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Contents

        Editorial Board, iii
        Contributors, v

        Preface: Year Three of This Journal: Bringing Future Developments in Veterinary Medicine Closer to Reality

        Philip H. Kass

        SECTION I: BEHAVIOR

        Factors to Consider when Selecting Puppies and Preventing Later Behavioral Problems

        Ludovica Pierantoni, Eleonora Amadei, and Federica Pirrone
        This review is aimed at going through current knowledge on all the factors that may have an influence on the development of behavioral problems in dogs. Moreover, by highlighting deficits and limitations of current knowledge, it aims to provide indications on how to best manage these delicate phases during the early life of puppies.
         Introduction,  1
         Critical aspects in behavioral development , 2
        Prenatal Experiences , 2
        Sensitive Periods and Early Life Stress , 2
        Style of Maternal Care , 5
        Maternal Care separation , 5
        Maternal Care attachment,  5
        Learning and Experiences , 7
         Discussion and practical implications , 7
         Clinics care points , 8
         Disclosure , 9

        Feline Behavioral Medicine – An Important Veterinary Discipline

        Sarah Heath
        Feline behavioral medicine is a relatively young veterinary discipline and it has been slow to achieve recognition within the profession. One of the most important developments in the field of feline behavior is an increasing understanding of the fact that emotional and cognitive health are important components of overall health and are of equal significance to physical health, which has been the traditional focus of the veterinary profession. In order for behavioral medicine to become a more mainstream feature of veterinary practice, it is helpful to emphasize the fact that it is another form of internal medicine and requires a very similar approach in terms of diagnosis and selection of management and treatment approaches for specific reported behavioral concerns. In addition, taking a behavioral medicine approach to veterinary practice enhances the diagnosis and treatment of physical disease in patients with feline.
         Introduction , 13
         Taking an internal medicine approach , 13
         The concept of emotional valence , 14
         Emotions not feelings , 14
         Motivational-emotional systems , 14
         Positive (engaging) emotional motivations , 15
        The Desire - Seeking System , 15
        The Social Play System , 15
        The Lust System , 15
        The Care System , 15
         Negative (protective) emotional motivations , 15
        The Fear-Anxiety System , 15
        The Pain System , 16
        The Panic-Grief System , 16
        The Frustration System , 16
         Recognizing the role of emotional arousal , 16
         Application of the Sink Model to veterinary behavioral medicine , 17
         Behavioral responses increase the distance from and decrease interaction with a trigger for protective emotion , 17
         Behavioral responses increase the availability of information about a trigger for protective emotion , 18
         Application of a behavioral medicine approach to the veterinary visit experience , 19
         Considering behavioral medicine in feline practice , 19
         “Problem” behaviors can result from positive, engaging, emotional motivation , 20
         Determining the significance of emotional motivation , 20
         Behavioral presentations related to justified emotional motivation and “normal” but unwanted behavioral responses , 20
         Behavioral presentations related to unjustified emotional motivation or involving “abnormal” behavioral responses , 21
         Relevance of feline behavioral medicine to general veterinary practice , 21
         Summary , 21
         Clinics care points , 22
         Disclosure , 22

        Peripheral Concentration of Amyloid-β, TAU Protein, and Neurofilament Light Chain as Markers of Cognitive Dysfunction Syndrome in Senior Dogs: A Meta-analysis

        Patrizia Piotti, Mariangela Albertini, and Federica Pirrone
        Canine cognitive dysfunction syndrome (CCDS) is an age-related neurodegenerative disease. The authors reviewed and performed a meta-analysis of the literature covering in vivo peripheral markers for CCDS. The quantitative analysis focused on 6 papers on amyloid-β 40 and 42 in the serum or plasma. Fixed effect models indicated a significant difference between dogs with CCDS and healthy senior controls in the pooled effect for Aβ42, but not Aβ42, showing moderate heterogeneity. Overall, the evidence for clinical use of Aβ as a peripheral marker of CCDS is not sufficient, but the current findings suggest that it is worthy of further research.
         Introduction , 23
        Clinical Signs of Canine Cognitive Dysfunction Syndrome , 23
        Diagnostic Process , 24
        Histopathological Changes , 25
        Biomarkers of Canine Cognitive Dysfunction Syndrome , 26
         Materials and methods , 28
        Search Strategy , 28
        Inclusion Criteria , 29
        Data Coding , 29
        Risk of Bias and Quality Assessment , 29
         Results , 30
         Discussion , 31
         Clinics care points , 35

