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Objective: To assess the agreement of transpulmonary thermodilution (TPTD) and transpulmonary ultrasound dilution (TPUD) against direct measurement of main pulmonary artery flow with an ultrasound transit time flow probe (UTF) over a wide range of conditions in anesthetized cats. Additionally, the trending ability of TPTD, TPUD, and esophageal Doppler ultrasonography (EDU) was evaluated against UTF., Methods: 12 purpose-bred cats were used. One cat was used for a pilot study. The cats were instrumented according to the manufacturer's recommendation. Paired measurements were made over a wide range of cardiac output. Agreement was analyzed with Bland-Altman analysis with repeated measures, and trending ability was assessed by 4-quadrant plot and concordance rate. Interchangeable was defined as percentage error less than simplified total error. Acceptable trending was defined as concordance rate > 95%., Results: Bias and percentage error were -0.084 L·min-1 and 38.2% for TPTD and -0.041 L·min-1 and 52.9% for TPUD. The concordance rate was 100%, 95.5%, and 64% to 65% for TPTD, TPUD, and EDU, respectively., Conclusions: Both TPTD and TPUD were not interchangeable to UTF. Both TPTD and TPUD provided acceptable trending ability but not EDU., Clinical Relevance: Transpulmonary thermodilution and TPUD allow detection of the direction of cardiac output changes in anesthetized cats but not EDU. Clinical and research use of these 3 devices warrants careful consideration of the limitations presented in this study.

Objective: To investigate the volume kinetic between 2 crystalloid fluid bolus rates in anesthetized cats., Design: Prospective, randomized, dose-response study., Setting: University laboratory., Animals: Ten convenience-sample, purpose-bred domestic shorthair and medium hair cats., Interventions: Intravenous 20 mL/kg balanced crystalloid fluid over 10 (G10) or 40 (G40) minutes under anesthesia in a randomized order with at least a 5-day washout period., Measurements and Main Results: Serial measurements of hemoglobin (Hb) concentration and PCV were performed up to 60 minutes after conclusion of the fluid bolus. Plasma dilution was calculated with the Hb dilution method and fitted to a 2-compartment microconstant kinetic model using nonlinear mixed-effect models. The apparent central plasma volume (V c ) was similar between the 2 groups (G10: 81.2 ± 23.8 mL/kg and G40: 78.8 ± 10.2 mL/kg). The apparent peripheral volume (V p ) of G10 (4.81E+8 ± 2.66E+8 mL/kg) was twice that of G40 (2.36E+8 ± 6.44E+7 mL/kg). The rate constant from V c to V p (K 12 ) of G10 (0.057 ± 0.0196/min) was almost twice that of G40 (0.0302 ± 0.00807/min). The elimination constant of G10 (0.0113 ± 0.00672/min) was almost twice that of G40 (0.00534 ± 0.00279/min). The peak plasma expansion was similar between G10 and G40 (20.7 ± 1.9 and 19.1 ± 5.1 mL/kg). Area under the curve for plasma dilution versus time of the first 90 minutes from the beginning of the boluses was not statistically different between G10 and G40., Conclusions: The volume expansion over time was not different likely due to the slow elimination. The plasma dilution to crystalloid bolus between subjects is varied in anesthetized cats. Clinicians should consider the slow elimination and return of crystalloid fluid from the V p to V c when prescribing fluid therapy in anesthetized cats., (© Veterinary Emergency and Critical Care Society 2025.)

