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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.
Tenascin-C Expression in Equine Tendon-derived Cells During Proliferation and Migration.
Journal of equine science    June 28, 2013   Volume 24, Issue 2 17-24 doi: 10.1294/jes.24.17
Nemoto M, Kizaki K, Yamamoto Y, Oonuma T, Hashizume K.In vitro cell studies might be a useful tool for studying tendon pathology, but no suitable in vitro models exist for tendon disorders. The purpose of this study was to confirm whether cell scratch culture using tendon-derived fibroblasts can provide a suitable in vitro tendon disorder model. Extracellular matrix components were examined immunohistochemically in tendon tissue, and then their related gene expression levels were analyzed by conventional reverse transcription polymerase chain reaction (RT-PCR) and/or quantitative real-time RT-PCR in tissues and cells. Collagen type I (Col I), col...
Effects of intravenous lipopolysaccharide infusion on glucose and insulin dynamics in horses with equine metabolic syndrome.
American journal of veterinary research    June 28, 2013   Volume 74, Issue 7 1020-1029 doi: 10.2460/ajvr.74.7.1020
Tadros EM, Frank N, De Witte FG, Boston RC.To test the hypothesis that glucose and insulin dynamics during endotoxemia differ between healthy horses and horses with equine metabolic syndrome (EMS). Methods: 6 healthy adult mares and 6 horses with EMS. Methods: Each horse randomly received an IV infusion of lipopolysaccharide (20 ng/kg [in 60 mL of sterile saline {0.9% NaCl} solution]) or saline solution, followed by the other treatment after a 7-day washout period. Baseline insulin-modified frequently sampled IV glucose tolerance tests were performed 27 hours before and then repeated at 0.5 and 21 hours after infusion. Results were ass...
Effects of equine metabolic syndrome on inflammatory responses of horses to intravenous lipopolysaccharide infusion.
American journal of veterinary research    June 28, 2013   Volume 74, Issue 7 1010-1019 doi: 10.2460/ajvr.74.7.1010
Tadros EM, Frank N, Donnell RL.To test the hypothesis that inflammatory responses to endotoxemia differ between healthy horses and horses with equine metabolic syndrome (EMS). Animals-6 healthy horses and 6 horses with EMS. Methods: Each horse randomly received an IV infusion of lipopolysaccharide (20 ng/kg [in 60 mL of sterile saline {0.9% NaCl} solution]) or saline solution, followed by the other treatment after a 7-day washout period. Baseline data were obtained 30 minutes before each infusion. After infusion, a physical examination was performed hourly for 9 hours and at 15 and 21 hours; a whole blood sample was collect...
Expression of reference genes and T helper 17 associated cytokine genes in the equine intestinal tract.
Veterinary journal (London, England : 1997)    June 27, 2013   Volume 197, Issue 3 817-823 doi: 10.1016/j.tvjl.2013.05.020
Hjertner B, Olofsson KM, Lindberg R, Fuxler L, Fossum C.There is accumulating evidence for the involvement of pro-inflammatory cytokines associated with a T helper 17 response in intestinal disorders such as inflammatory bowel disease (IBD) in humans. The involvement of interleukin (IL)-17 or IL-23 in equine IBD has not been studied and most gene expression studies in the equine intestine have been limited to the use of a single non-validated reference gene. In this study, expression of the reference gene candidates β2 microglobulin (β2M), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), histone H2A type 1, hypoxanthine-guanine phosphoribosyltra...
Solitary (primary) uveal T-cell lymphoma in a horse.
Veterinary ophthalmology    June 27, 2013   Volume 17, Issue 2 139-145 doi: 10.1111/vop.12078
Trope GD, McCowan CI, Tyrrell D, Lording PM, Maggs DJ.A 22-year-old Australian stockhorse gelding was presented with anterior uveitis in the right eye which was nonresponsive to anti-inflammatory therapy. Clinical examination revealed corneal edema and vascularization, marked hypopyon, and thickening of the dorsal iris, which was confirmed by ultrasonography. Hematologic and biochemical analyses, abdominal and thoracic ultrasonography, and abdominocentesis with cytologic and biochemical analysis revealed no significant abnormalities. Cytological examination of an aqueous humor sample revealed a population of predominantly large lymphoblasts with ...
