Demonstration of Single-Barium-Ion Sensitivity for Neutrinoless Double-Beta Decay Using Single-Molecule Fluorescence Imaging

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2  nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

Quantification of Urine Elimination Behaviors in Cats with a Video Recording System

Background

Urinary disorders in cats often require subjective caregiver quantification of clinical signs to establish a diagnosis and monitor therapeutic outcomes.

Objective

To investigate use of a video recording system (VRS) to better assess and quantify urination behaviors in cats.

Animals

Eleven healthy cats and 8 cats with disorders potentially associated with abnormal urination patterns.

Methods

Prospective study design. Litter box urination behaviors were quantified with a VRS for 14 days and compared to daily caregiver observations. Video recordings were analyzed by a behavior analysis software program.

Results

The mean number of urinations per day detected by VRS (2.5 ± 0.7) was significantly higher compared with caregiver observations (0.6 ± 0.6; P < .0001). Five cats were never observed in the litter box by their caregivers. The mean number of urinations per day detected by VRS was significantly higher for abnormal cats (2.9 ± 0.7) compared with healthy cats (2.1 ± 0.7; P = .02); there were no apparent differences in frequency between these groups reported by caregivers (0.7 ± 1.0 and 0.5 ± 1.0, respectively). There were no differences in mean urination time between healthy and abnormal cats as determined by VRS or caregivers. Mean cover‐up time determined by VRS was significantly longer in healthy cats (22.7 ± 12.9 seconds/urination) compared with abnormal cats (8.7 ± 12.9 seconds/urination; P = .03); differences in cover‐up time were not detected by caregivers.

Conclusions and Clinical Importance

Caregivers commonly underestimate urination frequency in cats when compared to video‐based observations. Video recording appears to facilitate objective assessment of urination behaviors and could be of value in future clinical studies of urinary disorders in cats.

Factors associated with long-term survival in dogs undergoing liver lobectomy as treatment for liver tumors

The objectives of the study were to describe clinicopathologic findings in dogs that underwent surgical treatment of liver tumors and to define outcome-associated variables in this canine population. Medical records of 118 dogs that underwent liver lobectomy were reviewed. Variables were assessed via univariate and multivariate Cox regression analyses. Hazard ratios, median survival times (MSTs), and Kaplan-Meier Survival curves (KMSCs) were created for significant variables. Of the dogs with surgically addressed hepatic tumors, 93% survived to discharge. The MST was not reached. Lethargic dogs had a mortality risk 10.2 times that of non-lethargic dogs. Non-tachypneic dogs had a mortality risk 4.3 times that of tachypneic dogs. Dogs that experienced anesthetic complications had a mortality risk 100 times that of dogs that did not. We conclude that the prognosis associated with liver tumors is good. Lethargy, respiratory rate, and anesthetic complications were associated with outcome.

Evaluation of percutaneously adjustable hydraulic urethral sphincters with and without induced mechanical failure

OBJECTIVE

To describe (1) the radiographic appearance of intact hydraulic urethral sphincters (HUS) and (2) the success of leak detection using clinically feasible methods.

STUDY DESIGN

Prospective, blinded in vitro study.

SAMPLE POPULATION

Thirty HUS devices (10 each of 8, 10, and 12 mm diameter sizes).

MATERIALS AND METHODS

All devices were inflated with saline (0.9% NaCl) solution to complete occlusion, inspected, and weighed over a 24-hour period for manufacturing defects. HUS phantoms were created to mimic surrounding soft tissues. One randomly selected HUS of each size was evaluated radiographically at different inflation volumes and angles. All HUS systems were then evaluated in random order before and after puncture with volumetry, manometry, radiography, and contrast fluoroscopy. Volumetry was the total volume (mL) retrieved from each HUS system. Manometry was the pressure (cm H2 O) within each HUS system. The HUS devices were filled to a known volume before each measurement.

RESULTS

When all HUS sizes were considered, volumetry did not reveal significant differences before and after puncture, but manometry was significantly different (P < .001). Radiography was 63.8% sensitive and 88.3% specific for puncture diagnosis, with inter-observer agreement of 0.58. Contrast fluoroscopy was 78.4% sensitive and 100% specific, with inter-observer agreement of 0.97.

CONCLUSIONS

Of those methods tested, contrast fluoroscopy was the most sensitive, specific, and consistent method of leak detection. Manometry was also helpful, but may be difficult to use clinically. Volumetry and radiography were relatively poor indicators of leakage in this model.

Dynamic mobilisation exercises increase cross sectional area of musculus multifidus

REASON FOR PERFORMING STUDY

In human subjects with back pain, the deep spinal stabiliser m. multifidus is inhibited ipsilaterally leading to atrophy, asymmetry and intervertebral instability. Specific physiotherapeutic exercises are required to reactivate m. multifidus. This study assesses the effect of dynamic mobilisation exercises on size and symmetry of m. multifidus in the equine caudal thoracic and lumbar spine.

HYPOTHESES

Regular performance of dynamic mobilisation exercises over a period of 3 months increases cross sectional area (CSA) and left-right symmetry of m. multifidus muscles in the caudal thoracic and lumbar spine.

