To gather baseline self-reported research anxiety and clinical research self-efficacy information in veterinary residents and interns and to assess changes after an in-person clinical research training program. A previously modified version of the Clinical Research Appraisal Inventory-12 was distributed electronically to 78 North American private practice veterinary house officers before and after a 2-day in-person clinical research training program in August 2024 or August 2025. Research anxiety and self-efficacy scores were compared between aggregate pre- and postsession survey responses using a Mann-Whitney test. A Spearman correlation assessed the relationship between research anxiety and previous experience and training. Respondents indicated at least moderate agreement with all statements related to research anxiety (median agreement, 4 to 5 of 7 for all questions). Previous research participation, but not previous didactic training, was associated with lower agreement with the statement "Research makes me anxious" (r = -0.417). Respondents reported higher baseline self-efficacy in tasks related to idea generation and working collaboratively and lower self-efficacy in data analysis, statistics, and identifying research funding. A 2-day research education program enhanced specific research competencies; it did not alleviate research anxiety. Given the shifting landscape toward house officer training and research activities in private practice, these results suggest that it might be useful to explore interventions tailored to reduce anxiety and promote sustained research involvement in this subset of veterinary postgraduate trainees.
To develop, validate, and use a survey tool to investigate veterinary students' attitudes toward careers in food animal veterinary medicine (FAVM). A prompt in an end-of-year questionnaire among veterinary students at the University of California-Davis identified latent constructs describing motivation and perception of careers in FAVM. Latent constructs were used to develop a survey distributed to veterinary students at Kansas State University, University of California-Davis, and Western University of Health Sciences from May 2023 through May 2024. Logistic regression correlated summary estimates of attitudes about working in FAVM as θ values from item response theory models to the outcome self-declared interest in FAVM careers. Latent class analysis evaluated subgroups of students to identify significant factors driving interest in FAVM careers. From 1,536 elicited students, a combined total of 491 usable surveys were received. The θ values for the construct "Lifestyle/work conditions/clients and industry-perception of FAVM" had the strongest association with the outcome in all 3 schools. Latent class analysis among students with an interest in FAVM showed 4 classes of students with differing profiles of their perception of careers in FAVM. A positive view of the lifestyle of food animal veterinarians (FAV) (workdays per week, time on call, work location) was the most important predictor for student interest in careers in FAVM. Availability of more flexible employment opportunities that improve student perceptions of the lifestyle of FAV may help expand the FAVM workforce.
To determine the main causes of death in aged horses residing at a retirement facility in California. A retrospective cross-sectional study design was utilized to evaluate signalment, medical history, and necropsy reports of horses aged 20 years or older at death and housed at a single retirement facility. All cases underwent a standard post mortem evaluation from 2010 through 2020 by the University of California-Davis William R. Pritchard Veterinary Medical Teaching Hospital. Euthanasia decisions were made by the retirement facility staff in consultation with a veterinarian. The main causes of death were determined as the primary reason associated with death or euthanasia after review of the necropsy reports and attending clinicians' records. 91 cases met inclusion criteria. Death was most commonly associated with the digestive system (38 of 91 [41.8%]), followed by the musculoskeletal system (20 of 91 [22%]), nervous system (12 of 91 [13.2%]), neoplasia (8 of 91 [8.8%]), and unexpected death (5 of 91 [5.5%]) or trauma (5 of 91 [5.5%]). Strangulating lesions (13 of 38) was the most common digestive system disease. Leading musculoskeletal diseases included osteoarthritis (10 of 20) and laminitis (5 of 20). The most common neurologic conditions were compressive myelopathy secondary to facet joint osteoarthritis (3 of 12) and temporohyoid osteoarthropathy (3 of 12). This study provides insight into common causes of death or euthanasia in an aged, nonreferral population of horses housed at a retirement facility in California. Veterinarians may expect to see a high incidence of digestive system disorders followed by musculoskeletal and neurologic disorders when treating aged patients and managing care at retirement facilities in California.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
To investigate the safety and complication rate of 2 vessel-sealing devices (VSDs) used for hepatic surgery in dogs. This was a retrospective study from 6 institutions from January 2012 through June 2024 including dogs that underwent a complete or partial liver lobectomy or a liver biopsy using a VSD as the sole method. Surgical complications based on the type of liver lobectomy, severity of complication, type of VSD used, mass size, and liver lobe location were reported as the percentage of dogs experiencing the event of interest. Group differences were compared using a 2-tailed Fisher exact or χ2 test. Maximal tumor diameter in relation to complication type was assessed using a Kruskal-Wallis test. Statistical significance was set at P = .05. 58 dogs were included in the study. For liver lobectomy cases, complications occurred in 42 of 48 dogs and were mostly minor. No differences in complications were noted based on liver mass size, liver lobe location, type of liver lobectomy performed, severity of complication, or type of VSD used. Intra- or postoperatively, biliary leakage occurred in 4 of 48 dogs. The complication rate for dogs undergoing a liver biopsy was 5 of 10 and consisted of minor bleeding in 90% of the cases. Despite the high incidence of minor complications, VSD can be safely used for hepatic surgery in dogs. The ability of the 2 VSDs used to seal bile ducts when a liver lobectomy is performed requires further investigation. VSDs can be considered an alternative method for performing liver lobectomies in dogs.
