Horses affected by EPM have increased sCD14 compared to healthy horses.

Equine protozoal myeloencephalitis (EPM) is a debilitating neurologic disease affecting horses across the Americas. Gaps in understanding the inflammatory immune response in EPM-affected horses create difficulties with diagnosis and treatment, subsequently negatively impacting the prognosis of affected horses. The purpose of the current study was to evaluate circulating levels of the inflammatory immune marker soluble CD14 (sCD14), in horses with EPM (n = 7) and determine if they differed from healthy neurologically normal horses (n = 6). Paired sera and cerebrospinal fluid (CSF) samples were analyzed for sCD14. Inclusion criteria for EPM horses consisted of the presence of neurologic signs consistent with EPM, Sarcocystis neurona surface antigens 2, 4/3 (SnSAG 2, 4/3) ELISA serum: CSF antibody ratio ≤ 100, and a postmortem diagnosis of EPM. Control horses were neurologically normal, healthy horses with SnSAG 2, 4/3 ELISA serum: CSF antibody ratios of > 100. Serum anti-Sarcocystis neurona antibodies indicate that healthy control horses were exposed to S. neurona but resistant to developing clinical EPM. EPM cases had significantly greater concentrations of sCD14 in CSF samples compared to control horses and increased serum sCD14 concentrations. A positive correlation between sCD14 serum and CSF concentrations was observed in EPM-affected horses but not healthy horses. Soluble CD14 is an inflammatory marker, and the study results suggest it is elevated in EPM patients. When performed in conjunction with clinical evaluation and standard antibody testing, there may be potential for sCD14 to be utilized as a correlate for EPM.

2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer.

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Since the guidelines for the management of ATC by the American Thyroid Association were first published in 2012, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, and researchers on published evidence relating to the diagnosis and management of ATC. Methods: The specific clinical questions and topics addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of the Task Force members (authors of the guideline). Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, targeted/systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues, including end of life. The guidelines include 31 recommendations and 16 good practice statements. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of ATC. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with ATC.

Prognostic value of colonic and peripheral venous lactate measurements in horses with large colon volvulus.

OBJECTIVE: To determine the prognostic value of (1) colonic venous lactate or peripheral lactate values obtained before and after manual correction of a large colon volvulus and (2) a combination of variables including pelvic flexure biopsy. STUDY DESIGN: Prospective clinical study. ANIMALS: Forty adult horses in which large colon volvulus was diagnosed intraoperatively. METHODS: Colonic venous, peripheral venous, and arterial blood samples were collected to measure lactate values before and after manual correction. Mucosal biopsy samples were obtained in cases that underwent enterotomy or colonic resection and anastomosis. Interstitium to crypt (I:C) ratio and hemorrhage scores were measured. Optimal cutoff values were determined by receiver operator curve analysis, and associations between variables and short-term outcome were determined by univariable regression. Short-term survival was defined as horses being discharged from the hospital. P ≤ .05 was considered significant. RESULTS: No association was found between colonic venous lactate values before (P = .011) or after (P = .201) manual correction of large colon volvulus and determination of short-term outcome. Peripheral venous lactate at admission ≥3.2 mmol/L and after manual correction ≥5 mmol/L, arterial lactate postmanual correction ≥3.53 mmol/L, and histomorphometric measurements of mucosal hemorrhage ≥3 and I:C ratio > 1 were associated with poor short-term outcome. CONCLUSION: Peripheral lactate values, histomorphometric measures of I:C ratio, and hemorrhage score provided prognostic information that could help guide recommendations made to owners. CLINICAL SIGNIFICANCE: Peripheral lactate values after manual correction provide important intraoperative diagnostic information to assist in predicting case outcome in the operative and immediately postoperative period.

The influence of perfusate volume on antimicrobial concentration in synovial fluid following intravenous regional limb perfusion in the standing horse.

