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Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats.

Background: Repeated PO dosing of anti‐epileptic drugs may contribute to poor compliance in treated cats. Intermediate‐release levetiracetam has been used safely in cats, but must be given q8h to maintain serum concentrations in the therapeutic interval for humans (5–45 μg/mL). Approved extended‐release levetiracetam (XRL) for human use may require less frequent dosing, but the large dosing unit has limited its use in cats. Hypotheses: In healthy cats, serum levetiracetam concentration will remain above 5 μg/mL for at least 24 hours after administration of a single dose of XRL PO and will be well tolerated. Animals: 7 healthy cats. Methods: Extended‐release levetiracetam (500 mg) was administered PO. Blood was collected and neurologic examination findings recorded at scheduled times over 30 hours. Serum levetiracetam concentration was quantitated by an immunoassay validated in cats. Data were subjected to noncompartmental analysis. Descriptive statistics were reported. Results: The median dosage of 86.2 mg/kg, (range, 80–94.3) achieved a mean maximum concentration (Cmax) of 89.8 ± 25.8 μg/mL at 4.9 ±1.57 hours. Serum levetiracetam was >5 μg/mL in all cats by 90 minutes. Mean concentrations were 43.7 ± 18.4 and 4.9 ± 3.4 μg/mL at 12 and 24 hours, respectively. The half‐life was 4.1 ± 1.0 hours. The drug was well tolerated. Conclusions and Clinical Importance: A single 500 mg PO dose of XRL safely maintained serum levetiracetam concentration ≥5 μg/mL in healthy cats for at least 21 hours. Clinical efficacy studies in epileptic cats receiving XRL are indicated; however, monitoring should be implemented for individual cats. [ABSTRACT FROM AUTHOR]

Glass manufacturing companies are pushing the limits on gross tons of high quality glass they are demanding from their glass furnaces, via pushing the furnaces longer and harder. The expectations for more robust refractories, timely and economical hot repairs and stable quality are now a "given"! The return on investment is expected to surpass the espoused life of the furnace. In order to accomplish this demand for longer campaign life, numerous proactive models must be placed in motion, beginning before the start of the latest campaign. Selection of robust refractories, design and operating parameter computer control systems must be implemented well before the first glass bottle or lite of glass ever comes off the line. In situ monitoring of the key furnace parameters throughout the campaign is vital and the consequence selection of "on-the-fly" hot repairs and the capable contractor who is selected to perform these repairs are all extremely important variables that affect both furnace glass quality and campaign life. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Few medications are available for parental administration to animals with seizures. Rectal administration of medications is often used if the animal cannot be administered oral medications. Hypothesis/Objectives To determine the pharmacokinetic differences in zonisamide when administered rectally in either of 2 vehicles and PO to dogs. Animals Eight healthy research dogs. Methods Randomized cross-over design. Zonisamide, 10 mg/kg, was administered rectally in polyethylene glycol ( PEG-R), rectally in water (H2O-R), and as an oral capsule. Plasma zonisamide concentrations were measured until 72 hours after administration. Zonisamide was quantitated by HPLC and plasma concentration versus time curve data was analyzed by using noncompartmental modeling. Results Mean maximum plasma zonisamide concentrations (μg/mL) were significantly higher after oral administration (11.56 ± 4.04) compared to H2O-R (5.00 ± 1.83) ( P = .004). Disappearance half-life (hours) and mean time to maximum concentration (hours) were not significantly different between methods of administration. Mean relative bioavailability of PEG-R (85 ± 69%) was significantly higher than that of H2O-R (53 ± 37%) ( P = .039). Dogs tolerated all dosing forms with no evidence of adverse effects. Conclusions and Clinical Importance The vehicle in which zonisamide is dissolved influences rectal bioavailability, with PEG preferred to H2O-R. Because of the prolonged time to maximum concentration, rectal administration of zonisamide should not be used to treat status epilepticus in dogs. A dose higher than what was used in this study might be necessary, if currently recommended minimum therapeutic concentrations (10 μg/mL) are to be achieved with a single-dose administration. