Erythrogram patterns in dogs with chronic kidney disease

Anemia is considered a common finding in dogs with chronic kidney disease (CKD), typically as normochromic, normocytic, and non-regenerative. Although anemia can occur at any CKD IRIS (International Renal Interest Society) stage, its severity is related with the loss of kidney function. The aim of the present study was to retrospectively evaluate quantitative and morphological abnormalities of the erythrogram in dogs at different CKD IRIS stages. A total of 482 CBCs from 3648 initially screened were included in the study. Anemia was present in 302/482 (63%) dogs, in the majority of which it was normochromic, normocytic, and non-regenerative (295/302; 98%). The number of reticulocytes was <60,000/mu L in the majority of dogs (248/295; 84%), with a correlation between poor regeneration rate and progression of CKD (p = 0.0001). The frequency of anemia significantly differed (p = 0.0001) among the IRIS stages: 108/231 (47%) in IRIS 2, 77/109 (71%) in IRIS 3, and 117/142 (82%) in IRIS 4. Dogs at IRIS stages 3 and 4 were more likely to have moderate to severe anemia, compared to dogs at IRIS stage 2 (p = 0.0001). Anisocytosis was the most frequent morphological abnormality (291/482; 60%), whereas the presence of poikilocytosis showed an association with progression of IRIS stages (p = 0.009). Among different morphological abnormalities, the frequency of fragmented red blood cells and Howell-Jolly bodies showed a significant association with the progression of CKD. Anemia was a frequent finding in CKD dogs, mostly associated with none to poor regeneration rate. Similar to human medicine, advanced CKD stages are more frequently characterized by morphological alterations, such as fragmented red blood cells and Howell-Jolly bodies, which may suggest a more severe condition of reduced bone marrow activity and microangiopathy

Mutation spectrum of MLL2 in a cohort of kabuki syndrome patients

ABSTRACT: BACKGROUND: Kabuki syndrome (Niikawa-Kuroki syndrome) is a rare, multiple congenital anomalies/mental retardation syndrome characterized by a peculiar face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies, and immunological defects. Recently mutations in the histone methyl transferase MLL2 gene have been identified as its underlying cause. METHODS: Genomic DNAs were extracted from 62 index patients clinically diagnosed as affected by Kabuki syndrome. Sanger sequencing was performed to analyze the whole coding region of the MLL2 gene including intron-exon junctions. The putative causal and possible functional effect of each nucleotide variant identified was estimated by in silico prediction tools. RESULTS: We identified 45 patients with MLL2 nucleotide variants. 38 out of the 42 variants were never described before. Consistently with previous reports, the majority are nonsense or frameshift mutations predicted to generate a truncated polypeptide. We also identified 3 indel, 7 missense and 3 splice site. CONCLUSIONS: This study emphasizes the relevance of mutational screening of the MLL2 gene among patients diagnosed with Kabuki syndrome. The identification of a large spectrum of MLL2 mutations possibly offers the opportunity to improve the actual knowledge on the clinical basis of this multiple congenital anomalies/mental retardation syndrome, design functional studies to understand the molecular mechanisms underlying this disease, establish genotype-phenotype correlations and improve clinical management

Characterisation of Stone Airborne Dust Populations by Opto-Digital Microscopy

The problem of the production of airborne dust emission during several industrial processes (i.e. dry stone working actions) was taken into account. In order to find new methods to reduce dust emissions, the proposed approach was the dimensional and morphological dust characteristics according to different working tools and materials. In this perspective, two different methods have been investigated: the size class distribution analysis of dust particles based on a laser diffraction system (LD) and the 2D fractal analysis of airborne dust populations acquired as digital images. The first approach (dust size class distribution through laser based diffraction system) permitted to directly characterise particle dust size class distribution in respect of the ornamental stone processed and the working action applied. The second one (2D fractal analysis method) allowed the study of dust image structure and texture by evaluating statistical fractal parameters (“fractal dimensions” and their precision), to quantify the efficiency in space or surface covering by dust particles. The 2D fractal analysis method appeared to be an interesting approach providing information on particles spatial disposition and on the structure of the disposition itself permitting this way to derive information concerning the overall characteristics of dust particles and, as a consequence, about the behaviour of the working process. The study was developed with reference to several materials resulting from ornamental stone dry working. Interesting correlation have been found between fractal parameters and the parameters deriving from the size class distribution analysis by LD, supporting the validity of the proposed approach. An application of the proposed method to other dust populations (i.e. wood-working airborne dusts) is straightforward

