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1.
Chest ; 161(1): e29-e34, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35000714

RESUMO

CASE PRESENTATION: A 65-year-old man with no past medical history sought treatment at the hospital with lower extremity swelling, pain, tingling in a stocking-glove distribution, and syncope. He reported a 23-pound unintentional weight loss. He felt unsteady walking with a couple of falls, and his exercise tolerance was limited to several hundred feet. He did not report vision changes, dysphagia, bowel or bladder problems, tremor, orthopnea, lightheadedness, or chest pain. He did not report any history of substance misuse, high-risk sexual behavior, or concerning exposures. The patient was admitted for further workup.


Assuntos
Hipertensão Pulmonar/diagnóstico , Neoplasias de Plasmócitos/diagnóstico , Síndrome POEMS/diagnóstico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Dexametasona/administração & dosagem , Edema/etiologia , Edema/fisiopatologia , Tolerância ao Exercício , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Lenalidomida/administração & dosagem , Masculino , Neoplasias de Plasmócitos/complicações , Neoplasias de Plasmócitos/terapia , Síndrome POEMS/complicações , Síndrome POEMS/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Transplante de Células-Tronco , Síncope/etiologia , Síncope/fisiopatologia , Tadalafila/uso terapêutico , Perda de Peso
4.
Osteoarthritis Cartilage ; 30(1): 42-51, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34774789

RESUMO

OBJECTIVE: To explore mechanisms of mechanoinflammation, we investigated the association between the presence of knee synovial perivascular edema and gait biomechanics that serve as surrogate measures of knee load in patients with knee osteoarthritis (OA). DESIGN: Patients with symptomatic, radiographic knee OA and neutral to varus alignment undergoing total knee arthroplasty or high tibial osteotomy participated in this cross-sectional analysis. All participants underwent 3D gait analysis prior to surgery. Synovial biopsies were obtained during surgery for histopathological assessment. The association between the presence of synovial perivascular edema (predictor) and the external knee moment (outcome) in each orthogonal plane was analyzed using multivariate linear regression and polynomial mixed effects regression models, while adjusting for age, sex, BMI, and gait speed. RESULTS: Ninety-two patients with complete gait and histopathological data were included. When fitted over 100% of stance, regression models indicated substantial differences between patients with and without synovial perivascular edema for knee moments in frontal, sagittal and transverse planes. The knee adduction moment was higher in patients with edema from 16 to 74% of stance, with the largest difference at 33% of stance (ß = 6.87 Nm [95%CI 3.02, 10.72]); whereas the knee flexion-extension moment differed from 15 to 92% of stance, with the largest difference in extension at 60% of stance (ß = -10.80 Nm [95%CI -16.20, -5.40]). CONCLUSIONS: In patients with knee OA, the presence of synovial perivascular edema identified by histopathology is associated with aberrant patterns of knee loading throughout stance, supporting the link between biomechanics and synovial inflammation.


Assuntos
Edema/fisiopatologia , Marcha , Osteoartrite do Joelho/fisiopatologia , Membrana Sinovial , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos Transversais , Edema/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações
5.
PLoS One ; 16(12): e0260505, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932567

RESUMO

Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint's skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.


Assuntos
Edema/diagnóstico , Insuficiência Cardíaca/diagnóstico , Obesidade/diagnóstico , Aparência Física , Santos/história , Gordura Abdominal/fisiopatologia , Índice de Massa Corporal , Restos Mortais/anatomia & histologia , Diagnóstico , Diagnóstico Diferencial , Edema/história , Edema/fisiopatologia , Insuficiência Cardíaca/história , Insuficiência Cardíaca/fisiopatologia , História do Século XXI , História Medieval , Humanos , Itália , Obesidade/história , Obesidade/fisiopatologia , Religião e Medicina
6.
Cell Mol Biol (Noisy-le-grand) ; 67(1): 106-111, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34817360

RESUMO

This study aimed to investigate the high-performance thin-layer chromatography (HPTLC) fingerprinting and in-vivo anti-inflammatory and antinociceptive activities of different leaf extracts (ethanolic extract, n-hexane, chloroform, and ethyl acetate) of Pyracantha coccinea M.Roem. plant. A total of one hundred and twenty-four Wistar rats for anti-inflammatory and antinociceptive tests (carrageenan and formalin tests, respectively) were treated with two doses of the ethanolic extract (100 and 300 mg/kg), two doses of other plant fractions (30 and 100 mg/kg), Diclofenac (25 mg/kg) as the positive control, and normal saline as the negative control group, by oral gavage route. HPTLC fingerprinting is used for assay of terpenoids, flavonoids, alkaloids, and antioxidant activity. Treatment of the animal with the ethanolic extract at doses of 100 and 300 mg/kg, both ethyl acetate and chloroform fractions at the dose of 30 mg/kg and 100 mg/kg decreased the pain score in the formalin test and paw edema caused by carrageenan relative to control group significantly. Moreover, these extracts reported the highest amounts of flavonoid contents. In conclusion, phytochemicals present in Pyracantha coccinea M.Roem. leaves have anti-inflammatory and antinociceptive activities. Future studies are needed to identify the compounds with the anti-inflammatory and antinociceptive potential present in the plant.


