Javma-journal of The American Veterinary Medical Association最新文献

Objective: To evaluate plasma from dogs with sudden acquired retinal degeneration syndrome (SARDS) for coagulability, extent of clot turnover, and plasminogen activator inhibitor-1 (PAI-1) concentrations.

Methods: Archived (2016 to 2017) or fresh (2023 to 2024) citrated plasma was collected (jugular venipuncture) at a university clinic from dogs with confirmed SARDS and controls (age, breed, and sex matched to a dog with SARDS). Light absorbance fibrinolysis assay assessed clot formation (clot formation velocity, peak optical density [POD], and area under the curve [AUC]) and degradation (percent clot lysis at 30 to 60 minutes, clot lysis velocity). Concentrations of PAI-1 were measured (ELISA). Results were analyzed with the Wilcoxon signed rank test, Spearman correlation, and multiple logistic regression.

Results: There were 6 dogs with confirmed SARDS in the pilot study and 10 in the prospective study. Dogs with SARDS had higher POD and AUC than controls (POD median difference [MD] = 306 milliabsorbance units [mAU; pilot], 356 mAU [prospective]; AUC MD = 1,900 AU [pilot], 6,775 AU [prospective]), indicating greater extent of clot formation. Dogs with acute SARDS (< 6 months' duration; n = 11) had higher POD (MD = 382 mAU), AUC (MD = 4,857 AU), and clot formation velocity (MD = 0.6 mAU/s), indicating greater strength and rate of clot formation. Dogs with acute SARDS also had lower clot lysis at 30 minutes (MD = -16%) and 60 minutes (MD = -22%), indicating reduced clot lysis. The combined fibrinolysis assay outcomes allowed excellent differentiation between dogs with SARDS and controls (area under the receiver operating curve, 0.93). There was no difference in PAI-1 plasma concentrations between groups.

Conclusions: Dogs with SARDS are hypercoagulable with evidence of decreased clot turnover in the acute stage.

Clinical relevance: Dogs with SARDS are hypercoagulable; reduced clot lysis may contribute to thrombus-associated ischemic risk.

Objective: Evaluate clinical and fecal parameters in dogs with refractory chronic enteropathy (CE) treated with repeated fecal microbiota transplantation (FMT) as adjunct treatment.

Methods: This was a prospective longitudinal observational study from September 25, 2021, to June 20, 2024. Thirty-nine dogs received 2 to 3 rectal FMTs over 1 month. Canine inflammatory bowel disease activity index (CIBDAI) and fecal samples were assessed for 6 months. Fecal samples were analyzed for dysbiosis index, bile acids, and calprotectin.

Results: 28 of 39 dogs responded to FMT. Eight dogs had a short-lasting response. Before FMT, baseline CIBDAI was equivalent in responders and nonresponders. Responders had a significantly decreased CIBDAI at 1 month, which remained unaltered at 6 months in long-lasting responders (LLRs). Baseline dysbiosis index (mean [95% CI]) was significantly lower in LLRs (-0.02 [-3.3 to 2.7]) versus nonresponders and short-lasting responders combined (N/SRs; 2.9 [-0.2 to 6.0]). Baseline percentage of secondary unconjugated fecal bile acids was higher in LLRs (65 [41 to 89]) versus N/SRs (30 [6 to 54]). Dysbiosis index decreased significantly at the time point for the third FMT in LLRs (-2.4 [-3.9 to 2.2]) but not in N/SRs (3.3 [-0.4 to 5.7]). Corticosteroid tapering was achieved in 13 responders. Mild adverse events were noted in 4 dogs.

Conclusions: This repeated FMT protocol was an effective adjunct treatment in refractory CE dogs, especially in dogs with no or mild dysbiosis. Marked dysbiosis and BA dysmetabolism before and after FMT appeared associated with no clinical response or a short-lasting response to FMT, potentially requiring repeated FMT.

Clinical relevance: Repeated FMT could reduce disease activity and corticosteroid usage in dogs with refractory CE.

Objective: To report low-field standing MRI findings and, when available, postmortem findings of 25 thoracic limbs with degenerative joint disease of the distal interphalangeal joint (DIPJ) characterized by narrowing of the joint space suggestive of cartilage loss.