Objective: To assess the impact of mild hypothermia on the distribution and elimination of an IV crystalloid fluid bolus in healthy anesthetized cats using volume kinetic (VK) analysis., Methods: 10 adult cats were anesthetized and included in a prospective, randomized, cross-over study. The subjects were maintained either normothermic (38.3 ± -16.9 °C) or mildly hypothermic (35 ± -16.9 °C), with a 7-day washout period between anesthetic episodes. All cats received 20 mL/kg of a balanced isotonic solution (Normosol-R) IV over 20 minutes, following the achievement and stabilization of target temperature. Hemoglobin concentration, PCV, and urinary output were measured at established time points and served as input variables for VK analysis., Results: Hypothermia was associated with a larger central compartment volume (Vc); higher body weights were associated with an increased Vc and a decreased elimination rate; higher end-tidal isoflurane concentration (ETISO) was associated with an increased Vc and a higher distribution rate constant. Heart rate, blood pressure, and ETISO were significantly lower in the hypothermic group. No statistically significant difference was observed in urinary output between groups., Conclusions: Body weight, temperature, and ETISO were significant covariates affecting VK parameters. Hypothermia did not induce cold diuresis but was associated with an increase in Vc. The negative relationship between body weight and the elimination rate constant requires further verification. Hypothermia was associated with lower heart rate and blood pressure despite reduced ETISO., Clinical Relevance: Hypothermia was associated with smaller plasma volume expansion from fluid bolus. Fluid dosing based on ideal body weight should be considered to avoid overdosing.

Objective: Assessment of feasibility and proof of concept study for microvascular reactivity in anesthetized cats., Methods: 12, adult, healthy, purpose-bred cats were included. Cats were anesthetized and instrumented with a perivascular ultrasound transit time flow probe around the main pulmonary artery, a femoral arterial catheter, a central venous catheter, and a laser Doppler flowmeter with a heating unit. After a 20-minute stabilization period, microvascular reactivity, hemodynamic variables, and arterial and central venous blood gases were measured during 3 phases: (1) baseline, (2) hemorrhage, and (3) isotonic crystalloid bolus. Hemorrhage was induced by atraumatic blood loss of 20 mL/kg over 20 minutes. An isotonic crystalloid bolus at 20 mL/kg was administered IV over 20 minutes., Results: 6 cats were excluded from the analysis due to equipment errors or surgical complications. Microvascular reactivity decreased significantly after hemorrhage and remained below baseline after isotonic crystalloid bolus., Conclusions: Microvascular reactivity assessment is feasible in healthy anesthetized cats. Hemorrhage decreases microvascular reactivity, and the administration of an isotonic crystalloid bolus did not reverse these changes. However, the small sample size may limit the external validity of the results., Clinical Relevance: This study demonstrated the feasibility of microvascular reactivity assessment in anesthetized cats. However, proper validation is warranted before clinical application.

Background: Syndecan-1 (SDC1) is an established marker of endothelial glycocalyx shedding. Most research on SDC1 has focused on plasma or serum concentrations, and little is known about urine concentrations., Objectives: Measure urinary SDC1 concentrations in dogs undergoing anesthesia with either sevoflurane or isoflurane and assess the effects of anesthesia duration and IV crystalloids on urinary SDC1 concentrations., Animals: Thirty-one client-owned dogs undergoing anesthesia for magnetic resonance imaging (MRI) with or without surgery for suspected intervertebral disk disease (IVDD) were used., Methods: Dogs with suspected IVDD were randomized to undergo anesthesia with either sevoflurane or isoflurane. Urine was collected before and immediately after anesthesia for the analysis of SDC1. Urinary creatinine concentrations also were measured, and the ratio of urinary SDC1 to urinary creatinine (USCR) was used to account for dilution., Results: Median (range) USCR was significantly higher after anesthesia compared with baseline for all groups combined (P < .05). No significant difference was found between the groups for age, sex, weight, and type of anesthesia. Multiple regression analysis of the effect of the independent variables inhalant type, age, weight, sex, anesthesia time, surgery, and quantity of IV fluids on the dependent variable SDC1 found that only the quantity of IV fluids significantly predicted a change (P < .001)., Conclusions and Clinical Importance: The total volume of lactated Ringer's solution administered to anesthetized dogs may affect USCR. Further investigations are warranted to evaluate the relationship between IV fluids and SDC1., (© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objective: To identify the preferences of small animal veterinary clients for the timing of communication during CPR and whether these clients prefer the veterinarian or pet owner to decide on the termination of resuscitation., Sample: Surveys (n = 1,648) were completed between January 20 and February 3, 2023, by clients of the Wilford and Kate Bailey Small Animal Teaching Hospital., Methods: This cross-sectional observational study used an anonymous internet-based survey distributed to 28,000 clients of an academic small animal veterinary hospital. The survey included 16 questions asking for the respondents' demographics, healthcare professional status, questions pertaining to CPR, and preference for timing of communication during CPR, veterinary team members to speak to, and the decision on termination of resuscitation. An optional open comment section was provided., Results: The response rate was 7.5%, including 2,127 responses, with 1,648 complete responses used for further analysis. Of the respondents, 56% and 63% (when asked using a short and long scenario question, respectively) would prefer to be informed about their pet undergoing CPR after CPR has ended. Most clients (84%) wanted the veterinarian to decide when to stop CPR. In the comments section, clients predominantly emphasized that patient care should always be prioritized over client communication., Clinical Relevance: This study contributes to a better understanding of veterinary clients' preferences and may help improve client communication and decision-making during CPR. More studies are warranted to reach a wider population before broad recommendations can be made.

