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Topic:Inflammation

Inflammation is a biological response of the horse's body to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a complex process that involves the activation of immune cells, the release of inflammatory mediators, and changes in blood flow. In horses, inflammation can manifest in various forms, affecting different tissues and organs, including the joints, respiratory system, and skin. The inflammatory response is an essential component of the horse's immune system, aiming to eliminate the initial cause of cell injury, clear out damaged cells and tissues, and establish tissue repair. This topic page gathers peer-reviewed research studies and scholarly articles that explore the mechanisms, effects, and management of inflammation in equine health.
Quality control and immunomodulatory potential for clinical-grade equine bone marrow-derived mesenchymal stromal cells and conditioned medium.
Research in veterinary science    August 1, 2020   Volume 132 407-415 doi: 10.1016/j.rvsc.2020.07.023
Bastos FZ, Barussi FCM, Leite LMB, Jamur VR, Soares AA, Senegaglia AC, Michelotto PV.This study aimed to assess the safety and reproducibility of cell therapy for its use in clinical practice. We performed immunophenotypic characterization of equine bone marrow-derived mesenchymal stromal cells (BMMSCs) by flow cytometry using CD90, CD19, CD14, CD105, CD45, and HLA-DR markers (n = 4); GTG banding cytogenetic analysis (n = 3); and microbiological quality control (n = 4). The immunomodulatory potentials of BMMSCs (n = 4) and its conditioned medium (CM, n = 3) were investigated by in vitro lymphocyte inhibition assay using phytohemagglutinin (PHA)-stimulated peripheral ...
The evaluation of the effect of probiotics on the healing of equine distal limb wounds.
PloS one    July 29, 2020   Volume 15, Issue 7 e0236761 doi: 10.1371/journal.pone.0236761
Wilmink JM, Ladefoged S, Jongbloets A, Vernooij JCM.The effect of dressings saturated with either a standardized suspension of probiotic bacteria or saline on healing of traumatic distal limb wounds in horses was evaluated for 24 days, and the systemic inflammatory effect was assessed. The wounds were divided in two groups based on the phase of healing: wounds with an incomplete (ICGB) or a complete granulation bed (CGB). The wound area was expressed as percentage of the wound area at day 0 and defined as relative wound area. The mean relative wound area decreased faster in probiotic than saline treated wounds. The difference was most obvious i...
Infrared methodologies for the assessment of skin temperature daily rhythm in two domestic mammalian species.
Journal of thermal biology    July 29, 2020   Volume 92 102677 doi: 10.1016/j.jtherbio.2020.102677
Giannetto C, Arfuso F, Giudice E, Gianesella M, Fazio F, Panzera M, Piccione G.To assess the accuracy of infrared methodologies for daily rhythm monitoring of skin temperature, five clinically healthy Italian Saddle gelding horses, and five not pregnant and not lactating Camosciata goats, were monitored every 4 h over a 48 h period. The horses were housed in individual boxes, while the goats in two indoor pens, under natural photoperiod and natural environmental temperature. In each animal, skin temperature was recorded with the use of a digital infrared camera and a non-contact infrared thermometer, in five regions: neck, shoulder, ribs, flank and croup. Recorded valu...
Effect of the p38 MAPK inhibitor doramapimod on the systemic inflammatory response to intravenous lipopolysaccharide in horses.
Journal of veterinary internal medicine    July 23, 2020   Volume 34, Issue 5 2109-2116 doi: 10.1111/jvim.15847
Bauquier J, Tudor E, Bailey S.Doramapimod, a p38 MAPK inhibitor, is a potent anti-inflammatory drug that decreases inflammatory cytokine production in equine whole blood in vitro. It may have benefits for treating systemic inflammation in horses. Objective: To determine whether doramapimod is well tolerated when administered IV to horses, and whether it has anti-inflammatory effects in horses in a low-dose endotoxemia model. Methods: Six Standardbred horses. Methods: Tolerability study, followed by a blinded, randomized, placebo-controlled cross-over study. Horses were given doramapimod, and clinical and clinicopathologica...
