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1.
Medicine (Baltimore) ; 99(3): e18598, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011439

RESUMO

A large interarm and interleg systolic blood pressure (SBP) difference and ankle-brachial index (ABI) <0.9 were associated with peripheral artery disease and left ventricular hypertrophy. These 3 parameters were derived from 4-limb SBP data. However, there is no study to assess clinical significance of SBP heterogeneity in 4 limbs. The aim of this study was to evaluate the association of 4-limb SBP standard deviation (SD) with peripheral vascular parameters and echocardiographic data in patients with or without clinical findings of peripheral artery disease.A total of 1240 patients were included, of whom 1020 had no clinical evidence of overt peripheral artery disease. The 4-limb blood pressures, brachial-ankle pulse wave velocity, and ABI were measured simultaneously by an ABI-form device.In the multivariable linear regression analysis, increased left ventricular mass index (LVMI), ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg (P ≤ .030) were associated with increased 4-limb SBP SD. Additionally, a subgroup multivariable linear regression analysis in 1020 patients without ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg found 4-limb SBP SD still had a positive correlation with LVMI (P < .001).In addition to significant association with ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg, 4-limb SBP SD was positively correlated with LVMI in the multivariable linear regression analysis in all study patients. Furthermore, in the subgroup of patients without clinical evidence of peripheral artery disease, 4-limb SBP SD still had a positive correlation with LVMI. Hence, assessment of 4-limb SBP heterogeneity is useful in identification of high-risk group of peripheral artery disease and/or increased LVMI, irrespective of the presence of overt peripheral artery disease.


Assuntos
Pressão Sanguínea/fisiologia , Ecocardiografia/métodos , Extremidades/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Doença Arterial Periférica/fisiopatologia , Índice Tornozelo-Braço , Feminino , Humanos , Modelos Lineares , Masculino , Doença Arterial Periférica/diagnóstico , Análise de Onda de Pulso
2.
Hu Li Za Zhi ; 67(1): 81-88, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960399

RESUMO

BACKGROUND & PROBLEMS: Early rehabilitation after stroke is important for the recovery of bodily functions in stroke patients. However, the percentage of completion of early limb rehabilitation among stroke patients is only 16%. PURPOSE: Raise the early rehabilitation intervention rate to 88% for patients with stroke within 24 hours of hospitalization. RESOLUTION: We developed an education course on post-stroke rehabilitation and a related e-Learning course as well as organized an 'alliance for recovery' team. In addition, we established a standard for post-stroke relay rehabilitation and designed rehabilitation relay cards, Xbox rehabilitation games, and nine squares challenge for brain stroke care. RESULTS: The accuracy of the knowledge of nursing staff related to physical rehabilitation improved from 72.4% to 100%; the accuracy of their perceptions regarding early limb rehabilitation increased from 16% to 100%; and patient satisfaction increased from 68% to 98%. CONCLUSIONS: We deployed diverse and innovative strategies to assist limb rehabilitation in patients with stroke. Patients and caregivers should be encouraged to participate in early rehabilitation and related programs and should apply the skills and rehabilitation activities learned to daily life.


Assuntos
Extremidades/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/fisiopatologia , Difusão de Inovações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Desenvolvimento de Programas
3.
Acta Neurobiol Exp (Wars) ; 79(3): 290-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31587021

RESUMO

Post-stroke neurological deficits, such as sensorimotor impairments, are often permanent and a leading cause of disability. Stroke is also associated with changes in neuronal synchrony among different brain areas. Multiple studies demonstrated that non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), enhances the efficacy of existing rehabilitative therapies. We hypothesized that the therapeutic effects of tDCS could be due to its influence on neuronal synchrony. To study this, we recorded local field potentials in rats treated with anodal tDCS (a-tDCS) after unilateral ischemic motor cortex lesion. To enhance the effect of a-tDCS on neuronal synchrony, we added monopolar pulses (a-tDCSmp) during a treatment. We found that ischemic lesions reduced interhemispheric coherence in the low gamma frequency range. By contrast, a-tDCSmp treatment increased interhemispheric coherence along with motor improvement in a skilled reaching task. These observations indicate that increased neuronal coherence is a likely mechanism by which tDCS improves stroke recovery. Moreover, this work adds to previous evidence that measures of brain coherence could be used as a biomarker of stroke recovery, which may help in the design of more effective tDCS protocols for stroke rehabilitation.


