Topic:Cytology

Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019).
Journal of veterinary internal medicine    April 15, 2024   doi: 10.1111/jvim.17084
Craven A, Todd-Donato A, Stokol T, Liepman R, Glasberg I, Wilkins P, Luethy D, Wong D, Schoster A, van den Brom-Spierenburg AJ, Tomlinson JE.Prognostic indicators for equine multinodular pulmonary fibrosis (EMPF), an interstitial fibrosing lung disease, are poorly described. Objective: Describe diagnostic findings and outcome predictors for EMPF. Methods: Forty-six adult horses with EMPF. Methods: Retrospective multicenter case series from 2009 to 2019. Radiographic (n = 27) and ultrasonographic studies (n = 19) from EMPF horses and bronchoalveolar lavage fluid (BALF) cytology from 6 EMPF and 13 asthma cases were independently reviewed and blinded to diagnosis and outcome. Associations between predictor variables and surviv...
A cross-sectional observational study of birefringent particulates in bronchoalveolar lavage cytology in horses with equine asthma from the West v East coasts of the USA.
PloS one    April 4, 2024   Volume 19, Issue 4 e0297181 doi: 10.1371/journal.pone.0297181
Mazan MR, Deveney EF.Equine asthma (EA) is an important cause of wastage in the USA horse industry. Exposure to organic particulates, from stable dust, airborne pollen, and fungal loads, is posited to be the main cause. Dust arising from the earth's crust has been largely ignored as a contributor to EA in the veterinary literature. The objectives of this study were to investigate the occurrence of birefringent particulates in the bronchoalveolar lavage fluid (BALF) of horses with a clinical complaint of EA residing in the arid West of the USA v. the East, in an effort to determine the contribution of geolocation t...
The interaction between seminal plasma, sperm, and endometrium in inter- and intra-species breeding in equids.
Reproduction (Cambridge, England)    April 1, 2024   REP-23-0472 doi: 10.1530/REP-23-0472
Podico G, Bittar JH, Loux SC, Souza FF, Canisso IF.Anecdotal experience suggests horse mares have less post-breeding inflammation and better fertility when bred with donkeys. This study aimed to compare the post-breeding inflammatory response of mares exposed to donkey and horse semen and seminal plasma and evaluate the proteome and metabolome of donkey and horse sperm and seminal plasma. Uterine edema, intrauterine fluid accumulation, PMNs on cytology, and concentrations of progesterone, and pro- and anti-inflammatory cytokines (IL1, IL1, IL4, IL6, CXCL8, IL10) concentrations were assessed pre-and post-infusion of semen and seminal plas...
Equine Asthma Does Not Affect Circulating Myostatin Concentrations in Horses.
Animals : an open access journal from MDPI    March 4, 2024   Volume 14, Issue 5 799 doi: 10.3390/ani14050799
Kowalik S, O'reilly M, Niedu017awiedu017a A, Ku0119dzierski W.(1) Background: The number of horses suffering from chronic respiratory diseases, resembling human asthma, is increasing but there is still a lack of reliable and accurate methods to detect these disorders. Numerous studies have found elevated plasma concentrations of one of the myokines, namely, myostatin (MSTN), in people suffering from severe asthma. MSTN normally inhibits myoblast proliferation and differentiation through autocrine or paracrine signals. Therefore, given the pathogenesis of asthma, we hypothesize that MSTN could be a useful biomarker of equine asthma. Thus, this study aimed...
Metastatic cutaneous myxosarcoma in an adult horse.
Veterinary clinical pathology    March 3, 2024   Volume 53, Issue 1 116-121 doi: 10.1111/vcp.13329
Rabelo AA, Maranhu00e3o RPA, de Miranda ALS, Ocarino NM, Amaral CI, Paes PRO, Monteiro NCC, Fantini P.A 25-year-old mixed-breed equine with separate nodular cutaneous lesions in the right thoracic limb (RTL) and right ventral abdominal region was admitted to a Veterinary Hospital in Belo Horizonte, Minas Gerais. Fine-needle aspiration cytology was performed on the RTL lesion and superficial cervical lymph node, and the results were suggestive of a malignant neoplasm known as myxosarcoma. Due to the unfavorable prognosis, the animal was euthanized. Based on the macroscopic and microscopic findings, the diagnosis of metastatic cutaneous myxosarcoma was confirmed. Although rare, this tumor should...
