|
CFSAN/Office of Food Additive Safety
March 2004
Date of Submission:
Title of Petition or Notification:
Name and Address of Petitioner or Notifier:
1. Targeted dose levels:
Table # [Heading]
test group |
conc. in diet |
dose to animals |
number of males |
number of females |
---|---|---|---|---|
Control |
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Low |
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Mid |
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High |
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2. Total
number of animals:
3. Duration
of study (including recovery period, if any):
4. Length
of exposure to test substance:
5. Were
animals randomized?
6. Recovery
period:
7. Comments:
Parameter examined:
Table # [Heading]
Examined |
Not Examined |
---|---|
|
Feed Intake*
|
*These parameters are recommended in REDBOOK for subchronic toxicity studies.
2. Comments: (e.g., list frequency)
1. Parameter examined:
Table # [Heading]
Examined |
Not Examined |
---|---|
|
Appearance*
|
*These parameters are recommended in REDBOOK for subchronic toxicity studies.
**The parameters for neurotoxicity screening may include, but are not limited to, the following:
2. Comments:
1. Fasting duration prior to blood collection:
2. When were the blood samples collected?
3. How were the blood samples drawn?
4. Dose groups and number of animals tested:
5. Parameter examined:
Table # [Heading]
Measurement |
Examined |
Not Examined |
---|---|---|
Red Blood Cells |
|
Hematocrit (Hct)*
|
White Blood Cells |
|
Basophils*
|
Clotting Potential
|
|
Activated Partial-Thromboplastin Time*
|
Others |
|
Bone Marrow Cytology* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
6. Comments:
1. Fasting duration prior to blood collection:
2. When in the study were the blood samples collected?
3. How were the blood samples drawn?
4. Dose groups and number of animals tested:
5. Parameter examined:
Table # [Heading]
Measurement Related To |
Examined |
Not Examined |
---|---|---|
Electrolyte Balance |
|
Calcium* Chloride*,** Phosphorus* Potassium*,** Sodium*,** |
Carbohydrate Metabolism |
|
Glucose*,** |
Liver Function:
B) Hepatobiliary
|
|
Alanine Aminotransferase
|
|
Alkaline Phosphatase (ALP)*,**,
|
|
Kidney Function |
|
Creatinine*,**, |
Others |
|
Albumin (A)*
|
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
** These parameters should generally be given priority when adequate volumes of blood samples cannot be obtained from test animals.
6. Comments:
1. When
and how were urine samples collected?
2. Dose
groups and number of animals tested:
3. Parameter
examined:
Table # [Heading]
Examined |
Not Examined |
---|---|
|
Glucose*, Microscopic evaluation for sediment and presence of blood/blood cells*, pH*, Protein*, Specific Gravity*, Volume* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
4. Comments:
1. Organs weighed:
Table # [Heading]
Examined |
Not Examined |
---|---|
|
Adrenals*, Brain*, Epididymides*, Heart*, |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
2. Comments:
1. Organs
were collected from which dose groups?
2. Organs
were examined from which dose groups?
3. How
were the organs/tissues prepared for histopathology observation?
4. Organs/tissues
collected:
Table # [Heading]
System |
Examined
|
Not Examined |
---|---|---|
Digestive |
|
Salivary Gland*, Esophagus*, Stomach*, Duodenum*, Jejunum*, Ileum*, Cecum*, Colon*, Rectum*, Gall Bladder*, Liver (middle, left and triangular lobes)*, Pancreas* |
Respiratory |
|
Nasal Turbinates*, Trachea*, |
Cardiovascular |
|
Aorta*, Heart* |
Reticulo- Endothelial/ |
|
Bone Marrow (sternum)*, |
Urogenital |
|
Kidneys*, Ovaries*, Urinary Bladder*; As applicable: fallopian tubes*, Corpus Uteri*, Cervix Uteri*, Vagina*, Prostate*, Seminal Vesicle*, Testes* |
|
Brain (at least 3 different levels)*, Spinal-Cervical*, |
|
Glandular |
|
Adrenals*, Mammary Glands*, Pituitary Glands*, Thyroid/Parathyroid Glands*, Thymus* |
Other |
|
Bone (Femur)*, Eyes*, Skeletal Muscle*, Skin*, Epididymis* |
* These parameters are recommended in REDBOOK for subchronic toxicity studies.
5. Comments:
1. Methods of statistical analysis:
Table # [Heading]
Methods Of Statistical Analysis |
Parameters Tested |
---|---|
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2. Comments:
We suggest using an Excel file to calculate the Means and Standard Deviations (SD). (Optional): A sample Excel file (calculation.xls) is provided.
