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PloS one2020; 15(4); e0224720; doi: 10.1371/journal.pone.0224720

Ischaemic preconditioning and pharmacological preconditioning with dexmedetomidine in an equine model of small intestinal ischaemia-reperfusion.

Abstract: Small intestinal strangulation associated with ischaemia-reperfusion injury (IRI) is common in horses. In laboratory animals IRI can be ameliorated by ischaemic preconditioning (IPC) and pharmacological preconditioning (PPC) with dexmedetomidine. The aim of this study was to determine the effect of PPC with dexmedetomidine or IPC in an equine model of small intestinal ischaemia-reperfusion (IR). In a randomized controlled experimental trial, 15 horses were assigned to three groups: control (C), IPC, and PPC with dexmedetomidine (DEX). All horses were placed under general anaesthesia and 90% jejunal ischaemia was induced for 90 minutes, followed 30 minutes of reperfusion. In group IPC, three short bouts of ischaemia and reperfusion were implemented, and group DEX received a continuous rate infusion of dexmedetomidine prior to the main ischaemia. Jejunal biopsies were collected before ischaemia (P), and at the end of ischaemia (I) and reperfusion (R). Mucosal injury was assessed by the Chiu-Score, inflammatory cells were stained by cytosolic calprotectin. The degree of apoptosis and cell necrosis was assessed by cleaved-caspase-3 and TUNEL. Parametric data were analyzed by two-way ANOVA for repeated measurements followed by Dunnetts t-test. Non parametric data were compared between groups at the different time points by a Kruskal-Wallis-Test and a Wilcoxon-2-Sample-test. The mucosal injury score increased during I in all groups. After reperfusion, IRI further progressed in group C, but not in IPC and DEX. In all groups the number of cleaved caspase-3 and TUNEL positive cells increased from P to I. The number of TUNEL positive cells were lower in group DEX compared to group C after I and R. Infiltration with calprotectin positive cells was less pronounced in group DEX compared to group C, whereas in group IPC more calprotectin positive cells were seen. In conclusion, IPC and DEX exert protective effects in experimental small intestinal ischaemia in horses.
Publication Date: 2020-04-29 PubMed ID: 32348301PubMed Central: PMC7190151DOI: 10.1371/journal.pone.0224720Google Scholar: Lookup
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  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study examines the impact of pharmacological preconditioning (PPC) with dexmedetomidine and ischemic preconditioning (IPC) in reducing ischaemia-reperfusion injury (IRI), often associated with small intestinal strangulation in horses. The research concludes that both IPC and PPC with dexmedetomidine exert a protective effect in experimental small intestinal ischaemia in horses.

Research Methodology

  • The study is a randomized controlled experimental trial conducted on 15 horses, divided into three groups – control (C), IPC, and PPC with dexmedetomidine (DEX).
  • Ischaemia for all horses was induced in the same surgical procedure under general anaesthesia.
  • The groups underwent three short bouts of ischaemia and reperfusion in IPC and received a continuous rate infusion of dexmedetomidine prior to the main ischaemia in the DEX group.
  • Jejunal biopsies were taken before ischaemia (P), at the end of ischaemia (I), and after reperfusion (R).
  • Various biomarkers were studied including cleaved-caspase-3 and Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) for assessing apoptosis and cell necrosis, cytosolic calprotectin for staining inflammatory cells, and the Chiu-Score for assessing mucosal injury.

Results and Findings

  • All groups showed an increase in the mucosal injury score during I.
  • Post-reperfusion, the mucosal injury continued in the control group but not in the IPC and DEX groups, indicating the protective effects.
  • All groups had an increased number of cleaved caspase-3 and TUNEL positive cells from P to I.
  • The TUNEL positive cells were fewer in the DEX group compared to the control group post-I and R, suggesting the protective role of dexmedetomidine.
  • Group DEX showed less infiltration of calprotectin positive cells compared to the control group, while the IPC group had more calprotectin positive cells.

