Diagnostic Pitfall of Gastric Signet-Ring Cells: How to Diagnose a Benign Signet-Ring Cell From a Malignant One

Sometimes non-neoplastic changes of the gastric mucosa mimic diffuse-type gastric carcinoma, specifically signet-ring cell adenocarcinoma. In fact, gastric epithelial cells undergoing signet-ring cell change have a cellular morphology that is almost identical to signet-ring cell adenocarcinoma, often leading to misdiagnosis. Accurate recognition of signet-ring cell change is essential to avoid overdiagnosis and overtreatment of signet-ring cell adenocarcinoma. Research on this topic is limited and clinicians lack formal diagnostic tools when signet-ring cells are detected in biopsy specimens. The aims of this study are 3-fold. Firstly, to increase the awareness of both clinicians and pathologists of this rare but highly significant entity. Secondly, to report 4 additional examples of signet-ring cell change and analyze them alongside signet-ring cell adenocarcinoma to compare their morphological and phenotypic features and their evolution over time. Finally, to highlight the potential utility of endoscopic resection to confirm the diagnosis. Cells in signet-ring cell change strongly express E-cadherin, show a wild-type p53 expression, and have a low Ki67 index. In contrast, cells in signet-ring cell adenocarcinoma strongly express p53, have high proliferation rates, and show either no or weak E-cadherin staining. Genetic analysis may be useful in identifying patients at risk of hereditary early diffuse gastric adenocarcinoma, which can mimic signet-ring cell change.

Endoscopic papillectomy for ampullary lesions of minor papilla

BACKGROUND AND AIMS

Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied.

METHODS

We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or Fisher exact test as well as Mann-Whitney U test.

RESULTS

Propensity score-based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en-bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months).

CONCLUSIONS

EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.

Long-term clinical and radiological outcomes of endoscopic ultrasound-guided radiofrequency ablation of benign insulinomas

OBJECTIVE

In recent years, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative nonsurgical treatment for pancreatic neuroendocrine tumours. The aim of our study was to assess the long-term follow-up of patients treated with EUS-RFA for a sporadic insulinoma in our centre in terms of efficacy, safety and risk of recurrence.

DESIGN, PATIENTS AND MEASUREMENTS

We retrospectively analysed the data of 11 patients with an insulinoma treated by EUS-RFA in our tertiary centre between June 2018 and April 2022. Clinical and biological, as well as imaging, follow-up was planned at 3, 6, 12 months and then annually.

RESULTS

In our series, there were nine women and two men with a median age of 65 years. All tumours were sporadic, with a mean size of 11 mm. The procedure allowed an immediate and complete symptomatic and biological remission in all patients without notable complications. Complete radiological resolution of the tumour after ablation was observed in seven patients, and persistence of an asymptomatic tumour residue was observed in four patients. During the mean follow-up period of 26 months, two patients presented a significant but asymptomatic increase of the tumour residue; a second EUS-RFA session was performed in one patient and the other patient is being closely monitored.

CONCLUSIONS

EUS-RFA treatment of benign insulinomas provides a long-term complete clinical resolution of hypoglycaemia. A long-term follow-up is essential if residual tumour persists after initial EUS-RFA treatment.

Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort

Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( P = 0.006 and P < 0.001, respectively). Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.

EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study

Background and study aims  Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging and minimally invasive technique that seems promising for treatment of focal pancreatic and peripancreatic lesions. Our aim was to prospectively evaluate the feasibility, safety, and technical and clinical success of pancreatic and extra-pancreatic EUS-RFA. Patients and methods  We prospectively collected clinical and technical data for all patients who underwent EUS-RFA at two Belgian academic centers from June 2018 to February 2022. Feasibility, adverse events (AEs), and follow-up were also assessed. Results  Twenty-nine patients were included, accounting for 35 lesions: 10 non-functioning neuroendocrine tumors (29 %), 13 pancreatic insulinomas (37 %), one adenocarcinoma (3 %), and 11 intra-pancreatic and extra-pancreatic metastatic lesions (31 %). Technical success was achieved in 100 % of cases, with a median of three power applications per lesion (interquartile range 2). The majority of patients (59 %) presented no collateral effects, three (10.3 %) developed non-severe acute pancreatitis, and four (14 %) had mild abdominal pain. At 6 months follow-up (n = 25), 36 % of patients showed radiological complete response, 16 % presented a significant partial response and 48 % showed < 50 % decrease in diameter. At 12 months (n = 20), 30 % showed complete necrosis and 15 % > 50 % decrease in diameter. Hypoglycemia related to insulinoma was immediately corrected in all 13 cases, with no recurrence during follow-up. Conclusions  EUS-RFA is feasible, safe, and effective for treatment of pancreatic and peripancreatic tumors. Larger and longer multicenter prospective studies are warranted to establish its role in management of focal pancreatic lesions and oligometastatic disease. Symptomatic insulinoma currently represent the best indication.

Pharmacological characterization of GLPG1972/S201086, a potent and selective small-molecule inhibitor of ADAMTS5

OBJECTIVE

A disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) is a key enzyme in degradation of cartilage in osteoarthritis (OA). We report the pharmacological characterization of GLPG1972/S201086, a new, potent and selective small-molecule ADAMTS5 inhibitor.

METHODS

Potency and selectivity of GLPG1972/S201086 for ADAMTS5 were determined using fluorescently labeled peptide substrates. Inhibitory effects of GLPG1972/S201086 on interleukin-1α-stimulated glycosaminoglycan release in mouse femoral head cartilage explants and on interleukin-1β-stimulated release of an ADAMTS5-derived aggrecan neoepitope (quantified with ELISA) in human articular cartilage explants were determined. In the destabilization of the medial meniscus (DMM) mouse and menisectomized (MNX) rat models, effects of oral GLPG1972/S201086 on relevant OA histological and histomorphometric parameters were evaluated.

RESULTS

GLPG1972/S201086 inhibited human and rat ADAMTS5 (IC50 ± SD: 19 ± 2 nM and <23 ± 1 nM, respectively), with 8-fold selectivity over ADAMTS4, and 60->5,000-fold selectivity over other related proteases in humans. GLPG1972/S201086 dose-dependently inhibited cytokine-stimulated aggrenolysis in mouse and human cartilage explants (100% at 20 μM and 10 μM, respectively). In DMM mice, GLPG1972/S201086 (30-120 mg/kg b.i.d) vs vehicle reduced femorotibial cartilage proteoglycan loss (23-37%), cartilage structural damage (23-39%) and subchondral bone sclerosis (21-36%). In MNX rats, GLPG1972/S201086 (10-50 mg/kg b.i.d) vs vehicle reduced cartilage damage (OARSI score reduction, 6-23%), and decreased proteoglycan loss (∼27%) and subchondral bone sclerosis (77-110%).