METHODS

Eight horses performed dynamic mobilisation exercises (3 cervical flexions, one cervical extension and 3 lateral bending exercises to the left and right sides) with 5 repetitions/exercise/day on 5 days/week for 3 months during which time they were not ridden. Left and right m. multifidus CSA was measured ultrasonographically at 6 levels from T10 to L5 at the start (initial evaluation) and end (final evaluation) of the 3 month study. Changes in CSA of the right and left m. multifidus muscles and symmetry of m. multifidus CSA on the right and left sides between the 2 evaluations were sought using analysis of variance (P<0.05).

RESULTS

Between the initial evaluation and final evaluation m. multifidus CSA increased significantly at all 6 spinal levels on both right and left sides. Asymmetries in m. multifidus CSA between the right and left sides decreased between the initial and final evaluations.

CONCLUSIONS

Hypertrophy of multifidus occurred over a 3 month period during which dynamic mobilisation exercises were the only exercise performed.

POTENTIAL RELEVANCE

Dynamic mobilisation exercises maybe a useful rehabilitative technique for horses in which m. multifidus has atrophied in response to back pain.

Contrast-enhanced ultrasound of the feline kidney

Contrast-enhanced ultrasound offers a noninvasive means of subjectively and quantitatively evaluating renal perfusion in cats with renal disease, or in renal transplant patients. In this study, we characterized the pattern of ultrasonographic contrast enhancement in 16 normal feline kidneys in eight cats using contrast-enhanced power Doppler and contrast-enhanced harmonic ultrasound techniques. Mean time to peak contrast enhancement for the whole kidney was longer using contrast-enhanced harmonic ultrasound (16.8s, SD 4.7s) than contrast-enhanced power Doppler ultrasound (12.2s, SD 1.8s). The time to peak enhancement for the cortex alone in contrast-enhanced harmonic ultrasound was 13s (SD 3.2s), and for the renal medulla was 25.5s (SD 8.7s). The half time for washout of contrast agent was 39s (SD 14.5s) for contrast-enhanced harmonic ultrasound. The pattern of contrast enhancement in these normal feline kidneys can be used as normal reference values for the evaluation of clinical patients. Contrast-enhanced harmonic ultrasound may allow the differentiation between cortical and medullary perfusion patterns.

Intermittent and continuous enteral nutrition in critically ill dogs: a prospective randomized trial

BACKGROUND

Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals.

OBJECTIVES

To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit.

ANIMALS

Fifty-four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube.

METHODS

Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured.

RESULTS

PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation.

CONCLUSIONS AND CLINICAL IMPORTANCE

There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding.

Investigation on the effects of ciclosporin (Atopica) on intradermal test reactivity and allergen-specific immunoglobulin (IgE) serology in atopic dogs

The ability to use ciclosporin (Atopica®: Novartis Animal Health, Greensboro, NC, USA) prior to intradermal testing (IDT) would help avoid exacerbation of clinical disease that can be associated with drug withdrawal. This study evaluated the effects of 30 days of administration of ciclosporin at a dose of 5 mg/kg once daily on IDT reactivity (immediate phase reactions) in a group of dogs with atopic dermatitis (AD) with initial positive IDT reactions. 16 dogs diagnosed with AD were included in the study. Eight dogs (group A) were treated with ciclosporin orally at 5 mg/kg once daily for 30 days. Eight dogs (group P) were treated with a placebo orally once daily for 30 days. IDT was performed at day 0 and day 30 on all dogs enrolled using a standardized panel of 45 aqueous allergens (Greer Laboratories, Lenoir, NC, USA) appropriate to our geographical region. IDT reactivity was assessed by both subjective and objective methods at 15 min post-intradermal injection. Serum for allergen-specific immunoglobulin (IgE) serology was obtained at day 0 and day 30. The study was designed as a double-blinded, placebo-controlled, cross-over study. Data were analysed using a split-plot analysis of variance with the grouping factor of treatment and the repeat factor of time (SAS System for Windows). At week 4, ciclosporin did not have a statistically significant effect on IDT reactivity or serology results. It therefore appears that, no withdrawal is recommended to evaluate immediate phase reactions.

Endoscopic scoring of mucus quantity and quality: observer and horse variance and relationship to inflammation, mucus viscoelasticity and volume

REASONS FOR PERFORMING STUDY

Endoscopic scoring of airway mucus quantity and quality has not been critically assessed.

OBJECTIVES

To evaluate mucus scores for 1) observer- and horse-related variance and 2) association with inflammation, mucus viscoelasticity and measured volume.

METHODS

Variance of scoring within and between observers and over time within horses were determined for airway mucus accumulation, apparent viscosity, localisation and colour, and correlations of mucus accumulation scores with neutrophil ratios in secretions. The relationship of accumulation score to measured volumes of 'artificial mucus' was investigated. Correlations of mucus accumulation, apparent viscosity and colour scores with measured viscoelasticity were tested. Viscoelasticity was compared between tracheal secretion samples collected ventrally and dorsally.

