Objective
The exposure to constant light during the hospitalization was investigated to verify its influence on the daily rhythmicity of Schirmer tear test I (STT I) in the Felis catus.
Animal ...studied
One group (HG—hospitalized group) was consisted of 10 owned‐cats hospitalized to perform a sterilization procedure and was exposed to a 24/0 light/dark (L/D) cycle; the cat control group (CG) was consisted of 10 staff‐owned cats living in an indoor environment (12/12 L/D cycle).
Procedure
The STT I values was performed at 4 h intervals over a 48 h period (starting at 8:00 a.m. on Day 1 and finishing at 8:00 a.m. on Day 3) on the left (LE) and right (RE) eyes into two cat groups. A 35 x 5 mm commercial tear test strip was used to record tear production in millimeters wetting per minute (mm/min).
Results
Multivariate for repeated measure analysis of variance (ANOVA) showed a statistically significant effect of time. No difference was found between LE and RE tear production, and between the two experimental conditions. Robust daily rhythmicity was exhibited by the STT I in both eyes during the entire monitoring period in control cats and only during the Day 1 in hospitalized cats.
Conclusions
These data are a starting point for evaluating the imbalance of ocular physiology observed in hospitalized cats. Further studies on larger sample size and exposing the animals to various hospitalization procedures are needed to establish whether these alterations are caused by hospitalization procedures or by the light/dark schedules.
Abstract
Background
During contrast enhanced ultrasound (CEUS), the features of the regions of interest (ROI) can affect the value of the perfusion-related parameters obtained from a time intensity ...curve (TIC). In veterinary medicine, conflicting have been reported on the influence of ROI size and location on renal CEUS. There are some disagreeing evidences regarding the optimal method for selecting ROI in quantitative analysis of renal perfusion using CEUS.
The aim of this study was to evaluate the effect of the size and location of ROIs in the spleen of conscious dogs on perfusion variables determined using sulphur hexafluoride contrast-enhanced ultrasounds.
Results
A prospective observational study on 15 client-owned mixed-breed adult dogs was performed using a system equipped with contrast-tuned imaging technology. Qualitative and quantitative assessments of the spleen enhancement pattern were carried out. Three square ROIs (0.05 cm
2
) were manually drawn in a row and spaced 1 mm apart, placing adjacent ROIs at three different depths. Three medium rectangular ROIs (0.3 cm
2
) include the 3 smallest ROIs in each row, indicated by the letters A, B and C, and a single large square ROI (1 cm
2
) was drawn containing all previous ROIs. Software analysis of time-intensity curves generated within each ROI allowed us to calculate the perfusion-related parameters: peak enhancement, time to peak, regional blood flow, mean transit time and regional blood volume.
The coefficient of variation for all blood-related parameters was always lower in the larger ROI than in the other smaller ROIs. ROI A and B, positioned proximally and medially, levels respectively, showed similar coefficients of variation to the largest ROI. The analysis of variance model exhibited a significant effect of location and size of the ROIs in the quantitative analysis of canine spleen perfusion, with a reduction of perfusion-related parameters in the distal ROI.
Conclusions
The recommendation for a quantitative CEUS examination of a dog’s spleen is to analyze splenic perfusion by drawing a sufficiently large ROI proximal to the ultrasound beam on the splenic parenchyma. This may be of clinical relevance in the diagnosis of splenic diseases.
