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Benralizumab improves asthma control and lung function in patients with severe eosinophilic asthma, but the effect on the small airways has not been described. We determined changes in small airway function by forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW) in relation to symptom improvement. Patients with severe asthma commencing benralizumab had measurements at week 0, week 4, and week 24 including: 5-item Asthma Control Questionnaire (ACQ-5), spirometry, MBNW, and FOT at 5Hz. All other asthma treatment was kept constant for 4 weeks. Changes between visits and relationship with ACQ-5 were assessed using non-parametric tests, prediction of symptom improvement using receiver-operating-characteristics (ROC). 12 patients (7 males) aged 46±17yrs (mean±SD), BMI 26±5kg/m2, eosinophil count 1.0±0.4x10-9/L, and FEV1 62±20% predicted were studied. At week 4, eosinophil count was undetectable and ACQ-5 improved significantly (2.6±1.0 to 1.4±1.0, p 0.65, p In this cohort, small and large airway function improved soon after commencing benralizumab and predicted symptom improvement reported by patients. Physiological phenotyping may help identify patients most likely to benefit from treatment.

Background: Mepolizumab is an anti-IL5 monoclonal antibody approved for severe eosinophilic asthma (EA) primarily to reduce exacerbations. In clinical trials, mepolizumab is associated with modest improvements in symptom control and FEV1. The time course of changes in small airway function are unknown. Aim: To describe changes in ventilation inhomogeneity as a marker of small airway function after commencing mepolizumab. Methods: Prospective cohort of adults with severe EA commencing mepolizumab according to standard criteria. Measurements at baseline and one month after the first injection included the Asthma Control Questionnaire (ACQ5), spirometry and multiple breath nitrogen washout to measure global (Lung Clearance Index, LCI) and regional indices of ventilation inhomogeneity attributed to the acinar (Sacin) and conducting (Scond) airways. All other asthma therapy remained unchanged. Paired t-tests and Pearson’s correlation were used. Results: 12 patients (7 male) mean (SD) age 64 (13) years, were studied. Eosinophil count at baseline was 1.45 (3.15) x109/L. At one month, ACQ5, post bronchodilator FEV1, FEV1/FVC ratio, LCI and Sacin improved significantly (Table 1). The change in ACQ5 was only associated with the change in Sacin (r=0.49, p=0.05). Conclusion: Improved symptom control was seen rapidly after commencing mepolizumab in patients with severe EA. The early improvement in small airway function may be a significant contributor to the therapeutic response.

Clever Crows Understanding the adaptive significance of animal tool use requires reliable information on the foraging behavior in the wild. New Caledonian crows consume a range of foods and use sticks as tools to extract wood-boring beetle larvae from their burrows. These larvae, with their unusual diet, have a distinct isotopic signature that can be traced after consumption by the crows in the crows' feathers and blood. By comparing the stable isotope profiles of crows' tissues with those of their food sources, Rutz et al. (p. 1523 ) estimated the proportion of larvae in crow diets, providing a proxy for tool-use dependence in individual crows. Just a few larvae can satisfy a crow's daily energy requirements, highlighting the substantial rewards available to competent tool users and their offspring. Thus, tool use provides New Caledonian crows with access to a very nutritional food source that is not easily exploited by beak alone.

Blood samples were collected from 41 cats presented for pre-anaesthetic assessments, routine geriatric screening, or re-assessment of ongoing chronic medical disorders. Samples were either left to clot or anticoagulated with lithium heparin, then assessed for their potassium concentration within 1 h of collection, and again after remaining in contact with their cell pellet for 48 h. There was a significantly higher potassium concentration in the serum samples compared to the plasma samples, both in the basal and 48-h samples (although this difference was most marked in the basal samples). Ageing of both serum and plasma samples also resulted in an increase in the potassium concentration when compared with the basal values for each sample type. The mean difference (basal serum minus basal plasma) in potassium concentration was 0.47 mmol/l. While it is probable that the potassium came from either leukocytes and/or thrombocytes the mean total leukocyte count and the mean thrombocyte count were below the upper limit of the reference intervals for our laboratory and the rise in the potassium level did not appear to be directly related to either of these values.

An 8-year-old Somali cat presented with a 9-month history of inappetence, vomiting and weight loss. The disease progressed to involve neurological signs associated with a mass lesion at the level of the first lumbar vertebra. Histopathology identified the condition as malignant histiocytosis affecting the lungs, stomach, mesenteric lymph nodes, liver, spleen, brain and spinal cord. However, the presentation of this case differs from previously reported cases of malignant histiocytosis, and may therefore represent a variant form of histiocytic disease.

Congenital portosystemic shunts (cPSS) are a well-recognised vascular anomaly in dogs. Recent studies have shown an association between inflammation and hepatic encephalopathy (HE), which is a common clinical syndrome in dogs with a cPSS. Pro-inflammatory cytokines such as interleukin (IL)-6 and tumour necrosis factor (TNF)-α are frequently increased in the plasma of human patients with liver disease and have been implicated in the development of HE. In the current study, plasma concentrations of IL-2, IL-6, IL-8 and TNF-α were measured using a multiplex electrochemiluminescence immunoassay in 36 dogs with a cPSS and compared to 25 healthy dogs. There were no significant differences in plasma IL-2, IL-8 and TNF-α concentrations between the two groups; however, plasma concentrations of IL-6 were significantly higher in dogs with a cPSS compared to healthy dogs (P=0.02).

The records of 204 cats entering the intensive care unit (ICU) at the University of Edinburgh Small Animal Hospital between December 2002 and October 2006 were retrospectively analysed. Of these, 37 cats over 12 months of age had a systolic blood pressure recorded on entry into the ICU, and this group comprised our study population. Of these 37 cats, 36 had both heart rate and respiratory rate recorded on entry into the ICU, whilst 24 of these cats also had body temperature recorded. The relationship between (i) survival to discharge and (ii) survival until 21 days after admission to the ICU was analysed using univariate generalised linear models with binomial errors. The robustness of any significant relationship was assessed using multivariate analysis methods. In addition, receiver operator curves (ROC) were generated for any of the significant predictors of mortality and from these curves the threshold values, optimal sensitivity and specificity were calculated. Using these values survival curves were generated for any significant prognostic indexes. A decreased blood pressure at the time of admission to the ICU was found to be a significant negative predictor of survival until discharge from the hospital. Overall, a systolic blood pressure of 124 mmHg or higher at the time of admission to the ICU has a sensitivity of 47.8% and a specificity of 85.7% for predicting that a cat will survive until discharge from the hospital.

Hypocobalaminaemia in cats has previously been identified, but the incidence reported has varied, and the frequency of folate deficiency is unknown. The aims of this study were to evaluate the incidence of low cobalamin and folate levels in a population of cats that were suffering predominantly from diseases of the alimentary tract (including the liver and pancreas) and to ascertain whether severity of disease (as assessed by bodyweight and body condition score (BCS)) related to degree of deficiency. The study population comprised 103 cats, of which 16.5% had low cobalamin levels and 38.8% had low folate levels. A serendipitous finding was inorganic phosphate levels below the reference range in 48% of the cases. Significant associations were found between subnormal cobalamin levels and median BCS ( P=0.049); combined low folate and low cobalamin and bodyweight ( P=0.002), BCS ( P=0.024) and inorganic phosphate levels ( P=0.003). The finding of low levels of folate and cobalamin in clinical cases suggests that supplementation may be indicated more frequently than is currently recognised.