Pneumothorax in a persistent canine Angiostrongylus vasorum infection

Canine angiostrongylosis is a gastropod-borne parasitosis caused by the cosmopolitan nematode Angiostrongylus vasorum. It is associated with cardiorespiratory disorders and eventually fatal coagulopathies. A 6-months-old female dog previously diagnosed with bronchopneumonia and pneumothorax, treated accordingly without success, was hospitalized for further treatment. Complementary diagnostics confirmed previous findings plus pneumomediastinum, thoracic exudate, leucocytosis, thrombocytosis, hypercoagulability, and hyperglobulinemia. Coprological analysis showed a severe patent A. vasorum infection. After the third daily fenbendazole administration, all A. vasorum larvae were found dead in follow-up coprological analyses while in intensive care. Upon release, the dog was monitored until full clinical recovery 3 months later. Up to date, A. vasorum infection-related pneumothorax was rarely described, particularly with full recovery of such a young patient. Thus, a parasitological aetiology should be considered for dogs with severe bronchopneumonia or pneumothorax, especially in Europe and South America where increasing numbers of canine angiostrongylosis cases call for enhanced awareness of veterinary practitioners.

Radionuclide Assessment of the Natural Heart Ejection Fraction before and after LVAD Implantation

Complete pressure unloading of the ventricles can preserve ischemically damaged myocardium. Most clinical left heart assist device (LVAD) systems used after ischemic injury of the heart apply atrial cannulation which does not ensure pressure unloading. In order to assess the effect of the implantation of an intracorporeal LVAD on the function of the natural heart, we determined the ejection fraction (EF) in four male Holstein calves (90–105 kg) before and after insertion of a Cleveland Clinic pneumatic LVAD. A gated blood pool scan was obtained with a gamma camera after injection of 40 mCi Tc-labelled albumin. The animals were restrained in a sling to avoid movement artifacts.

All animals showed a drop of 65 ± 12% to 42 ± 14% EF in the first postoperative (p.o.) week. Left ventricular output did not maintain sufficient blood pressure as assessed by pump-off tests. Systolic blood pressure dropped from 122 ±6.5 mm Hg to 81 ± 6 mm Hg without pump support on the morning of the first p.o. day.

Apical coring and possible restrained heart movement by the implanted LVAD may lead to impaired myocardial function that renders the individual LVAD dependent until adaptative corrections take place.

Reticulocytosis in non-anaemic cats and dogs

OBJECTIVE

To evaluate the proportion of blood samples diagnosed with reticulocytosis without anaemia in cats and dogs and report the aetiology and mortality rate of affected animals.

MATERIALS AND METHODS

Retrospective multicentre study including haematological examination of 3956 cats and 11,087 dogs admitted to seven German veterinary clinics (2012 to 2014). The proportion of blood samples with reticulocytosis without anaemia was calculated, and after exclusion of multiple measurements of the same animal, clinical data were evaluated. Animals with reticulocytosis without anaemia were classified as healthy or diseased, and diseased patients were assigned to 12 disease groups. Pretreatment (i.e. non-steroidal anti-inflammatory drugs, glucocorticoids, dipyrone) was recorded.

RESULTS

The proportion of blood samples with reticulocytosis without anaemia was 3·1% (124/3956) in cats and 4·4% (492/11,087) in dogs. Overall, 1·8% (2/111) of cats and 1·5% (7/458) of dogs with reticulocytosis without anaemia were healthy. Blood loss/anaemia, cardiac/respiratory disorders, gastrointestinal disorders and inflammatory disorders as well as cancer were the most frequent underlying diseases. Pretreatment was noted in 39·5% (43/111) of cats and 42·4% (194/458) of dogs. The mortality rate was 37·8% (42/111) in cats and 29·7% (136/458) in dogs with reticulocytosis without anaemia; the median survival time in non-survivors was 1 day (range: 0 to 376 days in cats, 0 to 444 days in dogs).

CLINICAL SIGNIFICANCE

In both species, reticulocytosis without anaemia was observed in a low proportion of blood samples (dogs>cat). Though a bias towards sick animals is possible in our sample, reticulocytosis without anaemia was mainly seen in diseased animals and associated with a mortality rate of approximately one-third of patients.

Improved Endothelialization of Postfixation Treated Biological Vascular Grafts

Preliminary in vitro and in vivo studies have shown that endothelialization is improved by a detoxifying postfixation treatment of glutaraldehyde (GA) fixed bovine pericardial patches and grafts.

To test whether this is also true for GA tanned human vein (HUV) grafts, patches of commercially available HUV grafts (MHUV), postfixation treated HUV grafts (PTHUV) and GA fixed HUV granfts (GAHUV) were endothelialized in vitro. Eight pairs of MHUV and PTHUV grafts were implanted as femoropopliteal grafts in eight sheep. Endothelial cell adherence was significantly better on PTHUV (11910 ± 4413 cells/cm2) than on MHUV (6545 ± 2835 cells/mm2; p = 0.0007) and on GAHUV (3563 ± 1638; p = 0.0001) one day after cell seeding. After eight days of culture significantly more cells spread on PTHUV material than on MHUV (p = 0.0002), but none of the cultures on GAHUV remained viable. Four PTHUV grafts occluded in the femoropopliteal position, mostly because of kinking, so that only in four pairs of grafts could the thrombus-free surface be compared by planimetry. Again PTHUV material was covered more by endothelial cells than was MHUV material. On PTHUV endothelial cells spread directly on the graft material while on MHUV these cells spread on a layer of fibrin and macrophages.

