Model B vs. Model C, P = 0.003; Model C vs. Model D, P = 0.0018), but there were no significant differences between other combinations of models (Model A vs. Model B, P = 0.395; Model A vs. Model D, P = 0.128; Model B vs. Model D, P = 0.373). Convolutional neural networks could therefore assist veterinarians in detecting cardiomegaly in dogs from plain radiographs.

Development of a deep convolutional neural network to predict grading of canine meningiomas from magnetic resonance images.

An established deep neural network (DNN) based on transfer learning and a newly designed DNN were tested to predict the grade of meningiomas from magnetic resonance (MR) images in dogs and to determine the accuracy of classification of using pre- and post-contrast T1-weighted (T1W), and T2-weighted (T2W) MR images. The images were randomly assigned to a training set, a validation set and a test set, comprising 60%, 10% and 30% of images, respectively. The combination of DNN and MR sequence displaying the highest discriminating accuracy was used to develop an image classifier to predict the grading of new cases. The algorithm based on transfer learning using the established DNN did not provide satisfactory results, whereas the newly designed DNN had high classification accuracy. On the basis of classification accuracy, an image classifier built on the newly designed DNN using post-contrast T1W images was developed. This image classifier correctly predicted the grading of 8 out of 10 images not included in the data set.

Use of transfer learning to detect diffuse degenerative hepatic diseases from ultrasound images in dogs: A methodological study.

The aim of this methodological study was to develop a deep convolutional neural network (DNN) to detect degenerative hepatic disease from ultrasound images of the liver in dogs and to compare the diagnostic accuracy of the newly developed DNN with that of serum biochemistry and cytology on the same samples, using histopathology as a standard. Dogs with suspected hepatic disease that had no prior history of neoplastic disease, no hepatic nodular pathology, no ascites and ultrasonography performed 24h prior to death were included in the study (n=52). Ultrasonography and serum biochemistry were performed as part of the routine clinical evaluation. On the basis of histopathology, dogs were categorised as 'normal' (n=8), or having 'vascular abnormalities'(n=8), or 'inflammatory'(n=0), 'neoplastic' (n=4) or 'degenerative'(n=32) disease; dogs with 'neoplastic' disease were excluded from further analysis. On cytological evaluation, dogs were categorised as 'normal' (n=11), or having 'inflammatory' (n=0), 'neoplastic' (n=4) or 'degenerative' (n=37) disease. Dogs were categorised as having 'degenerative' (n=32) or 'non-degenerative' (n=16) liver disease for analysis due to the limited sample size. The DNN was developed using a transfer learning methodology on a pre-trained neural network that was retrained and fine-tuned to our data set. The resultant DNN had a high diagnostic accuracy for degenerative liver disease (area under the curve 0.91; sensitivity 100%; specificity 82.8%). Cytology and serum biochemical markers (alanine transaminase and aspartate transaminase) had poor diagnostic accuracy in the detection of degenerative liver disease. The DNN outperformed all the other non-invasive diagnostic tests in the detection of degenerative liver disease.

Abdominal ultrasound features and reference values in 21 healthy rabbits.

This study aimed to determine the ultrasonographic features and reference values of the abdominal anatomy in mixed-breed dwarf rabbits. Complete abdominal ultrasonographic examination was performed in 21 mixed-breed rabbits (12 males and 9 females) referred for examination to the Department of Animal Medicine, Production and Health, University of Padua, Italy. All animals were sedated during the procedure. The ultrasonographic anatomy of the abdomen was determined, including measurement (mean±SD) of the right kidney (length 2.87±0.34 mm; width 1.62±0.17 mm; height 1.66±0.14 mm) and left kidney (length 2.86±0.33 mm; width 1.72±0.19; height 1.58±0.15 mm), left adrenal gland (width 0.38±0.11 mm; length 0.71±0.14), right adrenal gland (width 0.34±0.08 mm; length 0.73±0.15 mm) and thickness of the walls of the stomach (0.10±0.01 mm), pylorus (0.28±0.04 mm), duodenum (0.19±0.04 mm), sacculus rotundus (0.22±0.06 mm), caecum (0.08±0.01 mm), appendix (0.19±0.04 mm), spiral loop of the ascending colon (0.14±0.04 mm) and distal colon (0.10±0.02 mm). A significant positive correlation between bodyweight and kidney size, adrenal gland length, stomach wall and sacculus rotundus wall was detected.

Evaluation of sedation and clinical effects of midazolam with ketamine or dexmedetomidine in pet rabbits.

