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1.
Wilderness Environ Med ; 30(4S): S87-S99, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31780084

RESUMO

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.


Assuntos
Padrões de Prática Médica , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/terapia , Medicina Selvagem/normas , Humanos , Imobilização/efeitos adversos , Imobilização/métodos , Sociedades Médicas , Traumatismos da Medula Espinal/prevenção & controle , Traumatismos da Coluna Vertebral/prevenção & controle , Medicina Selvagem/métodos
2.
Br J Radiol ; 92(1104): 20190526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31595778

RESUMO

OBJECTIVE: Unsuspected pulmonary embolism (UPE) has been increasingly diagnosed as an incidental finding on CT scans for routine staging in cancer patients. Previous studies suggest that obesity is an independent risk factor for venous thromboembolism in patients with malignant tumors. In this study, we aimed to investigate the association between abdominal adipose tissue, especially visceral adipose tissue (VAT) and the occurrence of UPE in hospitalized patients with gastrointestinal cancer. METHODS: Routine contrast-enhanced chest and abdominal CT scans of 1974 patients were retrospectively assessed for the presence of UPE, of which 58 patients were identified with UPE and 108 non-UPE patients were selected as the non-UPE control group based on several matching criteria. Abdominal adipose tissue was measured by volumes of VAT and subcutaneous adipose tissue (SAT) at the navel level. RESULTS: VAT, SAT, indwelling venous catheters, surgery, chemotherapy, and bed rest or immobilization were associated with the occurrence of UPE. Higher VAT volumes were associated with increased risk of UPE (odds ratio: 1.96; 95% confidence interval: 1.25, 3.06; p = 0.003) adjusting body mass index (BMI), bed rest or immobilization, surgery, chemotherapy and smoking, while SAT was not associated with UPE adjusting the same confounders (p = 0.117). No statistical association was found between BMI and UPE (p = 0.102). CONCLUSION: Higher VAT rather than SAT is associated with an increased risk of unsuspected pulmonary embolism on routine CT scans in hospitalized gastrointestinal cancer patients. ADVANCES IN KNOWLEDGE: Our findings indicate that VAT is a stronger risk factor for unsuspected pulmonary embolism than BMI and SAT in hospitalized patients with gastrointestinal cancer.


Assuntos
Embolia Gordurosa/etiologia , Gordura Intra-Abdominal/diagnóstico por imagem , Embolia Pulmonar/etiologia , Gordura Subcutânea Abdominal/diagnóstico por imagem , Idoso , Repouso em Cama/efeitos adversos , Índice de Massa Corporal , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Embolia Gordurosa/diagnóstico por imagem , Feminino , Neoplasias Gastrointestinais , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
3.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31368316

RESUMO

The objective of this study was to gain better insight into factors associated with the capture-related mortality rate in cheetahs. A link to an online questionnaire was sent to zoo and wildlife veterinarians through the Species Survival Plan Programme and European Endangered Species Programme coordinators and via the 'Wildlife VetNet' Google group forum. The questionnaire consisted of 50 questions relating to the veterinarians' country of residence and experience, the medicine combinations used, standard monitoring procedures, capture-related complications and mortalities experienced in this species under different capture conditions. In addition, necropsy data from the national wildlife disease database of the National Zoological Gardens of South Africa were examined for cases where anaesthetic death was listed as the cause of death in cheetahs. A total of 75 veterinarians completed the survey, with 38 from African countries and a combined total of 37 from Europe, the United States (US) and Asia. Of these, 24% (n = 18/75) had experienced at least one capture-associated cheetah mortality, with almost all of the fatalities (29/30) reported by veterinarians working in Africa. A lack of anaesthetic monitoring and the absence of supplemental oxygen were shown to be significant risk factors for mortality. Hyperthermia, likely to be associated with capture stress, was the most common reported complication (35%). The results suggest that free-ranging rather than habituated captive cheetahs are particularly at risk of dying during immobilisation and transport. The capture-related fatalities in this species do not appear to be associated with either the veterinarian's level of clinical experience or the immobilisation agents used.