Injection of platelet- and leukocyte-rich plasma at the junction of the proximal sesamoid bone and the suspensory ligament branch for treatment of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated suspensory ligament branch desmitis.
Journal of the American Veterinary Medical Association    June 22, 2013   Volume 243, Issue 1 120-125 doi: 10.2460/javma.243.1.120
Garrett KS, Bramlage LR, Spike-Pierce DL, Cohen ND.To determine the effects of treatment with platelet- and leukocyte-rich plasma (PRP) on future 2-, 3-, and 4-year-old racing performance of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated suspensory ligament branch (SLB) desmitis. Methods: Randomized clinical trial. Methods: 39 yearling Thoroughbreds. Methods: Yearling Thoroughbreds with radiographic evidence of performance-limiting proximal sesamoid bone inflammation and ultrasonographic evidence of associated SLB desmitis were identified and randomly assigned to undergo PRP (treatment group) or saline (0.9% NaC...
Assessment of serum amyloid A testing of horses and its clinical application in a specialized equine practice.
Journal of the American Veterinary Medical Association    June 22, 2013   Volume 243, Issue 1 113-119 doi: 10.2460/javma.243.1.113
Belgrave RL, Dickey MM, Arheart KL, Cray C.To compare serum amyloid A (SAA) concentration, plasma fibrinogen concentration, total WBC count, and serum albumin-to-globulin concentration ratio (A:G ratio) in clinically normal (CN) and clinically abnormal (CA) horses. Methods: Prospective cohort study. Methods: 111 CN horses and 101 CA horses hospitalized at a specialty clinical practice. Methods: Shortly after admission, a blood sample (20 mL) was collected from each horse for a CBC, serum protein electrophoresis, and determination of plasma fibrinogen concentration; SAA concentration was assessed with a previously validated immunoturbid...
Eosinophilic keratitis in 46 eyes of 27 horses in the Mid-Atlantic United States (2008-2012).
Veterinary ophthalmology    June 14, 2013   Volume 17, Issue 5 311-320 doi: 10.1111/vop.12076
Lassaline-Utter M, Miller C, Wotman KL.To review the signalment, clinical characteristics, treatment, and outcome of equine EK cases in the Mid-Atlantic United States; to evaluate the effects of topical or systemic corticosteroid treatment, oral cetirizine treatment and secondary corneal infection on disease duration; and to evaluate the association between corticosteroid and cetirizine treatment and likelihood of recurrence. Methods: Twenty-seven horses (47 eyes) diagnosed with EK from 2008 to 2012. Methods: Retrospective medical record review followed by phone interview to obtain recurrence data. Results: Average age of affected ...
Disparate effects of LPS infusion and carbohydrate overload on inflammatory gene expression in equine laminae.
Veterinary immunology and immunopathology    June 10, 2013   Volume 155, Issue 1-2 1-8 doi: 10.1016/j.vetimm.2013.05.001
Kwon S, Moore JN, Robertson TP, Hurley DJ, Wagner B, Vandenplas ML.Although clinical evidence of endotoxemia has been associated with the development of acute laminitis in hospitalized horses with gastrointestinal diseases and endotoxins have been detected in the circulation of horses with experimentally-induced laminitis, it is unclear what role, if any, endotoxins have play the pathogenesis of the disease. Therefore, in the present study we compared the effects of endotoxin infusion to that of intra-gastric administration of mixed carbohydrate (CHO) on clinical signs of laminitis, plasma concentrations of TNF-α and IL-10, and laminar tissue expression of 2...
Science in brief: the likely role of the central nervous system in bilateral tendinopathy and tendon healing.
Equine veterinary journal    June 7, 2013   Volume 45, Issue 4 401-402 doi: 10.1111/evj.12064
O'Brien EJ, Smith RK.No abstract available
Science in brief: resolving tendon inflammation. A new perspective.
Equine veterinary journal    June 7, 2013   Volume 45, Issue 4 398-400 doi: 10.1111/evj.12030
Dakin SG, Dudhia J, Smith RK.No abstract available
Analysis of soluble CD14 and its use as a biomarker in neonatal foals with septicemia and horses with recurrent airway obstruction.
