Case Report: Successful Intravenous Lipid Emulsion Therapy for Canine Amphetamine Toxicosis

A 4-year-old, female-spayed, mixed breed dog, weighing 24.2 kg, was presented for acute ingestion of ~12.3 mg/kg of Adderall XR^Ⓡ, an extended-release amphetamine medication. In dogs, the oral median lethal dose for amphetamines ranges anywhere from 9–11 mg/kg to 20–27 mg/kg. On presentation, the patient was agitated, tachycardic and hypertensive. Initial treatment was instituted with intravenous lipid emulsion (IVLE) therapy, and baseline and post-treatment amphetamine concentrations were quantified in serum and plasma. In both serum and plasma, post-IVLE concentrations of amphetamine were lower 1 h after treatment and IVLE was the only treatment instituted during this time. The dog improved significantly while in hospital and was discharged <24 h after presentation. This is the first known reported use of IVLE for treatment of amphetamine toxicosis with documented decreases in both serum and plasma amphetamine levels shortly after administration of IVLE.

Effects of oral administration of 5 immunosuppressive agents on activated T-cell cytokine expression in healthy dogs

BACKGROUND

Dogs are often adminstered >1 immunosuppressive medication when treating immune-mediated diseases, and determining whether these different medications affect IL-2 expression would be useful when performing pharmacodynamic monitoring during cyclosporine therapy.

HYPOTHESIS/OBJECTIVES

To determine the effects of 5 medications (prednisone, cyclosporine, azathioprine, mycophenolate mofetil, and leflunomide) on activated T-cell expression of the cytokines IL-2 and interferon-gamma (IFN-γ).

ANIMALS

Eight healthy dogs.

METHODS

Randomized, cross-over study comparing values before and after treatment, and comparing values after treatment among drugs. Dogs were administered each drug at standard oral doses for 1 week, with a washout of at least 21 days. Activated T-cell expression of IL-2 and IFN-γ mRNA was measured by quantitative reverse transcription polymerase chain reaction. Blood drug concentrations were measured for cyclosporine, mycophenolate, and leflunomide metabolites.

RESULTS

Least squares means (with 95% confidence interval) before treatment for IL-2 (2.91 [2.32-3.50] ΔCt) and IFN-γ (2.33 [1.66-3.00 ΔCt]) values were significantly lower (both P < .001) than values after treatment (10.75 [10.16-11.34] and 10.79 [10.11-11.46] ΔCt, respectively) with cyclosporine. Similarly, least squares means before treatment for IL-2 (1.55 [1.07-2.02] ΔCt) and IFN-γ (2.62 [2.32-2.92] ΔCt) values were significantly lower (both P < .001) than values after treatment (3.55 [3.06-4.00] and 5.22 [4.92-5.52] ΔCt, respectively) with prednisone. Comparing delta cycle threshold values after treatment among drugs, cyclosporine was significantly different than prednisone (IL-2 and IFN-γ both P < .001), with cyclosporine more suppressive than prednisone.

CONCLUSIONS AND CLINICAL IMPORTANCE

Prednisone and cyclosporine both affected expression of IL-2 and IFN-γ, suggesting that both have the ability to influence results when utilizing pharmacodynamic monitoring of cyclosporine treatment.

Multi-format all-optical processing based on a large-scale, hybridly integrated photonic circuit

We investigate through numerical studies and experiments the performance of a large scale, silica-on-silicon photonic integrated circuit for multi-format regeneration and wavelength-conversion. The circuit encompasses a monolithically integrated array of four SOAs inside two parallel Mach-Zehnder structures, four delay interferometers and a large number of silica waveguides and couplers. Exploiting phase-incoherent techniques, the circuit is capable of processing OOK signals at variable bit rates, DPSK signals at 22 or 44 Gb/s and DQPSK signals at 44 Gbaud. Simulation studies reveal the wavelength-conversion potential of the circuit with enhanced regenerative capabilities for OOK and DPSK modulation formats and acceptable quality degradation for DQPSK format. Regeneration of 22 Gb/s OOK signals with amplified spontaneous emission (ASE) noise and DPSK data signals degraded with amplitude, phase and ASE noise is experimentally validated demonstrating a power penalty improvement up to 1.5 dB.