Table # [Heading]
Dose Groups |
Targeted Daily Dose |
Targeted Concentration In Feed |
Concentrations Found In Feed |
Standarddeviation |
N*
|
---|---|---|---|---|---|
Low |
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Mid |
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High |
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* Number of measurements (N)
2. Verified by:
3. Comments:
1. Observations:
Table # [Heading]
|
Daily Feed Consumption (gram of feed consumed/day) |
|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sex |
Males |
Females |
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Targeted Daily Dose |
0 |
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0 |
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Number of Animals |
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X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
|
Body Weights (kg body weight/day) |
|||||||||||||||
Sex |
Males |
Females |
||||||||||||||
Targeted Daily Dose |
0 |
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0 |
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Number Of Animals |
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X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
|
Daily Intake Of Test Material (mg/kg body-weight/day)) |
|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sex |
Males |
Females |
||||||||||||||
Targeted Daily Dose |
0 |
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0 |
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Number Of Animals |
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X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
X |
SD |
0 week |
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1st week |
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2nd week |
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3rd week |
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4th week |
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5th week |
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6th week |
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7th week |
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8th week |
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9th week |
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10th week |
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11th week |
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12th week |
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13th week |
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X: Mean, SD: Standard Deviation
2. Comments:
1. Observations:
Table # [Heading]
Sex |
Males |
Females |
||||||||
---|---|---|---|---|---|---|---|---|---|---|
Daily Dose |
0 |
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0 |
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Number Of Animals |
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Red Blood Cells |
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Hematocrit (Hct) |
% |
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Hemoglobin Conc. (Hb) |
g/L |
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Mean Corp. Hb. (MCH) |
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Mean Corp. Hb. Conc. (MCHC) |
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Mean Corp. Volume (MCV) |
L/L |
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Total Erythrocyte Count (RBC) |
1012/L |
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White Blood Cells |
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Basophils |
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Eosinophils |
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Lymphocytes |
109/L |
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Macrophage/ |
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Neutrophils |
109/L |
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Total Leukocytes (WBC) |
109/L |
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Clotting Potential |
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Activated Partial-Thromboplastin Time |
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Clotting Time |
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Platelet Count |
109/L |
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Prothrombin Time |
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Others |
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Bone marrow cytology |
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Reticulocyte counts |
1012/L |
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(Specify a method of statistical analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations:
Table # [Heading]
Sex |
Males |
Females |
|||||||
Daily Dose |
0 |
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0 |
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Number Of Animals |
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Electrolyte Balance |
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Calcium |
mmol/L |
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Chloride |
mmol/L |
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Phosphorus |
mmol/L |
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Potassium |
mmol/L |
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Sodium |
mmol/L |
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Carbohydrate Metabolism |
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Glucose |
mmol/L |
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Liver Function: |
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Alanine Amino-transferase |
U/L |
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Aspartate Amino-transferase |
U/L |
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Glutamate Dehydrogenase |
U/L |
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Sorbitol Dehydrogenase |
U/L |
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Liver Function: |
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Alkaline Phosphatase (ALP) |
U/L |
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Gamma-Glutamyl Transferase (GGT) |
U/L |
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Total Bile Acids |
mmol/L |
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Total Bilirubin |
mmol/L |
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5' Nucleotidase |
U/L |
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Kidney Function |
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Creatinine |
mmol/L |
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Urea Nitrogen |
Mg/dL |
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Others |
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Albumin (A) |
g/L |
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Globulin (G, calculated) |
g/L |
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A/G Ratio |
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Total protein |
g/L |
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Total Cholesterol |
mmol/L |
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Fasting Triglycerides |
mmol/L |
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Cholinesterase |
U/L |
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(Specify statistical method of analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations:
Table # [Heading]
Sex |
Males |
Females |
|||||||
DAILY DOSE |
0 |
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|
0 |
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NUMBER OF ANIMALS |
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Glucose |
mmol/L |
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Microscopic evaluation for sediment and presence of blood/blood cells |
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pH |
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Protein |
g/L |
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Specific Gravity |
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Volume |
L/time |
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2. Comments:
1. Observations:
Table # [Heading]
|
Number Of Animals |
|||||||
---|---|---|---|---|---|---|---|---|
Sex |
Males |
Females |
||||||
Daily Dose |
0 |
|
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|
0 |
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Number Of Animals Examined |
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Observations Of Nervous System Toxicity + |
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Observation |
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Observation |
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Observation |
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Gross- And Histo-Pathology Changes In The Neurologic System # |
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Organ/Tissue |
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Gross Lesion |
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Non-Neoplastic Lesion |
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Non-Neoplastic Lesion |
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Non-Neoplastic Lesion |
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Neoplastic Lesions |
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Neoplastic Lesions |
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Neoplastic Lesions |
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+ See under section IV.G for the types of observation for nervous system toxicity: List noteworthy findings. If additional parameters (other than those in the Template) showed noteworthy changes, these should be added to the tables. In general, data at end of dosing period can be shown; however, if there were additional noteworthy findings at earlier timepoints, these should be included. Footnotes should be used as needed to provide additional information about the tests or the results. Note the severity of the abnormal observations using the following scales; + Mild, ++ Moderate, and +++ Marked or other scales, as appropriate.
