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Samuels AN, Kamr AM, Reed SM, Slovis NM, Hostnik LD, Burns TA, Toribio RE. Association of the neutrophil-lymphocyte ratio with outcome in sick hospitalized neonatal foals. J Vet Intern Med 2024; 38:1196-1206. [PMID: 38284437 PMCID: PMC10937482 DOI: 10.1111/jvim.16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) in human medicine is an objective biomarker that reflects prognosis. The NLR as an independent biomarker to help predict nonsurvival in hospitalized neonatal foals has not been thoroughly interrogated. OBJECTIVES/HYPOTHESIS Retrospectively evaluate if the NLR at admission is associated with nonsurvival in sick hospitalized foals <4 days old. We hypothesized that a lower NLR will be associated with nonsurvival. ANIMALS One thousand one hundred ninety-six client-owned foals <4 days old of any breed and sex: 993 hospitalized foals and 203 healthy foals. METHODS Retrospective multicenter study. Medical records of foals presenting to 3 equine referral hospitals were reviewed. Foals were included if they had complete CBCs, sepsis scores, and outcome data. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Data were analyzed by nonparametric methods and univariate analysis. RESULTS Of the 993 sick hospitalized foals, 686 were sick nonseptic and 307 were septic. The median NLR was lower in sick hospitalized foals (median [95% confidence interval], 3.55 [0.5-13.9]) compared with healthy foals (6.61 [3.06-18.1]). Septic foals had the lowest NLR (2.00 [0.20-9.71]). The NLR was lower in nonsurviving (1.97 [1.67-2.45]) compared with surviving foals (4.10 [3.76-4.33]). Nonsurviving septic foals had the lowest NLR (1.47 [1.70-3.01]). Foals with a NLR of <3.06 or <1.6 at admission had odds ratio of 3.21 (2.24-4.29) and 4.03 (2.86-5.67) for nonsurvival, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE A NLR < 3.06 at admission in sick hospitalized foals is readily available and clinically useful variable to provide prognostic information.
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Affiliation(s)
- Amanda N. Samuels
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ahmed M. Kamr
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Laura D. Hostnik
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Teresa A. Burns
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ramiro E. Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
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Johnson K, Peterson J, Kopper J, Dembek K. The hypothalamic-pituitary-adrenal axis response to ovine corticotropin-releasing-hormone stimulation tests in healthy and hospitalized foals. Vet Med (Auckl) 2023; 37:292-301. [PMID: 36651191 PMCID: PMC9889673 DOI: 10.1111/jvim.16604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenocortical axis (HPAA) response to sepsis can be impaired in critical illness. Corticotropin-releasing hormone (CRH) stimulation test might assess HPAA function in foals. OBJECTIVE To evaluate plasma cortisol, ACTH, arginine vasopressin (AVP), and endogenous CRH (eCRH) response to different doses of ovine CRH (oCRH). ANIMALS Healthy (n = 14) and hospitalized (n = 15) foals <7 days of age. METHODS In this prospective randomized study, oCRH (0.1, 0.3, and 1 μg/kg) was administered intravenously and blood samples were collected before, 15, 30, 60, and 90 minutes after administration of oCRH to determine plasma hormone concentrations. The hormonal response was evaluated as the difference (Delta; μg/dL or pg/mL) or percent change between baseline hormone concentration and each time point after oCRH stimulation. RESULTS Cortisol concentrations increased from baseline at 15 minutes with 0.1 and 0.3 μg/kg and at 30 and 60 minutes from baseline with 1 μg/kg oCRH (P < .05) in healthy and hospitalized foals. ACTH concentrations increased from baseline at 15 minutes with 0.1 μg/kg and at 30 minutes with 1 μg/kg oCRH (P < .05) in hospitalized foals. Delta cortisol 0 - 30, ACTH 0 - 30, and eCRH 0 - 30 was higher for the 1 μg/kg compared with 0.1 μg/kg oCRH in healthy foals (P < .05). Delta ACTH 0 - 15 and eCRH 0 - 30 was higher for the 1 μg/kg compared with the lower doses of oCRH in hospitalized foals (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE Cortisol, ACTH, and eCRH concentrations increased in response to administration of all doses of oCRH. One microgram per kilogram of oCRH appears to be optimal for the assessment of HPAA in healthy and hospitalized foals.
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Affiliation(s)
- Katheryn Johnson
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Jackie Peterson
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Jamie Kopper
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Katarzyna Dembek
- Department of Clinical SciencesNorth Carolina State University College of Veterinary MedicineRaleighNorth CarolinaUSA
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Dembek K, Timko K, Moore C, Johnson L, Frazer M, Barr B, Toribio R. Longitudinal assessment of adrenocortical steroid and steroid precursor response to illness in hospitalized foals. Domest Anim Endocrinol 2023; 82:106764. [PMID: 36162341 DOI: 10.1016/j.domaniend.2022.106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Sepsis is a major cause of morbidity and mortality in neonatal foals. Relative adrenal insufficiency (RAI), defined as an inadequate cortisol response to stress, has been associated with sepsis, prematurity, and poor outcome in newborn foals. In addition to cortisol, the adrenal gland synthesizes several biologically important steroids and steroid precursors, including aldosterone, androgens, and progestogens. However, concentration of these hormones during hospitalization and their association with the severity of disease and mortality in critically ill foals have not been completely evaluated. We hypothesized, that in addition to cortisol and aldosterone, concentration of steroid precursors (progestogens and androgens) will be altered in critically ill foals. We also proposed that septic foals will have higher concentrations of steroid precursors than healthy foals, and steroid concentrations will be persistently increased during hospitalization in non-surviving septic and premature foals. Foals <4 days of age were categorized as healthy, septic, sick non-septic, and premature based on physical exam, medical history, and laboratory data. Blood samples were collected on admission (0 h), 24 h, and 72 h after admission. Concentrations of steroids and ACTH were measured by immunoassays. The area under the curve over 72 h (AUC0-72h) of hospitalization was calculated for each hormone. Serum cortisol, aldosterone, progesterone, pregnenolone, dehydroepiandrosterone sulfate (DHEAS), and 17 α-hydroxyprogesterone concentrations were higher in septic and premature foals compared to healthy foals at 0 h and throughout 72 h of hospitalization (P < 0.05). Plasma ACTH concentrations were higher in septic and premature foals on admission compared to healthy controls (P < 0.05). The progesterone (AUC0-72h) cut-off value above which non-survival could be reliably predicted in hospitalized foals was 1,085 ng/mL/h, with 82% sensitivity and 77% specificity. Critically ill neonatal foals had an appropriate response to stress characterized by increased concentrations of cortisol and steroid precursors on admission. A rapid decline in steroid concentration was observed in healthy foals. However, persistently elevated progestogen and androgen concentrations were associated with a lack of improvement in the course of disease and poor outcome.
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Affiliation(s)
- K Dembek
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
| | - K Timko
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - C Moore
- Jacksonville Equine Associates, Jacksonville, FL, USA
| | - L Johnson
- Fairfield Equine Associates, Newtown, CT, USA
| | - M Frazer
- Hagyard Equine Medical Institute, Lexington, KY, USA
| | - B Barr
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - R Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Hair Cortisol and DHEA-S in Foals and Mares as a Retrospective Picture of Feto-Maternal Relationship under Physiological and Pathological Conditions. Animals (Basel) 2022; 12:ani12101266. [PMID: 35625111 PMCID: PMC9138058 DOI: 10.3390/ani12101266] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Equine fetal hair starts to grow at around 270 days of pregnancy, and hair collected at birth reflects hormones of the last third of pregnancy. The study aimed to evaluate cortisol (CORT) and dehydroepiandrosterone-sulfate (DHEA-S) concentrations and their ratio in the trichological matrix of foals and mares in relation to their clinical parameters; the clinical condition of the neonate (study 1); the housing place at parturition (study 2). In study 1, 107 mare-foal pairs were divided into healthy (group H; n = 56) and sick (group S; n = 51) foals, whereas in study 2, group H was divided into hospital (n = 30) and breeding farm (n = 26) parturition. Steroids from hair were measured using a solid-phase microtiter radioimmunoassay. In study 1, hair CORT concentrations measured in foals did not differ between groups and did not appear to be influenced by clinical parameters. A correlation between foal and mare hair CORT concentrations (p = 0.019; r = 0.312, group H; p = 0.006; r = 0.349, group S) and between CORT and DHEA-S concentrations in foals (p = 0.018; r = 0.282, group H; p < 0.001; r = 0.44, group S) and mares (p = 0.006; r = 0.361, group H; p = 0.027; r = 0.271, group S) exists in both groups. Increased hair DHEA-S concentrations (p = 0.033) and decreased CORT/DHEA-S ratio (p < 0.001) appear to be potential biomarkers of chronic stress in the final third of pregnancy, as well as a potential sign of resilience and allostatic load in sick foals, and deserve further attention in the evaluation of prenatal hypothalamus-pituitary-adrenal (HPA) axis activity in the equine species. In study 2, hormone concentrations in the hair of mares hospitalized for attended parturition did not differ from those that were foaled at the breeding farm. This result could be related to a too brief period of hospitalization to cause significant changes in steroid deposition in the mare’s hair.