Postfixation treatment of GA-fixed biological graft material by aminoacid solutions improves the biocompatibility of the material and enhances in vitro as well as spontaneous in vivo endothelialization.

Heparin Coating of the Extracorporeal Circuit Combined with Leukocyte Filtration Reduces Coagulation Activity, Blood Loss and Blood Product Substitution

Background

Cardiopulmonary bypass is associated with activation of the coagulation cascade. Occasionally, this results in postoperative hemorrhage and consequently the need for blood products associated with increasing costs and risk of infection. Contact activation of the intrinsic coagulation pathway, and damage to cellular blood components with the release of proteolytic substances from neutrophil granulocytes have been linked to these coagulation disorders.

Methods

Eighteen routine CABG-patients were randomly assigned to totally heparin coated circuits (Bioline coating) combined with leukocyte filtration in a double blind protocol (group I), 34 patients served as controls (group II). Leukocyte filters were activated before release of the aortic crossclamp. Coagulation activity, postoperative blood loss, and substitution with blood products were assessed.

Results

Blood loss in the first 24h after surgery was significantly lower with combined application of heparin coating and leukocyte filters (group I) vs. controls (group II) (526±78ml vs. 786±88ml; p<0.05). Thrombin formation represented by prothrombin fragments 1+2 was significantly lower in group I vs. group II after declamping of the aorta (2.1±0.3nmol/L vs. 4.0±0.3nmol/L; p<0.05). Group I showed higher AT III plasma than group II (48.8±3.2% vs. 41.5±1.7%; p<0.05).

Conclusions

Leukocyte filtration during reperfusion in heparin coated cardiopulmonary bypass circuits is associated with lower coagulation activation, decreased blood loss and reduced transfusion of packed red cells in elective CABG patients.

Mechanical Bridge to Transplantation with the Vienna Heart in TAH and LVAD Configuration

The Vienna heart uses a vacuum formed, pellethane pulsatile ventricle and is available in left ventricular assist (LVAD) and total artificial heart (TAH) configurations. This device was used as mechanical support of the failing heart in nine patients intended for heart transplantation. In two patients with cardiomyopathy an orthotopic TAH was implanted; one survived despite severe preoperative ischemic liver damage, and the other died of sepsis.

In seven patients an atrio-aortic LVAD was implanted; six had suffered an acute myocardial infarction with cardiogenic shock, and one could not be weaned off bypass. Three patients survived. These included one 65-year-old with incipient ARDS at operation, and a 40-year-old with preoperative liver and kidney insufficiency who was transplanted in septicemia. In this patient the septic focus, natural and artificial heart, were removed at transplantation.

Four patients died. In one we were unable to establish satisfactory circulation, one died after failure of the transplanted heart, one suffered a lethal cerebral embolism and one developed multi-organ failure after repeated attacks of ventricular fibrillation.

With the Vienna heart sufficient circulatory support could be established with cardiac outputs between 6 and 8 l/min for the TAH and 3.5 to 4.5 I/min for the LVAD. With this type of support an overall survival rate of 44% could be achieved. Mechanical hemolysis was not a clinical problem and no device failure occurred.

External Stenting with a New Polyester Mesh Reduces Neointimal Hyperplasia of Vein Grafts in a Sheep Model

Objective

External stents placed around vein grafts have demonstrated effectiveness in reducing neointimal hyperplasia by preventing distension of the thin-walled vein grafts when exposed to arterial pressure. However, the ideal stent material has yet to be defined. The following study investigates the short- and long-term effects of an innovative polyester mesh stent designed with optimized adaptation of circumferential compliance.

Methods

Following in vitro definition of the ideal macro-porous polyester stent material, a total of 12 sheep underwent implantation of bilateral carotid artery vein graft bypasses. In six sheep, the short-term outcome (four weeks of implantation) was investigated by comparing the newly-designed stent to native veins, micro-porous PTFE stent grafts and metallic Biocompound® stents (BCGs). Flow volume and graft diameter were measured prior to explantation. Grafts were evaluated histologically with respect to morphometry and immunoassaying. In the long-term group (6-month implantation time), the polyester stent was compared to native veins.

Results

All stents effectively prevented dilatation of the graft. Perfused vessel diameters of the polyester veins were 8.3±0.6 mm. BCG as well as PTFE veins showed diameter reduction to 7.4±0.7mm (p<0.05) and 7.8±0.4 mm (p<0.05), respectively. Both in the short and long terms, the new polyester stent led to significantly higher reduction of neointimal hyperplasia and luminal encroachment compared to the native vessel. It proved superior to PTFE stenting, while the Biocompound® material failed to prove efficacy.

Conclusions

It was demonstrated that the new macro-porous polyester mesh stent reduced neointimal hyperplasia more effectively than other commercially available stents.

