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Abstract Background Currently, low-level evidence suggests loss of ambulation associated with acute thoracolumbar disk extrusion is best treated by decompressive spinal surgery. Conservative management can be successful, but the proportion of dogs that recover and the fate of herniated material are uncertain. Objectives Determine the proportion of nonambulatory dogs with conservatively treated acute thoracolumbar disk extrusion that recover ambulation and measure the change in spinal cord compression during the first 12 weeks after presentation. Animals Seventy-two client-owned nonambulatory dogs with acute thoracolumbar intervertebral disk extrusion. Methods This is a prospective cohort study. Enrolled dogs underwent magnetic resonance imaging at presentation and owners were provided with conservative management recommendations. Imaging was repeated after 12 weeks. Recovery of ambulation was defined as 10 consecutive steps without falling. Spinal cord compression was determined from the cross-sectional area of the vertebral canal and extradural compressive material at the lesion epicenter. The association between recovery and change in compression over the 12-week observational period was examined. Results Forty-nine of fifty-one (96%; 95% confidence interval [CI], 87%-99%) of deep pain-positive and 10/21 (48%; 95% CI, 28%-68%) of deep pain-negative dogs recovered ambulation within the 12-week period. The median time to ambulation was 11 and 25 days for deep pain-positive and -negative dogs, respectively. Reduction in spinal cord compression varied among individuals from minimal to complete and apparently was unrelated to the recovery of ambulation. Conclusions and Clinical Importance A high proportion of conservatively treated dogs recovered ambulation after conservative management of acute thoracolumbar disk herniation. Recovery was not dependent on the resolution of compression.

Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.

Background Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. Methods This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0–2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. Results Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. Conclusion The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy

Background Thoracolumbar intervertebral disc extrusion (TL IVDE) is a common reason for the veterinary hospital admission. Various imaging factors including degree and length of compression have been tested for correlation with clinical severity, but no reliable correlation has been found. Half‐Fourier acquisition single‐shot turbo spin echo (HASTE) magnetic resonance imaging (MRI) sequences highlight the dorsal and ventral cerebrospinal fluid (CSF) columns and have been used to demonstrate spinal cord swelling in dogs with TL IVDE. This has been used as a predictor of progressive ascending‐descending myelomalacia but has not been correlated with neurological grade. Objective This study aims to investigate the correlation between the attenuation of CSF HASTE signal and clinical severity in dogs suffering from TL disc extrusions. Methods Dogs less than 15 kg who were non‐ambulatory due to suspected TL IVDE were prospectively recruited for a study into conservative management. MRI studies were undertaken under sedation including HASTE sequences. The ratio of the length of CSF attenuation to the length of the L2 vertebra was calculated and correlated with clinical severity. Results Twenty dogs met the inclusion criteria. No statistically significant difference was demonstrated between the mean CSF attenuation and neurological grade (p = 0.17 but there was a significant difference in the mean CSF attenuation in those who retained deep pain perception and those who did not (p = 0.02). Time to loss of ambulation was also found to not be correlated with CSF attenuation (p = 0.95). Conclusion In conclusion, the length of CSF attenuation of HASTE MRI sequences in dogs less than 15 kg suffering from IVDEs may be correlated with a loss of deep pain perception. Dogs who were non‐ambulatory due to suspected thoracolumbar intervertebral disc extrusion underwent MRI studies including half‐Fourier acquisition single‐shot turbo spin echo sequences. The ratio of the length of CSF attenuation to the length of the L2 vertebra was calculated and correlated with clinical severity. This showed that the length of CSF attenuation sequences may be correlated with a loss of deep pain perception.