This study investigated the influence of perfusate volume on antimicrobial concentration in synovial fluid following intravenous regional limb perfusion (IVRLP) and assessed the efficacy of low volume IVRLP. The front limbs of 9 horses were randomly assigned to 1 of 3 volume groups: 10 mL (Group 1), 30 mL (Group 2), or 60 mL (Group 3). A tourniquet was applied distal to the carpus and the limbs were perfused with 500 mg genta-micin diluted to the assigned volume via a catheter placed in the lateral palmar digital vein at the level of the proximal sesamoid bones. Synovial fluid samples were collected from the metacarpophalangeal joint at 30 minutes, followed by removal of the tourniquet. Gentamicin concentration in synovial fluid was detected using a fluorescence polarization immunoassay. There were no statistically significant differences among gentamicin concentrations in synovial fluid among perfusate volume groups. Mean gentamicin concentration in Group 1 (125.9 µg/mL) was higher than Group 2 (82.7 µg/mL) and Group 3 (56.1 µg/mL).

Influence du volume perfusé sur la concentration antimicrobienne dans le liquide synovial après la perfusion intraveineuse régionale d'un membre chez un cheval debout. Cette étude a étudié l'influence du volume perfusé sur la concentration antimicrobienne dans le liquide synovial après la perfusion intraveineuse régionale d'un membre (PIRM) et a évalué l'efficacité d'un faible volume de PIRM. Les membres antérieurs de 9 chevaux ont été assignés au hasard à 1 de 3 groupes de volume: 10 ml (Groupe 1), 30 ml (Groupe 2) ou 60 ml (Groupe 3). Un tourniquet a été appliqué en aval du carpe et les membres ont été perfusés avec 500 mg de gentamicine diluée au volume assigné par un cathéter placé dans la veine digitale palmaire latérale au niveau des os sésamoïdes proximaux. Les échantillons de liquide synovial ont été prélevés de l'articulation métacarpo-phalangienne à 30 minutes, suivis de l'enlèvement du tourniquet. La concentration de gentamicine dans le liquide synovial a été détectée à l'aide d'un immuno-essai par fluorescence polarisée. Il n'y avait pas de différences statistiquement significatives entre les concentrations de gentamicine dans le liquide synovial parmi les groupes de volume perfusé. La concentration médiane de gentamicine du Groupe 1 (125,9 µg/ml) était supérieure à celle du Groupe 2 (82,7 µg/ml) et du Groupe 3 (56,1 µg/ml).(Traduit par Isabelle Vallières).

Outbreak of equine piroplasmosis in Florida.

CASE DESCRIPTION: A 7-year-old Quarter Horse gelding was hospitalized in Ocala, Fla, because of lethargy, fever, anorexia, and swelling of distal aspects of the limbs. A tentative diagnosis of equine piroplasmosis (EP) was made on the basis of examination of a blood smear. The case was reported to the Florida State Veterinarian, and infection with Babesia equi was confirmed. The subsequent investigation included quarantine and testing of potentially exposed horses for B equi and Babesia caballi infections, tick surveillance, and owner-agent interviews. CLINICAL FINDINGS: 210 horses on 25 premises were tested for infection with EP pathogens. Twenty B equi-infected horses on 7 premises were identified; no horses tested positive for B caballi. Seven horses, including the index case, had clinical findings consistent with EP Dermacentor variabilis was considered the only potential tick vector for B equi collected, and all D variabilis specimens tested negative for Babesia organisms via PCR assay. Results of the epidemiological investigation suggested that B equi was spread by use of shared needles and possibly blood transfusions. All horses that tested positive were involved in nonsanctioned Quarter Horse racing, and management practices were thought to pose substantial risk of transmission of blood-borne pathogens. TREATMENT AND OUTCOME: Final outcome of B equi-infected horses was euthanasia, death from undetermined causes, or shipment to a US federal research facility. CLINICAL RELEVANCE: This investigation highlights the importance of collaboration between private veterinary practitioners, state veterinary diagnostic laboratories, and regulatory officials in the recognition, containment, and eradication of foreign animal disease.

Survival and complications after large colon resection and end-to-end anastomosis for strangulating large colon volvulus in seventy-three horses.