Sarcocystis gigantea infection associated with granulomatous eosinophilic myositis in a horse. Veronesi F, Di Palma S, Gabrielli S, Morganti G, Milardi GL, Middleton B, Lepri E.The only species currently known to inhabit the fibers of skeletal and cardiac muscles in horses are , and . We describe herein the invasion of myofibers in a horse by , a sheep-specific species with low virulence in the original host. A hunter gelding was referred to a veterinary surgeon in Newmarket (UK). The anamnestic data reported that the horse had an initial history of swelling of the right forelimb with fluid on the front of the carpus and edema spreading up the forearm. Subsequently, 2 firm lumps were found on the left pectoral muscle adjacent to the axilla of the left forelimb. Hist...
Genetics of Immune Disease in the Horse.
The Veterinary clinics of North America. Equine practice    July 14, 2020   Volume 36, Issue 2 273-288 doi: 10.1016/j.cveq.2020.03.007
Tallmadge RL, Antczak DF, Felippe MJB.Host defenses against infection by viruses, bacteria, fungi, and parasites are critical to survival. It has been estimated that upwards of 7% of the coding genes of mammals function in immunity and inflammation. This high level of genomic investment in defense has resulted in an immune system characterized by extraordinary complexity and many levels of redundancy. Because so many genes are involved with immunity, there are many opportunities for mutations to arise that have negative effects. However, redundancy in the mammalian defense system and the adaptive nature of key immune mechanisms bu...
Genetics and Signaling Pathways of Laminitis.
The Veterinary clinics of North America. Equine practice    July 14, 2020   Volume 36, Issue 2 379-394 doi: 10.1016/j.cveq.2020.04.001
Galantino-Homer H, Brooks SA.Laminitis is a devastating disease with diverse etiologies and few, if any, effective treatments. Gene expression and hypothesis-generating genomic studies have provided a fresh look at the key molecular players at crucial timepoints in diverse experimental and naturally affected tissues. We summarize findings to date, and propose a unifying model of the laminitis disease process that includes several pathogenesis concepts shared with other diseases of epidermal and epithelial tissues. The value of these new pathways as potential therapeutic targets is exciting but will require careful future ...
Endothelial cells and angiogenesis in the horse in health and disease-A review.
Anatomia, histologia, embryologia    July 8, 2020   Volume 49, Issue 5 656-678 doi: 10.1111/ahe.12588
Rieger J, Kaessmeyer S, Al Masri S, Hünigen H, Plendl J.The cardiovascular system is the first functional organ in the embryo, and its blood vessels form a widespread conductive network within the organism. Blood vessels develop de novo, by the differentiation of endothelial progenitor cells (vasculogenesis) or by angiogenesis, which is the formation of new blood vessels from existing ones. This review presents an overview of the current knowledge on physiological and pathological angiogenesis in the horse including studies on equine endothelial cells. Principal study fields in equine angiogenesis research were identified: equine endothelial progen...
Development of a computer-based quantification method for immunohistochemically-stained tissues and its application to study mast cells in equine wound healing (proof of concept).
BMC veterinary research    July 2, 2020   Volume 16, Issue 1 228 doi: 10.1186/s12917-020-02444-x
Dubuc V, Laverty S, Richard H, Doré M, Theoret C.There is a growing interest in the scientific community to use computer-based software programs for the quantification of cells during physiological and pathophysiological processes. Drawbacks of computer-based methods currently used to quantify immunohistochemical staining are the complexity of use, expense of software and overly-simplified descriptions of protocol thereby limiting reproducibility. The precise role of mast cells in equine cutaneous wound healing is unknown. Given the contribution of mast cells to the chronic inflammation observed in human keloid, a pathology similar to exuber...
Outcome and complications following transrectal and transabdominal large intestinal trocarization in equids with colic: 228 cases (2004-2015).
Journal of the American Veterinary Medical Association    July 1, 2020   Volume 257, Issue 2 189-195 doi: 10.2460/javma.257.2.189
Schoster A, Altermatt N, Torgerson PR, Bischofberger AS.To describe outcome and complications after large intestinal trocarization in equids with colic and identify factors associated with nonsurvival and clinically relevant peritonitis (CRP). Methods: 228 (198 horses, 24 ponies, and 6 donkeys and mules) equids with colic that underwent large intestinal trocarization. Methods: Medical records from 2004 through 2015 were reviewed for equids with colic that underwent large intestinal trocarization. Factors associated with nonsurvival in all (ie, surgically and medically treated) equids and with CRP in medically only treated equids were identified. Me...
