L. V. Soderholm

Investigations into the role of the thyrohyoid muscles in the pathogenesis of dorsal displacement of the soft palate in horses

REASONS FOR PERFORMING STUDY Contributes to the understanding of the pathogenesis of dorsal displacement of the soft palate during exercise so that management of this condition could be enhanced. HYPOTHESIS That the thyrohyoid muscles play an important role in the stability of the laryngo-palatal relationship and that dysfunction of these muscles leads to dorsal displacement of the soft palate (DDSP) during exercise. METHODS Ten horses were exercised on a high-speed treadmill under 4 different treatment conditions: control conditions (n = 10), after resection of thyrohyoid muscles (TH, n = 10), after sham-treatment (n = 5), or after restoration of function of the thyrohyoid muscles with surgical sutures (prosthesis-treatment, n = 6). During trials, the following determinations were made: videoendoscopy of the upper airway, gait frequency and pharyngeal and tracheal static pressures. RESULTS None of the 10 horses developed DDSP during 2 separate treadmill-exercise trials under the control conditions. Seven of the 10 horses developed DDSP after resection of the TH muscles, 4 of 5 of these horses still experienced DDSP after sham-treatment, but 5 of 6 horses no longer experienced DDSP at exercise after the prosthesis-treatment. There were significant anomalies in airway pressures, respiratory frequency, and occurrence of DDSP in both the TH resection and sham-treatment conditions compared to control conditions. In contrast, no statistical differences were noted in any of the parameters measured between the prosthesis-treatment and control conditions. CONCLUSIONS That the function of the TH muscles is important to the stability of the laryngo-palatal relationship and plays a role in the pathophysiology of exercise-induced DDSP. POTENTIAL RELEVANCE Management of horses with DDSP could be enhanced by restoring the function of the TH muscles.

Measurement of plasma cardiac troponin I concentration by use of a point-of-care analyzer in clinically normal horses and horses with experimentally induced cardiac disease

OBJECTIVE To compare cardiac troponin I (cTnI) concentrations determined by use of a point-of-care analyzer with values determined by use of a bench-top immunoassay in plasma samples obtained from clinically normal horses with and without experimentally induced cardiac disease, and to establish a reference range for plasma equine cTnI concentration determined by use of the point-of-care analyzer. ANIMALS 83 clinically normal horses, 6 of which were administered monensin to induce cardiac disease. PROCEDURES A blood sample was collected from each of the 83 clinically normal horses to provide plasma for analysis by use of the point-of-care analyzer; some of the same samples were also analyzed by use of the immunoassay. All 83 samples were used to establish an analyzer-specific reference range for plasma cTnI concentration in clinically normal horses. In 6 horses, blood samples were also collected at various time points after administration of a single dose of monensin (1.0 to 1.5 mg/kg) via nasogastric intubation; plasma cTnI concentration in those samples was assessed by use of both methods. RESULTS The analyzer-specific reference range for plasma cTnI concentration in clinically normal horses was 0.0 to 0.06 ng/mL. Following monensin treatment in 5 horses, increases in plasma cTnI concentration determined by use of the 2 methods were highly correlated (Pearson correlation, 0.83). Peak analyzer-determined plasma cTnI concentrations in monensin-treated horses ranged from 0.08 to 3.68 ng/mL. CONCLUSIONS AND CLINICAL RELEVANCE In horses with and without experimentally induced cardiac disease, the point-of-care analyzer and bench-top immunoassay provided similar values of plasma cTnI concentration.