Assuntos
Isquemia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Animais , Modelos Animais de Doenças , Extremidades/fisiopatologia , Isquemia/fisiopatologia , Masculino , Córtex Motor/fisiopatologia , Ratos Long-Evans , Estimulação Transcraniana por Corrente Contínua/métodos
4.
Med Hypotheses ; 131: 109312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443775

RESUMO

On evaluating patients with lymphedema, the authors found that obesity is associated with generalized edema of all extremities and the trunk with increased intracellular and extracellular fluids, thus suggesting a new concept of lymphedema that the authors have termed systemic subclinical lymphedema. Animal studies show that obesity and its progression lead to changes in the lymphatic system and microcirculation with alterations in lymphatic motility, inflammatory processes, capillary permeability and immune response. Systemic subclinical lymphedema is diagnosed when above normal fluid levels are detected in all the extremities and the trunk with the progression of obesity; this can lead to the appearance of clinical lymphedema of the extremities.


Assuntos
Edema/etiologia , Linfedema/etiologia , Obesidade/complicações , Animais , Cirurgia Bariátrica , Compartimentos de Líquidos Corporais , Progressão da Doença , Edema/fisiopatologia , Extremidades/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/fisiopatologia , Modelos Biológicos , Obesidade/fisiopatologia , Obesidade/cirurgia , Especificidade de Órgãos , Tronco/fisiopatologia , Perda de Peso
5.
Crit Care ; 23(1): 266, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362770

RESUMO

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an increasingly adopted life-saving mechanical circulatory support for a number of potentially reversible or treatable cardiac diseases. It is also started as a bridge-to-transplantation/ventricular assist device in the case of unrecoverable cardiac or cardio-respiratory illness. In recent years, principally for non-post-cardiotomy shock, peripheral cannulation using the femoral vessels has been the approach of choice because it does not need the chest opening, can be quickly established, can be applied percutaneously, and is less likely to cause bleeding and infections than central cannulation. Peripheral ECMO, however, is characterized by a higher rate of vascular complications. The mechanisms of such adverse events are often multifactorial, including suboptimal arterial perfusion and hemodynamic instability due to the underlying disease, peripheral vascular disease, and placement of cannulas that nearly occlude the vessel. The effect of femoral artery damage and/or significant reduced limb perfusion can be devastating because limb ischemia can lead to compartment syndrome, requiring fasciotomy and, occasionally, even limb amputation, thereby negatively impacting hospital stay, long-term functional outcomes, and survival. Data on this topic are highly fragmentary, and there are no clear-cut recommendations. Accordingly, the strategies adopted to cope with this complication vary a great deal, ranging from preventive placement of antegrade distal perfusion cannulas to rescue interventions and vascular surgery after the complication has manifested.This review aims to provide a comprehensive overview of limb ischemia during femoral cannulation for VA-ECMO in adults, focusing on incidence, tools for early diagnosis, risk factors, and preventive and treating strategies.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Extremidades/irrigação sanguínea , Isquemia/prevenção & controle , Isquemia/terapia , Cateterismo Periférico/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Extremidades/fisiopatologia , Humanos , Incidência , Isquemia/epidemiologia , Fatores de Risco
6.
Biomed Res Int ; 2019: 9365291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31309121

RESUMO

Objective: The aim of this study was to assess muscle injury associated with upper and lower closed limb fracture using ultrasound, and to develop ultrasound classification criteria for muscle injury. Patients and Methods: Thirty patients with limb fracture and muscle injury participated in this study. Ultrasonography was used to assess muscle fibre, hematoma, vascular injury, and diameter growth rate. Injury was classified into three grades according to the ultrasound imaging: scores of less than, equal to, or greater than 9. Results: Of 30 patients, focal fibre rupture was observed in 11 cases; in 9 cases, the injured area exceeded 30% of the muscle area. Six patients had muscle hematoma (the largest reaching 39 mm); in 4 patients, the hematoma showed a honeycombed pattern. Vascular rupture was observed in 6 patients, of which 2 had decreased main arterial diameter and blood flow. The greatest increase in muscle thickness was 17 mm. Of all patients, 11 showed an increase in the diameter growth rate of the muscle exceeding 50%. In addition, among the 30 patients, 11 patients with scores ranging from 4 to 8 received conservative treatment; 9 patients with scores ranging from 10 to 14 received operative treatment; and 10 patients with scores equal to 9 received either conservative or operative treatment. Conclusions: Ultrasonography is useful for diagnosing muscle injury associated with closed limb fracture. The ultrasound classification criteria for muscle injury can be used to assess the severity of injury and guide the decision of treatment.


