Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study

BACKGROUND

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers.

OBJECTIVE

This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs.

METHODS

We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes.

RESULTS

In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use.

CONCLUSIONS

KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Comparative analysis of antibody responses to outer surface protein (Osp)A and OspC in dogs vaccinated with Lyme disease vaccines

Lyme disease (LD), the most common tick-borne disease of canines and humans in N. America, is caused by the spirochete Borreliella burgdorferi. Subunit and bacterin vaccines are available for the prevention of LD in dogs. LD bacterin vaccines, which are comprised of cell lysates of two strains of B. burgdorferi, contain over 1000 different proteins and cellular constituents. In contrast, subunit vaccines are defined in composition and consist of either outer surface protein (Osp)A or OspA and an OspC chimeritope. In this study, we comparatively assessed antibody responses to OspA and OspC induced by vaccination with all canine bacterin and subunit LD vaccines that are commercially available in North America. Dogs were administered a two-dose series of the vaccine to which they were assigned (3 weeks apart): Subunit-AC, Subunit-A, Bacterin-1, and Bacterin-2. Antibody titers to OspA and OspC were determined by ELISA and the ability of each vaccine to elicit antibodies that recognize diverse OspC proteins (referred to as OspC types) assessed by immunoblot. While all of the vaccines elicited similar OspA antibody responses, only Subunit-AC triggered a robust and broadly cross-reactive antibody response to divergent OspC proteins. The data presented within provide new information regarding vaccination-induced antibody responses to key tick and mammalian phase antigens by both subunit and bacterin LD canine vaccine formulations.

Effects of increasing lysine on carcass composition and cutting yields of immunologically castrated male pigs

The objective of this experiment was to determine if increasing lysine in the diets of immunologically castrated (IC) male pigs would increase percentage fat free lean and carcass cutting yields when compared with physical castrates. The anti-gonadotropin-releasing factor (GnRF) immunological product (Improvest, Pfizer Animal Health) is used worldwide to immunologically castrate entire male pigs to control boar taint and take advantage of the inherent ability of the entire male to deposit more muscle, less fat, and grow more efficiently than physically castrated males. The immunization process essentially allows the pig to grow as an entire male pig for most of its life and then removes any boar odor (boar taint) before slaughter. Reported lean meat advantages may also provide economic benefits to the domestic meat industry. Approximately 1,200 male pigs [physical castrates, IC males, and entire males] were each assigned to 1 of 4 diet programs which differed in lysine content. In each case, lysine was fed in a conventional step-down program that culminated with the following concentrations in the late finishing diet: physical castrates fed low lysine (0.7%), IC fed low lysine (0.7%), IC fed low/medium lysine (0.8%), IC fed medium/high lysine (0.9%), IC fed high lysine (1.0%), and entire males fed high lysine (1.0%). At 25 wk of age (5 wk post-second injection), pigs were individually weighed and the 2 pigs (n=96) in each pen closest to the median pig BW were selected and slaughtered. The right side of each carcass was dissected into soft tissue, skin, and bone. Proximate composition was determined on the soft tissue to determine percentage fat-free lean. The left side of each carcass was weighed and initially fabricated into ham, loin, belly, and whole shoulder. Each primal piece was weighed again and further fabricated into respective subprimal cuts. Immunological castration did not change (P>0.05) shear force values or ultimate pH when compared with either physical castrates or entire males. Marbling appeared to decrease as dietary lysine was increased among IC males. As expected, IC males had a greater (P<0.05) percentage fat-free lean than physical castrates but less (P<0.05) than entire males. Immunologically castrated males fed diets with medium/high and high lysine had greater (P<0.05) lean cutting yields and carcass cutting yields than physical castrates. Lean cutting yield and carcass cutting yields appeared to increase as dietary lysine was increased among IC males. Overall, immunological castration improved carcass cutability, increased percentage fat free lean, and had no effect on pork quality when compared with physical castrates.

Prevalence and relationships of sensory taint, 5α-androstenone and skatole in fat and lean tissue from the loin (Longissimus dorsi) of barrows, gilts, sows, and boars from selected abattoirs in the United States

This study assessed prevalence of boar taint in backfat and lean of barrows, gilts, sows, and boars, collected from abattoirs, without knowledge of the farms of origin, in different regions in the United States. Concentrations of 5α-androstenone (liquid chromatography/mass spectroscopy) and skatole (liquid chromatography with fluorescent detection) in backfat were measured. A trained panel evaluated boar taint aroma in heated samples. Mean 5α-androstenone and skatole levels were low among barrows, gilts, and sows, whereas 55.8% of boars scored above a 1.0 μg/g threshold for 5α-androstenone concentrations and 34.2% were above a 0.2 μg/g threshold for skatole concentrations. Mean aroma scores for backfat and lean from barrows, gilts, and sows were low. In comparison, 59.2% of boars had elevated mean aroma scores from fat samples and 31.7% from lean. Importantly, boar taint aroma was detectable by the trained panel in at least some animals in each of the sex classes.

Improving treatment engagement in opioid-dependent outpatients with a motivated stepped-care adaptive treatment model

BACKGROUND

Substance abuse treatment programs that provide long term care that includes methadone routinely treat patients with both the chronic and severe form of opioid dependence disorder. In the early 1990s the Addiction Treatment Services clinic at Johns Hopkins Bayview Medical Center began experiencing a growing problem with poor counseling attendance and high rates of continuing opioid and other drug use, primarily cocaine.

METHODS

A comprehensive and adaptive treatment model was developed that adjusts the amount of individual counseling and group therapy, medication dose, and overall monitoring, and integrates them with clinic-based behavioral reinforcement procedures to increase patients' attendance. This model of care (Motivated Stepped Care [MSC]), an adaptive stepped-care treatment approach, was implemented in 1995.

RESULTS

The MSC model has demonstrated large improvements in counseling attendance and rates of urine specimens testing negative for drug use. Additional work has extended the model's evaluation to other common problems-continuing unemployment and limited access to and participation in drug-free social support.

CONCLUSION

The MSC adaptive treatment model is a viable and effective alternative to standard treatment approaches. It is integrated with performance improvement monitoring to inform and adjust the amount of services necessary to achieve and sustain good clinical response to treatment during months and years of care.

Efficacy and safety of dirlotapide in the management of obese dogs evaluated in two placebo-controlled, masked clinical studies in North America

Dirlotapide was evaluated in the management of obesity in dogs in two multicenter, clinical studies in North America. A total of 335 obese dogs of various breeds were randomized to dirlotapide or placebo in a 2:1 ratio. Dirlotapide was administered orally once daily to dogs at an initial dose of 0.05 mg/kg, increased after 14 days to 0.1 (study B, label dose) or 0.2 mg/kg (study A) and then adjusted according to individual weight loss at 28-day intervals. Dogs were examined and weighed, and body condition scores (BCSs) were recorded every 28 days. Study A had three consecutive phases: weight loss (16 weeks, day 0-112); weight management (12 weeks); and post-treatment (8 weeks). Study B had a weight loss phase only. For dirlotapide-treated dogs, mean weight loss by day 112 was 11.8-14.0% compared with 3.0-3.9% for placebo (P = 0.0001). In study A, weight losses for dirlotapide were 19.3% after 12 weeks of weight management and 16.7% (regain of 3.4%) by 8 weeks after dirlotapide was discontinued. In both studies, dogs in both treatments had emesis, lethargy, anorexia, diarrhea, and mildly elevated hepatic transaminase activity, that resolved spontaneously with time. These were experienced more frequently with dirlotapide. Improved activity levels and BCS for >50% dogs were reported with dirlotapide. Dirlotapide was safe and effective in the reduction and management of body weight in obese dogs.

