Influence of screw configuration on reduction and stabilization of simulated complete lateral condylar fracture in equine limbs.

OBJECTIVE: To determine the influence of screw configuration on the reduction and stabilization of simulated complete lateral condylar fracture. STUDY DESIGN: Randomized experimental crossover study. METHODS: A lateral condylar fracture was simulated in 18 cadaver limbs from nine horses. Each limb underwent repair with 4.5 mm diameter cortex screws, tightened to 4 Nm, in a linear and triangular configuration. Computed tomography (CT) of each repair was performed with the limbs in unloaded and loaded conditions. Fracture gaps were measured at the dorsal, palmar, and middle locations of the third metacarpal condyle. Fracture gap measurements were graded 0-4, based on voxels. Following descriptive analysis, a Bayesian network (BN) model was fitted to the data. RESULTS: The median fracture grade was 0 (range: 0-4) for unloaded linear repairs and 2 (0-4) for loaded linear repairs. The median fracture grade was 0 (0-3) for unloaded triangular repairs and 1 (0-3) for loaded triangular repairs. Bayesian network sensitivity analysis showed that the construct configuration reduced the uncertainty in the measured fracture outcome by 0.8%. CONCLUSION: Triangular screw configuration resulted in better fracture reduction and stability in comparison with linear screw configuration. However, the BN sensitivity analysis results showed that the effect of construct configuration on fracture outcome was weak. CLINICAL SIGNIFICANCE: These findings indicate a low probability that triangular repair of lateral condylar fracture will result in improved outcomes, when compared with linear repair.

A systematic review and meta-analysis of the efficacy of platelet-rich plasma products for treatment of equine joint disease.

BACKGROUND: Equine joint disease including septic arthritis (SA) and osteoarthritis (OA) is a critical cause of equine lameness. Platelet-rich plasma (PRP) is one of the most popular regenerative therapies to treat equine OA, even SA, but the evidence in support of the treatment is conflicting. OBJECTIVES: The aim of the study was to systematically review the current evidence on PRP products used for SA and OA, as well as the efficacy of PRP products as treatment for OA on the basis of a meta-analysis of the available literature. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic search of relevant databases (PubMed, Web of Science, Scopus) was performed to identify studies published from 2013 to 2023, in accordance with the PRISMA guidelines. Randomised controlled trials, non-randomised trials and controlled laboratory studies that used at least one type of PRP products were included. Dichotomous outcomes were presented using odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: A total of 21 publications were identified in the systematic review and 5 of them in the meta-analysis. These publications involved various types of PRP products and reported different outcomes. Although most of the studies were associated with a high risk of bias, the overall estimated effect was consistent with a significant improvement in the PRP products treatment group compared with the control group (OR: 15.32; 95% CI: 3.00-78.15; p < 0.05). There was a significant improvement in clinical performance outcomes between the groups (OR: 36.64; 95% CI: 3.69-364.30; p < 0.05). CONCLUSION: PRP products as intra-articular treatment are likely efficacious for treatment of equine OA and have potential for treating SA. These conclusions might be affected by the limited number of randomised controlled studies and high variability of different types of PRP products. To better evaluate the efficacy of PRP, a widely recognised classification system and the utilisation of randomised, blinded, equivalency or non-inferiority trials are required.

Wound healing of experimental equine skin wounds and concurrent microbiota in wound dressings following topical propylene glycol gel treatment.