Evaluation of bronchoalveolar lavage fluid from donkeys using four different cytological stains: a pilot study.
Journal of equine veterinary science    February 27, 2024   105035 doi: 10.1016/j.jevs.2024.105035
Vitale V, Bindi F, Briganti A, Bonelli F, Parietti C, Sgorbini M.Bronchoalveolar lavage fluid (BALF) cytology is used for the diagnosis of non-infectious lower airway inflammation in equids. Discrepancies have been reported in the differential cell count when different staining methods were used both in humans and horses. The objective of this study was to compare the results of BALF cytology in donkeys using four different staining methods: modified May-Grunwald Giemsa (mMGG), Diff-Quick (DQ), Toluidine blue (TB) and Perls Prussian blue (PPB). Nine healthy Amiata female donkeys were enrolled. The BAL procedure was performed as previously described and pair...
Cytokine mRNA expression in the bronchoalveolar lavage cells from horses affected by different equine asthma subtypes.
Journal of equine veterinary science    February 27, 2024   Volume 135 105033 doi: 10.1016/j.jevs.2024.105033
Equine asthma (EA) is a respiratory syndrome associated with the increase of different leukocyte populations in the bronchoalveolar lavage fluid (BALF). Its pathogenetic mechanisms remain unclear. This study aimed to evaluate the associations between the mRNA expression of different cytokines in the BALF, different EA subtypes and lung function. Fifteen horses underwent physical examination, airway endoscopy, BALF cytology and lung function testing (8/15). One horse did not have evidence of EA and was used as healthy reference, while the others were classified as affected by neutrophilic or mi...
Histologic and cytologic changes in normal equine joints after injection with 2.5% injectable polyacrylamide hydrogel reveal low-level macrophage-driven foreign body response.
Journal of the American Veterinary Medical Association    February 21, 2024   1-9 doi: 10.2460/javma.23.10.0553
Lowe J, Clifford L, Julian A, Koene M.The data presented in this paper are derived from an in vivo study performed to characterize the nature of the synovial integration process of a 2.5% synthetic cross-linked injectable polyacrylamide hydrogel (2.5 iPAAG) injected IA in horses. Methods: 10 healthy horses not suffering from OA or signs of joint disease were administered 50 or 100 mg 2.5 iPAAG in a total of 13 metacarpophalangeal or middle carpal joints. Methods: Injected joints were examined at 0, 14, 42, and/or 90 days postinjection. Parameters investigated included clinical examination, synoviocentesis, gross pathology, histolo...
Metagenomic analysis unravels novel taxonomic differences in the uterine microbiome between healthy mares and mares with endometritis.
Veterinary medicine and science    February 15, 2024   Volume 10, Issue 2 e1369 doi: 10.1002/vms3.1369
Virendra A, Gulavane SU, Ahmed ZA, Reddy R, Chaudhari RJ, Gaikwad SM, Shelar RR, Ingole SD, Thorat VD, Khanam A, Khan FA.The application of high throughput technologies has enabled unravelling of unique differences between healthy mares and mares with endometritis at transcriptomic and proteomic levels. However, differences in the uterine microbiome are yet to be investigated. Objective: The present study was aimed at evaluating the differences in uterine microbiome between healthy mares and mares with endometritis. Methods: Low-volume lavage (LVL) samples were collected from the uterus of 30 mares classified into healthy (n = 15) and endometritis (n = 15) based on their reproductive history, intrauterine fl...
Multicentric lymphoma in a donkey with intestinal and bone marrow involvement.
BMC veterinary research    February 15, 2024   Volume 20, Issue 1 57 doi: 10.1186/s12917-024-03903-5
Paraschou G, Xue C, Egan R, Bolfa P.Lymphoma is a common neoplasm in horses but is reported much less commonly in donkeys. In this case report, we describe the macroscopic, microscopic and immunohistochemical features of a multicentric lymphoma with intestinal and bone marrow involvement. Methods: A geriatric female donkey with history of chronic lameness was found dead. Post-mortem examination revealed advanced emaciation, periodontal disease, left front foot laminitis and multiple, soft, white to yellow tan intestinal transmural masses, up to 12 cm in diameter. Cytology suggested a round cell intestinal neoplasm. The femur of...