CONCLUSIONS

GLPG1972/S201086 is a potent, selective and orally available ADAMTS5 inhibitor, demonstrating significant protective efficacy on both cartilage and subchondral bone in two relevant in vivo preclinical OA models.

Design and validation of a therapeutic EUS training program using a live animal model: Taking training to the next level

Background and Objectives:

EUS has evolved into a therapeutic modality for gastrointestinal disorders. Simulators, ex vivo models, and phantoms are the current teaching methods for therapeutic EUS (TEUS). We create and evaluate a high-fidelity simulated live animal model (HiFi SAM) for teaching endoscopists TEUS.

Materials and Methods:

Designing a curriculum that uses HiFi SAM and enables trainees to perform realistic procedures with expert mentors.

Results:

Twenty-seven trainees participated in a 3-day program with 6 h of theoretical and 14 h of hands using life HiFi SAM. Eighteen experts participated. Twenty-two (20–25) TEUS were defined for each HiFi SAM, and 616 were performed in all. Of 616/264 (43%) were evaluated with a mean of 88 per course (ranging between 80 and 95). Ninety-one percent (240/264) of the procedures were completed successfully. In 24, success was not achieved due to technical and/or model problems. Student rating of HiFi SAM was: 71% excellent rating (scale 8–10) and 95% excellent/good. The HiFi SAM procedure evaluation was (scale 1–5): fine-needle biopsy: 4.79, radiofrequency: 4.76, common bile duct and gallbladder drainage: 4.75, cystic drainages: 4.72, neurolysis: 4.55, microbiopsy: 4.50, and hepatogastric drainage: 4.04, with an overall satisfaction rate of 4.56 (91%). A short survey showed: 83% would recommend absolutely (17% most likely), 33% think that ITEC training was sufficient for their practice, and 66% would like additional training, especially more practice in specific techniques rather than more clinical case discussion. Regarding impact on their practice, 66% of the trainees started a new procedure and/or noted improvement in previous ones.

Conclusion:

HiFi SAM is a complex model; however, experts and trainees are satisfied with the training this new curriculum provided.

Discovery of GLPG1972/S201086, a Potent, Selective, and Orally Bioavailable ADAMTS-5 Inhibitor for the Treatment of Osteoarthritis

There are currently no approved disease-modifying osteoarthritis (OA) drugs (DMOADs). The aggrecanase ADAMTS-5 is key in the degradation of human aggrecan (AGC), a component of cartilage. Therefore, ADAMTS-5 is a promising target for the identification of DMOADs. We describe the discovery of GLPG1972/S201086, a potent and selective ADAMTS-5 inhibitor obtained by optimization of a promising hydantoin series following an HTS. Biochemical activity against rat and human ADAMTS-5 was assessed via a fluorescence-based assay. ADAMTS-5 inhibitory activity was confirmed with human aggrecan using an AGC ELISA. The most promising compounds were selected based on reduction of glycosaminoglycan release after interleukin-1 stimulation in mouse cartilage explants and led to the discovery of GLPG1972/S201086. The anticatabolic activity was confirmed in mouse cartilage explants (IC₅₀ < 1.5 μM). The cocrystal structure of GLPG1972/S201086 with human recombinant ADAMTS-5 is discussed. GLPG1972/S201086 has been investigated in a phase 2 clinical study in patients with knee OA (NCT03595618).

Particulate matter and airborne endotoxin concentration in calf barns and their association with lung consolidation, inflammation, and infection

Agricultural operations are important sources of organic dust containing particulate matter (PM) and endotoxins, which have possible negative health consequences for both humans and animals. Dust concentrations and composition in calf barns, as well as the potential health effects for these animals, are scarcely documented. The objective of this study was to measure PM fractions and endotoxin concentrations in calf barns and study their associations with lung consolidation, respiratory tract inflammation, and infection in group-housed calves. In this cross-sectional study, samples from 24 dairy farms and 23 beef farms were collected in Belgium from January to April 2017. PM_1.0, PM_2.5 and PM₁₀ (defined as particulate matter passing through a size-selective inlet with a 50% efficiency cut-off at a 1.0-μm, 2.5-μm, and 10-μm aerodynamic diameter, respectively) were sampled during a 24-h period using a Grimm aerosol spectrometer (Grimm Aerosol Technik Ainring GmbH & Co. KG). Endotoxin concentration was measured in the PM₁₀ fraction. Thoracic ultrasonography was performed and broncho-alveolar lavage fluid was collected for cytology and bacteriology. Average PM concentrations were 16.3 µg/m³ (standard deviation, SD: 17.1; range: 0.20-771), 25.0 µg/m³ (SD: 25.3; range: 0.50-144.9), and 70.3 µg/m³ (SD: 54.5; range: 1.6-251.2) for PM_1.0, PM_2.5, and PM₁₀, respectively. Mean endotoxin in the PM₁₀ fraction was 4.2 endotoxin units (EU)/µg (SD: 5.50; range: 0.03-30.3). Concentrations in air were 205.7 EU/m³ (SD: 197.5; range: 2.32-901.0). Lung consolidations with a depth of ≥1, ≥3, and ≥6 cm were present in 43.1% (146/339), 27.4% (93/339), and 15.3% (52/339) of the calves, respectively. Exposure to fine (PM_1.0) PM fractions was associated with increased odds of lung consolidations of ≥1 cm (odds ratio, OR: 3.3; confidence interval (CI): 1.5-7.1), ≥3 cm (OR: 2.8; CI: 1.2-7.1), and ≥6 cm (OR: 12.3; CI: 1.2-125.0). The odds of having lung consolidations of ≥1 cm (OR: 13.9; CI: 3.4-58.8) and ≥3 cm (OR: 6.7; 1.7-27.0) were higher when endotoxin concentrations in the dust mass exceeded 8.5 EU/µg. Broncho-alveolar lavage fluid neutrophil percentage was positively associated with PM₁₀ concentration, and epithelial cell percentage was negatively associated with this fraction. Concentration of PM_2.5 was positively associated with epithelial cell percentage and isolation of Pasteurella multocida. Although concentrations of fine dust are lower in calf barns than in poultry and pig housings, in this study they were associated with pneumonia in calves. Dust control strategies for reducing fine dust fractions in calf barns may benefit human and animal respiratory health.

Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?