Introduction The concept of Integrated Medicine (IM) has been clearly defined for the first time in Italy on 3rd December 2011, when SIOMI presented its manifesto for IM, containing the conceptual ...and functional definitions of this discipline as agreed with the Italian leading health institution. The event has been celebrated with a monographic edition of HIMed (Homeopathy and Integrated Medicine, SIOMI?s official journal)1 in which the individual assertions written in the manifesto have been accompanied by the thorough scientific, clinical, ethical, and epistemological analysis habitually required to allow a complex discipline to interact transparently and safely with patients, doctors, and the medical world. There is a great confusion in the international literature over the terminology, conceptualization and even the definition of the health model of IM, which only increases the skepticism of many?albeit poorly informed?members of the scientific community. From this perspective, it should be stressed that IM has no intention of rejecting the use of everything that comes under the umbrella of academic medicine, but instead it aims, as its own name suggests, to integrate it with therapeutic practices currently defined as unorthodox, and now generally known as Traditional Medicine (TM) or Complementary Medicine (CM). Another important discussion is about the use of the term ?integrated? or ?integrative? medicine that are behind the same acronym IM, both indicating the concept of a medical approach with CM together with conventional medicine in a same therapeutic prescription. It has never officially stated but the term ?integrated,? should mean the use of ?shared protocols,? in which the intervention of complementary medicine is intended to complete a therapeutic protocol already in use in CM in a standardized schedule. In the case of ?Integrative Medicine? there are more people involved in putting together conventional medicine and CM and creating new approaches. When a model of care is yet existing, in our opinion is better to complete the existing one (integrated); however, as described in our scientific papers, as CM are finalized to personalization, to do this we should add in the standard protocol an homeopathic medicine or an acupuncture treatment based on a peculiar patients? aspect as result of a personal evaluation by the CM? doctor. In our opinion, this process is necessary because the evidence coming from the ever-growing number of scientific publications, together with the positive clinical experiences of doctors and patients alike, comprise a solid basis for the further exploration of disciplines that could integrate (or even in some cases replace) the practices of academic medicine and lead to improvements where the methods of biomedicine have produced disappointing results. After the clarification of these important points, we need to take a few steps back to understand the history that has led to this situation. Everything started in 1992, when the evidence-based medicine (EBM) workgroup published the results of an in-depth review of medical attitudes in JAMA,2 the first of this kind. The group was coordinated by David Sackett, who later has written a book3 that has been, for many years, considered the final statement on EBM. Sackett?s perspective can be approximately summarized as follows: ?The practice of Evidence Based Medicine means integrating individual clinical expertise with the best available external clinical evidence coming from a systematic research? including the more thoughtful identification and compassionate use of individual patients? predicaments, rights, and preferences in making clinical decisions about their care?4 (our italics). While EBM has led to the objective verification of most clinical practices, the individual patients? ?predicaments, rights, and preferences? are still now largely ignored. The reason is surprisingly clear, if interpreted considering the current model of chronic disease, which consider a given medical disorder as having an environmental trigger that could act on a constitutional predisposition, that may be considered the cause of the host individual?s response and, ultimately, of the chronic disease itself. EBM has always aimed to improve the efficiency of clinical studies by eliminating, as far as possible, all confounding factors (biases) that might alter the results? interpretation. This methodology is undoubtfully the best approach when studying any therapeutic treatments for acute disorders?those areas of medicine where the declared aim is to eradicate any interference generated by the patient?s response, to avoid ?contaminating? results and making it unreliable. For this reason, the study population must be as homogeneous as possible, with minimal differences between the participants? various characteristics. All this, it should be stressed, is ideal when applied to a disease with a short latency period that is consequently easy to recognize and diagnose. In brief, in an ?acute? case we could or indeed should focus on the disease, whose identified features can be found in all affected patients, while ignoring the constitutional prevalence of the patient where it occurs. In this context, it is very easy to extrapolate the results obtained in the study group to a larger population, as suggested by Sackett. The problem arises when the same system is applied to a chronic disease. This is a dramatically different situation, as the definition of chronicity includes several factors that make