# Organs/tissues listed under Section IV.O.
1. Observations:
Table # [Heading]
Sex |
Males |
Females |
|||||||
Daily Dose |
0 |
|
|
|
0 |
|
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|
Number Of Animals |
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Body Weight (gram) a |
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Brain |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Adrenals |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Epididymides |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Heart |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Kidneys |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Liver |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Spleen |
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Absolute Weight a |
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Per Body Weight a |
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Per Brain Weighta |
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Testes |
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Absolute Weight a |
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Per Body Weight a |
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Per Brain Weighta |
% |
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Thyroid and Parathyroid |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Thymus |
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Absolute Weight a |
gram |
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Per Body Weight a |
% |
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Per Brain Weighta |
% |
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Ovaries |
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Absolute Weight A |
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|
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Per Brain Weighta |
% |
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Uterus |
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Absolute Weight a |
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Per Brain Weighta |
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|
a: Group means at the end of terminal necropsy are shown.
(Specify methods of statistical analysis): * p<0.05, ** p<0.01
2. Comments:
1. Observations:
Table # [Heading)
|
Number Of Animals |
|||||||
Sex |
Males |
Females |
||||||
Daily Dose |
0 |
|
|
|
0 |
|
|
|
Number Of Animals Examined |
|
|
|
|
|
|
|
|
Digestive System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Respiratory System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cardiovascular System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reticulo-Endothelial /Hematopoietic System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Urogenital System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neurologic System 29 |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Glandular System |
|
|
|
|
|
|
|
|
Organ/Tissue # |
|
|
|
|
|
|
|
|
Gross Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
Non-Neoplastic Lesion |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
Neoplastic Lesions |
|
|
|
|
|
|
|
|
# See Section IV.O for the list of organs or tissues.
2. Comments:
1This Template is set up for typical 90-Day dog studies. The sections are adjustable; if you find you need more space for a larger group of animals, you can add them to the section. If you have a smaller group of animals, you can delete the unneeded sections. The same applies to sections on feed mixtures and data for levels of test substances in feed.
2Make note of: Study location (Volume, pages), Study title/Report #, Testing facility, publication dates and comments, if needed.
3Indicate Yes or No for the Questions A and B. However, you may want to elaborate on the type of GLP compliance (USFDA, OECD, etc.) or make other notations
4Description of the test substance should be given, including purity, any possible contaminants or impurities, any properties of the test substance that could affect its integrity. Are there factors that could affect the actual administered dose, as opposed to the intended dose?
5After you put a blinking cursor on the http address, (CTRL +) left-click once to follow the link and wait. Enter a chemical name, CAS Number, or molecular formula inside the search window and click 'search' button. Right-click inside the molecular structure and select 'copy' submenu. Return to your document and put the cursor underneath item #4 (molecular structure). Right click to open up the menu options and select 'paste' submenu. You can drag the structure to any position you want and resize. If preferred, use other methods of depicting the molecular structure.
6Indicate how the test substance was given and whether any vehicle was used to dissolve or suspend the test substance (e.g., dissolved in corn oil and mixed into the feed). Also note if there was adequate testing for concentration and homogeneity and whether stability tests were done. Was the strength of the test material checked over the period and under the conditions that the feed mix, test article in vehicle, etc., would be stored? Note anything that was not normal or routine.
7Note anything that might have affected the study. Use the comments to indicate extremes or other factors that impacted the study.
8Provide adequate details. Use the comments to indicate additional information about the experimental design. To change the table, place cursor in the row or column that you wish to modify, then from the "Table" menu, use "Select Row" or "Select Column" to highlight the row or column that you wish to change, and use the "delete" or "insert" functions to make your changes.