Contractile behavior of the forelimb digital flexors during steady-state locomotion in horses (Equus caballus): An initial test of muscle architectural hypotheses about in vivo function

The forelimb digital flexors of the horse display remarkable diversity in muscle architecture despite each muscle-tendon unit having a similar mechanical advantage across the fetlock joint. We focus on two distinct muscles of the digital flexor system: short compartment deep digital flexor (DDF(sc)) and the superficial digital flexor (SDF). The objectives were to investigate force-length behavior and work performance of these two muscles in vivo during locomotion, and to determine how muscle architecture contributes to in vivo function in this system. We directly recorded muscle force (via tendon strain gauges) and muscle fascicle length (via sonomicrometry crystals) as horses walked (1.7 m s(-1)), trotted (4.1 m s(-1)) and cantered (7.0 m s(-1)) on a motorized treadmill. Over the range of gaits and speeds, DDF(sc) fascicles shortened while producing relatively low force, generating modest positive net work. In contrast, SDF fascicles initially shortened, then lengthened while producing high force, resulting in substantial negative net work. These findings suggest the long fibered, unipennate DDF(sc) supplements mechanical work during running, whereas the short fibered, multipennate SDF is specialized for economical high force and enhanced elastic energy storage. Apparent in vivo functions match well with the distinct architectural features of each muscle.

Role of the hypoglossal nerve in equine nasopharyngeal stability

The equine upper airway is highly adapted to provide the extremely high oxygen demand associated with strenuous aerobic exercise in this species. The tongue musculature, innervated by the hypoglossal nerve, plays an important role in airway stability in humans who also have a highly adapted upper airway to allow speech. The role of the hypoglossal nerve in stabilizing the equine upper airway has not been established. Isolated tongues from eight mature horses were dissected to determine the distal anatomy and branching of the equine hypoglossal nerve. Using this information, a peripheral nerve location technique was used to perform bilateral block of the common trunk of the hypoglossal nerve in 10 horses. Each horse was subjected to two trials with bilateral hypoglossal nerve block and two control trials (unblocked). Upper airway stability at exercise was determined using videoendoscopy and measurement of tracheal and pharyngeal pressure. Three main nerve branches were identified, medial and lateral branches and a discrete branch that innervated the geniohyoid muscle alone. Bilateral hypoglossal block induced nasopharyngeal instability in 10/19 trials, and none of the control trials (0/18) resulted in instability (P<0.001). Mean treadmill speed (+/-SD) at the onset of instability was 10.8+/-2.5 m/s. Following its onset, nasopharyngeal instability persisted until the end of the treadmill test. This instability, induced by hypoglossal nerve block, produced an expiratory obstruction similar to that seen in a naturally occurring equine disease (dorsal displacement of the soft palate, DDSP) with reduced inspiratory and expiratory pharyngeal pressure and increased expiratory tracheal pressure. These data suggest that stability of the equine upper airway at exercise may be mediated through the hypoglossal nerve. Naturally occurring DDSP in the horse shares a number of anatomic similarities with obstructive sleep apnea. Study of species with extreme respiratory adaptation, such as the horse, may provide insight into respiratory functioning in humans.

Effect of a tart cherry juice blend on exercise-induced muscle damage in horses.

OBJECTIVE To evaluate whether administering a tart cherry juice blend (TCJB) prior to exercise would reduce skeletal and cardiac muscle damage by decreasing the inflammatory and oxidative stress response to exercise in horses. ANIMALS 6 horses. PROCEDURES Horses were randomly allocated into 2 groups in a crossover study with a 2-week washout period and orally administered either TCJB or a placebo solution (1.42 L, twice daily) in a double-masked protocol for 2 weeks prior to a stepwise incremental exercise protocol. Horses were tested for serum activities of creatine kinase and aspartate aminotransferase (AST) and concentrations of cardiac troponin I (cTnI), thiobarbituric acid reactive substances (TBARS; an indicator of oxidative stress), and serum amyloid A (SAA; an indicator of inflammation). To ensure that treatment would not result in positive results of an equine drug-screening protocol, serum samples obtained from each horse prior to and after 2 weeks of administration of TCJB or the placebo solution were tested. RESULTS All horses had negative results of drug screening at both sample times. The exercise protocol resulted in a significant increase in TBARS concentration, SAA concentration, and serum AST activity in all horses. Administration of TCJB or placebo solution was not associated with an effect on malondialdehyde or SAA concentrations. However, administration of TCJB was associated with less serum activity of AST, compared with administration of placebo solution. CONCLUSIONS AND CLINICAL RELEVANCE Administration of TCJB may diminish muscle damage induced by exercise.

