bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico‐ureteric reflux after renal transplantation
Authors: Pichler Renate , Buttazzoni Alexander , Rehder Peter , Bartsch Georg , Steiner Hannes , Oswald Josef
Published: November 2010

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

Vesicoureteral reflux (VUR) after renal transplantation may cause recurrent urinary tract infections (UTIs) and loss of renal function with consecutive risk of progressive graft damage. There are only a few series on the therapeutic success of dextranomer/hyaluronic acid copolymer treatment by transurethral injection. We assessed whether transurethral endoscopic therapy is an alternative strategy treating VUR in this special patient collective and we found out that this surgical method is a minimally invasive and efficient procedure with reflux resolution rate of approximately 60% after one and 79% after two injections with significant reduction of postoperative UTIs on short‐term follow up.

OBJECTIVE

• To evaluate the success of endoscopic dextranomer/hyaluronic acid copolymer (DHAC) application in the treatment of patients with recurrent urinary tract infections (UTIs) and vesico‐ureteric reflux (VUR) into the transplanted graft after renal transplantation.

PATIENTS AND METHODS

• Between January 2008 and April 2009, 19 patients with recurrent UTIs presented VUR proven by voiding cystourethrography.

• To correct VUR of the transplanted ureter, DHAC was injected endoscopically using hydrodistention technique.

• Pre‐ and postoperative serum creatinine levels, the number of pre‐ and postoperative UTIs, postoperative complications and reflux resolution rate were recorded. The mean follow‐up was 6.5 months.

RESULTS

• The average number of UTIs was reduced significantly from 4.89 (range 2–14) to 1.31 (range 0–4) on pre‐ and postoperative follow‐up, respectively, of 6 months (P < 0.001). The success rate increased from 57.9% after the first injection to 78.9% after the second injection.

• The remaining four patients with residual VUR received long‐term low dose antibiotic prophylaxis. In total, two (10.5%) patients developed increasing creatinine levels postoperatively as a result of distal ureteral obstruction, and temporary urinary drainage was necessary in both patients.

CONCLUSIONS

• DHAC appears to be an efficient and minimal invasive method for treating VUR after renal transplantation with respect to short‐term success.

• Further investigation with a larger group of patients and longer follow‐up is needed to evaluate the prolonged effect, as well as any potential side effects.
Communication in social networks: Effects of kinship, network size, and emotional closeness
Authors: ROBERTS SAM G. B. , DUNBAR ROBIN I. M.
Published: November 2010

Communication is important in preventing social relationships from decaying over time. This study examined the effects of social network size, emotional closeness, and type of relationship (kinship vs. friendship) on communication patterns in the social networks of 251 women. Participants with large kin networks had longer times to last contact to both kin and friends. Participants with high levels of emotional closeness in their networks had shorter times to last contact. The effect of emotional closeness on time to last contact was greater for kin than for friends. These results demonstrate that time to last contact is closely tied to emotional closeness and suggest that the costs of maintaining kin relationships are lower than the costs of maintaining friendships.
Efficacy and Safety of Dapoxetine for the Treatment of Premature Ejaculation: Integrated Analysis of Results from Five Phase 3 Trials
Authors: McMahon Chris G. , Althof Stanley E. , Kaufman Joel M. , Buvat Jacques , Levine Stephen B. , Aquilina Joseph W. , Tesfaye Fisseha , Rothman Margaret , Rivas David A. , Porst Hartmut
Published: November 2010

Introduction

Dapoxetine has been evaluated for the on-demand treatment of premature ejaculation (PE) in five phase 3 studies in various populations worldwide and has recently been approved in several countries.

Aim

To present integrated efficacy and safety data from phase 3 trials of dapoxetine.

Methods

Data were from five randomized, multicenter, double-blind, placebo-controlled studies conducted in over 25 countries. Men (N = 6,081) ≥18 years who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria for PE; four studies required a baseline intravaginal ejaculatory latency time (IELT) of ≤2 minutes. Dapoxetine 30 and 60 mg on demand (prn; 1–3 hours before intercourse) were evaluated for either 12 or 24 weeks in four studies; one study evaluated dapoxetine 60 mg daily (qd; included in safety assessments only) or prn for 9 weeks.

Main Outcome Measures

End points included stopwatch-measured IELT, Premature Ejaculation Profile (PEP) items, clinical global impression of change (CGIC) in PE, and adverse events (AEs).

Results

Average IELT (mean [standard deviation], geometric mean [standard error]) increased from baseline (across groups, 0.9 [0.49] minutes, 0.8 [1.01] minutes) to a significantly greater extent with dapoxetine 30 (3.1 [3.91] minutes, 2.0 [1.03] minutes) and 60 mg (3.6 [3.85] minutes, 2.3 [1.03] minutes) vs. placebo (1.9 [2.43] minutes, 1.3 [1.02] minutes; P < 0.001 for all) at week 12 (geometric mean fold increase, 2.5, 3.0, and 1.6, respectively). All PEP items and CGIC improved significantly with both doses of dapoxetine vs. placebo (P < 0.001 for all). The most common AEs included nausea, dizziness, and headache, and evaluation of validated instruments demonstrated no anxiety, akathisia, suicidality, or changes in mood with dapoxetine use and no discontinuation syndrome following abrupt withdrawal.