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Clothier J, Small A, Hinch G, Brown WY. Perinatal Stress in Immature Foals May Lead to Subclinical Adrenocortical Dysregulation in Adult Horses: Pilot Study. J Equine Vet Sci 2022; 111:103869. [DOI: 10.1016/j.jevs.2022.103869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/21/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022]
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Colmer SF, Luethy D, Abraham M, Stefanovski D, Hurcombe SD. Utility of cell-free DNA concentrations and illness severity scores to predict survival in critically ill neonatal foals. PLoS One 2021; 16:e0242635. [PMID: 33901192 PMCID: PMC8075268 DOI: 10.1371/journal.pone.0242635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Plasma cell-free DNA (cfDNA) levels have been associated with disease and survival status in septic humans and dogs. To date, studies investigating cfDNA levels in association with critical illness in foals are lacking. We hypothesized that cfDNA would be detectable in the plasma of foals, that septic and sick-nonseptic foals would have significantly higher cfDNA levels compared to healthy foals, and that increased cfDNA levels would be associated with non-survival. Animals used include 80 foals of 10 days of age or less admitted to a tertiary referral center between January and July, 2020 were stratified into three categories: healthy (n = 34), sick non-septic (n = 11) and septic (n = 35) based on specific criteria. This was a prospective clinical study. Blood was collected from critically ill foals at admission or born in hospital for cfDNA quantification and blood culture. Previously published sepsis score (SS) and neonatal SIRS score (NSIRS) were also calculated. SS, NSIRS, blood culture status and cfDNA concentrations were evaluated to predict survival. Continuous variables between groups were compared using Kruskal-Wallis ANOVA with Dunn’s post hoc test. Comparisons between two groups were assessed using the Mann-Whitney U-test or Spearman rank for correlations. The performance of cfDNA, sepsis score and NSIRS score to predict survival was assessed by receiver operator characteristic (ROC) curve analysis including area under the curve, sensitivity and specificity using cutoffs. Plasma cfDNA was detectable in all foals. No significant differences in cfDNA concentration were detected between healthy foals and septic foals (P = 0.65) or healthy foals and sick non-septic foals (P = 0.88). There was no significant association between cfDNA and culture status, SS, NSIRS or foal survival. SS (AUC 0.85) and NSIRS (AUC 0.83) were superior to cfDNA (AUC 0.64) in predicting survival. Although cfDNA was detectable in foal plasma, it offers negligible utility to diagnose sepsis or predict survival in critical illness in neonates.
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Affiliation(s)
- Sarah Florence Colmer
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Daniela Luethy
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Michelle Abraham
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Darko Stefanovski
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Samuel David Hurcombe
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Kinsella HM, Hostnik LD, Rings LM, Swink JM, Burns TA, Toribio RE. Glucagon, insulin, adrenocorticotropic hormone, and cortisol in response to carbohydrates and fasting in healthy neonatal foals. J Vet Intern Med 2021; 35:550-559. [PMID: 33415818 PMCID: PMC7848351 DOI: 10.1111/jvim.16024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022] Open
Abstract
Background The endocrine pancreas and hypothalamic‐pituitary‐adrenal axis (HPAA) are central to energy homeostasis, but information on their dynamics in response to energy challenges in healthy newborn foals is lacking. Objectives To evaluate glucagon, insulin, ACTH, and cortisol response to fasting and carbohydrate administration in healthy foals. Animals Twenty‐two healthy Standardbred foals ≤4 days of age. Methods Foals were assigned to fasted (n = 6), IV glucose (IVGT; n = 5), PO glucose (OGT; n = 5), and PO lactose (OLT; n = 6) test groups. Blood samples were collected frequently for 210 minutes. Nursing was allowed from 180 to 210 minutes. Plasma glucagon, ACTH, serum insulin, and cortisol concentrations were measured using immunoassays. Results Plasma glucagon concentration decreased relative to baseline at 45, 90, and 180 minutes during the OLT (P = .03), but no differences occurred in other test groups. Nursing stimulated marked increases in plasma glucagon, serum insulin, and glucose concentrations in all test groups (P < .001). Plasma ACTH concentration increased relative to baseline at 180 minutes (P < .05) during fasting and OLT, but no differences occurred in other test groups. Serum cortisol concentration increased relative to baseline during OLT at 180 minutes (P = .04), but no differences occurred in other test groups. Nursing resulted in decreased plasma ACTH and serum cortisol concentrations in all test groups (P < .01). Conclusions and Clinical Importance The endocrine response to enterally and parenterally administered carbohydrates, including the major endocrine response to nursing, suggests that factors in milk other than carbohydrates are strong stimulators (directly or indirectly) of the endocrine pancreas and HPAA.
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Affiliation(s)
- Hannah M Kinsella
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
| | - Laura D Hostnik
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
| | - Lindsey M Rings
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
| | - Jacob M Swink
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
| | - Teresa A Burns
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
| | - Ramiro E Toribio
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine
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Vitale V, Conte G, Baragli P, Jose-Cunilleras E, Sgorbini M. Heart rate variability in newborn foals and its association with illness: a pilot study. ITALIAN JOURNAL OF ANIMAL SCIENCE 2021. [DOI: 10.1080/1828051x.2021.1957724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Valentina Vitale
- Dipartimento Scienze Veterinarie, University of Pisa, Pisa, Italy
- Ospedale Didattico Veterinario “Mario Modenato”, University of Pisa, Pisa, Italy
| | - Giuseppe Conte
- Dipartimento di Scienze Agrarie, Alimentali e Agro-Alimentari, University of Pisa, Pisa, Italy
| | - Paolo Baragli
- Dipartimento Scienze Veterinarie, University of Pisa, Pisa, Italy
| | - Eduard Jose-Cunilleras
- Departament de Medicina i Cirurgia Animals, Autonomous University of Barcelona, Barcelona, Spain
| | - Micaela Sgorbini
- Dipartimento Scienze Veterinarie, University of Pisa, Pisa, Italy
- Ospedale Didattico Veterinario “Mario Modenato”, University of Pisa, Pisa, Italy
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Swink JM, Rings LM, Snyder HA, McAuley RC, Burns TA, Dembek KA, Gilsenan WF, Browne N, Toribio RE. Dynamics of androgens in healthy and hospitalized newborn foals. J Vet Intern Med 2020; 35:538-549. [PMID: 33277956 PMCID: PMC7848305 DOI: 10.1111/jvim.15974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023] Open
Abstract
Background Information on steroids derived from the adrenal glands, gonads, or fetoplacental unit is minimal in newborn foals. Objective To measure androgen concentrations in serum and determine their association with disease severity and outcome in hospitalized foals. Animals Hospitalized (n = 145) and healthy (n = 80) foals. Methods Prospective, multicenter, cross‐sectional study. Foals of ≤3 days of age from 3 hospitals and horse farms were classified as healthy and hospitalized (septic, sick nonseptic, neonatal maladjustment syndrome [NMS]) based on physical exam, medical history, and laboratory findings. Serum androgen and plasma ACTH concentrations were measured with immunoassays. Data were analyzed by nonparametric methods and univariate analysis. Results Serum dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone (DHT) concentrations were higher upon admission in hospitalized foals (P < .05), were associated with nonsurvival, decreased to 4.9‐10.8%, 5.7‐31%, and 30.8‐62.8% admission values in healthy, SNS, and septic foals, respectively (P < .05), but remained unchanged or increased in nonsurviving foals. ACTH:androgen ratios were higher in septic and NMS foals (P < .05). Foals with decreased androgen clearance were more likely to die (odds ratio > 3; P < .05). Conclusions and Clinical Importance Similar to glucocorticoids, mineralocorticoids, and progestagens, increased serum concentrations of androgens are associated with disease severity and adverse outcome in hospitalized newborn foals. In healthy foals, androgens decrease over time, however, remain elevated longer in septic and nonsurviving foals. Androgens could play a role in or reflect a response to disorders such as sepsis or NMS in newborn foals.
