The role of a clinical veterinarian in a safety assessment testing facility

A clinical veterinarian working in a safety assessment testing facility must balance animal welfare concerns with the attainment of sound, reproducible data necessary for regulatory studies. Drawing on her experience as a clinical veterinarian with specialty training in the field of toxicology, and past experience as a Study Director on safety assessment studies, the author describes practices that facilitate the veterinarian's role to ensure animal welfare on safety assessment studies.     

Making a nutritional assessment.

The assessment of nutritional deficiencies depends on both clinical and laboratory diagnosis. The standard physical examination should be supplemented by nutritional anthropometry, consisting of accurate growth and skinfold measurements. A careful dietary history, preferably taken by a dietitian, is necessary to construct a record of past nutrient intake. Since biochemical abnormalities often appear before clinical signs of nutritional deficiency a battery of biochemical tests is sometimes needed. In unusual cases newer techniques of assessing body composition or immunologic or physiologic function may be required. In all cases the patient''s physical state, nutritional intake and biochemical status must be related to age and sex standards.     

Tubal ligation in the chimpanzee (Pan troglodytes) as a means of contraception

Contraception of two chimpanzees was considered necessary for clinical reasons. After failure of reversible methods of contraception (an intrauterine device and a long-acting progestagen), tubal ligation was successfully performed, using a technique similar to one used in women.     

Plasma creatine determination using a luminescence method

A new luminescence procedure based on the creatine kinase reaction was developed for measuring creatine in plasma. The method is highly applicable to small animal work where the amount of blood volume is critical. Only 20 microliter of sample is necessary for creatine analysis. Deproteinizing the plasma sample with ethanol at room temperature is convenient. This extraction method is adaptable to a clinical setting. The ethanol used in the extraction is compatible with the luminescence method but precipitated enzymes in the NADH spectrophotometric method because of the greater sample volume needed for analysis. The creatine concentration is stable in plasma for at least 1 hr in a final anticoagulant concentration of 10 mM EDTA. The correlation between the new luminescence method with the established NADH spectrophotometric method was excellent (r = 0.99). The accuracy of the within-run precision is high, with a mean coefficient of variation, 2-3%. Plasma creatine levels could be an important indicator denoting early cellular damage and of potential prognostic value. Preliminary studies in human muscle ischemia and early shock in rabbits revealed a significant increase in plasma creatine levels. Further investigations are necessary to evaluate its clinical importance.     

Laboratory identification of Saksenaea vasiformis: a rare cause of zygomycosis in Australia

Saksenaea vasiformis was identified as the causative agent in three cases of sub-cutaneous zygomycosis in Australia. The laboratory techniques for inducing clinical isolates of S. vasiformis to produce sporangia, necessary for the precise identification of the fungus, are described and compared.     

Type I IFN as a natural adjuvant for a protective immune response: lessons from the influenza vaccine model

The identification of natural adjuvants capable of selectively promoting an efficient immune response against infectious agents would represent an important advance in immunology, with direct implications for vaccine development, whose progress is generally hampered by the difficulties in defining powerful synthetic adjuvants suitable for clinical use. Here, we demonstrate that endogenous type I IFN is necessary for the Th1 type of immune response induced by typical adjuvants in mice and that IFN itself is an unexpectedly powerful adjuvant when administered with the human influenza vaccine, for inducing IgG2a and IgA production and conferring protection from virus challenge. The finding that these cytokines, currently used in patients, are necessary for full expression of adjuvant activity and are sufficient for the generation of a protective immune response opens new perspectives in understanding the basis of immunity and in vaccine development.     

Establishing efficacy of a new experimental treatment in the 'gold standard' design

Provided that there are no ethical concerns, the comparison of an active drug with placebo in a randomized two-arm clinical trial provides the most convincing way to demonstrate the efficacy of a new experimental treatment. However, in a placebo-controlled clinical trial it is not sufficient to demonstrate merely a statistically significant treatment difference. Regulatory authorities strongly recommend to assess additionally whether the observed treatment difference is also of clinical relevance. The inherent issue is the necessity of the a priori definition of what constitutes a clinically relevant difference in efficacy. This problem can be solved in a three-arm study by including an active control group. We address the necessary conditions in the gold standard design which allow the claim of efficacy for the new treatment with particular focus on assay sensitivity.     

Coronary tortuosity: a long and winding road

Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise stress test has never been described in the literature. This article describes three cases of patients with anginal complaints, an abnormal exercise stress test and coronary angiography without the presence of a fixed atherosclerotic lesion. It is hypothesised that coronary tortuosity leads to flow alteration resulting in a reduction in coronary pressure distal to the tortuous segment of the coronary artery, subsequently leading to ischaemia. Future studies will be necessary to elucidate the actual mechanism of coronary tortuosity and its clinical significance. (Neth Heart J 2007;15:191-5.)     