Evaluation of the Cardiac reader® as a point-of-care instrument for measurement of fibrin D-dimers in dogs

Objective: The aim of this study was the evaluationof the automated point-of-care analyzer Cardiac reader® for quantitative fibrin D-dimer measurement compared to the Liatest™ D-Di™ run on the bench top analyzer STA Compact (all Roche). Material and methods: 41 fresh canine blood specimens submitted from the Clinic for Small Animals, Justus-Liebig-University Giessen were included. Measurement of fibrin D-dimers with the Liatest™ D-Di™ immunoturbidimetric assay was performed in citrated blood plasma stored at –80 °C until analysis. Using the Cardiac reader, D-dimer plasma concentrations were measured with an immunological assay in heparinized fresh (< 1 hour) whole blood specimens. Results: Mean intra-assay coefficient of variation (CV) was 6.13% (range: 2.2–10.0%) for the Liatest™ D-Di and 19.8% (range: 20.1–19.6%) for the Cardiac reader. Fibrin D-dimers detected with the STA Compact exceeded the upper limit of the reference interval (0.4 μg/ml; n = 62 healthy dogs) in 20/41 samples. There was a fair correlation between D-dimer measurements with the Cardiac reader and the comparison method (r = 0.78). Generally, results were underestimated with a mean proportional bias (0.45 μg/ml). The area under the Receiver Operating Characteristic (ROC) curve was 0.895 regarding the detection of increased fibrin D-dimers with the Cardiac reader. At a cut-off value of > 0.2 μg/ml, sensitivity/specificity were 85%/91% and positive/negative likelihood ratios were 8.93/0.17. At a lower cut-off value of 0.15 μg/ml sensitivity and specificity were 90% and 66%, respectively. Conclusion and clinical relevance: The Cardiac reader can be used for quantitative measurement of canine D-dimers, however, due to the odds of false negative results and the high imprecision the comparison method should be preferred.

Bakterienisolate aus dem unteren Respirationstrakt von erkrankten Hunden und deren aktuelle Resistenzsituation

Gegenstand: Retrospektive Untersuchung der mittels bronchoalveolärer Lavage (BAL) gewonnenen Keimflora der tiefen Atemwege erkrankter Hunde auf ihre Antibiotikaempfindlichkeit über 5 Jahre.

Material und Methoden: Auswertung der Ergebnisse der Agardiffusionstests von Bakterienisolaten, die in den Jahren 2004–2009 von 84 Hunden isoliert wurden, und Vergleich mit den Resultaten einer gleichartigen Analyse der Jahre 1999/2000.

Ergebnisse: Bei den 99 geprüften Bakterienisolaten handelte es sich um Pasteurella spp. (27,3%), Bordetella bronchiseptica (20,2%), Staphylococcus spp. (18,2%), Escherichia coli (15,2%), Klebsiella spp. (8,1%), Pseudomonas spp. (7,0%) und Streptococcus spp. (4,0%). Bei acht Hunden lagen Mischkulturen vor. Die Mehrzahl der Bordetella-(B.-)bronchiseptica-Isolate erwies sich als sensibel gegenüber den Fluorchinolonen sowie Tetracyclin, Doxycyclin und Polymyxin B. Im Vergleich zu 1999/2000 zeigte sich ein höherer Anteil der gegenüber Amoxicillin/Clavulansäure und Chloramphenicol empfindlichen B.-bronchiseptica-Isolate, wobei die Zunahme bezüglich Chloramphenicol statistisch signifikant war. Die überwiegende Anzahl der Staphylococcus-Isolate erwies sich gegenüber Enrofloxacin, Marbofloxacin, Amoxicillin/Clavulansäure, Chloramphenicol, Cephalexin, Doxycyclin und Polymyxin B sensibel. Im Vergleich zu 1999/2000 ergab sich ein erhöhter Anteil an Chloramphenicolund Tetracyclin-sensiblen Staphylococcus-Isolaten. Der Anteil Enrofloxacin-sensibler KlebsiellenIsolate betrug 62,5%, während er 1999/2000 bei 100% lag. Eine Sensibilität aller getesteten Klebsiellen-Isolate ließ sich noch gegenüber Polymyxin B nachweisen. Kein Antibiotikum zeigte eine Wirksamkeit gegenüber allen E.-coli-Isolaten. Statistisch signifikant war die Abnahme der gegenüber Amoxicillin/Clavulansäure-sensiblen Isolate.

Schlussfolgerung und klinische Relevanz: Die Studie unterstreicht den Nutzen der BAL für eine ätiologische Diagnostik und den anschließenden fundierten Einsatz von Antibiotika. Die Mehrzahl der Bakterienisolate erwies sich als empfindlich gegenüber den Fluorchinolonen.

Bestimmung von Serum-Amyloid A, Haptoglobin und Fibrinogen als Entzündungsparameter nach Kastration von Hengsten

Gegenstand und Ziel: Gegenstand der vorliegenden Studie war die Frage, ob sich die Akute-Phase-Proteine Serum-Amyloid A, Haptoglobin und Fibrinogen nicht nur für die Entzündungsdiagnostik eignen, sondern auch eine Aussage über das Ausmaß einer Entzündung und den postoperativen Heilungsverlauf zulassen. Material und Methoden: Es wurden zwei Gruppen von Hengsten verglichen, die alle einer bedeckten Kastration in Allgemeinanästhesie unterzogen wurden. Pferde in Gruppe 1 (n = 13, mittleres Alter drei Jahre) zeigten postoperativ keine bis geringgradige Wundheilungsstörungen. Dagegen traten bei Pferden der Gruppe 2 (n = 12, durchschnittliches Alter zwei Jahre) mittel- bis hochgradige Wundheilungsstörungen auf (geschwollener, vermehrt warmer Wundbereich, Exsudation, teilweise eitrig, Schmerzhaftigkeit, Lahmheit). Die Probanden wurden unmittelbar vor und sechs, 12, 24, 48 und 72 Stunden sowie sieben Tage nach der Operation untersucht. Ergebnisse: Die Körperinnentemperatur differierte ebenso wie die Gesamtleukozytenzahl zwischen den Gruppen deutlich. Die Konzentration von Serum-Amyloid A stieg bei allen Pferden innerhalb von 24 Stunden nach der Kastration signifikant an. Alle Probanden wiesen 48 Stunden nach dem Eingriff einen Anstieg der Fibrinogenkonzentration im Plasma auf. Die Haptoglobinmessung ergab eine Erhöhung im Plasma innerhalb von 48 Stunden in Gruppe 1 und innerhalb von 72 Stunden in Gruppe 2. Schlussfolgerung: Sowohl die Verlaufskontrolle der klinischen Parameter als auch der ausgewählten Akute- Phase-Proteine zeigte als Reaktion auf die Operation und eine nachfolgende Entzündung deutlich ansteigende Werte. Klinische Relevanz: Während bei der Kastration die Bestimmung der klinischen Parameter ausreichend erscheint, bietet sich eine kombinierte Messung von Serum-Amyloid A und Haptoglobin oder Fibrinogen zur Einstufung von unbekannten Entzündungsherden und -symptomen an.