Introduction: Topical wound treatments rely on carrier formulations with little to no biological impact. The potential for a common vehicle, a propylene glycol (PG) gel, to affect wound healing measures including microbiota is not known. Microbiome characterization, based on next generation sequencing methods is typically performed on tissue or directly obtained wound fluid samples. The utility for primary wound dressings to characterize equine wound microbiota in the context of topical treatments is currently unknown. This investigation reports the topical effect of an 80% PG based gel on wound healing and microbiota in wound dressings. Methods: Experiments were performed in six mature horses utilizing a surgical, distal limb wound model, histology of sequential wound biopsies, photographic wound measurements and microbiota profiling via 16s rRNA sequencing of wound dressing samples. Experimental wounds were surveyed for 42 days and either treated (Day 7, 14, 21 and 28; at 0.03 ml/cm2) or unexposed to the PG gel. Wound surface area, relative and absolute microbial abundances, diversity indices and histologic parameters were analyzed in the context of the experimental group (treatment; control) using qualitative or quantitative methods depending on data characteristics. Results: Compared to controls, treatment slowed the wound healing rate (17.17 ± 4.27 vs. 18.56 ± 6.3 mm2/day), delayed the temporal decline of polymorphonucleated cells in wound beds and operational taxonomic units (OTU) in wound dressings and lowered alpha-diversity indices for microbiota in primary wound dressing. Relative abundances of OTUs were in line with those previously reported for equine wounds. Clinical outcomes 42 days post wounding were considered similar irrespective of PG gel exposure. Discussion: Results highlight the potential for vehicle exposure to alter relevant wound outcome measures, imposing the need for stringent experimental control measures. Primary wound dressings may represent an alternate sample source for characterization of the wound microbiome alleviating the need for additional interventions. Further studies are warranted to contrast the microbiome in wound dressings against that present on wound surfaces to conclude on the validity of this approach.

Comparison of interfragmentary compression across simulated condylar fractures repaired using four techniques.

Introduction: Equine condylar fractures are commonly repaired using cortex screws applied in lag fashion. Inadequate interfragmentary compression can lead to post-operative complications. Methods: Lateral condylar fractures were simulated in 21 cadaver limbs (8 third metatarsals, 13 third metacarpals). In each limb, pressure-sensitive film (Prescale®, Fuji Photo Film Co.) was placed in each osteotomy prior to repair with 4.5 mm diameter cortex screws placed in lag fashion. Screws were placed in linear (L), triangular (T), linear plus a washer (LW) and sequentially tightened triangular configurations (TD1). All screws were tightened to a torque of 4 Nm. Pressure prints obtained were scanned using dedicated software (Fuji FPD-8010E, Fuji Photo Film Co.). A Bayesian Network (BN) model was developed to investigate the impact and interrelationship of each factor on interfragmentary compression. Sixty-three repairs (20*L, 24* T, 11*TD1, and 8*LW) performed on 21 limbs were included in the analysis. Results: The BN predicted mean contact area (±s.d.) for pressures within the operating range of the prescale film [≥2.5 Megapascals (MPa) ≤ 10 MPa] by L, T, TD1 and LW repairs were 403mm2 ± (140), 411 mm2 ± (120), 403 mm2 ± (120), and 366mm2 ± (70). The mean contact area (± s.d.) created by L, T, TD1 and LW repairs at pressures >10 MPa were 112 mm2 ± (48), 167 mm2 ± (67), 142 mm2 ± (50), and 100mm2 ± (27). When pressures ≥2.5 MPA to ≤10 MPa were considered, the construct (T or L), washer and screw tightening sequence variables had a very low effect on interfragmentary contact area. At pressures >10 MPa BN sensitivity findings were 16.3, 5.03, and 0.133% for construct, washer and screw tightening sequence. The BN model indicated that triangular repair configuration had a weak influence in the ≥2.5 MPa ≤ 10 MPa range and a moderate influence in the <10 MPa range, on interfragmentary compression. The addition of a washer and the screw tightening sequence had a weak influence on interfragmentary compression at all pressure ranges. Discussion: The results show that triangular repairs create larger interfragmentary contact areas at greater interfragmentary pressure in simulated condylar fractures, however it is unknown if this results in improved repair stability in the clinical scenario.

Visually Assessing Equine Quality of Movement: A Survey to Identify Key Movements and Patient-Specific Measures.