RESULTS

Mucus accumulation scoring showed excellent interobserver agreement and moderate horse-related variance, was related to measured volumes of 'artificial mucus', and correlated well with neutrophilic airway inflammation. Scores of mucus viscosity, colour and localisation showed high observer-related variance. Mucus accumulation, apparent viscosity and colour scores did not correlate with measured tracheal mucus viscoelasticity, but dorsally-localised mucus showed 2-fold higher measured viscoelasticity than ventrally-localised samples.

CONCLUSIONS

Mucus accumulation scores are a reproducible measure of mucus volumes in the trachea.

POTENTIAL RELEVANCE

Endoscopic scoring of mucus accumulation is a reliable clinical and research tool. In contrast, apparent viscosity, localisation and colour scores should be interpreted with caution.

Orlistat 120 mg improves glycaemic control in type 2 diabetic patients with or without concurrent weight loss

BACKGROUND

Both obesity and type 2 diabetes are associated with increased morbidity and mortality. Published data suggest that orlistat 120 mg, a lipase inhibitor used to treat obesity, may improve glycaemic parameters through weight loss-independent effects.

AIM

To investigate the effect of orlistat 120 mg on weight loss, and assess whether changes in glycaemic parameters [fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c)] are independent of weight loss.

METHODS

This retrospective analysis of pooled data from seven multicentre, double-blind, placebo-controlled studies involved overweight or obese patients with type 2 diabetes (aged 18-70 years). Patients were required to have a body mass index of 27-43 kg/m2, HbA1c of 6.5 to <13%, and stable weight for > or =3 months. Subjects received orlistat 120 mg tid or placebo for 6 or 12 months.

RESULTS

A total of 2550 overweight or obese patients with type 2 diabetes were enrolled and randomized to treatment with orlistat 120 mg tid (n = 1279) or placebo (n = 1271). For the whole population, patients treated with orlistat 120 mg had significantly greater mean decreases in FPG compared with placebo-treated patients (-1.39 mmol/l vs. -0.47 mmol/l; p < 0.0001). In addition, orlistat 120 mg provided significantly larger mean decreases in HbA1c compared with placebo (-0.74% vs. -0.31%; p < 0.0001). For patients with minimal weight loss (< or =1% of baseline body weight), orlistat 120 mg still provided a significantly greater decrease in the least squares mean value for both FPG (-0.83 mmol/l vs. +/-0.02 mmol/l; p = 0.0052) and HbA1c -0.29% vs. +/-0.14%; p = 0.0008). This suggested that the improvement of glycaemic control with orlistat 120 mg was independent of weight loss. Using linear regression analysis, improvement in glycaemic control (FPG and HbA1c) with orlistat 120 mg was less strongly correlated with weight loss than for placebo.

CONCLUSION

Orlistat 120 mg appears to improve glycaemic control more than would be predicted by weight loss alone in overweight or obese patients with type 2 diabetes. Postulated mechanisms underlying this effect include an improvement of insulin sensitivity, a slower and incomplete digestion of dietary fat, reduction of postprandial plasma non-esterified fatty acids, decreased visceral adipose tissue, and stimulation of glucagon-like peptide-1 secretion in the lower small intestine.

Left lateral and left middle liver lobe torsion in a Saint Bernard puppy

A 5-month-old, male Saint Bernard was presented for acute collapse and abdominal discomfort. Significant findings were a cranial abdominal mass, hemorrhagic abdominal effusion, anemia, and disseminated intravascular coagulation. An exploratory surgery revealed torsion of both the left lateral and middle liver lobes, a condition that has not been previously described in the veterinary literature. Torsion of one or more hepatic lobes is a rare condition but should be considered as a differential diagnosis for acute abdomen syndrome in both young and mature dogs. Early diagnosis and prompt surgical intervention may be curative.

Use of atropine to reduce mucosal eversion during intestinal resection and anastomosis in the dog

OBJECTIVE

To determine whether atropine altered the degree of mucosal eversion during jejunal resection and anastomosis in the dog.

STUDY DESIGN

Part I: Prospective, blinded, randomized, controlled study using a therapeutic dose (0.04 mg/kg systemic) of atropine. Part II: Prospective, unblinded, assigned, controlled study using a pharmacologic (0.04 mg/kg local arterial) dose of atropine.

ANIMALS

Part I: Twenty-two young adult female Beagle dogs used during a nonsurvival third-year veterinary student surgical laboratory (small intestinal resection and anastomosis). Part II: Ten young adult female Beagle dogs used immediately after completion of a nonsurvival third-year veterinary student orthopedic surgical laboratory.

METHODS

Part I: Dogs were randomly assigned to receive either atropine (0.04 mg/kg), or an equal volume of saline, given intramuscularly (premedication) and again intravenously prior to intestinal resection. Part II: In each dog, atropine (0.04 mg/kg)/saline was alternately given in the proximal/distal jejunum.

RESULTS

Part I: There was no clinically or statistically significant difference between systemic atropine and saline solution on the degree of jejunal mucosal eversion after resection. Part II: There was a statistically significant decrease in jejunal mucosal eversion with atropine compared with saline solution when injected into a local jejunal artery.

