Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Survey of electroencephalography usage and techniques for dogs.

Background: Canine epilepsy is a chronic common neurologic condition where seizures may be underreported. Electroencephalography (EEG) is the patient-side test providing an objective diagnostic criterion for seizures and epilepsy. Despite this, EEG is thought to be rarely used in veterinary neurology. Objectives: This survey study aims to better understand the current canine EEG usage and techniques and barriers in veterinary neurology. Methods: The online Qualtrics link was distributed via listserv to members of the American College of Veterinary Internal Medicine (ACVIM) Neurology Specialty and the European College of Veterinary Neurology (ECVN), reaching at least 517 veterinary neurology specialists and trainees worldwide. Results: The survey received a 35% response rate, for a total of 180 participant responses. Fewer than 50% of veterinary neurologists are currently performing EEG and it is performed infrequently. The most common indication was to determine a discrete event diagnosis. Other reasons included monitoring treatment, determining brain death, identifying the type of seizure or epilepsy, localizing foci, sleep disorders, for research purposes, and post-op brain surgery monitorization. Most respondents interpreted their own EEGs. Clinical barriers to the performance of EEG in dogs were mainly equipment availability, insufficient cases, and financial costs to clients. Conclusion: This survey provides an update on EEG usage and techniques for dogs, identifying commonalities of technique and areas for development as a potential basis for harmonization of canine EEG techniques. A validated and standardized canine EEG protocol is hoped to improve the diagnosis and treatment of canine epilepsy.

Teaching Accuracy through Repeated Gamified Echography Training (TARGET): Assessment of an Ultrasound Skill Simulator in Teaching Ultrasound-Guided Needle Placement, a Prospective Observational Study.

The increasing use of ultrasound in veterinary private practice and demand for skilled operators upon graduation has placed an increased burden on the ever-dwindling number of academic radiologists. Simulation-based medical education can help prepare for and consequently reduce this burden, allowing for the acquisition of clinical skills through deliberate practice in a safe, controlled, and low-stakes environment. Ultrasound-guided fine needle placement is the foundation for more advanced interventions such as ultrasound-guided fine needle aspirates and centeses. A reusable novel ultrasound skill simulator consisting of metal targets wired to a circuit and suspended in ballistics gel was created to teach ultrasound-guided fine needle placement. Forty-seven second-year veterinary students watched an instructional video and performed two ultrasound-guided fine needle placement skill tests on the simulator with a period of practice between. Significant improvement in time to task completion (p = .0021) was noted after the period of practice. The majority of student feedback was positive with 89% (42/47) indicating they would use the simulator again to practice and that it should be incorporated into the curriculum, 74% (35/47) indicating their basic skills, knowledge, and confidence using ultrasound improved using the simulator, and 55% (26/47) indicating they could now teach this skill to a peer. The authors suggest further development of this model for ease of manufacture and increased variation in difficulty, and veterinary curriculum incorporation for basic ultrasound-guided fine needle placement training.

Anionic Contrast-Enhanced MicroCT Imaging Correlates with Biochemical and Histological Evaluations of Osteoarthritic Articular Cartilage.

This study addressed difficulties in evaluating osteoarthritis (OA) progression in species with thin cartilage. Feasibility of using short, nonequilibrium contrast-enhanced micro-computed tomography (CE-µCT) to evaluate the physical and biochemical properties of cartilage was investigated. A preliminary in vitro study using CE-µCT study was performed using bovine osteochondral blocks with intact, mildly damaged (fibrillated), or severely damaged (delaminated) cartilage. Delamination of the superficial zone resulted in elevated apparent density compared with intact cartilage after 10 minutes of anionic contrast exposure (P < 0.01). OA was induced by unilateral meniscal destabilization in n = 20 sheep divided into: early phase OA (n = 9) and late phase OA (n = 11), while n = 4 remained as naive controls. In vivo anionic nonequilibrium contrast CT of the operated stifle was conducted in the early phase sheep 13 weeks postoperatively using clinical resolution CT. Cartilage visibility in the contrasted leg was significantly improved compared with the noncontrasted contralateral stifle (P < 0.05). Animals were sacrificed at 3 months (early phase) or 12 months (late phase) for additional ex vivo CE-µCT, and correlative tests with biochemical and histological measures. Concentration of sulfated glycosaminoglycan (sGAG) significantly varied between control, early, and late phase OA (P < 0.005) and showed a negative (r = -0.56) relationship with apparent density in the medial tibial plateau (R2 = 0.28, P < 0.001). Histologically, parameters in proteoglycan and cartilage surface structure correlated with increasing attenuation. While previous studies have shown that CE-CT increases the apparent density of proteoglycan-depleted cartilage, we concluded that superficial zone disruption also contributes to this phenomenon.