Objective: To assess intraobserver and interobserver reliability of capillary refill time (CRT) measurement in dogs using a standardized technique after training., Animals: 20 dogs presented to the emergency room., Methods: Dogs presented to the emergency room were prospectively recruited. Using a timing device and standardized technique, CRT was measured at the oral mucosa of the inner lip. Measurements were performed by 2 emergency and critical care residents (observer 1 [Ob1] and observer 2 [Ob2]) and repeated 3 times by each observer for each dog. CRT values and signalment were recorded. Intraobserver and interobserver reliability were analyzed by calculation of the coefficient of variation (CV%), intraclass correlation coefficient (ICC), and minimal detectable difference. Reliability was considered high if CV% was lower than 10% and ICC was between 0.9 and 1., Results: Median CRT for Ob1 was 1.22 seconds and for Ob2 was 1.19 seconds. Intraobserver reliability was high, evidenced by a median CV% of 6.2% (range, 1.0% to 18.6%) and 9.5% (range, 1.3% to 22.6%) and an ICC of 0.97 (95% CI, 0.94 to 0.99) and 0.95 (95% CI, 0.90 to 0.98) for Ob1 and Ob2, respectively. Between observers, the CV% was 4.4% (range, 0.8% to 17.5%) and the ICC was 0.98 (95% CI, 0.94 to 0.99), indicating high interobserver reliability. The minimal detectable differences for intraobserver and interobserver were 0.30 and 0.34 seconds, respectively., Clinical Relevance: The reported high reliability of CRT despite its subjective nature enhances its usefulness in daily practice. However, further research on the validity of CRT is warranted.

Objective: To establish a baseline reference and create a user-friendly chart for normal body surface area (BSA) in the adult domestic cat similar to the "Rule of Nines" chart., Design: Prospective cadaveric study., Setting: University Teaching Hospital., Animals: Seven adult domestic short-haired feline cadavers of normal body condition (4-6/9) and body weight., Intervention: Individual whole-body computed tomography (CT) scan was performed on all cats. Images were analyzed with 3-dimensional technology to measure the BSA. A chart was created, illustrating the individual surface area of each body part., Measurements and Main Results: Obtained measurements of the cats are different from surface areas of people and dogs. Percentage of total BSA for cats was as follows: head 13%, neck 5%, thorax 20%, abdomen 15%, pelvis and tail 9%, front legs 7% each, and pelvic legs 12% each., Conclusion: The distribution of BSA between body parts is different in cats compared to dogs and people. A species-specific chart was created to assure a more accurate estimation of BSA in cats., (© 2022 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Objectives: The aim of the study was to evaluate whether any admission vitals correlated with the presence of brain herniation diagnosed via MRI in cats presenting with neurologic signs., Methods: Medical records at two veterinary university referral centers were reviewed to identify cats that underwent brain MRI between 2010 and 2019. A control group of cats with intracranial lesions without concurrent brain herniation was analyzed for comparison. Data relating to signalment, vitals on admission, abnormalities observed on initial neurologic examination, underlying etiology, advanced imaging findings and outcome were reviewed. A Modified Glasgow Coma Scale (MGCS) score was determined retrospectively based on initial neurologic examination. Logistic regressions were performed to investigate the relationship between each risk factor and the odds of brain herniation as diagnosed on MRI., Results: Thirty-two cats with brain herniation and 44 cats with abnormal brain MRI without evidence of herniation (as a control group) based on MRI findings were included. Cats with intracranial neoplasia vs other diagnoses were found to be at increased risk of herniation (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.8-13.8; P = 0.001). The odds of herniation increased with age (OR 1.1, 95% CI 1.01-1.2; P = 0.031). Cats with herniation had a significantly lower level of consciousness in their MGCS score ( P <0.0001) than cats without herniation. There was no significant difference in either motor activity or brainstem reflexes between the groups ( P >0.05)., Conclusions and Relevance: Admission heart rate and blood pressure were not associated with brain herniation. Cats with herniation were presented with a significantly lower level of consciousness in their MGCS score; however, this clinical feature cannot be directly attributable to and predictive of herniation. Older cats with intracranial neoplasia are more likely to have brain herniation.