Assuntos
Acinonyx , Anestésicos Dissociativos/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Imobilização/veterinária , Mortalidade , Animais , Animais Selvagens , Animais de Zoológico , Autopsia/veterinária , Bases de Dados Factuais , Combinação de Medicamentos , Europa (Continente) , Imobilização/efeitos adversos , Imobilização/métodos , Ketamina/efeitos adversos , Modelos Logísticos , Medetomidina/efeitos adversos , Fatores de Risco , África do Sul/epidemiologia , Inquéritos e Questionários , Tranquilizantes/efeitos adversos , Médicos Veterinários
4.
Mol Med Rep ; 20(3): 2083-2090, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31257542

RESUMO

The intestinal epithelium is a monolayer of cells arranged side­by­side and connected by tight junction (TJ) proteins expressed at the apical extreme of the paracellular membrane. This layer prevents stress­induced inflammatory responses, thus helping to maintain gut barrier function and gut homeostasis. The aim of the present study was to evaluate the effects of chronic immobilization stress on the colonic expression of various parameters of homeostasis. A total of two groups of female BALB/c mice (n=6) were included: A stressed group (short­term immobilization for 2 h/day for 4 consecutive days) and an unstressed (control) group. Colon samples were obtained to detect neutrophils and goblet cells by optical microscopy, TJ protein expression (occludin, and claudin ­2, ­4, ­7, ­12 and ­15) by western blotting, mRNA levels of TJ genes and proinflammatory cytokines [tumor necrosis factor (TNF)­α, interleukin (IL)­1ß, ­6 and ­8] by reverse transcription­quantitative PCR, fecal lactoferrin by ELISA and the number of colony­forming units of aerobic bacteria. Compared with goblet cells in control mice, goblet cells were enlarged and reduced in number in stressed mice, whereas neutrophil cellularity was unaltered. Stressed mice exhibited reduced mRNA expression for all evaluated TJ mRNAs, with the exception of claudin­7, which was upregulated. Protein levels of occludin and all claudins (with the exception of claudin­12) were decreased in stressed mice. Fecal lactoferrin, proinflammatory cytokine mRNA levels and aerobic bacterial counts were all increased in the stressed group. These results indicated that immobilization stress induced proinflammatory and potential remodeling effects in the colon by decreasing TJ protein expression. The present study may be a useful reference for therapies aiming to regulate the effects of stress on intestinal inflammatory dysfunction.


Assuntos
Colo/patologia , Imobilização/efeitos adversos , Animais , Colo/microbiologia , Citocinas/análise , Fezes/química , Feminino , Células Caliciformes/patologia , Homeostase , Lactoferrina/análise , Camundongos Endogâmicos BALB C , Estresse Fisiológico , Proteínas de Junções Íntimas/análise
5.
World Neurosurg ; 129: e478-e484, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150857

RESUMO

BACKGROUND: Cervical spine immobilization, including cervical collars, has been recommended in most trauma guidelines. However, cervical spine immobilization can be associated with harm, and an increasing body of evidence has demonstrated associated complications. We hypothesized that older trauma patients placed in cervical collars for >24 hours were at greater risk of developing collar-related complications compared with those placed in cervical collars for ≤24 hours. METHODS: We conducted a retrospective cohort study of injured patients without a fracture of the cervical vertebrae, aged ≥65 years, who had been placed in a cervical collar during the period from January 1, 2015 to December 31, 2015. The primary outcome was the composite of the in-hospital development of nosocomial pneumonia and collar-related pressure ulcers. RESULTS: A total of 1154 patients had been treated with cervical collars during the study period, and 61 (5.1%) had developed collar-related complications. Male sex, a lower initial Glasgow Coma Scale score, a history of congestive heart failure, a history of chronic obstructive pulmonary disease or asthma, operative management, and longer hospital and intensive care unit lengths of stay demonstrated a univariable association with collar-related complications (P < 0.10), in addition to a duration in the collar for >24 hours. An independent association was found between collar duration >24 hours and the outcome of interest (adjusted odds ratio, 2.50; 95% confidence interval, 1.16-5.39; P = 0.02). CONCLUSIONS: Among older patients without a cervical vertebral fracture, duration of cervical collar use for >24 hours was associated with the development of collar-related complications. We recommend attention to early collar clearance for older trauma patients.


