Use of positive contrast radiography to identify synovial involvement in horses with traumatic limb wounds.

BACKGROUND: The diagnostic value of positive contrast radiography in the work-up of suspected synovial infection in horses with limb wounds near synovial structures has yet to be systematically evaluated. OBJECTIVES: To determine the specificity, sensitivity and positive and negative predictive values of positive contrast radiography for identification of synovial infection in a population of horses with limb wounds. STUDY DESIGN: Retrospective case study comparing the performance of positive contrast radiography to the gold standard of synovial fluid cytology in horses presenting with limb wounds in the vicinity of synovial structures. METHODS: Case records of horses presenting to the Royal Veterinary College Equine Hospital between 2010 and 2015 with limb wounds that may have compromised adjacent synovial structures were analysed. Synovial fluid cytology results were used to categorise synovial structures in infected and noninfected groups. Positive contrast radiography results were compared between infected and noninfected groups and sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Fifty horses with 66 synovial structures were included in the study. Positive contrast radiography had a high specificity (86.4%), but only a moderate sensitivity (59.1%) for the identification of synovial infection. In addition, a low positive predictive value (68.4%) and high negative predictive value (80.9%) were observed in this population of horses. MAIN LIMITATIONS: Sensitivity, specificity and predictive values may differ between different synovial structures and cases. Different conclusions may be drawn from the results in a single population. Sensitivity and specificity of positive contrast radiography may also be influenced by different techniques used by examiners and by inherent characteristics of individual cases. CONCLUSIONS: Positive contrast radiography should be used for the investigation of potential synovial infection in horses with limb wounds, particularly if no synovial fluid sample for laboratory analysis can be obtained. However, it appears that positive contrast radiography is best used in combination with other tests to ensure that a correct and timely diagnosis is made.

Technical innovation changes standard radiographic protocols in veterinary medicine: is it necessary to obtain two dorsoproximal-palmarodistal oblique views of the equine foot when using computerised radiography systems?

Since the 1950s, veterinary practitioners have included two separate dorsoproximal-palmarodistal oblique (DPr-PaDiO) radiographs as part of a standard series of the equine foot. One image is obtained to visualise the distal phalanx and the other to visualise the navicular bone. However, rapid development of computed radiography and digital radiography and their post-processing capabilities could mean that this practice is no longer required. The aim of this study was to determine differences in perceived image quality between DPr-PaDiO radiographs that were acquired with a computerised radiography system with exposures, centring and collimation recommended for the navicular bone versus images acquired for the distal phalanx but were subsequently manipulated post-acquisition to highlight the navicular bone. Thirty images were presented to four clinicians for quality assessment and graded using a 1-3 scale (1=textbook quality, 2=diagnostic quality, 3=non-diagnostic image). No significant difference in diagnostic quality was found between the original navicular bone images and the manipulated distal phalanx images. This finding suggests that a single DPr-PaDiO image of the distal phalanx is sufficient for an equine foot radiographic series, with appropriate post-processing and manipulation. This change in protocol will result in reduced radiographic study time and decreased patient/personnel radiation exposure.

Identifying optimal parameters for quantification of changes in pelvic movement symmetry as a response to diagnostic analgesia in the hindlimbs of horses.

REASONS FOR PERFORMING STUDY: Subjective evaluation of the response to diagnostic analgesia of hindlimb lameness is influenced by expectation bias. Quantification of pelvic movement with inertial measurement units is possible, but it is unclear which measure of movement symmetry best reflects the changes seen after diagnostic analgesia. OBJECTIVES: To test our hypothesis that objective measures closely relating to those used for subjective visual lameness scoring (quantifying the difference between sacral upward or downward movement or between movement amplitudes of the left and right tubera coxae) would show the largest and most consistent response. STUDY DESIGN: Retrospective analysis of subjective and objective clinical lameness data. METHODS: Thirteen horses with hindlimb lameness underwent visual lameness scoring and independent gait assessment with inertial measurement units. Established objective measures were calculated and changes before/after diagnostic analgesia regressed against the change in lameness grade. Slopes of regression lines were calculated and confidence intervals assessed. RESULTS: All objective parameters showed variation between horses and across lameness grades. The following 3 measures documented a consistent increase in symmetry for each grade of change in lameness score: difference between sacral displacement minima; upward movement difference; and range of motion difference between the tubera coxae. CONCLUSIONS: Several pelvic parameters are suitable for objective quantification of changes after diagnostic analgesia in hindlimb-lame horses. A change of 9-13% per lameness grade can be expected. Upward movement of the tubera coxae is the most sensitive objective measure for quantifying a response to diagnostic analgesia. However, when assessed visually, this measure requires simultaneous focusing on pelvic and limb movements. Other parameters that show a similar response might be more easily perceived, requiring only assessment of tubera coxae range of motion or downward displacement of the sacrum without simultaneous focus on limb movement.

