Heska (United States)

Objectives Although trauma clinical guidance has the potential to improve patient outcomes significantly, it is applied inconsistently across the USA today. Work is needed to improve guidance application among those who treat traumatic injury, including emergency medicine (EM) clinicians. A priority step of such improvement is the visual design of clinical directives, as it can markedly influence EM clinicians’ satisfaction and subsequent usage of guidance. This qualitative study aims to analyze EM clinicians’ needs and preferences for the visual design of trauma clinical guidance. Methods As part of a larger exploratory sequential mixed-methods study exploring trauma clinical guidance barriers and facilitators, we conducted semistructured video conference interviews during August and September 2024 with EM clinicians. Participants were selected through purposeful criteria and snowball sampling to ensure diverse representation across professional and personal characteristics. Interviews were audio recorded and analyzed through rapid qualitative content analysis. Results 12 EM clinicians completed interviews, providing feedback on their preferences for the visual design of trauma clinical guidance. Clinicians emphasized the need for simple guidance that can be easily used in a time-pressured setting. Dynamic features such as expandable or “clickable” content can provide deeper explanations of guidance concepts without compromising usability. Flowsheets and visual aids can clarify guidance recommendations. Clinicians asked that recommendations be specific and action-oriented. Conclusion When designing trauma clinical guidance, authors should promote visual design characteristics that prioritize simplicity, dynamic features, visual aids, and specificity. Level III

Keywords neoplasia, observational study design, oncology, pathology, prognostic markers, reporting guidelines, scientific publishing, surgical pathology, veterinary

The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p< 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p< 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p< 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p< 0.0001), but had similar mean J-CTO scores (2.5± 1.3 vs. 2.4± 1.3, p= 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p= 0.0201; 80.3% vs. 84.8%, p= 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p= 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.

Cats inoculated with feline herpesvirus 1, calicivirus, and panleukopenia (FVRCP) vaccines grown on the Crandell Rees feline kidney (CRFK) cell line have been shown to develop anti-CRFK antibodies. The identities of common CRFK antigens are unknown. Cats inoculated with CRFK lysates and FVRCP vaccines will develop autoantibodies measurable by Western blot immunoassay. Antigens associated with these antibodies can be isolated for further study. One CRFK hyperinoculated rabbit, 44 age-matched unvaccinated kittens purchased from a commercial vendor. Commonly recognized CRFK antigens were identified by comparison of Western blot immunoassays using sera from a hyperinoculated rabbit and kittens inoculated with CRFK lysate or 1 of 4 commercially available FVRCP vaccines. Antigens were purified from CRFK lysates and sequenced. Antigen recognition was confirmed by Western blot immunoassay and indirect ELISA for 2 proteins using sera from CRFK and FVRCP inoculated kittens. CRFK antigens 47, 40, and 38 kD in size were identified. Protein isolation and sequencing identified 3 CRFK proteins as alpha-enolase, annexin A2, and macrophage capping protein (MCP). Sera from FVRCP and CRFK inoculated cats were confirmed to recognize annexin A2 and alpha-enolase by Western blot immunoassay and indirect ELISA. This study validated the use of Western blot immunoassay for detection of antibodies against CRFK proteins and identified 3 CRFK antigens. In humans, alpha-enolase antibodies are nephritogenic; alpha-enolase and annexin A2 antibodies have been associated with autoimmune diseases. Further research will be necessary to determine the clinical relevance of these findings.

To determine the diagnostic usefulness of semiquantitative and quantitative microalbuminuria assays and urine albumin-to-creatinine (UAC) ratio for detecting disease in cats. Prospective study. 441 cats evaluated at a veterinary teaching hospital. Urine samples from cats for which a complete medical record was available were included. Urine dipstick results, urine protein-to-creatinine ratios (cutoffs, 0.1 and 0.4), semiquantitative and quantitative microalbuminuria assay results (cutoff, 1 mg/dL), and UAC ratio values (cutoffs, 100 and 200 mg/g) were determined. Clinical diagnoses determined within 3 months of enrollment were recorded. Sensitivity and specificity were determined with disease status used as the standard. The influences of clinical diagnosis, sex, age, serum urea nitrogen and creatinine concentrations, blood pressure, bacterial urine culture results, rectal temperature, pyuria, hematuria, and bacteriuria were evaluated by means of logistic regression. Of 441 cats that were eligible for inclusion, 40 were healthy and 401 had > or = 1 disease. Results of logistic regression indicated that significant associations existed for age, presence of disease, presence of urinary tract disease, azotemia, hematuria, and pyuria and results of 1 or both of the microalbuminuria assays. Microalbuminuria was associated with underlying disease. Sensitivity and specificity of the microalbuminuria assays for detection of systemic disease were superior to those of other tests. Microalbuminuria testing in conjunction with other screening procedures may increase identification of occult disease. A prospective study evaluating the predictive values of screening tests with and without microalbuminuria determination is needed to validate this recommendation.

Introduction: Surface enhanced laser desorption ionization time of flight (SELDI‐TOF) mass spectrometry is a powerful new tool for biomarker discovery and diagnostic test development. In this process, proteins in biological samples are selectively bound to chip surfaces that have various chemistries and then subjected to mass spectrometry. Selectively bound proteins are separated by mass and the relative quantities of each protein compared among samples. Unlike conventional diagnostic test formats that commonly use single biomarkers, SELDI‐TOF technology allows multiple biomarkers to be used in a single assay to improve sensitivity and specificity. This technology has been used to improve diagnostic tests for human prostate and ovarian cancers. The objective of this study is to investigate the utility of this technology for the proteomic profiling of canine B‐cell lymphoma. Developing a diagnostic serum screening test for B‐cell lymphoma in dogs would be valuable as early diagnosis and treatment may confer a more favorable outcome.Methods: Serum samples were collected from 26 dogs diagnosed with B‐cell lymphoma prior to treatment and from 26 apparently healthy dogs that were similar in age, breed, and sex to the test group. Serum proteins were selectively bound to weak cationic, strong anionic, and nickel chelating chip surface chemistries under optimized buffer conditions, and subjected to mass spectrometry. The protein profiles were then compared using Biomarker Wizard and classification trees developed using Biomarker Patterns software from Ciphergen Biosystems, Inc (Fremont, CA).Results: To date several putative biomarkers have been identified. These putative biomarkers have been used to build classification tree models that predict disease in test samples. Preliminary results using cross‐validation of the test and control sample sets indicate that trees built with two or more biomarkers have greater than 90% sensitivity and specificity.Conclusions: Proteomic profiling using SELDI‐TOF technology in canine serum is feasible. Further testing is planned to confirm these initial results.

Two distinct cDNAs that appear to encode proteins in the synaptic vesicle-2 (SV2) family were identified as expressed sequence tags from a Ctenocephalides felis hindgut and Malpighian tubule (HMT) cDNA library. To date, SV2 proteins have been described only in vertebrates, and have been detected only in synaptic vesicles in neuronal and endocrine tissues, where they are thought to regulate synaptic vesicle exocytosis. The cDNAs for the C. felis SV2-like proteins SVLP-1 and SVLP-2 encode predicted full-length proteins of 530 and 726 amino acids, respectively. Of characterized proteins, the SVLP protein sequences were most similar to rat SV2B. Northern blot analysis revealed that both mRNAs were up-regulated in larval stages that feed and in adults after feeding, and were expressed primarily or exclusively in the HMT tissues in adult fleas. These results suggest that the flea SVLP-1 and SVLP-2 gene products may have roles that are specific for the HMT tissues, and may differ in function from vertebrate SV2 proteins.