Objective: To identify preoperative risk factors associated with mortality before discharge in cats having a single or multiple ureterotomy procedures to treat a ureteral obstruction. Study Design: Case series. Animals: Cats (n = 47). Methods: Data were obtained from the medical records (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) of cats that had undergone ureterolithotomy procedures. Multiple preoperative factors were evaluated for association of survival to discharge. Result: Survival to discharge after ureterolithotomy was 79% (37/47). Over 79% of cats were azotemic before surgery and 94% had chronic kidney disease changes at the time of ultrasonographic diagnosis. Six cats required an additional surgical procedure because of complications with ureterolithotomy. Overall prevalence of postoperative uroabdomen was 6% (3/47). On multivariate analysis, there were no preoperative variables significantly associated with survival to discharge. Conclusions: Ureterolithotomy in cats was associated with a 21% mortality rate before hospital discharge. No preoperative variables associated with mortality were identified; therefore, further studies are needed to identify more discriminating preoperative characteristics for mortality after ureterolithotomy in this population of cats.The last 20 years has seen an increase in the diagnosis of ureteral calculi in cats.1,2 This is likely attributable to a combination of factors including a true increase in the predominance of the disease as well as improved diagnosis. Calculi can be associated with a partial or complete ureteral obstruction and if medical management fails to resolve an obstruction, surgical intervention may be necessary.In the largest case series evaluating 153 cats, 66% needed surgical intervention because of complete ureteral obstruction and worsening azotemia in the face of medical management.3 Of those cats needing ureteral surgery, 80% survived to discharge from the hospital. Other case series have shown success in surgical removal of the ureteroliths, thus preserving or preventing deterioration of renal function. 1,4 Kyles et al 3 showed that cats with complete or partial ureteral obstructions can benefit from medical management alone, as 30% showed a dramatic decrease in the degree of azotemia over a 1 month period. However, the remaining cats (70%) that were alive 1 month from diagnosis had levels of azotemia that either did not change or increased despite aggressive medical management. Results from that study suggest that early stabilization and surgical decompression can be beneficial in this cohort of cats. The interval between diagnosis and surgery also decreased in the latter part of their retrospective study, suggesting a decrease in reluctance to recommend surgery as well as an increase in comfort level of the investigators to perform ureteral surgery in cats. 3Many techniques for surgical removal of ureteral calculi have been reported in cats including pyelotomy, ureterotomy, and ureteral resection and reimplantation. 1,4 The small size of ...

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine.

In the originally published version of this article, Table 1 unfortunately included c.542G>A instead of c.542G>T. This mutation was correctly notated as c.

lifetime risk estimates of AD based on the same risk factors excluding APOE genotype. Perceptions of personal risk (PPR) for AD were assessed six weeks after risk assessments. PPR were correlated with actual lifetime risk estimates (r = 0.501; p < 0.0001). After controlling for lifetime risks communicated to participants, age, and number of affected relatives, PPR scores among those with an epsilon4-positive test result (the test result associated with increased AD susceptibility) (adjusted mean: 3.4 (SD: 0.7)) were not different from the PPR scores in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,91= 1.98; p = 0.162). Again, controlling for lifetime risk estimates, age, and number of affected relatives, the PPR score of those receiving an epsilon4-negative test result was significantly lower (adjusted mean: 3.1 (SD: 0.8)) than those in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,95 = 6.23; p = 0.014). Perceptions of risk of developing AD are influenced by genetic test disclosure in those receiving epsilon4-negative, but not those receiving epsilon4-positive test results. Despite the reduced perceptions of risk in the former group, there was no evidence of false reassurance (i.e., perceiving risks as equal to or lower than population risks of AD), although this possibility should be assessed in other testing contexts.

Significant increases in National Institutes of Health (NIH) spending on medical research have not produced corresponding increases in new treatments and cures. Instead, laboratory discoveries remain in what has been termed the "valley of death," the gap between bench research and clinical application. Recently, there has been considerable discussion in the literature and scientific community about the causes of this phenomenon and how to bridge the abyss. In this article, the authors examine one possible explanation: Clinician-scientists' declining role in the medical research enterprise has had a dilatory effect on the successful translation of laboratory breakthroughs into new clinical applications. In recent decades, the percentage of MDs receiving NIH funding has drastically decreased compared with PhDs. The growing gap between the research and clinical enterprises has resulted in fewer scientists with a true understanding of clinical problems as well as scientists who are unable to or uninterested in gleaning new basic research hypotheses from failed clinical trials. The NIH and many U.S. medical schools have recognized the decline of the clinician-scientist as a major problem and adopted innovative programs to reverse the trend. However, more radical action may be required, including major changes to the NIH peer-review process, greater funding for translational research, and significantly more resources for the training, debt relief, and early career support of potential clinician-scientists. Such improvements are required for clinician-scientists to conduct translational research that bridges the valley of death and transforms biomedical research discoveries into tangible clinical treatments and technologies.