Development and validation of an equine nerve block simulator to supplement practical skills training in undergraduate veterinary students.

Lameness is the most common presenting complaint in equine practice. Performing diagnostic nerve blocks is an integral part of any lameness work-up, and is therefore an essential skill for equine practitioners. However, the opportunities for veterinary students to practice this skill are limited. The aim of this study was to design and validate an equine nerve block simulator. It was hypothesised that the simulator would improve students' ability and enhance their confidence in performing nerve blocks. A simulator was built using an equine forelimb skeleton and building foam. Wire wool targets were placed under the foam in the positions corresponding to the anatomical location of the most palmar digital, abaxial and low four-point nerve blocks and attached to an electrical circuit. The circuit became complete when the operator placed a needle in the correct position and immediate audible feedback with a buzzer was provided. To validate the simulator, it was compared with two established teaching methods: cadaver training and theoretical training with a hand-out. Cadaver-trained students achieved the best results (73 per cent correct blocks), compared with simulator-trained students (71 per cent correct blocks), and a hand-out trained group (58 per cent correct blocks). Feedback obtained with a questionnaire showed that students enjoyed simulator training more, and that they felt more confident in performing diagnostic nerve blocks than the other two groups. The equine nerve block simulator provides a safe, cost-effective method to supplement the teaching of diagnostic analgesia to undergraduate veterinary students.

Forces applied with a hoof tester to cadaver feet vary widely between users.

Hoof testers are commonly used in equine practice. In this study, we determined the intraoperator and interoperator reliability of force application with hoof testers for different groups: experienced veterinarians, novices and farriers. For this purpose, we have developed and validated an instrumented hoof tester. Forces varied significantly between the different regions of the foot for experienced operators applying the highest forces to the heels, then the frog, then the toe, and the lowest forces to the quarters. Novices applied significantly more force to the toe versus the frog. Intraoperator reliability varied significantly between regions and operators. Novices had the narrowest width of limits of agreement for the frog and heel, but the widest for the toe and the quarters, whereas farriers had the narrowest width of agreement for the toe and quarter. Force application differed significantly between groups for the frog and heel regions, but not the toe and quarters. Veterinarians applied higher forces to the frog compared with farriers and novices, and higher forces to the heel compared with novices. This study showed that hoof tester forces vary widely within and between operators, and standardisation of hoof tester use is needed to make this diagnostic test more reliable.

Detection of joint effusion on radiographs of horses.

Joint effusion is one of the classic radiographic signs of osteoarthritis, but no information is available regarding clinicians' ability to detect joint effusion radiographically. This study determined the accuracy and precision of experienced and inexperienced observers in detecting joint effusion of the distal interphalangeal (DIP), metacarpophalangeal (MCP) and midcarpal joints on radiographs. Fresh cadaverous forelimbs were loaded in a material testing machine to mimic a standing horse. The joints were gradually distended and lateromedial and dorsopalmar radiographs were acquired. The images were assessed by three experienced and three inexperienced observers. This study showed that the sensitivity was high for both groups for all joints and projections. Specificity was high for the experienced group but low for the inexperienced group. There was a significant positive correlation between joint distension and severity of joint effusion when reported by experienced observersfor most views (except DIP joint), but only for the MCP joint for inexperienced observers. Interoperator agreement was poor to fair for the experienced group and poor for the inexperienced group. In conclusion, the accuracy and precision of grading joint effusion on radiographs was highly subjective and related to experience.

Stimulus-dependent release of tissue-regenerating factors by equine platelets.