Assuntos
Extremidades/fisiopatologia , Fraturas Ósseas/complicações , Fraturas Fechadas/complicações , Músculos/lesões , Doenças Musculares/diagnóstico , Doenças Musculares/etiologia , Adolescente , Adulto , Idoso , Feminino , Consolidação da Fratura/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/etiologia , Ultrassonografia/métodos , Adulto Jovem
7.
PLoS One ; 14(6): e0218546, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211805

RESUMO

In veterinary practice pain alleviation plays a part in managing lameness. The aim of this randomized and placebo-controlled clinical study was to evaluate the effect of a single administration of ketoprofen on locomotion characteristics and weight distribution in cattle with foot (located up to and including the fetlock; n = 31) and (proximal to the fetlock; n = 10) pathologies. Cattle were randomly allocated to either the ketoprofen (group K; intravenous 3 mg/kg of body weight; n = 21) or an equivalent volume of isotonic sterile saline solution (group P; n = 20). Two accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcome = foot load and toe-off), a 4-scale weighing platform (weight distribution and SD of the weight) and a subjective locomotion score were measured before (baseline) and after 1 h and 18 h of treatment. All variables were expressed as differences across contralateral limbs, and the measurements at 1 h and 18 h were compared to the baseline. A repeated measures ANOVA was used to determine the differences between groups K and P. A logistic regression model with a binary outcome (0 = no improvement and 1 = improvement of the differences across the contralateral limbs over time) was calculated. Mean (± SD) of locomotion scores at baseline were not significantly different (P = 0.102) in group K (3.10 ± 0.80) as compared to group P (3.48 ± 0.64). Cattle of group K showed significantly lower differences across contralateral limbs at 1 h as compared to group P for the relative stance phase and the weight distribution. Only the treatment (P versus K) remained a significant factor in the model for relative stance phase (odds ratio (OR) = 6.5; 95% CI = 1.38-30.68) and weight distribution (OR = 6.36; 95% CI = 1.30-31.07). The effects of ketoprofen were evident in improving the differences across contralateral limbs-both for stance phase during walking and weight bearing during standing-after 1 h but not after 18 h of administration.


Assuntos
Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/tratamento farmacológico , Extremidades/fisiopatologia , Cetoprofeno/farmacologia , Locomoção , Dor/veterinária , Suporte de Carga , Análise de Variância , Animais , Bovinos , Doenças dos Bovinos/etiologia , Gerenciamento Clínico , Marcha , Coxeadura Animal/diagnóstico , Coxeadura Animal/etiologia
8.
PLoS One ; 14(6): e0217917, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31199814

RESUMO

The promotion of muscle recovery after immobilization is important to preserve an optimum health status. Here, we examined the effect of dietary Alaska pollack protein (APP) on skeletal muscle weight after atrophy induced by hind limb immobilization using plaster immobilization technique. Rat left limb was casted with a wetted plaster cast under anesthesia. After 2 weeks of feeding, the cast was removed and the rats were divided into three groups, namely, a baseline group, high-fat casein diet group, and high-fat APP diet group. After 3 weeks of feeding, the skeletal muscles (soleus, extensor digitorum longus [EDL], and gastrocnemius) were sampled. The estimated weight gains of soleus, gastrocnemius, and EDL muscle in the immobilized limbs were significantly larger in the rats fed with APP diet as compared with those fed with casein diet. In soleus muscle, dietary APP increased the expression of Igf1 and Myog genes in the immobilized limbs after the recovery period.