Methods: Medical records from September 2015 to July 2022 were reviewed for clinical history, signalment, MRI, and postmortem findings. The study retrospectively analyzed cases in which lameness was linked to DIPJ joint space narrowing using a partially nested comparative design. Width was measured at 4 DIPJ sites, as well as a ratio to the proximal interphalangeal joint. Affected limbs were compared to contralateral and randomly selected control limbs. Statistically significant differences in measurements were found between affected and control groups. In the affected group, subjective DIPJ narrowing, synovial effusion, heterogeneous dorsal recess material, periarticular osteophytosis, and STIR hyperintense signal within the foot were graded.

Results: Standing low-field MRI identified DIPJ degenerative joint disease with joint space narrowing and cartilage loss. A dorsomedial DIPJ width measurement of < 3 mm suggests cartilage damage. Narrowing of the DIPJ may occur without marked effusion, periarticular osteophytosis, or adjacent bone STIR hyperintensity.

Conclusions: Measurements of the joint space on standing low-field MRI can be supportive for the identification of cartilage loss in the DIPJ, which may occur without other concomitant findings.

Clinical relevance: Low-field standing MRI is valuable for assessing DIPJ narrowing. Prognosis appears to be poor for cartilage loss, as 22 of 25 horses did not return to performance.

Objective: To compare CT-derived anatomical geometry of the soft palate and clinical outcome following folded-flap palatoplasty (FFP) or traditional staphylectomy (TS).

Methods: Client-owned French Bulldogs were prospectively enrolled between July 2021 and September 2024. An exercise tolerance test (ETT) and head CT were performed preoperatively and 3 months postoperatively. Dogs were randomized to receive FFP or TS in conjunction with modified multilevel surgery for brachycephalic obstructive airway syndrome (BOAS). Computed tomography measurements were performed and compared between groups. The length of the soft palate was measured from the end of the hard palate to the caudal tip of the soft palate. Soft palate thickness was measured by dividing the length into equal thirds, and measurements were taken of the rostral, middle, and caudal thirds.

Results: Eighteen dogs completed the study (FFP, n = 7; TS, 11). With the use of either surgical technique, soft palates were significantly shorter and significantly thinner postoperatively at the rostral and middle thirds but not at the caudal third when compared to preoperative measurements. Surgical technique was not shown to have a significant effect on the change in palatal length or thickness. There was no significant difference in improvement in ETT scores between the FFP and TS groups.

Conclusions: FFP did not result in a significantly thinner or shorter palate or greater improvement in ETT score when compared to TS. Both techniques resulted in significantly shorter and thinner palates postoperatively.

Clinical relevance: Equivalent clinical outcome can be expected following FFP or TS combined with modified multilevel surgical techniques for the treatment of BOAS.

Objective: To evaluate the efficacy and tolerability of eltrombopag in dogs diagnosed with primary immune-mediated thrombocytopenia (pITP).

Methods: Medical records from dogs diagnosed with pITP between January 2018 and March 2024 were retrospectively reviewed. Data collected included signalment, presenting signs, diagnostic findings, duration of hospitalization, time to platelet recovery (defined as days to achieve a platelet count ≥ 100,000/μL, with no evidence of bleeding), mortality, relapse incidence, transfusion requirements, and adverse events. Dogs were included if they received a combination of corticosteroids, vincristine, mycophenolate mofetil, and human immunoglobulin, with or without the addition of oral eltrombopag administered within 24 hours of diagnosis. Dogs were grouped on the basis of whether they did or did not receive eltrombopag (eltrombopag group vs control group), and results were compared between groups.

Results: 18 dogs met the inclusion criteria (control group, n = 13; eltrombopag group, 5). Median time to platelet recovery, hospitalization, transfusion needs, and mortality did not differ significantly between groups. Eltrombopag was well tolerated, and adverse events, primarily gastrointestinal, were less frequent in the eltrombopag group.

Conclusions: Eltrombopag was well tolerated as part of a multimodal treatment protocol for pITP in dogs. However, it was not associated with improved platelet recovery, shorter hospitalization, or reduced mortality compared with standard therapy alone.

Clinical relevance: This study provided evidence that eltrombopag may be safely incorporated into immunosuppressive regimens for canine pITP; however, its clinical benefit remains uncertain. Further research is required to determine its role in optimizing treatment for ITP in dogs.