Conclusion

  • The study concludes that both IPC and PPC with dexmedetomidine offer a level of protection against ischaemia-reperfusion injury in horses.
  • It highlights the potential use of these procedures to manage or prevent small intestinal strangulation associated with IRI in horses.

Cite This Article

APA
König KS, Verhaar N, Hopster K, Pfarrer C, Neudeck S, Rohn K, Kästner SBR. (2020). Ischaemic preconditioning and pharmacological preconditioning with dexmedetomidine in an equine model of small intestinal ischaemia-reperfusion. PLoS One, 15(4), e0224720. https://doi.org/10.1371/journal.pone.0224720

Publication

ISSN: 1932-6203
NlmUniqueID: 101285081
Country: United States
Language: English
Volume: 15
Issue: 4
Pages: e0224720
PII: e0224720

Researcher Affiliations

König, Kathrin S
  • Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
Verhaar, Nicole
  • Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
Hopster, Klaus
  • Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
Pfarrer, Christiane
  • Institute for Anatomy, University of Veterinary Medicine Hannover, Hannover, Germany.
Neudeck, Stephan
  • Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
Rohn, Karl
  • Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hannover, Germany.
Kästner, Sabine B R
  • Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
  • Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany.

MeSH Terms

  • Adrenergic alpha-2 Receptor Agonists / administration & dosage
  • Adrenergic alpha-2 Receptor Agonists / pharmacology
  • Adrenergic alpha-2 Receptor Agonists / therapeutic use
  • Animals
  • Dexmedetomidine / administration & dosage
  • Dexmedetomidine / pharmacology
  • Dexmedetomidine / therapeutic use
  • Horses
  • Ischemia / drug therapy
  • Ischemia / therapy
  • Ischemic Preconditioning / methods
  • Jejunum / blood supply
  • Jejunum / drug effects
  • Jejunum / pathology
  • Random Allocation
  • Reperfusion Injury / drug therapy
  • Reperfusion Injury / therapy

Conflict of Interest Statement

The authors have declared that no competing interests exist.