The effects of two sedation protocols combining midazolam with ketamine (ketamine group) or dexmedetomidine (dexmedetomidine group) were studied in dwarf companion rabbits undergoing abdominal ultrasound scan. The onset of sedation was faster in the ketamine group; a few rabbits in the dexmedetomidine group required additional doses to lose the righting reflex, although sedation time was not different between groups. A semi-quantitative scale was used to score sedation quality, which was higher in rabbits that received dexmedetomidine rather than ketamine. Pulse rate was lower in the dexmedetomidine group (206 vs 240 bpm), although Doppler blood pressure was higher than in the ketamine group (109 vs 89 mm Hg). Respiratory rate decreased in relation to the baseline values with both protocols but arterial haemoglobin saturation with oxygen was maintained similar to the pre-sedation values throughout the entire procedure, regardless of protocol used and without oxygen supplementation. Both protocols allowed performance of ultrasound scanning, although dexmedetomidine may be preferred if a deep sedation level is required.

Physical exercise introduced after weaning enhances pancreatic islet responsiveness to glucose and potentiating agents in adult MSG-obese rats.

Physical exercise represents an alternative way to prevent and/or ameliorate chronic metabolic diseases. Disruption of sympathetic nervous system (SNS) activity contributes to adiposity in obese subjects. Here, we verified the preventive effect of swimming training upon adiposity, adrenal catecholamine storage, and pancreatic islet function in obese monosodium glutamate (MSG)-treated rats. Male neonatal Wistar rats received MSG (4 mg/g body weight) during the first 5 days of life and, at weaning, half of the rats were submitted to swimming training, 30 min/day, 3 days a week, until 90 days of age (exercised rats: MSGex). Half of the rats were used as controls (sedentary group, MSGsd). Exercise training (ET) decreased insulinemia and fat deposition in MSGex, and increased adrenal catecholamine content, compared with MSGsd rats. Insulinemia during the ivGTT was lower in MSGex rats, despite a lack of difference in glycemia. Swimming training enhanced insulin release in islets challenged by 2.8-8.3 mmol/l glucose, whereas, at supraphysiological glucose concentrations (11.1-16.7 mmol/l), MSGex islets secreted less insulin than MSGsd. No differences in insulin secretion were observed following l-arginine (Arg) or K(+) stimuli. In contrast, islets from MSGex rats secreted more insulin when exposed to carbachol (100 µmol/l), forskolin (10 µmol/l), or IBMX (1 mmol/l) at 8.3 mmol/l glucose. Additionally, MSGex islets presented a better epinephrine inhibition upon insulin release. These results demonstrate that ET prevented the onset of obesity in MSG rats, probably by enhancing adrenal catecholamine levels. ET ameliorates islet responsiveness to several compounds, as well as insulin peripheral action.

A review of diagnostic imaging of snakes and lizards.

Snakes and lizards are considered 'stoic' animals and often show only non-specific signs of illness. Consequently, diagnostic imaging--along with clinical examination and laboratory tests--is gaining importance in making a final diagnosis and establishing a correct therapy. The large number of captive snake and lizard species commonly kept as pets, together with the high inter- and intraspecific morphological variability that is innate in these animals, make the analysis of diagnostic images challenging for the veterinary practitioner. Moreover, a thorough knowledge of the anatomy, physiology and pathology of the species that are the object of clinical investigation is mandatory for the correct interpretation of diagnostic images. Despite the large amount of clinical and scientific work carried out in the past two decades, the radiographic features of snakes and lizards have not undergone systematic description, and therefore veterinarians often have to rely mostly on anatomical studies rather than radiological literature. The aim of this paper is to review the most commonly used diagnostic imaging modalities, as well as to provide an overview of the available international original studies and scientific reviews describing the normal and pathological imaging features in snakes and lizards.

Comparative evaluation of the cadaveric and computed tomographic features of the coelomic cavity in the green iguana (Iguana iguana), black and white tegu (Tupinambis merianae) and bearded dragon (Pogona vitticeps).

Contrast-enhanced computed tomographic studies of the coelomic cavity in four green iguanas, four black and white tegus and four bearded dragons were performed using a conventional CT scanner. Anatomical reference cross sections were obtained from four green iguana, four black and white tegu and six bearded dragon cadavers; the specimens were stored in a -20°C freezer for 24 h then sliced into 5-mm intervals. The frozen sections were cleaned with water and photographed on both sides. The individual anatomical structures were identified by means of the available literature; these were labelled first on the anatomical images and then matched to the corresponding computed tomography images. The results provide an atlas of the normal cross-sectional and computed tomographic anatomy of the coelomic cavity in the green iguana, the black and white tegu and the bearded dragon, which is useful in the interpretation of any imaging modality.