Assuntos
Proteínas de Peixes da Dieta/farmacologia , Imobilização/fisiologia , Músculo Esquelético/efeitos dos fármacos , Atrofia Muscular/tratamento farmacológico , Alaska , Animais , Moldes Cirúrgicos , Extremidades/fisiopatologia , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Proteínas Musculares/metabolismo , Ratos , Ratos Sprague-Dawley
9.
Biomed Res Int ; 2019: 8329306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080830

RESUMO

Background: Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke. Methods: An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively. Results: Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949). Conclusions: BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Extremidades/fisiopatologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Tono Muscular/efeitos dos fármacos , Tono Muscular/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
10.
Int J Mol Sci ; 20(9)2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31052504

RESUMO

Modelling is essential for a better understanding of microcirculatory pathophysiology. In this study we tested our hyperoxia-mouse model with healthy and non-healthy mice. Animals (n = 41) were divided in groups-a control group, with 8 C57/BL6 non-transgenic male mice, a diabetic group (DB), with 8 C57BLKsJ-db/db obese diabetic mice and the corresponding internal controls of 8 age-matched C57BLKsJ-db/+ mice, and a cardiac hypertrophy group (CH), with 9 FVB/NJ cα-MHC-NHE-1 transgenic mice prone to develop cardiac failure and 8 age-matched internal controls. After anesthesia, perfusion data was collected by laser Doppler flowmetry (LDF) during rest (Phase 1), hyperoxia (Phase 2), and recovery (Phase 3) and compared. The LDF wavelet transform components analysis (WA) has shown that cardiorespiratory, myogenic, and endothelial components acted as main markers. In DB group, db/+ animals behave as the Control group, but WA already demonstrated significant differences for myogenic and endothelial components. Noteworthy was the increase of the sympathetic components in the db/db set, as in the cardiac overexpressing NHE1 transgenic animals, reported as a main component of these pathophysiological processes. Our model confirms that flow motion has a universal nature. The LDF component's WA provides a deeper look into vascular pathophysiology reinforcing the model's reproducibility, robustness, and discriminative capacities.


Assuntos
Vasos Sanguíneos/fisiopatologia , Hiperóxia/fisiopatologia , Animais , Modelos Animais de Doenças , Extremidades/irrigação sanguínea , Extremidades/fisiopatologia , Hiperóxia/genética , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Fluxo Sanguíneo Regional , Vasoconstrição
11.
Exp Brain Res ; 237(7): 1853-1867, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31087110

RESUMO

We studied 12 patients with Parkinson's disease (PD): 6 with postural instability (Hoehn and Yahr Stage 3) and 6 without (Stage 2 or 2.5), using a quantitative test based on the clinical pull test. Their findings were compared with those for 12 healthy controls. The patients on their usual medications were pulled either forwards or backwards at the level of the shoulders and asked not to take a step in a series of five trials. Acceleration was monitored for the upper trunk, sacrum, and both tibias. EMG was measured in soleus and tibialis anterior (TA) muscles in all and for thigh and truncal muscles in a subgroup. A target of 0.2 g trunk acceleration was used, but smaller perturbations were used in very unstable patients. All the Stage 3 patients lost balance in at least one trial for the posterior perturbations but none for the anterior ones. None of the Stage 2 patients lost balance. There was increased tonic EMG and agonist activity but no difference in EMG onset or initial force production compared to healthy controls. For posterior perturbations, there were two related disorders that separated the PD patients from controls. There was a significantly higher ratio of sacral-to-applied acceleration and both PD groups showed reduced knee acceleration and shortened latency, more so for the Stage 3 group. The increased sacral-to-C7 acceleration ratio was correlated with the tonic level of activation of the hamstrings (HS), quadriceps, and lumbar paraspinal muscles (PS), while the tibial acceleration latency was also correlated with the level of tonic PS activation. We also found that the size of balance responses, 0-200 ms post-perturbation, correlated significantly with the level of tonic activation in nearly all the muscles studied. We confirmed that PD patients show greater instability posteriorly than anteriorly to applied perturbations. Our findings support increasing axial and limb rigidity as the cause of the impaired pull test rather than postural bradykinesia and suggest that tonic truncal and thigh muscle activation may be an important underlying cause.


Assuntos
Eletromiografia/métodos , Extremidades/fisiopatologia , Rigidez Muscular/fisiopatologia , Doença de Parkinson/fisiopatologia , Equilíbrio Postural/fisiologia , Acelerometria/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rigidez Muscular/psicologia , Doença de Parkinson/psicologia , Propriocepção/fisiologia
12.
Clin Chest Med ; 40(2): 367-383, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31078215

RESUMO

"Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."