        SECTION II: DIAGNOSTIC IMAGING

        Cardiac Computed Tomography Imaging

        Brian A. Scansen
        The heart is a 3-dimensional structure, yet nearly all cardiac imaging performed in animals relies on 2-dimensional imaging techniques such as radiography, fluoroscopy, and ultrasonography. Cross-sectional imaging of the heart using cardiac computed tomography (cCT) allows visualization and reconstruction of cardiac anatomy in unique and useful ways and is particularly useful for planning surgical or catheter-based interventions. This review provides an overview of the technical aspects required for cCT as well as methods to optimize imaging protocols, with particular focus on aspects relevant to imaging small animals.
         Introduction , 39
         Evolution of computed tomography technology , 40
         Spatial resolution , 40
         Pitch and z-axis coverage , 40
         Temporal resolution , 42
         Contrast administration,  43
         Gating , 44
         Heart rate and rhythm , 47
         Development of a cardiac computed tomography protocol , 48
         Artifacts , 51
         Future avenues for research , 53
         Summary , 54
         Clinics care points , 54
         Disclosure , 54

        Advanced Imaging of the Pancreas

        Lauren von Stade and Angela J. Marolf
        Disorders of the pancreas in dogs and cats are often difficult to diagnose with radiographic and conventional ultrasonographic methods. The increased availability and research advancement in imaging technologies including contrast-enhanced ultrasonography, computed tomography, and magnetic resonance imaging are improving clinician options for the detection of diseases such as acute pancreatitis and pancreatic neoplasia, including insulinoma and adenocarcinoma. Advantages of these modalities include detailed assessment of full anatomy, decreased operator dependence, improved patient comfort, and evaluation of organ perfusion. Advanced imaging is now considered the gold standard for the detection and evaluation of pancreatic disease and associated sequelae.
         Introduction , 57
         Normal pancreas , 58
        Contrast-enhanced Ultrasound , 58
        Computed Tomography , 58
        Magnetic Resonance Imaging , 59
         Pancreatitis , 59
        Contrast-enhanced Ultrasound , 60
        Computed Tomography , 62
        Magnetic Resonance Imaging , 64
         Pancreatic neoplasia , 64
        Insulinoma , 64
        Pancreatic Adenocarcinoma , 67
         Summary and future avenues , 69
         Clinics care points , 69
         Disclosure , 69

        Update on Magnetic Resonance Imaging of the Brain and Spine

        Silke Hecht
        Compared to radiography, ultrasound, and computed tomography (CT), magnetic resonance imaging (MRI) is considered a “newcomer” in the world of diagnostic imaging. The first MR imaging-related articles were published in the late 1970s and early 1980s. Reports on the use of MRI in animals were largely limited to animal models at that point. Over the following decades and with increasing recognition of the superb imaging capabilities of MRI in combination with the apparent low risk to patients, MRI research and clinical use especially in the area of neurology rapidly grew in both human and veterinary medicine. Today, with few exceptions, MRI is generally recognized as the gold standard for the evaluation of the central nervous system in people and animals. MRI advances over time included improvement of available hardware (eg, type of magnet) and development/improvement of imaging techniques (eg, specialized MRI sequences). This article provides a brief comparison between low and high field MRI systems, gives an overview of recent advances in imaging technology as it pertains to small animal neuroimaging, provides recommendations for MRI protocols for the imaging of the canine and feline brain and spine, and discusses possible limitations of MRI in the evaluation for certain neurologic diseases in dogs and cats.
         Introduction , 73
         Magnetic resonance imaging hardware , 73
        Magnetic Field Strength , 73
        Gradients , 74
        Radiofrequency Coils , 74
         Magnetic resonance imaging techniques , 74
        Spin-Echo Sequences and Modified Spin-Echo Sequences , 75
        Inversion Recovery Sequences , 76
        Gradient-Echo Sequences , 78
        Functional Magnetic Resonance Imaging Techniques , 81
        Magnetic Resonance Angiography , 86
        Other Technical Modifications and Postprocessing Options , 86
         Magnetic resonance imaging protocol recommendations , 89
         Possible limitations of magnetic resonance imaging , 89
         Clinics care points , 91

