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Lexington, KY, United States

McCarrel T.M.,Rood and Riddle Equine Hospital | Minas T.,Brigham and Womens Hospital | Fortier L.A.,Cornell University
Journal of Bone and Joint Surgery - Series A | Year: 2012

Background: Numerous methods are available for platelet-rich plasma (PRP) generation, but evidence defining the optimum composition is lacking. We hypothesized that leukocyte-reduced PRP would result in lower inflammatory cytokine expression compared with concentrated-leukocyte PRP and that maintaining the platelet:white blood cell (WBC) ratio would compensate for the effect of increased WBC concentration. Methods: Blood and flexor digitorum superficialis tendons were collected from young adult horses. Three PRP groups were generated with the same platelet concentration but different WBC concentrations: intermediate-concentration standard PRP, leukocyte-reduced PRP, and concentrated-leukocyte PRP. An additional high-concentration PRP group was generated with the same WBC concentration as the concentrated-leukocyte PRP group and the same platelet:WBC ratio as the standard PRP group. The PRP groups were used as media for flexor digitorum superficialis tendon explants in culture for seventy-two hours with 10% plasma in Dulbecco modified Eagle medium (DMEM) serving as control. Tendon gene expression for collagen types I (COL1A1) and III (COL3A1), cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP-13), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) was performed. Results: The desired PRP groups were successfully generated. The expression of COMP, the COL1A1:COL3A1 ratio, and the expression of MMP-13 in flexor digitorum superficialis tendon explants was not different between PRP groups. The expression of COMP (p = 0.0027) and the COL1A1:COL3A1 ratio (p < 0.0001) were increased in the PRP groups as compared with the control group, and the expression of MMP-13 was decreased in the PRP groups as compared with the control group (p < 0.0001). The expression of IL-1β was lowest in leukocyte-reduced PRP and highest in concentrated-leukocyte PRP (p = 0.0001). The leukocyte-reduced PRP group and the control group had the lowest TNF-α expression, whereas the high-concentration PRP and concentrated-leukocyte PRP groups had the highest expression (p = 0.0224). Conclusions: A high absolute WBC concentration in PRP contributes to the expression of inflammatory cytokines in flexor digitorum superficialis tendon explants, and maintenance of the platelet:WBC ratio is not able to counteract this effect. Clinical Relevance: The optimum composition of PRP for the treatment of tendinopathy has not been directly investigated. Persistent inflammation results in inferior repair with scar tissue. The present study indicates that in an animal model, WBC in PRP contributes to inflammatory cytokine production. Therefore, leukocyte-reduced PRP may be the optimum preparation to stimulate superior healing without scar tissue formation. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated. Source

LeBlanc M.M.,Rood and Riddle Equine Hospital
Reproduction in Domestic Animals | Year: 2010

Contents: Rapid physical uterine clearance is paramount for fertility. Mares that are unable to clear the by-products of insemination or foaling quickly may develop post-mating-induced or acute endometritis. If endometritis is not promptly resolved, the infection can become chronic. Endometritis can be difficult to identify because clinical signs, ultrasonographic and laboratory findings can vary between uterine pathogens. Some micro-organisms are associated with an influx of neutrophils and fluid into the uterine lumen while others are associated with only heavy debris on cytological specimens. Identifying the inciting cause may require more than swabbing the endometrium. Culturing endometrial biopsy tissue or uterine fluids are more sensitive methods for identifying Escherichia coli than culture swab while endometrial cytology identifies twice as many mares with acute inflammation than uterine culture swab. While post-mating-induced endometritis is classically treated with uterine irrigation and ecbolics and acute endometritis is treated with either systemic or intra-uterine antibiotics, these therapies are not always effective in resolving chronic uterine inflammation or infections. Mucolytics can be used to break up mucus produced by an irritated endometrium, steroids can modulate the inflammatory response associated with insemination and buffered chelating agents can remove biofilm, a protective mechanism used primarily by gram-negative organisms and yeast to evade the host immune response. © 2010 Blackwell Verlag GmbH. Source

Reed S.M.,Rood and Riddle Equine Hospital | Reed S.M.,University of Kentucky | Howe D.K.,University of Kentucky | Morrow J.K.,Equine Diagnostic Solutions LLC | And 7 more authors.
Journal of Veterinary Internal Medicine | Year: 2013