CONCLUSION

Systemic atropine (0.04 mg/kg) does not alter the degree of jejunal mucosal eversion during resection and anastomosis. Jejunal intraarterial atropine (0.04 mg/kg) reduced jejunal mucosal eversion during resection and anastomosis.

CLINICAL RELEVANCE

The clinical usefulness and consequences of jejunal arterial atropine administration to reduce mucosal eversion remain to be determined.

Effect of orlistat-assisted weight loss in decreasing coronary heart disease risk in patients with syndrome X

This study describes the changes in risk factors for coronary heart disease in obese persons with syndrome X after orlistat-assisted weight loss. Data were available for 1,700 patients who completed 52 weeks of weight loss; 128 were defined as having syndrome X by being in the quintile with the highest plasma triglyceride levels (>2.2 mM/L) and the lowest high-density lipoprotein cholesterol (HDL, <1.0 mM/L) concentrations. Initial characteristics of those with syndrome X were similar to the 119 subjects (non-syndrome X) in the lowest quintile of plasma triglyceride (<0.975 mM/L) and highest quintile of HDL cholesterol (>1.5 mM/L). Subjects were placed on a calorie-restricted diet, and randomized to receive orlistat or placebo. Initial values were higher in those with syndrome X for diastolic blood pressure (p = 0.03), plasma insulin (p = 0.0001), triglyceride (p = 0.0001) concentrations, and ratio of low-density lipoprotein cholesterol to HDL cholesterol (p = 0.0001), and were lower for HDL cholesterol (p = 0.001) concentrations. Weight loss was greater in both groups of orlistat-treated patients (p = 0.026); in those with syndrome X, it was associated with a significant reduction in plasma insulin (p = 0.019) and triglyceride (p = 0.0001) concentrations, an increase in HDL cholesterol concentration, and a decrease in low-density lipoprotein/HDL cholesterol ratio (p = 0.0001). There were no significant changes in plasma insulin, triglycerides, or HDL cholesterol concentration in the non-syndrome X group. In conclusion, weight loss attenuates coronary heart disease risk factors in obese persons with syndrome X, and the risk factor reduction is enhanced with administration of orlistat.

RCPH modulation of a multi-oscillator network: effects on the pyloric network of the spiny lobster

The neuropeptide red pigment concentrating hormone (RPCH), which we have previously shown to activate the cardiac sac motor pattern and lead to a conjoint gastric mill-cardiac sac pattern in the spiny lobster Panulirus, also activates and modulates the pyloric pattern. Like the activity of gastric mill neurons in RPCH, the pattern of activity in the pyloric neurons is considerably more complex than that seen in control saline. This reflects the influence of the cardiac sac motor pattern, and particularly the upstream inferior ventricular (IV) neurons, on many of the pyloric neurons. RPCH intensifies this interaction by increasing the strength of the synaptic connections between the IV neurons and their targets in the stomatogastric ganglion. At the same time, RPCH enhances postinhibitory rebound in the lateral pyloric (LP) neuron. Taken together, these factors largely explain the complex pyloric pattern recorded in RPCH in Panulirus.

Orlistat: selective inhibition of caloric absorption can affect long-term body weight

Orlistat is a novel, noncentrally acting antiobesity agent that selectively inhibits gastrointestinal lipase activity, thereby reducing the absorption of dietary fat by approximately one-third. In a series of 1- and 2-yr randomized, placebo-controlled trials of obese subjects, treatment with orlistat in combination with a mildly calorie-restricted diet consistently produced significantly greater mean weight loss than diet alone. More orlistat-treated subjects than placebo recipients achieved clinically meaningful weight reduction (> or =5% or > or =10% of initial body weight) after 1 and 2 yr. Orlistat was also associated with a significant reduction in the regain of lost weight during long-term treatment. In addition, orlistat therapy resulted in significant improvements in several cardiovascular risk factors including serum total and low-density lipoprotein-cholesterol, serum insulin levels, systolic and diastolic blood pressure, and waist circumference. Furthermore, obese subjects with type 2 diabetes achieved a significantly greater decrease in body weight with orlistat compared with placebo, as well as significant improvements in HbA1c and fasting glucose levels. Among subjects with impaired glucose tolerance, orlistat compared with placebo reduced the proportion who developed type 2 diabetes. Conversely, orlistat increased the proportion of subjects who achieved a normalization of glucose tolerance. Orlistat acts locally in the gastrointestinal tract and is only minimally absorbed. In long-term clinical trials, orlistat was well tolerated by both diabetic and nondiabetic subjects.

Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults

BACKGROUND

Orlistat is a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, promotes weight loss, and may reduce the risk of developing impaired glucose tolerance and type 2 diabetes in obese subjects.

OBJECTIVE

To test the hypothesis that orlistat combined with dietary intervention improves glucose tolerance status and prevents worsening of diabetes status more effectively than placebo.