        SECTION III: GASTROENTEROLOGY

        Modifying the Gut Microbiota – An Update on the Evidence for Dietary Interventions, Probiotics, and Fecal Microbiota Transplantation in Chronic Gastrointestinal Diseases of Dogs and Cats

        Silke Salavati Schmitz
        Modifications of the intestinal microbiota can be achieved by dietary manipulations, introduction of probiotics, and fecal microbiota transplantation (FMT). Most dietary changes have a moderate impact on microbiota composition and diversity. For individual macro- and micronutrients such as dietary fiber and other prebiotics, changes in “gut health” parameters have been observed in healthy animals, but the effect on gastrointestinal disease is less clear. For probiotics, results are mixed, likely due to the use of different probiotic strains, dosages, durations, and the assessment of different outcomes. While FMT is a promising new treatment modality, information on its optimal use in small animals is currently too scarce to make recommendations.
         Introduction , 95
         Dietary modifications and prebiotics , 96
         Probiotics in canine and feline gastrointestinal disease , 98
         Fecal microbiota transplantation , 100
         Summary , 104
         Conclusion , 105
         Clinics care points , 105
         Disclosure , 105

        Nutrition in Canine and Feline Gastrointestinal Disease

        Aarti Kathrani
        This comprehensive review focuses first on the principles of nutritional management of canine and feline gastrointestinal diseases by detailing the process of nutritional assessment of the patient, the current diet, feeding management, environment, and reassessment and monitoring once the chosen dietary strategy has been implemented. Then a detailed review of the relevant nutritional strategies for the management of acute gastroenteritis, adverse reaction to food, chronic inflammatory enteropathy, intestinal lymphangiectasia, and feline constipation is provided.
         Introduction , 109
         Significance , 110
        Principles of Nutritional Management of Canine and Feline Gastrointestinal Diseases , 110
        Nutritional Strategies for Canine and Feline Gastrointestinal Diseases , 111
         Present relevance and future avenues to consider or to investigate , 116
         Summary/Discussion , 116
         Clinics care points , 116

        Challenges in Differentiating Chronic Enteropathy from Low-Grade Gastrointestinal T-cell Lymphoma in Cats

        Julien Dandrieux and Valérie Freiche
        Chronic enteropathies (CEs) are common diseases, particularly in elderly cats. The differentiation between CE and low-grade gastrointestinal T-cell lymphoma (LGITL) remains challenging. The end diagnosis is reached by combining clinical signs with gastrointestinal tract sampling for histology, immunohistochemistry, and molecular testing. There is currently a lack of international guidelines on molecular testing, with variable results depending on the laboratory used. The clinician needs to keep this in mind when requesting and interpreting a test. Although LGITL is neoplastic, the progression is slow, and most cats can be stabilized for 2 years or more with a combination of prednisolone and chlorambucil.
         Introduction , 121
         Significance , 122
        The Role of Diagnostic Imaging , 123
        Tissue Sampling , 124
        Histology, Immunohistochemistry, and Polymerase Chain Reaction for Antigen Receptor Rearrangement , 124
        Present Relevance and Future Avenues to Consider or to Investigate , 125
        Monitoring During Treatment of Low-Grade Gastrointestinal T-Cell Lymphoma , 128
        Chlorambucil Handling and Safety , 128
         Summary/Discussion , 129
         Clinics care points , 129
         Summary , 129
         Disclosure , 129