Objective: To create a chart for estimating body surface area (BSA) for use in canine burn victims, similar to the human Rule of Nines., Design: Prospective study, from 2016 to 2017., Setting: University teaching hospital., Animals: Nine adult, medium-sized, mesocephalic dogs (5 females, 4 males)., Interventions: Sedated dogs and fresh cadavers underwent full-body computed tomography (CT) scans. A 3-dimensional technique was used to calculate the surface area of specific body parts, as well as the surface area of the whole body. With the obtained measurements, a BSA chart was created., Measurements and Main Results: Estimates for percent of total BSA obtained with CT images were as follows: head and abdomen 14%, respectively, neck and each of the thoracic limbs 9%, thorax 18%, pelvic limbs 11% each, and pelvis including the tail 5%. The most considerable differences between dogs and people in respect to the Rule of Nines chart were noticed in the head, the pelvic limbs, as well as in the groin region in people as compared with the pelvic/tail area in dogs. The surface areas of the front legs and thorax were the only body parts that corresponded with that of human body surfaces., Conclusions: A chart for estimating canine body surface was created. Given the diversity of dog breeds, sizes, and body conformation, our results cannot be generalized to all dogs. Studies of more diverse populations are warranted., (© Veterinary Emergency and Critical Care Society 2021.)

Objective: To document the admission systolic blood pressure (SBP), heart rate (HR), and modified Glasgow coma scale (MGCS) score in dogs with and without brain herniation and to determine their relationship with brain herniation., Design: Retrospective study between 2010 and 2019., Setting: University veterinary teaching hospital., Animals: Fifty-four client-owned dogs with brain herniation and 40 client-owned dogs as a control group, as determined on magnetic resonance imaging., Interventions: None., Measurements and Main Results: SBP, HR, MGCS score, and outcome were extracted from medical records. MGCS score was retrospectively calculated based on initial neurological examination in dogs with adequate available information. Dogs with brain herniation had a significantly higher SBP (P = 0.0078), greater SBP-HR difference (P = 0.0006), and lower MGCS score (P < 0.0001) compared to control dogs. A cutoff value of an SBP ≥ 178 mm Hg, SBP-HR ≥ 60, and MGCS score ≤ 14 each provides a specificity of 90%-98%. A combination of an SBP > 140 mm Hg and HR < 80/min provided 24% sensitivity and 100% specificity to diagnose dogs with brain herniation (P < 0.0001)., Conclusions: A high SBP, a greater difference between SBP and HR, a combination of higher SBP and lower HR, and a low MGCS score were associated with brain herniation in dogs presenting with neurological signs upon admission. Early recognition of these abnormalities may help veterinarians to suspect brain herniation and determine timely treatment., (© Veterinary Emergency and Critical Care Society 2021.)

Xylitol, a sugar substitute frequently used in sugar-free gum, is generally considered harmless to humans but it can be extremely toxic to dogs. Dog-owning customers are becoming increasingly aware of the risks associated with xylitol-containing chewing gums. However, there remains some uncertainty if these chewing gums are still dangerous to dogs after they have been partially consumed. In this work, a reliable low-cost analytical method has been developed to quantify the xylitol in sugar-free gum samples. Xylitol was extracted from gum samples using water as a solvent. Extractions were analyzed by GC-MS with direct aqueous injection (DAI). This method was successfully applied to over 120 samples including fresh gum and 5 min, 15 min, and 30 min chewed gum samples.