Superficial digital flexor tendon lesions in racehorses as a sequela to muscle fatigue : A preliminary study

REASON FOR PERFORMING STUDY Racing and training related lesions of the forelimb superficial digital flexor tendon are a common career ending injury to racehorses but aetiology and/or predisposing causes of the injury are not completely understood. OBJECTIVES Although the injury takes place within the tendon, the lesion must be considered within the context of the function of the complete suspensory system of the distal limb, including the associated muscles. METHODS Both muscle and tendon function were investigated in vivo using implanted strain gauges in 3 Thoroughbred horses walking, trotting and cantering on a motorised treadmill. These data were combined with assessments of muscle architecture and fibre composition to arrive at an overview of the contribution of each muscle-tendon unit during locomotion. RESULTS The superficial digital flexor muscle has fatigue-resistant and high force production properties that allow its tendon to store and return elastic energy, predominantly at the trot. As running speed increases, deep digital flexor tendon force increases and it stabilises hyperextension of the fetlock, thus reinforcing the superficial digital flexor in limb load support. The deep digital flexor muscle has fast contracting properties that render it susceptible to fatigue. CONCLUSION Based on these measurements and supporting evidence from the literature, it is proposed that overloading of the superficial digital flexor tendon results from fatigue of the synergistic, faster contracting deep digital flexor muscle. POTENTIAL RELEVANCE Future research investigating distal limb system function as a whole should help refine clinical diagnostic procedures and exercise training approaches that will lead to more effective prevention and treatment of digital flexor tendon injuries in equine athletes.

Equine Laryngoplasty Sutures Undergo Increased Loading During Coughing and Swallowing

OBJECTIVES To report (1) the force required on a single laryngoplasty suture to achieve optimal abduction of the left arytenoid cartilage, (2) peak forces experienced by the suture during induced swallowing and coughing, and during 24-hour resting activity in a stall, and (3) peak forces during induced swallowing and coughing after left recurrent laryngeal nerve blockade. STUDY DESIGN Experimental study. ANIMALS Horses (n=8). METHODS Each laryngoplasty suture was instrumented with an E-type buckle force transducer to measure the force required for optimal intraoperative left arytenoid cartilage abduction. This was correlated with abduction observed postoperatively. Change in suture force from baseline was measured during induced coughing and swallowing, and during normal stall activity. RESULTS Optimal intraoperative arytenoid abduction was achieved with a mean (±SD) force of 27.6±7.5 N. During saline-induced swallowing and coughing mean force on the suture increased by 19.0±5.6 N (n=233 measurements; 7 horses) and 12.1±3.6 N (n=31; 4 horses), respectively. Sutures underwent increased loading a mean of 1152 times in 24 hours. No change in suture force was observed with respiratory rhythm. CONCLUSION Swallowing increases laryngoplasty suture force to a greater extent than coughing.

Intra-articular stabilisation of the equine cricoarytenoid joint.

REASONS FOR PERFORMING STUDY The success of laryngoplasty is limited by abduction loss in the early post operative period. OBJECTIVE To determine the efficacy of polymethylmethacrylate (PMMA) in stabilising the cricoarytenoid joint (CAJ) and reducing the force on the laryngoplasty suture. HYPOTHESIS Injection into the cricoarytenoid joint resists the forces produced by physiological laryngeal air flows and pressures thereby reducing the force experienced by the laryngoplasty suture. METHODS Ten cadaver larynges were collected at necropsy and PMMA was injected into one CAJ at selected random. Each larynx was subjected to physiological conditions with with constant (static) or cycling (dynamic) flow. The specimens were tested sequentially in each of 4 conditions: 1) bilateral full abduction (Control 1); 2) transection of the suture on the side without PMMA; 3) bilateral abduction achieved by replacing the suture (Control 2); and 4) cutting the suture on the PMMA side. Tracheal pressure and flow and pressure in the flow chamber were recorded using pressure and flow transducers. The strain experienced by each suture during bilateral abduction (Controls 1 and 2) was measured. Statistical comparison of the 4 conditions was performed using a mixed effect model with Tukeys post hoc test for multiple comparisons. The strain gauge data were analysed by paired comparison of the regression slopes. RESULTS In the static and dynamic states, tracheal pressure increased and tracheal flow decreased when the suture on the non-cement side was cut (P < 0.05). There was no significant difference in any outcome measure between PMMA injected into the CAJ and bilaterally abducted specimens (Controls 1 and 2) for either condition. The rate of increase in strain with increasing translaryngeal pressure was significantly less on the suture with PMMA placed in the CAJ (P = 0.03). CONCLUSIONS These data provide strong evidence that injecting PMMA into the CAJ resists the collapsing effect of physiological airflows and pressures in vitro and reduces the force experienced by the laryngoplasty suture during maximal abduction. POTENTIAL RELEVANCE Augmentation of prosthetic laryngoplasty with this technique may reduce arytenoid abduction loss in the early post operative period.