Contributing factors to surgical site infection after tibial plateau leveling osteotomy: A follow-up retrospective study.

OBJECTIVE: To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 541) that underwent TPLO (n = 659). METHODS: Medical records of dogs that underwent TPLO from 2011-2018 were reviewed. Data collected included perioperative and postoperative antimicrobial administration, stifle inspection, duration of surgery and anesthesia, comorbidities, and development of SSI including timing, microbiological investigation, and implant removal. Referring veterinarians were contacted for all dogs without a recorded return visit. Risk factors for SSI were assessed by using a multivariable logistic regression model built by using a stepwise approach. RESULTS: Surgical site infection was documented in 71 of 659 (11%) TPLO, with methicillin-resistant Staphylococcus pseudintermedius accounting for 20 of 71 (28%) infections. Protective factors against SSI included administration of postoperative antimicrobials (odds ratio [OR] 0.263; 95% CI = 0.157, 0.442) and timing of preoperative antimicrobial administration. Preoperative antimicrobial timing was protective against SSI when it was administered more than 60 minutes before the first incision compared with administration within 30 minutes (OR 0.275; 95% CI = 0.112, 0.676) or within 60 minutes (OR 0.419; 95% CI = 0.189, 0.929) of the first incision. CONCLUSION: Early administration of perioperative antimicrobials and postoperative antimicrobial administration were protective against SSI after TPLO. CLINICAL SIGNIFICANCE: Antimicrobials can influence the risk of SSI after TPLO. Perioperative and postoperative antimicrobial administration timing should be considered to reduce SSI.

Various 3D printed materials mimic bone ultrasonographically: 3D printed models of the equine cervical articular process joints as a simulator for ultrasound guided intra-articular injections.

INTRODUCTION: In the equine racehorse industry, reduced athletic performance due to joint injury and lameness has been extensively reviewed. Intra-articular injections of glucocorticoids are routinely used to relieve pain and inflammation associated with osteoarthritis. Intra-articular injections of pharmaceutical agents require practice for precise needle placement and to minimize complications. Training on simulators or models is a viable alternative for developing these technical skills. The purpose of this study was to compare the qualitative ultrasonographic characteristics of three-dimensional (3D) printed models of equine cervical articular process joints to that of a dissected equine cervical spine (gold standard). METHODS: A randomized complete block design study was conducted in which a total of thirteen cervical articular process joint models were printed using several materials, printers, and printing technologies. Ultrasound video clips with the models immersed in water were recorded. Two board certified veterinary radiologists and three veterinary radiology residents reviewed the videos and responded to a survey assessing and comparing the ultrasonographic characteristics of the 3D printed models to those of the gold standard. RESULTS: Six 3D printed models had ultrasonographic characteristics similar to the gold standard. These six models were (material, printer, printing technology): nylon PA 12, EOS Formiga P100, selective laser sintering (P = 0.99); Onyx nylon with chopped carbon fiber, Markforged Onyx Two, fused deposition modeling (P = 0.48); polycarbonate, Ultimaker 3, fused deposition modeling (P = 0.28); gypsum, ProJet CJP 660 Pro, ColorJet Printing (P = 0.28); polylactic acid, Prusa I3, fused deposition modeling (P = 0.23); and high temperature V1 resin, Form 2, stereolithography (P = 0.22). CONCLUSION: When assessed in water, it is possible to replicate the qualitative ultrasonographic characteristics of bone using three dimensional printed models made by combining different materials, printing technologies, and printers. However, not all models share similar qualitative ultrasonographic characteristics with bone. We suggest that the aforementioned six models be used as proxy for simulating bones or joints for use with ultrasound. In order to replicate the resistance and acoustic window provided by soft tissues, further work testing the ability of these models to withstand embedding in material such as ballistic gelatin is required.

Efficacy of a Novel Mechanical Cervical Dislocation Device in Comparison to Manual Cervical Dislocation in Layer Chickens.