Assuntos
Braquetes/efeitos adversos , Imobilização/efeitos adversos , Lesões do Pescoço/terapia , Traumatismos da Medula Espinal/terapia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
6.
Bone Joint J ; 101-B(6): 691-694, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154840

RESUMO

AIMS: To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population. PATIENTS AND METHODS: Patients treated with a lower limb cast between 2006 and 2018 were identified using plaster room records. Their electronic records and radiological reports were reviewed for details about their cast, past medical history, and any VTE recorded in our hospital within a year of casting. RESULTS: There were 136 episodes of casting in 100 patients. The mean age was 55 years (22 to 91). The mean time in a cast was 45 days (five days to eight months). A total of 76 patients had neuropathy secondary to diabetes. No patient received chemical thromboprophylaxis while in a cast. One VTE (0.7% of casting episodes) was documented. This was confirmed by Doppler scan nine days after removing the cast. CONCLUSION: The frequency of VTE was higher than that of the general population (0.05%); this is most likely attributable to our patients' apparent increase in VTE risk as suggested by The National Institute for Health and Care Excellence (NICE). These findings suggest that thromboprophylaxis is not routinely indicated in patients who undergo immobilization of the lower limb in a cast, although the risks of VTE should be assessed. While the cast itself does not pose an increased risk, other pathologies, such as active cancer, mean that each individual case needs to be considered on their merit. Cite this article: Bone Joint J 2019;101-B:691-694.


Assuntos
Moldes Cirúrgicos/efeitos adversos , Imobilização/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/diagnóstico por imagem
7.
Trials ; 20(1): 328, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171031

RESUMO

BACKGROUND: Shoulder pain is a highly prevalent complaint and disorders of the rotator cuff, including tears, are thought to be the most common cause. The number of operations repair the torn rotator cuff has risen significantly in recent years. While surgical techniques have progressed, becoming less invasive and more secure, rehabilitation programmes have remained largely like those initially developed when surgical techniques were less advanced and more invasive. Uncertainty remains in relation to the length of post-surgical immobilisation and the amount of early load permitted at the repair site. In the context of this uncertainty, current practice is to follow a generally cautious approach, including long periods of immobilisation in a sling and avoidance of early active rehabilitation. Systematic review evidence suggests early mobilisation might be beneficial but further high-quality studies are required to evaluate this. METHODS/DESIGN: RaCeR is a two-arm, multi-centre pilot and feasibility randomised controlled trial with nested qualitative interviews. A total of 76 patients with non-traumatic rotator cuff tears who are scheduled to have a surgical repair will be recruited from up to five UK NHS hospitals and randomly allocated to either early patient-directed rehabilitation or standard rehabilitation that incorporates sling immobilisation. RaCeR will assess the feasibility of a future, substantive, multi-centre randomised controlled trial to test the hypothesis that, compared to standard rehabilitation incorporating sling immobilisation, early patient-directed rehabilitation is both more clinically effective and more cost-effective. In addition, a sample of patients and clinicians will be interviewed to understand the acceptability of the interventions and the barriers and enablers to adherence to the interventions. DISCUSSION: Research to date suggests that there is the possibility of reducing the patient burden associated with post-operative immobilisation following surgery to repair the torn rotator cuff and improve clinical outcomes. There is a clear need for a high-quality, adequately powered, randomised trial to better inform clinical practice. Prior to a large-scale trial, we first need to undertake a pilot and feasibility trial to address current uncertainties about recruitment, retention and barriers to adherence to the interventions, particularly in relation to whether patients will be willing to begin moving their arm early after their operation. TRIAL REGISTRATION: ISRCTN Registry, 18357968 . Registered on 10 August 2018.


Assuntos
Terapia por Exercício , Imobilização/métodos , Lesões do Manguito Rotador/reabilitação , Manguito Rotador/cirurgia , Dor de Ombro/reabilitação , Terapia por Exercício/efeitos adversos , Estudos de Viabilidade , Humanos , Imobilização/efeitos adversos , Imobilização/instrumentação , Entrevistas como Assunto , Estudos Multicêntricos como Assunto , Dispositivos de Fixação Ortopédica , Projetos Piloto , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/fisiopatologia , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Reino Unido
8.
Br J Hosp Med (Lond) ; 80(6): 317-319, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31180783

RESUMO

Potential injury to the cervical spine should be considered in all patients who have suffered blunt trauma. Early spinal immobilization is required to minimize the risk of secondary spinal cord injury. However, prolonged immobilization is associated with its own morbidity. Clinical evaluation of the cervical spine in confused or unconscious adult trauma patients is challenging, and imaging is required to safely 'clear' the cervical spine. Despite the existence of national guidelines, significant variations in practice exist. This article summarizes the evidence for the initial stabilization of the cervical spine in adult trauma patients. It reviews the imaging modalities available and the criteria for discontinuation of cervical spine immobilization.