A growing literature has demonstrated a link between early-life socioeconomic conditions and adult health at a singular point in life. No research exists, however, that specifies the life course patterns of socioeconomic status (SES) in relation to the underlying biological processes that determine health. Using an innovative life course research design consisting of four nationally representative longitudinal datasets that collectively cover the human life span from early adolescence to old age (Add Health, MIDUS, NSHAP, and HRS), we address this scientific gap and assess how SES pathways from childhood into adulthood are associated with biophysiological outcomes in different adult life stages. For each dataset, we constructed standardized composite measures of early-life SES and adult SES and harmonized biophysiological measurements of immune and metabolic functioning. We found that the relative importance of early-life SES and adult SES varied across young, mid, and late adulthood, such that early-life SES sets a life course trajectory of socioeconomic well-being and operates through adult SES to influence health as adults age. We also documented evidence of the detrimental health effects of downward mobility and persistent socioeconomic disadvantage. These findings are the first to specify the life course patterns of SES that matter for underlying biophysiological functioning in different stages of adulthood. The study thus contributes new knowledge critical for improving population health by identifying the particular points in the life course at which interventions might be most effective in preventing disease and premature mortality.

Two decades of research indicate causal associations between social relationships and mortality, but important questions remain as to how social relationships affect health, when effects emerge, and how long they last. Drawing on data from four nationally representative longitudinal samples of the US population, we implemented an innovative life course design to assess the prospective association of both structural and functional dimensions of social relationships (social integration, social support, and social strain) with objectively measured biomarkers of physical health (C-reactive protein, systolic and diastolic blood pressure, waist circumference, and body mass index) within each life stage, including adolescence and young, middle, and late adulthood, and compare such associations across life stages. We found that a higher degree of social integration was associated with lower risk of physiological dysregulation in a dose-response manner in both early and later life. Conversely, lack of social connections was associated with vastly elevated risk in specific life stages. For example, social isolation increased the risk of inflammation by the same magnitude as physical inactivity in adolescence, and the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes in old age. Analyses of multiple dimensions of social relationships within multiple samples across the life course produced consistent and robust associations with health. Physiological impacts of structural and functional dimensions of social relationships emerge uniquely in adolescence and midlife and persist into old age.

Background: One mechanism to increase participation in research is to solicit potential research participants' general willingness to be recruited into clinical trials. Such research permissions and consents typically are collected on paper upon patient registration. We describe a novel method of capturing this information electronically., Purpose: The objective is to enable the collection of research permissions and informed consent data electronically to permit tracking of potential research participants' interest in current and future research involvement and to provide a foundation for facilitating the research workflow., Methods: The project involved systematic analysis focused on key areas, including existing business practices, registration processes, and permission collection workflows, and ascertaining best practices for presenting consent information to users via tablet technology and capturing permissions data. Analysis was followed by an iterative software development cycle with feedback from subject matter experts and users., Results: An initial version of the software was piloted at one institution in South Carolina for a period of 1 year, during which consents and permission were collected during 2524 registrations of patients. The captured research permission data were transmitted to a clinical data warehouse. The software was later released as an open-source package that can be adopted for use by other institutions., Limitations: There are significant ethical, legal, and informatics challenges that must be addressed at an institution to deploy such a system. We have not yet assessed the long-term impact of the system on recruitment of patients to clinical trials., Conclusions: We propose that by improving the ability to track willing potential research participants, we can improve recruitment into clinical trials and, in the process, improve patient education by introducing multimedia to informed consent documents.

