Dynamin-related protein 2 interacts with the membrane-associated methyltransferase domain of plantago asiatica mosaic virus replicase and promotes viral replication

Positive-strand RNA viruses replicate their RNA in the viral replication complex, a spherical structure formed by remodeling of host intracellular membranes. This process also requires the interaction between viral membrane-associated replication proteins and host factors. We previously identified the membrane-associated determinant of the replicase of plantago asiatica mosaic virus (PlAMV), a positive-strand RNA virus of the genus Potexvirus, in its methyltransferase (MET) domain, and suggested that its interaction with host factors is required to establish viral replication. Here we identified Nicotiana benthamiana dynamin-related protein 2 (NbDRP2) as an interactor of the MET domain of the PlAMV replicase by co-immunoprecipitation (Co-IP) and mass spectrometry analysis. NbDRP2 is closely related to the DRP2 subfamily proteins in Arabidopsis thaliana, AtDRP2A and AtDRP2B. Confocal microscopy observation and Co-IP confirmed the interaction between the MET domain and NbDRP2. Also, the expression of NbDRP2 was induced by PlAMV infection. PlAMV accumulation was reduced when the expression of NbDRP2 gene was suppressed by virus-induced gene silencing. In addition, PlAMV accumulation was reduced in protoplasts treated with dynamin inhibitor. These results indicate a proviral role of the interaction of NbDRP2 with the MET domain in PlAMV replication.

Evaluation of responses to immunosuppressive therapy in dogs with suspected non-regenerative immune-mediated anaemia: 11 cases (2012-2018)

OBJECTIVES

We aimed to determine the response time to immunosuppressive therapy and time required to achieve a 5% increase in haematocrit among dogs with non-regenerative immune-mediated anaemia.

MATERIALS AND METHODS

Client-owned dogs diagnosed with non-regenerative immune-mediated anaemia in Hokkaido University Veterinary Teaching Hospital between December 2012 and May 2018 were enrolled. The first treatment regimen included prednisolone (2 mg/kg/day) and ciclosporin (up to 10 mg/kg/day) for 8 weeks. Dogs that did not respond to the first regimen proceeded to the second regimen comprising prednisolone and mycophenolate mofetil (15 mg/kg, twice a day). Reticulocyte count and haematocrit were monitored every 1 to 2 weeks. Treatment response was defined as an absolute reticulocyte count more than 60×10³ /μL or increasing haematocrit.

RESULTS

During the study period, 23 dogs fulfilled the inclusion criteria for non-regenerative immune-mediated anaemia. Twelve dogs were excluded from this study for various reasons and response to therapy was evaluated in the remaining 11 dogs. Treatment responses were observed in 8 of 11 dogs, and the median time to response was 39.5 days (range 8 to 92 days). Two responders were unable to continue the first treatment regimen and were switched to the second regimen owing to anorexia and nausea, possibly induced by ciclosporin; withdrawal of ciclosporin improved their symptoms. The time required to achieve a 5% increase in haematocrit was assessed in the other six dogs, with a median of 55.5 days (range 8 to 135 days).

CLINICAL SIGNIFICANCE

Here we report the response to a standardised treatment protocol in dogs with non-regenerative immune-mediated anaemia. Knowledge of potential side effects and expected therapeutic outcomes may be of use for veterinary practitioners treating this condition.

Prognostic value of left atrial stiffness estimated using echocardiography in dogs with myxomatous mitral valve disease

INTRODUCTION

No studies have investigated the prognostic value of left atrial stiffness (LASt) estimated using echocardiography in dogs with myxomatous mitral valve disease (MMVD).

ANIMALS

Seventy-two dogs had MMVD and 46 dogs were healthy dogs.

MATERIALS AND METHODS

Clinical retrospective cohort study. The survival information of MMVD dogs that underwent echocardiographic examination was obtained. The peak velocities of early diastolic transmitral flow (E) and mitral annular motion as determined by pulsed wave Doppler (E') were determined. The left atrial reservoir strain (ε_S) was determined by two-dimensional speckle tracking echocardiography of the left atrium. The LASt was estimated by the formula: E/E'/ε_S. The 95% prediction interval of LASt was computed from the data of the healthy dogs.

RESULTS

Seventeen dogs having MMVD died of cardiac-related causes with 55 MMVD dogs censored. The MMVD dogs with LASt > its 95% upper prediction limit (LASt > 0.56; n = 26; median survival time, 484 days; 95% confidence interval, 283 days-indeterminable) had shorter survival times (P<0.001) than those with LASt ≤ its 95% upper prediction limit (LASt ≤ 0.56; n = 46; median survival time, >1112 days; 95% confidence interval, indeterminable). Multivariable Cox's proportional hazard analysis demonstrated that the ratio of the left atrial dimension to the aortic annulus dimension and LASt were independent predictors of cardiac-related death among conventional echocardiographic indices, ε_S and LASt in MMVD dogs.

CONCLUSIONS

In dogs with MMVD, increased LASt estimated using echocardiography is an independent predictor of cardiac-related death, and LASt can be more useful for prognostication than ε_S.

Cell death signalling is competitively but coordinately regulated by repressor-type and activator-type ethylene response factors in tobacco (Nicotiana tabacum) plants

Ethylene response factors (ERFs) comprise one of the largest transcription factor families in many plant species. Tobacco (Nicotiana tabacum) ERF3 (NtERF3) and other ERF-associated amphiphilic repression (EAR) motif-containing ERFs are known to function as transcriptional repressors. NtERF3 and several repressor-type ERFs induce cell death in tobacco leaves and are also associated with a defence response against tobacco mosaic virus (TMV). We investigated whether transcriptional activator-type NtERFs function together with NtERF3 in the defence response against TMV infection by performing transient ectopic expression, together with gene expression, chromatin immunoprecipitation (ChIP) and promoter analyses. Transient overexpression of NtERF2 and NtERF4 induced cell death in tobacco leaves, albeit later than that induced by NtERF3. Fusion of the EAR motif to the C-terminal end of NtERF2 and NtERF4 abolished their cell death-inducing ability. The expression of NtERF2 and NtERF4 was upregulated at the early phase of N gene-triggered hypersensitive response (HR) against TMV infection. The cell death phenotype induced by overexpression of wild-type NtERF2 and NtERF4 was suppressed by co-expression of an EAR motif-deficient form of NtERF3. Furthermore, ChIP and promoter analyses suggested that NtERF2, NtERF3 and NtERF4 positively or negatively regulate the expression of NtERF3 by binding to its promoter region. Overall, our results revealed the cell death-inducing abilities of genes encoding activator-type NtERFs, including NtERF2 and NtERF4, suggesting that the HR-cell death signalling via the repressor-type NtERF3 is competitively but coordinately regulated by these NtERFs.