Assuntos
Vértebras Cervicais/lesões , Imobilização/métodos , Traumatismos da Medula Espinal/diagnóstico , Inconsciência , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/terapia , Vértebras Cervicais/diagnóstico por imagem , Protocolos Clínicos , Humanos , Imobilização/efeitos adversos , Imagem por Ressonância Magnética , Guias de Prática Clínica como Assunto , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem
9.
Cochrane Database Syst Rev ; 5: CD004962, 2019 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-31074847

RESUMO

BACKGROUND: Acute anterior shoulder dislocation, which is the most common type of dislocation, usually results from an injury. Subsequently, the shoulder is less stable and is more susceptible to re-dislocation or recurrent instability (e.g. subluxation), especially in active young adults. After closed reduction, most of these injuries are treated with immobilisation of the injured arm in a sling or brace for a few weeks, followed by exercises. This is an update of a Cochrane Review first published in 2006 and last updated in 2014. OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions after closed reduction of traumatic anterior dislocation of the shoulder. These might include immobilisation, rehabilitative interventions or both. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PEDro and trial registries. We also searched conference proceedings and reference lists of included studies. Date of last search: May 2018. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials comparing conservative interventions with no treatment, a different intervention or a variant of the intervention (e.g. a different duration) for treating people after closed reduction of a primary traumatic anterior shoulder dislocation. Inclusion was regardless of age, sex or mechanism of injury. Primary outcomes were re-dislocation, patient-reported shoulder instability measures and return to pre-injury activities. Secondary outcomes included participant satisfaction, health-related quality of life, any instability and adverse events. DATA COLLECTION AND ANALYSIS: Both review authors independently selected studies, assessed risk of bias and extracted data. We contacted study authors for additional information. We pooled results of comparable groups of studies. We assessed risk of bias with the Cochrane 'Risk of bias' tool and the quality of the evidence with the GRADE approach. MAIN RESULTS: We included seven trials (six randomised controlled trials and one quasi-randomised controlled trial) with 704 participants; three of these trials (234 participants) are new to this update. The mean age across the trials was 29 years (range 12 to 90 years), and 82% of the participants were male. All trials compared immobilisation in external rotation (with or without an additional abduction component) versus internal rotation (the traditional method) following closed reduction. No trial evaluated any other interventions or comparisons, such as rehabilitation. All trials provided data for a follow-up of one year or longer; the commonest length was two years or longer.All trials were at some risk of bias, commonly performance and detection biases given the lack of blinding. Two trials were at high risk of selection bias and some trials were affected by attrition bias for some outcomes. We rated the certainty of the evidence as very low for all outcomes.We are uncertain whether immobilisation in external rotation makes a difference to the risk of re-dislocation after 12 months' or longer follow-up compared with immobilisation in internal rotation (55/245 versus 73/243; risk ratio (RR) 0.67, 95% confidence interval (CI) 0.38 to 1.19; 488 participants; 6 studies; I² = 61%; very low certainty evidence). In a moderate-risk population with an illustrative risk of 312 per 1000 people experiencing a dislocation in the internal rotation group, this equates to 103 fewer (95% CI 194 fewer to 60 more) re-dislocations after immobilisation in external rotation. Thus this result covers the possibility of a benefit for each intervention.Individually, the four studies (380 participants) reporting on validated patient-reported outcome measures for shoulder instability at a minimum of 12 months' follow-up found no evidence of a clinically important difference between the two interventions.We are uncertain of the relative effects of the two methods of immobilisation on resumption of pre-injury activities or sports. One study (169 participants) found no evidence of a difference between interventions in the return to pre-injury activity of the affected arm. Two studies (135 participants) found greater return to sports in the external rotation group in a subgroup of participants who had sustained their injury during sports activities.None of the trials reported on participant satisfaction or health-related quality of life.We are uncertain whether there is a difference between the two interventions in the number of participants experiencing instability, defined as either re-dislocation or subluxation (RR 0.84, 95% CI 0.62 to 1.14; 395 participants, 3 studies; very low certainty evidence).Data on adverse events were collected only in an ad hoc way in the seven studies. Reported "transient and resolved adverse events" were nine cases of shoulder stiffness or rigidity in the external rotation group and two cases of axillary rash in the internal rotation group. There were three "important" adverse events: hyperaesthesia and moderate hand pain; eighth cervical dermatome paraesthesia; and major movement restriction between 6 and 12 months. It was unclear to what extent these three events could be attributed to the treatment. AUTHORS' CONCLUSIONS: The available evidence from randomised trials is limited to that comparing immobilisation in external versus internal rotation. Overall, the evidence is insufficient to draw firm conclusions about whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.Considering that there are several unpublished and ongoing trials evaluating immobilisation in external versus internal rotation, the main priority for research on this question consists of the publication of completed trials and the completion and publication of ongoing trials. Meanwhile, evaluation of other interventions, including rehabilitation, is warranted. There is a need for sufficiently large, good-quality, well-reported randomised controlled trials with long-term follow-up. Future research should aim to determine the optimal immobilisation duration, precise indications for immobilisation, optimal rehabilitation interventions, and the acceptability of these different interventions.