more complicated to ?measure? the disease, its intensity, and its evolution. The ways in which individual patients have learned to adapt to their own condition make it very difficult, for example, to put together a homogeneous study group in which to investigate all these factors. Furthermore, the many complexities of the patient?s response mean that its adaptation process often succeeds in ?compensating? for the clinical imbalances caused by the disease, thus generating periods of relative well-being alternating with periods of relapse. It should also be considered that patients often present other comorbidities alongside their main disease, and that the complexity of everyone can lead to different responses even in similar conditions. It becomes evident that the simplification and verification process proposed by EBM is difficult to apply in such contexts. The undeniable results achieved by EBM have led to a growing disregard for individual clinical experience and a greater reliance on clinical trials, to the point that the latter have become the solo identifying element of a method applied even in the absence of the specific factors that require its use, such as in the case of lifelong diseases. Sackett himself recognized the excessive ?extremism? conferred upon his work, and indeed published an article5 in the British Medical Journal in which he attempted to redress the balance. This revision of EBM has, in recent years, led to the individual clinical expertise theorized by Sackett being identified with patient reported outcomes,6 which offer the patient?s perspective on a disease or treatment which cannot be measured with any clinical test, but that could be just as important for the patients themselves as the determination of any given parameter. In brief, individuals with the same state of health, diagnosis, or disease can have different perceptions of their own feelings and their own health status because they have different abilities to deal with their own limitations and disabilities, and this finally leads to a different perception of their quality of life (QoL). In this way, more suited factors to measuring the clinical variables typical of chronic diseases have gradually come in and play a role in the complex equilibrium of clinical research: QoL), the patients? satisfaction about the results of the treatment, their psychological condition, their limitations of working or social life, and also the adherence to treatment.7 All these factors, as noted by Jeff Sloan?s group in Explore,8 comprise an integral part of the investigational methodology in most procedures characterized as TM/CM, and above all in homeopathy. It is therefore legitimate to ask if randomized controlled trials (RCTs) are always the most reliable way to generate clinical evidence in medicine, given the complexity of the therapeutic regimens (especially in chronically ill patients with many comorbidities), the demographic and clinical variability of the patients, the continuation of many therapies and, finally, the questionable adherence of prescribers to the guidelines. As a result, RCTs without additional information on the patient?s experiences and chronicity are insufficient to guide the clinical-decisional process, due to the controlled (but false!) environment for which they are designed, which often makes it impossible to generalize their results to the so-called real world. The same conclusions9 were reached by a network of scientific societies10 involved, for the main part, in the study of chronic diseases. There is now an adequate body of scientific evidence to begin challenging the monopoly of EBM in clinical research in favor of a growing area known as real-world evidence, which also includes the patients? experiences and that can produce evidence on the best way to improve the prescribed treatments, especially in the case of chronic diseases. These were the premises on which Edward Wagner based an editorial in effective clinical practice,11 back in 1998, which laid the foundations for what is now known as thechronic care model (CCM): his discussion of the results of a four-year clinical trial on more than 4000 patients with diabetes, decompensated heart disease, anxiety, and depression confirmed the validity of a model that has had a significant effect on morbidity and complications. Later developments of the CCM in different clinical sectors12?14 offered an inevitab
Umbilical hernia is one of the most common developmental defects in swine, producing large economic losses for farmers, forced to slaughter animals at a younger age and therefore at a lower weight to ...prevent fatal complications. This study describes a surgical technique to repair umbilical hernia through the use of autologous prostheses, allowing recovery of the affected animals; Methods: After a general examination of the swine and examination of the lesions, the swine were anesthetized and underwent surgery. The surgery was performed by combining the traditional herniorrhaphy with the inclusion and fixation of a peritoneal flap obtained from the incision of the same hernial sac; Results: Follow-ups were carried out at 7, 30 and 60 days and demonstrated healing in all of the treated subjects; Conclusions: The use of this surgical technique allows for providing resistance to herniorrhaphy performed through the use of a cost-free autologous biomaterial prosthesis, with excellent tissue compatibility. This might allow for reducing significantly the rate of relapses and eliminating the risk of rejection.