More than the half number of the severe CAD patients without features of metabolic syndrome had hyperlipoprotein(a)-emia

Background

It was reported that insulin suppresses apolipoprotein(a) synthesis in primary cultures of cynomolgus monkey hepatocytes (Neele DM. Diabetologia 1999). Therefore, there is a possibility that inverse association exists between lipoprotein(a); Lp(a) and metabolic syndrome (Mets) with insulin resistance/ hyperinsulinemia for the coronary atherosclerosis.

Purpose

The purpose is to examine the association between Lp(a) and Mets on the CAD patients.

Method

847 male subjects with angiographically demonstrated CAD were enrolled. The subjects were divided into the five groups according to the scored numbers by the counting of Mets components shown below (presence 1, absence 0); 1. BMI ≥25kg/m2, 2. comorbidity of hypertension, 3. triglyceride ≥150mg/dL and/or HDL cholesterol &lt;40mg/dL, 4. fasting plasma glucose ≥110mg/dL and/or comorbidity of diabetes mellitus (Group 0; without any Mets components, Group 4; with all Mets component). The insulin levels (μU/mL) and the prevalence of hyperLp(a)-emia (≥30 mg/dL) were compared between in Group 0 and in Group 4. The blood samples for laboratory tests were collected after an over night fast.

Result

As the scored numbers increased, the insulin levels increased (Group 0; 5.1 μU/mL versus Group 4; 11.4 μU/mL: p&lt;0.0001) and the prevalence of hyperlipoprotein(a)-emia decreased (Group 0; 41.6% versus Group 4; 21.4%: p&lt;0.01). The prevalence of hyperLp(a)-emia increased as the severity of coronary atherosclerosis aggravated (Figure 1; one vessel disease 21.5%, two vessel disease 27.0% three vessel disease 32.1%: one vessel disease versus three vessel disease p&lt;0.01). Especially to limited the three vessel disease subjects (Figure 2), the prevalence of hyperlipoprotein(a)-emia in Group 0 was markedly high (56.7%).

Conclusion

More than the half number of severe CAD patients without features of Mets had hyperLp(a)-emia.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Association of common carotid artery measurements with the incidence of hypertension: a retrospective cohort study

Background

Diameter, intima–media thickness (IMT), and flow parameters, including resistance index (RI) and pulsatility index (PI), in the common carotid artery (CCA) are markers of arterial remodeling, atherosclerosis, and vascular resistance, respectively. These CCA parameters have usually been evaluated as markers of target organ damage. Little is known about whether these parameters predict a new onset of hypertension.

Purpose

In this study, we investigated the association of CCA parameters including IMT, diameter, RI, and PI with the incidence of hypertension.

Methods

This is an observational study involving 1249 participants (656 women, mean age 69.6 years) without hypertension, who underwent carotid artery ultrasonography at baseline. The participants were divided into elderly group (defined as age ≥70 years) and a middle-aged group. We defined obesity as BMI ≥25 kg/m2. CCA diameter was defined as the distance between the adventitia–media interface on the near wall and the media–adventitia interface on the far wall. IMT was defined as the distance between the lumen–intima and media–adventitia interfaces. RI was calculated as [peak systolic velocity (PSV)- end-diastolic velocity (EDV)]/PSV. PI was calculated as (PSV-EDV)/Vmean. Larger CCA diameter, increased IMT, high RI, and high PI were determined based on the optimal cutoff values from ROC curve analysis.

Results

Over a mean 5.1-year follow-up period, 524 participants developed hypertension. Multivariate logistic regression analyses showed that larger CCA diameter and increased IMT were significant predicators for incident hypertension in elderly group, but not in middle-aged group. High RI, and high PI were significant predicators for incident hypertension in both the two groups. CCA diameter, IMT, and RI predicted the incidence of hypertension only in nonobesity group, whereas PI predicted it in both obesity and nonobesity groups (Table).

Conclusion

CCA parameters assessed by ultrasonography are useful markers to estimate the risk of hypertension. In particular, PI is a better predictor for the incidence of hypertension.

Funding Acknowledgement

Type of funding sources: None.

Association of adipose tissue insulin resistance and serum free fatty acid levels with the incidence of type 2 diabetes: a retrospective cohort study

Background

Insulin resistance in adipose tissue attenuates the suppression of lipolysis, leading to increased free fatty acid (FFA) release. The excess FFA may be involved in the development of type 2 diabetes.

Purpose

In this study, we investigated the association of adipose tissue insulin resistance and serum free fatty acid levels with the incidence of type 2 diabetes.

Methods

This is an observational study involving 6800 participants (3451 women, mean age 69.2 years) without diabetes who underwent 75-g oral glucose tolerance test (OGTT) at baseline. The participants were divided into the obesity and nonobesity groups on the basis of body mass index of ≥25 and &lt;25 kg/m2, respectively. Serum FFA levels were assessed before and 30, 60, and 120 min after glucose ingestion, and the total area under the FFA curve (AUCFFA) was calculated. Adipose tissue insulin resistance was assessed using adipose insulin resistance index (adipo-IR) calculated based on fasting FFA and insulin concentrations. The homeostasis model assessment of insulin resistance (HOMA-IR), and the Matsuda index were evaluated as measures of insulin resistance in the liver and whole-body, respectively. High adipo-IR, high fasting FFA, great AUCFFA high HOMA-IR, and low Matsuda index were determined based on the optimal cutoff values from ROC curve analysis.

Results

Over a mean 5.3-year follow-up period, 485 participants developed type 2 diabetes. Multivariate logistic regression analyses showed that high adipo-IR was a significant predicator for incident type 2 diabetes in the obesity group, but not in nonobesity group. AUCFFA, HOMA-IR, and Matsuda index were significantly associated with incident type 2 diabetes in both the two groups (Table).