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Affiliation(s)
- Jacob M Swink
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lindsey M Rings
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA.,Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - Hailey A Snyder
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rachel C McAuley
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Teresa A Burns
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Katarzyna A Dembek
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Nimet Browne
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - Ramiro E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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Anderson MJ, Ibrahim AS, Cooper BR, Woolcock AD, Moore GE, Taylor SD. Effects of administration of ascorbic acid and low-dose hydrocortisone after infusion of sublethal doses of lipopolysaccharide to horses. J Vet Intern Med 2020; 34:2710-2718. [PMID: 33026127 PMCID: PMC7694830 DOI: 10.1111/jvim.15896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
Background Sepsis is associated with ascorbic acid (AA) depletion and critical illness‐related corticosteroid insufficiency (CIRCI) in humans. Hypotheses Intravenous infusion of lipopolysaccharide (LPS) would (a) decrease endogneous AA concentrations, (b) induce CIRCI and (c) administration of a combination of AA and hydrocortisone (HC) would have decreased indices of inflammation compared to either drug alone. Animals Thirty‐two healthy horses. Methods Randomized placebo‐controlled experimental trial. Horses were assigned to 1 of 4 groups (saline, AA and HC, AA only, or HC only). Treatments were administered 1 hour after completion of LPS infusion. Clinical signs, clinicopathological variables, pro‐inflammatory cytokine gene expression and production, and plasma AA concentrations were assessed at various time points. Serum cortisol concentrations and ACTH stimulation tests were used to detect CIRCI. Results There was no effect of drug on clinical signs or pro‐inflammatory cytokine gene expression or production compared to controls at any time point. Administration of AA was associated with higher blood neutrophil counts 6 hours after LPS infusion (11.01 ± 1.02 K/μl) compared to other groups (8.99 ± 0.94 K/μL; P < .009). Adminstration of HC was associated with higher blood neutrophil counts 12 hours after LPS infusion (10.40 ± 0.75 K/μl) compared to other groups (6.88 ± 0.68 K/μl; P < .001). Serum cortisol increased from 5.11 ± 1.48 μg/dL before LPS administration to 9.59 ± 1.83 μg/dL 1 h after completion of LPS infusion (T1) without an effect of treatment (P = 0.59). Conclusions and Clinical Importance Ascorbic acid and HC appeared to protect against LPS‐induced neutrophil depletion and could be considered as adjunctive therapy in horses with endotoxemia.
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Affiliation(s)
- Melinda J Anderson
- Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Alina S Ibrahim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Bruce R Cooper
- Bindley Bioscience Center, Purdue University, West Lafayette, Indiana, USA
| | - Andrew D Woolcock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Sandra D Taylor
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Rings LM, Swink JM, Dunbar LK, Burns TA, Toribio RE. Enteroinsular axis response to carbohydrates and fasting in healthy newborn foals. J Vet Intern Med 2019; 33:2752-2764. [PMID: 31664736 PMCID: PMC6872622 DOI: 10.1111/jvim.15641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022] Open
Abstract
Background The enteroinsular axis (EIA) comprises intestinal factors (incretins) that stimulate insulin release after PO ingestion of nutrients. Glucose‐dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1) are the main incretins. The EIA has not been investigated in healthy neonatal foals but should be important because energy demands are high in healthy foals and dysregulation is frequent in sick foals. Objectives and Hypothesis To evaluate the EIA response to carbohydrates or fasting in newborn foals. We hypothesized that incretin secretion would be higher after PO versus IV carbohydrate administration or fasting. Animals Thirty‐six healthy Standardbred foals ≤4 days of age. Methods Prospective study. Blood was collected before and after a PO glucose test (OGT; 300, 500, 1000 mg/kg), an IV glucose test (IVGT; 300, 500, 1000 mg/kg), a PO lactose test (OLT; 1000 mg/kg), and fasting. Foals were muzzled for 240 minutes. Blood was collected over 210 minutes glucose, insulin, GIP, and GLP‐1 concentrations were measured. Results Only PO lactose caused a significant increase in blood glucose concentration (P < .05). All IV glucose doses induced hyperglycemia and hyperinsulinemia. Concentrations of GIP and GLP‐1 decreased until foals nursed (P < .05), at which time rapid increases in glucose, insulin, GIP, and GLP‐1 concentrations occurred (P < .05). Conclusions and Clinical Importance Healthy newborn foals have a functional EIA that is more responsive to milk and lactose than glucose. Non‐carbohydrate factors in mare's milk may be important for EIA activity. Constant exposure of intestinal cells to nutrients to maintain EIA activity could be relevant to management of sick foals. Foals can be fasted for 4 hours without experiencing hypoglycemia.
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Affiliation(s)
- Lindsey M Rings
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jacob M Swink
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Laura K Dunbar
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Teresa A Burns
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Ramiro E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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12
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Stewart AJ, Hackett E, Bertin F, Towns TJ. Cortisol and adrenocorticotropic hormone concentrations in horses with systemic inflammatory response syndrome. J Vet Intern Med 2019; 33:2257-2266. [PMID: 31512777 PMCID: PMC6766528 DOI: 10.1111/jvim.15620] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Plasma adrenocorticotropic hormone (ACTH) and serum cortisol concentrations increase with illness-associated stress. Dynamics of plasma ACTH and serum cortisol concentrations in adult horses with systemic illness are undocumented. HYPOTHESIS/OBJECTIVE To determine whether ACTH and cortisol concentrations and the ACTH/cortisol ratio vary with survival, the presence of systemic inflammatory response syndrome (SIRS), or ischemic gastrointestinal lesions at admission, or throughout hospitalization. ANIMALS One hundred fifty-one adult horses. METHODS Prospective study measuring serum cortisol and plasma ACTH at admission and on days 2, 4, and 6 of hospitalization. Horses were grouped by outcome (survival, SIRS status, number of SIRS criteria [SIRS score], SIRS severity group, and the presence of an ischemic lesion). Differences between groups and over time for ACTH, cortisol, and ACTH/cortisol ratio were investigated with a mixed effect model. Receiving operator characteristic curves and odds ratios were calculated for survival and ischemia. RESULTS In all groups, ACTH, cortisol, and ACTH/cortisol ratio significantly decreased over time (P < .0001). ACTH, cortisol, and ACTH/cortisol ratio were higher at admission in nonsurvivors, and ACTH and cortisol were higher in horses with ischemic lesions (P < .01). Horses with ACTH above reference interval at admission were 6.10 (2.73-13.68 [95% confidence interval]) times less likely to survive (P < .0001). No significant difference in ACTH, cortisol, and ACTH/cortisol ratio between horses with different SIRS status, scores, or groups were detected, although nonsurvivors had a higher SIRS score (P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE Pituitary and adrenal responses are altered in nonsurviving horses and those with an ischemic gastrointestinal lesion.