Assuntos
Tratamento Conservador , Imobilização/métodos , Luxação do Ombro/terapia , Adulto , Feminino , Humanos , Imobilização/efeitos adversos , Instabilidade Articular/etiologia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Luxação do Ombro/complicações
10.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092495

RESUMO

This is a rare case of an anterior interosseous nerve (AIN) palsy in a patient as a result of a prolonged period of shoulder immobilisation. The patient had an open reduction internal fixation of a midshaft clavicle fracture. They subsequently underwent removal of metal due to symptomatic prominence of the metal work. The patient was in a shoulder immobiliser for a period of 5 months in total. They developed progressive AIN palsy as a result of a positional compression due to prolonged wearing of a shoulder immobiliser. This resolved with conservative management and careful observation.


Assuntos
Imobilização/efeitos adversos , Síndromes de Compressão Nervosa/etiologia , Articulação do Ombro/inervação , Clavícula/lesões , Tratamento Conservador , Humanos , Masculino , Síndromes de Compressão Nervosa/terapia , Redução Aberta/efeitos adversos , Adulto Jovem
11.
BMJ Case Rep ; 12(4)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948414

RESUMO

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.


Assuntos
Vértebras Cervicais/lesões , Imobilização/efeitos adversos , Aparelhos Ortopédicos/efeitos adversos , Lesões dos Tecidos Moles/diagnóstico , Fraturas da Coluna Vertebral/terapia , Contenções/efeitos adversos , Acidentes de Trânsito , Adolescente , Traumatismos Craniocerebrais , Erros de Diagnóstico , Feminino , Humanos , Imobilização/instrumentação , Couro Cabeludo/lesões , Lesões dos Tecidos Moles/complicações , Fraturas da Coluna Vertebral/complicações
12.
Chin J Traumatol ; 22(2): 93-98, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30928194

RESUMO

The clinical treatment of joint contracture due to immobilization remains difficult. The pathological changes of muscle tissue caused by immobilization-induced joint contracture include disuse skeletal muscle atrophy and skeletal muscle tissue fibrosis. The proteolytic pathways involved in disuse muscle atrophy include the ubiquitin-proteasome-dependent pathway, caspase system pathway, matrix metalloproteinase pathway, Ca2+-dependent pathway and autophagy-lysosomal pathway. The important biological processes involved in skeletal muscle fibrosis include intermuscular connective tissue thickening caused by transforming growth factor-ß1 and an anaerobic environment within the skeletal muscle leading to the induction of hypoxia-inducible factor-1α. This article reviews the progress made in understanding the pathological processes involved in immobilization-induced muscle contracture and the currently available treatments. Understanding the mechanisms involved in immobilization-induced contracture of muscle tissue should facilitate the development of more effective treatment measures for the different mechanisms in the future.