Myeloperoxidase deficiency in dogs observed with the ADVIA®120

Objective: In contrast to humans, neutrophil myeloperoxidase deficiency (MPOD) has been rarely investigated in dogs. The hematology analyzer ADVIA®120 differentiates leukocytes based on the cellular volume and their myeloperoxidase concentration. The aim of this study was the characterization of myeloperoxidase deficiency in dogs and the evaluation of the diagnostic use of the ADVIA®120 Myeloperoxidase Index (MPXI). Material and methods: ADVIA® peroxidase scatter plots indicative of MPOD were reviewed. Severity of MPOD was classified semiquantitatively in three groups (MPOD grade 1–3): MPOD grade 1 (MPOD-1): neutrophils showing an abnormal shift of the population, < 25% extending in the monocyte cluster and therefore misclassified, MPOD-2: ~25–50% of neutrophils misclassified, MPOD-3: 50–100% of the neutrophils misclassified due to their location in the monocyte cluster. Sex, age, and breed of the dogs as well as diagnosis, and MPXI were recorded. Results: 29 dogs (nine females and 20 males belonging to 23 breeds) with 38 analyses consistent with MPOD were found. Diseases were characterized by severe leukocyte consumption and included mainly parvovirosis (8/29), DIC/sepsis (3/29), pyometra, pyothorax, pneumonia, pancreatic abscess, and cystitis. A significantly lower mean MPXI in MPOD-3 was present in comparison to the mean MPXI of MPOD-1 (p < 0.05), however, there was a great overlap between the groups. Conclusion: Diseases associated with neutrophil consumption may show an acquired MPOD in dogs. High standard deviation limits the diagnostic use of the MPXI for detection of MPOD. Clinical relevance: The ADVIA®120 cytograms are a good screening tool for detection of MPOD in dogs, but the use of the MPXI is impaired in this species.

Ein Gentest für die GM1-Gangliosidose beim Alaskan Husky

Gegenstand und Ziel: Die GM1-Gangliosidose der Alaskan Huskies ist eine angeborene Erkrankung, die durch einen autosomal rezessiv vererbten Defekt des Gens für die saure β-Galaktosidase (GLB1) hervorgerufen wird. Klinisch zeigen die Tiere Minderwuchs sowie, beginnend im Alter von sechs bis acht Wochen, neurologische Ausfallerscheinungen wie Ataxie und Dysmetrie. Zur gezielten Vermeidung dieser Erkrankung ist es für Zuchtentscheidungen wichtig, Anlageträger für den Defekt sicher identifizieren zu können. Material und Methode: Die Spezifität und Sensitivität eines kürzlich beschriebenen Gentests zum direkten Nachweis des genetischen Defekts bei der GM1-Gangliosidose des Alaskan Husky wurde mit der biochemischen Bestimmung der enzymatischen Aktivität der β-Galaktosidase aus isolierten Hautfibroblasten, klinischen und pathologischen Befunden sowie einer Stammbaumanalyse verglichen. Ergebnisse: Die β-Galaktosidase-Enzymaktivitäten von Anlageträgern lagen im Durchschnitt niedriger als die Enzymaktivitäten homozygot gesunder Hunde. Da sich jedoch die Werte der beiden Gruppen überlappten, war eine sichere Identifizierung von Anlageträgern mit der biochemischen Analyse nicht möglich. Demgegenüber erlaubte der Gentest eine eindeutige Unterscheidung zwischen homozygot gesunden Tieren und Anlageträgern. Schlussfolgerung: Der Gentest ist der biochemischen Diagnostik überlegen. Klinische Relevanz: Mithilfe des Gentests können die phänotypisch unauffälligen Anlageträger sicher identifiziert werden. Damit lassen sich Anpaarungen von zwei Anlageträgern verhindern und das Auftreten der GM1-Gangliosidose kann zukünftig vermieden werden.