Biologic activity of dirlotapide, a novel microsomal triglyceride transfer protein inhibitor, for weight loss in obese dogs

Dirlotapide is a novel microsomal triglyceride transfer protein inhibitor intended for the treatment and management of obesity in dogs. The biologic effects of dirlotapide, weight loss, decreased food intake, increased fecal fat, decreased serum cholesterol, and body composition, were evaluated in a controlled, blinded study. Sixteen obese beagles were randomized to treatment with placebo (n = 4) or dirlotapide (n = 12) following a 2-week acclimation period in which baseline data were collected. The dirlotapide dose, adjusted to produce weight loss for 3 months and then stabilize body weight for 1 month (weight management), produced a significant difference (expressed as a percentage of baselines) in weekly weight loss, food intake, fecal fat, serum cholesterol concentration, and body composition (measured by dual energy X-ray absorptiometry) compared with placebo treatment (P < 0.05). The initial dirlotapide dosage of 0.5 mg/kg (10 times the initial label dose) resulted in a high rate of weight loss (3.3% weekly) and anorexia, emesis, and loose stools for some dogs. A 25% dose reduction (mean dosage: 0.36 mg/kg) followed by biweekly 25% dose adjustments based on individual weight loss, produced 1-2% weekly weight loss and total weight loss of 18.8% in 12 weeks at a final mean dosage of 0.41 mg/kg (range: 0.15-0.60); a dosage range of 0.10-0.34 mg/kg stabilized body weight. Body weight changes for placebo-treated dogs were -0.8% to +0.9% weekly; total weight gain during the weight loss phase was 10.6%. No apparent change in food intake, percentage of fecal fat, and serum cholesterol was observed in the placebo group. Food intake and body weight increased when dirlotapide was discontinued. Dirlotapide produced weight loss by both reducing appetite (about 90% of the weight loss activity) and by increasing fecal fat excretion (about 10% of the weight loss activity).

Pharmacokinetics of dirlotapide in the dog

An overview of the pharmacokinetics of dirlotapide in beagle dogs is presented. The following mean parameters were observed after a 0.3-mg/kg i.v. dose of dirlotapide: plasma clearance of 7.8 mL/min/kg and volume of distribution of 1.3 L/kg. Following single oral doses of 0.05, 0.3, and 1.0 mg/kg to fed dogs and 0.3 mg/kg to fasted dogs using the commercial formulation, mean C(max) of 7.5, 46, 97, and 31 ng/mL, respectively, were observed at mean t(max) of 0.8-2.0 h. AUC and C(max) increased with increasing dose, but not proportionally. Oral bioavailability was 22-41%. Exposure, as reflected by AUC, was 54% higher in the fed than fasted state. In a 14-day repeated-dose study (0.3 mg/kg dose), the mean accumulation ratio was 3.7. In a 3-month study at doses of 0.4-2.5 mg/kg, accumulation ratios ranged from 2.0 to 6.7 at day 29 and from 1.3 to 4.1 at day 87. In summary, dirlotapide exhibited low clearance, low first-pass metabolism, moderate volume of distribution, low-to-moderate oral bioavailability, a modest food effect, and variable accumulation. Large interanimal variability in systemic exposure was noted for all routes and doses, but there were no consistent sex differences.

The safety of dirlotapide in dogs

The safety of dirlotapide in dogs was evaluated in two studies with parallel designs. In an acute tolerance study, 24 beagles (six dogs per treatment) were treated orally once daily for 14 days with placebo or dirlotapide at 2.5, 5.0, or 10.0 mg/kg/day. In a margin-of-safety study, 38 overweight, neutered beagles were treated orally once daily for 3 months with dirlotapide at doses up to 0.5 mg/kg/day (six dogs), 1.5 mg/kg/day (12 dogs) and 2.5 mg/kg/day (six dogs). Control dogs received placebo at 0.3 mL/kg/day (10 dogs) and 0.5 mL/kg/day (four dogs). Results were similar for both studies, and no serious adverse events were observed. Dirlotapide was clinically well-tolerated in dogs at dosages up to 10 mg/kg/day for 14 days and 2.5 mg/kg/day for 3 months. Dirlotapide produced the expected decrease in food intake and body weight (up to 20-40%) without ill effects. Clinical, pathologic, and histopathologic findings were reversible and consistent with suppression of food intake and rapid weight loss produced by elevated dirlotapide dosages. In both studies, sporadic emesis and loose stools were observed in both placebo and dirlotapide-treated dogs. Incidence of emesis generally increased with dose and decreased with treatment time. Elevations in hepatic transaminase activity were seen in dogs treated with more than 1.5 mg/kg dirlotapide daily, but were not associated with clinical signs or microscopic evidence of hepatic degeneration or necrosis.

Evaluation of vaccines for atrophic rhinitis--a comparison of three challenge models

We compared three challenge models for the assessment of atrophic rhinitis (AR) vaccines: combined infection with Bordetella bronchiseptica (Bb) and Pasteurella multocida (Pm); application of acetic acid (AA) to the nasal mucosa followed by Pm infection; and Bb infection alone. Two vaccines were tested using standardized criteria, notably nasal lesion scores. The vaccines provided different levels of protection in the Bb and the AA/Pm challenges, but were similar in the combined (Bb/Pm) challenge. It is clear that the AA/Pm model shows the protective value of only the Pm component, whereas the single Bb challenge reflects the protective value merely of the Bb component of a combined vaccine. These results suggest that the best assessment of protection is provided if the two specific challenges are performed separately.

Short-term stability of NEO-PI-R personality trait scores in opioid-dependent outpatients

The present study examined the short-term stability of personality trait scores from the Revised NEO Personality Inventory (NEO-PI-R) among 230 opioid-dependent outpatients. The NEO-PI-R is a 240-item empirically developed measure of the five-factor model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). Participants completed the NEO-PI-R at admission and again approximately 19 weeks later. Results indicated fair to good stability for all NEO-PI-R factor domain scores, with coefficients ranging from .68 to .74. Stability of NEO-PI-R scores was decreased among potentially invalid response patterns but was not significantly affected by drug-positive versus drug-negative status at follow-up.

Influence of antisocial personality subtypes on drug abuse treatment response

This methodological study examined the impact of antisocial personality disorder (APD) and other psychiatric comorbidity on drug use and treatment retention in 513 new admissions to methadone maintenance treatment. Patients were classified into one of four groups: APD ONLY, APD plus other psychiatric disorder (APD MIXED), other psychiatric disorder, and no psychiatric disorder. Patients completed research assessments and were then followed for 1 year of treatment. Patients with APD had longer histories of heroin and cocaine use than non-APD patients and were more likely to meet criteria for cocaine dependence. Distinct clinical profiles emerged that differentiated APD ONLY from APD MIXED. APD ONLY patients exhibited higher rates of cocaine and heroin use, whereas those with APD MIXED exhibited higher rates of benzodiazepine use. Self-report measures supported urinalysis results, but group differences did not affect treatment retention. These differences in clinical profiles should be considered when evaluating treatment performance in substance abusers with APD.

Preventing transmission of Sarcoptes scabiei var. suis from infested sows to nursing piglets by a prefarrowing treatment with doramectin injectable solution

Studies were conducted at swine facilities in Illinois and North Carolina to evaluate the effect of treatment with doramectin injectable solution on transmission prevention of Sarcoptes scabiei var. suis from sows to nursing piglets. Approximately 42 days prefarrowing, 58 mange-free sows were experimentally infested with 200 S. scabiei in each ear. Seven to fourteen days prior to farrowing, 22 sows were given doramectin injectable intramuscularly at a dose of 300 microg/kg of body weight. A total of 21 sows served as untreated controls. Skin scrapings for mite counts and lesion scoring were performed on sows before treatment on day 21, and on either day 35 or 42. Each sow was observed on days 0, 7, 14, 21, 28, and 35 or 42 for the incidence of scratching/rubbing. Skin scrapings, lesion scoring, and observation of scratching/rubbing were performed on the piglets after weaning and at the end of the nursery stage. Geometric mean mite counts of the untreated sows were 0.70 and 0.26 on days 21 and 35 or 42, respectively, and 0.00 for doramectin-treated sows over the same time periods (P<0.05). Lesions scores and the incidence of scratching/rubbing were both higher in the untreated sows as compared to the doramectin-treated sows during the same time periods (P<0.05). Geometric mean mite counts of piglets farrowed by untreated sows were 0.50 and 0.60 after weaning and at the end of the nursery stage, respectively, and 0.00 for piglets from doramectin-treated sows over the same time periods (P>0.05). Lesion scores and the incidence of scratching/rubbing were both higher in piglets from untreated sows as compared to those piglets from doramectin-treated sows (P<0.05). Treating S. scabiei-infested sows with doramectin injectable solution before farrowing eliminated mite infestation and prevented the transmission of S. scabiei to piglets.