Conclusions

In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.
HMOs and Managed Care: Implications for Rural Physician Manpower Planning*
Authors: Weiner Jonathan P.
Published: November 2010

ABSTRACT: American health care is changing dramatically. Health maintenance organizations (HMOs) and other managed care plans are central to this change. Today, the majority of Americans living in metropolitan areas receive their care from these types of plans. The goal of this article is two‐fold. First, it will discuss the potential implications of HMOs and managed care for physician needs and supply in rural regions. Second, it will derive insight into alternative approaches for meeting rural health manpower needs by analyzing HMO staffing patterns.

As HMOs and other managed care plans expand, rural physicians, their practices, and their patients will almost certainly be affected. As described in this paper, most of these effects are likely to be positive.

The staffing patterns used by HMOs provide an interesting point of comparison for those responsible for rural health manpower planning and resource development. HMOs appear to meet the needs of their enrollees with significantly fewer providers than are available nationally or suggested by the federal standards. Moreover, HMOs make greater use of nonphysician providers such as nurse practitioners and physician assistants.
Drug Therapy for Resistant Hypertension: Simplifying the Approach
Authors: Mann Samuel J.
Published: November 2010

Despite the availability of many effective antihypertensive drugs, the drug therapy for resistant hypertension remains a prominent problem. Reviews offer only the general recommendations of increasing dosage and adding drugs, offering clinicians little guidance with respect to the specifics of selecting medications and dosages. A simplified decision tree for drug selection that would be effective in most cases is needed. This review proposes such an approach. The approach is mechanism‐based, targeting treatment at three hypertensive mechanisms: (1) sodium/volume, (2) the renin‐angiotensin system (RAS), and (3) the sympathetic nervous system (SNS). It assumes baseline treatment with a 2‐drug combination directed at sodium/volume and the RAS and recommends proceeding with one or both of just two treatment options: (1) strengthening the diuretic regimen, possibly with the addition of spironolactone, and/or (2) adding agents directed at the SNS, usually a β‐blocker or combination of an α‐ and a β‐blocker. The review calls for greater research and clinical attention directed to: (1) assessment of clinical clues that can help direct treatment toward either sodium/volume or the SNS, (2) increased recognition of the role of neurogenic (SNS‐mediated) hypertension in resistant hypertension, (3) increased recognition of the effective but underutilized combination of α‐ + β‐blockade, and (4) drug pharmacokinetics and dosing. J Clin Hypertens (Greenwich). 2011;13:120–130. © 2010 Wiley Periodicals, Inc.
Exploration of High‐Hardness/Low‐Melting Borate Glasses
Authors: Segawa Hiroyo , Igarashi Tatsuhiro , Sakamoto Tomoyuki , Mizuno Kento , Konishi Tomoya , Inoue Satoru
Published: November 2010

Numerous types of borate glass—AEO–ZnO–B2O3 (AEO=CaO, SrO, BaO), TMO–ZnO–B2O3 (TMO=MnO, Fe2O3, Co3O4, NiO, CuO), and REO–TMO–B2O3 (REO=Nd2O3 and La2O3)—were investigated to discover a glass with high hardness and low melting temperature. They were prepared using a combinatorial glass melting system, and their hardness and glass transition temperature, Tg, were measured. The REO–TMO–B2O3 glass systems had higher hardness than the other glass systems due to the large packing density of the glasses. In particular, the hardness values of the REO–NiO–B2O3 glasses were >8 GPa, with Tg values of about 650°C. The REO–NiO–B2O3 glasses are good candidates for high‐hardness and low‐melting‐temperature glasses. Among glasses having a Tg <550°C, Fe2O3–ZnO–B2O3, Co3O4–ZnO–B2O3, and REO–MnO–B2O3 glasses had hardnesses >6 GPa.
Influence of girth strap placement and panel flocking material on the saddle pressure pattern during riding of horses
Authors: BYSTRÖM A. , STALFELT A. , EGENVALL A. , VON PEINEN K. , MORGAN K. , ROEPSTORFF L.
Published: November 2010

Reasons for performing study: Saddle fit is well recognised as an important factor for the health and performance of riding horses. However, only few studies have addressed general effects of different saddle construction details within a group of horses.

Objective: To assess the influence of girth strap placement, traditional vs. v‐system, and panel flocking material, wool vs. synthetic foam, on the saddle pressure pattern during riding.

Methods: Six horses were ridden by 3 riders in sitting and rising trot and sitting canter. Saddle pressure was measured with 3 different saddle variants: 1) wool flocked panels and traditional girthing (baseline); 2) wool flocked panels and v‐system girthing; and 3) foam filled panels and traditional girthing. From the pressure data, a number of descriptive variables were extracted. These were analysed using ANCOVA models with horse, rider, saddle, seat (sitting/rising, trot only) and speed as independent variables.

Results: With foam filled panels stride maximum pressures under the hind part of the saddle increased by 7–12% and the area under the saddle with a stride mean pressure >11 kPa increased by 114 cm2 in trot and 127 cm2 in canter. With v‐system girthing, the latter variable also increased, but only by 53 and 38 cm2 in trot and canter, respectively. In addition, stride maximum pressures under the front part of the saddle tended to increase (≤9%).

Conclusions: Both flocking material and girthing have a significant influence on the saddle pressure and should thus be considered in saddle fitting. Wool seems a better flocking material than foam of the type used in the current study. For girthing, traditional placement seems equally good if not better than the v‐system. However, further studies are needed to show if these results are valid for a larger population of riding horses.
Oxygen consumption and gait variables of Arabian endurance horses measured during a field exercise test
Authors: COTTIN F. , METAYER N. , GOACHET A. G. , JULLIAND V. , SLAWINSKI J. , BILLAT V. , BARREY E.
Published: November 2010

Reasons for performing study: Arabian horses have morphological, muscular and metabolic features designed for endurance races. Their gas exchange and gait variables were therefore measured during a field exercise test. This study presents original respiratory and locomotor data recorded in endurance horses under field conditions.