Informed consents are a critical and essential component of the clinical research process. Currently, most consents and research privacy authorizations are being captured on paper. In this paper we describe a novel method of capturing this information electronically. The objective is to allow easier tracking of research participants' intent for current and future research involvement, enhance consent comprehension and facilitate the research workflow. After multidisciplinary analysis in key hospital registration areas and research participant enrollment, an open source software product was designed to capture this data through a user-friendly touch screen interface. The data may then be fed into a clinical data warehouse for use in cohort discovery or consent tracking. Despite ethical, legal and informatics challenges in clinical and research environments, we propose that this technology opens new avenues for significantly enhancing the consent process and positively impacting recruitment.

The purpose of this study was to compare two clinical samples of women substance abusers, one from Iowa and one from Norway, along several dimensions: "substance abuse" history, current "abuse" pattern, parental and spouse drinking history, symptoms of psychological distress, and "vulnerability" to relapse. A higher percentage of women substance abusers from Iowa were divorced and lived alone, were "vulnerable" to relapse, and reported more life problems secondary to their substance use than women from Norway. The Iowa women had used more substances in addition to alcohol than had the Norwegian women. The Norwegian women reported greater intensity of emotional distress than the women from Iowa.

The purpose of this study was to provide data on the validity of using the WPPSI--R with 16 preschoolers who had been referred for psychological assessment. A comparison of the preschoolers' performance on the WPPSI--R and the Stanford-Binet L-M was made. Children ranged in age from 3-0 to 6-0 years, with a mean age of 4-5 yr. The correlations between WPPSI--R and Stanford-Binet L-M scores were strong; WPPSI--R Verbal IQ and Stanford-Binet L-M IQ, r = .85; WPPSI--R Performance IQ and Stanford-Binet L-M IQ, r = .75, and WPPSI--R Full Scale IQ and Stanford-Binet L-M IQ, r = .82. For this very small sample of children whose mean IQ was significantly below average, the WPPSI--R appeared to assess validly their current intellectual functioning. Attention should be given concurrent and predictive validity as well as the efficiency of using the WPPSI--R with other and larger samples of referred children.

The purpose of this study was twofold. First, we evaluated the financial impact of a rapid, monoclonal antibody-based CK-MB mass assay (Stratus, Dade Division, Baxter Laboratories, Miami, Fla) for the direct measurement of CK-MB in serum samples from 65 patients admitted to the coronary care unit with the possible diagnosis of acute myocardial infarction. Second, we evaluated retrospectively the Stratus assay and an activity assay (electrophoresis) for CK-MB in the following patient categories: acute myocardial infarction treated with and without thrombolytic therapy, angina, congestive heart failure, skeletal muscle trauma, and the acutely ill without acute myocardial infarction. The advantageous features of the Stratus mass assay were as follows. First, the laboratory was able to perform the assay more frequently because of the short assay time per specimen (less than 10 minutes) without additional personnel. This had a substantial impact on the clinician's ability to diagnose acute myocardial infarction and to move patients out of an intensive care unit at substantial financial savings to the patient, the hospital, or the third-party payer. Second, the Stratus assay was able to detect low levels of CK-MB (1 to 2 micrograms/L) in the presence of low total creatine kinase activity (less than 100 U/L). Third, the Stratus assay showed no interference due to very-high-total creatine kinase activities (greater than 100,000 U/L), CK-BB, macro-creatine kinase, and mitochondrial creatine kinase.

We examined the patient records of 6445 patient visits to an executive health surveillance program to evaluate the diagnostic yield from screening for diabetes mellitus by measurement of fasting serum glucose and hemoglobin A1c. We found increased fasting serum glucose levels (greater than or equal to 6.6 mmol/L) in 3% (197/6445), of whom only half received further confirmatory testing. Increased screening values for glucose were associated with a 70% incidence of diabetes mellitus and impaired glucose tolerance when subsequent oral glucose tolerance tests were performed. Confirmatory testing with the oral glucose tolerance test was equivalent in cost and superior in diagnostic yield to repeated fasting glucose determination. Nonetheless, preferential use by clinicians of repeated glucose determination was found to contribute to underdiagnosis. Hemoglobin A1c could not reliably predict impaired or diabetic glucose tolerance. We conclude that maximal value of screening for diabetes mellitus is achieved only by obligatory confirmatory oral glucose tolerance testing.