Comparison of two methods for presurgical disinfection of the equine hoof

OBJECTIVES

To determine for equine hooves the normal resident aerobic bacterial population and the efficacy of 2 methods of disinfection. Study Design-Measurement of total bacterial, gram-positive bacterial, and gram-negative bacterial surface populations from the frog, sole, and hoof wall after each step of 2 different preoperative surgical disinfection techniques.

ANIMALS

Six adult horses.

METHODS

Hoof wall, sole, and frog samples were collected for quantitative bacteriology before, during, and after 2 multistep antiseptic preparation techniques: Method A-6-minute scrub with povidone-iodine soap, followed by 24-hour submersion in povidone-iodine solution-soaked cotton; and Method B-initial removal of superficial layer of hoof capsule before completing Method A disinfection procedures.

RESULTS

Removal of the superficial hoof layer, application of the povidone iodine scrub, and completion of the povidone-iodine soak all significantly (P < .0008) decreased total bacterial numbers. Method B had significantly lower bacterial counts than method A at each consecutive step. Final total bacterial counts remained greater than 10(5) bacteria per gram of tissue regardless of preparation method.

CONCLUSIONS

The hoof surface hosts a broad spectrum of aerobic gram-positive and -negative bacteria, many of which are potential pathogens. Bacterial numbers can be significantly reduced by removal of the superficial hoof surface, by application of a povidone-iodine scrub, and by use of a 24-hour povidone-iodine soak. However, bacterial populations >10(5) g per tissue persist after these disinfection procedures.

CLINICAL RELEVANCE

Regardless of the preparation methods used in this study, bacterial populations capable of inducing wound infection remain on the hoof capsule.

Influence of psychiatric comorbidity on HIV risk behaviors: changes during drug abuse treatment

This study evaluated whether psychiatric comorbidity is related to change in HIV high risk behaviors during outpatient drug abuse treatment. Participants were opioid abusers entering methadone treatment. Psychiatric and substance use diagnoses were determined at intake. Information on HIV high risk drug use and sexual behaviors, psychosocial functioning, and urine toxicology was assessed at intake and at month six. Subjects were divided into those with versus without a lifetime comorbid non-substance use psychiatric disorder. The comorbid group reported more injection equipment sharing, lower rates of condom use, and higher rates of alcohol use at intake and follow-up. Overall injection drug use behavior decreased over the follow-up period for both groups, however. Methadone treatment had a beneficial effect on HIV risk behaviors, and though some risk behaviors improved signiticantly for both groups, comorbid subjects continued to have higher rates of HIV risk factors than noncomorbid subjects.

Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment

Symptoms of DSM-IV attention-deficit hyperactivity disorder (ADHD) were determined in patients entering methadone maintenance treatment. The relationship of ADHD to psychiatric and substance abuse comorbidity, attention testing, and treatment outcome was analyzed; 19% of patients had a history of ADHD, and 88% of these had current symptoms. Continuous Performance Testing indicated poorer attention in patients with ADHD. The only substance use disorder more common in the ADHD group was clonidine. There was significantly more current axis I, dysthymic disorder, anxiety disorder (including social phobia), and antisocial personality disorder in the ADHD patients. There was no difference between groups at the 1-year follow-up for illicit drug use, treatment retention, or treatment performance. The ADHD diagnosis did not convey significant prognostic implications for methadone maintenance treatment. A strong psychiatric assessment and treatment focus in the treatment program may help to explain the good treatment outcome.

Results of renal ultrasonography performed before and during administration of saline (0.9% NaCl) solution to induce diuresis in dogs without evidence of renal disease

OBJECTIVE

To evaluate the effect of saline (0.9% NaCl) solution administered IV to induce diuresis on 15 dimensional variables of the kidneys, size of renal pelvis, and diameter of the cranial part of the ureters.

ANIMALS

25 dogs without evidence of renal disease that were undergoing chemotherapy for various neoplasms.

PROCEDURE

The kidneys, cranial aspect of the ureters, and trigone area of the urinary bladder of each dog were examined ultrasonographically before and during IV administration of saline solution (2.7 to 18.8 ml/kg of body weight/h).

RESULTS

Ultrasonography revealed unilateral and bilateral pyelectasis during diuresis in 16 of 23 (70%) dogs but unilateral pyelectasis in only 1 dog before diuresis. Unilateral pyelectasis during diuresis was observed in 11 of 16 (69%) dogs. Pyelectasis during diuresis was categorized as slight in 15 of 21 (71%) kidneys. Degree of pyelectasis during diuresis was not identical in both kidneys of 13 of 16 (81 %) dogs. Diuresis did not induce ureterectasis, and it did not cause changes in 15 dimensional variables of the kidneys.

CONCLUSIONS

In nonsedated, nonazotemic dogs, IV administration of saline solution to induce diuresis may cause slight pyelectasis without evidence of ureterectasis.

CLINICAL RELEVANCE

When dilatation of the cranial part of the ureter is > 2 mm at the same time that ipsilateral pyelectasis is detected during ultrasonographic examination of the urinary tract system of a nonsedated, nonazotemic dog receiving IV administration of saline solution to induce diuresis, additional examinations are recommended to determine the possibility of early obstructive nephropathy or pyelonephritis.

Clinical features of inflammatory liver disease in cats: 41 cases (1983-1993)

OBJECTIVE

To compare the clinical and clinicopathologic findings in and prognosis for cats with lymphocytic portal hepatitis (LPH) versus cats with acute or chronic cholangiohepatitis (CH).

DESIGN

Retrospective study.

ANIMALS

25 cats with LPH; 16 cats with CH (7 acute, 9 chronic).

PROCEDURE

Cats with LPH and CH were selected by evaluating records from liver biopsy specimens submitted to the University of Minnesota Veterinary Teaching Hospital during a 10-year period. Clinical and clinicopathologic data were retrieved.

RESULTS

Cats with CH had higher segmented and band neutrophil counts, alanine aminotransferase activities, and total bilirubin concentrations than did cats with LPH. Cats with acute CH had higher segmented and band neutrophil counts and lower serum alkaline phosphatase activities and total bilirubin concentrations than did cats with chronic CH. Twelve of 14 cats with LPH or CH had coarse or nodular texture to the liver on ultrasonography, with loss of portal vein wall clarity noticed in 4 of 8 cats with LPH. Sixteen of 23 cats with LPH and 8 of 15 cats with CH survived > 1 year. Of those cats living < 1 year, all cats with LPH and 5 of 7 cats with CH had a serious concurrent illness that may have been responsible for their deaths.

CLINICAL IMPLICATIONS

LPH and CH can be detected and tentatively differentiated through evaluation of clinical laboratory test results, but histologic evaluation of liver specimens is necessary for definitive differentiation. Survival time was good regardless of the type of inflammatory liver disease.