References

This article includes 49 references
  1. Tinker MK, White NA, Lessard P, Thatcher CD, Pelzer KD, Davis B, Carmel DK. Prospective study of equine colic incidence and mortality.. Equine Vet J 1997 Nov;29(6):448-53.
  2. Kaneene JB, Ross WA, Miller R. The Michigan equine monitoring system. II. Frequencies and impact of selected health problems.. Prev Vet Med 1997 Feb;29(4):277-92.
    doi: 10.1016/s0167-5877(96)01080-xpubmed: 9234436google scholar: lookup
  3. Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: Short-term survival following a single laparotomy.. Equine Vet J 2005 Jul;37(4):296-302.
    doi: 10.2746/0425164054529409pubmed: 16028616google scholar: lookup
  4. Tomai F, Crea F, Chiariello L, Gioffrè PA. Ischemic preconditioning in humans: models, mediators, and clinical relevance.. Circulation 1999 Aug 3;100(5):559-63.
    doi: 10.1161/01.cir.100.5.559pubmed: 10430772google scholar: lookup
  5. Cheung MM, Kharbanda RK, Konstantinov IE, Shimizu M, Frndova H, Li J, Holtby HM, Cox PN, Smallhorn JF, Van Arsdell GS, Redington AN. Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery: first clinical application in humans.. J Am Coll Cardiol 2006 Jun 6;47(11):2277-82.
    doi: 10.1016/j.jacc.2006.01.066pubmed: 16750696google scholar: lookup
  6. Krenz M, Baines C, Kalogeris T, Korthuis R. Cell survival programs and ischemia/reperfusion: hormesis, preconditioning, and cardioprotection. Morgan & Claypool Life Sciences 2013; pp. 1–122.
  7. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium.. Circulation 1986 Nov;74(5):1124-36.
    doi: 10.1161/01.cir.74.5.1124pubmed: 3769170google scholar: lookup
  8. Hausenloy DJ, Tsang A, Mocanu MM, Yellon DM. Ischemic preconditioning protects by activating prosurvival kinases at reperfusion.. Am J Physiol Heart Circ Physiol 2005 Feb;288(2):H971-6.
    doi: 10.1152/ajpheart.00374.2004pubmed: 15358610google scholar: lookup
  9. Hausenloy DJ, Yellon DM. The second window of preconditioning (SWOP) where are we now?. Cardiovasc Drugs Ther 2010 Jun;24(3):235-54.
    doi: 10.1007/s10557-010-6237-9pubmed: 20496105google scholar: lookup
  10. Hotter G, Closa D, Prados M, Fernández-Cruz L, Prats N, Gelpí E, Roselló-Catafau J. Intestinal preconditioning is mediated by a transient increase in nitric oxide.. Biochem Biophys Res Commun 1996 May 6;222(1):27-32.
    doi: 10.1006/bbrc.1996.0692pubmed: 8630069google scholar: lookup
  11. Erling Junior N, Montero EF, Sannomiya P, Poli-de-Figueiredo LF. Local and remote ischemic preconditioning protect against intestinal ischemic/reperfusion injury after supraceliac aortic clamping.. Clinics (Sao Paulo) 2013 Dec;68(12):1548-54.
    pmc: PMC3840383pubmed: 24473514doi: 10.6061/clinics/2013(12)12google scholar: lookup
  12. Sahin T, Begeç Z, Toprak Hİ, Polat A, Vardi N, Yücel A, Durmuş M, Ersoy MÖ. The effects of dexmedetomidine on liver ischemia-reperfusion injury in rats.. J Surg Res 2013 Jul;183(1):385-90.
    doi: 10.1016/j.jss.2012.11.034pubmed: 23321519google scholar: lookup
  13. Kucuk A, Yaylak F, Cavunt-Bayraktar A, Tosun M, Arslan M, Comu FM, Kavutcu M. The protective effects of dexmedetomidine on hepatic ischemia reperfusion injury.. Bratisl Lek Listy 2014;115(11):680-4.
    doi: 10.4149/bll_2014_132pubmed: 25428535google scholar: lookup
  14. Kocoglu H, Karaaslan K, Gonca E, Bozdogan O, Gulcu N. Preconditionin effects of dexmedetomidine on myocardial ischemia/reperfusion injury in rats.. Curr Ther Res Clin Exp 2008 Apr;69(2):150-8.
  15. Dong X, Xing Q, Li Y, Han X, Sun L. Dexmedetomidine protects against ischemia-reperfusion injury in rat skeletal muscle.. J Surg Res 2014 Jan;186(1):240-5.
    doi: 10.1016/j.jss.2013.07.052pubmed: 24007817google scholar: lookup
  16. Sun Y, Gao Q, Wu N, Li SD, Yao JX, Fan WJ. Protective effects of dexmedetomidine on intestinal ischemia-reperfusion injury.. Exp Ther Med 2015 Aug;10(2):647-652.
    doi: 10.3892/etm.2015.2561pmc: PMC4509460pubmed: 26622369google scholar: lookup
  17. Gozalo-Marcilla M, Gasthuys F, Luna SPL, Schauvliege S. Is there a place for dexmedetomidine in equine anaesthesia and analgesia? A systematic review (2005-2017).. J Vet Pharmacol Ther 2018 Apr;41(2):205-217.
    doi: 10.1111/jvp.12474pubmed: 29226340google scholar: lookup