Conclusion

Serum FFA levels after glucose loading predict the incidence of type 2 diabetes. Adipose tissue insulin resistance was associated with the risk of type 2 diabetes in individuals with obesity, but not in individuals without obesity.

Funding Acknowledgement

Type of funding sources: None.

Changes in fears and worries related to COVID-19 during the pandemic among current employees in Japan: a 5-month longitudinal study

Objectives

This study investigates and describes the time course of fears and worries about COVID-19 among current employees during this outbreak.

Study design

This was a longitudinal study.

Methods

This study was a part of the Employee Cohort Study in Japan. The study comprised 4120 individuals from February 2019. A baseline survey in March 2020, a 2-month follow-up survey in May 2020, and a 5-month follow-up survey in August 2020 were conducted. Questions surveyed respondents’ global fear and worry and six items related to COVID-19. A mixed model for repeated measures of an analysis of variance was used.

Results

A total of 1421 respondents completed the baseline survey. At 2- and 5-month follow-ups, 1032 and 1181 respondents completed surveys, respectively. Of those, 64 and 33 individuals who were temporarily laid off or on leave were recorded as missing values. Global fear and worry about COVID-19 significantly increased from March to August 2020. Fears of personal or family infection, limiting one's activities and national and local government policies also significantly increased with time. In contrast, fears of lack of knowledge and difficulty of obtaining hygiene products significantly decreased.

Conclusion

To conduct efficient risk communication during a pandemic, knowing the concerns of the populace, providing correct information and a sufficient supply of products, and setting clear guidelines are essential.

Pharmacological inhibition of C-C chemokine receptor 4 aggravates atherosclerosis through prevention of regulatory T cell recruitment to the lesions

Background

Regulatory T cells (Tregs) are demonstrated to play a protective role in the development of atherosclerosis. However, their sites of action in atherosclerosis remain unclear. Although C-C chemokine receptor 4 (CCR4) has been shown to contribute to the accumulation of Tregs in inflamed tissues and prevention of experimental autoimmune diseases, the role of CCR4 in Treg migration to atherosclerotic lesions and suppression of plaque formation remains unknown.

Methods and results

We intraperitoneally injected 8-week-old apolipoprotein E–deficient mice fed a normal diet with vehicle (n=9) or a 4-μg dose of a CCR4 antagonist (n=10) 3 times weekly for 8 weeks and evaluated atherosclerotic lesions at 16 weeks old. Administration of the CCR4 antagonist significantly aggravated atherosclerotic plaque formation (aortic sinus plaque area: 2.91±0.87×104 μm2 versus 5.41±0.98×104 μm2 in control vehicle-treated and CCR4 antagonist-treated mice, respectively; P&lt;0.05), associated with increased accumulation of macrophages and CD4+T cells in the plaques. Flow cytometric analysis revealed a decrease in Foxp3+ Tregs in the para-aortic lymph nodes and thoracoabdominal aortas of CCR4 antagonist-treated mice, along with a tendency toward increase in CD44highCD62Lloweffector T cells in para-aortic lymph nodes, indicating CCR4-dependent migration of Tregs to atherosclerotic lesions and their possible atheroprotective role. We observed no changes in splenic Foxp3+ Tregs and effector T cells following CCR4 antagonist treatment. We also investigated the effect of CCR4 blockade on advanced atherosclerosis using LDL receptor–deficient mice fed a high-cholesterol diet. Although 8-week treatment with the CCR4 antagonist led to a decrease in Foxp3+ Tregs in the atherosclerotic lesions, atherosclerotic lesion formation was not significantly affected, suggesting that CCR4-dependent Treg accumulation in atherosclerotic lesions is not critical for prevention of advanced atherosclerosis.

Conclusions

Our findings indicate an important role for CCR4 in promotion of Treg recruitment into atherosclerotic lesions and subsequent prevention of early atherosclerosis and suggest CCR4 as a novel therapeutic target for atherosclerosis.

Funding Acknowledgement

Type of funding source: None

Delayed hyperenhancement obtained by non-contrast computed tomography following coronary angiography in patients of extracorporeal cardiopulmonary resuscitation

Background/Introduction

Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to improve survival and neurologic outcome as compared to conventional CPR in refractory cardiac arrest. Although prognostic factors of these patients have been reported, predicting of outcome is difficult in real world. Recently, early evaluation of myocardial viability in acute myocardial infarction by non-contrast computed tomography (CT) post coronary angiography (CAG) has been reported. And myocardial contrast delayed enhancement obtained by this method related to higher risk of cardiac events. However, few studies have reported delayed enhancement on left ventricular wall findings in non-contrast CT after CAG in terms of patients performed ECPR.

Purpose

To investigate the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients performed ECPR.

Methods

We investigated 79 patients treated by ECPR for refractory cardiac arrest regardless of whether in-hospital or out-hospital in our institute from Apr 2009 to Feb 2018. Thirty-two in these patients received non-contrast CT following CAG with ECPR were enrolled. All ECPR cases underwent VA-ECMO in the catheter laboratory using percutaneous procedure while maintaining conventional CPR. Non-ECG-gated and non-contrast CT was performed using a 64-row multidetector CT scanner.

Results

Survival rate was 18.8% in this cohort. There was no significant difference between survive and in-hospital death group in terms of patient characteristics, clinical time courses, initial blood samples and procedure characteristics. Only delayed hyperenhancement showed significant difference between 2 groups (p=0.04). All delayed hyperenhancements were detected in only in-hospital death group. Delayed hyperenhancement was detected in 12 cases (37.5%). Initial shockable rhythm was less common in cases with delayed hyperenhancement. Cardiac death tended to be more frequent in patients with delayed hyperenhancement. The major causes of death were bleeding (41.7%) and heart failure (33%).

Conclusion(s)

Delayed hyperenhancement in patients treated ECPR was strong predictor of in-hospital death.