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary Reasons for performing study: No studies have determined the pharmacokinetics of low-dose amikacin in the mature horse. Objectives: To determine if a single i.v. dose of amikacin (10 mg/kg bwt) will reach therapeutic concentrations in plasma, synovial, peritoneal and interstitial fluid of mature horses (n = 6). Methods: Drug concentrations of amikacin were measured across time in mature horses (n = 6); plasma, synovial, peritoneal and interstitial fluid were collected after a single i.v. dose of amikacin (10 mg/kg bwt). Results: The mean ± s.d. of selected parameters were: extrapolated plasma concentration of amikacin at time zero 144 ± 21.8 µg/ml; extrapolated plasma concentration for the elimination phase 67.8 ± 7.44 µg/ml, area under the curve 139 ± 34.0 µg*h/ml, elimination half-life 1.34 ± 0.408 h, total body clearance 1.25 ± 0.281 ml/min/kg bwt; and mean residence time (MRT) 1.81 ± 0.561 h. At 24 h, the plasma concentration of amikacin for all horses was below the minimum detectable concentration for the assay. Selected parameters in synovial and peritoneal fluid were maximum concentration (Cmax) 19.7 ± 7.14 µg/ml and 21.4 ± 4.39 µg/ml and time to maximum concentration 65 ± 12.2 min and 115 ± 12.2 min, respectively. Amikacin in the interstitial fluid reached a mean peak concentration of 12.7 ± 5.34 µg/ml and after 24 h the mean concentration was 3.31 ± 1.69 µg/ml. Based on a minimal inhibitory concentration (MIC) of 4 µg/ml, the mean Cmax : MIC ratio was 16.9 ± 1.80 in plasma, 4.95 ± 1.78 in synovial fluid, 5.36 ± 1.10 in peritoneal fluid and 3.18 ± 1.33 in interstitial fluid. Conclusions: Amikacin dosed at 10 mg/kg bwt i.v. once a day in mature horses is anticipated to be effective for treatment of infection caused by most Gram-negative bacteria. Potential relevance: Low dose amikacin (10 mg/kg bwt) administered once a day in mature horses may be efficacious against susceptible microorganisms. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is increasing among Escherichia coli isolates associated with spontaneous infection in dogs and cats. Objectives: To describe E. coli resistance phenotypes and clonal relatedness and their regional prevalence. Animals: Isolates of E. coli (n = 376) collected from dogs and cats in the United States between May and September 2005. Methods: Isolates submitted from the South, West, Northeast, and Midwest regions of the United States were prospectively studied. Phenotype was based on E-test susceptibility to 7 antimicrobials. Isolates were classified as no (NDR), single (SDR), or multidrug resistance (MDR). Clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE). Results: One hundred and ninety-three (51%) isolates expressed resistance to at least 1 drug, yielding 42 phenotypes. SDR isolates (n = 84; 44%, 8 phenotypes), expressed resistance most commonly to amoxicillin (30%, n = 25) and least commonly to cefpodoxime (1%, n = 1). MDR isolates (n = 109; 56%, 31 phenotypes) were resistant to amoxicillin (96%, n = 105), amoxicillin-clavulanate (85%, n = 93), and enrofloxacin (64%, n = 70); 18% (n = 20) were resistant to all drugs tested. The frequency of MDR did not differ regionally ( P= .066). MDR minimum inhibitory concentrations (MICs) were 6-fold higher than SDR MICs ( P < .0001). Dendrograms of 91 isolates representing 25 phenotypes revealed 62 different PFGE profiles. Conclusions and Clinical Importance: E. coli strains spontaneously infecting dogs and cats are genetically and phenotypically diverse. Given the current prevalence of MDR among clinical isolates of E. coli in United States, implementation of a robust surveillance program is warranted. [ABSTRACT FROM AUTHOR]

There is little data available on the prevalence of motorcycle accidents, their resultant injuries and the demand on the health care services in Jamaica. We performed a descriptive, analytical study to evaluate the extent of this problem and the need for preventative national policy measures. Between 1 January 2000 and 1 January 2007, demographic and clinical data on all motorcycle accident victims admitted to the University Hospital of the West Indies were collected in a prospective database. The data were analysed using the SPSS version 12.0. Of 270 motorcycle accident victims, there were 257 (95.2%) males and 13 (4.8%) females. Overall, 134 (49.6%) victims wore helmets at the time of their accident. The more common injuries were as follows: soft tissue trauma 270 (100%); head injuries 143 (53.0%); long bone fractures 126 (46.7%); abdominal injuries 38 (14.1%); thoracic injuries 71 (26.3%); vascular injuries 11 (4.1%). The mean injury severity score was 9.0 (SD 9.4; Median 8; Mode 4). There were 195 patients needing surgical intervention in the form of orthopaedic operations (94), neurosurgical operations (43), abdominal operations (49) and vascular operations (14). The mean duration of hospitalisation was 10 days (SD 11.2; Range 0-115; Median 6; Mode 3). There were 12 (4.4%) deaths, 9 (75%) due to traumatic brain injuries. Fatal injuries were more common in males (11) and un-helmeted patients (10). Motorcycle accidents take a heavy toll on this health care facility in Jamaica. Measures to prevent motorcycle accidents and reduce consequent injuries may be one way in which legislators can preserve precious resources that are spent during these incidents. This can be achieved through active measures such as educational campaigns, adherence to traffic regulations and enforcement of helmet laws. [ABSTRACT FROM AUTHOR]

