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Background: Radioiodine ( 131 I) is effective treatment for hyperthyroidism in cats, but optimal dose to restore euthyroidism without inducing hypothyroidism is unclear. Treatment-induced hypothyroidism can lead to azotemia and reduced duration of survival., Objective: To compare efficacy and short-term outcomes of low-dose 131 I versus higher, standard-dose 131 I as treatment for hyperthyroidism., Animals: A total of 189 client-owned cats undergoing 131 I treatment for mild-to-moderate hyperthyroidism (serum T 4 ≥ 4.0 μg/dL and <13.0 μg/dL)., Methods: Prospective, nonrandomized, cohort study comparing treatment with either low-dose (2 mCi, n = 150) or standard-dose (4 mCi, n = 39) 131 I. Serum T 4 , thyroid-stimulating hormone (TSH), and creatinine concentrations were measured after 1, 3, and 6 months to determine persistent hyperthyroidism, overt hypothyroidism (low T 4 , high TSH), subclinical hypothyroidism (normal T 4 , high TSH), and azotemia., Results: There was no significant difference in prevalence of cats with persistent hyperthyroidism between standard- and low-dose treatment groups at 3 (0% versus 5.3%; P = .34) and 6 (0% versus 3.3%; P = .51) months. Overt (18% versus 1%; P = .0005) or subclinical (46% versus 21%; P = .004) hypothyroidism was more common in cats at 6 months after standard-dose 131 I. No difference in incidence of azotemia existed between groups, but cats treated with standard-dose 131 I had higher creatinine concentrations (P < .05) and higher percent rises in creatinine (P < .0001)., Conclusions and Clinical Importance: Low-dose 131 I is safe and effective for cats with mild-to-moderate hyperthyroidism, as evidenced by a cure rate of >95% with reduced frequency of iatrogenic hypothyroidism and azotemia., (Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Background: The study was prompted by a perceived high prevalence of myelographic complications varying in severity and type, and attributed to the contrast material or the procedure., Hypotheses: 1. Any adverse reaction (AAR) is associated with a change in CSF volume induced either by removal of CSF or addition of contrast material. 2. AAR occurs more frequently in horses with higher premyelography neurologic grade. 3. Nonspecific hyperthermia is attenuated by anti-inflammatory and osmotic agents., Animals: Horses (n = 278) that underwent myelography between 2000 and 2012 at 5 institutions: A (87), B (68), C (65), D (46), and E (12)., Methods: Multi-institutional, retrospective, observational cross-sectional study., Results: AAR were observed in 95/278 (34%) horses, were associated with longer general anesthesia time (P = .04) and higher contrast-medium volume (P = .04); euthanasia because of AAR was performed in 5/278 (2%) horses. Adverse neurologic reactions were the most common type of complication observed occurring in 15/278 (5%) and 42/235 (18%) of horses in the intra- and postmyelography periods. A relationship between AAR and premyelography neurologic grade was not identified (P = .31). Nonspecific hyperthermia was observed in 25/235 (11%) horses; no relationship was observed with administration of anti-inflammatory drugs and osmotic agents (P = .30)., Conclusions and Clinical Importance: The category of AAR occurred in one-third of the horses generally was mild and self-limiting. These reactions were associated with increased contrast-medium volume and longer anesthesia time; but, no specific procedural recommendations could be made because of small odds ratios (OR) of <2 for each 1 mL increase in contrast material and for each 1 minute of additional anesthesia time., (Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Immune cells in the ovarian stromal microenvironment play an important role in ovarian tumorigenesis. Up-regulation of immune cell-derived mediators during ovulation may generate a proinflammatory niche, which may subsequently induce transformation of normal ovarian epithelial cells or endometriotic cells in the ovary. Once transformed ovarian epithelial cells develop, an immunoediting process occurs in which immune cells and their mediators dictate the development and progression of ovarian tumors. Tumor cells also develop several mechanisms to evade anti-tumor immunity by developing an immunosuppressive microenvironment. The differences in the population of immune cells infiltrating into ovarian tumor tissues are associated with differences in clinical outcomes. The underlying molecular mechanisms of the association begin to unravel with the development of microdissection techniques, high throughput technologies, in vitro functional assays, and in vivo mouse modeling. A better understanding of the complex relationship between ovarian tumor cells and the associated immune cells will allow us to develop novel immunologic strategies for ovarian cancer prevention and treatment.