METHODS

We pooled data from 675 obese (body mass index, 30-43 kg/m2) adults at 39 US and European research centers in 3 randomized, double-blind, placebo-controlled multicenter clinical trials. Subjects received placebo plus a low-energy diet during a 4-week lead-in period. On study day 1, the diet was continued, and subjects were randomized to receive placebo 3 times a day (n=316) or treatment with orlistat, 120 mg 3 times a day (n=359), for 104 weeks. A standard 3-hour oral glucose tolerance test was performed on day 1 and at the end of treatment.

MAIN OUTCOME MEASURES

The categorical assessment of glucose tolerance status (normal, impaired, diabetic) and changes in status from randomization to end of treatment were the primary efficacy measures. The secondary measures were fasting and postchallenge glucose and insulin levels.

RESULTS

The mean length of follow-up was 582 days. Subjects who were treated with orlistat lost more weight (mean +/- SEM, 6.72 +/- 0.41 kg from initial weight) than subjects who received placebo (3.79+/-0.38 kg; P<.001). A smaller percentage of subjects with impaired glucose tolerance at baseline progressed to diabetic status in the orlistat (3.0%) vs placebo (7.6%) group. Conversely, among subjects with impaired glucose tolerance at baseline, glucose levels normalized in more subjects after orlistat treatment (71.6%) vs placebo (49.1%; P=.04).

CONCLUSIONS

The addition of orlistat to a conventional weight loss regimen significantly improved oral glucose tolerance and diminished the rate of progression to the development of impaired glucose tolerance and type 2 diabetes.

Orlistat in the long-term treatment of obesity in primary care settings

OBJECTIVE

To evaluate the long-term efficacy and tolerability within primary care settings of orlistat, a gastrointestinal lipase inhibitor, for the treatment of obesity.

DESIGN

Randomized, double-blind, placebo-controlled, multicenter study.

PARTICIPANTS

A group of 796 obese patients (body mass index, 30-44 kg/m2), treated with placebo 3 times a day (TID), 60 mg of orlistat TID, or 120 mg of orlistat TID, in conjunction with a reduced-energy diet for the first year and a weight-maintenance diet during the second year.

SETTING

Seventeen primary care centers in the United States.

MAIN OUTCOME MEASURES

Changes in body weight and obesity-related disease risk factors.

RESULTS

Patients treated with orlistat lost significantly more weight (7.08 +/- 0.54 and 7.94 +/- 0.57 kg for the 60-mg and 120-mg orlistat groups, respectively) than those treated with placebo (4.14 +/- 0.56 kg) in year 1 (P<.001) and sustained more of this weight loss during year 2 (P<.001). More patients treated with orlistat lost 5% or more of their initial weight in year 1 (48.8% and 50.5% of patients in the 60-mg and 120-mg groups, respectively) compared with placebo (30.7%; P<.001), and approximately 34% of patients in the orlistat groups sustained weight loss of 5% or greater over 2 years compared with 24% in the placebo group (P<.001). Orlistat produced greater improvements than placebo in serum lipid levels and blood pressure and was well tolerated, although treatment resulted in a higher incidence of gastrointestinal events.

CONCLUSIONS

This long-term study indicates that orlistat is an effective adjunct to dietary intervention in the treatment of obesity in primary care settings.

Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study

BACKGROUND

Long-term maintenance of weight loss remains a therapeutic challenge in obesity treatment.

OBJECTIVE

This multicenter, double-blind, placebo-controlled study was designed to test the hypothesis that orlistat, a gastrointestinal lipase inhibitor, is significantly more effective than a placebo in preventing weight regain.

DESIGN

Obese subjects who lost > or = 8% of their initial body weight during a 6-mo lead-in of a prescribed hypoenergetic diet (4180-kJ/d deficit) with no adjunctive pharmacotherapy were randomly assigned to receive placebo, 30 mg orlistat, 60 mg orlistat, or 120 mg orlistat 3 times daily for 1 y in combination with a maintenance diet to help prevent weight regain. Of 1313 recruited subjects [body mass index (in kg/m2): 28-43], 729 subjects lost > or =8% of their initial body weight during the 6-mo weight-loss lead-in period and were enrolled in the double-blind phase.

RESULTS

After 1 y, subjects treated with 120 mg orlistat 3 times daily regained less weight than did placebo-treated subjects (32.8 +/- 4.5% compared with 58.7 +/- 5.8% regain of lost weight; P < 0.001). Moreover, more subjects in the 120-mg orlistat group than in the placebo group regained < or = 25% of lost weight (47.5% of subjects compared with 29.9%). In addition, orlistat treatment (120 mg 3 times daily) was associated with significantly greater reductions in total and LDL-cholesterol concentrations than was placebo (P < 0.001).

CONCLUSION

The use of orlistat during periods of attempted weight maintenance minimizes weight readjustment and facilitates long-term improvement in obesity-related disease risk factors.

Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial

CONTEXT

Orlistat, a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, may promote weight loss and reduce cardiovascular risk factors.

OBJECTIVE

To test the hypothesis that orlistat combined with dietary intervention is more effective than placebo plus diet for weight loss and maintenance over 2 years.

DESIGN

Randomized, double-blind, placebo-controlled study conducted from October 1992 to October 1995.