Cold exposure regulates the norepinephrine uptake transporter in rat brown adipose tissue

The neuronal uptake of norepinephrine (NE) in sympathetically innervated tissues is mediated by a high-affinity NE uptake transporter (NET). Rat interscapular brown adipose tissue (ISBAT) is densely innervated by the sympathetic nervous system for the control of cold- and diet-induced thermogenesis. To determine if cold exposure regulates the NET, kinetic parameters for [3H]NE uptake and [3H]nisoxetine (Nis) binding were determined in ISBAT from 7-day cold-exposed (CE) and control rats. Uptake of [3H]NE in ISBAT slices was of high affinity (1.6 microM). After 7 days of cold exposure the affinity for [3H]NE uptake was not altered; however, the uptake capacity was decreased (38%) in ISBAT slices from CE rats. Kinetic parameters for [3H]Nis binding demonstrated a single high-affinity site in ISBAT from CE and control rats with similar affinity. The density of [3H]Nis sites in ISBAT was decreased (38%) following cold exposure. A time course (2 h-7 days) for cold exposure demonstrated downregulation of [3H]Nis binding density by day 3, which remained through day 7. The affinity for [3H]Nis binding was transiently decreased at 2 h of cold exposure. Similarly, ISBAT NE content was decreased at 2 h of cold exposure. Pair feeding CE rats to food intake of controls normalized plasma NE content; however, [3H]Nis binding density in ISBAT remained decreased in pair-fed rats. These results demonstrate that the ISBAT NET is downregulated following cold exposure. Reductions in ISBAT NE content precede alterations in NET density; however, plasma NE content is not related to regulation of the NET.

Influence of mating frequency on sow reproductive performance

Gilts and sows were bred one, two, or three times during a single estrous period in a commercial herd for evaluating the effect of mating frequency on reproductive performance. Estrus detection started at approximately 0630 daily by applying back pressure to females with the presence of a mature boar. Natural mating was used. Gilts detected in estrus were mated in the morning of d 1 (AM), the morning of d 1 and 2 (AM-AM), and the morning and afternoon of d 1 and morning of d 2 (AM-PM-AM) for mating frequencies 1, 2, and 3, respectively. Sows were bred in the AM, AM-AM, AM-PM-AM (1), and morning of d 1 and morning and afternoon of d 2 [AM-AM-PM (2)] for mating frequency 1, 2, 3 (1), and 3 (2), respectively. Breeding events in the morning and afternoon started at approximately 0730 and 1530. Females were randomly assigned to a mating frequency. Boars were randomly assigned to each breeding event. In total, 256 gilts and 766 sows were involved in the study. Gilts with a single mating (76.5%, P = .06) and triple matings (80.4%, P < .05) had higher farrowing rates than those with double matings (65.3%). No differences (P > .1) in the farrowing rates of sows were observed between mating frequencies 1, 2, 3 (1), and 3 (2). Double-mated gilts had more (P < .03) total born (9.7 vs 8.6) and pigs born alive (9.3 vs 8.2) than did single-mated gilts. There were no differences (P > .3) in total born and pigs born alive in sows between mating frequencies. We concluded that triple-mating gilts and sows did not improve farrowing rate and litter size compared with single and double matings. There were no differences in farrowing rate and litter size between double- and single-mated sows. Gilts with double matings had a larger litter size than those with a single mating.

Management factors associated with swine breeding-herd productivity in the United States

A database containing 24 key production measurements was created by abstracting data files of 673 U.S. farms which participated in the PigCHAMP data-share program in 1995. Summary statistics for breeding-herd performance data were presented for the Cornbelt and the South or Eastern regions. Eight models were built to assess the association between production system, operation management factors and productivity outcomes. Lactation length, percentage of multiple matings, parity of culled sows, percent gilts in the breeding-female inventory, and female culling rate were the management factors identified as having important associations with productivity outcomes. For example, shorter lactation length, higher percentage of multiple matings, and lower culling rate were associated with more pigs weaned per mated female per year. In addition, a lower percentage of gilts in the breeding-female inventory and a higher percentage of multiple matings were associated with fewer average non-productive female days. We recommend that producers change their management systems to decrease lactation length, the percentage of gilts in the breeding-female inventory, and female culling rate, and increase percentage of multiple matings in order to improve breeding-herd productivity on swine farms.

Predictive validity of cocaine, sedative, and alcohol dependence diagnoses

This study examined the predictive validity of Structured Clinical Interview for DSM-III-R (Spitzer, Williams, Gibbon, & First, 1990) based substance dependence diagnoses (i.e., cocaine, sedative, and alcohol) for 518 opioid-dependent outpatients entering methadone maintenance. Patients were followed over 1 year of treatment, which involved daily methadone substitution supplemented by individual and group counseling. Urine specimens were tested randomly 1-4 times per month. Patients diagnosed with current cocaine, sedative, or alcohol dependence were more likely to use these drugs than were patients with past only or no dependence syndrome. Current cocaine dependence predicted early treatment dropout. The results demonstrate the predictive and discriminant validity of several substance dependence diagnoses common among patients in substance abuse or other psychiatric treatment settings.

Increasing employment of opioid dependent outpatients: an intensive behavioral intervention

The impact of a new, mandatory employment requirement in a community-based methadone treatment program was evaluated. All patients who had been in the methadone substitution program for at least 1 year but who were not currently employed (n = 36) were required to enhance their treatment with 20 h of employment (paid or volunteer). Patients with significant psychiatric or medical disabilities were excluded from the routine treatment requirement. Patients were informed by counseling staff that they had 2 months to secure employment. Those who did not accomplish the goal within that time period were transferred to more intensive weekly counseling (i.e. up to 8 h/week) for 10 weeks, with the enhanced counseling focusing primarily on resistance to the employment goal. Patients who remained resistant to the treatment plan were eventually started on a 21 day methadone taper until employment was verified. Seventy-five percent of the patients secured employment and maintained the position for at least 1 month. Positions were found in an average of 60 days. Most patients (78%) continued working throughout the 6-month follow-up. Those who failed to find work or maintain employment engaged in more illicit drug use. These results demonstrate that behavioral contingencies can motivate many methadone maintenance patients to obtain verified employment in the community.

Predictive validity of cocaine, sedative, and alcohol dependence diagnoses

This study examined the predictive validity of Structured Clinical Interview for DSM-III-R (Spitzer, Williams, Gibbon, & First, 1990) based substance dependence diagnoses (i.e., cocaine, sedative, and alcohol) for 518 opioid-dependent outpatients entering methadone maintenance. Patients were followed over 1 year of treatment, which involved daily methadone substitution supplemented by individual and group counseling. Urine specimens were tested randomly 1-4 times per month. Patients diagnosed with current cocaine, sedative, or alcohol dependence were more likely to use these drugs than were patients with past only or no dependence syndrome. Current cocaine dependence predicted early treatment dropout. The results demonstrate the predictive and discriminant validity of several substance dependence diagnoses common among patients in substance abuse or other psychiatric treatment settings.

Prevalence and risk factors for odontoclastic resorptive lesions in cats

OBJECTIVE

To determine prevalence of, and risk factors for, odontoclastic resorptive lesions in cats seen in a private veterinary practice population.

DESIGN

Population-based cross-sectional study.

ANIMALS

145 cats more than 1 year of age that underwent anesthesia for various procedures.

PROCEDURE

Cats were evaluated under anesthesia for odontoclastic resorptive lesions. Lesions were graded, using a published classification system. Clients completed a standardized survey on signalment, indoor-outdoor status, medications, diet during the past year, number of daily feedings, treat feeding, source of water, and oral hygiene practices.

RESULTS

48% of cats had resorptive lesions. Lesions were most commonly mandibular, and premolars were more often affected. Compared with cats without oral lesions, cats with oral lesions were more likely to be older, female, taking medications, drinking city (vs well) water, and playing less often with toys. In addition, cats without oral lesions were more likely to have owners who cleaned their teeth daily or twice a week and to be fed diets with higher magnesium, calcium, phosphorus, and potassium contents. Frequency of teeth cleaning was inversely related to the development of odontoclastic resorptive lesions. Variables significantly associated with oral lesions were age and magnesium content of diet.

CLINICAL IMPLICATIONS

Older cats should be examined closely for odontoclastic resorptive lesions. Clients should be advised on methods and frequency of teeth cleaning in cats to prevent lesions. Dietary nutrients may play a role in the development of odontoclastic resorptive lesions in cats.