Cytological diagnosis of exercise-induced pulmonary haemorrhage: Comparison of tracheal wash and bronchoalveolar lavage in standardbred racehorses.
The Veterinary record    January 30, 2024   e3826 doi: 10.1002/vetr.3826
Barbazanges P, Richard EA, Lemonnier LC, Wouters CP, Toquet MP, Couroucu00e9 A.Cytology of airway samples is sensitive for diagnosis of exercise-induced pulmonary haemorrhage (EIPH), but the association between tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) is unknown. The objective of this study was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M) ratio, differs when based on TW or BALF. Methods: A prospective cross-sectional study was conducted on 102 standardbred horses in training. TW and BALF were collected concomitantly from all horses at rest (at least 24 hours after their last training or race), and their H/M ratios w...
Respiratory oscillometry testing in relation to exercise in healthy and asthmatic Thoroughbreds.
Equine veterinary journal    January 21, 2024   doi: 10.1111/evj.14065
Racehorses may experience exercise-induced bronchodilation or bronchoconstriction, with potential differences between healthy and asthmatic individuals. Objective: To identify exercise-related lung function variations by oscillometry in racehorses, compare lung function between healthy and mild equine asthma (MEA) horses, assess oscillometry's potential as a predictor of racing fitness. Methods: Prospective case-control clinical study. Methods: Fourteen Thoroughbred racehorses (5 healthy, 9 MEA) underwent a protocol including respiratory oscillometry at rest, exercise with fitness monitoring, ...
Equine ulcerative keratitis in the Netherlands (2012-2021): Bacterial and fungal isolates and antibiotic susceptibility.
Equine veterinary journal    January 14, 2024   doi: 10.1111/evj.14059
Verdenius CY, Slenter IJM, Hermans H, Broens EM, Djajadiningrat-Laanen SC.Ulcerative keratitis is a common ophthalmic disease in horses which can be complicated by microbial infection and requires immediate, accurate treatment to prevent loss of visual function or the eye. Objective: To report the results of microbial cultures, antibiotic susceptibility tests and corneal cytology in horses with ulcerative keratitis presented to a referral clinic, to assess agreement between cytology and culture results, to investigate whether previous topical treatment affected microbial culture results and whether the incidence of antimicrobial resistance changed during the study p...
Lower airway ultrasonographic, endoscopic, and cytological changes in horses undergoing inhalation anesthesia with controlled ventilation for minor elective surgeries.
Journal of equine veterinary science    December 21, 2023   Volume 132 104986 doi: 10.1016/j.jevs.2023.104986
Laclaire AL, Manguin E, Tanquerel L.Effects of general anesthesia with controlled ventilation on the respiratory system have had limited evaluation in horses. A prospective observational study was performed with eleven client-owned horses undergoing elective surgery. Physical examination, auscultation with a rebreathing bag, complete blood cell count, lung ultrasound imaging, tracheal endoscopy imaging and transendoscopic tracheal wash were conducted before and 24 hours after anesthesia. Lung ultrasound imaging was also repeated just after recovery. A significant increase in blood neutrophil count between pre- and post-anesthesi...
Macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia in horses with equine herpesvirus-2 and equine herpesvirus-5 infections.
Veterinary ophthalmology    December 5, 2023   doi: 10.1111/vop.13171
Ledbetter EC, Cutler TJ, Irby NL.The aim of this study was to describe the clinical, confocal microscopic, histologic, and virologic features of horses with macrodendritic ulcerative keratitis and conjunctival lymphoid hyperplasia associated with equine herpesvirus-2 and equine herpesvirus-5 infection. Methods: Four foals with bilateral ocular disease. Methods: Complete ophthalmic examination was performed for each horse, and corneal samples were collected for cytology and microbiologic evaluation, including virus isolation and molecular diagnostics for the equine herpesviruses. In vivo confocal microscopy examination of the...