        Update on Acute Hemorrhagic Diarrhea Syndrome in Dogs

        Kathrin Busch and Stefan Unterer
        Clostridial overgrowth and associated release of their toxins is responsible for the pathogenesis of acute hemorrhagic diarrhea syndrome. Diagnosis is based on exclusion of other causes for acute hemorrhagic diarrhea, because only invasive tests, such as small intestinal biopsies identifying clostridial colonization on the surface of a necrotic intestinal mucosa, support a diagnosis. These are not usually performed in unstable, hypovolemic patients with an acute disease. In the absence of complications, most dogs rapidly improve with intensive fluid replacement and symptomatic therapy. The short-term prognosis is good, but one-third of dogs develop signs of chronic gastrointestinal disease later in life.
         Introduction , 133
         Pathogenesis , 134
         Signalment, clinical, and clinicopathologic abnormalities , 135
         Recent discoveries , 137
         Diagnostic strategy and monitoring , 137
         Treatment and clinical course , 138
         Summary , 141
         Clinics care points , 141
         Disclosure , 141

        SECTION IV: INFECTIOUS DISEASE

        Feline Immunodeficiency Virus: Current Knowledge and Future Directions

        Paweł M. Bęczkowski and Julia A. Beatty
        Based on clinical observations and the increasing number of published reports, it is evident that many feline immunodeficiency virus (FIV)-positive cats display mild or inapparent clinical signs and frequently achieve normal life spans. Although the clinical manifestation of infection is determined by unknown viral, host, and environmental factors, the relative intrahost genetic stability of FIV may play an important role in the apparent clinical stability observed in many naturally infected cats. Performance of the commercial Fel-O-Vax FIV vaccine documented in recent field studies is suboptimal, reminding us that the fully efficacious lentiviral vaccine remains elusive.
         Introduction , 145
        Overview , 145
        Background , 145
         The virus , 146
        Discovery and Origins , 146
        Virion Structure and Genomic Organization , 146
        Viral Diversity on the Population Level , 146
        Intrahost Viral Diversity and Intrahost Evolution , 146
         Epidemiology , 147
        Prevalence , 147
        Transmission , 147
         Pathogenesis , 147
        Cell Tropism , 147
        Correlates of Immune Protection , 148
        The Course of Feline Immunodeficiency Virus Infection and Clinical Signs , 149
         Prognosis , 151
         Detection and diagnosis , 151
         Management of infected cats , 152
        Environment and Housing Conditions , 152
         Health care , 152
        Preventive Health Care , 152
        Supportive Treatment , 153
        Immunomodulatory and Specific Antiviral Therapies , 153
         Vaccination , 154
         Summary , 155
         Clinics care points , 155

        Diagnostic Testing for Infectious Respiratory Tract Disease

        Sean E. Hulsebosch, Jennifer C. Chan, and Lynelle R. Johnson
        Infectious disease testing is critical for the effective diagnosis of nasal, airway, parenchymal, and pleural space disease in dogs and cats because appropriate therapy requires an accurate diagnosis. While performing rhinoscopy, tracheal wash, bronchoscopy, or thoracocentesis, the clinician should be mindful of tests available for various infectious disease while procuring samples; these tests include cytology, bacterial and fungal cultures, histopathology, and polymerase chain reaction testing. Confirming a role for infection in respiratory disorders will allow appropriate antimicrobial stewardship and avoid development of resistant infections.
         Introduction to nasal diseases , 161
        Sample Collection , 161
         Specific disease considerations , 163
        Viral Infections , 163
        Fungal Infections , 164
        Bacterial Infections , 165
         Introduction to airway and parenchymal infections , 165
        Sample Collection , 165
         Specific disease considerations , 168
        Viral Pneumonia , 168
        Bacterial Pneumonia , 169
         Fungal pneumonia,  169
        Specific Fungal Characteristics , 171
        Parasitic Pneumonia , 171
        Protozoal Infections , 172
         Introduction to pleural infection and empyema , 172
        Thoracocentesis , 172
         Specific disease considerations , 173
        Bacterial Pyothorax , 173
        Viral Infection: Feline Infectious Peritonitis , 173
        Fungal Pyothorax and Empyema , 174
         Clinics care points , 175
         Disclosure , 175