Assuntos
Contratura/etiologia , Imobilização/efeitos adversos , Articulações , Músculo Esquelético , Transdução de Sinais/fisiologia , Atrofia , Autofagia , Cálcio/metabolismo , Caspases/metabolismo , Tecido Conjuntivo/metabolismo , Tecido Conjuntivo/patologia , Contratura/metabolismo , Contratura/patologia , Contratura/terapia , Fibrose , Humanos , Lisossomos/metabolismo , Metaloproteinases da Matriz/metabolismo , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Complexo de Endopeptidases do Proteassoma/metabolismo , Proteólise , Fator de Crescimento Transformador beta1/metabolismo , Ubiquitina/metabolismo
13.
Eur J Appl Physiol ; 119(6): 1387-1394, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30923873

RESUMO

PURPOSE: The discovery of musculoskeletal tissues, including muscle, tendons, and cartilage, as peripheral circadian clocks strongly implicates their role in tissue-specific homeostasis. Age-related dampening and misalignment of the tendon circadian rhythm and its outputs may be responsible for the decline in tendon homeostasis. It is unknown which entrainment signals are responsible for the synchronization of the tendon clock to the light-dark cycle. METHODS: We sought to examine any changes in the expression levels of core clock genes (BMAL1, CLOCK, PER2, CRY1, and NR1D1) in healthy human patellar tendon biopsies obtained from three different intervention studies: increased physical activity (leg kicks for 1 h) in young, reduced activity (2 weeks immobilization of one leg) in young, and in old tendons. RESULTS: The expression level of clock genes in human tendon in vivo was very low and a high variation between individuals was found. We were thus unable to detect any differences in core clock gene expression neither after acute exercise nor immobilization. CONCLUSIONS: We are unable to find evidence for an effect of exercise or immobilization on circadian clock gene expression in human tendon samples.


Assuntos
Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/genética , Exercício , Imobilização/efeitos adversos , Ligamento Patelar/metabolismo , Adulto , Idoso , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/metabolismo , Humanos , Masculino , Ligamento Patelar/crescimento & desenvolvimento , Ligamento Patelar/fisiologia
14.
Eur J Appl Physiol ; 119(6): 1353-1365, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30895459

RESUMO

PURPOSE: Suspension syndrome describes a potentially life-threatening event during passive suspension on a rope. The pathophysiological mechanism is not fully understood and optimal treatment unknown. We aimed to elucidate the pathophysiology and to give treatment recommendations. METHODS: In this experimental, randomized crossover trial, 20 healthy volunteers were suspended in a sit harness for a maximum of 60 min, with and without prior climbing. Venous pooling was assessed by measuring the diameter of the superficial femoral vein (SFV), lower leg tissue oxygenation (StO2) and by determining localized bioelectrical impedance. Hemodynamic response was assessed by measuring heart rate, blood pressure, stroke volume, and left ventricular diameters. Signs and symptoms of pre-syncope were recorded. RESULTS: Twelve (30%) out of 40 tests were prematurely terminated due to pre-syncopal symptoms (mean 44.7 min, minimum 13.4, maximum 59.7). SFV diameter increased, StO2 and the capacitive resistance of the cells decreased indicating venous pooling. Heart rate and blood pressure did not change in participants without pre-syncope. In contrast, in participants experiencing pre-syncope, heart rate and blood pressure dropped immediately before the event. All symptoms dissolved and values returned to normal within 5 min with participants in a supine position. CONCLUSIONS: Sudden pre-syncope during passive suspension in a harness was observed in 30% of the tests. Blood pools in the veins of the lower legs; however, a vagal mechanism finally leads to loss of consciousness. Time to pre-syncope is unpredictable and persons suspended on a rope should be rescued and put into a supine position as soon as possible.