Elacatinus gobies of the Caribbean have undergone rapid speciation along ecological axes, and particular species from this genus act as 'cleaners' that remove ectoparasites from larger coral reef fish, termed 'clients'. Evolutionary shifts in habitat use, behavior and lateral body stripe colors differentiate cleaners from ancestral sponge-dwelling lineages. High-contrast stripe colors associated with cleaning behavior on coral reefs may have evolved as a signal of cleaning status. We asked whether cleaner gobies with blue stripes are more conspicuous than ancestral yellow- and green-stripe phenotypes to a diverse set of potential client visual systems in the tropical reef environment where cleaning stations are commonly observed. Using spectrophotometric measurements of cleaners with blue and yellow stripes and their F1 hybrid, we tested the contrast of each color stripe to both potential dichromatic and trichromatic reef fish visual systems, against typical coral and sponge microhabitat background colors. Blue stripes provide the highest average chromatic contrast across a range of possible microhabitat colors to the majority of fish visual systems tested. The contrast provided by yellow and hybrid green stripes are comparable across habitats to dichromatic visual systems. The green stripe is less contrasting than both blue and yellow to many potential trichromatic visual systems. We suggest that the evolution of blue stripes in Elacatinus gobies could be a result of natural selection for signals of high color contrast, driven by the sensory biases and visual systems of diverse reef fish clients. [ABSTRACT FROM AUTHOR]

Objective--To determine the effect of WBC accumulation on the concentration of enrofloxacin in inflamed tissues in dogs. Animals--6 adult Bloodhounds. Procedures--Dogs were instrumented bilaterally with tissue chambers. Peripheral WBCs collected from each dog were exposed in vitro to radiolabeled enrofloxacin (14C-ENR). Inflammation was induced with carrageenan in 1 chamber. Ten hours later, treated cells were administered IV to each dog such that 14C-ENR was delivered at a mean ± SD dosage of 212 ± 43 µg. Samples of extracellular fluid from inflammation and control chambers and circulating blood were then collected before (baseline) and for 24 hours after WBCs were administered. Samples were centrifuged to separate WBCs from plasma (blood) or chamber fluid. Radiolabeled enrofloxacin was scintigraphically detected and pharmacokinetically analyzed. Comparisons were made between extra- and intracellular chamber fluids by use of a Student paired t test. Results--14C-ENR was not detectable in plasma, peripheral WBCs, control chambers, or baseline samples from inflammation chambers. However, 14C-ENR was detected in extracellular fluid from inflammation chambers (mean ± SD maximum concentration, 2.3 ± 0.5 ng/mL) and WBCs (maximum concentration, 7.7 ± 1.9 ng/mL). Mean disappearance half-life of 14C-ENR from extracellular fluid and WBCs from inflammation chambers was 26 ± 10 hours and 17 ± 6 hours, respectively. Conclusions and Clinical Relevance--WBCs were responsible for the transport and release of 14C-ENR at sites of inflammation. Accumulation of drug by WBCs might increase the concentration of drug at the site of infection, thus facilitating therapeutic success. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine an oral dosing regimen of zonisamide in healthy dogs such that therapeutic concentrations would be safely reached and maintained at steady-state. Adult hound dogs ( n = 8) received a single IV (6.9) and an oral (PO) dose (10.3 mg/kg) using a randomized cross-over design. Zonisamide was then administered at 10.3 mg/kg PO every 12 h for 8 weeks. Zonisamide was quantitated in blood compartments or urine by HPLC and data were subjected to noncompartmental pharmacokinetic analysis. Comparisons were made among blood compartments (one-wayanova; P ≤ 0.05). Differences among blood compartments occurred in all derived pharmacokinetic paramenters for each route of administration after single and multiple dosing. After single PO dosing, plasma Cmax was 14.4 ± 2.3 mcg/mL and elimination half-life was 17.2 ± 3.6 h. After IV dosing, volume of distribution was 1.1 ± 0.25 L/kg, clearance was 58 ± 11 mL/h/kg and elimination t1/2 was 12.9 ± 3.6 h. Oral bioavailability was 68 ± 12%; fraction of unbound drug approximated 60%. At steady-state (4 days), differences occurred for for all parameters except Cmax and Cmin. Plasma Cmax at steady-state was 56 ± 12 mcg/mL, with 10% fluctuation between Cmax and Cmin. Plasma t1/2 (h) was 23.52 ± 5.76 h. Clinical laboratory tests remained normal, with the exception of total T4, which was below normal limits at study end. In conclusion, 10 mg/kg twice daily results in peak plasma zonisamide which exceeds the recommended human therapeutic range (10 to 40 μg/mL) and is associated with suppression of thyroid hormone synthesis. A reasonable b.i.d starting dose for canine epileptics would be 3 mg/kg. Zonisamide monitored in either serum or plasma should be implemented at approximately 7 days. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine a therapeutic dose for Trental® (pentoxifylline) when used to treat dogs with dermatomyositis. Eleven dogs diagnosed with dermatomyositis based on history, physical examination and biopsy were treated with pentoxifylline (46.5 ± 8 mg kg-1 divided twice daily) with food. Biweekly for 3 months, urinalyses, complete blood counts, serum chemistries and therapeutic drug monitoring (peak collected at 3 h and trough before the next dose) were collected. Dermatological lesions were assessed during each visit and given a score (0 = nonexistent, 1 = mild, 2 = moderate and 3 = severe). Serum concentrations of pentoxifylline (pentoxy) and metabolites 1 (M1) and 5 (M5) were measured by high-performance liquid chromatography. Descriptive statistics were generated for the drug concentrations. Although all animals responded to therapy, the time to initial response (skin lesions changed to a lower score compared with the initial visit) varied between all of the dogs. The range was 4 to 10 weeks, with a median of 6 weeks of therapy. Laboratory tests did not differ between the first and last sampling times (month 3). Pentoxifylline and M1 and M5 concentrations (ng mL-1 ) for the 11 dogs varied between dog and across time for each dog. In general, concentrations for all three compounds were detectable only with peak (3 h) samples. Concentrations for M5 were highest for all dogs at each sampling time, and appeared to be the most consistent and characterized by the least variability. Concentrations were not detectable in one dog for pentoxy or M1 at any time, but were detectable for M5. Data for this dog were not included. Based on the response to therapy in this study, a dose 25 mg kg-1 of pentoxifylline administered every 12 h appears to be an effective beginning dose. Because of variability in disposition, including metabolite formation, monitoring of pentoxifylline may not offer a therapeutic... [ABSTRACT FROM AUTHOR]

Macrolides and lincosamides are first choice bacteriostatic antibiotics used in veterinary dermatology. The main antibiotics in these classes are erythromycin, lincomycin, clindamycin and tylosin. They are well absorbed if given orally and are able to penetrate well into infected skin. Their spectrum of action comprises bacteria commonly associated with skin infections, including staphylococci. Their main disadvantages are the rapid development of bacterial resistance and occasional gastroenteric upset, most often seen with erythromycin. More recently developed macrolides, such as azithromycin and clarithomycin, are bactericidal, have a larger spectrum of action, a longer endurance, less resistance and may be given once a day instead of two or three times daily. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study evaluates if use of hypofractionation (HFRT) for node negative intact breast cancer has significantly increased after guideline updates, publication of trial results in ultrahypofractionation, and the COVID 19 pandemic and if covariates affect its utilization. National Cancer Database was used to identify female patients ≥18 years old with N0 invasive breast cancer status post breast conserving surgery (BCS), surgical nodal evaluation, and adjuvant radiation (RT) in 2012-2021. HFRT was defined as 25-50 Gy in 5-20 fractions. Conventional RT (CFRT) was defined as 50-66 Gy in >20 fractions. Characteristics of those receiving HFRT versus CFRT were compared with X2 testing. Joinpoint analysis was used to identify the year after which HFRT trends significantly changed. Predictors of HFRT were identified by univariate (UVA) and multivariate (MVA) logistic regression. A P value <0.05 was considered significant. Patients eligible for analysis totaled 236,336. After BCS, 54.8% received CFRT and 45.2% received HFRT. Those receiving HFRT were significantly more likely to be ≥65 years old; white or Asian; non-Hispanic; insured by Medicare; treated at an academic center; rural; in the Northeast, Midwest, or West; ≥50 miles from treatment center; and diagnosed in 2017-2021. They were more likely to have grade 1-2, hormone receptor (HR) positive, HER2- disease with negative surgical margins (SM) and no lymph-vascular space invasion (LVSI). HFRT use significantly increased after 2015 on Joinpoint analysis (P <0.05). On secondary analysis, 5-fraction RT use significantly increased after 2019 (P <0.05). Age ≥65 years (OR 2.14, P <0.001); Asian race (OR 1.55, P <0.001); private insurance (OR 1.27, P = 0.03); treatment in Midwest (OR 1.66, P <0.001) or West (OR 3.77, P <0.001); distance ≥50 miles from treatment center (OR 1.16, P = 0.001); year of diagnosis (OR 1.44, P <0.001); and PBI (OR 2.08, P <0.001) were positively predictive of HFRT on MVA. Hispanic ethnicity (OR 0.84, P <0.001); treatment at community (OR 0.49, P <0.001) or integrated network (0.55, P <0.001) centers; urban location (OR 0.88, P <0.001); grade 2 (OR 0.83, P <0.001) or 3 (OR 0.49, P <0.001), HR- (OR 0.66, P <0.001), and HER2+ (OR 0.74, P <0.001) disease; +SM (OR 0.61, P <0.001); and LVSI+ (OR 0.86, P <0.001) were negatively predictive of HFRT on MVA. HFRT in N0 intact breast cancer increased after 2015, coinciding with guideline updates favoring HFRT in 2016 by National Comprehensive Cancer Network and 2018 by American Society for Radiation Oncology. Five-fraction RT increased after 2019, coinciding with onset of COVID 19 and publication of UK FAST and FAST-Forward trial results in 2020. Presence or absence of high-risk clinical features and barriers such as distance and location in rural or mountain states in the Midwest and West significantly affected use of HFRT. [ABSTRACT FROM AUTHOR]

Retrospective and post-hoc trial analyses have supported the omission of the tumor bed radiation boost in HER2-positive patients undergoing breast-conservation surgery in the era of HER2-directed therapy. In this analysis, we sought to describe the national patterns of care of tumor bed boost and its association with overall survival (OS) in this population. We queried the National Cancer Database to identify all female patients with HER2-positive invasive breast carcinoma treated with lumpectomy. Patients who were treated with neoadjuvant chemotherapy and those with metastatic disease at diagnosis were excluded from analysis. Clinical and demographic information and treatments were analyzed using standard T and χ2 tests. Predictors of receipt of tumor bed boost and predictors of death were identified with multivariable logistic regression. The Kaplan-Meier method was used to evaluated overall survival. We identified 6,620 female patients diagnosed with HER2-positive invasive breast carcinoma between 2006 and 2017. Of these patients, 2,825 (43%) were treated with a boost and 3,795 (57%) were not; 4,698 (71%) were hormone receptor positive and 1,909 (29%) were hormone receptor negative; 6,333 (96%) had negative surgical margins and 287 (4%) had positive surgical margins; 1,270 (19%) were ≤50 years of age and 5,350 (81%) were >50. On multivariable analysis, receipt of tumor bed boost was associated with age ≤50 years (Odds ratio [OR] 1.3, p<0.01), hormone receptor negative (OR 1.3, p<0.01). Factors associated with a higher risk for death included age >50 years (OR 2.4, p<0.01), positive surgical margins (OR 1.7, p<0.01), pN1 (OR 1.3, p = 0.03), pN2 (OR 2.3, p<0.01), pN3 (OR 3.2, p<0.02), and pT2 (OR 2.2, p<0.01) stage. Tumor bed boost was not associated with improved OS when compared to no boost among patients with HER2-positive disease who go on to receive adjuvant systemic therapy (HR 1.06, p = 0.60), even among patients who meet ASTRO tumor bed boost recommendation criteria (HR 0.90, p = 0.60), including age ≤50 with any grade, age 51-70 with high grade, or positive margin. A tumor bed boost is commonly implemented in HER2-positive breast cancer patients undergoing breast-conserving surgery and adjuvant radiation. This data supports previous retrospective and post-hoc trial analyses in omitting the tumor bed boost and treating patients who will receive adjuvant systemic therapy with whole breast radiation alone, provided that the patient receives HER2-directed therapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether hypofractionated radiotherapy (HF-RT) in node-negative intact breast cancer significantly increased after guideline updates, trial publications, and COVID-19., Methods: Patients with node-negative breast cancer undergoing lumpectomy and adjuvant RT were identified in the National Cancer Database. Receiving ≥25 and <50 Gy in 5-20 fractions defined HF-RT. Receiving 50 to 66 Gy in >20 fractions defined conventional RT (CF-RT). Patient characteristics were compared with X2 testing. Joinpoint analysis identified when fractionation significantly changed. Variables associated with HF-RT were identified by univariate and multivariate (MVA) logistic regression. Two-sided P-value <0.05 was significant., Results: Patients meeting criteria totaled 236,336; 54.8% received CF-RT and 45.2% HF-RT. HF-RT and 5-fraction RT