        Canine Leptospirosis – Global Distribution, Diagnosis, and Treatment

        Christine Griebsch, Michael P. Ward, and Jacqueline M. Norris
        Canine leptospirosis is a potentially fatal bacterial disease of global importance resulting in acute kidney injury in most affected dogs, while many will have hepatic and some hemorrhagic and pulmonary involvement. Infecting serovars and seroprevalence vary between geographic regions and despite an abundance of literature there are knowledge gaps due to differences in study design and limitations in available diagnostic tests. While new diagnostic tests including point-of-care tests and molecular methods are being developed, a combination of the microscopic agglutination test (MAT) (acute and convalescent titers) and PCR in blood and urine are recommended. The mainstay of prevention is risk mitigation tailored to different geographic regions taking epidemiological data (including reservoir hosts) into account. Vaccination is inconsistent in preventing disease and is influenced by the infecting serovar(s) and valency of the vaccine.
         Introduction , 177
         Bacterial properties, taxonomy, and transmission , 178
         Pathogenesis , 178
         Global distribution , 179
         Prevalence of silent shedders , 179
         Epidemiology , 179
         Clinical manifestations , 195
         Diagnosis , 197
        Clinicopathologic Changes , 197
        Diagnostic Imaging , 197
        Criteria Used to Establish a Diagnosis , 198
        Molecular Diagnostics , 198
         Serological diagnostics , 200
        Microscopic Agglutination Test , 200
        Enzyme-Linked Immunosorbent Assay , 202
        Commercially Available In-House Tests , 205
        Culture , 205
        Histopathology , 205
        Treatment , 205
        Treatment of Dogs in Close Contact with Cases , 206
        Zoonotic Risk , 206
        Prognosis , 207
        Prevention , 207
        Future Avenues for Investigation,  209
         Summary , 209
         Clinics care points , 209
         Disclosure , 209

        SECTION V: NUTRITION

        Nutritional Management of Acute Pancreatitis

        Daniel L. Chan
        Medical management of acute pancreatitis has shifted from the concept of “pancreatic rest” to early reinitiation of enteral feeding as soon as it is feasible. This shift is due to improved understanding of the pathophysiology of acute pancreatitis and growing evidence of the benefits of enteral feeding in this disease. Nutritional planning for patients with acute pancreatitis centers on nutritional assessment, selecting the most appropriate approach of nutritional support, and initiating enteral feeding as soon as it is feasible. Monitoring for tolerance of enteral feeding and adjusting the nutritional plan as appropriate is key in the management of these patients.
         Introduction , 221
         Significance , 221
         Nutritional management strategies , 222
         Enteral nutrition during acute pancreatitis , 222
         Feeding tubes and routes , 222
        Parenteral Nutrition , 223
         Dietary considerations , 224
         Future avenues to investigate , 224
        Emerging Role of Immunonutrition,  224
         Summary,  225
         Clinics care points,  225
         Disclosure of commercial or financial conflicts of interests,  225

        Creating a Weight Loss Plan with Owner Engagement

        Camille Torres and Jonathan Stockman
        The obesity epidemic affects more than half of dogs and cats in westernized countries. This disease has several negative implications on the quality of life, risk of concurrent disease, and longevity. Many pet owners may not recognize their pet is obese or realize the implications of obesity. Weight loss is a lengthy process that requires the owner’s commitment and diligence. There are multiple hurdles that can impede a successful outcome; however, there are steps that the veterinary team can take to mitigate some of the challenges during the pet’s weight loss and increase the chances for success.
         Introduction—Why is weight loss important? , 229
        Risk Factors for Obesity , 230
        Principles of Clinical Management of Weight Loss , 230
         Summary , 235
         Clinics care points , 235
         Disclosure , 236