Image of delayed hyperenhancement

Funding Acknowledgement

Type of funding source: None

FRI0497 THERAPEUTIC STRATEGIES AND LONG-TERM OUTCOME IN PATIENTS WITH INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES: A SINGLE CENTER LARGE-SCALE OBSERVATIONAL COHORT STUDY

Background:

Patients with idiopathic interstitial pneumonia (IIP) may have features of connective tissue diseases (CTDs). The term interstitial pneumonia with autoimmune features (IPAF) has been recently proposed for such patients [1]. To date, only few studies have comprehensively described outcomes over a long-term period and choices of treatment [2-4].

Objectives:

The aim of this study was to investigate the therapeutic strategies and long-term outcome among patients with IPAF, IIP, and CTD-ILD.

Methods:

Six hundreds- and seventy-two patients who had visited our department between April 2009 and March 2019 and were evaluated by chest HRCT scan. They were clinically and radiologically diagnosed as having interstitial lung disease (ILD), including IIP, CTD-ILD, undifferentiated connective tissue diseases associated ILD or other ILD. Then, we applied IPAF criteria to these patients, 68 patients were diagnosed as IPAF. We extracted the treated patients from IPAF patients. Then, the treated patients were divided into two groups, which were treated with monotherapy (glucocorticoid: GC) and with combination therapy (GC and immunosuppressant: IS). Clinical, laboratory and imaging data were collected from medical records and statistically analyzed.

Results:

Proportion of treatment received patients with IPAF, IIP, or CTD-ILD was 44.1%, 28.1%, and 88.0%, respectively. Then we compared long-term outcomes among patients with IPAF, IIP, and CTD-ILD, 5-year non-exacerbation rate in IPAF patients, IIP patients, and CTD-ILD patients was 53.7%, 28.3%, and 59.5%, respectively (Figure 1.). No significant difference between IPAF and CTD-ILD group was found (P=0.71). Next, we focused on IPAF and compared characteristics at diagnosis between the treatment group (n=30) and non-treatment group (n=38) in patients with IPAF. Interestingly, treatment group was significantly associated with signs of mechanic’s hands, arthritis, anti-SS-A antibody positivity, and anti-ARS antibody positivity (P=0.009, 0.05, 0.05, and 0.007). Among the treatment group, GC monotherapy was received in 46.7% (n=14), whereas GC+IS combination therapy group was 50% (n=15). When we compared long-term outcomes between two groups, 3-year non-exacerbation rate was 70.1%, 43.5%, and 83.3% (Figure 2.). No significant difference was not seen between two different treatment groups (P=0.24).

Conclusion:

Our large-scale cross-sectional cohort study identified that the prognosis of IPAF patients was poor as same as that of CTD patients, and even though GC mono or GC+IS combination treatment was applied for IPAF patients, prognosis was still poor and thus new intervention for IPAF should be needed to improve their prognosis.

References:

[1]Eur Respir J. 2016; 47:1622–1624,

[2]J Rheumatol. 2013; 40:640-646,

[3]Respirology. 2019 Aug 6,

[4]Autoimmun Rev. 2019 Dec 12

Disclosure of Interests:

Okinori Murata: None declared, Katsuya Suzuki: None declared, Nobuhito Sasaki: None declared, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd., Makoto Maemondo: None declared

Predictors of Cerebral Aneurysm Rupture after Coil Embolization: Single-Center Experience with Recanalized Aneurysms

BACKGROUND AND PURPOSE

Recanalization after coil embolization is widely studied. However, there are limited data on how recanalized aneurysms rupture. Herein, we describe our experience with the rupture of recanalized aneurysms and discuss the type of recanalized aneurysms at greatest rupture risk.

MATERIALS AND METHODS

A total of 426 unruptured aneurysms and 169 ruptured aneurysms underwent coil embolization in our institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms (unruptured group) and 37 (21.9%) of 169 ruptured aneurysms (ruptured group). The Modified Raymond-Roy classification on DSA was used to categorize the recanalization type. Follow-up DSA was scheduled until 6 months after treatment, and follow-up MRA was scheduled yearly. If recanalization was suspected on MRA, DSA was performed.

RESULTS

In the unruptured group, the median follow-up term was 74.0 months. Retreatment for recanalization was performed in 18 aneurysms. Four of 20 untreated recanalized aneurysms (0.94% of total coiled aneurysms) ruptured. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .025). In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .02).

CONCLUSIONS

The types of recanalization after coil embolization may be predictors of rupture. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.

P4403Sleep quality is associated with visit-to-visit blood pressure variability in elderly people

Background

The proportion of people suffering from poor sleep quality increases with age. Several studies reported that poor sleep quality is involved in elevation of blood pressure (BP) level and the development of hypertension. However, it is unclear whether sleep quality is associated with visit-to-visit BP variability, which is related to the incident cardiovascular disease independent of mean BP.

Purpose

In this study, we investigated the association between sleep quality and visit-to-visit BP variability in elderly people.

Methods

This is an observational study involving 3313 participants without atrial fibrillation, aged 68 years or older, who underwent assessment of sleep quality at general health examination between October 2014 and September 2015, and had more than four visits during the first 3 years following the assessment. Of these, 1951 participants (59%) had hypertension, 488 (17%) had diabetes, 432 (13%) had dyslipidemia, and 333 (10%) were on treatment for, or with a history of, cardiac disease. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), which yields seven component scores (0, 1, 2, or 3 is given for each component). A sum of the seven scores was used to calculate the global PSQI score which ranged from 0 to 21. Higher scores indicated poorer sleep quality. Visit-to-visit BP variability for each individual was evaluated by coefficient of variation (CV, defined as standard deviation/mean).

Results

The mean global PSQI score was 5.2±3.2. The mean CV of SBP and CV of DBP was 6.9±3.0, and 8.0±3.5, respectively. The global PSQI score was significantly associated with CV of SBP (ρ= 0.039, P=0.025), and CV of DBP (ρ= 0.039, P=0.024) in Spearman's rank correlation coefficient test. Multiple regression analyses showed that the global PSQI score was a significant contributor to CV of SBP, and CV of DBP, after adjusting for variables with P values <0.1 in Spearman's test (Table).

Table 1. Multiple regression analysis for blood pressure variability (n=3313) Variables CV of SBP CV of DBP β P β P Age 0.131 <0.001 0.140 <0.001 Female −0.017 0.338 0.023 0.186 Hypertension 0.037 0.032 0.031 0.073 Cardiac disease 0.045 0.009 0.038 0.030 Global PSQI score 0.035 0.042 0.047 0.007

Conclusion

Sleep quality is associated with visit-to-visit BP variability in elderly people.