ObjectivesLung cancer is increasingly being diagnosed in non-smokers, with mounting evidence that household air pollution is a potential factor. Environmental risk factors for lung cancer in never-smokers (LCINS) in relation to combustion of biomass for heating and cooking in low-middle-income countries (LMICs) have been extensively explored. However, such evidence in high-income countries (HICs) is limited. We conducted a systematic review to explore potential relationships between exposure to cooking fumes, a type of household air pollution, and lung cancer, specifically in relation to never-smokers in HICs.DesignSystematic review and narrative synthesis using the Critical Analysis Skills Programme (CASP) guidelines for case–control studies.Data sourcesEmbase, Scopus, the Cochrane library and CINAHL were searched, from inception to March 2024. Reference lists of articles were hand searched for additional papers.Eligibility criteriaCase–control studies focusing on household air pollution and its impact on LCINS in HICs were included.Data extraction and synthesisTwo independent reviewers searched, screened and coded included studies using a bespoke table. Quality of evidence was assessed in the selected studies using the CASP tool for case–control studies. Retained studies used different exposure assessment and reporting methods which were sufficiently heterogeneous to preclude meta-analysis; therefore, narrative synthesis was performed.ResultsThree papers were included, with a total of 3734 participants. All studies were conducted in Taiwan or Hong Kong, focusing on Chinese women using traditional Chinese cooking methods. All three found a dose/response correlation between exposure to cooking fumes and the risk of developing LCINS.Chen et al assessed the risk of lung cancer risk by ‘cooking time-years’, measuring exposure to cooking fumes over a participant’s lifetime, citing OR 3.17 (95% CI 1.34 to 7.68) for the highest levels of exposure. Yu et al used ‘cooking dish-years’ as a measure of exposure to cooking fumes, with OR 8.09 (95% CI 2.57 to 25.45) for the highest exposure levels, while Ko et al found that the number of dishes cooked daily was a greater indicator of risk than the number of cooking years, citing a threefold increased risk of lung cancer among women who cooked three meals per day compared with those who cooked one (OR 3.1, 95% CI 1.6 to 6.2).Ventilation hoods were found to have a protective effect against LCINS with adjusted ORs of 0.49 (95% CI 0.32 to 0.76).ConclusionsThis review of three studies found a possible association between exposure to cooking fumes and the risk of developing LCINS in high-income settings. This corroborates the substantial body of evidence that links cooking fume exposure to LCINS in LMICs, with definitive confirmation of the exposure hazards.PROSPERO registration numberCRD42024524445.

Abstract Background Humans with peripheral vestibular disorders can suppress nystagmus through visual fixation, a capability often compromised in those with central vestibular disorders. Bedside tests that exploit this difference can aid neurolocalization in humans. These tests remain unexplored in veterinary medicine. Hypothesis Removal of visual input will reveal or enhance nystagmus in animals with peripheral vestibular disease, while animals with central vestibular disease would show little change. Animals Twenty-one dogs and cats with peripheral vestibular lesions and 16 with central vestibular lesions. Diagnosis was confirmed by MRI. Methods A prospective study was conducted using a modified penlight-cover test. Because animals cannot be easily instructed to fixate on a visual target, removal of visual input was used as a substitute for eliminating visual fixation, based on the assumption that visual fixation also occurs spontaneously. A 0.5-W LED penlight was shined into one eye while covering the other to eliminate visual input. Nystagmus beat frequency (BF) and subjective evaluation of slow phase velocity (SPV) were recorded before and during penlight application. Results In animals with peripheral lesions, BF increased in 33% and SPV in 24% of cases after removal of visual input. Among those with central lesions, only one of 16 showed an increase in BF, and none exhibited an increase in SPV. Conclusions When used alongside the neurological examination, the modified penlight-cover test, could raise suspicion of a peripheral vestibular lesion if it reveals increased BF or SPV.

Intervertebral disc extrusion (IVDE) is a common neurological condition in veterinary medicine, with chondrodystrophic breeds being particularly susceptible. Studies have compared breed-related risks and clinical characteristics, but here, we investigate the disease in three common chondrodystrophic breeds, the English cocker spaniel, French bulldog and dachshund, and aim to describe and compare the clinical features and anatomical distribution between them. We performed a multicentre retrospective observational study that included 465 dachshunds, 327 French bulldogs and 145 English cocker spaniels with an imaging confirmed diagnosis of IVDE. The mean age at presentation differed in all three breeds, with the French bulldog presenting youngest and English cocker spaniels presenting oldest. IVDE was most common in the thoracolumbar region in all three breeds, although French bulldogs showed the highest proportion of cervical IVDE, dachshunds the highest proportion of thoracolumbar IVDE, and English cocker spaniels the highest proportion of lumbosacral IVDE. The results of this study suggest a differing clinical presentation for IVDE between these three breeds with regard to both the age of onset and the anatomical region most likely to be affected.