Background and study aims  Pancreatic cancer represents the fourth most common cause of cancer-related deaths in Western countries and the need of a low-risk investigation to obtain an accurate histopathological diagnosis has become increasingly pressing. Endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) is the standard method for obtaining samples from pancreatic masses. In recent years, there has been an increasing need to obtain histological specimens during EUS procedures, rather than cytological ones, to guide oncological treatment options, leading to the so-call "FNB concept." Different needles have been developed for fine-needle biopsy (FNB) in recent years, enabling acquisition of larger specimens on which to perform histological and molecular analyses. The aim of this narrative review was to assess the role of EUS-guided FNA and FNB in patients with pancreatic masses, and to identify which needle and which acquisition technique should be used to improve tissue acquisition.

Discovery of 9-Cyclopropylethynyl-2-((S)-1-[1,4]dioxan-2-ylmethoxy)-6,7-dihydropyrimido[6,1-a]isoquinolin-4-one (GLPG1205), a Unique GPR84 Negative Allosteric Modulator Undergoing Evaluation in a Phase II Clinical Trial

GPR84 is a medium chain free fatty acid-binding G-protein-coupled receptor associated with inflammatory and fibrotic diseases. As the only reported antagonist of GPR84 (PBI-4050) that displays relatively low potency and selectivity, a clear need exists for an improved modulator. Structural optimization of GPR84 antagonist hit 1, identified through high-throughput screening, led to the identification of potent and selective GPR84 inhibitor GLPG1205 (36). Compared with the initial hit, 36 showed improved potency in a guanosine 5'-O-[γ-thio]triphosphate assay, exhibited metabolic stability, and lacked activity against phosphodiesterase-4. This novel pharmacological tool allowed investigation of the therapeutic potential of GPR84 inhibition. At once-daily doses of 3 and 10 mg/kg, GLPG1205 reduced disease activity index score and neutrophil infiltration in a mouse dextran sodium sulfate-induced chronic inflammatory bowel disease model, with efficacy similar to positive-control compound sulfasalazine. The drug discovery steps leading to GLPG1205 identification, currently under phase II clinical investigation, are described herein.

BSGIE survey on COVID-19 and gastrointestinal endoscopy in Belgium : results and recommendations

BACKGROUND AND AIMS

With the first wave of the COVID-19 pandemic declining, activities in the gastrointestinal clinic are being recommenced after a period of stringent measures. Since a second COVID-19 wave is not entirely ruled out health care professionals might remain faced with the need to perform endoscopic procedures in patients with a confirmed positive or unknown COVID-19 status. With this report we aim to provide a practical relevant overview of preparation and protective measures for gastroenterologists based on the currently available guidelines and our local experience and results of a national Belgian survey, to guarantee a fast recall of an adequate infection prevention if COVID-19 reoccurs.

METHODS

From the 23rd of March 2020 and the 13th of May 2020 we performed a Pubmed, Embase and Medline search, resulting in 37 papers on COVID-19 and endoscopy. Additionally, we combined these data with data acquired from the national BSGIE survey amongst Belgian gastroenterologists.

RESULTS

Based on 72 completed surveys in both university and non-university hospitals, the results show (1) a dramatic (<20%) or substantial (<50%) decrease of normal daily endoscopy in 74% and 22% of the units respectively, (2) a difference in screening and protective measures between university and non-university hospitals. These findings were subsequently compared with the current guidelines.

CONCLUSION

Based on new data from the BSGIE survey and current guidelines we tried to realistically represent the current COVID-19 trends in protective measures, screening and indications for endoscopy and to provide a practical overview as preparation for a possible second wave.

Pathogen-specific risk factors in acute outbreaks of respiratory disease in calves

Respiratory tract infections (bovine respiratory disease) are a major concern in calf rearing. The objective of this study was to identify pathogen-specific risk factors associated with epidemic respiratory disease in calves. A cross-sectional study was conducted, involving 128 outbreaks (29 dairy, 58 dairy-mixed, and 41 beef) in Belgium (2016–2018). A semiquantitative PCR for 7 respiratory pathogens was done on a pooled nonendoscopic bronchoalveolar lavage sample for each herd. Potential risk factors were collected by questionnaire and derived from the national cattle registration databank. Most outbreaks occurred between October and March, and single and multiple viral infections were detected in 58.6% (75/128) and 13.3% (17/128), respectively. Bovine coronavirus (BCV) was the most frequently isolated virus (38.4%), followed by bovine respiratory syncytial virus (bRSV; 29.4%) and parainfluenzavirus type 3 (PI-3; 8.1%). Mycoplasma bovis, Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni were detected in 33.3, 41.2, 89.1, and 36.4% of the herds, respectively. Specific risk factors for BCV detection were detection of M. haemolytica [odds ratio (OR) = 2.8 (95% confidence interval = 1.1–7.5)], increasing herd size [OR = 1.3 (1.0–1.8) for each increase with 100 animals] and detection of BCV by antigen ELISA on feces in calves in the last year [OR = 3.6 (1.2–11.1)]. A seasonal effect was shown for bRSV only {more in winter compared with autumn [OR = 10.3 (2.8–37.5)]}. Other factors associated with bRSV were PI-3 detection [OR = 13.4 (2.1–86.0)], prevalence of calves with respiratory disease [OR = 1.02 (1.00–1.04) per 1% increase], and number of days with respiratory signs before sampling [OR = 0.99 (0.98–0.99) per day increase]. Next to its association with BCV, M. haemolytica was more frequently detected in herds with 5 to 10 animals per pen [OR = 8.0 (1.4–46.9)] compared with <5 animals, and in herds with sawdust as bedding [OR = 18.3 (1.8–191.6)]. Also, for H. somni, housing on sawdust was a risk factor [OR = 5.2 (1.2–23.0)]. Purchase of cattle [OR = 2.9 (1.0–8.0)] and housing of recently purchased animals in the same airspace [OR = 5.0 (1.5–16.5)] were risk factors for M. bovis. This study identified pathogen-specific risk factors that might be useful for the development of customized control and prevention and for the design of decision support tools to justify antimicrobial use by predicting the most likely pathogen before sampling results are available.

Short communication: Herd-level analysis of antimicrobial use and mortality in veal calves: Do herds with low usage face higher mortality?