Assuntos
Analgésicos/farmacologia , Anti-Inflamatórios/farmacologia , Cromatografia em Camada Delgada/métodos , Compostos Fitoquímicos/farmacologia , Folhas de Planta/química , Pyracantha/química , Analgésicos/química , Animais , Animais de Laboratório , Anti-Inflamatórios/química , Carragenina , Edema/induzido quimicamente , Edema/fisiopatologia , Edema/prevenção & controle , Flavonoides/análise , Flavonoides/farmacologia , Masculino , Dor/fisiopatologia , Dor/prevenção & controle , Compostos Fitoquímicos/análise , Fitoterapia/métodos , Extratos Vegetais/análise , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Ratos Wistar , Terpenos/análise , Terpenos/farmacologia
7.
Cells ; 10(10)2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34685662

RESUMO

The incidence of spinal cord injury (SCI) is ever-growing, resulting in life-changing neurological deficits which can have devastating long-term impacts on a person's quality of life. There is an unmet clinical need for a treatment which will prevent progression of the injury, allowing improved axonal regeneration and functional recovery to occur. The initial mechanical insult, followed by a cascade of secondary mechanisms, leads to the exacerbation and remodelling of the lesion site, thus inhibiting neurological recovery. Oedema rapidly accumulates following SCI and contributes to the detrimental pathophysiology and worsens functional outcomes. This study systematically reviewed the current experimental treatments being explored in the field of SCI, which specifically target oedema. Abiding by PRISMA guidelines and strict inclusion criteria, 14 studies were identified and analysed from three online databases (PubMed, Web of Science and EMBASE). As a result, we identified three key modalities which attenuate oedema: selective inhibition of the main water channel protein, aquaporin 4 (AQP4), modulation of inflammation and surgical interventions. Collectively, however, they all result in the downregulation of AQP4, which crucially leads to a reduction in oedema and improved functional outcomes. We concluded that trifluoperazine (TFP), a calmodulin kinase inhibitor which prevents the cell-surface localisation of AQP4, was the most efficacious treatment, significantly eliminating oedema within 7 days of administration. To date, this study is the most concise analysis of current experimental treatments for oedema, exposing its molecular mechanisms and assessing potential therapeutic pathways for future research.


Assuntos
Edema/complicações , Edema/terapia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapia , Animais , Barreira Hematoencefálica/patologia , Edema/fisiopatologia , Humanos , Atividade Motora , Viés de Publicação , Ratos , Recuperação de Função Fisiológica , Risco , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento
8.
Phys Ther ; 101(12)2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34636891

RESUMO

OBJECTIVE: The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes. METHODS: This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT- and UQE-SF-generated scores were assessed for reliability, validity, and administration efficiency. RESULTS: The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14-89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5). CONCLUSION: Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. IMPACT: The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.


Assuntos
Edema/fisiopatologia , Edema/terapia , Linfedema/fisiopatologia , Linfedema/terapia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários/normas , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
11.
Nutrients ; 13(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34371824

RESUMO

Delayed-onset muscle soreness (DOMS) is associated with increases in acute inflammatory and biochemical markers, muscle swelling, pain, and reduced functional performance. This study aimed to investigate the preventative effects of crocodile blood supplementation on DOMS induced by eccentric exercise. Sixteen healthy males were randomly allocated to either a crocodile blood (CB, n = 8) or a placebo (PL, n = 8) treatment. Participants receiving the CB treatment consumed four capsules of freeze-dried CB powder (1 g day-1) over 18 days. Participants receiving the other treatment were administered a placebo over the same period. An eccentric exercise protocol was performed, and functional performance, visual analogue scale (VAS)-measured pain, knee range of movement (ROM), thigh circumference (swelling), and cytokines, enzymes, and biochemical parameters were assessed immediately after exercise as well as after 24 h, 48 h, and 72 h. CB supplementation could significantly maintain maximum voluntary isometric contraction (MVIC) at 24 h (p = 0.001) and 48 h after exercise (p = 0.001) when comparing values at different times for the CB group. In the CB group, thigh circumference decreased only immediately after eccentric exercise (p = 0.031) in comparison with pre-eccentric exercise values. An 18-day supplementation (1 g day-1) of crocodile blood does aid in the maintenance of functional performance and muscle swelling after eccentric exercise. Our data indicate that 1 g day-1 of crocodile blood supplementation should be safe for human consumption.