Monolateral chronicon orchitis in a stallion.
Veterinaria italiana    June 30, 2020   Volume 56, Issue 2 133-135 doi: 10.12834/VetIt.2330.13219.1
De Amicis I, Bucci R, Giangaspero B, D'Alterio N, Trachtman AR, Robbe D.Orchitis and epididymo-orchitis are inflammatory lesions of the testicle. We herein describe a case of monolateral chronic orchitis which occurred in a Tiro Pesante Rapido (TPR) stallion, born in 2002, with a history of good fertility. The stallion was healthy and asymptomatic although the left testis was found to be smaller as compared with the right one and was hard in consistency. Histopathology examination revealed tubular atrophy and parenchymal sclerosis. Scattered foci of calcification and chronic inflammation, the latter dominated by macrophages and lymphocytes, were also observed. Alt...
Effect of Mycobacterium cell wall fraction on endometrial histomorphometry of mares resistant and susceptible to persistent breeding-induced endometritis.
Theriogenology    June 30, 2020   Volume 156 2-10 doi: 10.1016/j.theriogenology.2020.06.034
Herrera MF, Otermin M, Herrera JM, Simoy MV, Bianchi CP, Aguilar JJ, Fumuso EA.Mycobacterium cell wall fraction (MCWF) is a biological component made up of molecules with immunostimulant properties, which is therapeutically used to modulate persistent breeding-induced endometritis (PBIE). The aim of this study was to analyze the effect of this immunomodulator on the endometrial histological structure during the diestrus of PBIE-resistant and -susceptible mares that either received treatment with MCWF or not. The experiment was conducted with 10 resistant mares (RM) and 9 susceptible mares (SM). In the first estrous cycle of the trial, all mares were inseminated with dead...
Erratum: Effects of intra-articular administration of lidocaine, mepivacaine, and the preservative methyl parahydroxybenzoate on synovial fluid biomarkers of horses.
American journal of veterinary research    June 26, 2020   Volume 81, Issue 7 614 doi: 10.2460/ajvr.81.7.614
No abstract available
Alterations in the chondrocyte surfaceome in response to pro-inflammatory cytokines.
BMC molecular and cell biology    June 26, 2020   Volume 21, Issue 1 47 doi: 10.1186/s12860-020-00288-9
Jeremiasse B, Matta C, Fellows CR, Boocock DJ, Smith JR, Liddell S, Lafeber F, van Spil WE, Mobasheri A.Chondrocytes are exposed to an inflammatory micro-environment in the extracellular matrix (ECM) of articular cartilage in joint diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA). In OA, degenerative changes and low-grade inflammation within the joint transform the behaviour and metabolism of chondrocytes, disturb the balance between ECM synthesis and degradation, and alter the osmolality and ionic composition of the micro-environment. We hypothesize that chondrocytes adjust their physiology to the inflammatory microenvironment by modulating the expression of cell surface prote...
Comparison of analgesic and tissue effects of subcutaneous perineural injection of liposomal bupivacaine and bupivacaine hydrochloride in horses with forelimb lameness induced via circumferential clamp.
American journal of veterinary research    June 26, 2020   Volume 81, Issue 7 551-556 doi: 10.2460/ajvr.81.7.551
Le KM, Caston SS, Hossetter JM, Hay Kraus BL.To evaluate the analgesic and tissue effects of liposomal bupivacaine administered SC as an abaxial sesamoid nerve block in horses with experimentally induced lameness. Methods: 6 healthy mature light-breed horses. Methods: In a randomized crossover study, a circumferential hoof clamp was applied to a forelimb to induce reversible lameness. An abaxial sesamoid nerve block of the lame forelimb was performed by SC perineural injection of 10 mg of liposomal bupivacaine or bupivacaine HCl/site. Quantitative gait data were objectively obtained with a body-mounted inertial sensor system before (base...
Effects of Autologous Conditioned Serum, Autologous Protein Solution, and Triamcinolone on Inflammatory and Catabolic Gene Expression in Equine Cartilage and Synovial Explants Treated With IL-1β in Co-culture.