The veal calf sector fears that a too-rapid and large decrease in antimicrobial use (AMU) as demanded by European authorities would increase mortality, causing economic and welfare issues. To determine whether this concern is justified, the relationship between AMU (total and different classes) and mortality in dairy-type white veal calves, managed by 2 large veal companies, was explored. A retrospective cohort study was performed on electronically collected antimicrobial consumption and mortality data from the largest Belgian veal practice during the period 2014 to 2016. Mixed linear [mortality (%) as continuous outcome] and generalized linear mixed models with binary outcome for event and trial approach were built to identify factors associated with mortality. Data consisted of 76 production cycles from 29 farms managed by 2 veal companies (1 and 2) and covering 45,001 calves. Average AMU was 30.1 ± 10.4 defined daily doses for animals per year (± standard deviation) and was higher in veal company 2 than in veal company 1 (35.9 ± 9.3 and 22.4 ± 5.7 defined daily doses for animals per year, respectively). In contrast, mean mortality was lower in veal company 2 (2.3 ± 1.4%) than in veal company 1 (4.1 ± 1.4%). Both models showed a positive association between AMU and mortality in veal company 1 and no association in veal company 2. The final linear model identified increasing herd size and the use of third- or fourth-generation cephalosporins as risk factors for mortality and the use of long-acting macrolides as a protective factor. The final logistic model identified an increased mortality risk with increased use of third- or fourth-generation cephalosporins and sulfonamides-trimethoprim and decreased mortality when using long-acting macrolides. Based on these data, at the current levels of AMU in Belgian veal calves, an increase in mortality when reducing AMU could not be evidenced. Differences in herd size and factors other than AMU likely better explain why one veal company faces almost double the mortality of another one. Abandoning the use of long-acting macrolides might have negative consequences for mortality under the current state of the industry. The most ethical way to further reduce AMU in veal calves is likely simultaneously monitoring AMU and animal welfare parameters, starting with, but not limited to, mortality.

Atrial and ventricular electrical and contractile remodelling and reverse remodelling due to chronic pacing-induced atrial fibrillation in horses: preliminary results

In humans, electrical and contractile reverse remodelling following restoration of sinus rhythm (SR) after a prolonged period of spontaneous atrial fibrillation (AF), requires several weeks. There is little known about this phenomenon in horses. In the present study, six healthy horses were instrumented with a neurostimulator and a pacemaker to maintain AF for four months by intermittent burst pacing and to study atrial and ventricular electrophysiology. AF became persistent in all horses after two to six weeks of burst pacing. Before, during and after the AF period, parameters, such as the atrial fibrillation cycle length, the right atrial and ventricular refractory period and vulnerability, such as inducing atrial arrythmias, atrial tachyarrythmias or maintaining AF, were determined. Two-dimensional echocardiography was used to measure atrial and ventricular contractility expressed as fractional shortening and size expressed as diameter and area. In two of the six horses, the procedure was discontinued due to an increased threshold (1 horse) and due to infection at the level of the pacemaker pocket (1 horse). In the four remaining horses, significant electrical and contractile remodelling compared to baseline values was observed from 48 hours onwards after AF induction. Upon restoration of SR with quindine sulfate, all electrical and contractile values returned to normal within one to two months. No ventricular remodelling was observed. Four months of pacing-induced AF resulted in electrical and contractile remodelling and reverse remodelling. The results suggest that pacing-induced chronic AF does not cause permanent damage and suggest that a resting period of six to eight weeks before returning to training might be beneficial.

Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training.Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD trainingESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small ( < 30 mm), located in the antrum or in the rectum for the first 20 procedures. Beginning human practice in the colon is not recommended. ESGE recommends that at least the first 10 human ESD procedures should be done under the supervision of an ESD-proficient endoscopist.Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection ("curative"), local risk resection, and high risk resection ("non-curative"), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.

Retrospectief onderzoek naar de activiteiten van de Vlaamse gezelschapsdierenpracticus met het oog op aanpassing van het curriculum diergeneeskunde

De literatuur over de activiteiten van de gezelschapsdierenpracticus in Vlaanderen is vrij beperkt. Het doel van dit onderzoek was informatie te verwerven over de samenstelling van de gemiddelde praktijk, de meest uitgevoerde handelingen en het belang van de verschillende klinische disciplines. Er werd hiervoor gebruik gemaakt van logboeken, i. e. documenten geschreven door studenten diergeneeskunde tijdens hun stages. De hond was de meest aangeboden diersoort. De belangrijkste disciplines waren dermatologie, gastro-enterologie, wondzorg, algemene ziekte en orthopedie. De meest frequent uitgevoerde chirurgische ingrepen waren castratie en sterilisatie.Bovendien mag het aandeel preventieve diergeneeskunde niet onderschat worden: tijdens 28% van alle consultaties werd gevaccineerd. Deze informatie kan gebruikt worden om het curriculum van de studenten diergeneeskunde aan te passen zodat deze beter voorbereid worden op het werken in de praktijk.

Diagnostische parameters voor klinische wintercyathostominose bij paarden

Wintercyathostominose is een van de belangrijkste parasitaire aandoeningen bij het grazende paard. Deze studie werd opgezet om de meest significante parameters te identificeren die geassocieerd zijn met klinische wintercyathostominose. Het betreft een retrospectief onderzoek van 307 paarden die tussen 2008 en 2018 aangeboden werden op de Faculteit Diergeneeskunde van de Universiteit Gent. Paarden ouder dan drie maanden die op de faculteit een mestonderzoek ondergingen en diarree hadden, werden opgenomen in de studie. De diagnose van larvale cyathostominose werd gesteld op basis van een positief mestonderzoek, i.e. het aantonen van L4- larven in de feces. De gegevens van paarden met larvale cyathostominose zonder diarree werden niet in de studie opgenomen. Klinische, biochemische, hematologische en parasitaire parameters werden onderzocht. Na statistische analyse van deze retrospectieve gegevens kwam albumine als meest significante parameter naar voor. Een serum-albuminegehalte dat lager was dan 20 g/L, had een hoge gevoeligheid voor het voorspellen van een positief mestonderzoek. De combinatie van het serum-albuminegehalte, het geslacht, de lichaamstemperatuur, het neutrofielenpercentage en het seizoen was volgens het finale statistische model de beste combinatie om de aanwezigheid van wintercyathostominose te voorspellen. Aan de hand van de diagnostische accuraatheid van het finale model werd aangetoond dat hiermee echter geen sluitende diagnose van larvale cyathostominose kan gesteld worden en dat een mestonderzoek nog steeds noodzakelijk is om het vermoeden van larvale cyathostominose te bevestigen.

Equine metabool syndroom

Het equine metabool syndroom wordt omschreven als een verzameling van risicofactoren voor het ontstaan van endocrinologisch veroorzaakte hoefbevangenheid. Een verstoring van de insulineregulatie ligt aan de basis van het probleem. Voeding, voedingstoestand en genetische factoren zijn belangrijke risicofactoren voor het ontstaan van deze verstoorde insulineregulatie. Er is een groot aantal diagnostische methoden beschreven, elk met hun voor- en nadelen. Behandeling en management van paarden en pony’s met het equine metabool syndroom bestaan vooral in het aanpakken van een aantal risicofactoren, waarbij diëtaire maatregelen de belangrijkste rol spelen.