Koagulopathien bei Hund und Katze

Der Gerinnungsprozess findet in drei Phasen statt, der primären und sekundären (plasmatischen) Hämostase sowie der Gerinnungsinhibition/Fibrinolyse. Nach der neueren Definition von Koagulopathien werden diese in „Minus-Koagulopathien“ (= verminderte sekundäre Hämostase) und „Plus-Koagulopathien“ (= Thrombophilie, d. h. Thromboseneigung) unterteilt. Minus-Koagulopathien können angeboren oder erworben sein. Die wichtigsten angeborenen Koagulopathien beim Hund umfassen Faktor-VIIIund FaktorIX-Mangel (Hämophilie A/B). Bei Katzen ist ein Faktor-XII-Mangel bekannt, der jedoch nicht mit ausgeprägten klinischen Symptomen einhergeht. Die häufigste erworbene Minus-Koagulopathie ist die disseminierte intravasale Gerinnung (DIC), gefolgt von Kumarinvergiftung, hochgradigem Leberversagen oder einer Heparintherapie. Die Ätiologie von Plus-Koagulopathien umfasst renalen Proteinverlust, Neoplasien, immunvermittelte Anämie und Vaskulitis. Patienten mit Minus-Koagulopathien zeigen klinisch Hämatome, Epistaxis und Blutungen in Körperhöhlen. Dagegen sind Erkrankungen der primären Hämostase durch Petechien/Ekchymosen charakterisiert. Die Symptome von Störungen der Gerinnungsinhibition sind vielfältig und von der Lokalisation der Thrombusbildung abhängig. Die Patienten können Lahmheit (bei Aortenthrombose) oder Dyspnoe im Fall einer Lungenembolie zeigen. Die wichtigsten diagnostischen Tests bei Patienten mit Blutungsneigung sind die Bestimmung der Thrombozytenzahl sowie eine Messung der Thromboplastinzeit (PT) und aktivierten partiellen Thromboplastinzeit (aPTT). Bei Hunden mit Verdacht auf DIC sollten zusätzlich D-Dimere und Fibrinogen bestimmt werden. Ein erhöhter D-Dimer-Wert ist Anzeichen einer Lyse quervernetzter Fibringerinnsel und kann auch bei Hunden mit Thromboembolien, vorangegangenen chirurgischen Eingriffen oder Blutungen in Körperhöhlen auftreten. Die Therapie von Koagulopathien ist variabel und abhängig von der Ätiologie der Erkrankung.

Sensitivität und Spezifität der CDV-RT-PCR zur Diagnose der kaninen Staupe

Die Diagnostik bei Hunden mit Staupeverdacht stützt sich in der Regel auf die Anamnese und die Kombination spezifischer klinischer Befunde. Das Ziel der vorliegenden Studie war die Beurteilung der klinisch relevanten Sensitivität und Spezifität des Nachweises von Nukleinsäure des kaninen Staupevirus (CDV) mittels Reverse-Transkriptase-Polymerasekettenreaktion (CDV-RT-PCR) zur In-vivo-Diagnostik der kaninen Staupe. Zur Auswertung kamen 53 (48,6%) männliche und 56 (51,4%) weibliche Hunde im durchschnittlichen Alter von 1,25 Jahren. Bei 61 Tieren (56%) wurde wegen zentralnervöser, bei 38 (35%) wegen katarrhalischer Symptome und bei 10 (9%) Patienten wegen schwerer Allgemeinstörung mit zunächst ungeklärtem Fieber die Staupe-RT-PCR im Vollblut, Liquor, Urin oder Serum eingeleitet. Der positive bzw. negative Nachweis von Nukleinsäure des kaninen Staupevirus wurde dann in Bezug zu den Ergebnissen der klinischen, der weiterführenden bildgebenden und labordiagnostischen Untersuchungen sowie zum weiteren Krankheitsverlauf, im Todesfall zum Ergebnis der pathologisch-anatomischen bzw. histopathologischen Untersuchung als »klinisch« richtig (richtig positiv oder negativ) oder falsch (falsch positiv oder negativ) bewertet. Bei 15 Hunden war das CDV-RT-PCR-Ergebnis richtig positiv, bei 87 richtig negativ, bei 7 falsch positiv und bei keinem Tier falsch negativ. Hieraus lassen sich für die klinische Diagnostik der kaninen Staupeerkrankung mittels CDV-RT-PCR eine Sensitivität von 100% (81,9-100%), eine Spezifität von 92% (85,3-97,0%), ein positiver prädiktiver Wert von 68% (45,1-86,1%) sowie ein negativer prädiktiver Wert von 100% (96,6-100%) berechnen. Die diagnostische Effizienz des Testes liegt bei 93% (87,2-97,6%). Die Staupe-RT-PCR ist somit derzeit das Nachweisverfahren der Wahl zur ätiologischen Diagnose einer kaninen Staupeerkrankung. Ein negatives Ergebnis schließt die Staupe mit hoher Sicherheit aus, ein positives Resultat muss aber immer in Bezug zum klinischen Bild des Patienten interpretiert werden und im Zweifelsfall sollte der Test nach ca. 14 Tagen wiederholt werden.

Formation of spheroids by dental pulp cells in the presence of hypoxia and hypoxia mimetic agents

AIM

To evaluate the impact of hypoxia and hypoxia mimetic agents (HMA) on the formation and activity of spheroids by dental pulp cells (DPC).

METHODOLOGY

DPC on agarose-coated plates were treated with hypoxia and the HMA dimethyloxallyl glycine (DMOG), desferrioxamine (DFO) and L-mimosine (L-MIM). Images of spheroids were taken directly after seeding and at 6 h and 24 h. Spheroid sizes were quantified by area measurement with ImageJ software. Viability was assessed with Live-Dead staining, MTT and resazurin-based toxicity assay. Production of VEGF, IL-8 and SDF-1 was evaluated using immunoassays. Data were analysed using Kruskal-Wallis test and post hoc Mann-Whitney U-test.

RESULTS

DPC formed spheroids in the presence of hypoxia, HMA and combined treatment with hypoxia and HMA. No pronounced difference in spheroid size was found in the groups treated with hypoxia, DMOG, DFO, L-MIM and the combination of hypoxia and the HMA relative to their normoxic controls (P > 0.05). Spheroids appeared vital in Live-Dead and MTT staining and the resazurin-based toxicity assay. Evaluation of protein production with immunoassays revealed significantly enhanced levels of VEGF and IL-8 (P < 0.05), but there was no significant effect on SDF-1 production (P > 0.05). Treatment with a combination of hypoxia and HMA did not further boost VEGF and IL-8 production (P > 0.05).