Outcome measures are essential for monitoring treatment efficacy. The lack of measures for quality of movement in equine physiotherapy and rehabilitation impairs evidence-based practice. To develop a new field-based outcome measure, it is necessary to determine movements most frequently observed during assessment of rehabilitation and performance management cases. An online survey of 81 equine sports medicine veterinarians and equine allied-health clinicians was conducted. The key movements identified included walk and trot on both firm and soft surfaces in a straight line and on a small circle, plus step back, hind leg cross-over, transitions and lunging at walk, trot and canter. The main barriers to observing some movements are access to suitable surfaces and the training level of the horse and handler. Subjective visual assessment of live or videoed horses was the most common method used to track progress of complex movements. The majority (82%) of survey participants agreed or strongly agreed that a modified Patient-Specific Functional Scale would be useful for measuring complex movements. Comments from all professions show a desire to have outcome measures relevant to their needs. This survey identified 24 in-hand movements, which can be used to form the foundation of a simple field-based outcome measure for quality of movement.

The effect of exercise on cytokine concentration in equine autologous conditioned serum.

BACKGROUND: Autologous conditioned serum (ACS) is a commonly administered intra-articular treatment for the management of osteoarthritis in athletic horses. OBJECTIVES: To investigate the influence of exercise on the concentration of cytokines in a non-commercial method of ACS production. STUDY DESIGN: Non-randomised cross over design. METHODS: Whole blood was obtained from eight healthy Standardbred horses immediately prior to, 1 h and 24 h following a single bout of exhaustive exercise. Blood was processed using a non-commercial method of ACS production. Fluorescent microsphere immunoassay (FMIA) analysis was performed to quantify Interleukin 1 receptor antagonist (IL-1Ra), Interleukin-10 (IL-10), Interleukin 1ß (IL-1ß) and tumour necrosis factor α (TNF-α) concentrations at each time point. Mixed effect repeated measures analysis of variance (ANOVA) was used to compare the pre-exercise and post-exercise cytokine concentrations. Significance was set at P < 0.05. RESULTS: A reduced concentration of IL-1Ra (median 584.4, IQR 81.9-5098 pg/ml, p = 0.004) and an increased concentration of TNF-α (11.92, 9.28-39.75 pg/ml, P = .05) at 1 h post-exercise were observed when compared with baseline values (IL-Ra 7349, 1272-10 760 pg/ml; TNF TNF-α 11.16, 8.36-32.74 pg/ml). No difference in cytokine concentrations of IL-10 or IL-1ß were found between any of the time points. MAIN LIMITATIONS: The large biological variability and small sample size represents limitations of this study. CONCLUSIONS: These results suggest that a single bout of intense exercise can reduce the concentration of the anti-inflammatory cytokine IL-1Ra and increase the concentration of the pro-inflammatory cytokine TNF-α, reducing the 'anti-inflammatory' cytokine composition of ACS. Our findings suggest that collection of blood for ACS production should be performed no sooner than 24 h following a single episode of intense exercise.

INTRODUCTION/CONTEXTE: Le sérum autologue conditionné (ACS) est fréquemment administré de façon intra-articulaire dans les cas d'ostéoarthrose chez l'athlète équin. OBJECTIFS: Tait d'Investiguer l'influence de l'exercice sur la concentration des cytokines dans l'ACS produit de façon non-commerciale. TYPE D'ÉTUDE: Étude croisée non-aléatoire. MÉTHODES: Le sang entier de 8 chevaux Standardbred en santé a été prélevé immédiatement, 1 heure et 24 heures suivant un seul épisode d'exercice intense. Le sang a été traité en utilisant une méthode de production d'ACS non-commercialisée. Une analyse par test immunologique à microsphères (FMIA, fluorescent microsphere immunoassay) a été effectuée afin de quantifier la concentration dans le temps du récepteur antagoniste de l'interleukine 1 (IL-1Ra), interleukine 10 (IL-10), interleukine 1 beta (IL-1ß) et du facteur de nécrose tumorale alpha (TNF-α). Une analyse de variance ajustée par mesures répétées à effets mixtes a été utilisée pour comparer les concentrations de cytokines avant et après l'exercice. Les données avec une valeur de p < 0.05 ont été considérées significatives. RÉSULTATS: Une concentration diminuée d'IL-1Ra (médiane 584.4, IIQ 81.9-5098 pg/ml, p = 0.004) et une concentration augmentée de TNF-α (11.92, 9.28-39.75 pg/ml, p = 0.05) ont été observées 1 heure après l'exercice par rapport aux valeurs de base (IL-1Ra 7349, 1272-10760 pg/ml; TNF-α 11.16, 8.36-32.74 pg/ml). Aucune différence de concentration de cytokines dans le temps n'a été identifiée pour IL-10 et IL-1ß. LIMITES PRINCIPALES: Grande variabilité biologique et petite taille d'échantillon. CONCLUSIONS: Ces résultats suggère qu'une seule séance d'exercice intense puisse réduire la concentration de la cytokine anti-inflammatoire IL-1Ra et augmenter la concentration de la cytokine pro-inflammatoire TNF-α, ce qui réduirait la composition en cytokines anti-inflammatoires dans l'ACS. Nos trouvailles suggèrent que le prélèvement de sang pour la production d'ACS devrait être fait au moins 24 heures suivant une période d'exercice.