Whole-slide imaging (WSI) uses a machine to scan and convert the contents of a glass slide into a series of digital images that can be viewed on a computer. Students' interactions with this technology are typically limited to interpreting scanned slides. This does not address the preanalytical aspects of sample submission, where errors most frequently occur, and it does not expose future clinicians to technology they may encounter in general practice. In this study, 251 clinical veterinary students experienced WSI while learning about cytology and hematology specimen submission. Preliminary experience and opinions were collected through a pretest survey. Students scanned the glass slide(s) using a commercially available digital slide scanner and submitted the case for interpretation by a remote pathologist unaffiliated with their own institution. A posttest survey collected experiences and opinions about WSI after the activity concluded. In the postscanning survey, students reported they were more confident in the following: providing clinically relevant information to pathologists; understanding the essential components of reports, utility, and limitations of WSI; and being prepared to submit specimens in general practice. They reported they were more motivated to provide relevant information to pathologists than in the prescanning survey. Their recognition accuracy of incomplete submission forms improved. Most reported that the experience was good to excellent. Clinical veterinary students had a positive experience using WSI to enhance cytology and hematology sample submission training. Veterinary pathology education is enhanced by incorporating WSI into sample submission training.
To compare the prevalence of incidental pathologies during gastrointestinal foreign body retrieval surgery in 2 groups of dogs and to assess correlation between incidental pathological findings, patient age, and if this was the dog's first foreign body retrieval procedure. Medical records were retrospectively reviewed for dogs undergoing foreign body retrieval surgery from January 2023 through August 2025. Dogs were distributed into 2 groups: (1) younger than 8 years of age or (2) 8 years of age and older. The prevalence of incidentally found intraoperative findings was compared between groups. Dogs 8 years of age and older were reviewed to correlate whether the surgery was their first instance of surgical foreign body retrieval. 313 dogs were included; 7.6% of dogs under 8 years had incidental intra-abdominal pathology compared to 56.7% of dogs 8 years and older undergoing their first surgical foreign body retrieval. Senior dogs with a history of foreign body retrieval had a 5.9% incidence of pathologic findings. Pathologic findings were 16 times more likely in dogs 8 years and older undergoing their first foreign body retrieval surgery. Dogs 8 years of age and older undergoing their first surgical foreign body retrieval were significantly more likely to exhibit pathologic findings than those with previous foreign body retrievals and dogs less than 8 years of age. Preoperative discussions for geriatric dogs undergoing first-time foreign body surgery should address the increased likelihood of abnormal findings intraoperatively, potential need for additional surgical procedures, and risks of associated procedures.