Objective: To determine whether congestive heart failure (CHF) or specific degrees of left atrial enlargement increase the probability of coughing in dogs with myxomatous mitral valve disease (MMVD).

Methods: Data from 2 previous studies were examined separately and collectively. Proportions of dogs coughing at each level of left atrial enlargement (none, mild, moderate, and severe) were compared in all dogs regardless of clinical status, in dogs with subclinical disease, and in dogs with CHF. Binomial logistic regression examined whether coughing or left atrial enlargement predicted the presence of coughing.

Results: 352 dogs with varying degrees of left atrial enlargement were included from the 2 studies. Only severe left atrial enlargement (left atrial-to-aortic ratio, > 2.29) resulted in an increased probability of coughing in dogs with MMVD. Dogs with lesser degrees of left atrial enlargement had similar probabilities of coughing as dogs without left atrial enlargement. Congestive heart failure was not found to be an independent predictor of coughing.

Conclusions: We found no evidence that CHF contributes to or increases the probability of coughing in dogs with MMVD. Conversely, we found that severe left atrial enlargement does increase this probability, independent of clinical status.

Clinical relevance: Clinicians should not include coughing (or absence thereof) when considering whether dogs with MMVD have CHF or not. Instead, other findings (regardless of coughing status) should inform the diagnosis.

Objective: This paper reports perspectives drawn from current and former veterinary students who spent 2 clinical weeks at a community veterinary clinic focused on developing a spectrum-of-care (SOC) approach.

Methods: An initial qualitative study was conducted 1 month following the completion of a 2-week clinical rotation while participants were still students. The results were used to conduct semistructured interviews of some of these students after they graduated in the years 2020 to 2024.

Results: 1 month following the rotation, 38 current students reported 4 themes: tailoring care more appropriately, developing greater empathy, growth toward independence, and awareness of privilege. One to 5 years after graduation, alumni offered rich descriptions that reiterated these aspects with deeper context and understanding.

Conclusions: This work has implications for the development of the veterinary curriculum and raises some important questions. Use of an SOC approach recognizes the value of turning academic knowledge into authentic practice, potentially leading to professional identities that value and offer more inclusive practice, less moral distress, and greater empathy with clients and their animals.

Clinical relevance: The results revealed that creating intentional student experiences that integrate service learning, reflection, and SOC practices creates positive impacts that can help prepare graduates to work with community programs to improve access to care and permission to offer an SOC, which are 2 ways that the profession can mitigate the negative impact of owners' financial limitations on animal medical care as well as develop more adaptive veterinarians.

Objective: This study aimed to demonstrate the educational effectiveness of a spectrum-of-care (SOC) preclinical training program including associated practical work experiences at The Ohio State University College of Veterinary Medicine.

Methods: Doctor of Veterinary Medicine students (classes 2022 to 2025; n = 165/cohort) were purposefully trained to practice in a newly redesigned curriculum using an SOC approach with early practical work experiences in the Frank Stanton Veterinary Spectrum of Care Clinic from freshman year through to entry into full-time clinics. Educational program efficacy was critically evaluated by considering evidence at progressive levels of the Kirkpatrick Hierarchy or Four-Level Model.

Results: At the lowest level of the Kirkpatrick Hierarchy, there was evidence of student enjoyment during the Frank Stanton Veterinary Spectrum of Care Clinic work experiences, while the second and third levels showed learning of SOC knowledge and skills, along with observable changes in student behavior. At the highest level, employers provided evidence that new graduates demonstrated improvement in SOC skills as they practiced.

Conclusions: Collectively, these hierarchy evidence levels indicate that SOC training and practical work experiences provided at The Ohio State University College of Veterinary Medicine positively contributed to the Doctor of Veterinary Medicine training program and the preparation of more practice-ready veterinary graduates.

Clinical relevance: Purposeful SOC training with practical work experiences can help veterinary students and graduates to practice with more enjoyment, confidence, and competence, which may ultimately help ease workforce transition.

When a pet owner cannot afford care, is it the responsibility of the veterinary practice to offer flexible payment options? Many practices hesitate to do so based on past negative experiences with in-house, staff-managed plans; however, partnerships with third-party-managed pay-over-time plans, digital wallet payments, and crowdfunding platforms can alleviate distress for clients and veterinary teams while increasing acceptance of recommended diagnostics and treatment plans.