Preliminary evidence of good treatment response in antisocial drug abusers

Antisocial personality disorder (APD) is a chronic debilitating condition strongly associated with the development and maintenance of severe drug and alcohol use disorder. The overlap of these problems is associated with high rates of personal and social suffering. Available literature consistently point to this as a population in need of effective clinical services. The present study reports preliminary data from a controlled clinical trial aimed at improving the treatment outcomes of antisocial drug abusers using an intensive behavioral approach relying upon a highly structured contingency management intervention. Drug abusers in methadone substitution therapy (n = 40) were assessed for APD and other psychiatric and substance use problems. Patients were randomly assigned to an experimental (n = 20) or control (n = 20) condition following stratification on demographic and selected clinical variables (baseline drug use, evidence of other non-substance use psychiatric diagnoses). Treatment outcome data are presented for the first 17 weeks of participation in the study (4 weeks baseline and 13 weeks randomized treatment), including results of weekly urine drug testing and monthly self-reports of drug use and other psychosocial problems. Patients in both study conditions attained generally good outcomes. These early results suggest that antisocial drug abusers can respond positively to drug abuse treatments with a behavioral focus, but fail to support superior effectiveness for the more intensive intervention used in the experimental condition.

The fluctuation of tear production in the dog

The fluctuation and variation in canine tear production were established by evaluating the results of daily Schirmer tear test I (STT I) and weekly STT I and Schirmer tear test II (STT II) conducted on healthy dogs. The objectives of the study were to determine the fluctuation in STT values in dogs and its significance on both a daily and weekly basis; to determine the magnitude of the measured differences; and to identify any factors that might influence the fluctuation in STT values or variations of normal values between different dogs. The results of the study indicate that fluctuations in the STT values occur on both a daily and weekly basis. The fluctuations were only biologically significant on a week-to-week basis. There are significant differences between STT I and STT II values in dogs. The results also indicate that weight has a significant effect on STT values, with higher values measured in dogs of increasing body weight.

Influence of various factors on farrowing rate on farms using early weaning

A database containing 12,110 farrowing records from 16 commercial farms was abstracted from the PigCHAMP production information system. The farms were selected based on the willingness of producers to keep records and average weaning age. The ADFI records of 10,846 of these lactating sows were also obtained. Sows weaned at < or = 7 and > 28 d after farrowing were excluded. Farrowing rate excluding sows culled for nonreproductive reasons after mating from the denominator was 85.5%. Parity, farrowing season, and the lactation length x ADFI interaction were associated with farrowing rate (P < .05) using a categorical additive linear model in the CATMOD procedure in SAS (1988). Parity 1 sows had a lower farrowing rate than parities 2 and > or = 6 (P < .05). The summer and spring groups had the lowest and second-lowest farrowing rates among the four seasons (P < .05). In the high ADFI (> or = 5.7 kg) group, no differences in farrowing rate were observed between lactation length groups. In the low (< or = 4.2 kg) and medium (4.2 to 5.6 kg) ADFI groups, farrowing rate varied depending on lactation length. In conclusion, our results suggest that optimizing ADFI (> or = 5.7 kg) alleviates the negative effects of lactation length on farrowing rate.

Duplex doppler estimation of intrarenal pourcelot resistive index in dogs and cats with renal disease

In human beings, intrarenal blood flow impedance, expressed as the resistive index (RI) and obtained by duplex Doppler ultrasonography, has been used to aid in diagnosis and prognosis of renal failure. Higher than normal values for RI were obtained in 3 of 4 dogs with acute tubular necrosis (ATN) and in 5 of 10 dogs with glomerulonephrosis (GN). Normalization of RI was observed in 2 dogs with ATN evaluated serially during treatment. Increased RI values were obtained in 9 of 10 cats with nonobstructive renal disease and in 2 of 5 cats with obstructive renal disease. Normalization of RI was observed in 3 cats with renal failure in which treatment was effective (1 with obstruction; 2 with nonobstructive disease). The magnitude of increase in RI did not correlate with the magnitude of concurrent renal dysfunction. These results suggest that duplex Doppler evaluation of intrarenal RI is more useful as an ancillary diagnostic technique in azotemic dogs with ATN than in those with GN and in azotemic dogs with nonobstructive than in those with obstructive disease.

Returns to service after mating and removal of sows for reproductive reasons from commercial swine farms

We studied the records of 30 herds with an average inventory of 11,705 sows, 25,719 farrowings and 25,040 daily feed intake logs. Production events were recorded by producers using the PigCHAMP production information system. Of 21,505 matings, 7.2% of sows subsequently returned to estrus after service. The proportionate rates of intervals from service to the subsequent post service event were 0 to 17 d, 2.1%; 18 to 25 d, 27.9%; 26 to 37 d, 13.8%; 38 to 46 d, 15.8%; 47 to 108 d, 30.4%; and >108 d, 10.0%. Sows returned to service after mating were categorized into groups that either regularly or irregularly returned to service after mating. Of a total inventory of 19,076 sows, 10.0% were removed following weaning for reproductive reasons. The reasons for removal included those of anestrus (25.2%), failure to conceive (37.0%), failure to farrow (15.0%), not pregnant (1.4%), negative pregnancy check (14.0%), and abortion (7.4%). The last 5 types of post weaning reproductive failure were grouped into the category of did not farrow. Categorical additive models and comparisons using contrasts were used to analyze the influence of risk factors on reproductive failure. Parity 1 sows had a higher proportion (P < 0.01) of returns to service and a greater proportion of sows remaining anestrous post weaning relative to Parity 3 sows. The proportion of sows that did not farrow was higher (P < 0.01) in Parities 9 and 10 than in Parity 3. More sows were removed for anestrus during the spring (P < 0.01) and summer (P = 0.06) than during the winter. All categories of lactation length had similar rates of reproductive failure except for the lactation length 1 to 7 d, which had a higher (P < 0.05) proportion of reproductive failure. Lower lactational feed intake was associated with an increased risk of occurrence of each reproductive failure category. The odds ratios of lactation feed intake in logistic regression analyses were 0.84, 0.89, 0.82 and 0.88 for regularly and irregularly returned to service, anestrus, and did not farrow groups, respectively. This means, for example, that a sow was 0.88 times less likely to have an occurrence of not farrowing for each 1 kg increase in average daily feed intake during lactation. Our results indicate that lower and higher parities, spring and summer seasons, a lactation length of less than 8 d and lower feed intake during lactation affect the occurrence of return to service after mating and of herd removal for reproductive reasons.

Production responses following strategic parasite control in a beef cow/calf herd

Strategic parasite control has been reported to improve performance in a beef cow/calf herd that does not demonstrate clinical parasitism. This study was conducted to determine if strategic anthelmintic treatment at turnout and at midsummer would improve growth and reproduction. Two cow/calf groups of similar composition were grazed on separate, but equivalent pastures in the spring, and at midsummer, they were moved to new pastures. The treated group was given fenbendazole at tumout (cows) and at midsummer (cows and calves). The control group was not treated. The study was repeated in the following year. Across both years of the study, parasite egg counts were substantially reduced in both the treated cows (P < 0.005) and treated calves (P < 0.0001). The calves in the treated group significantly (P < 0.0001) outgained the control calves in both years of the study by 19.3 kg and 13.2 kg, respectively. Average daily gain (ADG) after adjusting for birth weight and birth date for treated calves was 0.13 kg greater than for control calves (0.83 vs 0.70) for the 2-year study (P < 0.0001) There was also a significant (P = 0.0357) increase in the reproductive performance of the cows. The pregnancy rate averaged across years was 94% for the treated cows compared to 82% for the control animals.

Long-term results of treatment of traumatic coxofemoral joint dislocation in dogs: 64 cases (1973-1992)

OBJECTIVE

To determine long-term results of various treatments for traumatic coxofemoral joint dislocation in dogs.

DESIGN

Retrospective case series.

ANIMALS

64 dogs that underwent closed reduction and bandage stabilization, extracapsular suture stabilization, transacetabular pinning, toggle pinning, DeVita pinning, or femoral head and neck excision.

PROCEDURE

Follow-up evaluations included owner evaluation (64 dogs), physical evaluation (23), and radiography (19). Follow-up time ranged from 8 to 156 months.