CONCLUSIONS

Pre-conditioning with hypoxia and HMA increased the pro-angiogenic capacity of spheroids whilst not interfering with their formation. Pre-clinical studies will reveal whether pre-conditioning of spheroids with hypoxia and HMA can effectively improve the efficiency of cell transplantation approaches for regenerative endodontics.

Suspected aspirin resistance in individual healthy adult warmblood horses

The reasons for this prospective experimental study were to determine a dosing scheme with loading and maintenance dose of aspirin inducing inhibition of platelet function measured by whole blood impedance aggregometry. Ten horses received aspirin orally in the morning with one loading dose of 4.7-5 mg/kg and maintenance doses of 1-1.3 mg/kg daily the following 4 days. Aggregometries (COLtest, ASPItest, ADPtest) and serum salicylic acid were measured. ASPItest showed significant difference in inhibition at 24 and 48 hr (p < .05) and 96 hr (p < .01). Significant change for ADPtest and COLtest couldn't be detected. Serum salicylic acid concentrations were significantly (p < .01) increased at 6 and 12 hr. Despite this, three horses failed any inhibitory effect of platelet function, suspecting an aspirin resistance. Regarding the other seven horses platelet aggregation induced by ASPItest was reduced between 37% and 100% from baseline at 6 and 12 hr and between 0 and 98% during the next 4 days. Correlations of serum concentration of salicylic acid and aggregometries couldn't be detected. It can be presumed that equine platelets are less susceptible to aspirin what may compromise eventually the anticoagulatory effects and efficacy in preventing and treating diseases with increased platelet activation as endotoxaemia or laminitis.

Inhibition of neutrophil activity in cardiac surgery with cardiopulmonary bypass: a novel strategy with the leukocyte inhibition module

Recently, we showed that the arterial in-line application of the leukocyte inhibition module (LIM) within the heart-lung machine limits overshooting leukocyte activity and cardiac tissue damage. Moreover, significantly better cardiac function was found in an experimental animal model when LIM was used. In the meantime, the first promising clinical data exist. LIM has to be regarded as an essential tool in extracorporeal circulation, in the future, to improve postoperative clinical outcome and to reduce costs. This review summarizes the biological background of LIM and the current experience obtained in experimental models and clinical studies.

Enamel Surface Changes After Exposure to Bleaching Gels Containing Carbamide Peroxide or Hydrogen Peroxide

OBJECTIVE

This study evaluated the differences in enamel color change, surface hardness, elastic modulus, and surface roughness between treatments with four bleaching gels containing carbamide peroxide (two at 10% and one each at 35%, and 45%) and two bleaching gels containing hydrogen peroxide (two at 40%).

METHODS

Enamel specimens were bleached and color changes were measured. Color change was calculated using either ΔE or the Bleaching Index (BI). Then, surface hardness, elastic modulus, and surface roughness of the enamel specimens were evaluated. All measurements were performed at baseline and directly after the first bleaching treatment for all carbamide peroxide- and hydrogen peroxide-containing bleaching gels. In addition, final measurements were made 24 hours after each of a total of 10 bleaching treatments for carbamide peroxide bleaching gels, and 1 week after each of a total of three bleaching treatments for hydrogen peroxide bleaching gels.

RESULTS

After the last bleaching treatment, respective ΔE scores were 17.6 and 8.2 for the two 10% carbamide peroxide gels, 12.9 and 5.6 for the 45% and 35% carbamide peroxide gels, and 9.6 and 13.9 for the two 40% hydrogen peroxide gels. The respective BI scores were -2.0 and -2.0 for the two 10% carbamide peroxide gels, -3.5 and -1.5 for the 45% and 35% carbamide peroxide gels, and -2.0 and -3.0 for the two 40% hydrogen peroxide gels. Each bleaching gel treatment resulted in significant whitening; however, no significant difference was found among the gels after the last bleaching. Whitening occurred within the first bleaching treatments and did not increase significantly during the remaining treatments. Surface hardness significantly decreased after the last bleaching treatment, when 10% carbamide peroxide was used. Furthermore, significant changes in the elastic modulus or surface roughness occurred only after treatment with 10% carbamide peroxide.

CONCLUSION

All six bleaching gels effectively bleached the enamel specimens independent of their concentration of peroxide. Gels with low peroxide concentration and longer contact time negatively affected the enamel surface.

Hemostatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus

OBJECTIVE

Prospective characterization of hemostastatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus (GDV).

MATERIAL AND METHODS

Coagulation variables (platelets, prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen, antithrombin [AT], protein C [PC], protein S [PS], D-dimers), plasma lactate concentration and inflammatory biomarkers (C-reactive protein, white blood cell [WBC] count, lymphocyte and neutrophil numbers) were assessed in 20 dogs with GDV presented between 2011 and 2012. Blood was taken preoperatively and at days 1 and 3 postoperatively. The prognostic value of these variables before and after surgery was evaluated as well as the behavior of variables during the study.