Physiological values and factors affecting the metacarpal bone density of healthy feedlot beef cattle as measured by dual-energy X-ray absorptiometry.

The metacarpal bone mineral density of 136 healthy feedlot beef cattle of four different breeds (Charolaise, Limousine, Irish Crossbreed and Slovakian Crossbreed) raised and fed on standard conditions was measured by means of a dual-energy X-ray absorptiometry technique in an ex vivo study design. The average reference values (mean ± SD) of bone mineral density (BMD) for animals aged between 12 and 22 months and weighing between 236 and 546 kg have been reported and the effects of (i) breed, (ii) gender, (iii) age and (iv) body weight on bone mineral density have been considered. A significant difference (i) among different breeds and (ii) between genders resulted, whereas a high correlation between bone density and (iii) age and (iv) body weight was detected within the same breed and gender, with body weight being the most important factor affecting BMD. A modern new technological insight into the study of bovine bone physio-pathology is proposed.

A landmark analysis-based approach to age and sex classification of the skull of the Mediterranean monk seal (Monachus monachus) (Hermann, 1779).

This work aimed at applying geometric morphometric analysis techniques to the skull of the Mediterranean monk seal (Monachus monachus, Hermann, 1779). Inferential analyses were performed using a non-parameteric permutation framework based on a series of skulls of different age classes belonging to individuals of both sexes. Our goal was to establish whether a statistical approach based on osteometric measurements and surface analysis of photographs of the left lateral plane of the skull may lead to a different and scientifically sound method of age and sex classification in this critically endangered marine mammal. Our data indicate that non-parametric combination methodology enables the researcher to give local assessment using a combination with domains. Developing geometric morphometric techniques in a non-parametric permutation framework could be useful in solving high dimensional and small sample size problems as well as classification problems, including zoological classification of specimens within a specific population. The Mediterranean monk seal is believed to be the world's rarest pinniped and one of the most endangered mammals of the world, with fewer than 600 individuals currently surviving. The use of shape analysis would allow new insights into the biological characteristics of the monk seal by simply extracting potentially new information on age and size from museal specimens.

Communicating medical information: a little lesson from Italian patients.

OBJECTIVE: To construct and validate a questionnaire that could be used to investigate the clarity of the medical information received by patients and their satisfaction with it, as well as their knowledge and opinions concerning advance directives and their associated variables. METHODS: We administered a 30-item questionnaire to 157 adult patients affected by progressive neurological, oncological and nephrological diseases. RESULTS: The results indicate the good reliability and structure of the questionnaire, which identifies three factors: "information and knowledge" (alpha .91), "need for physical and mental support" (alpha .89), and "determination and decision-making capacity" (alpha .75). The amount of time dedicated to medical communication proved to be one of the variables determining the patients' knowledge of their disease and their capacity to express their needs, neither of which changed over time. The oldest patient, a man in the most advanced phase of disease, was the most fragile in expressing his needs and making decisions. Advance directives, living wills, active/passive euthanasia and therapeutic obstinacy' at most only marginally reach the cognitive and emotional sphere of the patients. CONCLUSION: Patients' needs unequivocally lead us back to the primary matrices of medical act: paying attention to patients, offering adequate time, listening to him/her concerns and asking when no question emerges. This so obvious evidence does not match with the increasingly techno-oriented attitude of health professional, who also have to guarantee more productivity in less time. The quality of medical information received by patients impacts their decision making process, particularly in the oldest people. In Italy, as well as in other countries, it is necessary to pay more attention to this issue, keeping in mind that nobody can really choose without knowing exactly what it is going to happen.

[New questionnaire to evaluate psychological treatment effects]. / Proposta di un nuovo strumento per la verifica dell'efficacia nella pratica dei trattomenti psicologici e psicoteropeutici.

A new questionnaire named CBA-VE (Cognitive Behavioral Assessment for outcome evaluation) was developed to evaluate psychological treatment intervention--especially for counseling and psychotherapy. The questionnaire has 80 items and a 5 point Likert-like scale ranging from 1 = nothing to 5 = a lot. The aim of this study was to evaluate the validity and the reliability of the five constructs of the questionnaire both in normal and clinical subjects. Participants. Two samples were analyzed: a "Normal" group composed of 250 normal adults plus 51 university students; and a "Clinical" group including 261 adults undergoing psychotherapy and psychological counseling provided by the public health service. The questionnaire includes five scales: three of them are related to important psychological aspects (anxiety, depression, and psychological distress); the remaining two are measurements of psychological wellbeing and self-perception of a positive change. The questionnaire has excellent psychometric characteristics, both for normal and clinical subjects. We observed a good reliability, good internal consistency, and an excellent structural validity for the five interrelated dimensions. The normalized factorial loadings are consistent, significant (from around 0.6 up), and similar in both the groups. The so-called Clinical group showed higher scores in anxiety, depression, and psychological distress and smaller scores in wellbeing and change perception. This is coherent with what the authors assumed a priori.