RESULTS

Owner evaluation scores after closed reduction were significantly better than scores after DeVita pinning, extracapsular suture stabilization, and femoral head and neck excision. On physical examination, 6 of 23 dogs were lame on the side of the previous dislocation. Signs of pain and crepitation were evident during palpation of 12 and 8 of 25 joints, respectively. Thirteen of 21 joints had radiographic evidence of degenerative joint disease. There was a greater progression of degenerative joint disease in previously dislocated joints than in unaffected joints. There were not any significant differences between treatments in regard to results of physical and radiographic evaluation. Time between trauma and treatment and existence of concomitant injuries did not influence follow-up results, but there was a significant association between body weight and radiographic evaluation score.

CLINICAL IMPLICATIONS

Concomitant injuries do not appear to justify a worse prognosis in dogs with traumatic coxofemoral joint dislocation, nor does a delay in treatment of > 3 days. Gait abnormalities and degenerative joint disease might develop in the long term. Proper body weight should be maintained regardless of treatment.

Psychiatric and substance use comorbidity among treatment-seeking opioid abusers

BACKGROUND

Major studies of psychiatric comorbidity in opioid abusers reported rates of comorbidity that far exceeded general population estimates. These studies were published more than a decade ago and reported on few women and few substance use diagnoses.

METHODS

Psychiatric and substance use comorbidity was assessed in 716 opioid abusers seeking methadone maintenance. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic assessment was conducted 1 month after admission. Rates of psychiatric and substance use disorder were compared by gender, and associations were assessed between psychiatric comorbidity and dimensional indexes of substance use severity, psychosocial impairment, and personality traits.

RESULTS

Psychiatric comorbidity was documented in 47% of the sample (47% women and 48% men). Antisocial personality disorder (25.1%) and major depression (15.8%) were the most common diagnoses. Patients had at least 2 substance use diagnoses, most often opioid and cocaine dependence. Demographics, substance use history, and personality variables discriminated between patients with vs without comorbidity. Psychiatric comorbidity also was associated with a more severe substance use disorder.

CONCLUSIONS

Psychiatric comorbidity, especially personality and mood disorder, was common in men and women. The positive associations between psychiatric comorbidity and severity of substance use and other psychosocial problems were most consistent among those with antisocial personality.

Motivating methadone patients to include drug-free significant others in treatment: a behavioral intervention

The present study introduced a novel behavioral approach for encouraging methadone-treated patients to bring drug-free significant other support into treatment. Seventy-five patients referred to high-intensity psychosocial treatment due to chronic drug use were given 3 weeks to identify a drug-free significant other. Patients noncompliant with this intervention were started on a methadone dose taper that was stopped when significant other support was identified. Patients and their significant others were required to attend a significant other group one time per week for a minimum of 6 weeks. Eighty-five percent of the patients brought a drug-free significant other into treatment. Significant others included family members, partners, and friends. Patients who identified significant other support complied with 77% of their scheduled sessions. The results demonstrated that most methadone patients have drug-free support people who are willing to participate in their treatment. These individuals can be utilized to help patients initiate the process of building new drug-free social support networks.

Ultrasonographic evaluation of the equine placenta by transrectal and transabdominal approach in the normal pregnant mare

The objective of this study was to determine normal variations in the utero placental thickness during mid- and late gestation in the mare. Normal, healthy pregnant mares (n = 9) were examined monthly from 4 mo of gestation until parturition by transrectal and transabdominal ultrasonography. At each examination, the combined thickness of the uterus and the placenta (CTUP) was measured at the placento-cervical junction (transrectally) and at the uterine body or the uterine horns (transabdominally). In addition, the echogenicity of the amniotic and allantoic fluids was evaluated by transrectal ultrasonography. Following parturition and expulsion of the fetal membranes, the allantochorion was measured and visually examined for abnormalities. At all examinations, both transrectal and transabdominal, the chorioallantois and the uterus were indistinguishable from each other on the ultrasound image. The CTUP, measured by transrectal ultrasonography did not change between 4 and 8 mo of gestation, but increased significantly for each month between 10 and 12 mo of gestation (P < 0.001). A change in the CTUP was detected between months when measured by transabdominal ultrasonography, but no distinct pattern in these changes was observed. No correlation was found between transabdominal and transrectal measurements of the CTUP. The echogenicity of the amniotic and allantoic fluids did not consistently change over time during mid- and late gestation. The amniotic fluid was more echogenic than the allantoic fluid at most examinations from 6 mo of pregnancy and throughout gestation (P < 0.05). It was concluded that transrectal ultrasonographic examination to assess the CTUP and the echogenicity of the fetal fluids is superior to the transabdominal approach. We suggest that transrectal ultrasonographic examination should be added to current diagnostic tools during late gestation and that it be part of the biophysical profile of high risk equine pregnancies.

Duplex Doppler estimation of resistive index in arcuate arteries of sedated, normal female dogs: implications for use in the diagnosis of renal failure

The resistive index (RI), an ultrasonographic method of evaluating intrarenal resistance to blood flow, may be used to aid in diagnosis of renal failure. Values for arcuate artery RI, expressed as mean +/- two standard deviations, were obtained in clinically normal female dogs sedated with atropine, acepromazine maleate, diazepam, and ketamine hydrochloride. No statistically significant differences were noted between the values for the right kidney (0.33 to 0.57) versus the left kidney (0.32 to 0.56); however, the values were statistically significantly lower than values reported for nonsedated, normal dogs.

Feed intake pattern during lactation and subsequent reproductive performance of sows

Daily feed intake during lactation was recorded for 20,296 lactating sows on 30 commercial farms in the United States. Each lactation feed record was categorized into one of six patterns: RAPID, rapid increase in feed intake; MAJOR, major drop; MINOR, minor drop; LLL, low feed intake throughout lactation; LHH, low intake during the 1st wk then an increase in feed intake for the remainder of lactation; and GRADUAL, gradual increase. A database containing 24,340 farrowing records and 19,015 subsequent litter records were abstracted from the PigCHAMP data files of the farms enrolled in the study. Multiple regression analyses revealed that ADFI during lactation had nonlinear or linear associations with weaning-to-first service interval (WSI), weaning-to-conception interval (WCI), litter weight at weaning (WWT), and subsequent litter size (SLS). Sows having LLL and LHH had longer (P < .01) WSI and WCI than the other patterns. Sows with MAJOR had a longer WCI (P < .05) than females with RAPID. Further, sows having MAJOR had lighter (P < .01) WWT than those with RAPID, MINOR, and GRADUAL. Sows having MAJOR had a higher (P < .01) proportion of females culled for anestrus relative to RAPID. Furthermore, sows exhibiting a drop in feed intake in either wk 1 or 2 were more likely to be culled for anestrus than sows having no drop. These results suggest that both the amount and pattern of feed intake during lactation influence subsequent reproductive performance.

Estimation of arcuate artery resistive index as a diagnostic tool for aminoglycoside-induced acute renal failure in dogs

OBJECTIVE

To determine the potential clinical usefulness of duplex Doppler estimation of arcuate artery resistive index (a measure of intrarenal blood flow impedance) for diagnosis of aminoglycoside-induced nephrotoxicosis.

ANIMALS

30 adult, female, mixed-breed dogs, allotted to 3 groups of 10 dogs each as: toxic dosage of gentamicin, therapeutic dosage of gentamicin, and saline solution sham equivalent in volume to that of the toxic dosage of gentamicin.

PROCEDURE

After baseline screening to establish normalcy (serum biochemical analysis, endogenous creatinine clearance determination, urinalysis, urine protein-to-creatinine ratio, urine culture, gray-scale sonography, and percutaneous ultrasound-guided renal biopsy), results of arcuate artery resistive index determination were compared with serum creatinine and urine specific gravity values on a Monday-Wednesday-Friday data collection schedule for 10 days. Endogenous creatinine clearance determination, ultrasound-guided renal biopsy, and urine culture were repeated at the end of data collection in all 3 groups.

RESULTS

Significant differences in resistive index measurements were not observed, despite clinicopathologic and renal biopsy results compatible with severe acute tubular necrosis in dogs of the toxic dosage group.