Clinical skills of medical residents: a review of physical examination.

Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. A practical and satisfactory method of addressing this problem during internship and residency training has not been forthcoming because of the lack of a regular forum for the teaching of clinical skills in busy tertiary referral hospitals and the shortage of teachers with the necessary skills and commitment to teaching a large number of house staff. We describe a program whose unique hierarchical approach has permitted a detailed ongoing review of physical examination. One clinician was able to teach 24 residents by instructing a small group of senior residents, who in turn, after practising with clinical clerks, taught groups of junior residents.     

Mesenchymal stem cells: a new front emerges in coronavirus disease 2019 treatment

Currently, treating coronavirus disease 2019 (COVID-19) patients, particularly those afflicted with severe pneumonia, is challenging, as no effective pharmacotherapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exists. Severe pneumonia is recognized as a clinical syndrome characterized by hyper-induction of pro-inflammatory cytokine production, which can induce organ damage, followed by edema, dysfunction of air exchange, acute respiratory distress syndrome, acute cardiac injury, secondary infection and increased mortality. Owing to the immunoregulatory and differentiation potential of mesenchymal stem cells (MSCs), we aimed to outline current insights into the clinical application of MSCs in COVID-19 patients. Based on results from preliminary clinical investigations, it can be predicted that MSC therapy for patients infected with SARS-CoV-2 is safe and effective, although multiple clinical trials with a protracted follow-up will be necessary to determine the long-term effects of the treatment on COVID-19 patients.     

Continuing medical education: a personal view.

Over many generations doctors have kept up to date in ways which reflect their own learning styles. The current fashion for formalised and policed continuing medical education may prove ineffective unless it is recognised that individual needs must be taken into account. Attendance at formal courses based on lectures and papers may not suit a large proportion of those who attend to acquire the necessary points to satisfy their royal college. The ability to show that health care teams are up to date should come from effective clinical audit, which should also identify local educational needs.     

A validation study of a new instrument for low cost bite force measurement

Quantitative assessment of force in masticatory muscles is not a routine clinical test, probably due to the lack of an “easy-to-use” device. Aim of this study is (1) to present a low cost bite force instrument located in a custom-made housing, designed to guarantee a comfortable and effective bite action, (2) to evaluate its mechanical characteristics, in order to implement it in clinical settings and in experimental setups.Linearity, repeatability and adaptation over time were assessed on a set of four different sensors in bare and housed condition. Application of the housing to the transducer may appreciably alter the transducer's response. Calibration of the housed transducer is thus necessary in order to correctly record real bite force. This solution may represent a low cost and reliable option for biting force measurement and objective assessment of individual force control in the scientific and clinical setting.     

Selection of Media for the Isolation of Common Bacterial L-Phase Organisms from a Clinical Specimen

The L-phase of 13 bacteria commonly associated with disease were induced by penicillin and inoculated into various solid and broth media; their growth was recorded for a period of 14 days. Plates containing highly purified agar and sucrose as the stabilizing agent and those incubated under aerobic conditions gave the best results. Magnesium seems to be necessary for growth in broth media on primary isolation, although it may not be necessary on multiple transfers after a more stable state has been reached. Growth in broth media is much more difficult to achieve. Reversion is aided by using a higher concentration of agar in plates, by decreasing the sucrose concentration, and by omitting the antibiotics and horse serum. A procedure has been outlined for the routine culture and identification of L-phase organisms from a clinical specimen.     

Role of a microbial factor, necrotic tissue and a foreign body in the development of wound suppuration

The effect of microorganisms, necrotic tissues and a foreign body on the development of festering process in rat wounds was studied. It was found that the presence of necrotic tissues is the necessary and sufficient condition for a clinical manifestation of infection in rat wounds. Additional infection of the wounds and introduction of a foreign body did not appreciably change the clinical picture. A model is suggested of a festering wound in rats without artificial infecting. In the festering wound, one could observe the replacement of the gram-positive coccal microflora by the gram-negative one. Meanwhile the gram-positive coccal microflora was predominant in the non-festering wound. The level of potential biochemical indicators of infection in the blood of animals with festering wounds was higher than in the blood of those with non-festering wounds. The morphology, and the content of microbial cells, the content of nucleic acids, and total proteolytic activity in festering wound tissues were examined over time.     