Assuntos
Hemodinâmica , Síncope Vasovagal/fisiopatologia , Adulto , Veia Femoral/fisiologia , Veia Femoral/fisiopatologia , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Montanhismo , Consumo de Oxigênio , Síncope Vasovagal/etiologia , Nervo Vago/fisiologia , Nervo Vago/fisiopatologia , Ausência de Peso/efeitos adversos
15.
Physiol Res ; 68(3): 375-384, 2019 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-30904005

RESUMO

The objectives of this study were to investigate the role of endogenous opioids in the mediation of stress-induced cardiomyopathy (SIC), and to evaluate which opioid receptors regulate heart resistance to immobilization stress. Wistar rats were subjected to 24 h immobilization stress. Stress-induced heart injury was assessed by 99mTc-pyrophosphate accumulation in the heart. The opioid receptor (OR) antagonists (naltrexone, NxMB - naltrexone methyl bromide, MR 2266, ICI 174.864) and agonists (DALDA, DAMGO, DSLET, U-50,488) were administered intraperitoneally prior to immobilization and 12 h after the start of stress. In addition, the selective micro OR agonists PL017 and DAMGO were administered intracerebroventricularly prior to stress. Finally pretreatment with guanethidine was used. Naltrexone did not alter the cardiac 99mTc-PP accumulation in stressed rats. NxMB aggravated stress-induced cardiomyopathy (P=0.005) (SIC). The selective micro OR agonist DALDA, which does not cross the blood-brain barrier, completely prevented (P=0.006) SIC. The micro OR agonist DAMGO exhibited weaker effect than DALDA. The selective delta ligand (DSLET) and kappa OR ligand (U-50,488) did not alter stress-induced 99mTc-pyrophosphate accumulation in the heart. Intracerebroventricular administration of the micro OR agonists aggravated SIC. Pretreatment with guanethidine abolished this effect (P=0.01). Guanethidine alone exhibited cardioprotective properties. A stimulation of central micro OR promotes an appearance of SIC. In contrast, stimulation of peripheral micro OR contributes to an increase in cardiac tolerance to stress.


Assuntos
Analgésicos Opioides/uso terapêutico , Cardiotônicos/uso terapêutico , Cardiopatias/metabolismo , Cardiopatias/prevenção & controle , Miocárdio/metabolismo , Estresse Psicológico/metabolismo , Analgésicos Opioides/farmacologia , Animais , Cardiotônicos/farmacologia , Ala(2)-MePhe(4)-Gly(5)-Encefalina/farmacologia , Ala(2)-MePhe(4)-Gly(5)-Encefalina/uso terapêutico , Cardiopatias/induzido quimicamente , Imobilização/efeitos adversos , Imobilização/psicologia , Masculino , Naltrexona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Ratos , Ratos Wistar , Receptores Opioides mu/agonistas , Receptores Opioides mu/metabolismo , Estresse Psicológico/psicologia
16.
Thromb Res ; 176: 115-119, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30822715

RESUMO

BACKGROUND: Previous studies have reported that around 50% of patients with venous thromboembolism (VTE) has undergone recent hospitalization. However, studies on the impact of hospitalization as a trigger factor for VTE are limited. OBJECTIVES: To investigate the impact of hospitalization with and without concurrent immobilization as a trigger factor for VTE. METHODS: We conducted a case-crossover study of 530 cancer-free VTE patients. Hospitalizations were registered during the 90-day period preceding the VTE diagnosis (hazard period), and in four preceding 90-day control periods. A 90-day washout period between the control- and hazard periods was implemented to avoid potential carry-over effects. Conditional logistic regression was used to calculate odds ratios (OR) of VTE according to hospitalization. RESULTS: In total, 159 (30%) of the VTE-patients had been hospitalized in the hazard period, and the OR of hospitalization was 9.4 (95% CI: 6.8-12.8). The risk increased slightly with the total number of days spent in hospital (OR per day: 1.11, 95% CI: 1.04-1.18), and with the number of hospitalizations (OR 8.9, 95% CI: 6.4-12.4 for 1 hospitalization and OR 12.3, 95% CI 6.4-23.6 for ≥2 hospitalizations). Hospitalization without immobilization was 6-times (OR: 6.3, 95% CI: 4.4-9.2) more common, whereas hospitalization with immobilization was near 20-times (OR: 19.8, 95% CI: 11.5-34.0) more common in the 90-days prior to a VTE compared to the control periods. CONCLUSIONS: Hospitalization is a major trigger factor for VTE also in the absence of immobilization. However, immobilization contributes substantially to the risk of VTE among hospitalized patients.