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Affiliation(s)
- Allison J. Stewart
- School of Veterinary ScienceThe University of QueenslandGattonQueenslandAustralia
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabama
- Swedish University of Agricultural SciencesUppsalaSweden
| | - Eileen Hackett
- College of Veterinary Medicine & Biomedical SciencesColorado State UniversityFort CollinsColorado
| | - Francois‐Rene Bertin
- School of Veterinary ScienceThe University of QueenslandGattonQueenslandAustralia
| | - Taylor J. Towns
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabama
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Dembek KA, Johnson LM, Timko KJ, Minuto JS, Hart KA, Barr BS, Toribio RE. Multiple adrenocortical steroid response to administration of exogenous adrenocorticotropic hormone to hospitalized foals. J Vet Intern Med 2019; 33:1766-1774. [PMID: 31111575 PMCID: PMC6639474 DOI: 10.1111/jvim.15527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background The hypothalamic‐pituitary‐adrenal axis regulates the response to sepsis‐associated stress. Relative adrenal insufficiency or adrenocorticotropic hormone (ACTH):cortisol imbalance, defined as a poor cortisol response to administration of ACTH, is common and associated with death in hospitalized foals. However, information on other adrenal steroid response to ACTH stimulation in sick foals is minimal. Objective To investigate the response of multiple adrenocortical steroids to administration of ACTH in foals. Animals Hospitalized (n = 34) and healthy (n = 13) foals. Methods In this prospective study, hospitalized foals were categorized into 2 groups using cluster analysis based on adrenal steroids response to ACTH stimulation: Cluster 1 (n = 11) and Cluster 2 (n = 23). After baseline blood sample collection, foals received 10 μg of ACTH with additional samples collected at 30 and 90 minutes after ACTH. Steroid and ACTH concentrations were determined by immunoassays. The area under the curve (AUC) and Delta0‐30 were calculated for each hormone. Results The AUC for cortisol, aldosterone, androstenedione, pregnenolone, 17α‐OH‐progesterone, and progesterone were higher in critically ill (Cluster 1) compared to healthy foals (P < .01). Delta0‐30 for cortisol and 17α‐OH‐progesterone was lower in Cluster 1 (24%, 26.7%) and Cluster 2 (16%, 11.2%) compared to healthy foals (125%, 71%), respectively (P < .05). Foals that died had increased AUC for endogenous ACTH (269 versus 76.4 pg/mL/h, P < .05) accompanied by a low AUC for cortisol (5.5 versus 15.5 μg/dL/h, P < .05), suggesting adrenocortical dysfunction. Conclusion and Clinical Importance The 17α‐OH‐progesterone response to administration of ACTH was a good predictor of disease severity and death in hospitalized foals.
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Affiliation(s)
- Katarzyna A Dembek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Lindsey M Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Kathryn J Timko
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jillian S Minuto
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Kelsey A Hart
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Bonnie S Barr
- Internal Medicine, Rood and Riddle Equine Hospital, Lexington, Kentucky
| | - Ramiro E Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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14
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Müller V, Curcio BR, Toribio RE, Feijó LS, Borba LA, Canisso IF, Nogueira CE. Cortisol, progesterone, 17α OH progesterone, and pregnenolone in foals born from mare's hormone-treated for experimentally induced ascending placentitis. Theriogenology 2019; 123:139-144. [DOI: 10.1016/j.theriogenology.2018.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/16/2018] [Accepted: 06/24/2018] [Indexed: 11/30/2022]
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15
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Wilkins PA. What's in a word? The need for SIRS and sepsis definitions in equine medicine and surgery. Equine Vet J 2018; 50:7-9. [PMID: 29193295 DOI: 10.1111/evj.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P A Wilkins
- University of Illinois - Veterinary Clinical Sciences, Champain-Urbana, Illinois, USA
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16
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Tadros EM, Fowlie JG, Refsal KR, Marteniuk J, Schott HC. Association between hyperinsulinaemia and laminitis severity at the time of pituitary pars intermedia dysfunction diagnosis. Equine Vet J 2018; 51:52-56. [PMID: 29761574 DOI: 10.1111/evj.12963] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hyperinsulinaemia is the suspected component of insulin dysregulation having the strongest association with laminitis and occurs variably in equids with pituitary pars intermedia dysfunction (PPID). OBJECTIVES We hypothesised that magnitude of hyperinsulinaemia correlates with laminitis severity in PPID-affected equids. Furthermore, we hypothesised that owners can be unaware of chronic endocrinopathic laminitis. STUDY DESIGN Cross-sectional study. METHODS Serum insulin concentrations, owner-reported laminitis history and radiographic evidence of laminitis were determined in 38 client-owned horses and ponies with confirmed PPID. Laminitis severity was classified into four categories (normal [nonlaminitic], mild, moderate or severe laminitis) based on degree of distal phalangeal rotation. Animals were also categorised as normoinsulinaemic (<20 μU/ml), mildly hyperinsulinaemic (20-50 μU/ml) and severely hyperinsulinaemic (>50 μU/ml). One-way ANOVA, t tests and Fisher's exact tests were performed. RESULTS While owners reported laminitis in 37% of animals, 76% were laminitic based on study criteria (P = 0.01). Owners reported laminitis more frequently in hyperinsulinaemic vs. normoinsulinaemic animals; recognition increased with severity of hyperinsulinaemia (P = 0.03). Mean insulin concentrations were higher in equids with moderate to severe radiographic laminitis (geometric mean 74.1, 95% confidence interval (CI) 38.4-143.1 uU/ml) vs. those classified radiographically as normal to mild (31.9, 95% CI 21.1-48.1 uU/ml P = 0.03). MAIN LIMITATIONS Dynamic insulin testing was not performed; some normoinsulinaemic animals might have had subtle insulin dysregulation. CONCLUSIONS Although radiographic abnormalities were present in most animals at the time of PPID diagnosis, chronic laminitis remained unrecognised by many owners. Owner awareness of laminitis increased with severity of hyperinsulinaemia and higher insulin concentrations were detected in association with more severe radiographic changes. The Summary is available in Chinese - See Supporting Information.
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Affiliation(s)
- E M Tadros
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan, USA
| | - J G Fowlie
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - K R Refsal
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan, USA
| | - J Marteniuk
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - H C Schott
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
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Lauteri E, Corsalini J, Pepe M, Mandara MT, Passamonti F, Beccati F. EHV-1 Congenital Infection and Concurrent Actinobacillus equuli Septicemia in a Standardbred Neonatal Foal: Clinical, Diagnostic Findings, and Evaluation of Adrenal Gland Function. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2017.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dembek KA, Timko KJ, Johnson LM, Hart KA, Barr BS, David B, Burns TA, Toribio RE. Steroids, steroid precursors, and neuroactive steroids in critically ill equine neonates. Vet J 2017; 225:42-49. [PMID: 28720298 DOI: 10.1016/j.tvjl.2017.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/27/2017] [Accepted: 05/19/2017] [Indexed: 12/30/2022]
Abstract
Hypothalamic-pituitary-adrenal axis (HPAA) dysfunction has been associated with sepsis and mortality in foals. Most studies have focused on cortisol, while other steroids have not been investigated. The objectives of this study were to characterise the adrenal steroid and steroid precursor response to disease and to determine their association with the HPAA response to illness, disease severity, and mortality in hospitalised foals. All foals (n=326) were classified by two scoring systems into three categories: based on the sepsis score (septic, sick non-septic [SNS] and healthy) and the foal survival score (Group 1: 3-18%; Group 2: 38-62%; Group 3: 82-97% likelihood of survival). Blood concentrations of adrenocorticotropic hormone (ACTH) and steroids were determined by immunoassays. ACTH-cortisol imbalance (ACI) was defined as a high ACTH/cortisol ratio. Septic foals had higher ACTH, cortisol, progesterone, 17α-OH-progesterone, pregnenolone, and androstenedione concentrations as well as higher ACTH/cortisol, ACTH/progesterone, ACTH/aldosterone, and ACTH/DHEAS ratios than SNS and healthy foals (P<0.01). Foals with DHEAS of 0.4-5.4ng/mL were more likely to have ACI (OR=2.5). Foals in Group 1 had higher ACTH, aldosterone, progesterone, and cortisol concentrations as well as ACTH/cortisol, ACTH/progesterone, and ACTH/DHEAS ratios than foals in Groups 2 and 3 (P<0.01). High progesterone concentrations were associated with non-survival and the cutoff value below which survival could be predicted was 23.5ng/mL, with 75% sensitivity and 72% specificity. In addition to cortisol, the response to the stress of illness in foals is characterised by the release of multiple adrenal steroids. DHEAS and progesterone were good predictors of HPAA dysfunction and outcome in hospitalised foals.