Space is one of the main drivers of biodiversity, as it regulates the underlying processes affecting the distribution and dynamics of species and communities. It is a fundamental factor when considering the rapid climate and land cover changes occurring at local and global scales, which are linked to habitat loss and fragmentation, as well as their impacts on biodiversity. The Atlantic Forest of South America is among the world's biodiversity hotspots because of its exceptionally high species richness and endemism. Most of the threats to the Atlantic Forest's biodiversity stem from the expansion of urbanization and industry, extensive agricultural and livestock production, and mining. Here, we provide integrated and fine-scale spatial information (30-m resolution) for the entire extent of the Atlantic Forest for the years 2020 to 2022. The spatial data include different vegetation classes (forest, and forest combined with other non-forest vegetation), the effects of linear structures (roads and railways), and landscape metrics computed at multiple scales (radius buffers-moving window sizes-ranging from 50 to 2500 m, and up to 10 km for some metrics). The dataset comprises the Atlantic Forest delimitation vector and more than 500 rasters, available through a series of thematically grouped files in multiple Zenodo repositories. This data can also be accessed using the R package atlanticr, which we developed to facilitate data retrieval and organization from Zenodo. The dataset includes landscape, topographic, hydrological, and anthropogenic metrics. Landscape metrics were calculated for two vegetation classes-Forest Vegetation (which combined different forest cover classes) and Natural Vegetation (which combined forest and non-forest cover classes)-as well as for a heterogeneous, multi-class classification of the landscape (31 land cover classes). The landscape metrics include landscape morphology (classification as matrix, core, edge, corridor, branch, stepping stone, and perforation), fragment area and proportion, patch area and number, edge and core areas and proportions, structural and functional connectivity (for different organisms' gap-crossing capabilities), distance to and from fragment edges, fragment perimeter and perimeter-area ratio, and landscape diversity (heterogeneity). Topographic metrics include elevation, slope, aspect, curvature, and landform elements (peak, ridge, shoulder, spur, slope, hollow, footslope, valley, pit, and flat). Hydrological metrics comprise potential springs (and their kernel density) and streams (and distance to the nearest feature). Anthropogenic metrics include maps of roads, railways, protected areas, Indigenous territories, and quilombola territories (localities of self-defined Afro-Brazilian traditional communities), as well as the distance to each feature. This dataset facilitates the efficient integration of biodiversity and spatially explicit data for the Atlantic Forest, serving as a data source for studies, landscape planning, biodiversity conservation, and forest restoration programs. The data are released under a CC BY-NC 4.0: Creative Commons Attribution-Non-Commercial 4.0 International license and this data paper should be cited when the data are reused.
To extend the literature on the relationship between emotional intelligence and self-reported levels of stress, anxiety, and depression among veterinary medicine students across universities in the Midwestern US. A cross-sectional survey was distributed via email to individuals enrolled in veterinary medicine programs in the Midwestern US. Participants completed a 57-item survey, which included demographic information as well as targeted psychological variables of stress, anxiety, depression, and emotional intelligence. The survey was open for a 1-month collection period and analyzed using descriptive statistics, Pearson correlations, and independent-samples t tests. Key findings from 184 completed surveys included self-reports of moderate to high levels of stress (89.1%), anxiety (58%), and depression (29.8%) in veterinary medicine students. Additionally, negative relationships were found between reported levels of stress and emotional intelligence (r [182] = -0.362; P < .01) as well as screening positive for depression and emotional intelligence levels (r [182] = -0.349; P < .01). This study supports the hypothesis that emotional intelligence is negatively correlated with stress and depression among veterinary medicine students. Further research into this correlation is warranted as well as exploration of a possible causal relationship between emotional intelligence and reduced self-reports of stress and depression. Considering these findings, veterinary medicine programs may consider using emotional intelligence as a means to identify at-risk students and get them needed support and as a guide to including mental health curriculum into their curriculum.