Can the type of organisational structure affect individual well-being in health and social welfare occupations?

The aim of this study was to analyse the perceived stress and individual resources of people involved in health and social welfare occupations, and evaluate whether belonging to different organisational structures leads to different reactions. To this end, we used the Maslach Burnout Inventory, the Coping Inventory for Stressful Situations, and the Team Climate Inventory. The sample consisted of 327 subjects (67% females) with a mean age of 35.9 +/- 8.8 years; most had a middle or high school diploma (63%), and they had been employed in the same place for about four years (47.5 +/- 7.3 months): 103 worked for health and social welfare cooperatives, and 224 for a local health authority. The results showed average burnout values and coping strategies prevalently aimed at directly solving the stressing situation in both working contexts. In comparison with the variables expressing the perceived organisational climate, sociodemographic characteristics did not seem to have a determining influence on the perception of individual stress. Comparison of the subjects employed in the two settings showed that organisational vision and a sense of belonging significantly determined subjective well-being, with the healthcare workers showed greater individual ill-being and a worse vision (i.e. an unclear perception of hospital choices and objectives). Our findings confirm that subjective well-being in high-touch occupations may be determined by the organisational culture: a mutual aid culture such as that of a cooperative has a protective effect despite the fact that the employment situation of the workers is more precarious and flexible than that of workers employed in highly structured environments such as that of a hospital.

[Perception and opinions on the right of choice in medical field: what caregivers teach us on the communication]. / Percezione e opinioni sul diritto di scelta in campo medico: cosa ci insegnano i caregiver sulla comunicazione.

The aim of the present study was to analyse caregivers' perceptions and opinions concerning medical information and advance directives. Fifty-one subjects (mean age 63.07+/-12.2) were enrolled and filled in some questionnaires: the Family Strain Questionnaire (FSQ), the SF-12 and a specifically assembled questionnaire which we named Communication and Consent (CCQ). Correlations were found between FSQ factors, which refer to caregiving-related problems, and SF-12, which refers to the self-perception of mental and physical health. The subjects who resulted emotionally distressed referred to care for more critical patients and that they had not received sufficient attention by physician at the time of diagnosis. Self-determination and decision-making resulted inversely correlated to caregivers' age and education. In general, caregiver's role itself influences attitudes towards medical information and advanced directives. The study also indicates that health professionals have to pay more attention to the relationship than they use to do, trying to understand which kind of emotional sound a technical term may produce for the patients and their caregivers.

[EuroQol-5D FOR quality of life assessment in cardiac rehabilitation]. / L'EuroQol 5D per la valutazione della qualità della vita in riabilitazione cardiologica.

EuroQol-5D (EQ-5D) is a well-known generic instrument measuring quality of life in different diseases; it includes 5 dimensions (mobility, self-care, daily activities, pain-discomfort, anxiety and depression) and a Visual Analogue Scale that evaluates patients' perceived health status. The aim of this study was to verify the utility of the EQ-5D in the Italian Cardiac Rehabilitation setting. The study population consisted of 248 consecutive cardiac rehabilitation inpatients (176 males and 72 females, aged 65.3 +/- 10.75 years), 200 of whom had recently undergone cardiac surgery (aortocoronary by-pass and/or valve replacement). Patients filled in the EQ-5D and A-D schedule (on anxiety and depression) on their second day in hospital. Exploratory and Confirmatory Factor Analysis confirmed the robust nature of the EQ-5D and its mono-factorial structure (EFA: Total Variance 50.39% - CFA: chi2 = 3.596; p approximately equal .60; RMSEA = 00; CFI = 1.00; RMR = .007). The instrument showed a good internal consistency (a .73) despite the limited number of items. T test and ANOVA showed the independence of the EQ-5D dimensions and VAS evaluation with respect to patients' education level, but an influence of age and sex. In general, females reported a lower quality of life than males, and older patients a lower quality of life than younger. Furthermore, cardiac-surgery patients reported more problems in self-care and pain-discomfort than ischemic/heart failure patients, and patients in NYHA Classes III and IV reported more difficulties in mobility than patients in lower NYHA classes. In 15% of patients, of heterogeneous socio-demographic and clinical characteristics, no problems in any of the 5 EQ-5D dimensions were reported: this group was characterised by scores under the clinical cut-off on anxiety and depression and showed a better quality of life on the VAS. Results confirm the robustness of the EuroQol-SD psychometric properties and the instrument's utility for the routine assessment of quality of life in the Italian Cardiac Rehabilitation setting.

