Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements

BACKGROUND: Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. HYPOTHESIS/OBJECTIVES: To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. ANIMALS: Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. METHODS: Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. RESULTS: The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational use of Antithrombotics in Veterinary Critical Care (CURATIVE) Guidelines: Small Animal

Objectives To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence‐based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi‐style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings Academic and referral veterinary medical centers. Results Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field

Clinical Application of the American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational use of Antithrombotics in Veterinary Critical Care (CURATIVE) Guidelines to Small Animal Cases

Objective To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case‐based approach. Etiology Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis. Diagnosis Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis. Therapy Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included. Prognosis In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus‐based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation

Galaxy Flow in the Canes Venatici I Cloud

We present an analysis of Hubble Space Telescope/WFPC2 images of eighteen galaxies in the Canes Venatici I cloud. We derive their distances from the luminosity of the tip of the red giant branch stars with a typical accuracy of ~12 %. The resulting distances are 3.9 Mpc (UGC 6541), 4.9 Mpc (NGC 3738), 3.0 Mpc (NGC 3741), 4.5 Mpc (KK 109), >6.3 Mpc (NGC 4150), 4.2 Mpc (UGC 7298), 4.5 Mpc (NGC 4244), 4.6 Mpc (NGC 4395), 4.9 Mpc (UGC 7559), 4.2 Mpc (NGC 4449), 4.4 Mpc (UGC 7605), 4.6 Mpc (IC 3687), 4.7 Mpc (KK 166), 4.7 Mpc (NGC 4736), 4.2 Mpc (UGC 8308), 4.3 Mpc (UGC 8320), 4.6 Mpc (NGC 5204), and 3.2 Mpc (UGC 8833). The CVn I cloud has a mean radial velocity of 286 +- 9 km/s, a mean distance of 4.1 +- 0.2 Mpc, a radial velocity dispersion of 50 km/s, a mean projected radius of 760 kpc, and a total blue luminosity of 2.2 * 10^{10} L_{\sun}. Assuming virial or closed orbital motions for the galaxies, we estimated their virial and their orbital mass-to-luminosity ratio to be 176 and 88 M_{\sun}/L_{\sun}, respectively. However, the CVn I cloud is characterized by a crossing time of 15 Gyr, and is thus far from a state of dynamical equilibrium. The large crossing time for the cloud, its low content of dSph galaxies ($< 6$ %), and the almost ``primordial'' shape of its luminosity function show that the CVn I complex is in a transient dynamical state, driven rather by the free Hubble expansion than by galaxy interactions.Comment: 23 pages, 6 figures, A&A in preparation. The version does not include Figure 2. High resolution figures 1 and 2 (11311k) are available at http://luna.sao.ru/~sme/figsCVn.tar.g

The Disk and Extraplanar Regions of NGC 55

The stellar content of the nearby SB(s)m galaxy NGC 55 is investigated using images covering the visible and near-infrared wavelength regions. A well-defined plume, which stellar evolution models suggest contains stars with masses near the RSG - AGB transition, is detected in CMDs of the disk, and it is concluded that star formation in the thin disk of NGC 55 has ocurred at a significant rate for at least the past 0.1 - 0.2 Gyr. The disk also contains a large population of old (log(t_yr) ~ 10) stars, and it is argued that a stable disk has been in place in NGC 55 for a significant fraction of the age of the Universe. At projected distances in excess of 2 kpc off of the disk plane the brightest AGB stars have ages 10(+3)(-2) Gyr. Thus, despite indications that dust and gas are present in the envelope surrounding the NGC 55 disk, the AGB content suggests that recently formed stars do not occur in large numbers in the extraplanar region. The mean metallicity of extraplanar RGB stars is in excellent agreement with that measured in the extraplanar HII regions EHR 1 and 2, suggesting that the age-metallicity relation in this part of NGC 55 has been flat for at least a few Gyr. Finally, the RGB-tip occurs near i' = 23.1 in the extraplanar region, and a distance modulus of 26.5 is computed from this feature.Comment: 27 pages of text, 20 postscript figures. Accepted for publication in the Ap

2022 Update of the consensus on the rational use of antithrombotics and thrombolytics in Veterinary Critical Care (CURATIVE) Domain 6: Defining rational use of thrombolytics

Objectives To systematically review available evidence and establish guidelines related to the use of thrombolytics for the management of small animals with suspected or confirmed thrombosis. Design PICO (Population, Intervention, Control, and Outcome) questions were formulated, and worksheets completed as part of a standardized and systematic literature evaluation. The population of interest included dogs and cats (considered separately) and arterial and venous thrombosis. The interventions assessed were the use of thrombolytics, compared to no thrombolytics, with or without anticoagulants or antiplatelet agents. Specific protocols for recombinant tissue plasminogen activator were also evaluated. Outcomes assessed included efficacy and safety. Relevant articles were categorized according to level of evidence, quality, and as to whether they supported, were neutral to, or opposed the PICO questions. Conclusions from the PICO worksheets were used to draft guidelines, which were subsequently refined via Delphi surveys undertaken by the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) working group. Results Fourteen PICO questions were developed, generating 14 guidelines. The majority of the literature addressing the PICO questions in dogs is experimental studies (level of evidence 3), thus providing insufficient evidence to determine if thrombolysis improves patient-centered outcomes. In cats, literature was more limited and often neutral to the PICO questions, precluding strong evidence-based recommendations for thrombolytic use. Rather, for both species, suggestions are made regarding considerations for when thrombolytic drugs may be considered, the combination of thrombolytics with anticoagulant or antiplatelet drugs, and the choice of thrombolytic agent. Conclusions Substantial additional research is needed to address the role of thrombolytics for the treatment of arterial and venous thrombosis in dogs and cats. Clinical trials with patient-centered outcomes will be most valuable for addressing knowledge gaps in the field