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1.
Int J Mol Sci ; 20(20)2019 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-31635068

RESUMO

Stroke is the second-leading cause of death globally and the leading cause of disability in adults. Medical complications after stroke, especially infections such as pneumonia, are the leading cause of death in stroke survivors. Systemic immunodepression is considered to contribute to increased susceptibility to infections after stroke. Different experimental models have contributed significantly to the current knowledge of stroke pathophysiology and its consequences. Each model causes different changes in the cerebral microcirculation and local inflammatory responses after ischemia. The vast majority of studies which focused on the peripheral immune response to stroke employed the middle cerebral artery occlusion method. We review various experimental stroke models with regard to microcirculatory changes and discuss the impact on local and peripheral immune response for studies of CNS-injury (central nervous system injury) induced immunodepression.


Assuntos
Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Imunitário/etiologia , Tolerância Imunológica , Microcirculação , Acidente Vascular Cerebral/patologia , Traumatismos do Sistema Nervoso/complicações , Animais , Biomarcadores , Doenças do Sistema Nervoso Central/etiologia , Modelos Animais de Doenças , Humanos , Doenças do Sistema Imunitário/metabolismo , Imunomodulação , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/metabolismo , Traumatismos do Sistema Nervoso/etiologia
2.
Dev Med Child Neurol ; 61(6): 631-638, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30680713

RESUMO

This review summarizes studies that examined the effectiveness of cannabinoids in treating spasticity, with a focus on understanding the relevance of the existing evidence to paediatric populations. MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched to identify studies that examined the use of cannabinoids in spasticity. We identified 32 studies in adult and paediatric populations. Results were summarized by condition, with adult and paediatric studies considered separately. There is evidence from randomized controlled clinical trials that cannabinoids are more effective than placebo in reducing symptoms of spasticity in adults with multiple sclerosis. Most positive effects were based on patient-rated rather than clinician-rated measures, were modest in size, and should be considered in the context of the narrow therapeutic index of cannabinoids for spasticity and adverse effects. There were comparatively few, and no large studies, of spasticity in conditions other than multiple sclerosis. Few studies have been conducted in paediatric populations. Paediatric studies of spasticity provide low quality evidence and are inadequate to inform clinical practice. Cannabinoids have modest efficacy in reducing muscle spasticity in adults with multiple sclerosis. There is limited evidence of efficacy for cannabinoid use in other conditions, particularly in paediatric populations. Studies in paediatric populations have been of low quality and are insufficient to inform clinical practice.


Assuntos
Canabinoides/farmacologia , Paralisia Cerebral/tratamento farmacológico , Doença dos Neurônios Motores/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Espasticidade Muscular/tratamento farmacológico , Traumatismos do Sistema Nervoso/tratamento farmacológico , Adulto , Animais , Paralisia Cerebral/complicações , Criança , Humanos , Doença dos Neurônios Motores/complicações , Esclerose Múltipla/complicações , Espasticidade Muscular/etiologia , Traumatismos do Sistema Nervoso/complicações
3.
Rev. argent. radiol ; 82(4): 161-167, dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-985211

RESUMO

La solicitud de estudios de imagen en pacientes con trauma cervical es muy frecuente en la práctica diaria. Esa patología es causa relativamente frecuente de discapacidad en pacientes jóvenes junto con el trauma encéfalo craneano. En un porcentaje no despreciable de los casos, las lesiones traumáticas comprometen la unión cráneo- cervical y en esos pacientes, la morbi-mortalidad es más significativa. La transición entre el cráneo y el raquis se basa en un conjunto de estructuras óseas relacionadas por articulaciones muy móviles y estabilizadas por un grupo de ligamentos y músculos que le brindan al mismo tiempo gran solidez. Para una correcta interpretación de los estudios de imagen de uso corriente en la clínica, es fundamental un sólido conocimiento anatómico de la unión cráneo-cervical y sus componentes. Es el objetivo de esta revisión, sistematizar la anatomía de la unión cráneo-cervical con especial énfasis en sus ligamentos, analizar la fisiología de sus movimientos y el concepto de estabilidad para luego realizar una correlación con tomografía computada multi-detector y resonancia magnética.


