Superglue to Close Intestinal Surgery???

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Surgical adhesive to close enterotomies? Read on…

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Better Way to Predict Splenic Cancer in Dogs?

This comprehensive study evaluates the effectiveness of two scoring systems, the HeLP score and the T-STAT, designed to predict hemangiosarcoma and malignancy in dogs with splenic masses. Here are the key points: 

5. HeLP Score (Hemangiosarcoma Likelihood Prediction Model): 

• Developed for dogs with nontraumatic hemoperitoneum from any organ, utilizing variables such as body weight, plasma protein, platelet count, and thoracic radiograph findings. 

• The cumulative HeLP score shows better predictive ability (AUC of 0.79 in the external validation group) than the categorical score (AUC of 0.73) for diagnosing hemangiosarcoma, particularly in distinguishing dogs with nontraumatic hemoperitoneum. 

• The model indicates that dogs with higher platelet counts are less likely to be correctly categorized by risk level, showing that platelet count is a nonspecific marker. 

6. T-STAT (Tufts Splenic Tumor Assessment Tool): 

• Estimates the probability of malignancy in dogs with splenic masses, with or without hemoperitoneum, based on multiple variables including bloodwork and imaging findings. 

• The T-STAT showed poorer performance (AUC of 0.68 in the validation group) in accurately predicting malignant lesions compared to the HeLP score. 

• The variables used in T-STAT, such as splenic mass diameter and number of hepatic nodules, are criticized for their lack of specificity in differentiating between malignancy types. 

7. Comparison and Performance: 

• The study found that the cumulative HeLP score performed acceptably in predicting hemangiosarcoma, whereas the T-STAT had poor discrimination in distinguishing between malignant and benign splenic masses. 

• Neither scoring system should be used as the sole basis for clinical decision-making but rather in conjunction with a comprehensive clinical evaluation. 

8. Limitations and Future Directions: 

• A significant number of dogs were excluded from the analysis due to missing essential data, highlighting the need for complete clinical records. 

• The study suggests that development of more specific and discriminating calculators, possibly incorporating new biomarkers, could enhance the predictability of splenic mass etiology in dogs. 

Overall, while the HeLP score shows relatively better performance and reliability, particularly for hemangiosarcoma prediction, both scoring systems face challenges in specificity and accuracy, necessitating further refinement and validation in broader dog populations. 

Hillier, T. N., Grimes, J. A., Wallace, M. L., Sutherland, B. J., & Schmiedt, C. W. (2024). Improved predictability is needed for calculators used to preoperatively determine the etiology of splenic masses in dogs: an external validation study of the HeLP score and T-STAT. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.01.0016 

Bottom line — Can provide guidance but we still need a better system.

Gene Therapy for Arthritis in Horses.

The article discusses the use of scAAVIL-1ra gene therapy in an equine model to treat posttraumatic osteoarthritis (PTOA), which is prevalent in horses and a significant cause of retirement in sport horses. The therapy involves using scAAV vectors to deliver the IL-1 receptor antagonist (IL-1ra) gene directly into the joints, thereby counteracting the inflammatory effects of IL-1β, a key mediator in PTOA. This approach aims to provide a long-term increase in IL-1ra levels within the joint. 

Key findings from the study include: 

1. Therapeutic Levels of IL-1ra: The gene therapy resulted in therapeutic or supra-therapeutic levels of IL-1ra in treated joints for up to 70 days, far surpassing the duration achieved by traditional protein therapies. 

2. Clinical Improvements: Treated joints showed significant improvements in clinical parameters such as lameness, reductions in PGE2 (a marker of inflammation), and enhancements in cartilage and subchondral bone histology. 

3. Safety and Side Effects: Although the treatment led to desirable anti-inflammatory effects, it also caused some adverse reactions including lymphocyte perivascular cuffing, synovial fibrosis, and osteophyte formation, which were attributed to an immune response to the viral vector used. 

4. Potential for Dose Reduction: The study suggests that lower doses of the vector could be effective, potentially reducing side effects, since the CMV promoter used in the vector may be upregulated by the inflammatory environment in osteoarthritic joints, enhancing IL-1ra production. 

Overall, the research supports the potential of scAAVIL-1ra gene therapy as a promising treatment for PTOA in horses, with implications for future clinical trials and possibly extending to human treatments. Further research is needed to optimize dosing and minimize adverse effects to ensure safety and efficacy in larger scale clinical applications. 

Goodrich, L. R., McIlwraith, C. W., Grieger, J., Kraus, V. B., Stabler, T., Werpy, N., Phillips, J., Samulski, R. J., & Frisbie, D. (2024). IL-1ra gene therapy in equine osteoarthritis improves physiological, anatomical, and biological outcomes of joint degeneration. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.02.0078 

Bottom line — Early results support this as a beneficial tool in the future.

Surgical Adhesive to Close Enetrotomies

This study investigates the effectiveness of different enterotomy closure techniques in preventing intestinal leakage in a canine cadaveric model. The techniques compared were handsewn enterotomy (HSE), cyanoacrylate enterotomy (CE), and a combination of handsewn and cyanoacrylate enterotomy (HS + CE). The primary metrics assessed were initial leak pressures (ILP) and maximal intraluminal pressures (MIP), with a focus on where the leaks originated (initial leak location, ILL). 

The results showed that the combined HS + CE technique provided significantly higher ILP compared to HSE alone or CE alone, suggesting it's more effective at preventing leaks. The study also noted that leaks primarily occurred at the suture holes in the HSE group, while the HS + CE group showed fewer leaks from the suture holes, indicating that cyanoacrylate may help seal these potential leak points. 

Despite the effectiveness of cyanoacrylate in enhancing leak resistance, the study suggests that it should not replace sutures entirely but could be beneficial as an adjunct in high-risk cases to reduce postoperative complications like intestinal leakage and dehiscence. The findings pave the way for further research on the clinical safety and practical application of surgical sealants in veterinary medicine. 

Thompson J-L, Miller L, Bowlt Blacklock K. Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies. Veterinary Surgery. 2024; 53(2): 367-375. doi:10.1111/vsu.14059 

Bottom line — Potentially helpful in certain situations. More study is needed.

Just putting things in perspective …