significantly increased after 2015 and 2019, respectively (P<0.05). On MVA, HF-RT was positively associated with: age older than or equal to 65 years (OR 2.14, P<0.001); private insurance (OR 1.27, P=0.03); treatment in Midwest (OR 1.66, P<0.001) or Western United States (US) (OR 3.77, P<0.001); distance ≥50 miles (OR 1.16, P=0.001); later year of diagnosis (OR 1.44, P<0.001); and partial breast irradiation (OR 2.08, P<0.001). HF-RT was negatively associated with: community (OR 0.49, P<0.001) or integrated network (0.55, P<0.001) centers; grade 2 (OR 0.83, P<0.001) or 3 (OR 0.49, P<0.001), hormone receptor negative (OR 0.66, P<0.001), and HER2+ (OR 0.74, P<0.001) disease; positive surgical margins (OR 0.61, P<0.001); and presence of lympho-vascular invasion (OR 0.86, P<0.001)., Conclusions: HF-RT in node-negative intact breast cancer increased after 2015, coinciding with US and European guideline updates. Five-fraction RT increased after 2019, coinciding with COVID-19 and FAST-Forward trial results., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

The brain's spatial orientation system uses different neuron ensembles to aid in environment-based navigation. Two of the ways brains encode spatial information are through head direction cells and grid cells. Brains use head direction cells to determine orientation, whereas grid cells consist of layers of decked neurons that overlay to provide environment-based navigation. These neurons fire in ensembles where several neurons fire at once to activate a single head direction or grid. We want to capture this firing structure and use it to decode head direction and animal location from head direction and grid cell activity. Understanding, representing, and decoding these neural structures require models that encompass higher-order connectivity, more than the one-dimensional connectivity that traditional graph-based models provide. To that end, in this work, we develop a topological deep learning framework for neural spike train decoding. Our framework combines unsupervised simplicial complex discovery with the power of deep learning via a new architecture we develop herein called a simplicial convolutional recurrent neural network. Simplicial complexes, topological spaces that use not only vertices and edges but also higher-dimensional objects, naturally generalize graphs and capture more than just pairwise relationships. Additionally, this approach does not require prior knowledge of the neural activity beyond spike counts, which removes the need for similarity measurements. The effectiveness and versatility of the simplicial convolutional neural network is demonstrated on head direction and trajectory prediction via head direction and grid cell datasets., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Biophysical Society. All rights reserved.)

Background: Diabetic foot infection represents a significant complication of diabetes mellitus, contributing substantially to morbidity, mortality, and healthcare expenditure worldwide. Accurate diagnosis relies on a comprehensive assessment integrating clinical evaluation, imaging studies, and microbiological analysis. Management necessitates a multidisciplinary approach, encompassing surgical intervention, antimicrobial therapy, and advanced wound care strategies. Preventive measures are paramount in reducing the incidence and severity, emphasizing patient education, regular foot screenings, and early intervention., Methods: The researchers performed a systematic review of literature using PUBMED MESH keywords. Additionally, the study was registered in the International Prospective Register of Systematic Reviews at the Center for Reviews and Dissemination, University of York (CRD42021277788). This review provides a comprehensive overview of the microbial spectrum and antibiotic susceptibility patterns observed in diabetic foot infections., Results: The search through the databases finally identified 13 articles with 2545 patients from 2021 to 2023. Overall, the predominant Gram-positive microbial species isolated were Staphylococcus aureus, Enterococcus fecalis, Streptococcus pyogenes, Streptococcus agalactiae, and Staphylococcus epidermidis. Whereas the predominant Gram-negative included Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa., Conclusion: Diabetic foot infections represent a complex and multifaceted clinical entity, necessitating a holistic approach to diagnosis, management, and prevention. Limited high-quality research data on outcomes and the effectiveness of guideline recommendations pose challenges in updating and refining existing DFI management guidelines., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42021277788, identifier CRD42021277788., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Maity, Leton, Nayak, Jha, Anand, Thompson, Boothe, Cromer, Garcia, Al-Islam and Nauhria.)