Assuntos
Tolerância ao Exercício/fisiologia , Extremidades/fisiopatologia , Força Muscular/fisiologia , Atrofia Muscular/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Feminino , Humanos , Masculino
13.
Anticancer Res ; 39(5): 2459-2466, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092440

RESUMO

BACKGROUND/AIM: This study aimed to identify the prognostic factors and outcomes of osteosarcoma (OS) located in proximal versus distal extremity long bones. PATIENTS AND METHODS: A nationwide cohort comprising all Norwegian high-grade OSs in extremity long bones between 1982 and 2009 was investigated. RESULTS: The univariate analysis results identified no significant differences in survival between patients with OS in proximal long bones (101 cases) as a group in comparison to patients with OS in the distal part of these bones (120 cases). However, proximal femur and primary metastasis were both independent adverse prognostic factors for sarcoma-specific survival in multivariate analyses, while elevated LDH and secondary OS were inferior prognostic factors for event-free survival. Adequate surgery and chemotherapy had a positive impact on survival. CONCLUSION: OS of the proximal femur had an unfavorable outcome in comparison to OS in other anatomical locations in extremity long bones.


Assuntos
Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/fisiopatologia , Extremidades/fisiopatologia , Osteossarcoma/fisiopatologia , Prognóstico , Adolescente , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Osteossarcoma/epidemiologia , Adulto Jovem
14.
Arq Neuropsiquiatr ; 77(3): 155-160, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30970127

RESUMO

Deficits in motor skills and depressive symptoms are common effects observed after stroke, so it is necessary to understand how these variables interact with each other. Therefore, the aim of this study was to investigate the relationship between these two variables in post-ischemic stroke patients. We evaluated 135 patients with a mean age of 60 years (± 15). The Fugl-Meyer assessment of motor function was used to assess motor skills in the upper limbs, lower limbs, balance, and sensitivity and the Beck Depression Inventory was applied to evaluate depressive symptoms. To assess the relationship between both components, Spearman's correlation was performed. Depressive symptoms were negatively correlated with all variables of motor skills. This study suggests that higher motor skills in post-stroke patients may be associated with fewer depressive symptoms. Thus, a better understanding of how post-stroke symptoms are interrelated may improve patient treatment and care, contributing to a better quality of life.


Assuntos
Depressão/etiologia , Transtornos das Habilidades Motoras/etiologia , Transtornos das Habilidades Motoras/psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Fatores Etários , Idoso , Extremidades/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Reabilitação do Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Fatores de Tempo
15.
PLoS One ; 14(4): e0215830, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013317

RESUMO

Following injury to a tendon little is known about potential for pathology to develop in other regional tendons from overloading or altered function. The aim of this study was to investigate the gene expression and histopathological changes that occur 1) within the deep digital flexor tendon (DDFT) after injury to the superficial digital flexor tendon (SDFT) and 2) within the flexor tendons (SDFT and DDFT) after injury to the extensor tendons. Merino wethers [Ovis aries] (n = 18) were divided into three equal groups and underwent either partial transection of the SDFT, complete transection of the extensor tendons or were left as non-operated controls. Tendons were harvested and sampled regionally for gene expression (real time PCR) and histologic analysis eight weeks after surgery. Transection of the SDFT resulted in increased expression of collagen III, versican, biglycan, lumican and MMP1 (P<0.026 for all genes) within the DDFT. There was no effect of transecting the extensor tendons on the expression of any gene tested in either the SDFT or the DDFT. The DDFT had elevated histopathology scores induced by transection of the SDFT, eight weeks previously. There were minimal histological differences in either the SDFT or DDFT after transection of the extensor tendons. Transection of the SDFT results in a mild, subclinical tendinopathy within the DDFT with potential implications on treatment and rehabilitation of SDFT injuries. Injury to the extensor tendons has minimal measured effect on the SDFT or DDFT.