Assuntos
Jacarés e Crocodilos/sangue , Suplementos Nutricionais , Exercício Físico/fisiologia , Doenças Musculares/prevenção & controle , Mialgia/prevenção & controle , Animais , Biomarcadores/análise , Método Duplo-Cego , Edema/etiologia , Edema/fisiopatologia , Edema/prevenção & controle , Voluntários Saudáveis , Humanos , Contração Isométrica/efeitos dos fármacos , Masculino , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiopatologia , Doenças Musculares/etiologia , Doenças Musculares/fisiopatologia , Mialgia/etiologia , Mialgia/fisiopatologia , Medição da Dor , Desempenho Físico Funcional , Amplitude de Movimento Articular/efeitos dos fármacos , Adulto Jovem
15.
Eur J Haematol ; 107(4): 428-435, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34137077

RESUMO

Light-chain (AL) amyloidosis is a multisystem disorder with a high early mortality and diagnostic delays of >1 year from symptom onset. This retrospective observational study sought to characterize the clinical prodrome and diagnostic delay to inform early detection. We identified 1523 adults with newly diagnosed AL amyloidosis in the Optum de-identified Clinformatics® Datamart US healthcare claims database as those with ≥2 new diagnosis codes for AL or other amyloidosis in 90 days with ≥1 multiple myeloma treatment within 730 days, excluding patients with prior hereditary or secondary amyloidosis and Familial Mediterranean Fever. We considered 34 signs/symptoms using diagnosis codes in all observable time on or before AL amyloidosis diagnosis. Sign/symptom prevalence was compared to that of 1:4 matched population controls. The overlap and sequence of signs/symptoms and the median time from first sign/symptom to AL amyloidosis diagnosis were explored. Healthcare utilization was summarized. The most common individual AL amyloidosis signs/symptoms were malaise/fatigue (61%) and dyspnea (59%). Cardiac signs/symptoms were observed in 77% of patients, followed by renal (62%) and neurologic (59%) signs/symptoms. Multisystem involvement (≥3 systems) was present in 54%. Monoclonal gammopathy was detected in 29% before diagnosis. Median time from symptom onset to AL amyloidosis diagnosis was 2.7 years. Healthcare utilization was high between first AL amyloidosis signs/symptoms and diagnosis, with 50% visiting ≥5 physician types. AL amyloidosis patients have a lengthy and complex clinical prodrome. Novel approaches to early diagnosis are needed to improve outcomes.


Assuntos
Diagnóstico Tardio , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Sintomas Prodrômicos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Bases de Dados Factuais , Dispneia/diagnóstico , Dispneia/fisiopatologia , Edema/diagnóstico , Edema/fisiopatologia , Fadiga/diagnóstico , Fadiga/fisiopatologia , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paraproteinemias/diagnóstico , Paraproteinemias/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos
16.
Clin Radiol ; 76(9): 710.e9-710.e14, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34119304

RESUMO

AIM: To assesses whether utilising bone marrow oedema (BMO) maps improved fracture read times and reader confidence in a large series of acute lower extremity trauma dual-energy computed tomography (DECT) studies. MATERIALS AND METHODS: One hundred and six DECT studies, including 60 fracture cases and 46 non-fracture cases, were evaluated retrospectively in this cross-sectional study. Three-dimensional (3D) BMO maps were generated for each study and coded to display skeletal anatomy in blue and marrow oedema in green. Studies were interpreted by two readers in two timed stages (without and with BMO maps). Readers identified the number, anatomical location, and comminution of fractures. Reader confidence (five-point Likert scale) for fracture identification and anatomical regions where oedema was present was also recorded. RESULTS: Decreased read times (p<0.01) were observed when readers utilised BMO maps for their fracture search. The presence of oedema on BMO maps corresponded with associated fracture in 75.7% reads. No differences in reader confidence were observed as a result of using this BMO-guided technique (>95%, 5/5 for both readers with and without the aid of BMO maps). CONCLUSIONS: DECT BMO maps improve the speed of radiological identification of suspected acute lower extremity fractures with preserved reader confidence. It may help emergent detection of fractures, important for patient management and outcomes.


Assuntos
Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Medula Óssea/fisiopatologia , Estudos Transversais , Edema/complicações , Edema/fisiopatologia , Feminino , Fraturas Ósseas/complicações , Humanos , Imageamento Tridimensional/métodos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tempo
18.
J Tissue Viability ; 30(3): 434-438, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33893014

RESUMO

BACKGROUND: Technologies have been developed to monitor changes in dermal oedema, indicative of the early signs of pressure ulcers. However, there is limited information on the effects of regional differences in tissue morphology on these sub-epidermal moisture (SEM) parameters. This study was designed to investigate the absolute SEM readings across different anatomical sites using a commercial device. METHODS: Twenty-four healthy participants were recruited to evaluate basal SEM values at different bony prominences, sampled by an experienced operator. RESULTS: Distinct differences were observed in unloaded SEM values across different anatomical sites, notably between the upper and lower extremities. A high degree of variability was observed in particular sites, such as the heels. Moreover, SEM values at certain locations revealed significant relationships with age, BMI and gender (p < 0.05). CONCLUSION: The study revealed a high level of variability between and within anatomical sites in a healthy cohort of participants. Determining the changes in local skin and sub-dermal tissue status using SEM may require consideration of both site specific and individual demographic factors, with further research needed in cohorts at risk of pressure ulcers.


Assuntos
Bioacumulação/fisiologia , Edema/diagnóstico , Umidade/efeitos adversos , Tela Subcutânea/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Tela Subcutânea/anormalidades
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