1436Overexpression of Cytotoxic T-Lymphocyte Associated Antigen-4 suppresses aortic immunoinflammatory responses and prevents angiotensin II-induced abdominal aortic aneurysm formation in mice

Aims

Vascular inflammation via T-cell-mediated immune responses has been shown to be critically involved in the pathogenesis of abdominal aortic aneurysm (AAA). T-cell coinhibitory molecule cytotoxic T-lymphocyte–associated antigen-4 (CTLA-4) is known to act as a potent negative regulator of immune responses. However, the role of this molecule in the development of AAA remains completely unknown. In the present study, we determined the effects of CTLA-4 overexpression on experimental AAA.

Methods and results

We continuously infused 12-week-old CTLA-4 transgenic (CTLA-4-Tg)/apolipoprotein E–deficient (Apoe−/−) mice (n=35) or control Apoe−/− mice (n=40) fed a high-cholesterol diet with angiotensin II by implanting osmotic mini-pumps and evaluated the development of AAA. Ninety percent of angiotensin II-infused mice developed AAA, with 50% mortality because of aneurysm rupture. Overexpression of CTLA-4 significantly reduced the incidence (66%), mortality (26%), and diameter (18%) of AAA (incidence: P=0.0104; mortality: P=0.031; diameter: P=0.011). These protective effects were associated with a decreased number of effector CD4+ T cells and the downregulated expression of costimulatory molecules CD80 and CD86, ligands for CTLA-4, on CD11c+ dendritic cells in lymphoid tissues. In addition, by performing in situ zymography of the abdominal aortic aneurysm lesions, we observed a trend toward a decrease in MMP activity in the aneurysmal lesion following overexpression of CTLA-4. Finally, CTLA-4-Tg/Apoe−/− mice had reduced macrophage and CD4+ T cell accumulation and MMP activity in the aneurysmal lesion, leading to attenuated aortic inflammation, preserved vessel integrity, and decreased susceptibility to AAA and aortic rupture.

Conclusion

Our findings suggest that CTLA-4 protects against AAA by suppressing immunoinflammatory responses and could be an attractive therapeutic target for AAA.

P6366High blood pressure cut-off by 130/80 mmHg in middle-ages may be valid for predicting heart failure in ages of seventies

Background

ESC/ESH Guidelines (2018) recommended that treated BP values should be targeted to 130/80 mmHg or lower in most patients. However, it remains unclear whether this target in middle-aged population is associated with future development of heart failure.

Purpose

We conducted a retrospective analysis to determine whether high blood pressure cut-off by 130/80 mmHg in the middle-age predicts the risk of heart failure, detected by high N-terminal pro-brain natriuretic peptide (NT-proBNP) level, in the elderly in a cohort in which longitudinal blood pressure records exist.

Methods

The cohort consists of health check examinee who consulted the examination institute between 2015 and 2018 (n=8513), aged 70 years or older, and had previous institution-visit record at least once from 50 to 69 years old. We measured serum NT-proBNP level in the all examinee and defined the group of high NT-proBNP as ≥144 pg/ml [defined as the highest quartile, n=2135 (25%)]. The number of participants whose previous blood pressure records exists was 8123 (95%) for 65–69 years old, 6980 (82%) for 60–64 years old, 5233 (61%) for 55–59 years old, and 3018 (35%) for 50–54 years old, respectively. The each generation subgroups were divided into the three gradual categories according to the blood pressure records: SBP ≥140 and/or DBP ≥90, SBP130–139 and/or DBP80–89, and SBP <130 and DBP <80 mmHg.

Results

Categorization to high NT-proBNP group in ages of 70 or more was significantly associated with the categorization to high blood pressure, which was not only the SBP ≥140 and/or DBP ≥90 mmHg but also the SBP130–139 and/or DBP80–89 mmHg at any time points of previous blood pressure measurements. The multivariable adjusted odds ratios for having high NT-proBNP level in the elderly against the two high blood pressure categories based on the previous blood pressure measurements were shown in the Table.

Table 1. Multivariable adjusted OR for high NT-proBNP level in elderly Age N SBP 130–139 and/or DBP 80–89 SBP ≥140 and/or DBP ≥90 OR P OR P 65–69 8123 1.30 <0.001 1.68 <0.001 60–64 6980 1.26 0.002 1.55 <0.001 55–59 5233 1.25 0.013 1.41 <0.001 50–54 3018 1.32 0.023 1.58 <0.001 Model included age, gender, BMI, serum creatinine, hemoglobin, and presence of antihypertensive medications, and cardiac disease.

Conclusion

High blood pressure cut-off by 130/80 mmHg in the middle-age may be valid to predict the risk of heart failure in the elderly.

Epidemiology of massive hepatocellular carcinoma in dogs: A 4-year retrospective study

Hepatocellular carcinoma (HCC) is the most common primary liver tumour in dogs. However, the clinical features and risk factors of HCC have not been confirmed. The objective of this study was to investigate the clinical features and risk factors for canine HCC. Medical records of 44 dogs diagnosed with HCC at Hokkaido University Veterinary Teaching Hospital between 2013 and 2017 were retrospectively reviewed. All dogs evaluated at the teaching hospital during the study period were used as the reference population for breed, age, sex predispositions or possible related factors for HCC, including concurrent disorders. Clinical characteristics of HCC were determined using propensity score matching analysis. The prevalence of HCC diagnosis was 0.96%. Multivariate analysis revealed that dogs diagnosed with HCC were significantly older (odds ratio [OR], 1.20; 95% confidence intervals [CI], 1.07-1.33) than the reference population. Welsh Corgis (OR, 3.68; 95% CI, 1.56-8.67) and Beagles (OR, 4.33; 95% CI, 1.58-11.90) were significantly predisposed to HCC. Twenty-seven of 44 dogs with HCC had at least one concurrent disorder. The most common concurrent disorder was hyperadrenocorticism (n = 10), and the adjusted odds of hyperadrenocorticism in dogs with HCC were 4.13 higher than those of the reference population (95% CI, 1.95-8.76). Propensity score matching analysis revealed that thrombocytosis (n = 30/43), increased alanine aminotransferase (n = 41/44), increased alkaline phosphatase (n = 42/44), and hypercalcemia (n = 13/32) were significantly associated with HCC diagnosis. The results of this study suggest that Welsh Corgis and Beagles are breeds with a predisposition for HCC and that hyperadrenocorticism might be a potential risk factor.