Assuntos
Tromboembolia Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Cross-Over , Feminino , Hospitalização , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
17.
Biochem Biophys Res Commun ; 508(2): 516-520, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30509487

RESUMO

Cells activate the unfolded protein response (UPR) to cope with endoplasmic reticulum (ER) stress. In the present study, we investigated the possible involvement of psychological stress on UPR induction in the mouse brain. When mice were exposed to immobilization stress for 8 h, XBP1 mRNA splicing was significantly induced in the hippocampus, cortex, hypothalamus, cerebellum, and brain stem. On the other hand, we did not observe any increase in XBP1 splicing in the liver, suggesting that this effect is specific to the brain. Stress-induced XBP1 splicing was attenuated 2 days after immobilization stress. We did not observe increases in any other UPR genes, such as CHOP or GRP78, in mouse brains after immobilization stress. These findings indicate an important specific role of XBP1 in response to psychological stress in the mouse brain.


Assuntos
Encéfalo/metabolismo , Processamento de RNA , Estresse Psicológico/genética , Proteína 1 de Ligação a X-Box/genética , Animais , Imobilização/efeitos adversos , Camundongos , Resposta a Proteínas não Dobradas/genética , Proteína 1 de Ligação a X-Box/metabolismo
18.
J Forensic Sci ; 64(1): 298-301, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29852536

RESUMO

Endogenous pulmonary thromboemboli are a common cause of noncardiac sudden natural death. Embolism of exogenous material is a rare but potential finding in autopsies following surgeries, medical procedures, penetrating trauma, and nonparenteral drug abuse. This report describes the first case of a suture embolism of the left superior lobar pulmonary artery following complicated abdominal surgery.


Assuntos
Complicações Pós-Operatórias , Artéria Pulmonar/patologia , Embolia Pulmonar/etiologia , Suturas/efeitos adversos , Fundoplicatura/efeitos adversos , Parada Cardíaca/etiologia , Hérnia Hiatal/cirurgia , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/patologia , Trombose Venosa/complicações
19.
J Pediatr Orthop ; 39(4): e248-e252, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30451810

RESUMO

BACKGROUND: Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up. METHODS: We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients. RESULTS: At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group's ultradistal radius and whole wrists (+4.8% to +5.2%). CONCLUSIONS: A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.


Assuntos
Densidade Óssea , Fraturas Ósseas/fisiopatologia , Extremidade Superior/lesões , Absorciometria de Fóton , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/fisiopatologia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Imobilização/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiologia , Masculino , Valores de Referência , Extremidade Superior/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia
20.
Eur J Appl Physiol ; 119(1): 201-211, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30350153

RESUMO

PURPOSE: To determine whether an innovative, motorized, wellness device that effortlessly produces physical activity (JD) can mitigate the hypertensive effects of prolonged sitting or lying down. METHODS: Twenty-two normotensive and hypertensive adults of both genders gave informed consent to participate in a randomized controlled crossover study of a passive simulated jogging device (JD) in both supine and seated postures. Each study participant was monitored with a continuous non-invasive arterial pressure monitoring device (CNAP) over 60 min. The initial 10 min served as baseline for each posture. The subjects were randomized to begin with either JD or SHAM control for 30 min, and monitoring was continued for an additional 10 min in one posture; three days later posture and order of JD or SHAM were changed. RESULTS: In both seated and supine postures, SHAM was associated with a significant rise in blood pressure (BP) which was observed within 5-10 min; it continued to rise or remain elevated for over a 40-min observation period. In contrast, JD produced a significant decrease in both systolic and diastolic blood pressure in both postures. During recovery in seated posture JD decreased systolic and diastolic BP by - 8.1 and - 7.6 mmHg, respectively. In supine posture, a similar decrease in BP occurred. CONCLUSIONS: There is rapid onset of increase in systolic and diastolic BP with physical inactivity in both supine and seated postures. Administration of JD significantly decreased BP in both postures. Further studies are needed to assess long-term effectiveness.


Assuntos
Repouso em Cama/efeitos adversos , Pressão Sanguínea , Terapia por Exercício/métodos , Hipertensão/prevenção & controle , Imobilização/efeitos adversos , Adulto , Terapia por Exercício/instrumentação , Feminino , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Decúbito Dorsal
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