A Longitudinal Analysis of Equine Asthma Presentation and Response to Treatment Using Lung Function Testing and BAL Cytology Analysis in Combination with Owner Perception.
Animals : an open access journal from MDPI    November 1, 2023   Volume 13, Issue 21 3387 doi: 10.3390/ani13213387
Robins TJ, Bedenice D, Mazan M.(1) Background: Equine asthma (EA) is a pervasive and important cause of poor performance and respiratory morbidity in horses. Diagnosis of EA includes an owner complaint, clinical scoring, lung function testing, and cytological analysis of bronchoalveolar lavage (BAL) cytology. There is a paucity of information about the longitudinal course of the disease using these outcome assessments; thus, this study sought to describe and quantify, in horses with more than one visit to a specialty pulmonary clinic in New England, the type and range of clinical presentations with an eventual diagnosis of ...
Intra-articular bone marrow mononuclear cell therapy improves lameness from naturally occurring equine osteoarthritis.
Frontiers in veterinary science    October 9, 2023   Volume 10 1256284 doi: 10.3389/fvets.2023.1256284
Everett JB, Menarim BC, Barrett SH, Bogers SH, Byron CR, Pleasant RS, Werre SR, Dahlgren LA.Osteoarthritis (OA) can be debilitating and is related to impaired resolution of synovial inflammation. Current treatments offer temporary relief of clinical signs, but have potentially deleterious side effects. Bone marrow mononuclear cells (BMNC) are a rich source of macrophage progenitors that have the ability to reduce OA symptoms in people and inflammation in experimentally-induced synovitis in horses. The objective of this study was to evaluate the ability of intra-articular BMNC therapy to improve clinical signs of naturally occurring equine OA. Horses presenting with clinical and radio...
Detection of fungi in the airways of horses according to the sample site: a methodological study.
Veterinary research communications    September 13, 2023   doi: 10.1007/s11259-023-10213-y
Lemonnier LC, Couroucu00e9 A, Cessans M, Petit L, Cardwell JM, Barbazanges P, Toquet M-, Richard EA.Fungal detection in equine airways may be performed on either tracheal wash (TW) or bronchoalveolar lavage fluid (BALF) by either cytology or culture. However, method comparisons are sparse. Our objective was to determine the prevalence of fungi in airways of horses according to the sample site and laboratory methodology. Sixty-two adult horses, investigated in the field or referred for respiratory disease, were included. Tracheal wash, and BALF collected separately from both lungs, were collected using a videoendoscope. Fungi were detected in cytologic samples examined by light microscopy, an...
Visualizing neutrophil extracellular traps in septic equine synovial and peritoneal fluid samples using immunofluorescence microscopy. Birckhead EM, Das S, Tidd N, Raidal SL, Raidal SR.Septic synovitis and peritonitis are routinely diagnosed in horses based on clinical examination findings and laboratory assessment of synoviocentesis and abdominocentesis samples, respectively. Diagnosis is difficult in some cases because of an overlap in laboratory results for septic and non-septic inflammation. Neutrophil extracellular trap (NET) formation is part of the innate immune response against pathogens. Identifying and quantifying NETs, which have not been explored in clinical samples from horses with septic synovitis and peritonitis, to our knowledge, may be helpful in detecting i...
Bronchoalveolar Lavage Cytology in Severe Equine Asthma: Cytocentrifugated versus Sediment Smear Preparations.
Veterinary sciences    August 16, 2023   Volume 10, Issue 8 527 doi: 10.3390/vetsci10080527
Morini M, Gobbo F, Rinnovati R, Romagnoli N, Peli A, Massarenti C, Spadari A, Pietra M.Equine asthma is a common respiratory disease that may affect horses of any age. The diagnosis of severe equine asthma (SEA) (historically referred as recurrent airway obstruction or RAO) is based mainly on the history of the animal and clinical signs, which are further supported by the cytological examination of the bronchoalveolar lavage (BAL). This can also be helpful in monitoring the inflammation of the lower airways in response to environmental management and medication. The cytocentrifugated preparation is usually considered the method of choice for BAL cytological interpretation. The a...
Effect of Lavage Solution Type on Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses.