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Affiliation(s)
- K A Dembek
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - K J Timko
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - L M Johnson
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - K A Hart
- College of Veterinary Medicine, University of Georgia, 501 D.W. Brooks Drive, Athens, GA 30602, USA
| | - B S Barr
- Rood and Riddle Equine Hospital, 2150 Georgetown Rd, Lexington, KY 40511, USA
| | - B David
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40511, USA
| | - T A Burns
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - R E Toribio
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
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20
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Hematological and Blood Biochemical Characteristics of Newborn Heavy Draft Foals After Dystocia. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Fratto MA, Hart KA, Norton NA, Barton MH, Giguère S, Hurley DJ. The effect of free and carrier-bound cortisol on equine neutrophil function. Vet Immunol Immunopathol 2017; 183:16-21. [DOI: 10.1016/j.vetimm.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 09/21/2016] [Accepted: 11/17/2016] [Indexed: 02/08/2023]
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22
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General Systemic States. Vet Med (Auckl) 2017. [PMCID: PMC7195945 DOI: 10.1016/b978-0-7020-5246-0.00004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Abstract
Sepsis and septic shock represent a major cause of morbidity and mortality in equine neonates and in all species. Early recognition of the condition is important, but definitive examination and laboratory variables to predict equine neonatal sepsis are lacking. Early and aggressive treatment should include broad-spectrum antimicrobial coverage, source control, and hemodynamic support. Field practitioners and intensive care clinicians work together in the management of this condition because the recognition and initial treatment should begin as early as possible.
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Zakari FO, Ayo JO, Rekwot PI, Kawu MU. Effects of age and season on haematological parameters of donkeys during the rainy and cold-dry seasons. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:1813-1824. [PMID: 25860334 DOI: 10.1007/s00484-015-0989-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Abstract
The aim of the study was to investigate the effects of age and season on haematological parameters of donkeys at rest during the rainy and cold-dry seasons. Thirty healthy donkeys divided into three groups based on their age served as the subjects. During each season, blood sample was collected from each donkey thrice, 2 weeks apart, for haematological analysis, and the dry-bulb temperature (DBT), relative humidity (RH) and temperature-humidity index (THI) were obtained thrice each day during the experimental period using standard procedures. During the rainy season, the mean DBT (33.05 ± 0.49 °C), RH (73.63 ± 1.09 %) and THI (84.39 ± 0.71) were higher (P < 0.0001) than the corresponding values of 24.00 ± 0.44 °C, 36.80 ± 0.92 % and 64.80 ± 0.62, during the cold-dry season. Packed cell volume (PCV), erythrocyte count [red blood cell (RBC)], haemoglobin concentration (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), platelet count (PLT), leucocyte count [white blood cell (WBC)], lymphocyte count (LYM) and neutrophil/lymphocyte ratio (N/L) were higher (P < 0.05) in adults than foals during the rainy season. The MCV, MCH, WBC, NEU, LYM and PLT of adult and yearling donkeys were higher (P < 0.05) during the rainy than the cold-dry season. The PCV, RBC, Hb, MCV, MCH, and NEU of foals were higher in the rainy than the cold-dry season. The N/L of adult and foal donkeys were higher (P < 0.05) in the rainy than in the cold-dry season. In conclusion, PCV, RBC, Hb and LYM were considerably higher in foals than yearlings or adults during the rainy season, while erythrocytic indices and platelet counts were higher in adults or yearlings than in foals in both seasons. Erythrocytic indices, PLT and N/L were higher in the rainy than the cold-dry season in adults, yearlings and foals.
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Affiliation(s)
- Friday Ocheja Zakari
- Department of Physiology, Faculty of Veterinary Medicine, Ahmadu Bello University, PMB 1045, Zaria, Nigeria.
| | - Joseph Olusegun Ayo
- Department of Physiology, Faculty of Veterinary Medicine, Ahmadu Bello University, PMB 1045, Zaria, Nigeria
| | - Peter Ibrahim Rekwot
- National Animal Production Research Institute, Ahmadu Bello University, PMB 1096, Zaria, Nigeria
| | - Mohammed Umar Kawu
- Department of Physiology, Faculty of Veterinary Medicine, Ahmadu Bello University, PMB 1045, Zaria, Nigeria
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26
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Gomez D, Biermann N, Sanchez L. Physicochemical Approach to Determine the Mechanism for Acid-Base Disorders in 793 Hospitalized Foals. J Vet Intern Med 2015; 29:1395-402. [PMID: 26256847 PMCID: PMC4858039 DOI: 10.1111/jvim.13590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/12/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The quantitative effect of strong electrolytes, unmeasured strong anions (UAs), pCO2, and plasma protein concentrations in determining plasma pH can be demonstrated using the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess UAs in different species. HYPOTHESES Strong ions are a major factor influencing changes in plasma pH of hospitalized foals. AG and SIG accurately predict severe hyper-L-lactatemia ([L-lac(-)] > 7 mmol/L). ANIMALS Seven hundred and ninety three hospitalized foals < 7 days old. METHODS Retrospective study. The relationship between measured pH and physicochemical variables, and the relationship between plasma [L-lac(-)] and AG and SIG, were determined using regression analyses. Optimal AG and SIG cut points to predict hyper-L-lactatemia were identified using an ROC curve analysis. RESULTS Combined, the measured strong ion difference and SIG accounted for 54-69% of the changes in the measured arterial pH of hospitalized foals. AG and SIG were significantly associated with plasma [L-lac(-)] (P < .0001). The receiver operator characteristics (ROC) AUC of AG and SIG for prediction of severe hyper-L-lactatemia were 0.89 (95%CI, 0.8-0.95; P < .0001) and 0.90 (95%CI, 0.81-0.96; P < .0001), respectively. Severe hyper-L-lactatemia was best predicted by AG > 27 mmol/L (sensitivity 80%, 95%CI, 56-94, specificity 85%, 95%CI, 73-93; P < .0001) and SIG <-15 mmol/L (sensitivity 90%, 95%CI, 68-98; specificity 80%; 95%CI, 68-90; P < .0001). CONCLUSION AND CLINICAL RELEVANCE Altered concentrations of strong ions (Na(+), K(+), Cl(-)) and UAs were the primary cause of acidemia of hospitalized foals. AG and SIG were good predictors of hyper-L-lactatemia and could be used as surrogate tests.
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Affiliation(s)
- D.E. Gomez
- Department of Health ManagementAtlantic Veterinary CollegeUniversity of Prince Edward IslandCharlottetownPECanada
| | - N.M. Biermann
- Department of Health ManagementAtlantic Veterinary CollegeUniversity of Prince Edward IslandCharlottetownPECanada
| | - L.C. Sanchez
- Department of Large Animal Clinical SciencesCollege of Veterinary MedicineUniversity of FloridaGainesvilleFLUSA
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Castagnetti C, Mariella J. Anti-inflammatory Drugs in Equine Neonatal Medicine. Part II: Corticosteroids. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dembek KA, Hurcombe SD, Stewart AJ, Barr BS, MacGillivray KC, Kinee M, Elam J, Toribio RE. Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals. Equine Vet J 2015; 48:176-81. [PMID: 25421257 DOI: 10.1111/evj.12393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Critically ill foals often present to veterinary hospitals with impaired organ perfusion which can be demonstrated by increased blood L-lactate concentrations. As a compensatory mechanism to low blood pressure and electrolyte abnormalities, aldosterone and arginine vasopressin (AVP) are released to restore organ perfusion and function. Several studies have investigated the ability of blood L-lactate concentrations to predict severity of disease and outcome in critically ill human patients, adult horses and foals. However, information on the aldosterone and AVP response to hypoperfusion and its association with L-lactate concentrations in neonatal foals is limited. OBJECTIVES To determine the association between clinical hypoperfusion and endocrine markers of reduced tissue perfusion in normo- and hypoperfused foals. STUDY DESIGN Prospective, multicentre, cross-sectional observational study. METHODS Blood samples were collected on admission from 72 clinically hypoperfused, 110 normoperfused (73 hospitalised and 37 healthy) foals of ≤4 days of age. Foals were considered clinically hypoperfused if they had L-lactate concentrations ≥2.5 mmol/l and one of the 3 following findings: heart rate >120 beats/min, packed cell volume (PCV) >0.44 l/l or azotaemia (increased creatinine and blood urea nitrogen [BUN]). Blood concentrations of aldosterone and AVP were determined by radioimmunoassays. RESULTS Aldosterone, AVP, creatinine and BUN concentrations and heart rate, PCV and blood osmolality were higher in clinically hypoperfused compared with normoperfused foals (P<0.05). Risk of hypoperfusion increased with the presence of hypothermic extremities (OR = 5.26) and with each one unit increase in albumin concentrations (OR = 3.5) (P<0.05). The proposed admission L-lactate cut-off value above which nonsurvival could be reliably predicted in hospitalised foals was 10.6 mmol/l with 82% of sensitivity and 74% of specificity. CONCLUSIONS Hyperaldosteronaemia and hypervasopressinaemia as well as hypothermic extremities and increased albumin concentrations are potent predictors of hypoperfusion in hospitalised foals.