Hypothesis and objectives: Respiratory gas exchange ratio (RER) of Arabian horses at the speed required to win endurance races (18 km/h for 120–160 km) are <1 and running economy (RE) is also low in order to maintain exercise intensity using aerobic metabolism for long intervals. The purpose of this study was to measure oxygen consumption and gait variables in Arabian endurance horses running in the field in order to estimate RER and RE.

Materials and methods: Five Arabian horses trained for endurance racing were test ridden at increasing speeds on the field. Their speed was recorded and controlled by the rider using a GPS logger. Each horse was equipped with a portable respiratory gas analyser, which measured breath‐by‐breath respiratory variables and heart rate. The gait variables were recorded using tri‐axial accelerometer data loggers and software for gait analysis. Descriptive statistics and linear regressions were used to analyse the speed related changes in each variable with P<0.05 taken as significant.

Results: At a canter speed corresponding to endurance race winning speed (18 km/h), horses presented a VO2= 42 ± 9 ml/min/kg bwt, RER = 0.96 ± 0.10 and RE (= VO2/speed) = 134 ± 27 l/km/kg bwt. Linear relationships were observed between speed and VO2, HR and gait variables. Significant correlations were observed between VO2 and gait variables.

Conclusions and potential relevance: The RER of 0.96 at winning endurance speed indicates that Arabian horses mainly use aerobic metabolism based on lipid oxidation and that RER may also be related to a good coordination between running speed, respiratory and gait parameters.
Kinematic characteristics of hoof landing in jumping horses at elite level
Authors: HERNLUND E. , EGENVALL A. , ROEPSTORFF L.
Published: November 2010

Reasons for performing study:Biomechanical events of the distal limb during the landing phase of a jump have been proposed to be risk factors for injury, indicating need for further characterisation of the landing and the hoof‐surface interaction. This is essential also for valid testing of arena surfaces when simulating actual conditions.

Objectives:To investigate the hoof landing characteristics for different limbs of elite showjumping horses during the landing phase when jumping 1.30–1.50 m competition fences on 2 different arena surfaces.

Materials and methods:A single, fixed high speed camera (1000 frames/s) was aimed at landing spots after different fences during 2 competitions. A total of 64 hoof landings were recorded on one sand and one turf surface (using studs on the turf). Hoof movements were tracked from calibrated video sequences. Landing velocities, landing angles, maximal vertical and horizontal deceleration and timing of maximal deceleration peaks were calculated and compared between leading/trailing fore‐/hindlimbs. All outcomes were analysed for limb, using generalised linear models and controlling for effects of surface and obstacle.

Results:Landing speed differed among limbs (P<0.02 for all speeds and models). The leading hoof approached the ground more acutely angled to the horizontal plane than the trailing comparing fore‐ (P<0.001) and hindlimbs (0.05≥P>0.01), respectively. Differences in landing and braking kinematics were also found between surfaces and obstacles; however, these effects were hard to separate because of the nonexperimental design.

Conclusions:The landing and braking characteristics of the hooves varied substantially between hind‐, fore‐, trailing and leading limbs. Developing mechanical testing devices for arena surfaces, this fairly wide range of biomechanical events must be considered, in order to simulate the horse‐surface interaction.
Relationship between saddle pressure measurements and clinical signs of saddle soreness at the withers
Authors: Von PEINEN K. , WIESTNER T. , Von RECHENBERG B. , WEISHAUPT M. A.
Published: November 2010

Reasons for performing the study: Similar to human decubitus ulcers, local high pressure points from ill‐fitting saddles induce perfusion disturbances of different degrees resulting in tissue hypoxia and alteration in sweat production.

Objective: To relate the different clinical manifestations of saddle sores to the magnitude of saddle pressures at the location of the withers.

Methods: Sixteen horses with dry spots after exercise (Group A) and 7 cases presented with acute clinical signs of saddle pressure in the withers area (Group B) were compared with a control group of 16 sound horses with well fitting saddles (Group C). All horses underwent a saddle pressure measurement at walk, trot and canter. Mean and maximal pressures in the area of interest were compared between groups within each gait.

Results: Mean pressures differed significantly between groups in all 3 gaits. Maximal pressure differed between groups at trot; at walk and canter, however, the only significant difference was between Group C and Groups A and B, respectively, (P>0.05). Mean and maximal pressures at walk in Group A were 15.3 and 30.6 kPa, in Group B 24.0 and 38.9 kPa and in Group C 7.8 and 13.4 kPa, respectively; at trot in Group A 18.1 and 43.4 kPa, in Group B 29.7 and 53.3 kPa and in Group C 9.8 and 21.0 kPa, respectively; and at canter in Group A 21.4 and 48.9 kPa, in Group B 28.6 and 56.0 kPa and in Group C 10.9 and 24.7 kPa, respectively.

Conclusion: The study shows that there is a distinguishable difference between the 3 groups regarding the mean pressure value, in all gaits.
The effect of treadmill speed and gradient on equine hindlimb muscle activity
Authors: CROOK T. C. , WILSON A. , HODSON‐TOLE E.
Published: November 2010

Reasons for performing study: Locomotion requires successful negotiation of different terrains, but we currently know little of how the musculoskeletal system adapts to cope with positive and negative slopes.

Objective: To compare the effects of treadmill speed and gradient on equine hindlimb muscle mean electromyographic (EMG) intensity.