Frontiers in veterinary science    June 26, 2020   Volume 7 323 doi: 10.3389/fvets.2020.00323
Velloso Alvarez A, Boone LH, Pondugula SR, Caldwell F, Wooldridge AA.Autologous conditioned serum (ACS) and autologous protein solution (APS) are newer therapeutic options for osteoarthritis (OA). Co-culture of cartilage and synovium stimulated with IL-1β produces a similar physiologic response to tissues from naturally-ocurring OA. The study objective was to investigate the effects of ACS, APS, and triamcinolone (TA) on inflammatory and catabolic gene expression of inflamed joint tissues in co-culture. Blood was collected and processed for ACS and APS from six horses. Cartilage and synovial explants were harvested from the stifle, placed in co-culture, and tr...
Effect of digital hypothermia on lamellar inflammatory signaling in the euglycemic hyperinsulinemic clamp laminitis model.
Journal of veterinary internal medicine    June 25, 2020   Volume 34, Issue 4 1606-1613 doi: 10.1111/jvim.15835
Stokes SM, Burns TA, Watts MR, Bertin FR, Stefanovski D, Medina-Torres CE, Belknap JK, van Eps AW.Continuous digital hypothermia (CDH) prevents lamellar failure in the euglycemic hyperinsulinemic clamp (EHC) model of laminitis, but the protective mechanisms are unclear. Objective: To determine if CDH inhibits lamellar inflammatory signaling in the EHC model of laminitis. Methods: Eight Standardbred horses. Methods: Prospective experimental study. Horses underwent an EHC, with 1 forelimb treated with CDH and the other kept at ambient temperature (AMB). Horses were euthanized 48 hours after initiation of the EHC and lamellar tissue was analyzed via polymerase chain reaction (pro-inflammato...
Histologic Evaluation of Palmar Digital Nerves after Perineural Injection of 2% Ammonium Chloride in Miniature Horses.
Journal of equine veterinary science    June 20, 2020   Volume 92 103171 doi: 10.1016/j.jevs.2020.103171
Dau SL, Azevedo MDS, Mazaro RD, de La Corte FD, Fighera R.Neurolytic compounds are widely used by equine practitioners for the management of lameness, mostly related to the foot. The present study aimed to evaluate the neurotoxicity of 2% ammonium chloride (2% AC) applied adjacent to the palmar digital nerves in six miniature horses. The 2% AC and 0.9% saline solution were randomly injected into three and one palmar digital nerve of each horse, respectively. Nerve samples were collected by neurectomy performed under general anesthesia at 5, 12, 19, 35, 47, and 62 days after treatment, with one horse per day of surgery. The inflammatory reaction to p...
Effect of gallium maltolate on a model of chronic, infected equine distal limb wounds.
PloS one    June 19, 2020   Volume 15, Issue 6 e0235006 doi: 10.1371/journal.pone.0235006
Lawless SP, Cohen ND, Lawhon SD, Chamoun-Emanuelli AM, Wu J, Rivera-Vélez A, Weeks BR, Whitfield-Cargile CM.Distal limb wounds are common injuries sustained by horses and their healing is fraught with complications due to equine anatomy, prevalence of infection, and challenges associated with wound management. Gallium is a semi-metallic element that has been shown to possess antimicrobial properties and aid in wound healing in various preclinical models. The effects of Gallium have not been studied in equine wound healing. Therefore, the objective of this study was to compare healing rates between gallium-treated and untreated wounds of equine distal limbs and to demonstrate the antimicrobial effect...
Tamoxifen and its metabolites induce mitochondrial membrane depolarization and caspase-3 activation in equine neutrophils.
Veterinary medicine and science    June 17, 2020   Volume 6, Issue 4 673-678 doi: 10.1002/vms3.316
Albornoz A, Morales N, Uberti B, Henriquez C, Burgos RA, Alarcon P, Moran G.Neutrophils participate in innate immunity as the first line of host defence against microorganisms. However, persistent neutrophil activity and delayed apoptosis can be harmful to surrounding tissues; this problem occurs in diverse inflammatory diseases, including asthma-affected horses. Previous studies in horses with acute lung inflammation indicated that treatment with tamoxifen (TX), a selective oestrogen receptor modulator, produces a significant decrease in bronchoalveolar lavage fluid (BALF) neutrophil content. The aim of this study was to investigate the effect of tamoxifen and its me...
Identification of monoclonal antibodies suitable for blocking IGF-1 receptors in the horse.