  18. Reichert C, Kästner SB, Hopster K, Rohn K, Rötting AK. Use of micro-lightguide spectrophotometry for evaluation of microcirculation in the small and large intestines of horses without gastrointestinal disease.. Am J Vet Res 2014 Nov;75(11):990-6.
    doi: 10.2460/ajvr.75.11.990pubmed: 25350089google scholar: lookup
  19. Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN. Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal.. Arch Surg 1970 Oct;101(4):478-83.
  20. White NA, Moore JN, Trim CM. Mucosal alterations in experimentally induced small intestinal strangulation obstruction in ponies.. Am J Vet Res 1980 Feb;41(2):193-8.
    pubmed: 7369591
  21. Wagner A, Junginger J, Lemensieck F, Hewicker-Trautwein M. Immunohistochemical characterization of gastrointestinal macrophages/phagocytes in dogs with inflammatory bowel disease (IBD) and non-IBD dogs.. Vet Immunol Immunopathol 2018 Mar;197:49-57.
    doi: 10.1016/j.vetimm.2018.01.011pubmed: 29475506google scholar: lookup
  22. Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN. Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal.. Arch Surg 1970 Oct;101(4):478-83.
  23. Wang Z, Ji Y, Wang S, Wang R, Li Z, Kang A, Xu H, Shi M, Zhao M. Protective effect of intestinal ischemic preconditioning on ischemia reperfusion-caused lung injury in rats.. Inflammation 2015 Feb;38(1):424-32.
    doi: 10.1007/s10753-014-0047-3pubmed: 25359707google scholar: lookup
  24. Aksöyek S, Cinel I, Avlan D, Cinel L, Oztürk C, Gürbüz P, Nayci A, Oral U. Intestinal ischemic preconditioning protects the intestine and reduces bacterial translocation.. Shock 2002 Nov;18(5):476-80.
  25. Varga J, Tóth S, Staško P, Tóth S Jr, Bilecová-Rabajdová M, Ostró A, Veselá J. Intestinal ischemia-reperfusion injury - the histopathological status of remote vital organs in acute and subacute phases.. Ann Transplant 2012 Jan-Mar;17(1):11-20.
    pubmed: 22466904doi: 10.12659/aot.882631google scholar: lookup
  26. Kageyama S, Hata K, Tanaka H, Hirao H, Kubota T, Okamura Y, Iwaisako K, Takada Y, Uemoto S. Intestinal ischemic preconditioning ameliorates hepatic ischemia/reperfusion injury in rats: role of heme oxygenase 1 in the second window of protection.. Liver Transpl 2015 Jan;21(1):112-22.
    doi: 10.1002/lt.24006pubmed: 25234134google scholar: lookup
  27. Aufricht C, Bidmon B, Ruffingshofer D, Regele H, Herkner K, Siegel NJ, Kashgarian M, Van Why SK. Ischemic conditioning prevents Na,K-ATPase dissociation from the cytoskeletal cellular fraction after repeat renal ischemia in rats.. Pediatr Res 2002 Jun;51(6):722-7.
  28. Santos CH, Gomes OM, Pontes JC, Miiji LN, Bispo MA. The ischemic preconditioning and postconditioning effect on the intestinal mucosa of rats undergoing mesenteric ischemia/reperfusion procedure.. Acta Cir Bras 2008 Jan-Feb;23(1):22-8.
  29. Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists.. Crit Care Clin 2009 Jul;25(3):451-69, vii.
    doi: 10.1016/j.ccc.2009.04.004pubmed: 19576524google scholar: lookup
  30. Gonullu E, Ozkardesler S, Kume T, Duru LS, Akan M, Guneli ME, Ergur BU, Meseri R, Dora O. Comparison of the effects of dexmedetomidine administered at two different times on renal ischemia/reperfusion injury in rats.. Braz J Anesthesiol 2014 May-Jun;64(3):152-8.
    pubmed: 24907872doi: 10.1016/j.bjane.2013.06.002google scholar: lookup
  31. Dahmani S, Paris A, Jannier V, Hein L, Rouelle D, Scholz J, Gressens P, Mantz J. Dexmedetomidine increases hippocampal phosphorylated extracellular signal-regulated protein kinase 1 and 2 content by an alpha 2-adrenoceptor-independent mechanism: evidence for the involvement of imidazoline I1 receptors.. Anesthesiology 2008 Mar;108(3):457-66.
    pubmed: 18292683doi: 10.1097/aln.0b013e318164ca81google scholar: lookup
  32. Okada H, Kurita T, Mochizuki T, Morita K, Sato S. The cardioprotective effect of dexmedetomidine on global ischaemia in isolated rat hearts.. Resuscitation 2007 Sep;74(3):538-45.
  33. Wang YQ, Tang YF, Yang MK, Huang XZ. Dexmedetomidine alleviates cerebral ischemia-reperfusion injury in rats via inhibition of hypoxia-inducible factor-1α.. J Cell Biochem 2019 May;120(5):7834-7844.
    pubmed: 30456861doi: 10.1002/jcb.28058google scholar: lookup