Subtotal Ovariohysterectomy Following Fetal Maceration and Pyometra in a Maiden Welsh Pony Mare.

Fetal maceration and pyometra were diagnosed in a 16-year-old maiden Welsh pony mare. Due to anatomical and surgical difficulties encountered throughout treatment, previously reported techniques including both per-vaginum removal of fetal remnants and ovariohysterectomy were attempted and resulted in novel complications. Fetal bones were unable to be removed completely transcervically due to failure of cervical dilation despite repeated attempts. Subsequent surgical complications such as inadequate exposure of the uterus and incorporation of fetal bones into the uterine stump following ovariohysterectomy also occurred. This case highlights some of the difficulties in managing rare cases of mid-term fetal loss and retention that result in maceration. Ultimately, this may provide useful insights to practitioners when managing similar cases in future.

Standing flank laparotomy for colic: 37 cases.

BACKGROUND: Standing flank laparotomy can be an alternative to ventral midline laparotomy in horses with colic. Standing flank laparotomy avoids general anaesthesia, provides excellent access to some regions of the abdominopelvic cavity and costs less than ventral midline laparotomy. OBJECTIVE: To report a series of cases of peritoneal and intestinal diseases other than SC diseases managed with standing flank laparotomy. STUDY DESIGN: Retrospective case series. METHODS: Records from equids with colic subjected to standing flank laparotomy at five hospitals (2003-2020) were reviewed. Descriptive data analysis was performed. RESULTS: Thirty horses (sixteen survived to discharge), six ponies (four survived) and one donkey (euthanised) were subjected to standing flank laparotomy via the left flank (n = 31), right flank (n = 2) or both flanks (n = 4). The primary disease affected the peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived). Enterotomy was performed in four animals (all survived). Partial typhlectomy was performed in one horse (euthanised). Resection-anastomosis of the SI or LC was performed in three animals (one survived). Three animals had intraoperative complications that negatively affected the outcome: Two ponies had intolerance to abdominopelvic exploration; one mare had spontaneous exteriorisation of a long segment of the SI leading to a large tear in the mesentery. In seven cases, severe/extensive lesions found during standing flank laparotomy warranted immediate euthanasia. The survival rate was 54%. All owners were satisfied with the decision to perform standing flank laparotomy. MAIN LIMITATIONS: The retrospective design, lack of a control group, small number of cases and lack of standardised protocols between hospitals. CONCLUSIONS: Although ventral midline laparotomy is the standard of care for horses with colic, standing flank laparotomy is a viable approach for some types of colic. Systemic administration of analgesics may not produce sufficient peritoneal analgesia, which can lead to intolerance to abdominopelvic exploration during standing flank laparotomy in horses with colic and may negatively affect the outcome.

Effects of Production Method and Repeated Freeze Thaw Cycles on Cytokine Concentrations and Microbial Contamination in Equine Autologous Conditioned Serum.