Veterinary immunology and immunopathology    June 6, 2013   Volume 155, Issue 1-2 124-128 doi: 10.1016/j.vetimm.2013.05.018
Wagner B, Ainsworth DM, Freer H.Soluble CD14 (sCD14) binds bacterial lipopolysaccharide (LPS) and acts as an anti-inflammatory LPS-inhibitor in vivo. In humans, sCD14 is one of the soluble biomarkers used for various inflammatory diseases and conditions, however, sCD14 assays have not yet been evaluated in horses. Here, we developed and optimized a bead-based assay for the quantification of sCD14 in horses. The assay was then used to determine native sCD14 concentrations in serum from healthy and septic foals, in the colostrum of healthy mares and in plasma from adult horses with recurrent airway obstruction (RAO) and contro...
Colour analysis of the equine endometrium: comparison of spectrophotometry and computer-assisted analysis of photographs within the L*a*b* colour space system.
Veterinary journal (London, England : 1997)    May 23, 2013   Volume 197, Issue 3 753-760 doi: 10.1016/j.tvjl.2013.04.013
Neuhauser S, Handler J.The aims of this study were to compare two different methods of quantifying the colour of the luminal surface of the equine endometrium and to relate the results to histopathological evidence of inflammation and fibrosis. The mucosal surfaces of 17 equine uteri obtained from an abattoir were assessed using a spectrophotometer and by computer-assisted analysis of photographs. Values were converted into L(*)a(*)b(*) colour space. Although there was significant correlation between the two methods of quantification, variations in 'brightness', 'red' and 'yellow' values were noted. Within a given u...
Mesenchymal stem cell therapy in horses: useful beyond orthopedic injuries?
The veterinary quarterly    May 22, 2013   Volume 33, Issue 4 234-241 doi: 10.1080/01652176.2013.800250
De Schauwer C, Van de Walle GR, Van Soom A, Meyer E.In the past decade, mesenchymal stem cells (MSC) have received much attention in equine veterinary medicine. The first therapeutic use of equine MSC was reported in 2003. Since then, the clinical application of MSC has been exploding with thousands of horses now treated worldwide. At present, MSC are mainly used in veterinary medicine to treat musculoskeletal diseases based on their ability to differentiate into various tissues of mesodermal origin. This is in marked contrast to human medicine, where MSC therapies are primarily focused on immune-mediated, inflammatory, and ischemic diseases. I...
Inflammatory stimuli differentially modulate the transcription of paracrine signaling molecules of equine bone marrow multipotent mesenchymal stromal cells.
Osteoarthritis and cartilage    May 14, 2013   Volume 21, Issue 8 1116-1124 doi: 10.1016/j.joca.2013.05.004
Vézina Audette R, Lavoie-Lamoureux A, Lavoie JP, Laverty S.Osteoarthritis (OA) is a degenerative disease of joint tissues that causes articular cartilage erosion, osteophytosis and loss of function due to pain. Inflammation and inflammatory cytokines in synovial fluid (SF) contribute to OA progression. Intra-articular (IA) injections of multipotent mesenchymal stromal cells (MSCs) are employed to treat OA in both humans and animals. MSCs secrete paracrine pro-inflammatory and anabolic signaling molecules that promote tissue repair. The objective of this study was to investigate the effects of OASF on the gene expression of paracrine signaling molecule...
The effect of selenium supplementation on vaccination response and immune function in adult horses.
Journal of animal science    May 8, 2013   Volume 91, Issue 8 3702-3715 doi: 10.2527/jas.2012-5819
Brummer M, Hayes S, Adams AA, Horohov DW, Dawson KA, Lawrence LM.Selenium status has been reported to affect immune function across many different species. Yet few studies have focused on the effect of Se status on the equine immune system. This study examined the effect of Se supplementation on vaccination response and immune function in mature horses. Twenty-eight horses were blocked by age and sex and were randomly allocated to 1 of 4 dietary treatment groups: low Se (LS), adequate Se (AS), Se-yeast (SP), and sodium selenite (SS). For 35 wk, horses allocated to LS, SP, and SS received a low-Se diet (0.06 mg/kg DM) with the intention to lower Se stores, w...
