Laminitis: Recognition of At-Risk Individuals,and Methods of Prevention

Even with the many advances made in the understanding of the pathophysiology, new treatments and preventative measures, laminitis continues to plague the equine population. Identification of risk factor and at-risk individuals remains the best approach with this disease.     

一种致命的隐形杀手:肉毒杆菌与肉毒毒素

2013年8月,因肉毒杆菌污染,问题奶粉再次进入公众视野。肉毒杆菌(Clostridium botulinum)是一种革兰阳性粗短杆菌,严格厌氧,有A～G 7个亚型,每个亚型都可产生一种剧毒的大分子外毒素,即肉毒毒素(botulinum toxin)。这种毒素可引起人和动物发生以松弛性麻痹为主症的肉毒中毒(botulism),虽然并不常见,但却是一种致命的中毒性疾病。本文综述了肉毒杆菌生物学特征、肉毒毒素结构与毒性、肉毒中毒临床表现以及检验鉴定等,并介绍了食品安全生产中肉毒杆菌与肉毒毒素的安全风险与控制措施。     

Clinical Application of Current Research Findings Toward the Prevention and Treatment of Acute Laminitis in Horses With Systemic Inflammatory Diseases: An Internist’s Perspective

Laminitis is most commonly caused by metabolic disorders or systemic inflammatory diseases. There are numerous recent publications that have reported on pathophysiology of laminitis associated with systemic inflammation. These studies include both in-vitro and in-vivo models investigating inflammatory profiles, vascular reactivity or oxidative stress at different stages of development or clinical laminitis and some studies have proposed therapeutic interventions. Although the amount of information in these studies is great and quality of the research is often outstanding, it has not always been clear how these findings might be applied to clinical practice. This article is intended to report one internist's perspective on recent research findings on the pathophysiology and prevention of laminitis in horses with systemic inflammatory diseases and how these findings might be applied to clinical practice.     

Potential Proteomic-Based Strategies for Understanding Laminitis: Predictions and Pathogenesis

With today's understanding of the genome, advanced molecular techniques, and our growing ability to analyze complex biologic data, proteomics, the broad-based study of the repertoire of proteins expressed by cells or organisms, offers great promise for understanding the causes of complex diseases. Identifying and measuring novel protein biomarkers present in blood that predict the onset and resolution of laminitis would both aid clinical management of at-risk equine patients and shed light on underlying mechanisms with the intent of developing novel preventive strategies and therapeutic approaches. Identifying alterations in the profiles of proteins present in tissues of horses that develop laminitis or within in vitro model systems also can advance our understanding of this puzzling disease.     

奶牛蹄叶炎的病因探究

本文旨在对严重影响奶业健康发展的奶牛蹄叶炎的病因进行探究。在辉山奶牛场阜新市彰武县三场经产奶牛中,挑选临床健康奶牛10头作为对照组;患蹄叶炎奶牛10头作为试验组。采集两组奶牛血液,分别用牛内毒素酶联免疫试剂盒和荧光分光光度法测定血浆中内毒素和组胺的含量。结果显示,试验组血浆内毒素及组胺含量分别比对照组高0.65ng/mL、21.8ng/mL,差异均极显著(P<0.01)。说明患病牛血浆内毒素和组胺含量升高是诱发奶牛蹄叶炎的重要因素。     

A Fresh Look at the Process of Arriving at a Clinical Prognosis Part 1: Laminitis

Laminitis is a disease that represents a loss of the normal homeostatic mechanisms that control the day-to-day function of the distal phalanx. The degree or severity to which homeostasis is affected is directly related to the severity and the final outcome for the equine patient. A systematic approach including the physical examination, digital radiography, venography, and newer techniques such as computer tomography and magnetic resonance imaging can assist the clinician in developing a prognosis for the acute and chronic laminitis case. How quickly we are able to return the foot back to a normal state of homeostasis or the response to treatment is important as a predictive value for outcome.     