In Vitro Model for Testing Novel Implants for Equine Laryngoplasty

OBJECTIVE To develop an in vitro laryngeal model to mimic airflow and pressures experienced by horses at maximal exercise with which to test laryngoplasty techniques. STUDY DESIGN Randomized complete block. SAMPLE POPULATION Cadaveric equine larynges (n=10). METHODS Equine larynges were collected at necropsy and a bilateral prosthetic laryngoplasty suture was placed with #5 Fiberwire suture to achieve bilateral maximal arytenoid abduction. Each larynx was positioned in a flow chamber and subjected to static flow and dynamic flow cycling at 2 Hz. Tracheal pressure and flow, and pressure within the flow chamber were recorded at a sampling frequency of 500 Hz. Data obtained were compared with the published physiologic values for horses exercising at maximal exercise. RESULTS Under static flow conditions, the testing system produced inspiratory tracheal pressures (mean+/-SEM) of -33.0+/-0.98 mm Hg at a flow of 54.48+/-1.8 L/s. Pressure in the flow chamber was -8.1+/-2.2 mm Hg producing a translaryngeal impedance of 0.56+/-0.15 mm Hg/L/s. Under dynamic conditions, cycling flow and pressure were reproduced at a frequency of 2 Hz, the peak inspiratory (mean+/-SEM) pharyngeal and tracheal pressures across all larynges were -8.85+/-2.5 and -35.54+/-1.6 mm Hg, respectively. Peak inspiratory flow was 51.65+/-2.3 L/s and impedance was 0.57+/-0.06 mm Hg/L/s. CONCLUSIONS The model produced inspiratory pressures similar to those in horses at maximal exercise when airflows experienced at exercise were used. CLINICAL RELEVANCE This model will allow testing of multiple novel techniques and may facilitate development of improved techniques for prosthetic laryngoplasty.

Functional electrical stimulation of intrinsic laryngeal muscles under varying loads in exercising horses.

Bilateral vocal fold paralysis (BVCP) is a life threatening condition and appears to be a good candidate for therapy using functional electrical stimulation (FES). Developing a working FES system has been technically difficult due to the inaccessible location and small size of the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle. A naturally-occurring disease in horses shares many functional and etiological features with BVCP. In this study, the feasibility of FES for equine vocal fold paralysis was explored by testing arytenoid abduction evoked by electrical stimulation of the PCA muscle. Rheobase and chronaxie were determined for innervated PCA muscle. We then tested the hypothesis that direct muscle stimulation can maintain airway patency during strenuous exercise in horses with induced transient conduction block of the laryngeal motor nerve. Six adult horses were instrumented with a single bipolar intra-muscular electrode in the left PCA muscle. Rheobase and chronaxie were within the normal range for innervated muscle at 0.55±0.38 v and 0.38±0.19 ms respectively. Intramuscular stimulation of the PCA muscle significantly improved arytenoid abduction at all levels of exercise intensity and there was no significant difference between the level of abduction achieved with stimulation and control values under moderate loads. The equine larynx may provide a useful model for the study of bilateral fold paralysis.