The purpose of the current study was to investigate the effects of two commonly used sedation protocols in dogs, acepromazine (ACP) and acepromazine–methadone (ACP–MET) combination, on tear ...production measured by the Schirmer Tear Test (STT) 1. We hypothesized that both sedation protocols cause a reduction in canine tear production for a variable time. Fifteen client-owned dogs were recruited for the study. Each dog was subjected to sedation twice, 2–3 weeks apart, and they were randomly allocated to one of two groups receiving ACP (0.015 mg kg−1) or ACP–MET (0.010 mg kg−1 and 0.2 mg kg−1) intramuscularly. In both eyes, tear production was measured 15 min before sedation (T0) and 20 min (T20 m), 40 min (T40 m), 1 h (T1), 2 h (T2), 4 h (T4) and 8 h (T8), after drug administration. Two-way repeated measures ANOVA, followed by the Bonferroni post hoc test (p < 0.05), showed a significant effect of time (p < 0.0001) and treatment (p < 0.0001). A significant decrease in tear production at T20 m, T40 m, T1 and T2 compared to T0 was observed in the ACP experimental protocol, while in the ACP + MET protocol, this reduction persisted until T8. Comparing the two experimental protocols, no statistically significant differences were observed at T0 or T20 m, and STT 1 values were statistically lower in the ACP + MET than the ACP protocol at the other data points. In the ACP + MET group, at T40 m, 100% of dogs showed STT 1 readings lower than 15 mm/min. This finding is clinically relevant as it can predispose dogs to corneal injuries. The major reduction in tear production due to the ACP + MET protocol proves the need for adequate corneal hydration, particularly to discourage its use in animals with altered tear production. The data obtained provide important information helping clinicians to better manage the drug’s effects on tear production.
Sterilization by intratesticular injection of chemical agents is a non-surgical alternative to neutering male companion animals. We used contrast-enhanced ultrasound (CEUS) to monitor vascular ...alterations to testes immediately after the intratesticular injection of CaCL2 in alcohol. We evaluated the CEUS features of normal and damaged testes in 20 dogs after the intratesticular injection of CaCl2. The CEUS evaluation was performed at the site of the chemical agent inoculation. In treated testes, qualitative CEUS showed a lower intensity enhancement of the parenchyma than pre-treatment normal testes with a predominantly anechoic pattern and only a few hyperechoic vascular focal spots. Quantitative CEUS showed significantly lower values of time-intensity curve (TIC) parameters, including signal intensity (Peak: 4.72 ± 2.1), regional blood volume (RBV: 134.3 ± 63.7), and regional blood flow (RBF: 4.36 ± 2.18) than normal testes (p < 0.001). Sonographic findings from CEUS showed hypovascularization of the canine testicular parenchyma caused by the hardening agent. This diagnostic technique helps clinicians define testicular vascular alterations achieved by chemical castration more efficiently. Nevertheless, more studies are required to apply this methodology to more subjects with a broader weight range and stray dogs.
Background
Pollen‐induced allergic rhinoconjunctivitis (AR) is highly prevalent and rapidly evolving during childhood. General practitioners may not be fully aware of the nature and severity of ...symptoms experienced by patients and might underestimate the prevalence of moderate or severe disease. Thus, the relevance of early diagnosis and intervention may be overlooked.
Objectives
To investigate the severity of pollen‐induced AR and its determinants in Italian children referred to allergy specialists and who had never received specific immunotherapy (SIT).
Methods
Children (age 4–18 yr) affected by pollen‐induced AR who had never undergone SIT were recruited between May 2009 and June 2011 in 16 pediatric outpatient clinics in 14 Italian cities. Recruited children's parents answered standardized questionnaires on atopic diseases (International Study of Allergy and Asthma in Childhood, Allergic Rhinitis and its Impact on Asthma, Global Initiative for Asthma). The children underwent skin‐prick test (SPT) with several airborne allergens and six food allergens. Information on socio‐demographic factors, parental history of allergic diseases, education, perinatal events, breastfeeding, nutrition and environmental exposure in early life was collected through an informatics platform shared by the whole network of clinical centers (AllergyCARD™).
Results
Among the 1360 recruited patients (68% males, age 10.5 ± 3.4 yr), 695 (51%) had moderate‐to‐severe AR, 533 (39%) asthma, and 325 (23.9%) oral allergy syndrome (OAS). Reported onset of pollen‐induced AR was on average at 5.3 ± 2.8 yr, and its mean duration from onset was 5.2 ± 3.3 yr. Only 6.2% of the patients were pollen‐monosensitized, and 84.9% were sensitized to ≥3 pollens. A longer AR duration was significantly associated with moderate‐to‐severe AR symptoms (p 0.004), asthma (p 0.030), and OAS comorbidities (p < 0.001).