To analyse mechanotransduction resulting from tensile loading under defined conditions, various devices for in vitro cell stimulation have been developed. This work aimed to determine the strain distribution on the membrane of a commercially available device and its consistency with rising cycle numbers, as well as the amount of strain transferred to adherent cells. The strains and their behaviour within the stimulation device were determined using digital image correlation (DIC). The strain transferred to cells was measured on eGFP-transfected bone marrow-derived cells imaged with a fluorescence microscope. The analysis was performed by determining the coordinates of prominent positions on the cells, calculating vectors between the coordinates and their length changes with increasing applied tensile strain. The stimulation device was found to apply homogeneous (mean of standard deviations approx. 2% of mean strain) and reproducible strains in the central well area. However, on average, only half of the applied strain was transferred to the bone marrow-derived cells. Furthermore, the strain measured within the device increased significantly with an increasing number of cycles while the membrane's Young's modulus decreased, indicating permanent changes in the material during extended use. Thus, strain magnitudes do not match the system readout and results require careful interpretation, especially at high cycle numbers.

Local mechanical conditions are known to play a role during the regeneration of musculoskeletal tissues, and histomorphometrical investigations of the time course of healing have enabled specific conclusions regarding the mechanosensitivity of tissue differentiation. However, the mechanism for this influence is not clearly understood. In order to extend this analysis, it is essential to link local histological understanding with direct characterisation of the local mechanical environment. Digital image correlation (DIC) is a computer-based image analysis technique that enables the non-contact measurement of strains on material surfaces and is finding application in many areas of biomechanics. Here we report a DIC technique to investigate the local distribution of mechanical strain within regenerating soft tissue sections. We provide exemplary data from analysis of a section of sheep bone callus. An assessment of displacement measurement accuracy gave an RMS error of 4.2 microm, corresponding to an estimated strain error of 1.4%. The sections showed concentrations of up to four times the applied strain and comparison of the strain patterns with histological analysis confirmed that these concentrations reflected boundaries between hard and soft callus.

Background: Large interfragmentary movements may delay bone-healing. The hypothesis of the present study was that a reduction of interfragmentary movements, especially of torsional rotation and bending angles, would support the healing process and lead to improved healing following unreamed tibial nailing. The objective of this study was to investigate healing of an unstable tibial osteotomy site following stabilization with unreamed nailing with a modified tibial device that had angle stable holes for the locking bolts. We compared those findings with healing after stabilization of such sites with standard unreamed tibial nailing. The duration of the study period was nine weeks., Methods: The site of a standardized displaced osteotomy (3-mm gap) in twelve ovine tibiae was stabilized with unreamed tibial nailing: six animals were treated with a modified nail that had angle stable holes for the locking bolts, and six were treated with standard unreamed tibial nailing. In vivo gait analysis with optical measurements of interfragmentary movements and simultaneous measurements of ground reaction parameters were performed three days after the operation and once weekly afterward. After the animals were killed at nine weeks, the treated and contralateral tibiae were explanted, the implants were removed, and radiographs were made and evaluated for bridged cortices. Each pair of tibiae was also mechanically tested until torsional failure, after which the whole callus region was subjected to histological and histomorphometric analysis., Results: Throughout the examination period, the interfragmentary movements in all directions were significantly smaller in the group treated with the angle stable tibial nail than they were in the group treated with standard unreamed tibial nailing. The limbs treated with the angle stable tibial nails returned to almost full weight-bearing during the period of the investigation, whereas those treated with standard nailing did not. Histomorphometric analysis, radiographic data, and mechanical testing showed superior bone-healing following treatment with the angle stable tibial nail., Conclusions: Use of an angle stable tibial nail may help to reduce interfragmentary movements in vivo and thus lead to superior bone-healing compared with that following standard unreamed tibial nailing.

The engineering polymer polyacetal (also known as polyoxymethylene) has a long history of clinical use including in the femoral component of the Freeman all-polymer knee replacement. The polymer is a promising material for novel applications including the femoral component of hip resurfacing prostheses. However, no work following the effect on mechanical properties of extended immersion in the physiological environment has been reported. Samples of five grades of polyacetal were obtained and tested on an MTS Bionix 858 at 37 degrees C in physiological saline. Three groups of specimens were tested: "as received"; immersed in Ringer's solution at 37 degrees C for one month; immersed in Ringer's solution at 37 degrees C for six months'. While there were negligible reductions in the ultimate tensile strengths, the Young's moduli of all polymer grades showed significant reductions (p < 0.01) of up to 19.5% following one months' immersion. There were negligible changes in ultimate tensile strength and stiffness between one and six months' immersion, however some polymers showed a small, but significant (p < 0.05) increase in stiffness. The percentage elongation and true stress for plastic instability showed negligible changes following immersion for one and six months'. These results encourage the use of polyacetal in load-bearing orthopaedic applications., (Copyright 2001 Kluwer Academic Publishers)