Background: Recent work demonstrated the value of antigen-specific antibody indices (AI and C-value) to detect intrathecal antibody production against Sarcocystis neurona for antemortem diagnosis of equine protozoal myeloencephalitis (EPM). Objectives: The study was conducted to assess whether the antigen-specific antibody indices can be reduced to a simple serum : cerebrospinal fluid (CSF) titer ratio to achieve accurate EPM diagnosis. Animals: Paired serum and CSF samples from 128 horses diagnosed by postmortem examination. The sample set included 44 EPM cases, 35 cervical-vertebral malformation (CVM) cases, 39 neurologic cases other than EPM or CVM, and 10 non-neurologic cases. Methods: Antibodies against S. neurona were measured in serum and CSF pairs using the SnSAG2 and SnSAG4/3 (SnSAG2, 4/3) ELISAs, and the ratio of each respective serum titer to CSF titer was determined. Likelihood ratios and diagnostic sensitivity and specificity were calculated based on serum titers, CSF titers, and serum : CSF titer ratios. Results: Excellent diagnostic sensitivity and specificity was obtained from the SnSAG2, 4/3 serum : CSF titer ratio. Sensitivity and specificity of 93.2 and 81.1%, respectively, were achieved using a ratio cutoff of ≤100, whereas sensitivity and specificity were 86.4 and 95.9%, respectively, if a more rigorous cutoff of ≤50 was used. Antibody titers in CSF also provided good diagnostic accuracy. Serum antibody titers alone yielded much lower sensitivity and specificity. Conclusions and Clinical Importance: The study confirms the value of detecting intrathecal antibody production for antemortem diagnosis of EPM, and they further show that the antigen-specific antibody indices can be reduced in practice to a simple serum : CSF titer ratio. © 2013 by the American College of Veterinary Internal Medicine. Source

McCarrel T.M.,Rood and Riddle Equine Hospital | Mall N.A.,Rush University Medical Center | Lee A.S.,Rush University Medical Center | Cole B.J.,Rush University Medical Center | And 2 more authors.
Sports Medicine | Year: 2014

The use of platelet-rich plasma (PRP) is expanding to numerous medical fields, including orthopedic surgery and sports medicine. The popularity of this new treatment option has prompted a rapid increase in research endeavors; however, the differences in application technique and the composition of PRP have made it difficult to compare results or make any firm conclusions regarding efficacy. The purpose of this article is twofold. First, to recommend details that should be provided in basic science and clinical PRP studies to allow meaningful comparisons between studies which may lead to a better understanding of efficacy. Second, to provide an understanding of the different PRP preparations and their clinical relevance. There are biochemical rationales for the use of PRP because it addresses several aspects of the healing process, including cell proliferation and tissue matrix regeneration, inflammation, nociception, infection, and hemostasis, all of which will be addressed. Given the current understanding of the importance the composition of PRP plays in tissue regeneration, it is likely that our future understanding of PRP will dictate 'customizing' the PRP preparation to the specific pathology of interest. The potential complications following PRP use are minor, and thus it appears to be a safe treatment option with a variety of potentially beneficial effects to injured musculoskeletal tissues. © 2014 Springer International Publishing Switzerland. Source

Troy J.R.,Rood and Riddle Equine Hospital | Bergh M.S.,Iowa State University
Journal of Veterinary Medical Education | Year: 2015

Canine cranial cruciate ligament rupture (CCLR) is the most common cause of pelvic limb lameness in dogs. CCLR results in palpable stifle instability secondary to cranial translation of the tibial relative to the femur, and it can be diagnosed during the orthopedic exam using the cranial drawer test (CDT) and tibial compression test (TCT). Accurate diagnosis of CCLR depends on the efficacy in performing these tests. In this study, two threedimensional canine pelvic limb models were developed: one simulating a normal stifle and one simulating CCLR. Thirty-eight veterinary student participants answered questionnaires and performed both the CDT and TCT on a randomly assigned model. Twenty-one participants also manipulated the models one week later to assess skill retention in the short term. Mean levels of reported confidence in diagnosing CCLR and finding anatomic landmarks for CDT/TCT were significantly higher following model manipulation. Nearly all participants reported that they desired a model for teaching the diagnosis of CCLR. Most participants (92.5%) felt that the tested model would be useful for teaching CCLR diagnosis. Accuracy in diagnosing CCLR with the TCT significantly improved over time. Participant response indicated that while the tested model was effective and desirable, an ideal model would be more durable and lifelike. Further studies are needed to evaluate the developed models' effectiveness for teaching CCLR diagnosis compared to traditional teaching methods. © 2015 AAVMC. Source

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