Methods: Surface EMG recorded the activity of gluteus medius (GM), biceps femoris (BF), vastus lateralis (VL), gastrocnemius lateralis (GL) and extensor digitorum longus (EDL) in 6 horses at walk (1.4–1.6 m/s) and trot (2.6–3 m/s) on 3 different treadmill gradients (0, 10% and −10%). Significant differences in mean EMG intensity and kinematic data were determined using Friedman and Wilcoxon signed rank tests (P<0.05).

Results: Increasing velocity increased the mean EMG intensity of GM, BF and GL regardless of gradient. Treadmill incline increased the mean EMG intensity for all muscles at the walk and that of GM at trot. Treadmill decline reduced the mean EMG intensity of GM at both the walk and the trot and that of BF at the walk, but not the trot. The mean EMG intensity of EDL, VL and GL remained similar at both gaits when compared to the horizontal.

Conclusions: The hip retractors are the primary muscles responsible for powering equine locomotion in response to increasing workload.

Potential relevance: A better understanding of the effects of speed and gradient on the functional activity of the horses' locomotor muscles will enable the development of more effective training programmes pre‐ and post injury.
Differences in the metabolic properties ofgluteus mediusand superficial digital flexor muscles and the effect of water treadmill training in the horse
Authors: BORGIA L. A. , VALBERG S. J. , ESSEN‐GUSTAVSSON B.
Published: November 2010

Reasons for performing study:Flexor tendon injury may be due to flexor muscle fatigue, contributing to fetlock joint hyperextension and tendon damage. A water treadmill provides resistance training on flexor tendon muscles, which might reduce the risk of tendon injury.

Objective:To determine the effect of water treadmill training on the properties of the gluteal and superficial digital flexor (SDF) muscles and on cardiocirculatory response to a standardised exercise test.

Methods:Five healthy unfit horses were trained on a water treadmill for 5 days/week for 4 weeks, starting with 5 min/day increasing to 20 min/day. Before and after the water treadmill training, an incremental SET was performed on a land treadmill to determine velocity at a heart rate 200 beats/min (V200) and resting gluteal and SDF muscle biopsies were obtained for biochemical analyses.

Results:There was no measurable difference in resting concentrations of gluteal or SDF muscle glycogen, lactate, ATP or glucose‐6‐phosphate (G6P), or activities of citrate synthase (CS), 3‐hydroxyacyl CoA dehydrogenase (HAD) and lactate dehydrogenase (LDH) after training and no change in V200, Lactate, glycogen, G6P and ATP concentrations were 50% lower andtype 1fibres 30% higher in SDF compared to gluteal muscles. CS and HAD activities were similar between SDF and gluteal, while LDH was lower in the SDF muscle.

Conclusions:A more strenuous water treadmill conditioning protocol may be needed to induce a training effect in gluteal and SDF muscle and heart rate response. The low substrate concentrations and oxidative capacity of SDF may predispose this muscle to catastrophic fatigue during maximal exercise.
Investigation of the incidence and type of injuries associated with high‐speed treadmill exercise testing
Authors: FRANKLIN S. H. , BARAKZAI S. Z. , COUROUCÉ‐MALBLANC A. , DIXON P. , NANKERVIS K. J. , PERKINS J. D. , ROBERTS C. A. , VANERCK‐WESTERGREN E. , ALLEN K. J.
Published: November 2010

Reasons for performing study:During the past 20 years, treadmill exercise testing has played an important role in both the study of equine exercise physiology and the investigation of poor athletic performance. However, it has been suggested that some trainers and veterinarians may be reluctant to refer horses for treadmill exercise testing because of fears that horses may be at increased risk of musculoskeletal injury during treadmill exercise.

Objective:To investigate the incidence and types of injuries sustained by horses undergoing treadmill exercise.

Methods:Data were collated from 9 centres in the UK, France and Belgium, and the prevalence and types of injury were established.

Results:A total of 2305 records were reviewed, with 2258 horses performing treadmill exercise. There was an overall injury rate of 5.4%. However, the majority of injuries sustained were minor in nature (4.7%). Only 13 horses (0.6%) sustained major injuries in association with treadmill exercise. These included 5 cases of severe exercise‐induced myopathy, 4 fractures (of which 1 was catastrophic), 2 tendon injuries, 1 case with undiagnosed severe lameness and 1 with marked exacerbation of a previously diagnosed lameness. Two other major incidents were reported but were not directly associated with treadmill exercise (one had iliac thrombosis and one collapsed and died as a result of a pulmonary embolism).

Conclusions:This study confirms that the majority of horses undergo treadmill exercise without incident. The majority of injuries that did occur were minor in nature and the incidence of major injuries was similar to that reported during competition elsewhere.

Potential relevance:Treadmill exercise is a safe procedure and does not appear to pose an increased risk of injury in comparison with overground exercise.
Saddle pressure patterns of three different training saddles (normal tree, flexible tree, treeless) in Thoroughbred racehorses at trot and gallop
Authors: LATIF S. N. , Von PEINEN K. , WIESTNER T. , BITSCHNAU C. , RENK B. , WEISHAUPT M. A.
Published: November 2010

Reasons for performing study:To a large extent the success of a racehorse depends on effective and health preserving training methods. An important issue is the prevention of back pain. The influence of different types of training saddles (normal tree: SA, treeless: SB, flexible tree: SC) on the saddle pressure patterns in racehorses have not previously been investigated. It is commonly assumed that SAlimits the motion of the back especially in the lower thoracic region during gallop.