A 3-D airway epithelial cell and macrophage co-culture system to study Rhodococcus equi infection.
Veterinary immunology and immunopathology    May 7, 2013   Volume 154, Issue 1-2 54-61 doi: 10.1016/j.vetimm.2013.05.003
Schwab U, Caldwell S, Matychak MB, Felippe J.We developed a 3-D equine bronchial epithelial cell (BEC) culture that fully differentiates into ciliary beating and mucus producing cells. Using this system, we evaluated how mucus affects the phagocytic activity of macrophages. Adult horse monocyte-derived macrophages were incubated with Rhodococcus equi for 4h either in the mucus layer of in vitro generated airway epithelium or on collagen coated membranes. Using light and electron microscopy, we noted that the number of macrophages with intracellular bacteria, and the number of intracellular bacteria per macrophage were lower in the presen...
Effects of serum and autologous conditioned serum on equine articular chondrocytes treated with interleukin-1β.
American journal of veterinary research    May 1, 2013   Volume 74, Issue 5 700-705 doi: 10.2460/ajvr.74.5.700
Carlson ER, Stewart AA, Carlson KL, Durgam SS, Pondenis HC.To compare the effects of autologous equine serum (AES) and autologous conditioned serum (ACS) on equine articular chondrocyte metabolism when stimulated with recombinant human (rh) interleukin (IL)-1β. Methods: Articular cartilage and nonconditioned and conditioned serum from 6 young adult horses. Methods: Cartilage samples were digested, and chondrocytes were isolated and formed into pellets. Chondrocyte pellets were treated with each of the following: 10% AES, 10% AES and rhIL-1β, 20% AES and rhIL-1β, 10% ACS and rhIL-1β, and 20% ACS and rhIL-1β, and various effects of these treatments...
Intra-articular use of a platelet-rich product in normal horses: clinical signs and cytologic responses.
Veterinary surgery : VS    April 30, 2013   Volume 42, Issue 5 499-510 doi: 10.1111/j.1532-950X.2013.12015.x
Textor JA, Tablin F.(1) To report the clinical and synovial effects of a platelet-rich product (PRPr) in normal equine joints, (2) to assess the persistence of platelets within synovial fluid after intra-articular injection, (3) to compare responses to different preparations of that product, and (4) to evaluate a gravity filtration system for PRPr preparation in horses. Methods: Experimental. Methods: A platelet-rich saline product (PRPr) was prepared from 7 normal horses using a proprietary preparation device and was divided into 3 treatments: resting, CaCl2 -activated (23 mM, final), and bovine thrombin-activ...
Relationships between intrauterine infusion of N-acetylcysteine, equine endometrial pathology, neutrophil function, post-breeding therapy, and reproductive performance.
Theriogenology    April 25, 2013   Volume 80, Issue 3 218-227 doi: 10.1016/j.theriogenology.2013.03.026
Gores-Lindholm AR, LeBlanc MM, Causey R, Hitchborn A, Fayrer-Hosken RA, Kruger M, Vandenplas ML, Flores P, Ahlschwede S.Persistent endometritis in the mare is associated with hypersecretion of mucus by endometrial epithelium and migration of neutrophils into the uterine lumen. This study examines the relationships between N-acetylcysteine (NAC), a mucolytic agent with anti-inflammatory properties, and endometrial architecture, serum neutrophil function, post-breeding therapy, and reproductive performance of NAC-treated mares in a clinical setting. In study 1, endometrial biopsies from mares receiving intrauterine saline (fertile-control, n = 6) or 3.3% NAC (fertile-treatment, n = 6; barren-treatment, n = 10) we...
Oxytocin stimulated release of PGF2α and its inhibition by a cyclooxygenase inhibitor and an oxytocin receptor antagonist from equine endometrial cultures.