CONCLUSIONS

Duplex Doppler sonography of arcuate artery blood flow impedance, expressed as the resistive index, appears to have poor clinical usefulness as a diagnostic tool in this disorder.

CLINICAL RELEVANCE

Normal arcuate artery resistive index values obtained in dogs for which aminoglycoside-induced nephrotoxicosis is suspected do not exclude the disorder. If abnormal arcuate artery resistive index values are obtained for such dogs, further evaluation for nephropathies other than aminoglycoside-induced nephrotoxicosis may be considered.

Concurrent validity of cocaine and sedative dependence diagnoses in opioid-dependent outpatients

The present study evaluated the relationship between diagnoses of cocaine and sedative dependence and drug use early in treatment among opioid-dependent patients in methadone substitution therapy. New admissions (n = 138) were assessed via the Structured Clinical Interview for the DSM III-R (SCID) for presence of Axis I and Axis II disorders and followed for five weeks on standard methadone maintenance. Patients submitted urines three times per week tested for opioids, cocaine, and benzodiazepines. Patients diagnosed with current cocaine dependence (n = 90) submitted a higher proportion of cocaine-positive urines (M = 0.84) than patients diagnosed with past cocaine dependence (n = 32; M = 0.28) and those diagnosed with no cocaine use disorder (n = 14; M = 0.12), P < 0.001. Current cocaine dependence diagnosis accounted for 52% of the cocaine use variance. Patients exhibiting current sedative dependence (n = 25) submitted a higher proportion of benzodiazepine-positive urines (M = 0.60) than patients with past sedative dependence (n = 44; M = 0.20) and those with no sedative use disorder (n = 60; M = 0.05), P < 0.001. Current sedative dependence diagnosis accounted for 37% of the benzodiazepine use variance. Lifetime major depression (12%) and antisocial personality disorder (39%) were the most common nonsubstance use comorbid diagnoses. Axis I nonsubstance use disorder was associated with benzodiazepine use, while Axis II disorder was associated with both benzodiazepine and cocaine use early in treatment (P < 0.05). These data demonstrate the concurrent validity of DSM-III-R cocaine and benzodiazepine use diagnoses, and support the potentially important relationship between drug use and other psychiatric disorders.

Gray-scale sonographic characterization of aminoglycoside-induced nephrotoxicosis in a canine model

RATIONALE AND OBJECTIVES

The diagnostic usefulness of gray-scale sonography was evaluated in a canine model of aminoglycoside-induced nephrotoxicosis.

METHODS

Sonography was performed before and during the onset and progression of nephrotoxicosis induced by administration of a toxic dosage of gentamicin. Subjective visualization of increased renal cortex echogenicity (IRCE) was objectified with digital image analysis methods. Results of both subjective and objective evaluation were correlated with clinicopathologic tests and renal cortex biopsy obtained concurrently.

RESULTS

Subjective visualization of IRCE was associated with significant nephrotoxicosis and was superior to serum creatinine elevation in nephrotoxicity detection. Objective detection of IRCE improved nephrotoxicity detection sensitivity to that of increased urine enzymuria.

CONCLUSIONS

Based on the above results, subjective visualization of IRCE in patients with aminoglycoside-induced nephrotoxicity may occur before azotemia and is suggestive of significant renal dysfunction; application of digital image analysis methods may lead to earlier sonographic recognition of nephrotoxicity.

The use of a synthetic prostaglandin E1 analog as a gastric protectant against aspirin-induced hemorrhage in the dog

Misoprostol prevented gastric hemorrhage in dogs, each of which received aspirin (35 mg/kg body weight, orally q 8 hrs for 10 days). All dogs receiving aspirin alone had gastroscopic and histopathological lesions. No lesions were noted in four of five dogs given aspirin plus misoprostol (15 micrograms/kg body weight, q 8 hrs for five days; then 7.5 micrograms/kg body weight, q 8 hrs for five days). Four of 10 dogs receiving 15 micrograms/kg body weight of misoprostol developed diarrhea. The misoprostol dose was reduced to 7.5 micrograms/kg body weight, and the diarrhea subsided.

Evaluation of urine gamma-glutamyl transpeptidase-to-creatinine ratio as a diagnostic tool in an experimental model of aminoglycoside-induced acute renal failure in the dog

The potential diagnostic utility of the urine gamma-glutamyl transpeptidase (GGT)-to-creatinine ratio was evaluated in an experimental canine model of aminoglycoside-induced nephrotoxicity. A therapeutic dosage of gentamicin resulted in a twofold increase in the mean urine GGT-to-creatinine ratio that was not associated with clinically significant nephrotoxicity. In dogs each given a nephrotoxic dosage of gentamicin, an increase in mean urine GGT-to-creatinine ratios approximately three times baseline values preceded clinically significant abnormalities in serum creatinine, urine specific gravity, and urine protein-to-creatinine ratio. The urine GGT-to-creatinine ratio appears superior as an early indicator of aminoglycoside-induced nephrotoxicity. Further studies in canine clinical cases are warranted.

Characterization of feed intake patterns during lactation in commercial swine herds

This study created and used a data-base containing 25,719 farrowing and 19,393 subsequent litter records abstracted from the PigCHAMP records of 30 commercial farms and daily feed intake records of 25,040 of these lactating sows. Each lactation feed record was categorized into one of six patterns: RAPID, rapid increase in feed intake following farrowing; MAJOR, major drop in feed intake during lactation; MINOR, minor drop; LLL, low feed intake throughout lactation; LHH, low feed intake during the first week then increasing for the remainder of lactation; and GRADUAL, gradual increase in feed intake throughout lactation. At the herd level, patterns RAPID, MAJOR, MINOR, LLL, LHH, and GRADUAL were observed in 22.8%, 32.9%, 27.8%, 1.0%, 8%, and 14.7% of sows, respectively. On a sow basis, across all feed intake records of all farms, patterns RAPID, MAJOR, MINOR, LLL, LHH, and GRADUAL were observed at frequencies of 17.8%, 38.3%, 25.8%, 1.2%, 1.5%, and 15.4%, respectively. Using logistic regression, the risk factors affecting the occurrence of MAJOR and MINOR patterns were lower parity, thicker backfat, higher room temperature, and greater feed intake during early lactation. Average daily feed intake and the day of peak intake were 5.2 (1.4 SD) kg/sow and 12.6 (4.6 SD) d after farrowing. Regression coefficients of factors affecting ADFI derived from multiple regression analyses were 247 g for parity, 9 g for weaning litter weight (kg), -13 g for room temperature (degree C), 62 g for lactation length (d), and -.4 g for energy density (kcal/kg). This study demonstrated substantial individual sow and farm variation in overall feed intake and pattern of feed intake during lactation. It also identified key risk factors (i.e., parity, lactation length, room temperature, weaning litter weights, energy density) for ADFI and pattern of feed intake on commercial farms.

Influence of imposed feed intake patterns during lactation on reproductive performance and on circulating levels of glucose, insulin, and luteinizing hormone in primiparous sows

Thirty-six primiparous sows were assigned to one of five treatments designed to mimic the lactation feed intake patterns observed in a previous study of commercial farms: high energy intake (HHH) or low energy intake during each week of a 3-wk lactation (LLL), or reduced intake during wk 1 (LHH), wk 2 (HLH) or wk 3 of lactation (HHL). The metabolizable energy intake of sows was either 16.5 (H) or 6.5 (L) Mcal/d. Diets were equal in lysine, providing 45 g/d. The HHH sows had a shorter (P < .05) weaning-to-estrus interval (9 +/- 3.2 d) than the sows in the LLL (23 +/- 3.5 d), HLH (22 +/- 3.5 d), and HHL (18 +/- 3.2 d) groups. The LH pulse frequencies of HHH (d 14: 1.5 pulses/8 h; d 21: 2.1 pulses/8 h) were greater (P < .05) than those of LLL (.2 pulses/8 h) and HLH (.5 pulses/8 h) on d 14 and those of LLL (0 pulses/8 h) and HHL (.9 pulses/8 h) on d 21 of lactation. No differences (P > .1) in mean serum concentrations of LH were observed among treatment groups either on d 21 of lactation or on d 1 postweaning. When fed a low-energy diet, sows had lower (P < .05) concentrations of serum insulin and plasma glucose than did sows fed a high-energy diet. Our results indicate that energy intake during lactation influences circulating insulin and glucose levels and LH pulse frequency and amplitude during midlactation and during the postweaning period.