Abstract Background Myasthenia gravis (MG) is categorized into several subgroups, including seronegative MG. Seronegative human patients are well documented, but seronegative dogs remain clinically uncharacterized and their prevalence unknown. Objectives This study aims to evaluate the clinical presentation, diagnosis, treatment, and outcome of canine MG subgroups. Animals One hundred sixty-seven owner-owned dogs diagnosed with MG from three referral centers. Methods Retrospective case series. We classified myasthenic dogs into subgroups, adhering to human guidelines. Results We classified 167 dogs into four subgroups: acetylcholine receptor (AChR) antibody-positive generalized (49.7%, n = 83/167), focal (19.2%, n = 32/167) and thymoma-associated MG (9%, n = 15/167) and seronegative MG (22.2%, n = 37/167). Dogs with thymoma-associated MG were older (median 102 months; Interquartile Range (IQR) 96–120; p < 0.001) and seronegative dogs were younger (median 30 months; IQR 11.5–66; p = 0.017), compared to the generalized subgroup (median 67 months; IQR 36–96). Seronegative dogs presented less frequently with megaesophagus, compared to the generalized subgroup (63.8% vs. 85.7%; Odds Ratio 3.4; 95% confidence intervals (C.I.) 1.4–8.9; p = 0.025). Myasthenic dogs' survival time was significantly reduced when thymoma (Hazard Ratio (H.R.) 3.7; 95% C.I. 1.4–9.9; p = 0.028) or esophageal weakness (H.R. 3.8; 95% C.I. 2.0–7.0; p < 0.001) was present. Conversely, a higher likelihood of remission was achieved when esophageal weakness was absent (H.R. 3.8; 95% C.I. 1.4–10.0; p = 0.007). Conclusion and Clinical Importance Dogs with seronegative MG are more common than previously reported. Myasthenic subgroups differ in presentation and outcome, with esophageal weakness key to survival and remission. Diagnostic tests for seronegative dogs and effective treatments for esophageal weakness in myasthenic dogs are urgently needed.

Background Global annual cancer incidence is forecast to rise to 27.5 M by 2040, a 62% increase from 2018. For most cancers, prevention and early detection are the most effective ways of reducing mortality. This study maps trials in cancer screening, prevention, and early diagnosis (SPED) to identify areas of unmet need and highlight research priorities. Methods A systematic mapping review was conducted to evaluate all clinical trials focused on cancer SPED, irrespective of tumour type. The National Cancer Research Institute (NCRI) portfolio, EMBASE, PubMed and Medline were searched for relevant papers published between 01/01/2007 and 01/04/2020. References were exported into Covidence software and double-screened. Data were extracted and mapped according to tumour site, geographical location, and intervention type. Results One hundred seventeen thousand seven hundred one abstracts were screened, 5157 full texts reviewed, and 2888 studies included. 1184 (52%) trials focussed on screening, 554 (24%) prevention, 442 (20%) early diagnosis, and 85 (4%) a combination. Colorectal, breast, and cervical cancer comprised 61% of all studies compared with 6.4% in lung and 1.8% in liver cancer. The latter two are responsible for 26.3% of global cancer deaths compared with 19.3% for the former three. Number of studies varied markedly according to geographical location; 88% were based in North America, Europe, or Asia. Conclusions This study shows clear disparities in the volume of research conducted across different tumour types and according to geographical location. These findings will help drive future research effort so that resources can be directed towards major challenges in cancer SPED.

Abstract Background Limited data exist on intervertebral disk disease (IVDD) prevalence and risk factors in English cocker spaniels. Hypothesis/Objectives IVDD risk factors and prevalence vary between breeds and within sub-populations. Animals Two thousand six hundred fifty-four English cocker spaniels. Methods An online survey investigating prevalence and factors associated with IVDD was distributed via the UK Kennel Club to registered English cocker spaniel owners (November 14, 2022 to February 2, 2023). Prevalence estimates with 95% confidence intervals were calculated (Wilson score interval). Descriptive statistics were applied to demographic, exercise, and diet variables. Univariable associations were explored using unadjusted odds ratios with 95% CI (Wald method). Results Overall IVDD prevalence was 5.73% (95% CI, 4.82-6.62) and was greater in the show [8.99% (95% CI, 7.30-11.03)] than the working [3.44% (95% CI, 2.61-4.49)] dogs. Dogs in the show group were taller relative to their length compared to those in the working group. The lumbar region accounted for 53.02% (n = 79) cases, with an onset time most frequently of less than one day (40.14%, n = 59). Males were at greater odds of IVDD in our study compared to females (OR:14.39, 95% CI, 7.30-28.36), with neutered males or females at greater odds compared to the entire dogs (OR:7.9, 95% CI, 4.25-14.67). Conclusions and clinical importance IVDD is common in English cocker spaniels, with a higher prevalence in the show dogs.