Assuntos
Tendinopatia/genética , Traumatismos dos Tendões/genética , Tendões/metabolismo , Animais , Colágeno/genética , Modelos Animais de Doenças , Extremidades/fisiopatologia , Regulação da Expressão Gênica/genética , Humanos , Carneiro Doméstico/genética , Tendinopatia/fisiopatologia , Traumatismos dos Tendões/fisiopatologia , Tendões/fisiopatologia
16.
Int Emerg Nurs ; 45: 36-42, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30981624

RESUMO

BACKGROUND: Nurse practitioners (NP) are an integral part of the urgent and emergency care workforce in the United Kingdom providing safe and effective care. Despite this, there is limited research assessing the ability of NPs to correctly interpret isolated paediatric limb injury radiographs in the urgent and emergency care environment. AIM: The aim of this study was to compare the accuracy in interpreting isolated paediatric limb radiographs between NPs and consultant radiologists. SETTING: A nurse-led urgent care centre (UCC) in central London, United Kingdom. PARTICIPANTS: 296 paediatric patients with isolated limb injuries who had a radiograph requested and interpreted by an NP. METHODS: Thirteen NPs (adult registered) with various backgrounds and qualifications participated in this prospective, single-centre healthcare analysis. Review of all clinical presentations at the UCC over a 3-month period (September-November 2017) identified 296 paediatric patients (aged 2-15) who received a peripheral limb radiograph. Clinical records for each patient were analysed to document demographics, mechanism of injury, NP examination findings, radiographic interpretation and formal radiologist report. NP interpretation of each radiograph was classified as definite fracture, possible fracture or no fracture. This was compared to the final radiologist report (considered the gold standard) to calculate the sensitivity and specificity of NP radiograph interpretation. RESULTS: NPs reported a total of 94 radiographs (32%) as definite fracture, 176 (59%) as no fracture and 26 (9%) as possible fracture, as compared to radiologists at 71 (24%), 218 (74%) and 7 (2%). A total of 242 (82%) of radiographs were correctly identified by NPs, while 54 (18%) were incorrectly interpreted. The sensitivity of the NP limb radiographic interpretation was 92%, with a specificity of 78%. CONCLUSIONS: The findings validate the clinical and diagnostic skills of NPs in the interpretation of isolated paediatric limb radiographs.


Assuntos
Extremidades/lesões , Profissionais de Enfermagem Pediátrica/normas , Radiografia/métodos , Adolescente , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Extremidades/fisiopatologia , Feminino , Humanos , Londres , Masculino , Profissionais de Enfermagem Pediátrica/estatística & dados numéricos , Estudos Prospectivos
17.
Mil Med ; 184(Suppl 1): 83-91, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901441

RESUMO

We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009-2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25-2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.


Assuntos
Técnicas de Apoio para a Decisão , Extremidades/lesões , Infecção dos Ferimentos/diagnóstico , Ferimentos e Lesões/complicações , Adulto , Extremidades/fisiopatologia , Feminino , Humanos , Salvamento de Membro/métodos , Masculino , Militares/estatística & dados numéricos , Fatores de Tempo , Infecção dos Ferimentos/fisiopatologia , Ferimentos e Lesões/tratamento farmacológico
18.
Ann Clin Transl Neurol ; 6(2): 310-323, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30847363

RESUMO

Objective: We aimed to evaluate the safety and effectiveness of short-term remote ischemic postconditioning (RIPC) in acute stroke monkey models. Methods: Acute stroke monkeys were allocated to four groups based on the number of limbs exposed to RIPC. RIPC was initiated by 5-min cuff inflation/deflation cycles of the target limb(s) for 5-10 bouts. Vital signs, skin integrity, brain MRI, and serum levels of cardiac enzymes (myoglobin, creatine kinase [CK], CK-muscle/brain [CK-MB]), one inflammatory marker (high-sensitivity C-reactive protein [hsCRP], and one endothelial injury marker (von Willebrand factor [vWF]) were assessed. Spetzler scores were used to assess neurological function. Results: No significant differences in vital signs or local skin integrity were found. Short-term RIPC did not reduce infarct volume under any condition at the 24th hour after stroke. However, neurological function improved in multi-limb RIPC compared with sham and single-limb RIPC at the 30th day follow-up after stroke. Myoglobin, CK, and CK-MB levels were reduced after multi-limb RIPC, regardless of the number of bouts. Moreover, multi-limb RIPC produced a greater diminution in CK-MB levels, whereas two-limb RIPC was more effective in reducing serum CK levels at the 24th hour after stroke. hsCRP increased after 5 bouts of multi-limb RIPC before decreasing below baseline and single-limb RIPC levels. Serum vWF was decreased at later time points after RIPC in all RIPC groups. Conclusions: Stroke monkeys in hyperacute stage may benefit from short-term RIPC; however, whether this intervention can be translated into clinical use in patients with acute ischemic stroke warrants further study.