Risk factors for antimicrobial use in veal calves and the association with mortality

The intensive use of antimicrobials in the veal industry is heavily criticized, but drivers for antimicrobial usage (AMU) are still poorly understood. The industry fears that a drastic reduction in AMU would increase mortality, creating an unacceptable welfare issue. The objectives of the present study were to identify risk factors for AMU and to explore the relationship between AMU and mortality. A retrospective cohort study was performed on the antimicrobial registration data from the largest Belgian veterinary veal practice. The data set contained 295 production cycles from 78 farms, representing 146,014 calves and 8 veal companies (also called integrations). The average AMU was 32.3 defined daily dose animal per year (standard deviation: 11.04), of which 76.2% was administered orally and 23.8% parentally. The AMU remained stable between 2014 and 2016 with only a slight, but significant increase in total AMU between 2015 (31.0 defined daily dose animal per year, standard deviation: 10.5) and 2016 (35.1, 10.8). Use of almost all antimicrobial classes decreased over 2014 to 2016; however, use of long-acting macrolides, doxycycline, and aminosides increased significantly. Analysis identified breed (higher use in beef calves compared with dairy and crossbreeds), month of arrival (lower use when arrived in April or May compared with winter months), and veal company as risk factors. The veal company not only significantly affected total AMU, but also affected the majority of the antimicrobial classes. Additionally, breed differences were present for oxytetracycline, colistin, and classic macrolides, and a month effect was present for doxycycline only. These data illustrate that this veterinary practice realized a reduction of 46% in total AMU and of 96% in critically important antibiotics (fluoroquinolones, cephalosporins of the third and fourth generation) compared with the Belgian benchmark from 2007 to 2009. Replacement of critically important drugs by an increased use of long-acting macrolides is worrisome. Mortality risk was very low compared with benchmarks referenced internationally and did not increase with decreasing AMU. Use of trimethoprim-sulfonamides was a risk factor, whereas use of oxytetracycline was a protective factor for mortality. The absence of a relationship with mortality at the current levels of AMU suggests that a further rational reduction is possible. Attention should be paid to consider different AMU benchmarks for different breeds and to include the veal company as a target for antibiotic awareness campaigns.

The risk of flax versus straw bedding on ileal impaction in colic horses: Retrospective analysis of 2336 cases (2008-2017)

While mature coastal bermudagrass hay is strongly associated with ileal impaction in the Southeastern United States, stabling on flax bedding has anecdotally been associated with this condition in Europe. The aim of this retrospective study was to investigate the association between ileal impaction and the use of flax shives compared to straw as bedding in horses with colic. Medical records of 2336 referral cases evaluated for abdominal pain between January 2008 and May 2017 at the Department of Large Animal Internal Medicine, Ghent University were reviewed. Diagnosis, date of admission, age, breed, gender, body weight and stable bedding were recorded. Conditional logistic regression analysis was used to assess the association between ileal impaction and each individual variable. Odds ratios (OR) and 95% confidence intervals (CI) were determined. Predictors with a value of P < 0.2 were included in a multivariable Cox regression model and Wald’s test was used to assess parameter estimate significance. Further, the association between survival to discharge and type of bedding or type of treatment (medical versus surgical) was analyzed for horses with ileal impactions. The proportion of colic cases stabled on flax bedding at home was 11.3%. The overall prevalence of ileal impaction was 4.2%. In the flax group, the prevalence of ileal impaction was 9.4% as opposed to 3.6% within the straw group. The OR of 2.8 (95% CI 1.7-4.7; P < 0.001) in the multivariable logistic regression model indicated that horses stabled on flax shives were approximately three times more likely to have ileal impactions than horses stabled on straw. There was no significant association found between ileal impaction and the period of admission, age, gender or body weight in a multivariable logistic regression model. The odds for having ileal impaction is approximately six times (OR 6.3; 95% CI 2.4-16.4; P < 0.001) higher in draft horses than in warmbloods in the multivariable logistic regression model. No significant association was found between survival to discharge and type of bedding or treatment. These results suggest that horses with colic that were housed on flax bedding are more likely to present ileal impactions than horses housed on straw.

Can heart rate variability parameters derived by a heart rate monitor differentiate between atrial fibrillation and sinus rhythm?

BACKGROUND

Heart rate variability (HRV) parameters, and especially RMSSD (root mean squared successive differences in RR interval), could distinguish atrial fibrillation (AF) from sinus rhythm(SR) in horses, as was demonstrated in a previous study. If heart rate monitors (HRM) automatically calculating RMSSD could also distinguish AF from SR, they would be useful for the monitoring of AF recurrence. The objective of the study was to assess whether RMSSD values obtained from a HRM can differentiate AF from SR in horses. Furthermore, the impact of artifact correction algorithms, integrated in the analyses software for HRV analyses was evaluated. Fourteen horses presented for AF treatment were simultaneously equipped with a HRM and an electrocardiogram (ECG). A two-minute recording at rest, walk and trot, before and after cardioversion, was obtained. RR intervals used were those determined automatically by the HRM and by the equine ECG analysis software, and those obtained after manual correction of QRS detection within the ECG software. RMSSD was calculated by the HRM software and by dedicated HRV software, using six different artifact filters. Statistical analysis was performed using the Wilcoxon signed-rank test and receiver operating curves.

RESULTS

The HRM, which applies a low level filter, produced high area under the curve (AUC) (> 0.9) and cut off values with high sensitivity and specificity. Similar results were obtained for the ECG, when low level artifact filtering was applied. When no artifact correction was used during trotting, an important decrease in AUC (0.75) occurred.

CONCLUSION

In horses treated for AF, HRMs with automatic RMSSD calculations distinguish between AF and SR. Such devices might be a useful aid to monitor for AF recurrence in horses.

Risk factors for antimicrobial use in food-producing animals: disease prevention and socio-economic factors as the main drivers?

The European Union requests an urgent decrease in antimicrobial use (AMU) in food producinganimals to reduce antimicrobial resistance in animals and humans and safeguard the efficacy of antimicrobials for future generations. The identification of risk factors (RFs) for AMU is essential to obtain a rapid reduction. The aim of this review was to summarize the current knowledge of RFs for AMU in veal calves, pigs and poultry. Thirty-three observational studies were included. Well-identified RFs for an increased AMU are frequent purchase of animals, herd size (large or small depending on the animal species), and a lack of selected biosecurity measures. Also in beef breed calves, more antimicrobials are used than in Holstein calves. AMU is influenced by the farmer, the veterinarian and by the integration. In general, socio-economic RFs are largely unexplored. The causal factors for AMU are multiple and complex, with possible confounding factors and unidentified interactions. Additional knowledge of socio-economic drivers appears particularly urgent to create tailor-made guidelines and awareness campaigns for each sector.