Radiographic features of two cases of feline proximal femoral dysplasia.

Congenital or acquired feline femoral dysplasia have seldom been reported in the literature. This report describes two cases of femoral dysplasia involving the proximal epiphyses. Bilateral agenesis of the femoral head and neck (case 1) constituted an incidental finding during a post-traumatic radiographic examination, while right proximal femoral dysplasia (case 2) was observed during an orthopaedic examination for lameness. To the authors' knowledge, such imaging findings have not been reported before in cats.

Dual-energy X-ray absorptiometry in canine legg-Calvé-Perthes disease.

Radiographic examination and subsequent dual-energy X-ray absorptiometry scans of the hips were performed in seven dogs with monolateral Legg-Perthes-Calvé disease to quantify bone changes produced by osteonecrosis in the proximal femur on the affected and unaffected side. All dogs were found to be affected with grade 2 and 3 of the radiographic classification proposed by Ljunggren. Bone mineral density (g/cm(2)) of the femoral neck and proximal femoral metaphysis were evaluated on the affected and unaffected side; we detected no differences in bone mineral density for both regions of interest within the population studied in relation to gender, body weight and side analysed nor between the affected and the unaffected limb. We therefore assume that radiographic areas of decreased density in the proximal femoral epiphysis during chronic stages of Legg-Calvé-Perthes disease do not alter the global mineral content of the scanned region.

Vertebral mineral density measured by dual-energy X-ray absorptiometry (DEXA) in a group of healthy Italian boxer dogs.

We studied the feasibility of using dual-energy X-ray absorptiometry (DEXA) to obtain reference bone density values in relation to age, gender and body weight in growing and young adult Italian boxer dogs. The study was performed on eight animals (three males and five females) at 7, 12 and 18 months of age. Animals were carefully examined and blood samples were collected from each dog to detect any sign of metabolic and/or endocrine disease. Each subject underwent radiographs to evaluate growth of the spine and hip. One female was not considered in the statistical model because of the development of grade 4 spondylosis deformans during the study period. All animals were serially scanned using DEXA; the region of interest was the whole spine T12-L2, while the subregions of interest were the four vertebrae (T12-T13-L1-L2) within the scanned spine. Statistical analysis was performed separately for each region of interest. Age had the strongest relationship with bone density (P < 0.001). Gender effect on spinal mineral density was not significant while vertebral site effect was highly significant. Average bone mineral density (BMD) +/- SD for the whole spine trait was 0.862 +/- 0.108 g/cm2 while average BMD +/- SD for subregions of interest ranged from 0.836 +/- 0.141 g/cm2 for T12 to 0.928 +/- 0.119 g/cm2 for L2. Estimated reference BMD values at 7, 12 and 18 months of age for each vertebral site in males and females are provided.

[Occupational stress and assessment of human resources in health: from assessment to the changing process]. / Stress occupazionale e valorizzazione delle risorse umane in azienda sanitaria: dalla valutazione al processo di cambiamento.

Health professionals are at risk for occupational stress, as confirmed by diverse sources including the Italian legislative decree, D.L. 626/94, the Health Promoting Hospital of the World Health Organization, and the Ottawa Charter. The aim of this study was to analyze quantitatively and qualitatively the principal sources of stress in the work environment and the resources, both individual and organizational, that health professionals feel they possess to cope with it. The instruments utilized for the first quantitative phase were: the Maslach Burn out Inventory, the Job Content Questionnaire, Coping Inventory for Stressful Situation and Team Climate Inventory. The study population consisted of 224 subjects belonging to the nursing profession (nurses-in-charge of ward, specialized and general nurses), working in the community and in hospital. The results show medium levels of burn out, and coping strategies that are primarily oriented towards a direct solution of the stressful situation. Vision is a critical aspect, ie. a clear perception of institutional choices and goals is lacking. The administration and analysis of the questionnaires was followed by a second phase in which, by means of the focus group methodology, the results were qualitatively analyzed and the health professionals stimulated to an active and pro-positive approach in the search for solutions to the critical situations.