Objective: To determine the complementary DNA (cDNA) sequence of interleukin-1 receptor antagonist (IL-1ra) in horses and compare messenger RNA (mRNA) expression of IL-1ra among horses of various breeds., Sample Population: Blood samples from neonatal and adult horses examined for a variety of diseases., Procedure: A polymerase chain reaction procedure was used to amplify a 220 base pair (bp) portion of the genomic DNA. The upstream and downstream regions of the cDNA sequence were determined by means of 5' and 3' rapid amplification of cDNA ends (RACE) procedures. Northern blot hybridization was used to examine steady-state mRNA expression of IL-1ra., Results: The consensus sequence of the cDNA obtained with the 5'-RACE procedure and the sequence for the 220 bp portion of the genomic DNA represented the putative sequence for secreted IL-1ra. The predicted secreted IL-1ra amino acid sequence contained 176 residues with an in-frame stop codon; the N-terminal 25 amino acid residues resembled the signal peptide reported for human secreted IL-1ra. An approximately 1.3 kilobase pair (kb) band that represented a portion of the 3' end of the coding region and the 3' untranslated region was obtained by use of the 3' -RACE procedure. Northern blot hybridization detected a 1.6 kb transcript in blood RNA from adult Arabian, Belgian, Thoroughbred, and Standardbred horses., Conclusions: Results suggest that the DNA for equine secreted IL-1ra has a short (29 bp) 5' untranslated region, a 534 bp coding region, and a long (approximately 1,080 bp) untranslated region.

Four cats with idiopathic chylothorax were given rutin. Three of the 4 cats had clinical improvement, and complete resolution of chylous effusion was evident in 2 cats. Idiopathic chylothorax in cats is a condition that may be difficult to resolve with medical or surgical treatment. Currently, thoracic duct ligation is considered the preferred technique, but expense and a guarded prognosis for resolution may make this procedure undesirable to cat owners. Rutin administration may offer an alternative to traditional treatments or may be useful as an adjunctive treatment.

The development of a low-temperature method of producing bioactive coatings for medical implants has been shown to bypass the problems associated with high temperature processing routes, in particular the appearance of amorphous phases and non-stoichiometric hydroxyapatite (HA), and delamination of the coating from the substrate. An electric field/aqueous solution technique for producing adherent, crack-free calcium phosphate coatings on titanium and stainless steel substrates is described. The characteristics of the coating are a function of electrode spacing, supersaturation, temperature and current and voltage conditions. Scanning electron microscopy (SEM) characterized the surface morphology of the coatings, which were shown to be HA. The possibility of producing a coating of carbonate-substituted HA having the same chemical composition as bone apatite, and forming at physiological temperatures, has also been demonstrated. The size of the microstructure decreased and the morphology changed as the carbonate ion concentration in the calcium and phosphate ion solution increased., (Copyright 1999 Kluwer Academic Publishers)

A seven-week-old, male chow chow-keeshond cross puppy was presented with acute paraplegia and episcleral hemorrhage. An X-linked, hereditary coagulopathy was suspected and confirmed by clotting factor analysis and necropsy findings of intraspinal hemorrhage. In young, male puppies with acute spinal pain and long-tract signs, intraspinal hematoma secondary to inherited X-linked coagulation factor deficiencies should be considered in the differential diagnosis.

When a flexor digitorum superficialis tendon crossing a flexed or extended wrist has a load applied to it in excess of that applied to adjacent tendons, that tendon may translate across the carpal tunnel. In 6 cadaver specimens, each of the 9 carpal tunnel tendons was loaded with a baseline tension of 85 g and the moment arms of the flexor pollicis longus and the 4 flexor digitorum superficialis tendons were determined. Applying a higher 540-g load to individual flexor digitorum superficialis tendons and the flexor pollicis longus while loading the remaining tendons with the baseline 85-g tension significantly changed the moment arms from those measured under baseline load. The results demonstrated that tendons with applied differential loads in the carpal tunnel shift their positions, as revealed by their changing moment arms.