Paratuberculosis in dairy and pygmy goats: an underestimated problem?

Paratuberculosis is a chronic intestinal disease affecting goats and other ruminants worldwide. The objective of this review was to summarize current knowledge on the prevalence, diagnostic possibilities and possible prevention and control measures for paratuberculosis in dairy and pygmy goats in Europe. The herd level prevalence of Mycobacterium avium subspecies paratuberculosis (MAP) in dairy goat farms is very high, namely 71%, 63% and 86% in Germany, France and the Netherlands, respectively. The prevalence in pygmy goats is undocumented. Antibody ELISA, fecal culture and PCR testing are readily available for diagnosis. A highly suggestive finding for paratuberculosis is the presence of enlarged intestinal lymph nodes on abdominal ultrasonography. To control the disease a combination of ‘test and cull’ and environmental hygienic measures are recommended. In contrast to cattle, vaccination is available and might be an additional tool in the control program for goats. Vaccine antibodies are no longer detectable after one year, and therefore serological monitoring can be continued on vaccinating herds. The worrisome prevalence data from neighboring countries indicate the need for a prevalence study on dairy goat farms in Belgium.

Rational antimicrobial therapy for sepsis in cattle in face of the new legislation on critically important antimicrobials

Sepsis is a life-threatening condition in cattle, as in humans. Successful sepsis treatment requires a fast initiation of antimicrobial therapy with a broad-spectrum, bactericidal drug, administered intravenously. However, the new legislation limits the use of critically important fluoroquinolones and cephalosporins in food animal medicine, drugs which are considered highly effective for sepsis treatment and were previously frequently used for this indication. This article aims at providing an overview of the current knowledge of sepsis in cattle to aid practitioners in adapting their decision making process to treat sepsis. Sepsis incidence in cattle is likely seriously underestimated. This disease is almost unexplored in cattle, which makes it particularly difficult to design species specific guidelines. Sepsis diagnosis by blood culture reaches sufficient accuracy with the current laboratory technology. When adapting this procedure to a field environment, difficulties might arise, and the availability of adapted incubators in veterinary laboratories may be limited. However, these difficulties are likely to be overcome. Severe sepsis and septic shock are likely the only indications where the ‘urgency’ criterion of the new legislation would apply, but it is important to realize that alternative antimicrobial treatments with possibly similar efficacy are available.

Short communication: Effect of freezer storage time and thawing method on the recovery of Mycoplasma bovis from bovine colostrum

Mycoplasma bovis is an important cause of mastitis in dairy cattle, and pneumonia, arthritis, and otitis in calves. Milk and colostrum are considered important sources of infection for calves. knowledge on the effect of on-farm freezing (-18°C) and thawing methods on the recovery of M. bovis from colostrum samples is missing. In this study, 2 separate experiments were performed. The first experiment consisted of a longitudinal study examining the survival [as measured by log(10) reduction] of 2 M. bovis strains in frozen colostrum over 14 wk. The second experiment examined the effect of different thawing temperatures (45 and 20°C), thawing frequencies (once or twice), and initial colostrum titer (10⁴ or 10⁶ cfu/mL) on M. bovis survival. A single freeze-thaw cycle led to an approximate 1 log reduction of M. bovis titer, independent of the thawing temperature. Freezing for 14 wk did not significantly further reduce the titer of bacteria compared with freezing for 2 wk. A second freeze-thaw cycle further reduced the M. bovis count by approximately 0.5 log compared with a single freeze-thaw cycle. Thawing temperature and initial bacterial concentration did not significantly affect M. bovis reduction. In conclusion, storage of colostrum samples in the freezer at -18°C during epidemiological studies, herd monitoring, or test and cull programs will probably have little influence on qualitative bacteriological test results for M. bovis. The epidemiological or clinical relevance of an approximate 1 log reduction of M. bovis in colostrum is currently unclear.

Analyse van de arbeidssituatie en perceptie van de kwaliteit van de opleiding van dierenartsen afgestudeerd aan de Faculteit Diergeneeskunde van de Universiteit Gent

In een enquête werd gepeild naar de arbeidssituatie van dierenartsen afgestudeerd aan de Universiteit Gent en de perceptie van de kwaliteit van de opleiding. Hiervoor werden drie cohorten dierenartsen gecontacteerd die afgestudeerd zijn gedurende drie tijdsintervallen, met name tussen 2002 en 2004, 2009 en 2011 en tussen 2014 en 2016. Uit 488 ingevulde vragenlijsten (47% van de gecontacteerde respondenten) werd onder andere duidelijk dat dierenartsen in Vlaanderen gemiddeld 47 uur per week werken en relatief tevreden zijn over de invulling van hun job. Tachtig procent (meest recent afgestudeerde cohorte) en 68% (langst afgestudeerde cohorte) van de respondenten werkt als practicus en 81% van deze practici werkt in een groepspraktijk. Dierenartsen met de Belgische nationaliteit hebben voornamelijk het statuut van zelfstandige, terwijl dierenartsen met de Nederlandse nationaliteit voornamelijk in loondienst werken. De respondenten geven aan tevreden te zijn over het theoretische aandeel binnen de opleiding diergeneeskunde maar ervaren het praktisch onderricht als te beperkt. Tijdens de opleiding zou er volgens de respondenten meer nadruk gelegd moeten worden op eerstelijnsdiergeneeskunde, op het verwerven van communicatievaardigheden met klanten en collega’s en op praktijkmanagement.

Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017

For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

A Deep Nasopharyngeal Swab Versus Nonendoscopic Bronchoalveolar Lavage for Isolation of Bacterial Pathogens from Preweaned Calves With Respiratory Disease

Background

Nonendoscopic bronchoalveolar lavage (BAL) is a practical alternative for a deep nasopharyngeal swab (DNS) to sample the airways of a large number of calves in a short period of time. The extent of commensal overgrowth and agreement of BAL with DNS culture results in preweaned calves are unknown.

Objectives

To compare commensal overgrowth and bacterial culture results between DNS and BAL samples.

Animals

A total of 183 preweaned calves (144 with bovine respiratory disease and 39 healthy animals).

Methods

Cross‐sectional study. Deep nasopharyngeal swab and BAL samples were taken from each calf and cultured to detect Pasteurellaceae and Mycoplasma bovis. Agreement and associations between culture results of DNS and BAL samples were determined by kappa statistics and logistic regression.

Results

Bronchoalveolar lavage samples were less often polymicrobial, more frequently negative and yielded more pure cultures compared to DNS, leading to a clinically interpretable culture result in 79.2% of the cases compared to only in 31.2% of the DNS samples. Isolation rates were lower in healthy animals, but not different between DNS and BAL samples. Only Histophilus somni was more likely to be isolated from BAL samples. In clinical cases, a polymicrobial DNS culture result did not increase the probability of a polymicrobial BAL result by ≥30%, nor did it influence the probability of a negative culture. A significant herd effect was noted for all observed relationships.