  34. Zhang W, Zhang JQ, Meng FM, Xue FS. Dexmedetomidine protects against lung ischemia-reperfusion injury by the PI3K/Akt/HIF-1α signaling pathway.. J Anesth 2016 Oct;30(5):826-33.
    doi: 10.1007/s00540-016-2214-1pubmed: 27412350google scholar: lookup
  35. Hanci V, Erol B, Bektaş S, Mungan G, Yurtlu S, Tokgöz H, Can M, Ozkoçak Turan I. Effect of dexmedetomidine on testicular torsion/detorsion damage in rats.. Urol Int 2010;84(1):105-11.
    doi: 10.1159/000273476pubmed: 20173379google scholar: lookup
  36. Arslan M, Metin Çomu F, Küçük A, Oztürk L, Yaylak F. Dexmedetomidine protects against lipid peroxidation and erythrocyte deformability alterations in experimental hepatic ischemia reperfusion injury.. Libyan J Med 2012;7.
    pmc: PMC3360891pubmed: 22645631doi: 10.3402/ljm.v7i0.18185google scholar: lookup
  37. Yui S, Nakatani Y, Mikami M. Calprotectin (S100A8/S100A9), an inflammatory protein complex from neutrophils with a broad apoptosis-inducing activity.. Biol Pharm Bull 2003 Jun;26(6):753-60.
    doi: 10.1248/bpb.26.753pubmed: 12808281google scholar: lookup
  38. Grosche A, Morton AJ, Polyak MM, Matyjaszek S, Freeman DE. Detection of calprotectin and its correlation to the accumulation of neutrophils within equine large colon during ischaemia and reperfusion.. Equine Vet J 2008 Jun;40(4):393-9.
    doi: 10.2746/042516408X302500pubmed: 18487110google scholar: lookup
  39. Wittenberg-Voges L, Kästner SB, Raekallio M, Vainio OM, Rohn K, Hopster K. Effect of dexmedetomidine and xylazine followed by MK-467 on gastrointestinal microperfusion in anaesthetized horses.. Vet Anaesth Analg 2018 Mar;45(2):165-174.
    doi: 10.1016/j.vaa.2017.08.010pubmed: 29439859google scholar: lookup
  40. Ranheim B, Risberg ÅI, Spadavecchia C, Landsem R, Haga HA. The pharmacokinetics of dexmedetomidine administered as a constant rate infusion in horses.. J Vet Pharmacol Ther 2015 Feb;38(1):93-6.
    doi: 10.1111/jvp.12157pubmed: 25229603google scholar: lookup
  41. Rezende ML, Grimsrud KN, Stanley SD, Steffey EP, Mama KR. Pharmacokinetics and pharmacodynamics of intravenous dexmedetomidine in the horse.. J Vet Pharmacol Ther 2015 Feb;38(1):15-23.
    doi: 10.1111/jvp.12138pubmed: 25066475google scholar: lookup
  42. Zhang L, Huang H, Cheng J, Liu J, Zhao H, Vizcaychipi MP, Ma D. Pre-treatment with isoflurane ameliorates renal ischemic-reperfusion injury in mice.. Life Sci 2011 Jun 20;88(25-26):1102-7.
    doi: 10.1016/j.lfs.2011.04.004pubmed: 21565202google scholar: lookup
  43. Aantaa R, Jaakola ML, Kallio A, Kanto J. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine.. Anesthesiology 1997 May;86(5):1055-60.
  44. Hopster-Iversen CC, Hopster K, Staszyk C, Rohn K, Freeman DE, Rötting AK. Effects of experimental mechanical manipulations on local inflammation in the jejunum of horses.. Am J Vet Res 2014 Apr;75(4):385-91.
    doi: 10.2460/ajvr.75.4.385pubmed: 24669925google scholar: lookup
  45. Duan WR, Garner DS, Williams SD, Funckes-Shippy CL, Spath IS, Blomme EA. Comparison of immunohistochemistry for activated caspase-3 and cleaved cytokeratin 18 with the TUNEL method for quantification of apoptosis in histological sections of PC-3 subcutaneous xenografts.. J Pathol 2003 Feb;199(2):221-8.
    doi: 10.1002/path.1289pubmed: 12533835google scholar: lookup
  46. Dabareiner RM, Snyder JR, White NA, Pascoe JR, Harmon FA, Gardner I, Woliner MJ, Pinney D, Sullins KE. Microvascular permeability and endothelial cell morphology associated with low-flow ischemia/reperfusion injury in the equine jejunum.. Am J Vet Res 1995 May;56(5):639-48.
    pubmed: 7661461
  47. Vente C (2011) Intestinale Entzündungsreaktionen während Ischämie und Reperfusion im Jejunum des Pferdes unter besonderer Berücksichtigung der eosinophilen und neutrophilen Granulozyten. Hannover: Bibliothek der Tierärztlichen Hochschule Hannover.
  48. Blikslager AT, Moeser AJ, Gookin JL, Jones SL, Odle J. Restoration of barrier function in injured intestinal mucosa.. Physiol Rev 2007 Apr;87(2):545-64.
    doi: 10.1152/physrev.00012.2006pubmed: 17429041google scholar: lookup
  49. Freeman DE, Cimprich RE, Richardson DW, Gentile DG, Orsini JA, Tulleners EP, Fetrow JP. Early mucosal healing and chronic changes in pony jejunum after various types of strangulation obstruction.. Am J Vet Res 1988 Jun;49(6):810-8.
    pubmed: 3400918