Autologous conditioned serum (ACS) is a common intra-articular treatment for osteoarthritis in horses. The objective of this study was to investigate the influence of ACS preparation method on product contamination and concentrations of relevant cytokines and the influence of multiple freeze/thaw cycles. Blood was obtained from 10 healthy Thoroughbred horses and processed in parallel using a commercial and a non-commercial method to obtain ACS. Fluorescent microsphere immunoassay (FMIA) analysis was performed to quantify Interleukin 1 receptor antagonist (IL-1Ra), Interleukin-10 (IL-10), Interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) concentrations in ACS obtained by both production methods. Effect of 3, 4 and 5 freeze/thaw cycles on concentrations of IL-1Ra, IL-10, IL-1ß and TNF-α were assessed against baseline samples (2 cycles) in commercial ACS products. Standard aerobic and anaerobic culture methods were applied to both ACS products. Mixed effect one-way analyses of variance (ANOVA) were used to compare the two ACS production method for each cytokine. Repeated measures, mixed effect ANOVA were used to assess the effect of freeze/thaw on cytokine concentrations. Significance was set at P < 0.05. There was no difference in cytokine concentration between production methods (IL-1Ra P = 0.067, IL-1ß P = 0.752, IL-10 P = 0.211 and TNF-α P = 0.25). Microbial growth was only observed in two samples obtained using the commercial production method. When compared to baseline, IL-1Ra concentration was decreased following the 5th freeze/thaw cycle (P < 0.001). These results suggest that the concentration of important cytokines are not influenced by ACS production method. When storing ACS samples for future use, freeze/thaw cycles associated with standard clinical practice are unlikely to influence cytokine concentrations. However, the lack of outcome measures associated with 1 or 2 freeze/thaw cycles represents a limitation of this study.

Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses.

OBJECTIVE: To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures. STUDY DESIGN: Controlled laboratory study. SAMPLE POPULATION: Twenty equine cadaver forelimbs. METHODS: Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were assessed on computed tomography (CT) images and with intraplanar force-sensitive resistors measuring voltage ratios (V△ ) between loaded recumbent (R-1) and standing repair simulations (R-2). Extensor branch borders were determined relative to implant position and sagittal P1 width on transverse CT images. P ≤ .05 was considered significant. RESULTS: Standing repair simulation-associated fracture gaps were not wider than in R-1 while controlling for confounding factors (loading weight, implant position, or animal age; P > .7, repeated-measures analysis of variance). Voltage ratio data associated with R-2 were not smaller than with R-1 (mean difference, 0.002 ± 0.052; one-sided Wilcoxon signed-rank test, P = .27). More of P1 width was approachable palmar to extensor branches when limbs were loaded (0.804 ± 0.314 cm) vs unloaded (0.651 ± 0.31 cm; paired Student's t test, P < .001). CONCLUSION: Simulated standing repair was not associated with inferior fracture reduction compared with loaded simulations of recumbent repairs. Limb loading affected extensor branch location relevant to implant positioning. CLINICAL SIGNIFICANCE: Unloading during standing repair of incomplete parasagittal proximal P1 fractures may not be required to optimize fracture reduction.

Standing low-field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study.

High-field MRI of the proximal metacarpal/metatarsal region has been associated with great diagnostic potential and clinical reports of standing low-field MRI of the forelimb suggest the same. To better understand diagnostic outcomes with standing low-field MRI of the proximal suspensory region, a prospective survey study was conducted and users of a widely available system questioned on their experience, operating procedures, and interpretation of standing low-field MRI findings. Response data included scores on a modified Likert scale from which weighted ratings were calculated for statistical analyses. Depending on the question, responses were obtained from 17 to 29 of the 38 invited facilities. Users indicated that standing low-field MRI was most frequently performed in the face of equivocal diagnostic findings; compared to Sports horses, general purpose riding horses were thought less likely to have detectable abnormalities and standing low-field MRI was rated most useful for the detection of primary bone pathology in the proximal metacarpal region. Standing low-field MRI signal change involving both the suspensory ligament and adjacent bone concurrently was rated most relevant and abnormalities solely affecting the muscle/adipose tissue bundles least relevant for diagnosing suspensory ligament injury. Transverse scans and in decreasing order T1-weighted gradient echo, short-tau inversion recovery FSE, T2*-weighted gradient echo, and T2-weighted FSE sequences were most frequently acquired and judged most useful by the majority of users experienced in imaging of the target area. This survey supports the relevant impact of standing low-field MRI on clinical case management, particularly in the context of imaging the proximal metacarpal region.