9Indicate the measurements that were made by highlighting the parameter and dragging the term into the "Examined" side. Those parameters not examined will remain in the "Not Examined" side. Use the comments to indicate when observations were made and any other notable fact.
10Indicate the measurements or observations that were made by highlighting the parameter and dragging the term into the "Examined" side. Those parameters not examined will remain in the "Not Examined" side. Use the comments to indicate when observations were made and any other notable fact.
11Drag and drop to indicate the parameters that were examined. Use comments to indicate other important information.
12Drag and drop to indicate parameters that were examined. Use comments to indicate other important information.
13Note when urine was collected for testing, the groups that were tested, and drag and drop the parameters that were tested. Make comments on anything significant.
14Note here whether there was a check or verification of the doses being administered (by what analytical methodology and in which laboratory). If the test substance was mixed in the feed, was there a statement in the study report verifying, for example, that a 100 ppm feed mixture was analyzed to contain 100 ± 5 ppm, or 100 ± 10 ppm of the test substance? Was this done more than once? Were there adequate data to calculate the actual dose that was administered?
We suggest using an Excel file to calculate the Means and Standard Deviations (SD). (Optional): Download the Excel file named 'calculation.xls' to your computer. This Excel file contains four sheets named: Dose verification, Body Wt, Feed Consumption, and Intake of test substance. Each sheet can be accessed by clicking the name tab that appears on the lower left-hand side of the Excel file.
15Note any statistically or biologically significant feed consumption changes. Also note feed consumption changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. You may wish to insert graphs or use a table as provided in this section or delete it if not needed. To use the optional Excel file (calculation.xls) click the 'Feed Consumption' tab on the lower left-hand side of the file) to calculate the Means and Standard Deviations (SD).
16Note any statistically or biologically significant body weight changes. Also note body weight changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. You may wish to insert graphs or use a table as provided in this section or delete it if not needed. To use the optional Excel file, (calculation.xls) click the 'Body Weight' tab on the lower left-hand side of the file) to calculate the Means and Standard Deviations (SD).
17Knowing what the intake of feed and the level of test substance in the feed was, what was the dose actually being delivered to the animals? You may wish to use the table as provided in this section or delete it if not needed. . To use the optional Excel file (calculation.xls), click the 'Intake of Test Substance' tab on the lower left-hand side of the file to calculate the Means and Standard Deviations (SD).
18Note in this section if feed efficiency was determined; if any changes were observed; if feed efficiency was calculated for all groups or only selected groups; and if calculations were made per group or per animal.
19List significant, dose-related abnormal cage-side observations reported. Also, use the Table in Section V. L. to note any significant, dose-related abnormal neurotoxicological observations (see Section IV. G for a list of neurotox parameters).
20For each animal with an unscheduled death, note the group, date of death, and any observations, including lesions observed at necropsy.
21Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. The comment section is available to explain data findings, if needed.
22Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. The comment section is available to explain data findings, if needed.
23Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. The comment section is available to explain data findings, if needed.
24 If indicated, list treatment-related findings in the nervous system that were noted under results sections V. F: Abnormal cage-side observations, V. O: Gross pathological changes, and V.P: Histopathological changes. Provide a statement whether or not the test substance presents a potential neurotoxicity hazard. If no neurotoxicity was indicated, this section may be omitted or deleted.
25 When other tests were conducted, make note of the tests and any significant treatment-related effects.
26Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. The comment section is available to explain data findings, if needed.
27Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. The type of lesion should be noted. The comment section is available to explain data findings, if needed. Also, use a Table at the next histopathology section to note any findings.
28Note findings that were statistically or biologically treatment-related. Also note changes that were not statistically significant (e.g., at low or mid dose) but could indicate a treatment-related trend. Note treatment-related findings in the nervous system in this section, if not already noted in Section V. L. The type of lesion should be noted. The comment section is available to explain data findings, if needed.
To change the table, place cursor in the row or column that you wish to modify, then from the "Table" menu, use "Select Row" or "Select Column" to highlight the row or column that you wish to change, and use the "delete" or "insert" functions to make your changes.
29If this information has already been entered in section V.L., delete the relevant rows in this table to prevent duplication of neurologic system entries.
30Give your evaluation of the study: what was done well; what the problems were; did the study accomplish what it was supposed to do?
31Summarize the key findings from the study. Was there a dose-effect relationship? Were target organs identified? Was a NOEL achieved for each significant effect/observation? What was the NOEL? The whole study should be summarized in this section.