Conclusions
This nationwide study may raise awareness of the severity of pollen‐induced AR among Italian children who have never received pollen SIT. The strong association between pollen‐induced AR duration and several markers of disease severity needs replication in longitudinal studies, while suggesting that countrywide initiatives for earlier diagnosis and intervention should be planned.
The partial or complete cranial cruciate ligament rupture is a common skeletal disease affecting the stifle joint in dogs. The tibial plateau levelling osteotomy, performed with several synthesis ...systems, changed the approach to its treatment in dogs. The aim of this study was to compare two types of fixation implants, locking compression system and locking system, evaluating radiographically the progression of osteoarthritis of the stifle joint in dogs with complete cranial cruciate ligament deficiency treated surgically with tibial plateau levelling osteotomy. Moreover, we evaluated bone healing and lameness scores to show biomechanical effects by the implant used. Twenty-eight dogs, who met the inclusion criteria, were divided into two groups. Group A: 14 dogs treated using locking compression plates; Group B: 14 dogs treated using locking plates. Radiographic osteoarthritis scores were evaluated up to 1 year following tibial plateau levelling osteotomy. At each visit, animals were clinically and radiographically assessed. Each dog was evaluated before (T0) and after two (T2) and twelve (T12) months after the surgery. At T2 the stage of bone healing was evaluated. The clinical follow up was performed before the surgery and at 10, 15 and 20 days after the surgery, grading the lameness at walk and trot.
An increase in osteoarthritis score at T12 versus T0 in both groups was detected. A decrease of the lameness score was observed in Group A versus Group B. The healing score system at T2 showed a lower score in Group A versus Group B.
The osteoarthritis score following tibial plateau levelling osteotomy did not differ when comparing the two different fixation systems. The locking compression system allowed a more rapid functional recovery of the limb and a quicker bone healing than the locking system. Locking compression system should be carefully considered for dogs subjected to tibial plateau levelling osteotomy surgery, because it may reduce the recovery time.
Little is known about the prevalence and clinical relevance of hypersensitivity to the plant panallergen profilin in children.
The present study aimed to investigate prevalence, risk factors and ...clinical relevance of profilin sensitization in a large cohort of Italian children of different ages living in different geographic areas.
Children with pollen allergy enrolled by 16 pediatric outpatient clinics sited in three main geographic areas of Italy were studied. SPT were carried out with commercial pollen extracts and a commercial purified date palm pollen profilin. IgE specific for allergenic pollen molecules, Phl p 12 (grass profilin) and Pru p 3 (peach lipid transfer protein) were tested by ImmunoCAP FEIA.
IgE to Phl p 12 (≥0.35 kU/l) was observed in 296 of the 1,271 participants (23%), including 17 of the 108 (16%) preschool children. Profilin SPT was positive (≥3 mm) in 320/1,271 (25%) participants. The two diagnostic methods were concordant in 1,151 (91%, p < 0.0001) cases. Phl p 12 IgE prevalence declined from northern to southern Italy and was directly associated with IgE to Phl p 1 and/or Phl p 5 and Ole e 1. Among children with IgE to Phl p 12, OAS was provoked by kiwi, melon, watermelon, banana, apricot and cucumber.
Profilin sensitization is very frequent among pollen-allergic children, occurs at a very young age and contributes to the development of childhood OAS with a typical pattern of offending foods. Pediatricians should always consider IgE sensitization to profilin while examining pollen-allergic children, even if they are at preschool age.
Flavonoids are a group of secondary metabolites widely distributed in plants that represent a huge portion of the soluble phenolics present in grapevine (Vitis vinifera L.). These compounds play ...different physiological roles and are often involved in protection against biotic and abiotic stress. Even if the flavonoid biosynthetic pathways have been largely characterized, the mechanisms of their transport and accumulation in cell wall and vacuole are still not completely understood. This review analyses the known mechanisms of flavonoid uptake and accumulation in grapevine, with reference to the transport models and membrane carrier proteins described in other plant species. The effect of different environmental factors on flavonoid biosynthesis and transporters is also discussed.
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