A standard strategy in structural equation modeling is to conduct multiple Lagrange multiplier (LM) tests after rejection of an initial model. Controlling for Type 1 error across these tests minimizes the likelihood of including unnecessary additional parameters in the model. Three methods for controlling Type I errors are evaluated using simulated data for factor analytic models: the standard approach which involves testing each parameter at the .05 level, a Bonferroni approach, and a simultaneous test procedure (STP). In the first part of the study, all samples were generated from a population in which all null hypotheses associated with the LM tests were correct. Three factors were manipu1,~ted: factor weights, sample size, and number of parameters in the specification search. The standard and the STP approaches yielded overly liberal and overly conservative familywise error rates, respectively, while the Bonferroni approach yielded error rates closer to the nominal level. In the second part of the study, data were generated in which one or more null hypotheses associated with the LM test were incorrect, and the number of parameters in the search was manipulated. Again the Bonferroni method was the best approach in controlling familywise: error rate, particularly when the alpha level was adjusted for the number of parameters evaluated at each step.

The BMP family of polypeptide growth factors has been shown to play diverse roles in establishing embryonic patterning and tissue fates. We report the cloning of the zebrafish homologue of BMP-2, examine its expression during embryogenesis, and find that it is localized to the distal end of the long arm of zebrafish chromosome 20. A missense mutation of the bmp2 gene has recently been shown to be responsible for the early dorsalized phenotype of the zebrafish swirl mutant [Kishimoto et al., 1997]. Given the dynamic expression of bmp2 in the developing embryo and the complex interactions of BMP signaling response in vertebrates, it is possible that other mutant phenotypes, due to altered bmp2 gene expression, will eventually map to or interact with this genetic locus.

David Bromham's editorial on contraceptive implants ignores the wider issues to voice concern that trial by media could limit contraceptive choice by jeopardising research into new methods. However, it is more beneficial to the public for points of conflict to be debated openly. Furthermore, the impetus for research into new contraceptive technology is driven by profit and political motives and is only marginally affected by the media. Implanted contraceptives may increase the choice of contraceptive methods, but they put control of fertility increasingly into the hands of the medical profession. Herein lies their greatest problem: their potential to increase providers' control over clients' choice. There is the danger that certain groups of women may be targeted for their use: in the United States the coercive use of Norplant for mothers receiving welfare benefit has been suggested. Long acting contraceptives are a contraceptive of choice only when they are available without pressure, as part of a wider menu; when instant removal on request is guaranteed; and when there is an open and free flow of information and opinions between users, health professionals, and special interest groups.

We present a case of the use of an arthroscope as an adjunct in the resection of a tumor (chondroblastoma) of the femoral head. Use of the endoscope in this case allowed preservation of the femoral head and neck. Although the arthroscope has been used intraarticularly for the resection of tumors, to our knowledge it has not been used endosteally.

The Health Care Quality Improvement Initiative is moving Medicare's quality improvement activities from review and action on individual cases to the analysis of patterns of care. A primary source for pattern analysis is the mortality data presented in the Medicare Hospital Information release. One of the requirements set forth by the Health Care Financing Administration is that peer review organizations classify hospitals into peer groups in order to compare mortality rates within and among groups. It is hoped that this type of analysis will lead to a better understanding of the relationship between process and outcome for a variety of medical conditions. This report describes the experience of one peer review organization in establishing hospital peer groups.

Although several researchers argue that informal support systems provide economic and psychological resources for black families, little empirical research is available to inform policy and intervention programs. This article examines the impact of informal, formal, and societal support systems on the mental health of black adolescent mothers. Using the social work generalist theoretical framework, several types of resources are considered separately to determine whether they contribute similarly to psychological well-being. Data from a survey of black teenage mothers show that both lay and professional supports were important for the young mother's psychological well-being. Support from a male partner, caseworker contact, and membership in a support group decreased psychological distress and depression. Support from the male partner also enhanced psychological well-being. Support from friends, on the other hand, was associated with higher levels of psychological distress. A professional service plan that effectively incorporates informal and societal supports in a complementary manner offers the best possibility for reducing the distress of black teenage mothers.

The development of relatively inexpensive radioimmunoassay techniques opens new possibilities for widespread screening for hypo- and hyperthyroidism in developing regions where iodine deficiency is great. From component cost analysis, it appears that radioimmunoassays of thyroid hormones can be performed in India for as little as 2.4 rupees (29 cents) per test. Cost-effectiveness analysis indicates that screening for hypothyroidism in iodine-deficient areas in India is, of alternative detection strategies, the most cost-effective: Cases are found at an average cost of 40 rupees ($4.80) per case. Cost breakdowns and considerations of convenience and acceptability indicate that filter paper methods may soon be preferred to whole-blood assays, especially for screening. Cost-effectiveness findings for these screening strategies and for reasonable modifications of them should be compared with the estimated cost-effectiveness of iodine supplementation in determining optimal health policy toward subclinical thyroid disease.