The Repeatability and Left Atrial Strain Analysis Obtained via Speckle Tracking Echocardiography in healthy Dogs

INTRODUCTION

In left atrial (LA) strain-derived two-dimensional speckle tracking echocardiography, the reference intervals in healthy dogs can provide useful information to evaluate the LA function in dogs with heart disease.

ANIMALS

Six laboratory beagles and 120 privately owned dogs without cardiac diseases were recruited.

MATERIALS AND METHODS

The LA strain and strain rate (SR) and echocardiographic indices were obtained in dogs who underwent standard echocardiography and offline analysis for LA strain and SR measurement by speckle tracking echocardiography.

RESULTS

The intra-observer within-day variations of strain variables showed adequate repeatability (coefficient of variation <20%). The mean values of strain were 25.37 for the LA reservoir function, 11.06 for the LA conduit function, and 14.17 for the LA booster-pump function; the strain was significantly correlated with the LA fractional volume change at each phasic function. The left atrial longitudinal strain during early ventricular diastole showed moderate correlation with the peak velocity of early diastolic transmitral flow (r = 0.5560) and ratio of peak velocity of early diastolic transmitral flow to peak velocity of late transmitral flow (r = 0.5515). In multiple regression analysis, only age was significantly related to the strain/SR and volumetric change indices, indicating conduit function.

CONCLUSIONS

Left atrial speckle tracking echocardiographic analysis provided useful information to assess the LA function in healthy dogs. The influencing factors on strain and SR variables including the age, body weight, and heart rate should be considered in interpretation of these parameters in a clinical setting.

Pharmacological and Model-based Interpretation of Neuronal Dynamics Transitions during Sleep-Waking Cycle

Power spectral analysis has been applied to spontaneous single neuronal activities during the sleep-waking cycle in various regions of the cat’s central nervous system. During slow-wave sleep (SWS), the spontaneous activities of many neurons had a white noise-like power-spectral density profile in a very low frequency range (0.01-1.0 Hz) whereas, during rapid-eye-movement sleep (REMS), they showed a 1/f-like spectral pattern. This spectral transition between SWS and REMS was hypothesized to depend on the influence of serotonergic and cholinergic neuronal activity which is considered to modulate various brain functions. According to both pharmacological experiments and simulation studies with a neural network model, it was concluded that the serotonergic system may have a function to eliminate slow fluctuations in neuronal activity in wide areas, from the reticulothalamo-neocortical to the limbic systems. Consequently, simple signal processing of spontaneous neuronal activity has elucidated an important neurophysiological fact, which may lead to a principle of the basic brain function and its mechanism.

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases

Background

Transcranial Doppler ultrasound examination (TCD) is a rapid, noninvasive technique used to evaluate cerebral blood flow and is useful for the detection of intracranial hypertension in humans. However, the clinical usefulness of TCD in diagnosing intracranial hypertension has not been demonstrated for intracranial diseases in dogs.

Objectives

To determine the association between the TCD variables and intracranial hypertension in dogs with intracranial diseases.

Animals

Fifty client‐owned dogs with neurologic signs.

Methods

Cross‐sectional study. All dogs underwent TCD of the basilar artery under isoflurane anesthesia after magnetic resonance imaging (MRI). Dogs were classified into 3 groups based on MRI findings: no structural diseases (group I), structural disease without MRI evidence of intracranial hypertension (group II), and structural disease with MRI evidence of intracranial hypertension (group III). The TCD vascular resistance variables (resistive index [RI], pulsatility index [PI], and the ratio of systolic to diastolic mean velocity [Sm/Dm]) were measured.

Results

Fifteen, 22, and 13 dogs were classified into groups I, II, and III, respectively. Dogs in group III had significantly higher Sm/Dm (median, 1.78; range, 1.44–2.58) than those in group I (median, 1.63; range, 1.43–1.75) and group II (median, 1.62; range, 1.27–2.10). No significant differences in RI and PI were identified among groups.

Conclusions and Clinical Importance

Our findings suggest that increased Sm/Dm is associated with MRI findings of suspected intracranial hypertension in dogs with intracranial diseases and that TCD could be a useful tool to help to diagnose intracranial hypertension.

Washout Ratio in the Hepatic Vein Measured by Contrast-Enhanced Ultrasonography to Distinguish Between Inflammatory and Noninflammatory Hepatic Disorders in Dogs

Background

Perflubutane microbubbles, a second‐generation ultrasound contrast agent, are phagocytized by Kupffer cells. This characteristic may be useful to differentiate diffuse hepatic diseases in dogs.

Hypothesis/objectives

To determine whether the washout ratio in the hepatic vein (HV) measured by contrast‐enhanced ultrasonography (CEUS) can distinguish between inflammatory and noninflammatory hepatic disorders in dogs.

Animals

Forty‐one client‐owned dogs with hepatic disorders including 14 with hepatitis, 7 with primary hypoplasia of the portal vein (PHPV), 9 with congenital portosystemic shunt (cPSS), and 11 with other hepatopathy were enrolled. Six dogs without hepatic disease also were evaluated as healthy controls.

Methods

Dogs with hepatic disorders were prospectively included. Contrast‐enhanced ultrasonography of the HV was performed for 2 minutes. Washout ratio was defined as the attenuation rate from peak intensity to the intensity at the end of the CEUS study.

Results

Washout ratio in the hepatitis group (median, 18.0%; range, 2.0–37.0%) was significantly lower than that of the PHPV (median, 52.2%; range, 11.5–86.3%), cPSS (median, 60.0%; range, 28.6–77.4%), other hepatopathy (median, 70.5%; range, 26.6–88.4%), and normal (median, 78.0%; range, 60.7–91.7%) groups. The area under the receiver operating characteristic curve for hepatitis was 0.960, with a 95% confidence interval (CI) of 0.853–0.990. Washout ratio ≤37.1% resulted in a sensitivity of 100% (95% CI, 78.5–100%) and specificity of 85.2% (95% CI, 67.5–94.1%) for the prediction of hepatitis.

