Iatrogenic hypothyroidism in a hyperthyroid cat treated with 131 I = Iatrogene hypothyroïdie bij een hyperthyroïde kat behandeld met 131 I

A thirteen-year-old, male, castrated, non-azotemic European Shorthair was presented for treatment of hyperthyroidism. Thyroid scintigraphy using Tc-99m showed bilaterally enlarged thyroid glands with an increased thyroid to salivary (T/S) ratio. The cat was treated with an intravenous injection of 4.84 mCi (179MBa) I-131. One year later, the cat showed clinical deterioration, including lethargy, weight loss and a louder heart murmur; iatrogenic hypothyroidism was diagnosed. Concurrently, renal parameters were elevated compared to the pre-treatment values. Supplementation with levothyroxine was started. Four months later, the cat was euthyroid and improved creatinine values were noted. In this case report, the diagnosis and management of iatrogenic hypothyroidism in cats and the interplay with renal function are described. An algorithm with recommendations regarding diagnosis, monitoring and treatment of these cats is presented

The risk and burden of vertebral fractures in Sweden

The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis

Validation of less-invasive hemodynamic monitoring with Pulsioflex in critically ill patients

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Comparison of Bioelectrical Impedance Analysis (BIA)-Derived Parameters in Healthy Volunteers and Critically Ill Patients

Objective: To compare bioelectrical impedance analysis (BIA)-derived parameters in healthy volunteers and critically ill patients and to assess its prognostic value in an ICU patient cohort. Design: Retrospective, observational data analysis. Setting: Single centre, tertiary-level ICU (Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg Hospital). Patients: 101 patients and 101 healthy subjects, participants of International Fluid Academy Days. Measurements and main results: Compared to healthy volunteers, both male and female ICU patients had significantly higher values for total body water (TBW), extracellular water (ECW), extracellular fluid (ECF), plasma, and interstitial fluid volumes. The phase angle was significantly lower and the malnutrition index was significantly higher in ICU patients, regardless of gender. Non-survivors in the ICU had significantly higher extracellular water content (ECW, 50.7 ± 5.1 vs. 48.9 ± 4.3%, p = 0.047) and accordingly significantly lower intracellular water (ICW, 49.2 ± 5.1 vs. 51.1 ± 4.3%, p = 0.047). The malnutrition index was also significantly higher in non-survivors compared to survivors (0.94 ± 0.17 vs. 0.87 ± 0.16, p = 0.048), as was the capillary leak index (ECW/ICW). Conclusions: Compared to healthy volunteers, this study observed a higher malnutrition index and TBW in ICU patients with an accumulation of fluids in the extracellular compartment. ICU non-survivors showed similar results, indicating that ICU patients and a fortiori non-survivors are generally overhydrated, with increased TBW and ECW, and more undernourished, as indicated by a higher malnutrition index

Leptin Affects Life History Decisions in a Passerine Bird: A Field Experiment

BACKGROUND: Organisms face trade-offs regarding their life-history strategies, such as decisions of single or multiple broods within a year. In passerines displaying facultative multiple breeding, the probability of laying a second clutch is influenced by several life-history factors. However, information about the mechanistic background of these trade-offs is largely lacking. Leptin is a protein hormone produced by white fat cells, and acts as a signal between peripheral energy depots and the central nervous system. In addition, leptin affects cells at all levels of the reproductive axis and plays a critical role in regulating the allocation of metabolic energy to reproduction. As such, it is possible that leptin levels influence the decision of whether or not to invest time and energy into a second clutch. Accordingly, we expect a treatment with exogenous leptin to result in an increased number of second broods. METHODOLOGY/PRINCIPAL FINDINGS: At a later stage during the first brood, female great tits were treated either with long-term leptin-filled cholesterol pellets (the experimental birds) or with pellets containing only cholesterol (the control birds). We found that leptin-treated females were significantly more likely to have a second brood and that the earlier females were more likely to lay a second clutch than the late females. CONCLUSIONS/SIGNIFICANCE: As both timing of first brood and treatment with leptin were important in the decision of having multiple broods, the trade-offs involved in the breeding strategy most likely depend on multiple factors. Presumably leptin has evolved as a signal of energy supply status to regulate the release of reproductive hormones so that reproduction is coordinated with periods of sufficient nutrients. This study investigated the role of leptin as a mediator between energy resources and reproductive output, providing a fundamentally new insight into how trade-offs work on a functional basis

Planning in hybrid relational MDPs

We study planning in relational Markov decision processes involving discrete and continuous states and actions, and an unknown number of objects. This combination of hybrid relational domains has so far not received a lot of attention. While both relational and hybrid approaches have been studied separately, planning in such domains is still challenging and often requires restrictive assumptions and approximations. We propose HYPE: a sample-based planner for hybrid relational domains that combines model-based approaches with state abstraction. HYPE samples episodes and uses the previous episodes as well as the model to approximate the Q-function. In addition, abstraction is performed for each sampled episode, this removes the complexity of symbolic approaches for hybrid relational domains. In our empirical evaluations, we show that HYPE is a general and widely applicable planner in domains ranging from strictly discrete to strictly continuous to hybrid ones, handles intricacies such as unknown objects and relational models. Moreover, empirical results showed that abstraction provides significant improvements.status: publishe