Conclusions and Clinical Relevance

Nonendoscopic BAL samples are far less overgrown by bacteria compared to DNS samples under the conditions of this study, facilitating clinical interpretation and resulting in a higher return on investment in bacteriologic culturing.

Technological review on endoscopic submucosal dissection: available equipment, recent developments and emerging techniques

Endoscopic submucosal dissection (ESD) is widely practiced in Japan and the Eastern World and is rapidly expanding in western countries for the management of early malignancies of the upper and lower gastrointestinal tube. In addition, novel therapeutic applications deriving from ESD have emerged including the treatment of achalasia, of submucosal tumors, of diverticula, of strictures and of reflux disease. An ESD procedure necessitates not only skills and specific training, but also familiarization with a vast spectrum of devices (endoscopes, high-frequency generators and their settings, endoknives, hoods, irrigation devices) and techniques (such as countertraction, artificial ulcer closure), that render the procedure faster, more efficient and safer. This technological article gives an overview on current and novel equipment for an ESD and associated techniques.

Nosocomial Intravascular Catheter Infections with Extended-spectrum Beta-lactamase-producing Escherichia coli in Calves after Strain Introduction from a Commercial Herd

An outbreak of intravascular catheter-related infections by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in calves in an animal teaching hospital is reported. Pulsed-field gel electrophoresis was used for strain typing to determine the origin and dissemination of these strains. All 19 strains harboured the blaCTX-M-14, and six strains also overexpressed their chromosomal AmpC gene. Evidence on the introduction of the strain from a beef herd, experiencing neonatal diarrhoea and increased mortality, to the clinic through admission of diarrhoeic calves was provided. Strains isolated from phlebitis cases from other herds up to 5 months later showed a high similarity with the initial strain, suggesting that the strain had become nosocomial. The catheter infections with ESBL/AmpC-producing E. coli resulted in a prolonged hospitalization, increased anti-microbial use and mortality. This report points towards the potential dangers of the emergence of ESBL/AmpC-producing bacteria in susceptible food animals and warns farmers and veterinarians for the facility by which they are introduced into another environment.

Solid feed provision reduces fecal clostridial excretion in veal calves

Enterotoxemia is characterized by a highly fatal hemorrhagic enteritis in cattle, caused by Clostridium perfringens. Production systems with intensive feeding, such as the veal industry, are predisposed. The primary objective of this study was to determine the effect of solid feed provision on fecal C. perfringens excretion in veal calves. Ten Holstein Friesian bull veal calves were randomly assigned to one of two test diets. Group 1 received solemnly milk replacer twice daily, while group 2 received milk replacer and a maximum of 300g solid feed/day, consisting of a mixture of 30% barley, 30% corn, 30% hulled wheat and 10% chopped straw. The number of C. perfringens per g feces or fecal clostridial counts (FCC) were determined for all calves. Mean FCC were significantly lower in the calves fed milk replacer and solid feed, than in the calves fed solemnly milk replacer. Although the correlation between FCC and enterotoxemia risk remains to be determined, the provision of solid feed to veal calves reduced clostridial excretion, which might contribute to the prevention of this disease.

Vraag & Antwoord

Anesthetica voor ovariëctomie bij de kat Afwezigheid van keurders vóór het slachten Ribfracturen bij koeien

A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis

BACKGROUND

Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment.

METHODS

Patient's characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire.

RESULTS

From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication.

CONCLUSION

European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.

Non-toxic perfringolysin O and α-toxin derivatives as potential vaccine candidates against bovine necrohaemorrhagic enteritis

Bovine necrohaemorrhagic enteritis is a fatal Clostridium perfringens type A-induced disease that is characterised by sudden death. Recently the involvement of perfringolysin O and α-toxin in the development of necrohaemorrhagic lesions in the gut of calves was suggested, and thus derivatives of these toxins are potentially suitable as vaccine antigens. In the current study, the perfringolysin O derivative PFO^L491D, alone or in combination with α-toxin derivative GST-cpa_247-370, was evaluated as possible vaccine candidate, using in vitro assays. PFO^L491D showed no haemolytic effect on horse red blood cells and no cytotoxic effect on bovine endothelial cells. Furthermore, calves immunised with PFO^L491D raised antibodies against perfringolysin O that could inhibit the perfringolysin O-associated haemolytic activity on horse red blood cells. Antisera from calves immunised with PFO^L491D had a significantly higher neutralising capacity against the cytotoxic effect of C. perfringens culture supernatant to bovine endothelial cells than serum from control calves (P <0.05). Immunisation of calves with PFO^L491D in combination with GST-cpa_247-370 elicited antibodies against perfringolysin O and α-toxin and consequently inhibited both the perfringolysin O-associated haemolytic activity and the α-toxin-associated lecithinase activity in vitro. Additionally, the neutralising ability of these antisera on the cytotoxic effect of C. perfringens culture supernatant to bovine endothelial cells was significantly higher than that from calves immunised with PFO^L491D (P <0.001). In conclusion, perfringolysin O derivative PFO^L491D is an immunogenic antigen that can potentially be used to produce vaccine against bovine necrohaemorrhagic enteritis. Including α-toxin derivative GST-cpa_247-370 has an additional protective effect and therefore vaccination of calves with a combination of both antigens seems even more promising.

Multicentric B-cell lymphoma in a pygmy goat

A six-year-old, male pygmy goat was referred with a sudden onset of peripheral lymphadenopathy, which initially started as enlarged inguinal lymph nodes. Clinical examination showed swollen retropharyngeal, prescapular and inguinal lymph nodes. Serologic testing for bovine leukemia, caprine arthritis-encephalitis virus and caseous lymphadenitis was negative. Fine needle aspirates of the prescapular lymph nodes were taken and revealed multiple, large lymphoblastic cells on cytology. Because of the poor prognosis and clinical deterioration, the animal was euthanized. Full necropsy was performed and showed generalized lymphadenopathy. Further histological and immunohistochemical investigation of the lymph nodes characterized this neoplasia as a multicentric large B-cell lymphoma.