The main objective of this study was to assess the efficacy of mechanical cervical dislocation using the Koechner Euthanasia Device Model C (KED) in comparison to manual cervical dislocation in layer chickens. Laying hens and/or roosters in three different age groups (12, 27-29, and 65-70 weeks old) were randomly assigned to one of three experimental groups: manual cervical dislocation in conscious birds (CD), manual cervical dislocation in anesthetized birds (aCD), or mechanical cervical dislocation by KED in anesthetized birds (aMCD). Anesthetized birds received an intramuscular dose of 0.3 mg/kg medetomidine and 30 mg/kg of ketamine to achieve clinical anesthesia. A comparison of CD vs. aCD responses confirmed that the anesthetic plane abolished or reduced clonic convulsions, nictitating membrane reflex, tonic convulsions, and cloacal relaxation. Time to loss of the pupillary light reflex (~123 s), and time to cardiac arrest (~172 s) were longer (p < 0.001) in the birds in the aMCD group than aCD (~71 and ~137 s, respectively). Radiographs revealed that the majority of the birds killed by manual cervical dislocation (CD + aCD) had dislocations between the skull and atlas (C1) or between cervical vertebrae C1-C2. The KED resulted in a majority of dislocations at C2-C3. Birds killed by manual cervical dislocation presented more subdural and parenchymal hemorrhage in the brain stem compared to birds killed by KED. Radiographs indicated the presence of fractures in a few birds killed by either method (CD + aCD versus aMCD). Compared to manual CD, KED resulted in less brain trauma and a longer latency to brain death, indicating a lower efficacy of KED as an on-farm killing method.

Comparison of outcome in dogs undergoing single-incision laparoscopic-assisted intestinal surgery and open laparotomy for simple small intestinal foreign body removal.

OBJECTIVE: To evaluate and compare outcome in dogs that underwent single-incision laparoscopic-assisted intestinal surgery (SILAIS) and open laparotomy (OL) for simple foreign body removal. STUDY DESIGN: Retrospective study. ANIMALS: Twenty-eight client-owned dogs that underwent SILAIS (n = 13) or OL (n = 15). METHODS: Foreign body removal via SILAIS was performed with a commercially available single-port device. After laparoscopic evaluation, a wound retraction device (WRD) was inserted. The small intestine was extracorporeally explored, and foreign body removal was performed. The surgeon's hand was inserted through the WRD to palpate portions of the gastrointestinal tract not able to be extracorporeally evaluated. Open laparotomy with foreign body removal was performed via a ventral midline approach. Medical records were retrospectively reviewed, and perioperative data were collected. Follow-up data were collected with a standardized questionnaire with the referring veterinarian and/or owner via telephone interview. RESULTS: No postoperative complications were encountered in either the SILAIS or the OL group, and all dogs were successfully discharged from the hospital. Conversion from SILAIS to OL occurred in 3/13 cases. There was no significant difference in duration of hospitalization, duration of time to recovery, or surgical time between surgical approaches (SILAIS vs OL). CONCLUSION: Single-incision laparoscopic-assisted intestinal surgery for foreign body removal was not significantly different from OL in a variety of outcome measures in this cohort of dogs. Diagnostic imaging including ultrasonography or computed tomography may improve appropriate case selection for SILAIS for simple foreign body removal. CLINICAL SIGNIFICANCE: Single-incision laparoscopic-assisted intestinal surgery offers a minimally invasive technique for simple small intestinal foreign body removal. Additional study is required to compare SILAIS with OL.

Effect of pneumoperitoneum with warmed humidified or standard-temperature carbon dioxide during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs.

OBJECTIVE To evaluate effects of pneumoperitoneum created with warmed humidified CO2 (WHCO2) during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs. ANIMALS 6 mature purpose-bred dogs. PROCEDURES In a randomized crossover study, each dog was anesthetized twice, and pneumoperitoneum was created with standard-temperature CO2 (STCO2; 22°C and 0% relative humidity) and WHCO2 (37°C and 98% relative humidity). Data were collected during each procedure, including core body temperature, cardiorespiratory and thromboelastography variables, and inflammatory biomarkers. Peritoneal biopsy specimens were collected and evaluated with scanning electron microscopy. Dogs were assessed for signs of postoperative pain. RESULTS Mean core body temperature was significantly lower (35.2°C; 95% confidence interval, 34.5° to 35.8°C) with WHCO2 than with STCO2 (35.9°C; 95% confidence interval, 35.3° to 36.6°C) across all time points. Cardiac index increased during the procedure for both treatments but was not significantly different between treatments. Thromboelastography variables did not differ significantly between treatments as indicated by the coagulation index. Subjective evaluation of peritoneal biopsy specimens revealed mesothelial cell loss with STCO2. There was no significant difference in circulating C-reactive protein or interleukin-6 concentrations. There was a significant increase in the number of postoperative pain scores > 0 for the WHCO2 treatment versus the STCO2 treatment. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of these data suggested that effects on evaluated variables attributable to the use of WHCO2 for creating pneumoperitoneum in healthy mature dogs undergoing laparoscopy did not differ from effects for the use of STCO2.