Animal reproduction science    April 24, 2013   Volume 139, Issue 1-4 69-75 doi: 10.1016/j.anireprosci.2013.04.010
Penrod LV, Allen RE, Rhoads ML, Limesand SW, Arns MJ.Uterine inflammation results in a poor uterine environment and early embryonic loss in the mare due to an inhibition of maternal recognition of pregnancy caused from increased prostaglandin F2α (PGF2α). Oxytocin binds to endometrial cell receptors to activate prostaglandin synthesis. An oxytocin receptor antagonist (Atosiban) and a cyclooxygenase inhibitor (indomethacin) both decrease PGF2α production. The aim of this study was to evaluate the in vitro effects of Atosiban and indomethacin on equine uterine prostaglandin secretion. Equine endometrial explants were harvested on day two of beh...
Investigating the efficacy of amnion-derived compared with bone marrow-derived mesenchymal stromal cells in equine tendon and ligament injuries.
Cytotherapy    April 17, 2013   Volume 15, Issue 8 1011-1020 doi: 10.1016/j.jcyt.2013.03.002
Lange-Consiglio A, Tassan S, Corradetti B, Meucci A, Perego R, Bizzaro D, Cremonesi F.This is the first study to compare the treatment of horse tendon and ligament injuries with the use of mesenchymal stromal cells (MSCs) obtained from two different sources: amniotic membrane (AMSCs) and bone marrow (BM-MSCs). The objective was to prove the ability of AMSCs to exert beneficial effects in vivo. Methods: Five million allogeneic frozen-thawed AMSCs or autologous fresh BM-MSCs were injected intralesionally in horses belonging to group A (51 horses) and group B (44 horses). The interval lesion/implantation was of 6-15 days for the AMSCs and 16-35 days for the BM-MSCs. Healing was as...
Investigation of the solubility and the potentials for purification of serum amyloid A (SAA) from equine acute phase serum–a pilot study.
BMC research notes    April 16, 2013   Volume 6 152 doi: 10.1186/1756-0500-6-152
Christensen MB, Sørensen JC, Jacobsen S, Kjelgaard-Hansen M.Serum amyloid A (SAA) is useful as a diagnostic marker of systemic inflammation in horses, but only heterologous assays based on non-equine calibration and standardization are available for measurements of equine SAA. More accurate measurements could be obtained using purified species-specific SAA in native conformation for assay calibration and standardization. Further knowledge about the biochemical properties of SAA would facilitate a future production of native species-specific calibration material Therefore, the aim of the study was an investigation of the solubility and potentials for pu...
Endometrial inflammatory markers of the early immune response in mares susceptible or resistant to persistent breeding-induced endometritis.
Reproduction (Cambridge, England)    April 13, 2013   Volume 145, Issue 3 289-296 doi: 10.1530/rep-12-0452
Woodward EM, Christoffersen M, Campos J, Betancourt A, Horohov D, Scoggin KE, Squires EL, Troedsson MH.Transient endometritis after breeding is necessary for clearance of bacteria and spermatozoa; however, in a subpopulation of mares, the inflammation fails to resolve in a timely fashion. The objective of this study was to describe the uterine inflammatory response in mares susceptible or resistant to persistent breeding-induced endometritis (PBIE) during the first 24 h after induction of uterine inflammation.Twelve mares were classified as susceptible (nZ6) or resistant (nZ6) to PBIE. Mares were inseminated over five estrous cycles and endometrial biopsies were collected at one time point per ...
Serum amyloid A and haptoglobin concentrations in serum and peritoneal fluid of healthy horses and horses with acute abdominal pain.
Veterinary clinical pathology    April 11, 2013   Volume 42, Issue 2 177-183 doi: 10.1111/vcp.12031
Pihl TH, Andersen PH, Kjelgaard-Hansen M, Mørck NB, Jacobsen S.Peritoneal fluid (PF) analysis is a valuable diagnostic tool in equine medicine. Markers such as serum amyloid A (SAA) and haptoglobin (Hp) could facilitate the diagnosis of inflammatory abdominal conditions. Objective: The objectives were to (1) establish reference intervals (RI) for SAA and Hp in serum and PF in healthy horses, (2) compare SAA and Hp concentrations between healthy horses and horses with colic, and (3) to assess the correlation between serum and PF concentrations. Methods: Serum amyloid A and Hp concentrations were determined by automated assays in prospectively enrolled heal...
Establishment and evaluation of a bead-based luminex assay allowing simultaneous quantification of equine IL-12 and IFN-γ.