Hypothesis:SAproduces higher pressures in the caudal part of the saddle at trot (rising trot), canter and gallop (both in a jockey seat) compared to SBand SC.

Methods:Saddle pressures were measured in 8 racehorses ridden on a training track at trot (3.5 m/s), canter (6.4 m/s) and gallop (12.6 m/s). Each horse performed the protocol with each saddle. To analyse the pressure distribution over the horse's back the pressure picture was divided into thirds (TDfront, TDmid, TDhind). The stride‐mean loaded areas, forces and mean and peak pressures were determined.

Results:At canter and gallop, all 3 saddles were mainly loaded in TDfront(>80% of the rider's weight), with a decreasing gradient to TDmidand TDhind(<3%), which was least pronounced in SC. At trot, the load was shifted towards TDmidand TDhind(10–15%, each). High peak pressures occurred in TDfrontat canter and gallop and in TDhindat trot.

Conclusions:The type of tree had no influence on the pressure picture of the caudal third at gallop. The high peak pressures observed in TDhindat trot in all saddles may limit the activity of the horse's back, which is of particular importance since trot is an integral part of the daily work.
Use of biochemical parameters to predict metabolic elimination in endurance rides
Authors: TRIGO P. , CASTEJON F. , RIBER C. , MUÑOZ A.
Published: November 2010

Reasons for performing study:Endurance races are the competition with the biggest metabolic demands for the sport horse. During races, some horses show homeostasis alterations, having repercussions in diverse biochemical parameters and negative consequences on performance and health.

Objectives:To evaluate the utility of biochemical analysis in the early diagnosis of metabolic stress and to determine cut‐off values of biochemical parameters to assist in the prevention of metabolic alterations in endurance horses.

Methods:This study involved 36 CEI races and 283 horses (41 eliminated because of metabolic disturbances). Blood samples were taken before competition, after the vet‐gates and after finishing the race or veterinary disqualification. Packed cell volume (PCV), activities of CK, AST and LDH, and concentrations of total plasma proteins (PP), urea, creatinine (Cr), uric acid (UA) and plasma lactate were determined. Successful horses were compared with horses eliminated due to metabolic conditions in the values obtained in the phase prior to being removed from the competition. Factors associated with metabolic elimination were further analysed using multiple logistic regression analysis. Dichotomisation for each variable was made using the receiver‐operating characteristic curve to enter into the model.

Results:PCV>52%, PP>82 g/l, standardised Cr>30 mg/l 100 km, UA>72 mg/l, standardised CK>12.6 ui/l km and standardised AST>6.2 ui/l km were associated with the development of metabolic alterations. Of the horses with an imbalance between PCV and PP, 30% had metabolic elimination in the following phases. Muscle enzymes and Cr were directly related to the distance covered.

Conclusions:Selected biochemical markers are evident in some endurance horses before their elimination. However, most horses developed metabolic disturbances without any important alterations in the variables determined in this study.

Potential relevance:Analysis of selected plasma biochemical parameters could be useful in the prevention and early diagnosis of metabolic stress in endurance horses.
Efficacy of spinal manipulation and mobilisation on trunk flexibility and stiffness in horses: a randomised clinical trial
Authors: HAUSSLER K. K. , MARTIN C. E. , HILL A. E.
Published: November 2010

Reasons for performing the study: Spinal mobilisation and spinal manipulative therapy (SMT) are being applied to horses; however, there are limited objective measures of their effects on spinal mobility or stiffness in actively ridden horses.

Objectives: To quantify passive spinal movements induced during dorsoventral mobilisation of the trunk and to identify any potential effects of SMT on measures of spinal mobility within the thoracolumbar region in standing horses. We hypothesise that displacement amplitudes will be significantly increased across vertebral levels after SMT, compared to spinal mobilisation only within the control group.

Methods: Passive spinal mobility was assessed in 24 actively ridden mature horses once a week for 3 weeks. Peak vertical displacement, loading and unloading velocities, applied force, stiffness and the frequency of truncal oscillations induced during dorsoventral spinal mobilisation were measured at 5 thoracolumbar sites and compared between treatment (n = 12) and control (n = 12) groups. Each week, outcome parameters were measured pre‐ and post intervention, 10 min apart. Treatment consisted of manually‐applied, high‐velocity, low‐amplitude (HVLA) thrusts directed at the 5 intervertebral sites. Control horses received no additional intervention. A mixed‐effects linear regression model was used to assess the interactive effects of treatment group, vertebral level, week and pre‐/post intervention.

Results: Post intervention displacement amplitudes of the trunk and applied forces were significantly higher in the SMT group, compared to the control group. A similar trend was found for increased spinal stiffness within the SMT group. Across vertebral levels, SMT induced a 40% increase in displacement, a 20% increase in applied force and a 7% increase in stiffness.

Conclusions and potential relevance: SMT increased dorsoventral displacement of the trunk, which is indicative of producing increased passive spinal flexibility in actively ridden horses. Further clinical research is needed on the effectiveness of manual therapies in horses with objective measures of back pain, stiffness and poor performance.
Heel movement in horses: comparison between glued and nailed horse shoes at different speeds
Authors: YOSHIHARA E. , TAKAHASHI T. , OTSUKA N. , ISAYAMA T. , TOMIYAMA T. , HIRAGA A. , WADA S.
Published: November 2010

Reasons for performing study:It has been suggested that the heel of the horse's hoof expands in the stance phase and this reduces the concussion at impact and helps pump blood into the hoof. Therefore, farriers usually leave a gap in the heel region when using the traditional nailed shoe. Recently glued shoes which are attached firmly to the heel have been developed and these could restrict heel movement.

