Validation of a Clinical Scoring System for Outcome Prediction in Dogs with Acute Kidney Injury Managed by Hemodialysis.

BackgroundA scoring system for outcome prediction in dogs with acute kidney injury (AKI) recently has been developed but has not been validated.HypothesisThe scoring system previously developed for outcome prediction will accurately predict outcome in a validation cohort of dogs with AKI managed with hemodialysis.AnimalsOne hundred fifteen client-owned dogs with AKI.MethodsMedical records of dogs with AKI treated by hemodialysis between 2011 and 2015 were reviewed. Dogs were included only if all variables required to calculate the final predictive score were available, and the 30-day outcome was known. A predictive score for 3 models was calculated for each dog. Logistic regression was used to evaluate the association of the final predictive score with each model's outcome. Receiver operating curve (ROC) analyses were performed to determine sensitivity and specificity for each model based on previously established cut-off values.ResultsHigher scores for each model were associated with decreased survival probability (P < .001). Based on previously established cut-off values, 3 models (models A, B, C) were associated with sensitivities/specificities of 73/75%, 71/80%, and 75/86%, respectively, and correctly classified 74-80% of the dogs.Conclusions and clinical relevanceAll models were simple to apply and allowed outcome prediction that closely corresponded with actual outcome in an independent cohort. As expected, accuracies were slightly lower compared with those from the previously reported cohort used initially to develop the models

Evaluation of Canine Pancreas-Specific Lipase Activity, Lipase Activity, and Trypsin-Like Immunoreactivity in an Experimental Model of Acute Kidney Injury in Dogs.

BackgroundDiagnosis of pancreatitis in dogs is complicated by extrapancreatic disorders that can alter the results of laboratory tests. Extrapancreatic disorders can also affect the diagnosis of exocrine pancreatic insufficiency (EPI). The effects of acute kidney injury (AKI) on pancreas-specific lipase activity (Spec cPL(®) Test), serum lipase activity and trypsin-like immunoreactivity (TLI) in dogs have not been evaluated.Hypothesis/objectivesSerum Spec cPL, lipase activity, and TLI concentrations will increase secondary to decreased kidney function.AnimalsFive purpose-bred dogs.MethodsExperimental prospective study. Gentamicin was used to induce AKI in 5 purpose-bred dogs. Serum samples were collected for measurement of creatinine, Spec cPL, lipase activity and TLI over 60 days, during both induction of, and recovery from, AKI.ResultsAll dogs developed and recovered from AKI. Six of 52 (12%) serum Spec cPL concentrations were increased (2 in the equivocal zone and 4 consistent with pancreatitis) in 2 of 5 (40%) dogs. Two of 51 (4%) serum lipase activity values were increased in 2 of 5 dogs. Serum TLI was increased above the reference range in 17 of 50 (34%) samples in 3 of 5 dogs. For all biomarkers, there was no consistent correlation with increases in serum creatinine concentration.Conclusions and clinical importanceDecreased renal excretion during experimental AKI did not cause consistent and correlated increases in serum Spec cPL, lipase activity, or TLI in this cohort of dogs

False discovery rate regression: an application to neural synchrony detection in primary visual cortex

Many approaches for multiple testing begin with the assumption that all tests in a given study should be combined into a global false-discovery-rate analysis. But this may be inappropriate for many of today's large-scale screening problems, where auxiliary information about each test is often available, and where a combined analysis can lead to poorly calibrated error rates within different subsets of the experiment. To address this issue, we introduce an approach called false-discovery-rate regression that directly uses this auxiliary information to inform the outcome of each test. The method can be motivated by a two-groups model in which covariates are allowed to influence the local false discovery rate, or equivalently, the posterior probability that a given observation is a signal. This poses many subtle issues at the interface between inference and computation, and we investigate several variations of the overall approach. Simulation evidence suggests that: (1) when covariate effects are present, FDR regression improves power for a fixed false-discovery rate; and (2) when covariate effects are absent, the method is robust, in the sense that it does not lead to inflated error rates. We apply the method to neural recordings from primary visual cortex. The goal is to detect pairs of neurons that exhibit fine-time-scale interactions, in the sense that they fire together more often than expected due to chance. Our method detects roughly 50% more synchronous pairs versus a standard FDR-controlling analysis. The companion R package FDRreg implements all methods described in the paper

Manejo de gliricidia sepium para produção de forragem em sistemas silvipastoris.

O objetivo deste trabalho foi avaliar o efeito da intensidade de pastejo num banco de proteína de G. sepium sobre a produção de materia seca (MS), crescimento de plantas e proteína bruta e digestibilidade da forragem produzida

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension

When Ethics Survive Where People Do Not

The provision of health care service in resource-poor settings is associated with a broad set of ethical issues. Devakumar's case discusses the ethical issues related to the inability to treat in a cholera clinic patients who do not have cholera. This paper gives a closer look on the context in which Devakumar's case took place. It also analyses the potential local and organizational factors that gives rise to ethical dilemmas and aggravate them. It also proposes a framework to help in the proactive handling of the factors that leads to ethical dilemmas and resolving the ethical issues as they appear. It adopts the four principles of autonomy, beneficence, non-maleficence and justice as universal and prima facie principles, but with the inclusion of a local understanding of what of each of these principles means. It is based on a collaborative approach that involves the beneficiaries and other partners in the field to help share information and resources, as well as adopting the provision of a wider service to the whole community. This is done by asking three basic questions: (a) who are the relevant stakeholders? (b) what ought to be the ethical principles in place? and (c) how should we take, implement and follow the decision about service provision

Oral tongue cancer in public hospitals in Madrid, Spain (1990-2008)

The cancer which appears in the mobile portion of the tongue is the most common neoplasm of the oral cavity. The objective of this study was to analyse oral tongue cancer epidemiology in a population of 610 patients diagnosed between 1990 and 2008 and detailed in the Tumour Registry of the Madrid region. A retrospective analysis based on the following variables provided in the Tumour Registry was achieved: age, gender, histology, stage, location, treatment. Descriptive and analytic statistics with these variables, using Pearson?s Chi-square test to study the relationship between the qualitative variables. Patients? mean age was 61.53±13.95 years, with a gender ratio of 2.09:1 (413 males vs 197 females). The lesion was mainly localized in the lateral border of tongue, with other sites (dorsal face, ventral face, lingual tonsil, contiguous sites, tongue NOS) represented at lower rates. Squamous cell carcinomas (94.9%) far outweighted other histologies (salivary gland tumours, soft tissue tumours, haematolymphoid tumours). 59% of the cases appeared in localized stages, versus 35.2% in regional and 4.8% in distant stages. Surgery was the most frequently used treatment, followed by surgery in combination with radiotherapy. Oral tongue cancer is a disease of the elderly, with a male predominance. It mainly appears in its lateral border, localized squamous cell carcinomas representing the great majority of lingual neoplasms