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.

Quantification of nonmonetary aspects of disease is a major challenge for economic analysts. Using the amounts of money recipients are willing to pay for nonmonetary benefits has theoretical appeal, but it has proven difficult to implement. Difficulties encountered include noncomprehension by subjects, misrepresentation of preferences, extraneous determinants of answers, and ethical concerns. In a preliminary exploration of feasibility, 184 patients with osteoarthritis and rheumatoid arthritis were asked their willingness to pay (WTP) for hypothetical complete cure. With minimal pressure put on the patients to respond, 27 percent gave plausible answers. People with more schooling, with paid employment, or who were having more treatments for their arthritis were more likely to respond. Patients were willing on average to pay 17 percent of family income for arthritis cure. Methods for measuring WTP are being strengthened and may soon play an important role in health services research.

In a 6-month randomized trial at 14 sites, the cost effectiveness of auranofin (AF) treatment for patients with rheumatoid arthritis was gauged in comparison with placebo. Measures of global health and of impacts on daily life suggest that the benefits of disease modification outweigh adverse effects after 4 and 6 months of treatment (p less than 0.01), with negligible differences between placebo and treated patients after 1 and 2 months. Additional medical costs directly associated with AF treatment amounted to $778/patient annually. Observed differences in less direct medical costs, help received, and earnings were not statistically significant.

There is uncertainty about the efficacy of electronic fetal monitoring (EFM) in lowering perinatal mortality among births at low prospective risk. A randomized controlled trial offers the greatest promise of reducing this uncertainty. Haphazard methods of evaluating decision making have prevailed in the past and have led to study sizes too small to estimate effects on perinatal mortality. Statistical methods can determine the study size necessary to meet statistical parameters. Choice of these parameters is, however, somewhat arbitrary. Decision-analytic methods calculate the expected value of information (EVI) as the likely worth of future decision guidance. The optimal size, cost, and focus for an evaluation study can then be taken as those maximizing the net EVI after consideration of study cost. This methodology indicates that, in evaluating EFM, two randomly-assigned groups of roughly 180,000 births each should be studied. This would achieve net expected societal benefits estimated at $118 million at a cost of roughly $22 million. The optimal study size is somewhat sensitive to analytic parameters. If feasible, a superior dynamic strategy is to allow study findings to determine the ultimate study size.

Four evaluations of ambulatory pediatric tasks were used for quality assurance in eight pediatric group practices situated in two teaching hospitals and six related health centers. The evaluations used criteria incorporating branching logic to judge the quality of care revealed in data abstracted from medical records. Performance was evaluated for follow-up of positive urine cultures, assessment and follow-up of otitis media, initial assessment for gastroenteritis, and "well child" care for infants. A computerized data system was developed to process evaluation data and produce easily read reports. This work is part of a controlled trial of the feasibility, cost, and effectiveness of quality assurance as a means to improve patient care, but this preliminary report concerns only the principles for design of the evaluations and their use in quality assurance. Acceptance of evaluations by site providers was high: of 203 provider responses to a survey, only four reported disagreement with the criteria. Rates of cases "variant" from criteria and found on peer review to represent deficiencies in care, when averaged across sites, ranged by task from 1% to 47% of cases evaluated. In most sites, providers planned and implemented actions to correct these deficiencies. It is noted that improvements in care may increase costs of care.

Although total joint replacement (TJR) is a major advance in the treatment of patients with osteoarthritis, its cost-effectiveness has been questioned. We report the results of a study of the costs and benefits of TJR in consecutive osteoarthritis patients, 6 months after the surgery. Health status was measured by the Index of Well-Being. Costs of services for arthritis were determined by interview and billing records. Six months after TJR, significant improvements were seen in global health and in functional status. The average cost of care for the 6 months prior to TJR was $933. The average cost during the 6 months beginning with the TJR was $22,730 per patient--due almost entirely to costs of surgery. In general, the surgery did not change work status, probably because the mean age of the patients was 66.4 years. There were large effectiveness/cost differentials (the larger the effectiveness/cost differential, the higher the degree of cost-effectiveness [CE]). At 6 months, for all patients, the CE was associated with initial health status. The highest CE was observed in 10 patients who initially had the poorest health. TJR is more cost-effective for patients with the most to gain and less effective for those with better preoperative health status.