Objective:To compare the degree of mediolateral heel movement between glued and nailed shoes.

Methods:Seven Thoroughbreds were used. Either their fore‐ or hind hooves were shod with plain aluminium shoes, attached first with glue and later with nails. Measurements were collected continuously with a displacement sensor fixed between the medial and lateral hoof walls at the heel. The horses ran on a treadmill at a walk (1.8 m/s), trot (3.5 m/s), canter (8 m/s) and gallop (12 m/s). The mediolateral heel movement in a nonweightbearing position was set at zero for each hoof and thus positive and negative numbers represented expansion and contraction, respectively. Average values of 10 consecutive strides at each speed were compared between the 2 shoeing methods by pairedttest.

Results:At all running speeds, the heels expanded in the first 70–80% of the stance phase and contracted at breakover. The total heel movement calculated as the sum of the maximum expansion and contraction value was less with glued shoeing than with nailed shoeing for walking (all limbs), trotting (all limbs), cantering (leading forelimb and both hindlimbs) and galloping (both hindlimbs).

Conclusions:Glueing restricted heel movement, suggesting possible interference with shock absorption and blood pumping in the hoof. Further study is needed to evaluate the influence of glued shoeing on hoof mechanics.
Effects of intravenous aminocaproic acid on exercise‐induced pulmonary haemorrhage (EIPH)
Authors: BUCHHOLZ B. M. , MURDOCK A. , BAYLY W. M. , SIDES R. H.
Published: November 2010

Reasons for performing study:The antifibrinolytic, 6‐aminohexanoic acid, also named aminocaproic acid (ACA), has been used empirically as a treatment for exercise‐induced pulmonary haemorrhage (EIPH) on the unsubstantiated basis that transient coagulation dysfunction may contribute to its development.

Objective:To assess the effect of ACA on bronchoalveolar lavage fluid (BALF) erythrocyte counts in horses performing treadmill exercise at an intensity greater than that needed to reach maximal oxygen consumption.

Methods:Eight Thoroughbreds were exercised to fatigue 3 times on a 10% inclined treadmill at a speed for which the calculated oxygen requirement was 1.15 times. Horses were treated with a saline placebo, 2 and 7 g ACA i.v. 4 h before exercise, with a crossover design being used to determine the order of the injections. Exercise‐induced pulmonary haemorrhage severity was quantified via the erythrocyte count in BALF. Bronchoalveolar lavage fluid was collected 4 h before and 30–60 min post exercise. Results were expressed as mean ± s.e.m. and analysed by one way repeated measures ANOVA (P<0.05).

Results:Aminocaproic acid administration had no effect on any measured variables ( = 148 ± 3.0 [C]; 148 ± 3.0 [2 g ACA]; 145 ± 3.0 [7 g ACA] ml/kg bwt/min, respectively; run time = 77 ± 3 [C]; 75 ± 2 [2 g ACA]; 79 ± 3 [7 g ACA] seconds, respectively). All horses developed EIPH: 1691 ± 690 vs. 9637 ± 3923 (C); 2149 ± 935 vs. 3378 ± 893 (2 g ACA); 1058 ± 340 vs. 4533 ± 791 (7 g ACA) erythrocytes/µl pre‐ vs. post exercise recovered in BALF, respectively.

Conclusion:Aminocaproic acid was not effective in preventing or reducing the severity of EIPH or improving performance under the exercise conditions of this study.
Effects of collecting blood into plastic heparinised Vacutainer®tubes and storage conditions on blood gas analysis values in horses
Authors: NOËL P. G. , COUËTIL L. , CONSTABLE P. D.
Published: November 2010

Reasons for performing study:Plastic heparinised Vacutainer®(registered trademark of Becton, Dickinson and Company) tubes are used for blood gas analysis in horses. This collection method may not be ideal because influx of atmospheric O2through the permeable plastic wall of the Vacutainer®tube and loss of CO2into the gas phase above the blood sample should increase blood PO2and decrease PCO2, respectively.

Objectives:To determine the effects of collecting blood into plastic Vacutainer®tubes and storage conditions on blood gas analysis values.

Methods:Blood was obtained from 6 healthy horses and tonometered at 37°C with 12% O2and 5% CO2. Three ml aliquots of tonometered blood were collected using a glass syringe or Vacutainer®tube and stored in iced water or at room temperature for 0, 5, 15, 30, 60 and 120 min. Blood samples from Vacutainer®tubes were collected aerobically (tube opened for 5 s) or anaerobically (tube remained closed). Blood gas analysis was performed in duplicate using a Radiometer ABL5. Data was analysed using repeated measures analysis of variance and P<0.05 was significant.

Results:Compared to the glass syringe, tonometered blood collected in Vacutainer®tubes had an immediate, significant, sustained and marked increase in PO2and an immediate, significant, transient but small decrease in PCO2. Blood PO2and PCO2were higher when Vacutainer®tubes were stored in iced water instead of at room temperature. Measured blood pH and calculated values for plasma bicarbonate and total CO2concentration and base excess of extracellular fluid were similar when blood was collected in glass syringes or Vacutainer®tubes and values were not altered by storage temperature or time.

Conclusions:Plastic heparinised Vacutainer®tubes should not be used to collect samples for measurement of blood PCO2and PO2. Vacutainer®tubes provide an accurate method for measuring plasma bicarbonate concentration, total CO2concentration and base excess.
Altered systolic left ventricular function in horses completing a long distance endurance race
Authors: AMORY H. , VOTION D.‐M. , FRAIPONT A. , GOACHET A. G. , ROBERT C. , FARNIR F. , VAN ERCK E.
Published: November 2010

Reasons for performing study:It is unknown whether or not exercise‐induced cardiac fatigue (EICF), as demonstrated in human athletes performing long duration exercise, occurs in endurance horses.