RESULTS

Overall, 7/20 (35%) dogs did not survive; two dogs (29%) were euthanized during surgery due to severe gastric necrosis and 5 (71%) dogs after surgery due to sepsis and disseminated intravascular coagulopathy. Prior to surgery, median plasma lactate concentration was significantly (p = 0.01) lower in survivors (6.2 mmol/l, range 1.9-9.7 mmol/l) when compared to non-survivors (11.8 mmol/l, range 7.5-16.2 mmol/l). In dogs dying after surgery, significantly higher plasma lactate concentration, coagulation times and D-dimer concentration were present as well as lower fibrinogen concentration and activity of PC and AT compared to survivors. At discharge, activity of AT, PC and PS were markedly below the reference interval in 6/13 (46%), 11/13 (85%), and 8/13 (62%) dogs, respectively.

CLINICAL RELEVANCE

Only lactate plasma concentration was of preoperative prognostic value. After surgery, severe abnormalities of coagulation variables, especially the endogenous anticoagulants were present in most of the dogs. The severity of the abnormalities was associated with survival.

[Extreme neutrophilia in cats - aetiology and prognosis]

OBJECTIVE

The aim of this retrospective study was to evaluate the aetiology and prognostic factors of extreme neutrophilia in cats.

MATERIAL AND METHODS

Patient data over a 5-year period (January 2008  -  December 2013) were reviewed. Cats with a neutrophil count > 40 x 10⁹/l were included. They were further assigned to four groups: "inflammation", "neoplasia", "immune-mediated diseases", "unknown aetiology". Clinical signs, rectal temperature, hospitalisation, duration of hospitalisation, survival, left-shift and toxicity of neutrophils were evaluated.

RESULTS

In total, 28/5185 cats (0.5%) displayed extreme neutrophilia with a mean neutrophil count of 48.5 x 10⁹/l (40.0-76.0 x 10⁹/l). The most common aetiology was a severe inflammation, as seen in 16/28 cats (57%), whereby peritonitis (5/15 cats, 31%) predominated. In cats with neoplastic diseases (9/28 cats, 32%), intestinal neoplasia with subsequent peritonitis was the most common diagnosis (4/9 cats, 44%). Diseases of unknown aetiology (2/28 cats, 7%) and immune-mediated diseases (1/28, 3.6%) were rare. The most common clinical indications included lethargy, anorexia, fever, and gastrointestinal signs. Rectal temperature ranged between 33.9  °C and 40.2   °C, whereby in 2/24 cats (8%) hyperthermia (> 39.3°C) and in 5/24 cats (21%) hypothermia (< 38.0°C) was observed. Hospitalisation occurred in 21/28 cats (75%) with a median duration of 5.5 days (1-30 days). In 24/28 cats, a manual differential count was performed. A left-shift and toxicity of neutrophils were seen in 23/24 cats (96%) and 21/24 cats (88%), respectively. The overall median survival rate was 50%, whereby the survival rate was significantly lower in cats with neoplasia than in those with inflammatory diseases (22% vs. 56%, p < 0.0001).

CLINICAL RELEVANCE

An extreme neutrophilia is rare. It is commonly caused by peritonitis due to foreign bodies or ruptured intestinal tumours (in particular, intestinal lymphomas) and is characterised by a high mortality.

Dose/time-dependent modulation of the endothelial function through induction agents: non-depleting versus depleting agents

BACKGROUND

Polyclonal anti-thymocyte globulins (ATGs) and anti-CD25 antibodies are agents used for induction of immunosuppression in solid-organ transplantation. We aimed to investigate the effect of different regimens of these immunosuppressive induction agents on transendothelial migration of peripheral blood mononuclear cells (PBMC) and evaluated the endothelial apoptosis after treatment.

METHODS

Human microvascular endothelial cells were either activated with tumor necrosis factor-α/interferon-γ or not and further treated with 25 or 125 μg/mL ATG (Thymoglobulin, Sanofi-Aventis, Germany) for 2 hours or 24 hours, or with 5 μg/mL Basiliximab (Simulect, Novartis, Germany) for 2 hours or 24 hours. PBMC were either activated with phytohaemagglutinin (PHA) or not and further treated with 25 or 125 μg/mL ATG or with 5 μg/mL Basiliximab for 2 h and then used for transendothelial migration assays. Apoptosis of endothelial cells was detected by means of Annexin-V staining after 2-hour incubation with either 25 or 125 μg/mL ATG or 5 μg/mL Basiliximab.

RESULTS

Prophylactic 24-hour administration of ATG to naive endothelial cells without PBMC treatment reduced transendothelial migration. Prophylactic 24-hour administration of ATG and Basiliximab to naive endothelial cells after PBMC treatment with the same agents reduced the transendothelial migration after 24 hours. In both cases, no effect could be observed after 2-hour treatment. Basiliximab but not ATG showed a reduction of transmigration after 2-hour treatment of PBMCs without naive EC treatment. Apoptosis of endothelial cells after treatment increased in both cases, being in case of ATG dose-dependent, increasing from 1.2% after either 25 μg/mL ATG to 8.7% after 125 μg/mL ATG.

CONCLUSIONS

Immunosuppressive induction agents modulate the endothelial activity in a dose- and time-dependent manner. Our results suggest that administration of induction agents over longer time periods could provide a potential benefit regarding endothelial immunomodulation. Increased doses may, however, show a deleterious effect on endothelial survival.

Necrotizing pulmonary aspergillosis and ventricular assist device infection: case report and review of literature

Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication.

Differential inflammatory response of dental pulp explants and fibroblasts to saliva

AIM

To investigate the inflammatory response of dental pulp fibroblasts and the respective explants to whole saliva.

METHODOLOGY

Explants from human and porcine dental pulp tissue and isolated dental pulp fibroblasts were used to investigate the inflammatory response to sterile saliva. Cytokine and chemokine expression was assessed by RT-PCR. Western blot analysis and pharmacologic inhibitors were used to determine the involvement of signalling pathways.