OBJECTIVE: To report complications and survival after large colon resection and end-to-end anastomosis in horses with strangulating large colon volvulus. STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n=73) with strangulating large colon volvulus. METHODS: Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow-up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. RESULTS: The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short-term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long-term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. CONCLUSION: None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self-limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. CLINICAL RELEVANCE: Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long-term survival with minimal negative impact on quality of life and use.

A multicenter case-control study of risk factors for equine protozoal myeloencephalitis.

OBJECTIVE: To identify risk factors for equine protozoal myeloencephalitis (EPM) among horses examined at 11 equine referral hospitals. DESIGN: Case-control study. ANIMALS: 183 horses with EPM, 297 horses with neurologic disease other than EPM (neurologic controls), and 168 horses with non-neurologic diseases (non-neurologic controls) examined at 11 equine referral hospitals in the United States. PROCEDURES: A study data form was completed for all horses. Data were compared between the case group and each of the control groups by means of bivariate and multivariate polytomous logistic regression. RESULTS: Relative to neurologic control horses, case horses were more likely to be > or = 2 years old and to have a history of cats residing on the premises. Relative to non-neurologic control horses, case horses were more likely to be used for racing or Western performance. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that cats may play a role in the natural epidemiology of EPM, that the disease is less common among horses < 2 years of age relative to other neurologic diseases, and that horses used for particular types of competition may have an increased risk of developing EPM.

Fertility and complications after fetotomy in 20 brood mares (2001-2006).

OBJECTIVE: To report fertility (foals conceived, live foal births) of mares after partial fetotomy to resolve dystocia and complications associated with fetotomy. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n=20). METHODS: Medical records (2001-2006) of mares that had partial fetotomy (1-3 cuts) for dystocia were reviewed. Complications and subsequent fertility were obtained by interview and live foal data were recorded by the Jockey Club. Postfetotomy conception and live foals produced over 21 breeding seasons (defined as years each mare was bred regardless of conception) were recorded. RESULTS: Twenty mares were identified. Bilateral carpal flexion alone (3 mares) or in combination with another deformity (7 mares) was the most common presentation for dystocia. From 2001 to 2006, there were 24 breeding seasons for which 20 mares conceived (83%). Eighteen mares conceived before 2006 and all produced live foals. Three mares were bred in 2006; 2 became pregnant, 1 was electively aborted, and 1 is pregnant. Eight of 19 (42%) mares had retained placenta, which were expelled within 24 hours after medical therapy. CONCLUSION: Partial fetotomy performed with 1-3 cuts does not impede a successful reproductive future. CLINICAL RELEVANCE: In selected equine dystocia cases, partial fetotomy should be given primary consideration when the foal is dead and vaginal delivery cannot be readily achieved. Fetotomy should not adversely affect the future fertility of the mare.

Use of colonic luminal pressure to predict outcome after surgical treatment of strangulating large colon volvulus in horses.

OBJECTIVE: To evaluate the relationship of colonic luminal pressure (CLP) measurements to outcome in horses with large colon volvulus (LCV) after either manual correction or large colon resection and anastomosis (LCRA). STUDY DESIGN: Retrospective study. ANIMALS: Horses (n=57) that had LCV. METHODS: Records for horses with LCV (March 1997-December 2003) were reviewed. Inclusion criteria were strangulating LCV proximal to the cecocolic ligament (>270 degrees), recorded CLP, and successful recovery from anesthesia. CLP measurements and survival/mortality rates were compared between horses that had manual correction (M) or LCRA (R). RESULTS: Of 57 horses, 27 had M and 30 had LCRA. For group M, CLP measurements had a sensitivity of 0.60 and specificity of 0.77 for predicting survival, whereas for group R, sensitivity was 0.50 and specificity was 0.54. CONCLUSION: In our LCV population, elevated CLP measurements had poor accuracy for predicting outcome in horses after surgical correction, especially after LCRA. CLINICAL RELEVANCE: CLP measurements based on a single hospital population of horses with LCV should be used with caution for other hospital populations of LCV. CLP may be only one of many variables needed for predicting outcome of horses with strangulating LCV, especially after LCRA.