The request of imaging techniques in patients with cervical spine trauma is very common in clinical practice. Cervical trauma is a relatively common cause of disability in young patients. In a significant percentage of cases traumatic injuries compromise the cranio-cervical junction with more important morbidity and mortality in this group of patients. The transition between the skull and the spine is based on a set of bony structures, high mobility joints, and stabilization mechanism formed by a group of ligaments and muscles. A solid anatomical knowledge of the cranio-cervical junction and its components is essential for a correct interpretation of current high resolution imaging studies. The goal of this review is highlight the anatomy of the cranio-cervical junction with special emphasis on the ligaments, analyze the biomechanics of their movements and the concept of stability. At last but not leastwe will establish a correlation with multidetector computed tomography and high-resolutionmagnetic resonance imaging.


Assuntos
Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/fisiologia , Vértebras Cervicais/lesões , Vértebras Cervicais/diagnóstico por imagem , Traumatismos do Sistema Nervoso/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Crânio/anatomia & histologia , Membrana Tectorial/anatomia & histologia , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X , Vértebras Cervicais/anatomia & histologia , Ligamentos Longitudinais/anatomia & histologia , Lesões do Pescoço/diagnóstico por imagem , Traumatismos do Sistema Nervoso/complicações
4.
J Sex Med ; 15(11): 1558-1569, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30415811

RESUMO

INTRODUCTION: Many studies have shown that electrostimulation of the cavernosal nerve can induce and maintain penile erection. Based on these discoveries, neurostimulation to activate the erectile response has been considered a potential solution to treat erectile dysfunction (ED). However, despite recognized potential, this technology has not been further developed. The barrier is the complex anatomy of the human cavernous nerve, which challenges the intraoperative identification of the cavernosal nerves for electrode placement. AIM: To overcome this major barrier, we proposed a practical solution: a 2-dimensional flexible electrode array that can cover the entire plexus area, ensuring that at least 1 of the electrodes will be in optimal contact with the cavernosal nerve, without the need of intraoperative identification. The present study aims to evaluate this concept intraoperatively. METHODS: 24 patients enrolled for open radical prostatectomy were recruited. During the surgical procedures, the electrode array was positioned on the pelvic plexus (on the prostatic apex or pelvic wall) and electrical stimulation was applied to induce penile erection. Penile erectile response was assessed by (i) visual change of penile tumescence and (ii) by a penile plethysmograph system. MAIN OUTCOME MEASURE: Ability and success rate of evoking penile response were measured by applying electrical stimulation using the developed electrode array. RESULTS: Electrical stimulation produced immediate penile response in all cases when tested before (on prostatic apex) or after prostate removal (on pelvic wall). Clear visual penile engorgement was observed in 75% of the cases, whereas 25% showed minimal to moderate penile tumescence. As expected, patients with lower International Index of Erectile Function-5 score presented a reduced response, whereas stimulation before prostate removal showed greater response than following removal. Interestingly, erectile response was potentiated by bilateral stimulation (circumference increase [mm]: 2.7 ± 1.02 vs. 8.2 ± 1.9, P = .01). CLINICAL IMPLICATIONS: These data bring sufficient proof of concept of a conceivable novel medical implant for the treatment of ED caused by mechanical nerve injury, such as prostatectomy and spinal cord injury. STRENGTH & LIMITATIONS: This is the first approach that can ensure the optimal site stimulation of the erectogenic neuronal path within the lower pelvic area and overcome the major barrier of individual anatomic variability. However, because this study was performed intraoperatively in an acute scenario, further studies are needed to evaluate its chronic efficacy for clinical practice. CONCLUSION: The flexible electrode array concept can ensure the electrostimulation of erectogenic neuronal path when positioned on the prostate apex or pelvic floor. Skoufias S, Sturny M, Fraga-Silva R, et al. Novel concept enabling an old idea: A flexible electrode array to treat neurogenic erectile dysfunction. J Sex Med 2018;15:1558-1569.