To describe the surgical technique, complications, and outcomes of laparoscopic iliosacral lymph node (ISLN) extirpation in dogs with apocrine gland anal sac adenocarcinoma (AGASACA), with or without intraoperative lymphangiography. 18 client-owned dogs underwent laparoscopic ISLN extirpation (19 procedures) between March 2012 and May 2024. Dogs were included if medical records were complete, the dogs were diagnosed with AGASACA, and an attempted laparoscopic ISLN extirpation was performed. Dogs were evaluated for staging and/or management of suspected metastasis to ISLNs. The study population included 11 male castrated and 7 female spayed dogs with a mean age of 9.95 ± 1.8 years (range, 7 to 14 years). Pertinent physical examination abnormalities included firm, irregular, or nodular masses involving one or both anal sacs, perianal subcutaneous tissues, or prior anal sacculectomy sites. 16 of 19 procedures (84.2%) were completed totally laparoscopically, while 3 of 19 (15.8%) required reactive conversion to open celiotomy. Intraoperative lymphangiography was attempted in 6 of 19 procedures (31.6%) using indocyanine green, methylene blue, or both. Indocyanine green was successful in 2 of 3 cases (66.7%), whereas methylene blue was unsuccessful in all attempts. Intraoperative surgical complications occurred in 9 of 19 procedures (47.3%), and most were mild and self-limiting. Histopathology confirmed metastatic ISLN(s) in 14 of 19 cases (73.7%). All dogs survived to discharge, and 18 of 19 cases (94.7%) survived beyond 14 days postoperatively. Laparoscopic ISLN extirpation, with or without intraoperative lymphangiography, is a viable diagnostic and treatment approach for dogs with AGASACA, supporting the increasing role of minimally invasive surgery in veterinary surgery including oncologic staging.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
To identify factors influencing veterinary students and recently graduated veterinarians in the desire to pursue practice ownership. This observational cross-sectional study distributed a 28-item online survey via social media and email from June to December 2024 to veterinary students and recent graduates (< 5 years) in the US. Participants ranked factors influencing practice ownership, and logistic regression analyses assessed associations with demographic characteristics, education, and previous experiences. We analyzed responses from 282 participants. Overall, 50.4% of participants aspired to own a practice. Among aspiring practice owners, the most frequently ranked reason was freedom to practice medicine how they desire, followed by job satisfaction and leadership opportunities. Conversely, among participants not interested in practice ownership, the most frequently ranked factor was the responsibility of practice ownership, followed by back-office tasks, liability and legal responsibilities, and stress/burnout. Logistic regression analyses revealed that men, Veterinary Business Management Association members, and those interested in/currently working in mixed-animal practice had higher odds of interest in practice ownership. Approximately 50% of participants reported an interest in practice ownership, a proportion higher than reported in profession-wide surveys. Consistent with prior research, barriers to practice ownership included the responsibilities associated with ownership and concerns about work-life balance. This study highlights the need to integrate more comprehensive practice management education into the veterinary curriculum. Experiential learning opportunities, such as externships focused on practice management or ownership, may help bridge gaps between clinical training and business skills.
Approximately 50% of patients that undergo surgical reconstruction to repair the congenital heart defect tetralogy of Fallot (ToF) experience adverse effects by the age of 50. These effects can be linked to the poor healing response elicited by the synthetic materials in the commonly used cardiovascular patches. Extracellular matrix (ECM) biomaterial-based therapies, on the other hand, have been shown to elicit positive healing responses in various tissues and pathologies, including those in the heart. Few studies, however, have been directed towards the development of an ECM-based cardiovascular patch that can realistically fill the voids in tissue present in ToF patients. Furthermore, cardiac ECM is typically derived from adult sources, despite knowledge that only fetal and neonatal rodents can fully regenerate functional cardiac tissue. Here, we demonstrate the widening of the RVOT in young porcine with a novel cardiovascular patch fabricated from fetal cardiac ECM and silk fibroin (cECM-silk). Histological analyses show our fetal cECM-silk patches improve patch-tissue integration and patch degradation compared to a clinical-standard GORE ACUSEAL cardiovascular patch, as a representative of expanded polytetrafluoroethylene (ePTFE)-based material. Our fetal cardiac ECM-silk patches also improve vascularization in and around the patch and reduce the detrimental fibrotic response typically seen with the GORE ACUSEAL patches. Finally, the culture of activated cardiac fibroblasts in vitro showed analogous reduction in fibroblast activation when treated with solubilized fetal cECM. Our results suggest that fetal cECM is a potential alternative cardiovascular patch material that enables improved healing responses over synthetic materials post-surgical repair of ToF and other CHDs.