Domestic animal endocrinology    June 17, 2020   Volume 74 106510 doi: 10.1016/j.domaniend.2020.106510
Rahnama S, Vathsangam N, Spence R, Anderson ST, de Laat MA, Bailey S, Sillence MN.Prolonged hyperinsulinemia is thought to be the cause of equine endocrinopathic laminitis, a common and crippling disease of the foot, for which there are no pharmacologic treatments other than pain relief. It has been suggested that insulin causes its effects on the lamellae by activating IGF-1 receptors (IGF-1R), as insulin receptors (InsR) are scarce in this tissue, whereas IGF-1R are abundant and become downregulated after prolonged insulin infusion. As a first step toward confirming this mechanism and beginning to develop a therapeutic anti-IGF-1R monoclonal antibody (mAb) for horses, it ...
Assessment of the anti-inflammatory and engraftment potential of horse endometrial and adipose mesenchymal stem cells in an in vivo model of post breeding induced endometritis.
Theriogenology    June 14, 2020   Volume 155 33-42 doi: 10.1016/j.theriogenology.2020.06.010
Navarrete F, Saravia F, Cisterna G, Rojas F, Silva PP, Rodríguez-Alvarez L, Rojas D, Cabezas J, Mançanares ACF, Castro FO.Horse mesenchymal stem cells (MSC) are potential anti-inflammatory tools for post-breeding induced endometritis (PBIE). In this research MSCs isolated from the endometrium or subcutaneous fat of the same donors were infused iu into mares with PBIE for assessment of their anti-inflammatory action and engraftment. PBIE was induced in nine gynecologically healthy mares by iu infusion of 500 million dead sperm in saline. Inflammatory markers were analyzed in uterine lavages and biopsies immediately before (phase I) and 3 h after infusion of sperm (phase II). Measurements: polymorph nuclear cells ...
Differential Proteomic Expression of Equine Cardiac and Lamellar Tissue During Insulin-Induced Laminitis.
Frontiers in veterinary science    June 12, 2020   Volume 7 308 doi: 10.3389/fvets.2020.00308
Campolo A, Frantz MW, de Laat MA, Hartson SD, Furr MO, Lacombe VA.Endocrinopathic laminitis is pathologically similar to the multi-organ dysfunction and peripheral neuropathy found in human patients with metabolic syndrome. Similarly, endocrinopathic laminitis has been shown to partially result from vascular dysfunction. However, despite extensive research, the pathogenesis of this disease is not well elucidated and laminitis remains without an effective treatment. Here, we sought to identify novel proteins and pathways underlying the development of equine endocrinopathic laminitis. Healthy Standardbred horses ( = 4/group) were either given an electrolyte in...
Pre-conditioning of Equine Bone Marrow-Derived Mesenchymal Stromal Cells Increases Their Immunomodulatory Capacity.
Frontiers in veterinary science    June 11, 2020   Volume 7 318 doi: 10.3389/fvets.2020.00318
Caffi V, Espinosa G, Gajardo G, Morales N, Durán MC, Uberti B, Morán G, Plaza A, Henríquez C.Mesenchymal stem/stromal cells (MSCs) are increasingly explored for the treatment of degenerative and inflammatory diseases in human and veterinary medicine. One of the key characteristics of MSCs is that they modulate inflammation mainly through the secretion of soluble mediators. However, despite widespread clinical use, knowledge regarding the effector mechanisms of equine MSCs, and consequently their effectiveness in the treatment of diseases, is still unknown. The objectives of this study were to determine the mechanisms underlying inhibition of lymphocyte proliferation by equine bone mar...
Equine granulosa cell tumours among other ovarian conditions: Diagnostic challenges.
Equine veterinary journal    June 10, 2020   Volume 53, Issue 1 60-70 doi: 10.1111/evj.13279
Renaudin CD, Kelleman AA, Keel K, McCracken JL, Ball BA, Ferris RA, McCue PM, Dujovne G, Conley AJ.Granulosa cell tumours (GCT) are the most common ovarian tumours in mares. While the classical presentation may not represent diagnostic challenges, diagnosis is not easy in the early stages. Objective: Illustrate the variability in the presentation and serum biomarkers associated with ovarian abnormalities in the mare. Methods: Retrospective case series. Methods: Nonclassical cases of GCTs and other ovarian conditions were identified and behaviour, GCT endocrine results, palpation and ultrasonographic findings are described and the diagnostic value of each is discussed. Results: Mares in this...