Citations

This article has been cited 5 times.
  1. Verhaar N, Hoppe S, Grages AM, Hansen K, Neudeck S, Kästner S, Mazzuoli-Weber G. Dexmedetomidine Has Differential Effects on the Contractility of Equine Jejunal Smooth Muscle Layers In Vitro. Animals (Basel) 2023 Mar 10;13(6).
    doi: 10.3390/ani13061021pubmed: 36978562google scholar: lookup
  2. Dengler F, Sternberg F, Grages M, Kästner SB, Verhaar N. Adaptive mechanisms in no flow vs. low flow ischemia in equine jejunum epithelium: Different paths to the same destination. Front Vet Sci 2022;9:947482.
    doi: 10.3389/fvets.2022.947482pubmed: 36157182google scholar: lookup
  3. Wei MF, Cheng CH, Wen SY, Lin JC, Chen YH, Wang CW, Lee YH, Kuo SH. Atorvastatin Attenuates Radiotherapy-Induced Intestinal Damage through Activation of Autophagy and Antioxidant Effects. Oxid Med Cell Longev 2022;2022:7957255.
    doi: 10.1155/2022/7957255pubmed: 36092168google scholar: lookup
  4. Grages AM, Verhaar N, Pfarrer C, Breves G, Burmester M, Neudeck S, Kästner S. Low Flow versus No Flow: Ischaemia Reperfusion Injury Following Different Experimental Models in the Equine Small Intestine. Animals (Basel) 2022 Aug 22;12(16).
    doi: 10.3390/ani12162158pubmed: 36009747google scholar: lookup
  5. Verhaar N, Kopp V, Pfarrer C, Neudeck S, König K, Rohn K, Kästner S. Alpha(2) Antagonist Vatinoxan Does Not Abolish the Preconditioning Effect of Dexmedetomidine on Experimental Ischaemia-Reperfusion Injury in the Equine Small Intestine. Animals (Basel) 2023 Aug 30;13(17).
    doi: 10.3390/ani13172755pubmed: 37685019google scholar: lookup