To characterize the dynamics of Mesomycoplasma ovipneumoniae colonization and serum antibody responses in a rangeland flock of domestic sheep (Ovis aries). A cohort of 40 female lambs was repeatedly tested for M ovipneumoniae from birth to 25 months of age. Nasal swabs were analyzed for M ovipneumoniae infection by PCR, and a competitive ELISA was utilized to determine antibody levels. Body weights and body condition scores also were determined. M ovipneumoniae infection was rapidly acquired, with 80% of the study animals testing PCR positive at 2 months of age and 96.2% testing PCR positive at 4 months of age. The PCR positivity rate then fluctuated between 35% at 10 months and 94% at 25 months. Antibody levels expressed as percentage of inhibition were 57.9% in the dams and 52.7% in their offspring within 24 hours after birth, fell to 18.7% in the lambs at 2 months, and then remained variable, ranging from 36% to 64.2%. No significant association between M ovipneumoniae colonization and antibody levels or daily weight gains was found. In a flock with high M ovipneumoniae infection rates, infections were acquired early in life and then fluctuated over time with no clear trends. Importantly, the serum antibody responses that we measured did not appear to enable sustained pathogen clearance. Our study indicates that, once infected, sheep do not develop effective sterilizing immunity to M ovipneumoniae, and serum antibodies cannot be considered a reliable correlate of protection in individual sheep.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
To describe the Traumatic Brain Injury Clinical Score (TBICS), assess its prognostic accuracy in dogs and cats hospitalized with acute TBI, and compare its performance with the modified Glasgow Coma Scale (MGCS). Cases were identified at the Koret School of Veterinary Medicine Teaching Hospital retrospectively (from 2017 through 2019) and prospectively (from 2019 through 2020). Animals were included if injury occurred within the preceding 24 hours and TBICS could be calculated from the neurological examination recorded within 24 hours after injury. The outcomes were survival to hospital discharge and survival ≥ 6 months. Receiver operating characteristic curves were generated, and the areas under the curve (AUCs) were compared between the TBICS and MGCS. Short-term survival rates were 65.8% in dogs (25 of 38) and 64.5% in cats (20 of 31). In dogs, TBICS AUCs were 0.846 (short term) and 0.892 (long term); a cutoff of ≤ 8 yielded sensitivity/specificity of 80%/69.2% and 90.5%/73.3%, respectively. The MGCS AUCs were 0.812 and 0.873 with a cutoff of ≥ 14 (sensitivity/specificity, 60.0%/92.3% and 66.7%/93.3%, respectively). In cats, TBICS AUCs were 0.861 and 0.929; a cutoff of ≤ 7 yielded sensitivity/specificity of 70%/81.8% and 71.4%/88.9%. The MGCS AUC was 0.775 for short-term survival (cutoff, ≥ 13; sensitivity/specificity, 80%/63.6%). TBICS demonstrated good predictive accuracy for short- and long-term survival in dogs and cats with TBI and produced slightly higher AUC values than the MGCS in this cohort. TBICS is an effective clinical tool for evaluating prognosis that can be completed within minutes of admission.
To reassess the 8-hour postdexamethasone (T8) cortisol diagnostic cutoff for suspected naturally occurring Cushing syndrome (CS) in dogs comparing a chemiluminescent cortisol immunoassay (Immulite 2000 XPi; Siemens Healthineers) results before and after the 2020 antibody change. Low-dose dexamethasone suppression test results were retrospectively evaluated in dogs with CS and in those with disease mimicking Cushing syndrome (DMCS), with sensitivity (Se), specificity (Sp), and receiver operating characteristic curves assessed. Cortisol concentrations after the antibody change were adjusted using the Siemens Healthineers conversion formula. 61 dogs with CS and 32 with DMCS were included between January 2016 and October 2020 (old antibody [OA]). Forty dogs with CS and 40 with DMCS were included between November 2020 and January 2024 (new antibody [NA]). The area under the curve for T8 cortisol to differentiate CS from DMCS dogs was 0.96 (95% CI, 0.91 to 0.99) with OA and 0.96 (95% CI, 0.90 to 1.0) with NA. The cutoff associated with the best sensitivity and specificity to diagnose CS was > 35.9 nmol/L (1.3 μg/dL; Se = 88.9%, 95% CI, 78.4% to 95.4%; Sp = 96.9%, 95% CI, 83.8% to 99.9%) with OA and > 33.1 (1.2 μg/dL; Se = 92.5%, 95% CI, 79.6% to 98.4%; Sp = 95.0%, 95% CI, 83.08% to 99.4%) with NA. The optimal cut point of the low-dose dexamethasone suppression test T8 cortisol for CS diagnosis after the antibody change was > 33.1 nmol/L (1.2 μg/dL), which is lower than the currently accepted cutoff of > 38.6 nmol/L (1.4 μg/dL). New cutoff value of T8 cortisol has been identified for the diagnosis of CS.