Is clinical effect of autologous conditioned serum in spontaneously occurring equine articular lameness related to ACS cytokine profile?
BMC veterinary research    June 8, 2020   Volume 16, Issue 1 181 doi: 10.1186/s12917-020-02391-7
Marques-Smith P, Kallerud AS, Johansen GM, Boysen P, Jacobsen AM, Reitan KM, Henriksen MM, Löfgren M, Fjordbakk CT.Biologic' therapies, such as autologous conditioned serum (ACS), are gaining popularity in treating orthopaedic conditions in equine veterinary medicine. Evidence is scarce regarding ACS constituents, and large inter-individual differences in cytokine and growth factor content have been demonstrated. The objective of the current study was to investigate the potential association between cytokine and growth factor content of ACS and clinical effect in harness racehorses with spontaneously occurring low-grade articular lameness. Horses received 3 intra-articular injections of ACS administered at...
Fibrinonecrotic Placentitis and Abortion Associated With Pantoea agglomerans Infection in a Mare.
Journal of equine veterinary science    June 6, 2020   Volume 92 103156 doi: 10.1016/j.jevs.2020.103156
Henker LC, Lorenzett MP, Keller A, Siqueira FM, Driemeier D, Pavarini SP.Pantoea agglomerans, family Enterobacteriaceae, is a Gram-negative bacterium that may be isolated from soil and from plants. This bacterium has been associated with disease in plants, humans, and rarely in domestic animal species. We describe here a case of fibrinonecrotic placentitis and equine abortion associated with P. agglomerans infection in southern Brazil. A fetus with 10 months of gestation and its placenta were evaluated. Gross lesions were observed in the cervical star extending to the body of the chorioallantois and consisted of a focally extensive, transmural, severely thickened...
Investigation of the Usefulness of Serum Amyloid A in Supporting the Diagnosis of Equine Proliferative Enteropathy.
Journal of equine veterinary science    June 6, 2020   Volume 92 103151 doi: 10.1016/j.jevs.2020.103151
Pusterla N, Barnum S, Hall JA, Marshall-Lund L, Gebhart C.The objective of this study was to determine if serum amyloid A (SAA), a major acute-phase protein, could help support the diagnosis of equine proliferative enteropathy (EPE) caused by Lawsonia intracellularis infection in foals. Archived serum samples from 101 foals with enteric signs and hypoproteinemia were available for SAA testing. Based on immunodiagnostics for L. intracellularis, the foals were divided into EPE-suspect (67) and non-EPE-suspect cases (34). Serum amyloid A values ranged from 0 to 2,761 μg/mL (median 466 μg/mL) and from 0 to 2,555 μg/mL (median 192 μg/mL) for the ...
Airway Hyperresponsiveness Is Severe and Persistent in an Equine Model of Neutrophilic Asthma.
American journal of respiratory cell and molecular biology    May 30, 2020   Volume 62, Issue 6 808-810 doi: 10.1165/rcmb.2019-0049LE
Hunter CL, Bowser JE, Wills RW, Byars P, Moore JW, Wilson RM, Byrne R, Swiderski CE.The research article presents findings on the severity and persistence of airway hyperresponsiveness (AHR) in an equine model of neutrophilic asthma, which is relevant for understanding human asthma and its […]
The Effects of Treatment with N-Acetyl Cysteine on Clinical Signs in Persistent Breeding-Induced Endometritis Susceptible Mares.
Journal of equine veterinary science    May 30, 2020   Volume 92 103142 doi: 10.1016/j.jevs.2020.103142
Caissie MD, Gartley CJ, Scholtz EL, Hewson J, Johnson R, Chenier T.Persistent breeding-induced endometritis (PBIE) is a major cause of infertility in mares. Endometrial inflammation that persists until embryonic descent ultimately results in early embryonic death. A poor endometrial biopsy grade (IIb or III) has been identified as a risk factor for PBIE. Intrauterine fluid accumulation (>2 cm in depth), pathologic endometrial edema, and elevated intrauterine neutrophil levels are all clinical features of PBIE. Commonly applied treatment options include uterine lavage and oxytocin therapy. N-acetyl cysteine (NAC), a mucolytic used to treat bacterial endome...
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