Conclusions and Clinical Importance

Washout ratio can distinguish hepatitis from the other noninflammatory disorders with high accuracy. This result might reflect impaired Kupffer cell phagocytosis in dogs with hepatitis.

Left Atrial Strain at Different Stages of Myxomatous Mitral Valve Disease in Dogs

Background

Decreased function of the left atrium (LA) is a useful prognostic indicator in dogs with myxomatous mitral valve disease (MMVD). In humans, LA strain is a novel severity indicator of mitral regurgitation, but its clinical utility in dogs has not been confirmed.

Objectives

To examine whether LA strain as evaluated with speckle‐tracking echocardiography is associated with MMVD stage in dogs.

Animals

Fifty‐two client‐owned dogs with MMVD.

Methods

Cross‐sectional study. Dogs were classified as stage B1, B2, C, or D, according to the American College of Veterinary Internal Medicine consensus. Physical examination findings and echocardiographic variables were compared among the groups. To assess the comparative accuracy of echocardiographic variables in identifying dogs with the presence or history congestive heart failure (CHF), receiver operating characteristic curves and multivariate logistic analysis were used.

Results

There were no significant differences in parameters of LA strain between B1 and B2 groups. However, LA longitudinal strain during atrial contraction (ε_A) (median, 19.1%; interquartile range, 15.3–24.3% in B1, 19.6%; 14.1–21.4% in B2, 6.2%; 3.18–11.2% in C/D) and during ventricular systole (ε_S) (32.7%; 28.9–39.2% in B1, 35.6%; 31.7–41.9% in B2, 23.6%; 16.9–26.1% in C/D) were significantly lower in stages C/D than in stages B1 and B2. In multivariate logistic regression analysis, ε_A and peak early diastolic mitral inflow velocity were identified as independent indicators of stage C/D.

Conclusions and Clinical Importance

ε_A was the best predictor of the presence or history of CHF. Further studies are needed to determine the clinical implications of these findings for treatment decisions and prognosis determination.

Localization of Toll-like Receptor (TLR) 2 and TLR4 mRNA in the Colorectal Mucosa of Miniature Dachshunds with Inflammatory Colorectal Polyps

Inflammatory colorectal polyps (ICRPs) are characterized by the formation of multiple or solitary polyps with marked neutrophil infiltration in the colorectal area, and are speculated to be a novel form of breed-specific canine idiopathic inflammatory bowel disease (IBD). In human IBD, toll-like receptor (TLR) 2 and TLR4 have been reported to be involved in the pathogenesis of the disease. The aim of this study was to evaluate the expression of TLR2 and TLR4 mRNA in the colorectal mucosa of dogs with ICRPs by in-situ hybridization using an RNAscope assay. Samples of inflamed colorectal mucosa (n = 5) and non-inflamed mucosa (n = 5) from miniature dachshunds (MDs) with ICRPs and colonic mucosa from healthy beagles (n = 5) were examined. TLR2 and TLR4 hybridization signals were localized to the colorectal epithelium, inflammatory cells and fibroblasts in the inflamed colorectal mucosa of affected dogs. The signals were significantly greater in inflamed colorectal epithelium compared with non-inflamed epithelium of MDs with ICRPs and healthy beagles (P <0.05). These results suggest that increased expression of TLR2 and TLR4 mRNA in the inflamed colorectal mucosa results from not only inflammatory cell infiltration, but also the upregulation of TLR2 and TLR4 mRNA in the colonic epithelium.

Two Cases of Feline Malignant Craniopharyngioma

Tumors at the cranial base in 2 cats (a 9 1/2-year-old, castrated male Chinchilla and a 7-year-old, castrated male American shorthair) were diagnosed as malignant craniopharyngioma. The tumor lesion was histopathologically divided into four parts: 1) a small acinus part, in which relatively large cells with a pale cytoplasm composed small acini; 2) a duct part, in which small cuboidal cells composed ducts; 3) a cyst part, in which there were large cysts lined with flat cells; and 4) a pavement part, in which large multiangular-shaped cells proliferated in a pavement pattern. The epithelial cells of some parts were positive for keratin by immunohistochemistry. Histopathologic findings of the present feline cases were identical to those of malignant craniopharyngioma in other animal species.

Development of a compact ECR ion source for various ion production

There is a desire that a carbon-ion radiotherapy facility will produce various ion species for fundamental research. Although the present Kei2-type ion sources are dedicated for the carbon-ion production, a future ion source is expected that could provide: (1) carbon-ion production for medical use, (2) various ions with a charge-to-mass ratio of 1/3 for the existing Linac injector, and (3) low cost for modification. A prototype compact electron cyclotron resonance (ECR) ion source, named Kei3, based on the Kei series has been developed to correspond to the Kei2 type and to produce these various ions at the National Institute of Radiological Sciences (NIRS). The Kei3 has an outer diameter of 280 mm and a length of 1120 mm. The magnetic field is formed by the same permanent magnet as Kei2. The movable extraction electrode has been installed in order to optimize the beam extraction with various current densities. The gas-injection side of the vacuum chamber has enough space for an oven system. We measured dependence of microwave frequency, extraction voltage, and puller position. Charge state distributions of helium, carbon, nitrogen, oxygen, and neon were also measured.

Prognostic Value of Right Ventricular Tei Index in Dogs with Myxomatous Mitral Valvular Heart Disease

BACKGROUND

The right ventricular (RV) Tei index (TX) has a significant correlation with the severity of pulmonary hypertension. However, the role of RV dysfunction in dogs with myxomatous mitral valvular heart disease (MMVD) has not been addressed.

OBJECTIVES

To investigate the correlation between right ventricular Tei-index (RVTX) and the prognosis for dogs with MMVD.

ANIMALS

Thirty client-owned dogs with MMVD.

METHODS

Clinical cohort study. Dogs were divided into two groups on the basis of the onset of cardiac-related death within 1 year of the first echocardiographic examination. Physical examination and echocardiographic variables were compared between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic analysis were used to assess the comparative accuracy when identifying dogs with cardiac-related death.