In clinical research, laryngeal hemiplegia (LH) is induced by temporarily supressing recurrent laryngeal nerve function; however, the technique is challenging. The aim was to develop a novel method to induce LH by injecting bupivacaine directly into the cricoarytenoid dorsalis (CAD) muscle with ultrasound guidance. 5 cadaver larynges and 9 Thoroughbreds with normal laryngeal function. Part 1: A high-frequency (6.5- to 13.0-MHz) linear ultrasound probe was used to inject methylene blue (5 mL) into the CAD of 5 cadaver larynges. Part 2: The left side of the larynges of 9 horses were aseptically prepared, and the cricoid, thyroid, and arytenoid cartilages were identified with ultrasonography. With the use of a horizontal view dorsally, the cricoarytenoid lateralis muscle was visualized, followed by the arytenoid cartilage and CAD superficial to the cricoarytenoid joint. An 18-gauge, 3.5-inch spinal needle was advanced into the left CAD under ultrasound guidance. Bupivacaine was injected (0.5% concentration, 4.5 mL). Part 3: The efficiency, reversibility, and duration of LH was assessed at rest and during maximal treadmill exercise with overground endoscopy. Laryngeal function was reassessed 1 week later. All cadaver larynges showed evidence of methylene blue in the CAD, confirming that ultrasonography can be used to inject the CAD. Laryngeal hemiplegia was observed within 5 minutes of injection (grade IV), continued throughout exercise (grade D), and persisted for 70 to 90 minutes after exercise (grade IV). Horses had normal CAD echogenicity and laryngeal function at rest and exercise 7 days after injection. Injecting bupivacaine into the CAD under ultrasound guidance is a practical technique for inducing transient LH that is sustainable during maximal exercise.
To investigate the presence of subclinical cranial nuchal bursitis and characterize its histopathologic features and association with Borrelia burgdorferi. This was a prospective descriptive cadaver study on a convenience population of horses in a B burgdorferi-endemic region (15 horses: 5 geldings and 10 mares of various breeds; 4 to 29 years old). Horses without history or clinical signs of cranial nuchal bursitis underwent euthanasia and tissue donation. Cranial nuchal bursa, synovial fluid, and nuchal ligament were collected postmortem. The bursa and ligament were evaluated via histopathology, grading inflammation, edema, fibrosis, hemorrhage, and mineralization (each scored 0 = normal to 3 = severe). Lyme multiplex assay on serum and B burgdorferi polymerase chain reaction on bursa were performed. 16S rRNA gene sequencing was performed on 3 samples. Gross abnormalities were found in 4 horses (mineralization, thickened bursa, synovial effusion, deposits of amorphous material, and adhesions). On histopathology, inflammation was detected in 5 horses, nearly all with 1 or more additional abnormalities (edema, necrosis, fibrosis, and mineralization). The overall histopathology score ranged from 1 to 8. Five horses had positive Lyme multiplex assay antibody titers. Nuchal bursa, ligament, and synovial fluids were negative on B burgdorferi polymerase chain reaction. There was no association between histopathology score and age or Lyme multiplex titers. Our study identified mild to moderate cranial nuchal bursa and ligament histopathologic changes suggestive of subclinical inflammation. The detection of subclinical gross and histopathologic changes in clinically normal horses warrants further investigation of the predisposing causes and clinical implications.
This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.