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Affiliation(s)
- K A Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
| | - S D Hurcombe
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
| | - A J Stewart
- College of Veterinary Medicine, Auburn University, Alabama, USA
| | - B S Barr
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | | | - M Kinee
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - J Elam
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - R E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
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Abstract
Sepsis is defined as an exaggerated, systemic inflammatory response to infection and is a common condition in horses. Systemic inflammatory response syndrome (SIRS) associated with bacterial infection is a hallmark of sepsis. Sepsis in neonatal foals is a common sequela of failure of passive transfer and, in addition to development of SIRS, may be characterised by bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis. Sepsis in mature horses is most commonly observed secondary to gastrointestinal lesions that result in disrupted mucosa and bacterial translocation into circulation (endotoxaemia). Pleuropneumonia and metritis may also cause sepsis in mature horses. Diagnosis of sepsis is based on SIRS criteria as well as suspected or confirmed infection. Due to the relatively low sensitivity of microbial culture and the subjectivity of sepsis scoring, many sepsis biomarkers are being studied for their usefulness in diagnosis and prognostication of sepsis in horses. Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome. Multiple organ dysfunction syndrome may occur in severe cases of sepsis, with common manifestations including laminitis and coagulopathies. Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45-60%.
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Affiliation(s)
- S Taylor
- Veterinary Clinical Sciences Purdue University West Lafayette Indiana USA
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Creedon JMB. Controversies surrounding critical illness-related corticosteroid insufficiency in animals. J Vet Emerg Crit Care (San Antonio) 2014; 25:107-12. [PMID: 25516097 DOI: 10.1111/vec.12270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/28/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. ETIOLOGY Critical illness-related corticosteroid insufficiency may be due to hypothalamic-pituitary-adrenal (HPA) axis dysfunction, alterations in cortisol-plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness. DIAGNOSIS Appropriate tests to diagnose CIRCI are unknown. The diagnosis in people is currently based on response to treatment with hydrocortisone. There is currently no consensus on appropriate diagnostic feature(s) in veterinary species. THERAPY Low-dose hydrocortisone is the treatment of choice for patients with CIRCI. PROGNOSIS If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.
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Dembek KA, Hurcombe SD, Frazer ML, Morresey PR, Toribio RE. Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling. PLoS One 2014; 9:e109212. [PMID: 25295600 PMCID: PMC4189956 DOI: 10.1371/journal.pone.0109212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/29/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Medical management of critically ill equine neonates (foals) can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission. METHODS AND RESULTS Data from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM) to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7) and the lowest (0) scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively. CONCLUSIONS The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.
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Affiliation(s)
- Katarzyna A. Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Samuel D. Hurcombe
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Michele L. Frazer
- Hagyard Equine Medical Institute, Lexington, Kentucky, United States of America
| | - Peter R. Morresey
- Rood and Riddle Equine Hospital, Lexington, Kentucky, United States of America
| | - Ramiro E. Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Dunkel B, Corley KTT. Pathophysiology, diagnosis and treatment of neonatal sepsis. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- B. Dunkel
- Department of Clinical Science and Services; Equine Referral Hospital; The Royal Veterinary College; North Mymms UK
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Mair TS, Sherlock CE, Boden LA. Serum cortisol concentrations in horses with colic. Vet J 2014; 201:370-7. [PMID: 24986316 DOI: 10.1016/j.tvjl.2014.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 06/02/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
Few studies have evaluated cortisol concentrations in horses with colic. In humans with septic shock, high cortisol levels are associated with an increased risk of death. The objectives of this study were to compare the serum total cortisol concentrations (STCCs) in horses with colic to those without colic, and to assess whether the STCC relates to the pathological nature or outcome of the disease. STCCs were determined at presentation in horses with colic and in systemically healthy 'control' horses. Horses with colic were grouped based on clinical and clinico-pathological parameters at admission, treatment, lesion type and location, and outcome. Univariable and multivariable logistic regression were performed using two different outcome measures: (a) whether the horse had colic or not (yes vs. no), and (b) horse STCC (≥200 nmol/L vs. <200 nmol/L). Horses were more likely to have colic if they presented with high STCCs (≥200 nmol/L compared with <200 nmol/L). Horses with colic and with STCCs ≥200nmol/L were more likely to have moderate or severe colic signs (compared with mild colic) and heart rates >45 beats per min (compared with ≤45 beats per min). It was concluded that colic in horses is associated with elevated STCCs, and increased STCC in horses with colic appears to relate to the severity of the disease. STCCs may provide additional decision-making and prognostic information in horses with colic but further studies are required to avoid misinterpretations associated with the wide variation in STCCs.
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Affiliation(s)
- T S Mair
- Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent ME18 5GS, UK
| | - C E Sherlock
- Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent ME18 5GS, UK.
| | - L A Boden
- Institute of Comparative Epidemiology, Faculty of Veterinary Medicine, University of Glasgow, 464 Bearsden Road, Glasgow G61 1QH, UK
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Abstract
Despite advances in neonatal intensive care sepsis, severe sepsis and septic shock remain the biggest killers of neonatal foals. Management of this severe syndrome remains difficult, requiring intensive intervention. Key aspects of management include infection control, hemodynamic support, immunomodulatory interventions, and metabolic/endocrine support. Infection control largely consists of early antimicrobial therapy, plasma transfusions, and local therapy for the infected focus. In cases with severe sepsis or septic shock, hemodynamic support with fluids, vasoactive agents, and respiratory support insuring oxygen delivery to vital organs is important. Nutritional support is important, but close monitoring is needed to avoid hyperglycemia and hypoglycemia.
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Toth B, Slovis NM, Constable PD, Taylor SD. Plasma adrenomedullin concentrations in critically ill neonatal foals. J Vet Intern Med 2014; 28:1294-300. [PMID: 24773029 PMCID: PMC4857949 DOI: 10.1111/jvim.12358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/05/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background Bacterial sepsis remains a leading cause of morbidity and mortality in neonatal foals, but accurate diagnostic and prognostic markers are lacking. Adrenomedullin (AM) is a polypeptide with diverse biologic effects on the cardiovascular system that increases in septic humans and laboratory animals. Hypotheses Plasma AM concentration (p[AM]) is increased in septic neonatal foals compared to sick nonseptic and healthy control foals, and p[AM] is predictive of survival in septic neonatal foals. Animals Ninety critically ill (42 septic, 48 sick nonseptic) and 61 healthy foals <1 week of age. Methods A prospective observational clinical study was performed. Venous blood was collected from critically ill foals at admission and from healthy foals at 24 hours of age. Critically ill foals were categorized as septic or sick nonseptic based on blood culture results and sepsis score. Plasma [AM] was measured by using a commercially available ELISA for horses. Data were analyzed by using the Mann‐Whitney U‐test and P < .05 was considered significant. Results Plasma [AM] was not significantly different between septic and sick nonseptic foals (P = .71), but critically ill foals had significantly increased p[AM] compared to healthy controls (P < .0001). In critically ill foals, p[AM] was not predictive of survival (P = .051). A p[AM] cutoff concentration of 0.041 ng/mL provided a test sensitivity of 91% and specificity of 54% to predict illness. Conclusions and Clinical Relevance Plasma [AM] shows promise as a marker of health in neonatal foals, but p[AM] increases nonspecifically during perinatal illnesses and is not necessarily associated with sepsis.
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Affiliation(s)
- B Toth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Abstract
Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to as insulin dysregulation in this review. Insulin dysregulation is a key component of equine metabolic syndrome: a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation and pituitary pars intermedia dysfunction, as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. An oral sugar test or in-feed oral glucose tolerance test can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose-insulin test or i.v. insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The term insulin dysregulation is introduced here to refer collectively to excessive insulin responses to sugars, fasting hyperinsulinaemia and insulin resistance, which are all components of equine metabolic syndrome.