Animals : an open access journal from MDPI    August 15, 2023   Volume 13, Issue 16 2637 doi: 10.3390/ani13162637
Westermann CM, de Bie AG, Olave C, de Grauw JC, Teske E, Couetil LL.Equine bronchoalveolar lavage (BAL) is usually performed with 250-500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer's solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148 have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed tw...
Lymphocyte immunophenotyping and concentration of MMP-9 in transudates and exudates in horses.
Veterinary immunology and immunopathology    August 12, 2023   Volume 263 110645 doi: 10.1016/j.vetimm.2023.110645
Hamouzovu00e1 P, Dobeu0161ovu00e1 O, u0158ehu00e1kovu00e1 K, Stehlu00edkovu00e1 u0160, u010cu00edu017eek P, Dru00e1bkovu00e1 Z, Jahn P, Doubek J.This study is the first to provide information on the lymphocyte subpopulations in peritoneal effusions in horses. Peritoneal transudates (n = 12), peritoneal exudates (n = 6) and a pleural exudate (n = 1) were analyzed. The total nucleated cell count (TNCC), total protein (TP) and matrix metalloproteinase-9 (MMP-9) concentration determined by ELISA were measured and routine cytological evaluation was performed. CD3, CD4, CD8 and CD21 positive cells were detected by flow cytometry. A higher percentage of neutrophils (P < 0.05) and higher MMP-9 (P < 0.01) levels were found in ex...
Unilateral keratitis secondary to Leishmania spp. infection in a horse: Clinical signs and successful topical therapy.
Veterinary ophthalmology    July 25, 2023   doi: 10.1111/vop.13134
Matas Riera M, Cardenas Nadal M, Martínez-Sogues L, Ferrer L.Dermatological clinical signs have been seldom reported in the literature secondary to equine leishmaniasis. This case depicts the clinical signs, treatment, and outcome of a young horse with a pink, elevated lesion on the ventromedial quadrant of the cornea. A corneal cytology was performed and revealed the presence of leishmania amastigotes reaching the diagnosis of keratitis secondary to leishmania. Surgical resection was recommended but the owner declined the procedure, and the lesion was treated with a topical antimonial for 6 weeks. The lesion reduced remarkably during the first weeks ...
Topical Bacteriophage Therapy for Staphylococcal Superficial Pyoderma in Horses: A Double-Blind, Placebo-Controlled Pilot Study.
Pathogens (Basel, Switzerland)    June 14, 2023   Volume 12, Issue 6 828 doi: 10.3390/pathogens12060828
Marshall K, Marsella R.Increased antimicrobial resistance highlights the need for alternatives to antibiotics. Bacteriophages, which are benign viruses that kill bacteria, are promising. We studied the efficacy of topical bacteriophages for treating equine staphylococcal superficial pyodermas. Eight isolates were tested against a bacteriophage bank, and a cocktail consisting of two bacteriophages was prepared. Twenty horses with clinical and cytological evidence of superficial pyoderma and confirmed infection based on swabbed culture were enrolled in the study. Each horse received both the bacteriophage cocktail a...
Bronchoalveolar lavage hemosiderosis in lightly active or sedentary horses.
Journal of veterinary internal medicine    March 28, 2023   Volume 37, Issue 3 1243-1249 doi: 10.1111/jvim.16692
Mahalingam-Dhingra A, Bedenice D, Mazan MR.Hemosiderophages in bronchoalveolar lavage fluid (BALF) are commonly ascribed to exercise-induced pulmonary hemorrhage (EIPH). Little information exists regarding the presence of these cells in horses that perform light or no work and that are referred for respiratory problems. Objective: Evaluate the presence of hemosiderophages in BALF of horses suspected of respiratory disease without history of or risk factors for EIPH and determine predictors of hemosiderophages in BALF in this population. Methods: Observational retrospective cross-sectional study using STROBE (Strengthening the Reporting...
Evaluation of a commercial NGS service for detection of bacterial and fungal pathogens in infectious ulcerative keratitis.