RESULTS

Dental pulp explants of human and porcine origin exposed to human saliva exhibited no major changes of IL-6 and IL-8 mRNA expression (P > 0.05). In contrast, isolated porcine and human dental pulp fibroblasts, when stimulated with human saliva, exhibited a vastly increased expression of IL-6 and IL-8 mRNA (P < 0.05). In pulp fibroblasts, saliva also increased the expression of other cytokines and chemokines via activation of NFkappaB, ERK and p38 signalling. Notably, a significantly reduced inflammatory response was elicited when pulp fibroblasts were transiently exposed to saliva.

CONCLUSIONS

Saliva has a potential impact on inflammation of dental pulp fibroblasts in vitro but not when cells are embedded in the intrinsic extracellular matrix of the explant tissue.

Suspected involvement of EPTFE membrane in sterile intrathoracic abscess and pericardial empyema in a multi-allergic LVAD recipient: a case report

Device-related infections in recipients of left ventricular assist devices (LVAD) have been recognized as a major source of morbidity and mortality. They require a high level of diagnostic effort as part of the overall burden resulting from infectious complications in LVAD recipients. We present a multi-allergic patient who was treated for persistent sterile intrathoracic abscess formation and pericardial empyema following minimally invasive LVAD implantation including use of a sheet of e-polytetrafluoroethylene (ePTFE) membrane to restore pericardial integrity. Sterile abscess formation and pericardial empyema recurred after surgical removal until the ePTFE membrane was removed, suggesting that in disposed patients, ePTFE may be related to sterile abscess formation or sterile empyema.

Immune response of healthy horses to DNA constructs formulated with a cationic lipid transfection reagent

Background

Deoxyribonucleic acid (DNA) vaccines are used for experimental immunotherapy of equine melanoma. The injection of complexed linear DNA encoding interleukin (IL)-12/IL-18 induced partial tumour remission in a clinical study including 27 grey horses. To date, the detailed mechanism of the anti-tumour effect of this treatment is unknown.

Results

In the present study, the clinical and cellular responses of 24 healthy horses were monitored over 72 h after simultaneous intradermal and intramuscular application of equine IL-12/IL-18 DNA (complexed with a transfection reagent) or comparative substances (transfection reagent only, nonsense DNA, nonsense DNA depleted of CG).

Although the strongest effect was observed in horses treated with expressing DNA, horses in all groups treated with DNA showed systemic responses. In these horses treated with DNA, rectal temperatures were elevated after treatment and serum amyloid A increased. Total leukocyte and neutrophil counts increased, while lymphocyte numbers decreased. The secretion of tumour necrosis factor alpha (TNFα) and interferon gamma (IFNγ) from peripheral mononuclear blood cells ex vivo increased after treatments with DNA, while IL-10 secretion decreased. Horses treated with DNA had significantly higher myeloid cell numbers and chemokine (C-X-C motif) ligand (CXCL)-10 expression in skin samples at the intradermal injection sites compared to horses treated with transfection reagent only, suggesting an inflammatory response to DNA treatment.

In horses treated with expressing DNA, however, local CXCL-10 expression was highest and immunohistochemistry revealed more intradermal IL-12-positive cells when compared to the other treatment groups.

In contrast to non-grey horses, grey horses showed fewer effects of DNA treatments on blood lymphocyte counts, TNFα secretion and myeloid cell infiltration in the dermis.

Conclusion

Treatment with complexed linear DNA constructs induced an inflammatory response independent of the coding sequence and of CG motif content. Expressing IL-12/IL-18 DNA locally induces expression of the downstream mediator CXCL-10.

The grey horses included appeared to display an attenuated immune response to DNA treatment, although grey horses bearing melanoma responded to this treatment with moderate tumour remission in a preceding study. Whether the different immunological reactivity compared to other horses may contributes to the melanoma susceptibility of grey horses remains to be elucidated.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-015-0452-3) contains supplementary material, which is available to authorized users.

Is removal of calcium bar during mitral valve surgery safe? Long-term clinical outcome of 109 consecutive patients

AIM

Risk factors for adverse outcome after decalcification and patch-reconstruction of the mitral annulus during mitral valve surgery are yet to be defined. For this purpose and for the report of long term results we reviewed our institutional data from over 10 years of mitral valve surgery in the presence of mitral annulus calcification.

METHODS

A total of 109 consecutive patients with a mean age of 66.4±14 years (Mean logistic EURO-Score: 18.6%) underwent mitral valve surgery in the presence of extensive calcification of mitral annulus between 1996 and 2008. After decalcification and patch-reconstruction of the mitral annulus, mitral valve repair was performed in 53 cases (49%) and the remaining 56 patients (51%) received a mitral valve replacement. Multivariate logistic regression analysis was performed to identify independent predictors of adverse outcome.

RESULTS

Inhospital-mortality was 8.3% and the actuarial survival rate at 8 years 76.2%. Echocardiographic follow up was complete. 65 survivors (94.5%) showed none or only trivial mitral valve insufficiency. The freedom of reoperation at 8 years was 91.8%. We found hypertension, diabetes mellitus, age older than 65 years, NYHA class IV, end stage renal failure, failure to preserve the subvalvular apparatus as well as concomitant aortic valve replacement to be associated with a significant increase of early or/and late mortality.

CONCLUSION

Despite the complexity of this pathology, decalcification and patch-reconstruction of the mitral annulus during mitral valve surgery can be performed with low technical risk and acceptable long-term results.