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Affiliation(s)
- N Frank
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA; Division of Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, UK
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Somatotropic and thyroid hormones in the acute phase of subarachnoid haemorrhage. Acta Neurochir (Wien) 2013; 155:2053-62. [PMID: 23494135 DOI: 10.1007/s00701-013-1670-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/24/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Somatotropic and thyroid hormones are probably important for the recovery after acute brain injury. Still, the dynamics of these hormones after spontaneous subarachnoid haemorrhage (SAH) is not well described. The purpose of this study was to investigate the relation between somatotropic and thyroid hormones and clinical factors after SAH. METHODS Twenty patients with spontaneous SAH were included prospectively. Serum concentrations of TSH, fT4, T3, IGF-1 and GH were measured once a day for 7 days after SAH. Hormone patterns and serum concentrations were compared to the severity of SAH, neurological condition at admission, clinical course and outcome of the patients. RESULTS During the first week after SAH, all patients showed increased GH and IGF-1 concentrations. In the whole group, concentrations of TSH increased, whereas T3 and fT4 decreased. There were no relations of serum concentrations of IGF-1 or GH to clinical condition at admission, clinical course or outcome of the patients. Half of the patients showed low T3 serum concentrations. A complicated course was associated with a deeper fall in TSH and T3 concentrations. There were negative correlations for mean concentrations of TSH and T3 versus WFNS grade and a positive correlation for T3 versus GOS after 6 months, indicating that low concentrations of TSH and T3 were connected to worse SAH grade and poor outcome. CONCLUSIONS All patients showed increased GH and IGF-1 concentrations irrespective of the grade of SAH or clinical course. Patients with a complicated clinical course showed a more pronounced fall in TSH and T3 concentrations and low serum T3 concentrations were related to a more serious SAH and poor patient outcome. These results need to be studied further and they may contribute to the accumulated knowledge needed to understand the complex mechanisms influencing the unpredictable clinical course after SAH.
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Borchers A, Magdesian KG, Schenck PA, Kass PH. Serial plasma vasopressin concentration in healthy and hospitalised neonatal foals. Equine Vet J 2013; 46:306-10. [DOI: 10.1111/evj.12121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 06/09/2013] [Indexed: 01/05/2023]
Affiliation(s)
- A. Borchers
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; USA
| | - K. G. Magdesian
- Department of Medicine and Epidemiology; University of California; USA
| | - P. A. Schenck
- Diagnostic Center for Population and Animal Health; Michigan State University; USA
| | - P. H. Kass
- Department of Population Health and Reproduction; University of California; USA
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Barsnick RJIM, Hurcombe SDA, Dembek K, Frazer ML, Slovis NM, Saville WJA, Toribio RE. Somatotropic axis resistance and ghrelin in critically ill foals. Equine Vet J 2013; 46:45-9. [PMID: 23663031 DOI: 10.1111/evj.12086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 03/14/2013] [Indexed: 12/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Resistance to the somatotropic axis and increases in ghrelin concentrations have been documented in critically ill human patients, but limited information exists in healthy or sick foals. OBJECTIVES To investigate components of the somatotropic axis (ghrelin, growth hormone and insulin-like growth factor-1 [IGF-1]) with regard to energy metabolism (glucose and triglycerides), severity of disease and survival in critically ill equine neonates. It was hypothesised that ghrelin and growth hormone would increase and IGF-1 would decrease in proportion to severity of disease, supporting somatotropic axis resistance, which would be associated with severity of disease and mortality in sick foals. STUDY DESIGN Prospective multicentre cross-sectional study. METHODS Blood samples were collected at admission from 44 septic, 62 sick nonseptic (SNS) and 19 healthy foals, all aged <7 days. Foals with positive blood cultures or sepsis scores ≥12 were considered septic, foals with sepsis scores of 5-11 were classified as SNS. Data were analysed by nonparametric methods and multivariate logistic regression. RESULTS Septic foals had higher ghrelin, growth hormone and triglyceride and lower IGF-1 and glucose concentrations than healthy foals (P<0.01). Sick nonseptic foals had higher growth hormone and triglycerides and lower IGF-1 concentrations than healthy foals (P<0.05). Growth hormone:IGF-1 ratio was higher in septic and SNS foals than healthy foals (P<0.05). Hormone concentrations were not different between septic nonsurvivors (n = 14) and survivors (n = 30), but the growth hormone:IGF-1 ratio was lower in nonsurvivors (P = 0.043). CONCLUSIONS Somatotropic axis resistance, characterised by a high growth hormone:IGF-1 ratio, was frequent in sick foals, associated with the energy status (hypoglycaemia, hypertriglyceridaemia) and with mortality in septic foals. POTENTIAL RELEVANCE A functional somatotropic axis appears to be important for foal survival during sepsis. Somatotropic resistance is likely to contribute to severity of disease, a catabolic state and likelihood of recovery.
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Affiliation(s)
- R J I M Barsnick
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, USA
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Armengou L, Jose-Cunilleras E, Ríos J, Cesarini C, Viu J, Monreal L. Metabolic and Endocrine Profiles in Sick Neonatal Foals Are Related to Survival. J Vet Intern Med 2013; 27:567-75. [DOI: 10.1111/jvim.12064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 01/18/2013] [Accepted: 01/30/2013] [Indexed: 12/14/2022] Open
Affiliation(s)
- L. Armengou
- Servei de Medicina Interna Equina and Unitat Equina; Departament de Medicina i Cirurgia Animals; Hospital Clínic Veterinari; Barcelona Spain
| | - E. Jose-Cunilleras
- Servei de Medicina Interna Equina and Unitat Equina; Departament de Medicina i Cirurgia Animals; Hospital Clínic Veterinari; Barcelona Spain
| | - J. Ríos
- Laboratory of Biostatistics & Epidemiology; Universitat Autònoma de Barcelona; Statistics and Methodology Support Unit; IDIBAPS; Hospital Clínic; Barcelona Spain
| | - C. Cesarini
- Servei de Medicina Interna Equina and Unitat Equina; Departament de Medicina i Cirurgia Animals; Hospital Clínic Veterinari; Barcelona Spain
| | - J. Viu
- Servei de Medicina Interna Equina and Unitat Equina; Departament de Medicina i Cirurgia Animals; Hospital Clínic Veterinari; Barcelona Spain
| | - L. Monreal
- Servei de Medicina Interna Equina and Unitat Equina; Departament de Medicina i Cirurgia Animals; Hospital Clínic Veterinari; Barcelona Spain
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41
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Dembek KA, Onasch K, Hurcombe SDA, MacGillivray KC, Slovis NM, Barr BS, Reed SM, Toribio RE. Renin-Angiotensin-aldosterone system and hypothalamic-pituitary-adrenal axis in hospitalized newborn foals. J Vet Intern Med 2013; 27:331-8. [PMID: 23398197 DOI: 10.1111/jvim.12043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 12/03/2012] [Accepted: 12/20/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The renin-angiotensin-aldosterone system (RAAS) and hypothalamic-pituitary-adrenal axis (HPAA) and their interactions during illness and hypoperfusion are important to maintain organ function. HPAA dysfunction and relative adrenal insufficiency (RAI) are common in septic foals. Information is lacking on the RAAS and mineralocorticoid response in the context of RAI in newborn sick foals. OBJECTIVES/HYPOTHESIS To investigate the RAAS, as well as HPAA factors that interact with the RAAS, in hospitalized foals, and to determine their association with clinical findings. We hypothesized that critical illness in newborn foals results in RAAS activation, and that inappropriately low aldosterone concentrations are part of the RAI syndrome of critically ill foals. ANIMALS A total of 167 foals ≤3 days of age: 133 hospitalized (74 septic, 59 sick nonseptic) and 34 healthy foals. METHODS Prospective, multicenter, cross-sectional study. Blood samples were collected on admission. Plasma renin activity (PRA) and angiotensin-II (ANG-II), aldosterone, ACTH, and cortisol concentrations were measured in all foals. RESULTS ANG-II, aldosterone, ACTH, and cortisol concentrations as well as ACTH/aldosterone and ACTH/cortisol ratios were higher in septic foals compared with healthy foals (P < .05). No difference in PRA between groups was found. High serum potassium and low serum chloride concentrations were associated with hyperaldosteronemia in septic foals. CONCLUSIONS AND CLINICAL IMPORTANCE RAAS activation in critically ill foals is characterized by increased ANG-II and aldosterone concentrations. Inappropriately low cortisol and aldosterone concentrations defined as high ACTH/cortisol and ACTH/aldosterone ratios in septic foals suggest that RAI is not restricted to the zona fasciculata in critically ill newborn foals.