Factors Associated With Survival and Return to Function Following Synovial Infections in Horses.

Synovial infections (SI) are common in horses of all ages and can be associated with high rates of morbidity and mortality. Identifying factors influencing survival and return to function may be useful for management of affected individuals and determination of prognosis. The objectives of this study were to identify factors associated with survival and return to function of horses and foals with SI presented to an equine hospital. This study is a retrospective case series. Data were collected from medical records of all horses with SI that were presented to a single equine hospital between April 1st, 2008 and May 1st, 2017. Long-term follow up was obtained by a semi-structured telephone questionnaire of clinical outcomes and analysis of online race records. Univariate models were created using generalized linear and linear mixed models to assess factors associated with outcomes. Multivariable models were created using generalized linear and linear mixed models to determine factors significantly associated with outcomes. Of 186 horses presented with SI, 161/186 (86.6%) were treated and 145/161 (90.1%) survived to discharge. The majority of joints were treated with synovial lavage (93.8%). One hundred and twenty horses were included in the return to function analysis and 79 (65%) returned to function. Increasing number of days of treatment with systemic antimicrobials was associated with increased likelihood of survival for each horse (OR 1.15, 95% CI 1.04-1.27, P = 0.025) and when considering each individual synovial structure (OR 1.11, 95% CI 1.04-1.17, P = 0.004). Horses treated with doxycycline were less likely to return to function (OR 0.39, 95% CI 0.19-0.8, P = 0.031). The overall rate of survival of horses treated with SI is good. The likelihood of return to function is lower than for survival. The findings of this study, combined with relevant antimicrobial stewardship practices, can be used as a part of evidence-based decision-making when veterinarians are treating horses with SI.

In vitro comparison of linear vs triangular screw configuration to stabilize complete uniarticular parasagittal fractures of the proximal phalanx in horses.

OBJECTIVE: To assess fracture gap reduction and stability of linear vs triangular 4.5-mm lag screw repair of experimental, uniarticular, and complete forelimb proximal phalanx (P1) fractures. STUDY DESIGN: Experimental. SAMPLE POPULATION: Fourteen equine cadaver limbs/horses. METHODS: Simulated fractures were repaired with 2 lag screws under 4-Nm insertion torque (linear repair). Computed tomography (CT) imaging was performed with the leg unloaded and loaded to forces generated while walking. The fracture repair was revised to include 3 lag screws placed with the same insertion torque (triangular repair) prior to CT. The width of the fracture gap was assessed qualitatively by 2 observers and graded on the basis of gap measurements relative to the average voxel size at dorsal, mid, and palmar P1 sites. Interobserver agreement was assessed with Cohen's κ. The effect of repair type, loading condition, and measurement site on fracture gap grades was evaluated by using Kendall's τ-b correlation coefficients and paired nonparametric tests. Significance was set at P ≤ .05. RESULTS: Agreement between loading and fracture gap widening was fair in triangular (κ = 0.53) and excellent in linear (κ = 0.81) repairs. Loading resulted in fracture gap distraction in linear repairs (Plinear = .008). Triangular repairs reduced fractures better irrespective of loading (Punloaded = .003; Ploaded < .001). The type of repair was not correlated with fracture gap grades at unloaded mid and loaded dorsal P1 sites. CONCLUSION: Repair of uniarticular complete parasagittal fractures with a triangular screw configuration improved in vitro fracture gap reduction and stability. CLINICAL SIGNIFICANCE: Triangular lag screw repair likely improves biomechanical conditions during postoperative weight bearing.