Human challenge studies: a review of adequacy of reporting methods and results

Since the 1940s, researchers have purposefully infected healthy adult humans with pathogenic organisms to study how these pathogens cause disease and can be treated and prevented. 'Challenge studies' can be safe, ethical, extremely informative and an efficient use of resources during the clinical development of vaccines, but knowledge of this form of clinical research trial is not widespread. A review of the human challenge literature was performed to determine whether common elements of challenge studies can be identified in the articles published to date. The review demonstrated incomplete reporting of study characteristics deemed necessary for the correct interpretation and application of human challenge study results and for the accurate replication of study methodology. An unofficial extension of the Consolidated Standards of Reporting Trials (CONSORT) statement is proposed.     

Morphometry of bladder carcinoma: definition of a new variable

In this study two measurements of nuclear size, the mean area and the size distribution curve of nuclear area, were used to differentiate between two polar groups: nuclei from non-neoplastic urothelium and nuclei from transitional cell carcinomas of bladder with a poor clinical outcome. Wide separation of these groups is necessary if a measurement is to be used to assess tumour grade where the morphometric differences are intermediate between such polar groupings. Separation between two groups was best achieved using a weighted distribution of nuclear size and this is a means of objective scoring of urothelial tumours.     

Concept and organization of a clinical gene therapy lab

Designing a dedicated clinical facility to meet the needs of existing and developing Gene Therapy Protocols presents a unique challenge. Here, we review some of the issues we faced and share some of our design concepts. An optimal Clinical Gene Therapy Lab must meet relevant regulatory guidelines, interface with other hospital labs as well as the clinic and patient care areas, be efficient and flexible in utilization of space, and have the potential to meet future needs without continual renovation. As clinical science expands to include more gene transfer approaches, specific laboratory areas for this type of work will become increasingly necessary.     

中药复方BBYNG对乳腺癌骨转移小鼠的作用观察

目的透过对中药复方BBYNG与西药双磷酸盐OSTAC的动物实验研究,观察中药治疗骨转移的疗效。方法参照文献建立高发骨转移的小鼠乳腺癌动物模型后,分别对不同组别的荷瘤小鼠灌喂相当于临床病人服用剂量的BBYNG或OSTAC,对比观察荷瘤小鼠的肿瘤生长、活动状态、生存时间、骨转移及骨破坏的程度等。结果BBYNG可减慢荷瘤小鼠的肿瘤生长,但不能显著缩小肿瘤的体积;可减轻肿瘤骨转移引起的活动障碍和骨破坏,延长生存时间。此结果与作者已进行的临床观察结果相似。结论BBYNG有减轻动物模型肿瘤引起的骨转移和骨破坏、延长荷瘤小鼠生存时间的作用;值得推广应用及开展用于预防肿瘤骨转移的探讨,并深化对其作用机理的研究。     

Stem cells as therapy for cardiac disease - a review

Acute myocardial infarction (AMI) is one of the most significant causes of morbidity and mortality worldwide. Stem cells represent an enormous chance to rebuild damaged heart tissue. Correct definition of the cardiac progenitors is necessary to understand heart development, and would pave the way for the use of cardiac progenitors in the treatment of heart disease. Identifying, purifying and differentiating native cardiac progenitor cells are indispensable if we are to overcome congenital and adult cardiac diseases. To understand their functions, physiology and action, cells are tested in animal models, and then in clinical trials. But because clinical trials yield variable results, questions about proper cardiac stem cells remain unanswered. Transplanted stem cells release soluble factors, acting in a paracrine fashion, which contributes to cardiac regeneration. Cytokines and growth factors have cytoprotective and neovascularizing functions, and may activate resident cardiac stem cells. Understanding all these mechanisms is crucial to overcoming heart diseases.     

Diagnosis of clinically unsuspected extrapulmonary tuberculosis by fine needle aspiration: a case report.

BACKGROUND: Mycobacterium tuberculosis (MTb) infection remains the cause of higher morbidity and mortality than any other infectious disease in the world. Intact cellular immunity is necessary to resist the disease, and therefore the AIDS epidemic has greatly contributed to the resurgence of MTb. Depending on the degree of immunosuppression, the presentation of MTb in patients with AIDS can be atypical and difficult to diagnose as compared to the classical presentation of MTb in the nonimmunocompromised population. CASE: A patient who was not known to be HIV positive had a clinical picture of extensive abdominal and pelvic lymphadenopathy without chest radiographic abnormalities. The diagnosis of MTb was made by fine needle aspiration (FNA) of a pelvic lymph node. CONCLUSION: Miliary tuberculosis associated with AIDS may have an unusual clinical presentation and unusual cytologic features on ENA.