Reprint of "Three-dimensional elemental mapping of phosphorus by quantitative electron spectroscopic tomography (QuEST)" [J. Struct. Biol. 160 (2007) 35-48]

We describe the development of quantitative electron spectroscopic tomography (QuEST), which provides 3-D distributions of elements on a nanometer scale. Specifically, it is shown that QuEST can be applied to map the distribution of phosphorus in unstained sections of embedded cells. A series of 2-D elemental maps is derived from images recorded in the energy filtering transmission electron microscope for a range of specimen tilt angles. A quantitative 3-D elemental distribution is then reconstructed from the elemental tilt series. To obtain accurate quantitative elemental distributions it is necessary to correct for plural inelastic scattering at the phosphorus L(2,3) edge, which is achieved by acquiring unfiltered and zero-loss images at each tilt angle. The data are acquired automatically using a cross correlation technique to correct for specimen drift and focus change between successive tilt angles. An algorithm based on the simultaneous iterative reconstruction technique (SIRT) is implemented to obtain quantitative information about the number of phosphorus atoms associated with each voxel in the reconstructed volume. We assess the accuracy of QuEST by determining the phosphorus content of ribosomes in a eukaryotic cell, and then apply it to estimate the density of nucleic acid in chromatin of the cell's nucleus. From our experimental data, we estimate that the sensitivity for detecting phosphorus is 20 atoms in a 2.7 nm-sized voxel.

Three-dimensional elemental mapping of phosphorus by quantitative electron spectroscopic tomography (QuEST)

We describe the development of quantitative electron spectroscopic tomography (QuEST), which provides 3-D distributions of elements on a nanometer scale. Specifically, it is shown that QuEST can be applied to map the distribution of phosphorus in unstained sections of embedded cells. A series of 2-D elemental maps is derived from images recorded in the energy filtering transmission electron microscope for a range of specimen tilt angles. A quantitative 3-D elemental distribution is then reconstructed from the elemental tilt series. To obtain accurate quantitative elemental distributions it is necessary to correct for plural inelastic scattering at the phosphorus L(2,3) edge, which is achieved by acquiring unfiltered and zero-loss images at each tilt angle. The data are acquired automatically using a cross correlation technique to correct for specimen drift and focus change between successive tilt angles. An algorithm based on the simultaneous iterative reconstruction technique (SIRT) is implemented to obtain quantitative information about the number of phosphorus atoms associated with each voxel in the reconstructed volume. We assess the accuracy of QuEST by determining the phosphorus content of ribosomes in a eukaryotic cell, and then apply it to estimate the density of nucleic acid in chromatin of the cell's nucleus. From our experimental data, we estimate that the sensitivity for detecting phosphorus is 20 atoms in a 2.7 nm-sized voxel.

National Bioterrorism Syndromic Surveillance Demonstration Program

The National Bioterrorism Syndromic Surveillance Demonstration Program identifies new cases of illness from electronic ambulatory patient records. Its goals are to use data from health plans and practice groups to detect localized outbreaks and to facilitate rapid public health follow-up. Data are extracted nightly on patient encounters occurring during the previous 24 hours. Visits or calls with diagnostic codes corresponding to syndromes of interest are counted; repeat encounters are excluded. Daily counts of syndromes by zip code are sent to a central data repository, where they are statistically analyzed for unusual clustering by using a model-adjusted SaTScan approach. The results and raw data are displayed on a restricted website. Patient-level information stays at the originating health-care organization unless required by public health authorities. If a cluster surpasses a threshold of statistical aberration chosen by the corresponding public health department, an electronic alert can be sent to that department. The health department might then call a clinical responder, who has electronic access to records of cases contributing to clusters. The system is flexible, allowing for changes in participating organizations, syndrome definitions, and alert thresholds. It is transparent to clinicians and has been accepted by the health-care organizations that provide the data. The system's data are usable by local and national health agencies. Its software is compatible with commonly used systems and software and is mostly open-source. Ongoing activities include evaluating the system's ability to detect naturally occurring outbreaks and simulated terrorism events, automating and testing alerts and response capability, and evaluating alternative data sources.