Extracorporeal perfusion of isolated organs of large animals - Bridging the gap between in vitro and in vivo studies.

Since the early 20th century, extracorporeal perfusion of large animal organs has been used to investigate a broad variety of research questions, thereby overcoming common drawbacks of in vitro studies without suffering from ethical concerns associated with live animal research. The technique is in accordance with the 3R principles and represents an excellent opportunity to investigate the physiology of organs in detail under standardized conditions. It is also suitable for the translation of basic pre-clinical research into a more relevant arena prior to or avoiding live animal research altogether. Furthermore, organ perfusion has also been an important tool in developing methods of organ preservation for transplantation surgery. Yet, due to the nature of the experiments, only short-term observations can be made and while cells are still exposed to their regional secretome, the whole organ itself is isolated from the body and correlations between organ systems cannot be taken into consideration. This review gives an overview over the history of extracorporeal perfusion of large animal organs and limbs, highlighting major achievements in the field and discussing different experimental set-ups. Advantages and limitations of the technique are presented. Prospective future research perspectives, which may include tracking of specific cell types and study of their distinct behavior towards different stimuli, are given to illustrate the relevance of this method.

Effect of intra-articular administration of superparamagnetic iron oxide nanoparticles (SPIONs) for MRI assessment of the cartilage barrier in a large animal model.

Early diagnosis of cartilage disease at a time when changes are limited to depletion of extracellular matrix components represents an important diagnostic target to reduce patient morbidity. This report is to present proof of concept for nanoparticle dependent cartilage barrier imaging in a large animal model including the use of clinical magnetic resonance imaging (MRI). Conditioned (following matrix depletion) and unconditioned porcine metacarpophalangeal cartilage was evaluated on the basis of fluorophore conjugated 30 nm and 80 nm spherical gold nanoparticle permeation and multiphoton laser scanning and bright field microscopy after autometallographic particle enhancement. Consequently, conditioned and unconditioned joints underwent MRI pre- and post-injection with 12 nm superparamagnetic iron oxide nanoparticles (SPIONs) to evaluate particle permeation in the context of matrix depletion and use of a clinical 1.5 Tesla MRI scanner. To gauge the potential pro-inflammatory effect of intra-articular nanoparticle delivery co-cultures of equine synovium and cartilage tissue were exposed to an escalating dose of SPIONs and IL-6, IL-10, IFN-γ and PGE2 were assessed in culture media. The chemotactic potential of growth media samples was subsequently assessed in transwell migration assays on isolated equine neutrophils. Results demonstrate an increase in MRI signal following conditioning of porcine joints which suggests that nanoparticle dependent compositional cartilage imaging is feasible. Tissue culture and neutrophil migration assays highlight a dose dependent inflammatory response following SPION exposure which at the imaging dose investigated was not different from controls. The preliminary safety and imaging data support the continued investigation of nanoparticle dependent compositional cartilage imaging. To our knowledge, this is the first report in using SPIONs as intra-articular MRI contrast agent for studying cartilage barrier function, which could potentially lead to a new diagnostic technique for early detection of cartilage disease.

A Rare Case of Deep Digital Flexor Tendinopathy following Centesis of the Navicular Bursa.

Navicular bursa (NB) centesis is a common diagnostic and therapeutic procedure in equine practice. This case report documents the clinical, diagnostic imaging and histological findings in a horse with a suspected iatrogenic deep digital flexor tendon (DDFT) injury following centesis of the NB via a modified distal plantar approach (placement of two needles in a weight bearing position). Although it cannot be proven with absolute certainty, the authors believe that this is the first reported case where NB centesis is the likely cause of a DDFT lesion, and with magnetic resonance imaging performed both pre- and post-centesis. With this potential, though rare, complication of the procedure, alternative tendon sparing injection techniques should be considered prior to NB centesis in certain cases.