Veterinary ophthalmology    March 21, 2023   doi: 10.1111/vop.13069
Bendlin A, Gemensky-Metzler AJ, Diaz-Campos D, Newbold GM, Miller EJ, Chandler HL.To compare results from a commercial next-generation sequencing (NGS) service to corneal cytology and culture for identification of causative organisms in veterinary patients presenting for infectious ulcerative keratitis (IUK). Methods: Swabs for corneal aerobic and fungal cultures and DNA swabs for NGS were submitted for canine and equine normal controls (n = 11 and n = 4, respectively) and IUK patients (n = 22 and n = 8, respectively) for which microbrush cytology specimens confirmed the presence of infectious organisms. The sensitivity of the NGS results was compared with bacterial...
Tulathromycin and Diclazuril Lack Efficacy against Theileria haneyi, but Tulathromycin Is Not Associated with Adverse Clinical Effects in Six Treated Adult Horses.
Pathogens (Basel, Switzerland)    March 14, 2023   Volume 12, Issue 3 453 doi: 10.3390/pathogens12030453
Onzere CK, Hulbert M, Sears KP, Williams LBA, Fry LM.Equine theileriosis, caused by and , leads to anemia, exercise intolerance, and occasionally, death. Theileriosis-free countries prohibit the importation of infected horses, resulting in significant costs for the equine industry. Imidocarb dipropionate is the only treatment for in the United States, but lacks efficacy against . The goal of this study was to assess the in vivo efficacy of tulathromycin and diclazuril against . Fourteen -infected horses were utilized. Six were treated with eight weekly 2.5 mg/kg doses of tulathromycin. Three were treated daily for eight weeks with 2.5 mg/kg di...
Effect of time and autologous serum addition on the analysis of cerebrospinal fluid in horses.
Journal of veterinary internal medicine    January 24, 2023   Volume 37, Issue 2 713-717 doi: 10.1111/jvim.16637
Quattrini C, Scalco R, Vernau W, Dini P, Aleman M.Cerebrospinal fluid (CSF) is highly labile and delayed processing might alter results of analysis. Objective: To determine the effects of time and addition of autologous serum on cytological evaluation of CSF. Methods: Ten client-owned adult horses requiring euthanasia. Methods: Prospective study. Serum and CSF were collected from each horse before and within 10 minutes after euthanasia. CSF samples were divided into 15 aliquots (2 mL each); 1 aliquot was submitted for routine CSF analysis within 60 minutes of collection. Four drops of autologous serum were added to 7 of the aliquots, and ...
Gene Expression Profiles of the Immuno-Transcriptome in Equine Asthma.
Animals : an open access journal from MDPI    December 20, 2022   Volume 13, Issue 1 4 doi: 10.3390/ani13010004
Padoan E, Ferraresso S, Pegolo S, Barnini C, Castagnaro M, Bargelloni L.Mild equine asthma (MEA) and severe equine asthma (SEA) are two of the most frequent equine airway inflammatory diseases, but knowledge about their pathogenesis is limited. The goal of this study was to investigate gene expression differences in the respiratory tract of MEA- and SEA-affected horses and their relationship with clinical signs. Methods: Clinical examination and endoscopy were performed in 8 SEA- and 10 MEA-affected horses and 7 healthy controls. Cytological and microbiological analyses of bronchoalveolar lavage (BAL) fluid were performed. Gene expression profiling of BAL fluid wa...
Synovial Fluid Analysis and Microscopic Assessment of Macrophage Quantities and Morphology in Equine Septic Arthritis.
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    December 14, 2022   Volume 50, Issue 6 377-385 doi: 10.1055/a-1956-5245
Strootmann T, Spitzbarth I, Della Tommasa S, Brehm W, Ku00f6ller G, Troillet A.Research and provision of data on macrophages by cytological synovial fluid analysis and light microscopy in horses with septic arthritis MATERIAL AND METHODS: Records of 167 synovial fluid samples were evaluated and subdivided into different groups: (1) non-septic, (2) haematogenous septic arthritis in foals and (3) traumatic/iatrogenic septic arthritis. The effect of joint lavage on synovial fluid cytology and on the occurrence of macrophage phenotypes was investigated. Results: Regardless of aetiology and age of the horse, macrophage concentrations in synovial sepsis are decreased to a medi...
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