Anticancer research    April 9, 2013   Volume 33, Issue 4 1325-1336 
Duran MC, Willenbrock S, Müller JM, Nolte I, Feige K, Murua Escobar H.Interleukin-12 (IL-12) and interferon gamma (IFN-γ) are key cytokines in immunemediated equine melanoma therapy. Currently, a method for accurate simultaneous quantification of these equine cytokines is lacking. Therefore, we sought to establish an assay that allows for accurate and simultaneous quantification of equine IL-12 (eIL-12) and IFN-γ (eIFN-γ). Methods: Several antibodies were evaluated for cross-reactivity to eIL-12 and eIFN-γ and were used to establish a bead-based Luminex assay, which was subsequently applied to quantify cytokine concentrations in biological samples. Results: ...
Effects of selenium source on measures of selenium status and immune function in horses. Montgomery JB, Wichtel JJ, Wichtel MG, McNiven MA, McClure JT, Markham F, Horohov DW.The effects of selenium (Se) supplementation and source on equine immune function have not been extensively studied. This study examined the effects of oral Se supplementation and Se source on aspects of innate and adaptive immunity in horses. Fifteen horses were assigned to 1 of 3 groups (5 horses/group): control, inorganic Se (sodium selenite), organic Se (Se yeast). Immune function tests performed included: lymphocyte proliferation in response to mitogen concanavalin A, neutrophil phagocytosis, antibody production after rabies vaccination, relative cytokine gene expression in stimulated lym...
Pharmacokinetics of tobramycin following intravenous, intramuscular, and intra-articular administration in healthy horses.
Journal of veterinary pharmacology and therapeutics    March 26, 2013   Volume 36, Issue 6 532-541 doi: 10.1111/jvp.12048
Newman JC, Prange T, Jennings S, Barlow BM, Davis JL.The objectives of this study were to examine the pharmacokinetics of tobramycin in the horse following intravenous (IV), intramuscular (IM), and intra-articular (IA) administration. Six mares received 4 mg/kg tobramycin IV, IM, and IV with concurrent IA administration (IV+IA) in a randomized 3-way crossover design. A washout period of at least 7 days was allotted between experiments. After IV administration, the volume of distribution, clearance, and half-life were 0.18 ± 0.04 L/kg, 1.18 ± 0.32 mL·kg/min, and 4.61 ± 1.10 h, respectively. Concurrent IA administration could not be...
Influence of an intra-articular lipopolysaccharide challenge on markers of inflammation and cartilage metabolism in young horses.
Journal of animal science    March 18, 2013   Volume 91, Issue 6 2693-2699 doi: 10.2527/jas.2012-5981
Lucia JL, Coverdale JA, Arnold CE, Winsco KN.Nineteen weanling Quarter Horses (225 to 380 kg) were used in a randomized complete block design to investigate the effects of intra-articular lipopolysaccharide (LPS) to induce acute joint inflammation in young horses. Horses were blocked by age, BW, and sex and were randomly assigned to 1 of 3 treatments for a 35-d experiment. Treatments included intra-articular injection of 0.25 ng (n = 7) or 0.50 ng (n = 6) of LPS obtained from Escherichia coli O55:B5 or sterile lactated Ringer's solution (n = 6; control) into the radial carpal joint. Synovial fluid was obtained at preinjection h 0 and 2, ...
Effect of selenium and vitamin C on clinical outcomes, trace element status, and antioxidant enzyme activity in horses with acute and chronic lower airway disease. A randomized clinical trial.
Biological trace element research    March 13, 2013   Volume 152, Issue 3 333-342 doi: 10.1007/s12011-013-9636-5
Youssef MA, El-khodery SA, Ibrahim HM.Excess production of reactive oxygen species is involved in the pathogenesis of airway disorders in horses. Trace element antioxidants have a beneficial role in oxidant/antioxidant balance. The aim of the present study was to evaluate the effect of a combination of sodium selenite and ascorbic acid on clinical outcome, antioxidant enzymes, and trace elements status in horses with lower airway disease. For this purpose, 40 draft horses with lower airway disease were randomly selected (acute, n = 20; chronic, n = 20). Both acute and chronic cases were randomly allocated into two subgroup...
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