SETTING AND PARTICIPANTS

Obese adults (body mass index [weight in kilograms divided by the square of height in meters], 30-43 kg/m2) evaluated at 18 US research centers.

INTERVENTION

Subjects received placebo plus a controlled-energy diet during a 4-week lead-in. On study day 1, the diet was continued and subjects were randomized to receive placebo 3 times a day or orlistat, 120 mg 3 times a day, for 52 weeks. After 52 weeks, subjects began a weight-maintenance diet, and the placebo group (n = 133) continued to receive placebo and orlistat-treated subjects were rerandomized to receive placebo 3 times a day (n = 138), orlistat, 60 mg (n = 152) or 120 mg (n = 153) 3 times a day, for an additional 52 weeks.

MAIN OUTCOME MEASURES

Body weight change and changes in blood pressure and serum lipid, glucose, and insulin levels.

RESULTS

A total of 1187 subjects entered the protocol, and 892 were randomly assigned on day 1 to double-blind treatment. For intent-to-treat analysis, 223 placebo-treated subjects and 657 orlistat-treated subjects were evaluated. During the first year orlistat-treated subjects lost more weight (mean +/- SEM, 8.76+/-0.37 kg) than placebo-treated subjects (5.81+/-0.67 kg) (P<.001). Subjects treated with orlistat, 120 mg 3 times a day, during year 1 and year 2 regained less weight during year 2 (3.2+/-0.45 kg; 35.2% regain) than those who received orlistat, 60 mg (4.26+/-0.57 kg; 51.3% regain), or placebo (5.63+/-0.42 kg; 63.4% regain) in year 2 (P<.001). Treatment with orlistat, 120 mg 3 times a day, was associated with improvements in fasting low-density lipoprotein cholesterol and insulin levels.

CONCLUSIONS

Two-year treatment with orlistat plus diet significantly promotes weight loss, lessens weight regain, and improves some obesity-related disease risk factors.

Prospective comparison of four sampling methods (cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith culture) to identify urinary tract infections in dogs with urolithiasis

A prospective study was conducted on 27 dogs with recurrent urinary tract infections (UTIs) and urolithiasis. Four sampling methods (i.e., urine obtained by cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith) were compared to identify UTI. Identical culture results were obtained from urine collected by cystocentesis and from the swab of bladder mucosa. In the presence of a positive urine culture, the same organism also was cultured from the bladder mucosal biopsy and urolith. However, in the presence of a negative urine culture, an organism was cultured from the bladder mucosal biopsy or the urolith in 18.5% of the cases. Therefore, when the culture from urine obtained by cystocentesis is negative, it is recommended that aerobic cultures of a bladder mucosal biopsy and a urolith be performed in cases of urolithiasis.

Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study

OBJECTIVE

Obesity is an important risk factor for type 2 diabetes. Weight loss in patients with type 2 diabetes is associated with improved glycemic control and reduced cardiovascular disease risk factors, but weight loss is notably difficult to achieve and sustain with caloric restriction and exercise. The purpose of this study was to assess the impact of treatment with orlistat, a pancreatic lipase inhibitor, on weight loss, glycemic control, and serum lipid levels in obese patients with type 2 diabetes on sulfonylurea medications.

RESEARCH DESIGN AND METHODS

In a multicenter 57-week randomized double-blind placebo-controlled study, 120 mg orlistat or placebo was administered orally three times a day with a mildly hypocaloric diet to 391 obese men and women with type 2 diabetes who were aged > 18 years, had a BMI of 28-40 kg/m2, and were clinically stable on oral sulfonylureas. Changes in body weight, glycemic control, lipid levels, and drug tolerability were measured.

RESULTS

After 1 year of treatment, the orlistat group lost 6.2 +/- 0.45% (mean +/- SEM) of initial body weight vs. 4.3 +/- 0.49% in the placebo group (P < 0.001). Twice as many patients receiving orlistat (49 vs. 23%) lost > or = 5% of initial body weight (P < 0.001). Orlistat treatment plus diet compared with placebo plus diet was associated with significant improvement in glycemic control, as reflected in decreases in HbA1c (P < 0.001) and fasting plasma glucose (P < 0.001) and in dosage reductions of oral sulfonylurea medication (P < 0.01). Orlistat therapy also resulted in significantly greater improvements than placebo in several lipid parameters, namely, greater reductions in total cholesterol, (P < 0.001), LDL cholesterol (P < 0.001), triglycerides (P < 0.05), apolipoprotein B (P < 0.001), and the LDL-to-HDL cholesterol ratio (P < 0.001). Mild to moderate and transient gastrointestinal events were reported with orlistat therapy, although their association with study withdrawal was low. Fat-soluble vitamin levels generally remained within the reference range, and vitamin supplementation was required in only a few patients.

CONCLUSIONS

Orlistat is an effective treatment modality in obese patients with type 2 diabetes with respect to clinically meaningful weight loss and maintenance of weight loss, improved glycemic control, and improved lipid profile.

Prevalence of autoantibodies to thyroglobulin in dogs with nonthyroidal illness

OBJECTIVE

To evaluate a thyroglobulin autoantibody (TgAA) assay and determine a diagnostic threshold.

