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

Objective: To characterize the clinical features, management, and short- and long-term outcomes of dogs experiencing insulin-induced hypoglycemic seizures (IIHS).

Methods: Dogs with documented blood glucose concentrations < 80 mg/dL (4.4 mmol/L) within 12 hours of insulin administration were retrospectively identified from 14 private practice emergency and specialty hospitals in the US (January 2017 to January 2025). Dogs were classified as having IIHS or insulin-induced hypoglycemia (IIH) without seizures. Data collected included signalment, insulin type and dose, blood glucose concentration at presentation, time to glucose correction, seizure characteristics, antiepileptic drug (AED) use, length of hospitalization, and survival to discharge. Associations between clinical variables and seizure occurrence were assessed with logistic regression.

Results: 49 dogs met the inclusion criteria: 34 with and 15 without seizure activity. Body weight showed a curvilinear association with seizure occurrence, with higher odds at low (< 10-kg) and high (> 25-kg) weights (body weight: OR, 0.26; 95% CI, 0.07 to 0.97; body weight2: OR, 1.41; 95% CI, 1.04 to 1.93). Antiepileptic drugs were used in 7 of 34 dogs (20.6%); 3 required long-term management. Multiple seizures were associated with AED use. No significant differences were found in insulin type, amount administered, or time to glucose correction between groups.

Conclusions: IIHS are common in diabetic dogs; however, long-term neurologic sequelae and the need for ongoing AEDs are uncommon.

Clinical relevance: Future studies are warranted to better identify patients at increased risk for long-term neurologic complications and to establish criteria for initiating AEDs. Additionally, research evaluating IIHS associated with other insulin preparations (eg, detemir, glargine) is needed.

Objective: To develop a machine learning (ML) model to identify fiducial points on canine ECGs to localize right-sided accessory pathways as posterior or anterior during ventricular preexcitation (VPE).

Methods: ECG recordings with VPE and documented accessory pathway locations were preprocessed for a 1-dimensional U-net algorithm. A web-based platform (https://setpsi.com/AccessoryPathways/) was created. Training used approximately 70% of pooled beats from 16 of 27 dogs. Testing used approximately 30% of pooled beats from 11 of 27 dogs to assess accurate diagnosis of posterior versus anterior accessory pathways. Vectorcardiograms and mean electrical axis (MEA) were calculated to validate the ML model. Fiducial boundary correctness and beat identification accuracy were assessed with receiver operator characteristic curves and reported as area under the curve (AUC; 95% CI). A Mann-Whitney test was used to compare MEA methods (median; IQR).

Results: The ML algorithm was trained on 3,405 beats and tested on 1,984 beats. The model identified fiducial points P wave to delta wave (AUC, 0.957; 95% CI, 0.957 to 0.958) and delta wave/QRS (AUC, 0.965; 95% CI, 0.964 to 0.966), classified individual beats as posterior (AUC, 0.917; 95% CI, 0.915 to 0.920) and anterior (AUC, 0.948; 95% CI, 0.947 to 0.949), and determined pathway location in 82% (9 of 11) of test dogs. Vectorcardiograms of posterior pathways showed oval or elliptical loops with superior leftward vectors, while anterior pathways displayed complex figure-eight loops with inferior leftward vectors. The MEA differed (P < .01) between posterior (-23.7°; IQR, 39.5°) and anterior (61.1°; IQR, 9.8°) pathways. Both methods validated the ML model.

Conclusions: The ML model accurately localized accessory pathways in canine VPE.

Clinical relevance: ML will advance the ability to accurately diagnose VPE.

Objective: To report the outcome of total lung lobectomy with self-ligating loop in cats.

Animals: This was a retrospective case series of cats that underwent total lung lobectomy with self-ligating loop between January 2020 and February 2025. Data regarding signalment, history, physical examination, diagnostics, surgical approach, lung lobe affected, hospitalization length, intraoperative/postoperative complications, and short- and long-term outcomes were analyzed.

Clinical presentation: 13 cats were included: 9 domestic shorthair, 2 domestic longhair, 1 Maine Coon, and 1 Burmese. Clinical signs included respiratory distress (4 of 13), lethargy (4 of 13), cough (3 of 13), hyporexia (3 of 13), dyspnea (2 of 13), vomiting (2 of 13), and pyrexia (1 of 13). Six cats suffered from more than 1 clinical sign.

Results: A total of 14 lung lobectomies were performed via either right (n = 2) or left (5) intercostal thoracotomy, median sternotomy (4), or video-assisted thoracic surgery (2). No major intraoperative complications occurred. Temporary hypoxemia was recorded during a video-assisted thoracic surgery procedure in 1 case and resolved with thoracic lift. Eleven cats survived hospital discharge. Minor postoperative complications (wound inflammation, vomiting, hyperthermia) occurred in 3 cats, while major postoperative complications (pleural effusion, intrathoracic infection) occurred in 3 cats. No revision surgery was necessary in any case. Three cats underwent humane euthanasia due to a sudden deterioration secondary to the underlying disease in the immediate postoperative period (catastrophic complication). On long-term follow-up, 7 cats were alive and no long-term complications related to the lobectomy were reported.

Clinical relevance: Lung lobectomy with self-ligating loop provides a safe technique for total lung lobectomy and can be considered as an alternative when thoracic stapler is not available in cats.

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.