Holistic Approach for Improved Safety Including a Proposal of New Virtual Test Conditions of Small Electric Vehicles

In the next 20 years the share of small electric vehicles (SEVs) will increase especially in urban areas. SEVs show distinctive design differences compared to traditional vehicles. Thus the consequences of impacts of SEVs with vulnerable road users (VRUs) and other vehicles will be different from traditional collisions. No assessment concerning vehicle safety is defined for vehicles within European L7e category currently. Focus of the elaborated methodology is to define appropriate test scenarios for this vehicle category to be used within a virtual tool chain. A virtual tool chain has to be defined for the realization of a guideline of virtual certification. The derivation and development of new test conditions for SEVs are described and are the main focus of this work. As key methodology a prospective methodical analysis under consideration of future aspects like pre-crash safety systems is applied. The studies show that certain collision types will be reduced in numbers and in average collision severity. Based on the evaluation following tests are proposed. Frontal: oblique (30°), test speed 35 km/h, 1,300kg Mobile Progressive Deformable Barrier (MPDB); Side: 90°, Advanced European Mobile Deformable Barrier (AE-MDB), barrier speed 40 km/h; Pedestrian safety: seven pedestrian impact locations, 2 speed ranges, four different percentiles. The proposed virtual testing procedure has to be based on well validated models and tools, which can be assumed to be available in the future. The focus of the presented work is on SEVs in L7e category, for which no specific, urban area relevant safety regulations are available. Overall occupant and VRU safety of future SEVs will increase significantly, if additionally to the standard crash tests the elaborated tests from the European Union (EU) initiative SafeEV are applied for the design of safety measures within L7e vehicle class

Preoperative risk factors in total thyroidectomy of substernal goiter

The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the presence of these factors, greater care should be taken

Preoperative risk factors in total thyroidectomy of substernal goiter

Aldo Bove, Raffaella Maria Di Renzo, Gauro D’Urbano, Manuela Bellobono, Vincenzo D’ Addetta, Alfonso Lapergola, Giuseppe Bongarzoni Department of Medicine, Dentistry and Biotechnology, University “G. d’Annunzio” Chieti-Pescara, Chieti Scalo, Italy Abstract: The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the presence of these factors, greater care should be taken. Keywords: substernal goiter, total thyroidectomy, complication

Early biomarkers of hypocalcemia following total thyroidectomy

AbstractHypocalcemia is the most frequent major complication following total thyroidectomy (TT), delaying timely hospital demission. We prospectively evaluated the diagnostic utility of parathyroid hormone (PTH) measured one hour after TT and the delta (post-minus pre-surgery) PTH in order to determine which biomarker best predicted post-surgery hypocalcemia.Ninety-six consecutive patients, with either plurinodular goiter, Graves' disease or cervico-mediastinal goiter (22 (23%) men and 74 (77%) women, mean age 48.5 ± 15.2 and 47.9 ± 13.2 years, respectively), scheduled to undergo TT were enrolled. PTH was measured prior and one hour after surgery. Delta PTH was defined as one-hour post-surgery values minus pre-surgery PTH level. Hypocalcemia was defined as a calcemia under 8.0 mg/dL. Receiver operating characteristic (ROC) analysis was used to evaluate the Area Under Curve (AUC), sensibility and specificity of the two biomarkers for the occurrence of hypocalcemia. Forty-nine (51%) patients presented biochemical values under the cut-off but only 17 (18%) had clinical symptoms.Both variables yielded statistically significant AUC (PTH one-hour post surgery: 0.654; p = 0.0403; 95%CI: 0.519–0.773 and delta PTH: 0.659; p = 0.0263; 95%CI: 0.527–0.776). Although comparison of the two ROC curves did not yield significant differences, delta PTH yielded a better sensitivity and PTH one-hour post-TT yielded a marginally better specificity (sensitivity of 50% and 87% and specificity of 76% and 67% for cut-offs of <39.8 pg/dl and <54.5 pg/dl, respectively).Both biomarkers have similar diagnostic accuracy for hypocalcemia, and can be used to indicate when supplemental therapy should be implemented in order to favor a timely discharge