SAMPLE POPULATION

Serum samples from dogs with various endocrine abnormalities and from 30 obese adult female Beagles.

PROCEDURE

TgAA were determined by use of the ELISA. Six experiments were done: 1, definition of positive results for TgAA using samples from normal and T3 autoantibody (T3AA) positive dogs; 2, establishment of prevalence of positive results in 91 clinically normal dogs; 3, evaluation of positive results for sera from dogs with nonthyroidal illnesses; 4, testing of samples from dogs with primary hypothyroidism but absence of T4AA or T3AA, or both; 5, determination of prevalence of false-negative results in dogs that are T4AA and/or T3AA positive, which were (18 dogs) or were not (22 dogs) receiving L-thyroxine replacement therapy; and 6, examination of thyroid biopsy specimens from 18 dogs (8 TgAA positive and 10 TgAA negative).

RESULTS

Positive results were defined as at least twice (200%) the optical density of the negative-control sample. False-positive results were obtained for only 3.4% of 146 dogs with nonthyroidal illness. Thirty-seven percent of dogs with primary hypothyroidism, but no evidence of T4AA or T3AA, or both, were TgAA positive. False-negative results were found in 1 of 22 and 2 of 18 T3AA-positive dogs with and without thyroid replacement therapy, respectively. Thyroid biopsy specimens from 8 TgAA-positive dogs had evidence of lymphocytic thyroiditis, whereas those from 10 TgAA-negative dogs did not.

CONCLUSION AND CLINICAL RELEVANCE

The assay is sensitive and specific for identification of lymphocytic autoimmune thyroiditis in dogs, and has potential for aiding early diagnosis of thyroiditis in dogs and identifying dogs likely to perpetuate hypothyroidism in breeding programs.

Neurotransmitter interactions in the stomatogastric system of the spiny lobster: one peptide alters the response of a central pattern generator to a second peptide

Two of the peptides found in the stomatogastric nervous system of the spiny lobster, Panulirus interruptus, interacted to modulate the activity of the cardiac sac motor pattern. In the isolated stomatogastric ganglion, red-pigment-concentrating hormone (RPCH), but not proctolin, activated the bursting activity in the inferior ventricular (IV) neurons that drives the cardiac sac pattern. The cardiac sac pattern normally ceased within 15 min after the end of RPCH superfusion. However, when proctolin was applied within a few minutes of that time, it was likewise able to induce cardiac sac activity. Similarly, proctolin applied together with subthreshold RPCH induced cardiac sac bursting. The amplitude of the excitatory postsynaptic potentials from the IV neurons to the cardiac sac dilator neuron CD2 (1 of the 2 major motor neurons in the cardiac sac system) was potentiated in the presence of both proctolin and RPCH. The potentiation in RPCH was much greater than in proctolin alone. However, the potentiation in proctolin after RPCH was equivalent to that recorded in RPCH alone. Although we do not yet understand the mechanisms for these interactions of the two modulators, this study provides an example of one factor that can determine the "state" of the system that is critical in determining the effect of a modulator that is "state dependent," and it provides evidence for yet another level of flexibility in the motor output of this system.

Use of force-plate analysis of gait to compare two surgical techniques for treatment of cranial cruciate ligament rupture in dogs

OBJECTIVE

To use ground reaction forces and related impulses as an objective measurement of limb function in the comparison of 1 extracapsular and 1 intracapsular surgical technique for repair of cranial cruciate ligament rupture in dogs.

ANIMALS

18 healthy dogs.

DESIGN

All dogs underwent force-plate analysis of gait prior to transection of the left cranial cruciate ligament. The dogs were randomly allotted to 3 groups. The ligamentous instability was corrected, using a modified retinacular imbrication technique (MRIT) in 1 group and an under-and-over technique in another group. No attempt was made to correct the ligamentous instability in a control group. Clinical grading of lameness and force-plate analysis of gait were performed at 4, 8, 12, 16, and 20 weeks after surgery.

PROCEDURE

Peak vertical force and vertical, braking, and propulsion impulses were recorded for each limb at each time. The degree of clinical lameness was graded at each time.

RESULTS

Left hind limb peak vertical forces and vertical impulses were significantly decreased at all times after surgery in the control and under-and-over technique group, compared with values before surgery. Dogs of the MRIT group had improved by 20 weeks, with no significant differences between left hind limb peak vertical forces or vertical impulses recorded before surgery and at 20 weeks.

CONCLUSION

Peak vertical forces and vertical impulses in dogs undergoing MRIT repair after experimentally created cranial cruciate ligament rupture are not significantly different when values recorded for the operated limb at 20 weeks after surgery are compared with those recorded prior to surgery.