Prevalence of respiratory pathogens in nasal swabs from horses with acute respiratory disease in Belgium

Contagious respiratory infections are an important cause of respiratory disease in horses, resulting in impaired pulmonary function, poor performance and sometimes severe illness. Although bacterial infections are often suspected to be involved, viruses are frequently overlooked and are an underestimated cause of respiratory disease outbreaks in horses. In this study, nasal swabs of 103 horses with acute symptoms of respiratory disease were analyzed for the presence of 13 different respiratory pathogens. Gamma herpesviruses were the most commonly detected, with 60% of the samples being positive, followed by streptococcus equi subsp. zooepidemicus infection (30%). Rhinovirus B, streptococcus equi subsp. equi, adenovirus 1 and EHV-4 were more rarely detected. Further research is necessary to correctly interpret the importance of gamma herpesviruses in horses, for example by screening a healthy control population. National surveillance of respiratory viruses in horses by PCR analysis on nasal swabs might be a useful, earlywarning system for viral epidemics.

Orale ivermectine-intoxicatie op een vleeskalverbedrijf

In deze casus wordt een vermoedelijk kwaadwillige, orale ivermectine-intoxicatie op een Vlaams vleeskalverbedrijf besproken. Alle 330 kalveren van twee tot vier weken oud werden in de eerste week na aankomst op het bedrijf getroffen. De symptomen waren ernstige depressie, het neerliggen in laterale of sternale positie, tremor en kopschudden. Uiteindelijk stierf 13,6% van de kalveren. De overige dieren herstelden gradueel met ondersteunende orale rehydratatietherapie over een termijn van vijf tot zeven dagen. In de kunstmelk kon een ivermectinegehalte van 35 mg/kg aangetoond worden. In het serum van drie kalveren werden ivermectinegehaltes van 0,75 mg/kg tot 1,1 mg/kg gevonden. De vermoedelijk toegediende dosering was 1,75 mg/kg lichaamsgewicht voor een gemiddeld kalf (40 kg). In deze casus wordt aangetoond dat orale toxiciteitsverschijnselen van ivermectine bij kalveren van twee tot vier weken oud kunnen optreden aan een dosis die 8,75 keer hoger is dan de geregistreerde therapeutische dosis voor subcutane toediening bij rundvee.

Health risks associated with the use of automatic milk feeders in calves

The objective of the present article was to summarize available evidence of the economic benefits and health risks associated with the use of automatic milk feeders (AMFs) in calves. Although AMFs are increasingly used in cattle production, clear evidence of their economic benefits (increased average daily gain, gradual weaning and reduced labor time) for the typical Belgian farm size and management is not available. Especially in smaller farms, where labor time is not a limiting factor, a careful economic consideration should be made. Regarding the association of AMFs with calf disease, studies have only been performed for bovine respiratory disease and confirmed an increased risk. However, since the use of AMFs is strongly related with several other risk factors (group housing at young age, large groups, age difference in a group, continuous system versus all-in/all-out), it is difficult to unequivocally identify the risk associated with AMFs alone. A group size of less than ten calves on a single drinking point, an all-in/allout grouping system and a minimum age at introduction to the automat of three weeks are recommended for farms with AMFs. To the authors’ knowledge, no scientific evidence supporting the presumed association of diarrhea and tongue ulcers with AMFs is available to date.

Gastro-intestinale Clostridium perfringens-infecties: een blijvend gevaar in de Belgische rundveehouderij

De intensivering van de moderne landbouw wordt geassocieerd met een toename van Clostridium perfringens-gerelateerde, gastro-intestinale problemen bij intensief gevoede runderen, zoals “hemorrhagic bowel disease” bij hoogproductief melkvee en enterotoxemie bij kalveren. Waar de pathogenese van hemorrhagic bowel disease nog grotendeels ongekend is, werden er de laatste jaren nieuwe inzichten in de pathogenese van enterotoxemie bekomen die een belangrijke repercussie op de aanpak van deze ziekte onder praktijkomstandigheden hebben. Ook andere clostridiumgeassocieerde maagdarminfecties, zoals “overeating disease” en neonatale clostridiose, worden regelmatig gediagnosticeerd. Overvoedering met structuurarme, eiwitrijke voeders is een overkoepelende risicofactor bij zowel HBD, enterotoxemie als overeating disease. Een goed uitgebalanceerd dieet dat zo stabiel mogelijk gehouden wordt, is dan ook het belangrijkste aandachtspunt op bedrijven die problemen hebben met clostridiose. Daarnaast dient bij jonge kalveren voldoende aandacht gegeven te worden aan een correcte en hygiënische biestverstrekking om problemen met neonatale clostridiose te vermijden.

A new predilection site of Mycoplasma bovis: Postsurgical seromas in beef cattle

Mycoplasma bovis is a highly contagious bacterium, which predominantly causes chronic pneumonia, otitis and arthritis in calves and mastitis in adult cattle. In humans, Mycoplasma species have been associated with post-surgical infections. The present study aimed to identify the bacteria associated with three outbreaks of infected seromas after caesarian section in Belgian Blue beef cattle. A total of 10 cases occurred in three herds which were in close proximity of each other and shared the same veterinary practice. M. bovis could be cultured from seroma fluid in five of the six referred animals, mostly in pure culture and was isolated from multiple chronic sites of infection (arthritis and mastitis) as well. DNA fingerprinting of the isolates targeting two insertion sequence elements suggested spread of M. bovis from chronic sites of infection (udder and joints) to the postsurgical seromas. Identical genetic profiles were demonstrated in two animals from two separate farms, suggesting spread between farms. Mortality rate in the referred animals positive for M. bovis in a seroma was 80% (4/5), despite intensive treatment. A massive increase in antimicrobial use was observed in every affected farm. These observations demonstrate involvement of mycoplasmas in outbreaks of postsurgical seromas in cattle.

Total plasma proANP increases with atrial dilatation in horses

Equine atrial natriuretic peptide (ANP) plasma concentrations are correlated with left atrial size. However, species-specific assays are lacking and the results from human assays are poorly reproducible. A new methodology called processing independent analysis (PIA) that measures the total proANP product in plasma has proven to be successful in human medicine, but has never been used in horses. The aims were to establish an equine proANP reference interval by measurement of the total proANP product using PIA and to examine the proANP concentrations in horses with atrial dilatation. Sample stability was studied by comparison of storage at -80°C and -20°C. Plasma samples were obtained from 23 healthy horses, 12 horses with moderate or severe valvular regurgitation without atrial dilatation and 42 horses with valvular regurgitation and atrial dilatation. The proANP concentration was significantly (P<0.001) higher in horses with atrial dilatation (761.4 (442.1-1859.1) pmol/l) than in healthy horses (491.6 (429.5-765.9) pmol/l; P<0.001) or horses with cardiac disease but without atrial dilatation (544.4 (457.0-677.6) pmol/l). A cut-off value (573.8 pmol/l) for detection of atrial dilatation was calculated. Sample storage at -80°C did not differ from sample storage at -20°C. The measurement of total proANP in plasma detects atrial dilatation in horses and may be useful for clinical evaluation in equine medicine.