Objective:To examine the effects of a long distance endurance race on left ventricular systolic function in horses.

Methods:Echocardiography was performed before, and after, a 2 or 3 star international endurance race (106–132 km) in 11 horses. Systolic (s) and diastolic (d) interventricular and left ventricular free wall thickness (IVS and LVFW, respectively), left ventricular, left atrial and aortic internal diameter (LVID, LA and Ao, respectively), fractional shortening (FS) and ejection fraction (EF) were measured by echocardiography. Heart rate (HR), peak flow velocity (Vmax), flow velocity integral (FVI), ejection time (ET), pre‐ejection period (PEP), velocity of circumferential fibre shortening (Vcf), stroke volume (SV) and cardiac output (CO) were measured from aortic Doppler wave recordings.

Results:After the race, LVIDd, Ao, LA, EF, FS, FVI, SV, ET and ET indexed for HR were significantly lower and IVSd, LVFWd, HR, PEP, PEP/ET and Vcf significantly higher as compared with prerace values. Pre‐ to post exercise changes in those parameters were not significantly correlated with changes in HR or in LVIDd.

Conclusions:Results suggest that EICF, with a decrease in left ventricular systolic function, could occur post exercise in horses performing long duration endurance races. However, a multanecus effect of altered preload and heart rate on the studied variables cannot be discounted.
Performance parameters and post exercise heart rate recovery in Warmblood sports horses of different performance levels
Authors: BITSCHNAU C. , WIESTNER T. , TRACHSEL D. S. , AUER J. A. , WEISHAUPT M. A.
Published: November 2010

Reasons for performing study:Standardised exercise tests are used for fitness evaluation of sports horses. Standards are described for Thoroughbreds and Standardbreds; however, limited information is available for Warmbloods.

Objectives:To establish normative standards of performance parameters and heart rate recovery (HRR) in Warmblood riding horses of different levels of fitness using a submaximal incremental exercise test (SIET) performed on a treadmill.

Methods:A SIET was carried out with 29 healthy and treadmill‐accustomed Warmbloods: eleven 3‐day event horses (TDE) and 18 horses from the National Equestrian Centre (NEC) competing in amateur jumping and/or dressage events. After a warm‐up phase, horses performed 2 stages at trot and 3–5 stages at gallop at 6% incline. The first stage lasted 120 s, all others 90 s. Velocity (V) and heart rate (HR) were measured continuously and blood lactate concentration (LAC) at the end of each exercise stage. V at HR 150 and 200 beats/min (V150, V200), V and HR at 2 and 4 mmol/l LAC (V2, V4and HR2, HR4, respectively) were calculated and compared between discipline groups. For reference values, horses were divided on the basis of the V4‐results in good (GP) and average performers (AP) (performance groups). Five minute passive HRR was compared between performance groups. Fifteen NEC horses were retested within 1–3 months. Groups were compared withttests and P<0.05 considered significant.

Results:Three‐day event horses had higher V150, V2and V4values than NEC. GP had higher values in all performance parameters compared to AP. No differences were found between test and retest. GP mean recovery HR was different from that of AP from 120 s of recovery onwards.

Conclusion:Treadmill SIETs are suitable to objectify aerobic capacity in Warmblood riding horses. Normative standards were assessed for well and averagely‐trained horses. The results can be referred to when diagnosing patients with exercise intolerance.
Effect of feed restriction on plasma dantrolene concentrations in horses
Authors: Mc KENZIE E. C. , GARRETT R. L. , PAYTON M. E. , RIEHL J. H. , FIRSHMAN A. M. , VALBERG S. J.
Published: November 2010

Reasons for performing study:Dantrolene sodium is used to prevent exertional rhabdomyolysis in predisposed horses. Food intake might negatively impact dantrolene bioavailability in horses; however, prolonged feed restriction might be detrimental to performance.

Objective:To determine a minimum duration of feed restriction that would optimise plasma dantrolene concentrations in horses after nasogastric administration. It was hypothesised that feed restriction for 4, 8 or 12 h before dantrolene administration would result in higher plasma dantrolene concentrations than achieved with no feed restriction before treatment.

Methods:Five healthy horses were randomly rotated through 4 feed restriction periods of 0, 4, 8 and 12 h duration prior to nasogastric administration of dantrolene sodium (6 mg/kg bwt). Plasma dantrolene concentration was measured by spectrofluorometry at 60, 90, 120, 150, 180 and 210 min after administration. Data were analysed via repeated measures ANOVA.

Results:Peak plasma dantrolene concentration was highest when horses had 0 and 4 h of feed restriction (0.65 ± 0.10 µg/ml at 120 min; 0.66 ± 0.17 at 180 min, respectively) and was lower when horses were restricted from feed for 8 h (0.45 ± 0.15 at 150 min) and 12 h (0.21 ± 0.09 at 180 min). Mean plasma dantrolene concentration did not differ between 0 and 4 h feed restriction at any sample time, but feed restriction for 8 h resulted in significantly lower plasma dantrolene concentration at 60 and 180 min after treatment than when horses were restricted 0 and 4 h, respectively. Plasma dantrolene concentration was significantly lower at all sample times when horses were restricted from feed 12 h compared to 0 or 4 h.