Laminitis in Horses: Through the Lens of Systems Theory

Systems theory is a way of describing complex and dynamic relationships. We applied systems theory to the structure and function of the equine foot in an effort to better understand laminitis and, in so doing, reconcile the various theories of its etiopathogenesis and find more universally effective preventive and therapeutic strategies. The foot is described as an open system, and its inherent vulnerabilities are explored. Cascade failure is discussed as a potentially unifying theory of laminitis. The fundamental failure in laminitis is failure of the lamellar dermal−epidermal bond, but that endpoint can be reached via vascular, enzymatic, inflammatory, or mechanical mechanisms, or any combination thereof. Inflammation is discussed as a common denominator, making anti-inflammatory therapy of greater importance than just pain management. Multimodal anti-inflammatory therapy is discussed, including selective COX-2 inhibitors, heparin, nutraceuticals, and inhibitors of matrix metalloproteinases (MMPs). Multimodal analgesic therapy also is important and may include nonsteroidal anti-inflammatory drugs (NSAIDs), opiates, epidural analgesics, physical therapy, relief of weight bearing, diligent nursing care, deep digital flexor tenotomy, and case-appropriate trimming and shoeing. Preventing laminitis still comes down to risk management: knowing the risk factors applicable to an individual horse and adjusting the management accordingly. Examples include weight management and control of carbohydrate intake in overweight horses and ponies, the use of pergolide in patients with pituitary pars intermedia dysfunction (PPID), and distal limb cryotherapy in high-risk patients. It is anticipated that application of molecular biologic techniques will further advance treatment and prevention of laminitis.     

Long-term Prognosis Using Deep Digital Flexor Tenotomy and Realignment Shoeing for Treatment of Chronic Laminitis

Transection of the deep digital flexor tendon is a controversial treatment for chronic laminitis largely because of the variation in personal experience with the procedure and the varying success rates reported in the previously published data. Differences in reported success rates are more likely because of the dissimilarities in foot pathology and the foot management associated with the procedure. This report presents 245 tenotomy cases, in which all cases received the same shoeing protocol (realignment shoeing). Outcomes were determined for the following categories: degree of bone disease, solar penetration, sinking, number of limbs involved, and front or hind feet affected. The success rates by different categories of disease may assist the clinician in formulating a prognosis for similar cases.     

Nutrition and Exercise in the Management of Horses and Ponies at High Risk for Laminitis

Obesity, insulin resistance (IR) and hyperinsulinemia are risk factors for laminitis in horses and ponies. Alterations in management, especially diet and physical activity, can be helpful in the management of these risk factors. Caloric restriction, ideally combined with increased physical activity, to promote weight loss and improve insulin sensitivity is indicated for the management of obese animals. Strict control of dietary NSC through the elimination of grains and sweet feeds and by restricted access to NSC-rich pastures is recommended for insulin-resistant animals, regardless of whether they are obese or not. Medical treatment with levothyroxine or metformin may be indicated in obese or insulin-resistant animals that do not respond to conservative management.     

A Farrier Making Every Contact Count: A Microlevel Analysis of Farrier-Client Interaction for Partnership Working in Managing a Horse With Laminitis

There is an evidence base in human and small animal veterinary health care contexts which understands how practitioners engage in partnership working with patients and owners to support adherence to treatment/care plans. However, as yet, it is believed there is no similar evidence base for how practitioners in equine health care contexts work with equine owners. It is argued that this is essential for understanding complex equine practitioner-owner interaction involving the prevention and management of laminitis. The aim of this study was to explore farrier-client interaction where risk management for an equine recovering from laminitis was being undertaken. A case report method involved a microlevel analysis of a farrier-client consultation. The consultation was video-recorded and analyzed using a conversation analysis approach to identify the linguistic and paralinguistic features of the interaction. These were compared with conversation analyses in other health care contexts to identify the actions being accomplished within the consultation. The analysis identified a number of joint actions, including managing epistemic stance (or knowledge rights) and deploying the animal’s presence to navigate problem sequences which supported progression of the consultation through a three-stage model involving “team-”, “option-”, and “decision-” talk, known to be associated with partnership working in human health care contexts. The study highlights the importance of developing an empirical evidence base in equine practice for how practitioners engage with owners based on a microlevel analysis of real-world interactions. It is argued this evidence base is necessary in supporting effective practitioner training in partnership working with clients to promote their adherence to treatment/care plans.