Pharmacokinetics of L-thyroxine after its oral administration in dogs

Twelve mature (5 sexually intact males, 4 castrated males, and 3 females) mixed-breed dogs were surgically thyroidectomized and used in a Latin-square design pharmacokinetic study of orally administered L-thyroxine. The dogs were treated with 44, 22, and 11 micrograms of L-thyroxine/kg as a single morning dose or in divided doses, morning and evening. Serum concentration of thyroxine (T4) was evaluated to determine a number of pharmacokinetic variables for comparison. Mean steady-state concentrations (Css) were determined from the area under the curve. Variables were analyzed for comparisons between dosages by use of ANOVA. Concentration at steady state was highest for dogs of the 44-micrograms/kg of body weight once-daily group and was lowest for dogs of the group given 11 micrograms/kg in 2 daily doses. Single daily administration resulted in higher Css, except at the 22-micrograms/kg/d dosage. Clearance was faster for the 22- and 44-micrograms/kg/d dosages than for the 11-micrograms/kg/d dosage. The half-life (t1/2) and mean residence time (MRT) also were shorter for the 44-micrograms/kg/d dosage, possibly indicating more rapid elimination of the drug at higher doses and dose-dependent kinetics. Perhaps, as the dogs' metabolism increased with higher iodothyronine concentrations, hormone degradation was accelerated. Interval (divided vs single dose) caused some expected changes: maximal concentration was higher and minimal concentration was lower when single administration was used. These undulations resulted in iodothyronine concentrations above the physiologic range for a number of hours, whereas concentration closer to physiologic ranges was achieved by use of divided doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinematic gait analysis of the trot in healthy greyhounds

A noninvasive computer-assisted kinematic gait analysis was used to describe flexion and extension movements of 6 joints in Greyhounds at a trot. Distinct patterns of movements were described for each joint studied. The coxofemoral and carpal joints were characterized by a single peak of maximal extension. The femorotibial, tarsal, scapulohumeral, and cubital joints had 2 peaks of maximal extension, with 1 peak preceding stance phase and a second peak within stance phase. A two-factor repeated-measures ANOVA was used to determine the variance in measurement of joint angles in degrees that was attributable to trial repetitions and to differences between dogs. The coxofemoral, femorotibial, tarsal, scapulohumeral, and cubital joints had a mean variance attributable to trial repetition of 6.6 (range, 1.7 to 12.9), and a mean variance attributable to differences between dogs of 5.1 (range, 0.9 to 9.2). The carpus had more variance, with a mean variance attributable to trial repetition of 16.3 (range, 13.3 to 20.5), and that attributable to differences between dogs of 31.8 (range, 20.5 to 46.7). Kinematic gait analysis provided a reliable description of flexion and extension movements in Greyhounds with minimal variance attributable to trial repetitions and to differences between dogs.

Bilateral ischiocavernosus myectomy for chronic urine spraying in castrated male cats

Bilateral myectomy of the ischiocavernosus muscles was evaluated prospectively in 10 castrated male cats as a treatment for chronic urine spraying. The procedure was followed by a significant reduction in the frequency of spraying during an observation period of 4 months. Complications were not observed. Further studies are indicated.

Obstructed portal venous flow and portal vein thrombus in a dog

A young adult Doberman Pinscher had clinical signs and laboratory data consistent with the copper-associated hepatopathy commonly found in Doberman Pinschers. Hepatic biopsy and hepatic copper analysis did not support this diagnosis. Furthermore, changes seen in the hepatic biopsy specimen did not explain the acquired portosystemic shunting or the portal hypertension that the dog had. A mesentery venoportagram revealed markedly delayed filling of one portal vein, and necropsy revealed a small thrombus partially occluding that hepatic vein. It was not determined whether obstructed portal venous flow caused the portal vein thrombus or vice versa; however, it was theorized that the portal vein thrombus, once formed, contributed to further portal hypertension and/or delayed portal vein filling.

Ultrasonographic findings associated with congenital hepatic arteriovenous fistula in three dogs

Three dogs were determined to have hepatic arteriovenous fistulas. This condition is similar to a portosystemic shunt; however, cure necessitates hepatic lobectomy instead of a venous ligature. Because of this, it is useful to differentiate these 2 conditions before surgery. Ultrasonography was found to be simple, sensitive, and specific in diagnosing hepatic arteriovenous fistulas and differentiating them from portosystemic shunts.

Angles of inclination and anteversion in hip dysplasia in the dog

The angles of inclination and anteversion of the femoral head and neck were measured on 150 limbs of 75 dogs. These hip angles were compared with pathoanatomic and radiographic scores of hip dysplasia. There was a minimal difference between dysplastic and healthy dogs in the angles of inclination and anteversion. It was concluded that in this series of dogs, hip angles did not have a part in the development of hip dysplasia.

Clinical and histological features of primary progressive, familial thyroiditis in a colony of borzoi dogs

A six-year study of clinical data and the morphologic changes involved in lymphocytic thyroiditis in a colony of related borzoi dogs was conducted. Lesions observed included initial degenerative thyroidal parenchymal changes which progressed to subacute inflammation with subsequent fibrosis and end stage thyroid gland disease. This study encompasses three successive generations of this borzoi colony and documents the progression of the histologic changes from the initial thyroid gland degenerative lesions to the end stage parenchymal atrophy. Spontaneous, familial thyroiditis has not been reported previously in the borzoi breed.