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Affiliation(s)
- K A Dembek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
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Muñoz A, Riber C, Trigo P, Gómez-Díez M, Castejón F. Bacterial Endocarditis in Two Spanish Foals After Neonatal Septicemia. J Equine Vet Sci 2012. [DOI: 10.1016/j.jevs.2012.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hurcombe SDA, Matthews AL, Scott VHL, Williams JM, Kohn CW, Toribio RE. Serum protein concentrations as predictors of serum immunoglobulin G concentration in neonatal foals. J Vet Emerg Crit Care (San Antonio) 2012; 22:573-9. [DOI: 10.1111/j.1476-4431.2012.00794.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel D. A. Hurcombe
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Adriel L. Matthews
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Victoria H. L. Scott
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Jarred M. Williams
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Catherine W. Kohn
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Ramiro E. Toribio
- From the Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
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44
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Muñoz A, Riber C, Trigo P, Castejón F. Age- and gender-related variations in hematology, clinical biochemistry, and hormones in Spanish fillies and colts. Res Vet Sci 2012; 93:943-9. [DOI: 10.1016/j.rvsc.2011.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/12/2011] [Accepted: 11/29/2011] [Indexed: 11/29/2022]
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Gold JR, Cohen ND, Welsh TH. Association of adrenocorticotrophin and cortisol concentrations with peripheral blood leukocyte cytokine gene expression in septic and nonseptic neonatal foals. J Vet Intern Med 2012; 26:654-61. [PMID: 22443385 DOI: 10.1111/j.1939-1676.2012.00910.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 01/26/2012] [Accepted: 02/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) is influenced by the proinflammatory cytokines IL-6, IL-1β, and TNF-α in critically ill humans. Information about the association of cytokines with the HPA axis in neonatal foals is lacking. HYPOTHESIS/OBJECTIVES The objectives were to describe for hospitalized septic and nonseptic foals (1) temporal changes in blood concentrations of ACTH, and cortisol, and leukocyte cytokine gene expression, and (2) coassociation of these HPA axis hormones with blood leukocyte cytokine gene expression. ANIMALS Hospitalized septic foals (N = 15) and hospitalized nonseptic foals (N = 11). METHODS Blood samples, obtained from study foals at admission (T = 0), and 24 (T = 1), 48 (T = 2), 72 (T = 3), and 96 (T = 4) hours after admission, were processed to isolate RNA from leukocytes and to harvest plasma and serum for hormone assays. Plasma ACTH and serum cortisol concentrations were determined by radioimmunoassay. Leukocyte mRNA expression of IL-1β IL-6, IL-8, IL-10, and TNF-α was determined using RT-PCR. RESULTS Cortisol concentrations were greater (P < .05) in foals at admission than at other time points. The expressions of IL-8 and IL-10 mRNA were lower (P < .05) at each time point in septic than in nonseptic foals. Among septic foals, ACTH was positively associated (P = .0026) with IL-6 mRNA expression. CONCLUSIONS Sepsis influences secretion of the HPA axis hormones and expression of cytokines in foals. A positive association with the HPA axis and IL-6 expression was detected. The clinical importance of these findings requires additional study.
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Affiliation(s)
- J R Gold
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, TX, USA.
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Stewart AJ, Behrend EN, Wright JC, Martin LG, Kemppainen RJ, Busch KA, Hanson RR. Validation of a low-dose ACTH stimulation test in healthy adult horses. J Am Vet Med Assoc 2012; 239:834-41. [PMID: 21916767 DOI: 10.2460/javma.239.6.834] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the lowest ACTH dose that would induce a maximum increase in serum cortisol concentration in healthy adult horses and identify the time to peak cortisol concentration. DESIGN Evaluation study. ANIMALS 8 healthy adult horses. PROCEDURES Saline (0.9% NaCl) solution or 1 of 4 doses (0.02, 0.1, 0.25, and 0.5 μg/kg [0.009, 0.045, 0.114, and 0.227 μg/lb]) of cosyntropin (synthetic ACTH) were administered IV (5 treatments/horse). Serum cortisol concentrations were measured before and 30, 60, 90, 120, 180, and 240 minutes after injection of cosyntropin or saline solution; CBCs were performed before and 30, 60, 120, and 240 minutes after injection. RESULTS For all 4 doses, serum cortisol concentration was significantly increased, compared with the baseline value, by 30 minutes after administration of cosyntropin; no significant differences were detected among maximum serum cortisol concentrations obtained in response to administration of doses of 0.1, 0.25, and 0.5 μg/kg. Serum cortisol concentration peaked 30 minutes after administration of cosyntropin at a dose of 0.02 or 0.1 μg/kg, with peak concentrations 1.5 and 1.9 times, respectively, the baseline concentration. Serum cortisol concentration peaked 90 minutes after administration of cosyntropin at a dose of 0.25 or 0.5 μg/kg, with peak concentrations 2.0 and 2.3 times, respectively, the baseline concentration. Cosyntropin administration significantly affected WBC, neutrophil, and eosinophil counts and the neutrophil-to-lymphocyte ratio. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in healthy horses, administration of cosyntropin at a dose of 0.1 μg/kg resulted in maximum adrenal stimulation, with peak cortisol concentration 30 minutes after cosyntropin administration.
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Affiliation(s)
- Allison J Stewart
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
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Zetterling M, Engström BE, Hallberg L, Hillered L, Enblad P, Karlsson T, Ronne Engström E. Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage. Br J Neurosurg 2012; 25:684-92. [PMID: 22115015 DOI: 10.3109/02688697.2011.584638] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE An adequate response of hypothalamic-pituitary-adrenal (HPA) axis is important for survival and recovery after a severe disease. The hypothalamus and the pituitary glands are at risk of damage after subarachnoid haemorrhage (SAH). A better understanding of the hormonal changes would be valuable for optimising care in the acute phase of SAH. PATIENTS Fifty-five patients with spontaneous SAH were evaluated regarding morning concentrations of serum (S)-cortisol and P-adrenocorticotropic hormone (ACTH) 7 days after the bleeding. In a subgroup of 20 patients, the diurnal changes of S-cortisol and P-ACTH were studied and urine (U)-cortisol was measured. The relationships of hormone concentrations to clinical and radiological parameters and to outcome were assessed. RESULTS S-cortisol and P-ACTH were elevated the day of SAH. S-cortisol concentrations below reference range were uncommon. Early global cerebral oedema was associated with higher S-cortisol concentrations at admission and a worse World Federation of Neurological Surgeons (WFNS) and Reaction Level Scale 85 grade. Global cerebral oedema was shown to be a predictor of S-cortisol at admittance. Patients in better WFNS grade displayed higher U-cortisol. All patients showed diurnal variations of S-cortisol and P-ACTH. A reversed diurnal variation of S-cortisol was more frequently found in mechanically ventilated patients. Periods of suppressed P-ACTH associated with S-cortisol peaks occurred especially in periods of secondary brain ischaemia. CONCLUSION There was an HPA response acutely after SAH with an increase in P-ACTH and S-cortisol. Higher U-cortisol in patients in a better clinical grade may indicate a more robust response of the HPA system. Global cerebral oedema was associated with higher S-cortisol at admission and was a predictor of S-cortisol concentrations. Global cerebral oedema may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischaemia, indicating a possible connection between brain ischaemia and ACTH suppression.
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Affiliation(s)
- Maria Zetterling
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Sweden.
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HIMLER M, HURCOMBE SDA, GRIFFIN A, BARSNICK RJ, RATHGEBER RA, MACGILLIVRAY KC, TORIBIO RE. Presumptive nonthyroidal illness syndrome in critically ill foals. Equine Vet J 2012:43-7. [DOI: 10.1111/j.2042-3306.2011.00480.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
FOWDEN AL, FORHEAD AJ, OUSEY JC. Endocrine adaptations in the foal over the perinatal period. Equine Vet J 2012:130-9. [DOI: 10.1111/j.2042-3306.2011.00505.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
50
|
Johnson PJ, LaCarrubba AM, Messer NT, DeClue AE. Neonatal respiratory distress and sepsis in the premature foal: Challenges with diagnosis and management. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2011.00365.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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