RESULTS

The highest accuracy was obtained for RVTX with an area under the ROC curve (AUC) of 0.95 (95% confidence interval [CI] 0.81-0.99) followed by the left atrial to aortic root ratio with an AUC of 0.91 (95% CI 0.74-0.98), peak early diastolic mitral inflow velocity with an AUC of 0.84 (95% CI 0.64-0.94), and Doppler estimates of systolic pulmonary artery pressure with an AUC of 0.84 (95% CI 0.61-0.95). According to the multivariate logistic regression analysis, RVTX was the only independent correlate of cardiac-related death within 1 year.

CONCLUSIONS AND CLINICAL IMPORTANCE

Right ventricular Tei-index has a strong correlation with the prognosis for dogs with MMVD. The most significant independent predictor of death was RVTX in this study.

Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study

BACKGROUND

This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness.

METHODS

Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance.

RESULTS

Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02).

CONCLUSIONS

After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov:NCT01479764.

Vitamin D Status in Different Stages of Disease Severity in Dogs with Chronic Valvular Heart Disease

Background

In humans with heart disease, vitamin D deficiency is associated with disease progression and a poor prognosis. A recent study showed that serum 25‐hydroxyvitamin D [25(OH)D] concentration, the hallmark of vitamin D status, was lower in dogs with heart failure than in normal dogs, and a low concentration was associated with poor outcome in dogs with heart failure.

Objectives

To elucidate the vitamin D status of dogs with chronic valvular heart disease (CVHD) at different stages of disease severity.

Animals

Forty‐three client‐owned dogs with CVHD.

Methods

In this cross‐sectional study, dogs were divided into 3 groups (14 dogs in Stage B1, 17 dogs in Stage B2, and 12 dogs in Stage C/D) according to ACVIM guidelines. Dogs underwent clinical examination including echocardiography. Serum 25(OH)D concentrations were measured in each dog.

Results

Serum 25(OH)D concentration was significantly lower in Stage B2 (median, 33.2 nmol/L; range, 4.9–171.7 nmol/L) and C/D (13.1 nmol/L; 4.9–58.1 nmol/L) than in Stage B1 (52.5 nmol/L; 33.5–178.0 nmol/L) and was not significantly different between Stage B2 and Stage C/D. Among clinical variables, there were significant negative correlations between 25(OH)D concentration and both left atrial‐to‐aortic root ratio and left ventricular end‐diastolic diameter normalized for body weight.

Conclusions and Clinical Importance

These results indicate that vitamin D status is associated with the degree of cardiac remodeling, and the serum 25(OH)D concentration begins to decrease before the onset of heart failure in dogs with CVHD.

Quantitative contrast-enhanced ultrasonographic assessment of naturally occurring pancreatitis in dogs

BACKGROUND

Quantitative contrast-enhanced ultrasonography (CEUS) can detect pancreatic perfusion changes in experimentally induced canine pancreatitis. However, its usefulness in detecting perfusion changes in naturally occurring pancreatitis is unclear.

HYPOTHESIS/OBJECTIVES

To determine the feasibility of using CEUS to detect pancreatic and duodenal perfusion changes in naturally occurring canine pancreatitis.

ANIMALS

Twenty-three client-owned dogs with pancreatitis, 12 healthy control dogs.

METHODS

Dogs diagnosed with pancreatitis were prospectively included. CEUS of the pancreas and duodenum were performed. Time-intensity curves were created from regions of interest in the pancreas and duodenum. Five perfusion parameters were obtained for statistical analyses: time to initial up-slope, peak time (Tp), time to wash-out (TTW), peak intensity (PI), and area under the curve (AUC).

RESULTS

For the pancreas, Tp of the pancreatitis group was prolonged when compared to controls (62 ± 11 seconds versus 39 ± 13 seconds; P < .001). TTW also was prolonged but not significantly (268 ± 69 seconds versus 228 ± 47 seconds; P = .47). PI and AUC were increased when compared to controls (95 ± 15 versus 78 ± 13 MPV; P = .009 and 14,900 ± 3,400 versus 11,000 ± 2,800 MPV*s; P = .013, respectively). For the duodenum, PI and AUC were significantly increased in the pancreatitis group when compared to controls.

CONCLUSIONS AND CLINICAL IMPORTANCE

Contrast-enhanced ultrasonography can detect pancreatic perfusion changes in naturally occurring canine pancreatitis characterized by delayed peak with prolonged hyperechoic enhancement of the pancreas on CEUS. Additionally, duodenal perfusion changes secondary to pancreatitis were observed.

Qualitative and quantitative contrast-enhanced ultrasonographic assessment of cerulein-induced acute pancreatitis in dogs

Background

Acute pancreatitis (AP) is the most common disease of the canine exocrine pancreas, and accurate noninvasive diagnosis is challenging.

Hypothesis/Objectives

To determine the feasibility of using quantitative contrast‐enhanced ultrasonography (CEUS) to detect pancreatic perfusional changes in cerulein‐induced AP in dogs.

Animals

Six adult female Beagles.

Methods

Each dog received 2 hours of IV infusion with 7.5 μg/kg/h of cerulein diluted in saline. As control, all dogs received 2 hours of IV infusion of saline 2 weeks before cerulein infusion. CEUS of the pancreas and duodenum were performed before (0 hour), and at 2, 4, 6, and 12 hours after saline and cerulein infusion. Time‐intensity curves were created from regions of interest in the pancreas and duodenum. Five perfusional parameters were measured for statistical analysis: time to initial up‐slope, peak time, time to wash‐out, peak intensity (PI), and area under the curve (AUC).

Results

In cerulein‐induced AP, pancreatic PI increased at 2 and 4 hours when compared to 0 hour, and at 2, 4, and 6 hours when compared to control. AUC increased at 4 hours when compared to 0 hour, and at 2 and 4 hours when compared to control. Time to wash‐out was prolonged at 4 hours when compared to control. For saline control, peak time was faster at 2 hours when compared to 0 hour.

Conclusions and Clinical Importance

CEUS parameters PI and AUC can provide useful information in differentiating acute pancreatitis from normal pancreas. Cerulein‐induced AP was characterized by prolonged hyperechoic enhancement on CEUS.