Conclusions:Absorption of nasogastrically administered dantrolene is inhibited by feed restriction before administration. To achieve optimal plasma dantrolene concentrations, feed restriction before oral administration should not exceed 4 h.
The incidence and severity of gastric ulceration does not increase in overtrained Standardbred horses
Authors: De GRAAF‐ROELFSEMA E. , KEIZER H. A. , WIJNBERG I. D. , Van Der KOLK J. H.
Published: November 2010

Reasons for performing study:Gastric ulceration can be caused by different pathophysiological mechanisms including dietary factors, psychological stress and exercise. Overtraining is a medical syndrome in performance horses associated with altered hormone levels, altered feed intake, altered behaviour and decreased performance. These components might lead to a higher incidence of gastric ulceration in overtrained horses.

Objectives:To investigate whether the incidence of gastric ulceration is increased in overtrained compared to control horses.

Methods:A longitudinal training study with twelve 1.5 years old Standardbred horses was performed on a treadmill for a total of 32 weeks. Training was divided into 4 periods: (1) acclimatisation (2) training (3) intensified training, and (4) detraining. In period 3, the horses were randomly divided into 2 groups: control (C) and intensified trained group (IT). At the end of each period, gastroscopy was performed in conscious horses after withholding feed for 12 h and water for 6 h using a 3.5 m video gastroendoscope. Lesion scores were assigned to areas of the stomach and graded 1–4. Logistic regression was used for statistical calculations.

Results:Evaluation of the stomach revealed only minor changes (grades 1or2) on each occasion. There were no significant differences in gastric lesion scores between groups or periods. Most lesions (70%) were found around the minor curvature. After detraining no lesions (0%) were found in contrast to periods 1 (40%, P = 0.056), 2 (30%) and 3 (30%).

Conclusions:Experimentally‐induced overtraining does not increase the incidence of gastric ulceration in normally fed Standardbred horses and detraining appears to reduce gastric ulceration.
Biomechanical analysis of hoof landing and stride parameters in harness trotter horses running on different tracks of a sand beach (from wet to dry) and on an asphalt road
Authors: CHATEAU H. , HOLDEN L. , ROBIN D. , FALALA S. , POURCELOT P. , ESTOUP P. , DENOIX J.‐M. , CREVIER‐DENOIX N.
Published: November 2010

Reasons for performing study: Sandy beaches are often considered good training surfaces for trotter horses. However, their biomechanical effects on locomotion are insufficiently documented. Events at hoof impact have mostly been studied under laboratory conditions with accelerometers, but there is lack of data (acceleration, force, movement) on events occurring under every day practical conditions in the field.

Objectives: To investigate hoof landing and stride parameters on different tracks (from wet to dry) of a sand beach and on an asphalt road.

Methods: The right front hoof of 4 trotter horses was equipped with a triaxial accelerometer and a dynamometric horseshoe. Acceleration and force recordings (10 kHz) were synchronised with a high speed movie (600 Hz). Horses were driven on a sand beach where 3 tracks of decreasing water content had been delimited (from the sea to the shore): firm wet sand (FWS), deep wet sand (DWS) and deep dry sand (DDS). Firm wet sand and DWS were compared at 25 km/h and DDS compared to an asphalt road at 15 km/h. Recordings (10 strides) were randomly repeated 3 times. Statistical differences were tested using a GLM procedure (P<0.05).

Results: Main significant results were 1) a decrease in the amplitude of the vertical deceleration (and force) of the hoof during impact on a softer surface (about 59% between DWS and FWS and 95% between DDS and asphalt), 2) a decrease in the longitudinal braking deceleration (and force) on softer grounds (50% for DWS vs. FWS and 55% for DDS vs. asphalt), 3) a decrease in the stride length and an increase in the stride frequency on a softer surface.

Conclusions and clinical relevance: Drier sand surfaces reduce shock and impact forces during landing. For daily training, it should, however, be realised that improved damping characteristics are associated with a shorter stride length and a higher stride frequency.
Use of an implantable transducer to measure force in the superficial digital flexor tendon in horses at walk, trot and canter on a treadmill
Authors: TAKAHASHI T. , YOSHIHARA E. , MUKAI K. , OHMURA H. , HIRAGA A.
Published: November 2010

Reasons for performing study:Although the main cause of injury to the superficial digital flexor tendon (SDFT) is assumed to be high intensity loading of the tendon, to date the forces exerted on the SDFT during cantering have never been measured.

Objective:To measure the force exerted on the SDFT at walk, trot and canter on a treadmill.

Methods:Arthroscopically implantable force probes (AIFP) were implanted in the SDFT of the left and right forelimbs of 8 Thoroughbred horses (480–565 kg). The output of the AIFP was calibrated using the SDFT force calculated by inverse dynamics and anin vitromodel of the lower forelimb at trot. The AIFP output was recorded at 1000 Hz at the walk, trot and canter (9 m/s) on a flat treadmill.

Results:AIFP data were analysed successfully in 13 measurement sessions at the walk and trot, in the leading forelimb in 8 sessions at canter and in the trailing forelimb in 5 sessions at canter. The mean ± s.d. maximal force in the SDFT was 3110 ± 1787 N at the walk, 5652 ± 2472 N at the trot, 7030 ± 2948 N in the leading forelimb and 6453 ± 2940 N in the trailing forelimb at canter.

Conclusions:The force in the SDFT increases with running speed from the walk to the canter. The force in the SDFT could not be measured at the gallop. Further study is needed to determine the force in the SDFT at high speed, because it is important for preventing injuries to the SDFT to limit overloading of this tendon.