Assuntos
Isquemia Encefálica/fisiopatologia , Extremidades/fisiopatologia , Pós-Condicionamento Isquêmico , Acidente Vascular Cerebral/fisiopatologia , Animais , Biomarcadores/sangue , Creatina Quinase Forma MB/sangue , Haplorrinos , Isquemia/fisiopatologia , Masculino , Traumatismo por Reperfusão Miocárdica/sangue , Traumatismo por Reperfusão Miocárdica/fisiopatologia
19.
Medicine (Baltimore) ; 98(10): e14750, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855470

RESUMO

BACKGROUND: Previous studies have reported that acupuncture combined Bobath approach (BA) can be used to treat limbs paralysis (LP) after hypertensive intracerebral hemorrhage (HICH) effectively. However, no systematic review has explored its effectiveness and safety for LP following HICH. In this systematic review, we aim to assess the effectiveness and safety of acupuncture plus BA for the treatment of LP following HICH. METHODS: The following 7 databases will be searched from their inception to the February 1, 2019: Cochrane Central Register of Controlled Trials, EMBASE, PUBMED, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure without any language restrictions. The randomized controlled trials (RCTs) of acupuncture plus BA that evaluate the effectiveness and safety for LP after HICH will be included. The methodological quality of all included studies will be assessed by using Cochrane risk of bias tool. Two authors will independently perform study selection, data extraction, and methodological quality evaluation. Any disagreements occurred between 2 authors will be resolved by a third author involved through discussion. Data will be pooled and analyzed by using RevMan 5.3 Software. RESULTS: This review will evaluate the effectiveness and safety of acupuncture combined BA for LP following HICH. The primary outcome is limbs function. The secondary outcomes are muscle strength, muscle tone, and quality of life, as well as the adverse events. CONCLUSION: The results of this study will summarize the latest evidence of acupuncture combined BA for LP following HICH.


Assuntos
Terapia por Acupuntura/métodos , Extremidades/fisiopatologia , Hemorragia Intracraniana Hipertensiva/complicações , Paralisia , Modalidades de Fisioterapia , Humanos , Paralisia/etiologia , Paralisia/terapia , Revisão Sistemática como Assunto , Resultado do Tratamento
20.
Hum Mol Genet ; 28(10): 1671-1681, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30649340

RESUMO

Hand-Foot-Genital syndrome is a rare condition caused by mutations in the HOXA13 gene and characterized by limb malformations and urogenital defects. While the role of Hoxa13 in limb development has been extensively studied, its function during the development of the urogenital system remains elusive mostly due to the embryonic lethality of Hoxa13 homozygous mutant mice. Using a conditional inactivation strategy, we show that mouse fetuses lacking Hoxa13 function develop megaureters, hydronephrosis and malformations of the uterus, reminiscent of the defects characterizing patients with Hand-Foot-Genital syndrome. Our analysis reveals that Hoxa13 plays a critical role in Müllerian ducts fusion and in ureter remodeling by regulating the elimination of the caudal common nephric duct, eventually preventing the separation from the nephric duct. Our data also reveal a specific role for Hoxa13 in the urogenital sinus, which is in part mediated by Gata3, as well as Hoxa13 requirement for the proper organization of the ureter. Finally, we provide evidence that Hoxa13 provides positional and temporal cues during the development of the lower urogenital system, a sine qua non condition for the proper function of the urinary system.


Assuntos
Anormalidades Múltiplas/genética , Deformidades Congênitas do Pé/genética , Fator de Transcrição GATA3/genética , Deformidades Congênitas da Mão/genética , Proteínas de Homeodomínio/genética , Anormalidades Urogenitais/genética , Sistema Urogenital/fisiopatologia , Anormalidades Múltiplas/fisiopatologia , Animais , Extremidades/crescimento & desenvolvimento , Extremidades/fisiopatologia , Deformidades Congênitas do Pé/fisiopatologia , Deformidades Congênitas da Mão/fisiopatologia , Humanos , Rim/anormalidades , Rim/patologia , Deformidades Congênitas dos Membros/genética , Deformidades Congênitas dos Membros/fisiopatologia , Camundongos , Ductos Paramesonéfricos/fisiopatologia , Mutação , Ureter/anormalidades , Ureter/fisiopatologia , Anormalidades Urogenitais/fisiopatologia , Sistema Urogenital/crescimento & desenvolvimento
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