Effect of topically applied Saccharomyces boulardii on the healing of acute porcine wounds: a preliminary study.

BACKGROUND: Normal wound healing progresses through a series of interdependent physiological events: inflammation, angiogenesis, re-epithelialization, granulation tissue formation and extracellular matrix remodeling. Alterations in this process as well as the bacterial type and load on a wound may alter the wound healing rate. The purpose of this study was to evaluate the effect of topical Saccharomyces boulardii on the healing of acute cutaneous wounds, using a prospective, controlled, experimental study, with six purpose bred landrace pigs. RESULTS: All wounds healed without apparent complications. Comparison of the mean 3D and 2D wound surface area measurements showed no significant difference between treatment groups as wounds decreased similarly in size over the duration of the study. A significant reduction in wound surface area was identified sooner using 3D assessments (by day 9) compared to 2D assessments (by day 12) (P < 0.001). There was no significant effect of treatment group on the number of multiple isolates or the most common isolates obtained relative to control wounds. There was no histologically appreciable difference between the wounds of the different groups. CONCLUSIONS: Topical application of Saccharomyces boulardii does not hasten wound healing or change the wounds' microbiome under the conditions reported in this study.

Magnetic resonance imaging assisted management in five cases of suspected quittor.

OBJECTIVES: Assessment of the usefulness of magnetic resonance imaging (MRI) in treatment planning in suspected cases of quittor in the horse. METHODS: Five horses with chronic discharging tracts at the level of the foot underwent MRI for treatment planning. RESULTS: The MRI examination revealed variable involvement of soft tissue and osseous structures of the foot in addition to abnormalities of the ungular cartilages in all cases. In two cases, follow-up MRI examination was performed. Four of five horses had a successful outcome, with three of these undergoing only one surgical procedure and one being managed medically. CLINICAL SIGNIFICANCE: We believe that the use of preoperative MRI facilitated accurate determination of the structures involved in cases of quittor, guiding the management, surgical approach and postoperative therapy.

ELASTOGRAPHIC EVALUATION OF NATURALLY OCCURING TENDON AND LIGAMENT INJURIES OF THE EQUINE DISTAL LIMB.

Compression elastography is an ultrasonographic technique that estimates tissue strain and may have utility in diagnosing and monitoring soft tissue injuries in the equine athlete. Recently, elastography has been proven to be a feasible and repeatable imaging modality for evaluating normal tendons and ligaments of the equine distal forelimb. The purposes of this prospective study were to investigate the ability of elastography to detect spontaneously occurring lesions of equine tendons and ligaments diagnosed with magnetic resonance imaging (MRI) and gray-scale ultrasound (US) and to characterize the differences in the elastographic appearance of acute vs. chronic injuries. Fifty seven horses with a total of 65 lesions were evaluated. Images were assessed quantitatively and qualitatively. Acute lesions were found to be significantly softer (P < 0.0001) than chronic lesions (P < 0.0001) and the stiffness of lesions increased with progression of healing (P = 0.0138). A negative correlation between lesion hypoechogenicity and softness was appreciated with more hypoechoic lesions appearing softer (P = 0.0087) and more hyperechoic regions harder (P = 0.0002). A similar finding occurred with increased signal intensity on short tau inversion recovery (STIR) and proton density (PD) MRI sequences correlating with increased softness on elastography (P = 0.0164). Using US and MRI as references, commonly encountered soft tissue injuries of the equine distal limb could be detected with elastography. However, elastography was limited for detecting small, proximal injuries of the hindlimb proximal suspensory ligament. Elastographic evaluation of equine tendons and ligaments may allow better characterization of lesion chronicity and severity, and sequential examinations may optimize lesion management, rehabilitation, and return to training.

Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury.

Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray-scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P < 0.01) however, the suspensory branches were not (P = 0.67). Findings supported future clinical application of elastography as a noninvasive "stall-side" imaging modality for evaluation of the tendons and ligaments of the distal forelimb in horses.