REASONS FOR PERFORMING THE STUDY: Platelet-rich plasma (PRP) is increasingly used for treatment of orthopaedic injuries. However, the effects of different stimuli on the release pattern of regenerative and proinflammatory factors from equine platelets are largely unknown and an optimal treatment protocol remains to be established. OBJECTIVES: The aim of this study was to identify a stimulus that enhanced release of histopromotive factors (platelet-derived growth factor BB [PDGF] and transforming growth factor 1ß[TGF]) without causing concurrent release of a proinflammatory mediator (CCL5). METHODS: Washed platelets were prepared from 6 healthy ponies and release of growth factors and CCL5 measured using commercially available ELISAs for human proteins following incubation with or without thrombin, chitosan or equine recombinant tumour necrosis factor (erTNF) over 24 h and subsequently over 96 h. Additionally, noncoagulated samples were analysed. RESULTS: Regardless of whether a stimulus was present or what stimulus was used, PDGF and TGF release was maximal by 0.5-1 h when clot formation took place and very little release was observed after 24 h. Growth factor release was minimal in noncoagulated samples. In contrast, CCL5 release was not associated with coagulation and appeared to persist for much longer. High concentrations of erTNF caused significantly greater release of CCL5 at 6 h than any other stimulus tested. CONCLUSIONS: Growth factor release from equine platelets is dependent on coagulation but independent of the initiating stimulus, and is accompanied by more sustained release of proinflammatory mediators. POTENTIAL RELEVANCE: Supernatants collected from coagulated platelets could be an alternative treatment to PRP.

The Determinacy of Variables in Structural Equation Models.

The indeterminacy of variables in a structural equation model - a path model with latent variables - is considered. It is shown that when the variables in the structural ]model are all manifest, the error-terms - disturbances - are uniquely determined given the parameters and the data; when the variables in the structural model are all latent, the error-terms have indeterminate components that are simple linear transformations of the indeterminate I components of the common factor model; and when they are mixed, a sufficient condition for the error-term associated with a manifest variable to be uniquely determined is that there is no directed path to it from a latent variable. Moreover, for error-terms that are indeterminate due to the effects of latent variables it is demonstrated that error-term analysis along the lines of residual analysis can be employed by the use of suitable estimates of the latent variables.

Non-suppurative myocarditis in piglets associated with porcine parvovirus infection.

The involvement of porcine parvovirus (PPV) in the aetiology of non-suppurative myocarditis in sucking piglets was investigated by a polymerase chain reaction (PCR), designed to assess the presence of viral genome in formalin-fixed paraffin wax-embedded tissue of diseased animals. Myocardium and lung of stillborn piglets with a confirmed PPV infection were used to set up the PCR amplification method. Subsequently, 20 myocardia with inflammatory lesions were examined in parallel with 20 myocardia without lesions, from age-matched control piglets. Tissues were first tested for the presence and the integrity of porcine DNA by amplifying a sequence encoding the highly conserved nuclear protein histone H4. Tissue from 15 out of 20 animals with myocarditis contained amplifiable histone H4 DNA and in 12 of the 15 histone H4-positive samples, PPV DNA was detected. It proved possible to amplify histone H4 DNA in all 20 negative controls (without myocarditis), and PPV DNA was detected in three cases. In-situ hybridization with a digoxigenin-labelled probe homologous to PPV was performed in four PCR-positive cases of non-suppurative myocarditis. In two animals several positively stained nuclei were observed in the myocardium, within or close to the mild inflammatory cellular infiltrates. These results strongly suggest that PPV can cause non-suppurative myocarditis in sucking piglets.

Computer measurement of the autokinetic effect.

Previous methods for measurement of the autokinetic effect have several drawbacks, including limited accuracy and limited information. A new computer technique for measurement of the autokinetic effect is presented. A computer and computer mouse record tracing movements every tenth of a second, yielding a permanent record that can be analyzed further. The method is flexible, sensitive, and stable, as shown by test-retest correlations using 26 subjects. Correlations and medians for latency, total distance traveled, number of stops, straight line distance from origin to end-point, maximum speed, maximum acceleration, percent of time in motion, and speed and percent of motion in each of eight compass directions were computed. The results are similar to previously reported values.