Fear of intimacy among dating couples

Fear of intimacy among heterosexual dating couples was examined with the Fear-of-Intimacy Scale (FIS) and the Personal Assessment of Intimacy in Relationships (PAIR). Following a 6-month interval, couples were again contacted to determine whether they continued to date. Males reported higher FIS scores than females, and FIS scores were positively correlated within couples. Also, FIS scores of males and females were significantly correlated with indices of actual and desired intimacy; however, for females, correlations of FIS scores with desired intimacy were significantly lower than correlations with actual intimacy. Females who were no longer in the dating relationship at the 6-month follow-up had higher FIS scores than those who were continuing in their dating relationship. These findings increase our understanding of fear of intimacy, especially gender differences in dating couples.

Technology management in an information age

Healthcare spending in this country is approaching 15% of the gross national product (GNP) while 1.4 million more Americans have become uninsured in the past 12 months. Although we spend nearly twice what some industrialized nations spend, an increasing number of people do not have access to our healthcare system. To complicate matters, healthcare reform legislation has stalled, leaving hospitals without a clear sense of direction. Yet, even without federal mandates, hospitals need to be more cost effective. Reform will occur regardless of whether it is driven by legislation, private payers, or marketplace competition. Successful hospitals in the post reform era will maintain or raise their quality standards while reducing operating expenses. The key question is: How can one do more with less? The answer, of course, is better resource management. To achieve real gains, however, it will be important to think of these resources in new ways. Typically hospitals have focused on managing human and capital resources, and many have undertaken initiatives to improve productivity and preserve financial reserves. But to be successful in the new era, you must define resources in non-traditional ways, then develop new strategies to manage them. This article suggests that technology is a resource that can be managed. A straightforward method for identifying a manageable, representative set of core technologies will be described. Once this informational baseline is established, the costs associated with a hospital's technology infrastructure can be estimated and summarized. Then, "if you can measure it, you can manage it." A template for a four-phase technology management program is proposed.

Specific genetic variants of Actinobacillus actinomycetemcomitans correlate with disease and health in a regional population of families with localized juvenile periodontitis

A geographically homogeneous population of 83 subjects, from 21 families with localized juvenile periodontitis (LJP), and 35 healthy control subjects was monitored, over a 5-year period, for the presence of the periodontal pathogen Actinobacillus actinomycetemcomitans. Restriction fragment length polymorphism (RFLP) analysis was used to monitor the distribution of genetic variants of this bacterium in LJP-susceptible subjects that converted from a healthy to a diseased periodontal status. A. actinomycetemcomitans was cultured from 57% of the LJP family members accessioned into the study. Nine of 36 LJP-susceptible subjects, in seven families, developed signs of periodontal destruction. All but one of these conversion subjects harbored A. actinomycetemcomitans. Bacterial variants representative of a single RFLP group (II) showed the strongest correlation with conversion (P < 0.002). Six of nine conversion subjects were infected with A. actinomycetemcomitans from this group. RFLP group II variants also prevailed in 8 of 22 probands but were absent in the 35 healthy control subjects. In contrast to the selective distribution of group II variants is diseased individuals, variants belonging to RFLP groups XIII and XIV were found exclusively in the control subjects. Thus, the use of RFLP to type clinical isolates of A. actinomycetemcomitans has resulted in the identification of genetic variants that predominate in LJP and health. These results indicate that studies concerned with the pathogenicity of this bacterium in LJP should be focused on the group II variants.

Reliability study of detection of somatic dysfunctions in the cervical spine

A reliability study was conducted to determine whether palpatory findings on the cervical spine, obtained under normal chiropractic clinical conditions were reproducible. Forty normal freshman chiropractic students underwent static and motion palpation of their cervical spines by three different chiropractors. Intra- and inter-examiner reliability of findings was assessed by concordance statistics (weighted kappa). There was statistically significant agreement of findings for all three examiners only for fixations in the lower cervical spine. There was a total lack of statistical agreement of fixation findings, both intra- and inter-examiner, in the middle cervical area. Agreement of fixation findings was intermediate for the upper cervicals and also for the other palpation parameters that were used (e.g. muscle spasms and pain) throughout the cervical spine. The results generally indicate a relatively high level of replicability of palpatory findings in a normal asymptomatic population by 'typical' chiropractors. The relation of these palpatory findings to vertebral lesions, or subluxations, are unknown.