Epizootiologic evaluation of urolithiasis in cats: 3,498 cases (1982-1992)

OBJECTIVE

to test the hypothesis that breed, sex and age of cats, and anatomic location of uroliths are risk factors for calcium oxalate and magnesium ammonium phosphate urolithiasis.

DESIGN

Retrospective case-control study.

SAMPLE POPULATION

Records of 3,498 feline urolith accessions submitted between September 1982 and September 1992.

PROCEDURE

Mineral composition of feline uroliths was quantitatively analyzed. Odds ratios and 95% confidence intervals were calculated for breed, sex, age, and urolith location as risk factors for calcium oxalate and magnesium ammonium phosphate urolith formation. The population at risk was defined as all cats for which that type of urolith had been submitted. The control population was all cats for which uroliths had been submitted, excluding cats with the type of urolith being evaluated.

RESULTS

Burmese, Persian, and Himalayan breeds were at higher risk for developing calcium oxalate uroliths, but at reduced risk for developing magnesium ammonium phosphate uroliths. Compared with females, neutered male cats had a higher risk for developing calcium oxalate uroliths, but a reduced risk for developing magnesium ammonium phosphate uroliths. The risk for calcium oxalate urolith formation increased with age. One- to 2-year-old female cats had the highest risk for magnesium ammonium phosphate uroliths. Uroliths removed from the kidneys were more likely to be composed of calcium oxalate than of magnesium ammonium phosphate.

CLINICAL IMPLICATIONS

Breed, sex, and age of cats, and anatomic location of uroliths should be considered when evaluating risk of calcium oxalate and magnesium ammonium phosphate urolithiasis in urolith-forming cats.

Reducing pig mortality through supervision during the perinatal period

A study was undertaken on a commercial swine farm to investigate methods of reducing perinatal mortality. During a 12-wk period, 251 sows and gilts were assigned randomly to one of four treatment groups in a 2 x 2 factorial design: 1) supervised/induced, 2) supervised/non-induced, 3) unsupervised/induced, and 4) unsupervised/non-induced. Supervised groups of sows and their litter were observed constantly for a minimum of 3 h before and until 3 d after farrowing. The onset of farrowing was induced with 250 micrograms of cloprostenol administered into the vulvo-vestibular mucosa. There was an increase (P = .012) in the number of pigs weaned from supervised (10.17 pigs/litter) relative to unsupervised group (9.44 pigs/litter). This increase was due to a reduction (P = .001) in both the number of stillborn pigs and the mortality of live-born pigs (P = .026). The latter resulted from fewer pigs that died (P = .003). Induction did not influence the mortality of pigs in the perinatal period in unsupervised groups. Induced sows farrowed an average of .43 d earlier than non-induced sows (P = .029). The mean interval from prostaglandin treatment to farrowing was 23.87 h (SD = 10.96). The results of this study suggest that a controlled farrowing system, coupled with good supervision, can improve pig survival. Financial analyses, based on improvements in pig survival resulting from additional labor in the farrowing house, suggested that this method of reducing preweaning mortality is a viable option for improving the profitability of commercial pig farms.

Evaluation of pulmonary function and analgesia in dogs after intercostal thoracotomy and use of morphine administered intramuscularly or intrapleurally and bupivacaine administered intrapleurally

Eighteen dogs undergoing lateral thoracotomy at the left fifth intercostal space were randomly assigned to 1 of 3 postoperative analgesic treatment groups of 6 dogs each as follows: group A, morphine, 1.0 mg/kg of body weight, IM; group B, 0.5% bupivacaine, 1.5 mg/kg given interpleurally; and group C, morphine, 1.0 mg/kg given interpleurally. Heart rate, respiratory rate, arterial blood pressure, arterial blood gas tensions, alveolar-arterial oxygen differences, rectal temperature, pain score, and pulmonary mechanics were recorded hourly for the first 8 hours after surgery, and at postoperative hours 12, 24, and 48. These values were compared with preoperative (control) values for each dog. Serum morphine and cortisol concentrations were measured at 10, 20, and 30 minutes, hours 1 to 8, and 12 hours after treatment administration. All dogs had significant decreases in pHa, PaO2, and oxygen saturation of hemoglobin, and significant increases in PaCO2 and alveolar-arterial oxygen differences in the postoperative period, but these changes were less severe in group-B dogs. Decreases of 50% in lung compliance, and increases of 100 to 200% in work of breathing and of 185 to 383% in pulmonary resistance were observed in all dogs after surgery. Increases in work of breathing were lower, and returned to preoperative values earlier in group-B dogs. The inspiratory time-to-total respiratory time ratio was significantly higher in group-B dogs during postoperative hours 5 to 8, suggesting improved analgesia. Blood pressure was significantly lower in group-A dogs for the postoperative hour. Significant decreases in rectal temperature were observed in all dogs after surgery, and hypothermia was prolonged in dogs of groups A and C. Significant differences in pain score were not observed between treatment groups. Cortisol concentration was high in all dogs after anesthesia and surgery, and was significantly increased in group-B dogs at hours 4 and 8. Significant differences in serum morphine concentration between groups A and C were only observed 10 minutes after treatment administration. In general, significant differences in physiologic variables between groups A and C were not observed. Results of the study indicate that the anesthesia and thoracotomy are associated with significant alterations in pulmonary function and lung mechanics. Interpleurally administered bupivacaine appears to be associated with fewer blood gas alterations and earlier return to normal of certain pulmonary function values. Interpleural administration of morphine does not appear to provide any advantages, in terms of analgesia or pulmonary function, compared with its IM administration.

Protection of C3H/He mice from experimental Borrelia burgdorferi infection by immunization with a 110-kilodalton fusion protein

A 110-kDa Borrelia burgdorferi fusion protein, Escherichia coli expressing the fusion protein, transformed E. coli lacking the fusion protein insert, and lyophilized whole B. burgdorferi bacteria were compared for immunogenicity in C3H/He mice. Immunized mice were challenged with a variety of isolates from the United States or the European isolate P/Gau 3 weeks following the last inoculation. An average of 76.7% of the mice immunized with 25 micrograms of lyophilized whole B. burgdorferi cells were protected from infection, while 60% of the mice immunized with the 110-kDa fusion protein were protected. Whole E. coli bacteria expressing the fusion protein protected 57.7% of immunized mice against experimental challenge. Lower levels of protection occurred in mice challenged with the European isolate than in those challenged with isolates originating from the United States. These results demonstrate the potential of the 110-kDa fusion protein for use as a component of a subunit vaccine for prevention of Lyme borreliosis.

Condom use rates for specific sexual behaviors among opioid abusers entering treatment

A structured interview was used to determine the details of high risk sexual behaviors, including number of sexual partners, frequency of condom use, and involvement in commercial sexual activity in 165 opioid abusers (mean age 34 years, 36% minority, 47% female) entering out-patient methadone substitution therapy. The median number of sexual partners in the sample was one, and 95% were sexually active in the past year. Most patients (84%) denied any commercial sexual activity and reported rates of monogamy and sexual abstinence (81%), and rates of condom use (15%), that were comparable with reports from general population surveys. However, intravenous drug abusers (IVDAs) remain at higher risk for exposure to HIV-1 because they are likelier to have sexual contact with other IVDAs and former IVDAs. Continuing efforts are needed to improve the safe sex practices of IVDAs, but it may be a significant challenge to reduce their high risk sexual behavior considerably below that of the general population. Concomitant drug abuse treatment may help in efforts to accomplish sexual behavior change.