Assuntos
Disfunção Erétil/terapia , Pênis/inervação , Idoso , Terapia por Estimulação Elétrica , Eletrodos Implantados , Desenho de Equipamento , Disfunção Erétil/etiologia , Disfunção Erétil/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Ereção Peniana/fisiologia , Pênis/fisiopatologia , Prostatectomia/efeitos adversos , Traumatismos do Sistema Nervoso/complicações
5.
Medicine (Baltimore) ; 97(21): e10821, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29794770

RESUMO

To investigate the incidence and pattern of child and adolescent (≤18 years old) traumatic fractures (TFs) as a result of collisions.We retrospectively reviewed 270 child and adolescent patients (228 males and 42 females aged 12.8 ±â€Š5.1 years old) with TFs as a result of collisions admitted to our university-affiliated hospitals from 2001 to 2010. The incidence and patterns were summarized with respect to different age groups, sex, etiology, and whether the patient presented with nerve injury.The most common etiologies were struck by object (105, 38.9%) and wounded by person (74, 27.4%). The most common fracture sites were upper limb fractures (126, 46.7%) and craniofacial fractures (82, 30.4%). A total of 65 (24.1%) patients suffered a nerve injury. The frequency of early and late complications/associated injuries was 35.6% (n = 96) and 8.5% (n = 23), respectively. The mean age (P = .001) and frequency of wounded by person (P = .038) was significantly larger in male than in female patients. The frequency of earthquake injury (P < .001) and lower limb fractures (P = .002) was significantly larger in females than in male patients. The frequency of upper limb fracture was significantly higher in the wounded by machine group (83.3%) than in the other groups (all P < .05). The frequency of lower limb fractures was significantly higher in the earthquake injury group (64.7%) than in the other groups (all P < .05). The frequency of craniofacial fracture was significantly higher in the wounded by person group (54.1%) than in the other groups (all P < .05). The emergency admission rate (P = .047), frequency of wounded by person (P < .001), craniofacial fracture (P < .001), and early complications/associated injuries (P < .001) were significantly larger in patients with nerve injury than in other patients.Struck by object and upper limb fractures were the most common etiology and site, respectively. Wounded by person and craniofacial fractures were risk factors for nerve injury. Therefore, we should pay more attention to patients wounded by person, presenting with craniofacial fracture, to find whether there is nerve injury.


Assuntos
Ossos Faciais/lesões , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Extremidade Inferior/lesões , Traumatismos do Sistema Nervoso/complicações , Extremidade Superior/lesões , Adolescente , Criança , Ossos Faciais/patologia , Feminino , Fraturas Ósseas/complicações , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Extremidade Inferior/patologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Fraturas Cranianas/complicações , Fraturas Cranianas/epidemiologia , Fraturas Cranianas/patologia , Traumatismos do Sistema Nervoso/epidemiologia , Traumatismos do Sistema Nervoso/etiologia , Extremidade Superior/patologia
6.
J Sex Med ; 15(3): 284-295, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502978

RESUMO

BACKGROUND: Whether combined transplantation of mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs) is more effective than transplantation of a single cell type in the restoration of erectile function is unknown. AIM: To investigate the effect of combined transplantation of MSCs and EPCs on restoration of erectile function in rats with cavernous nerve injury (CNI). METHODS: MSCs were isolated from human bone marrow and EPCs were isolated from human umbilical cord blood. MSCs and EPCs were identified by flow cytometry and in vitro differentiation or immunofluorescence staining. 25 8-week-old male Sprague-Dawley rats were allocated to 1 of 5 groups: sham operation group, bilateral CNI group receiving periprostatic implantation of MSCs plus EPCs, MSCs, EPCs, or phosphate buffered saline (control group). 2 weeks after CNI and treatment, erectile function of rats was measured by electrically stimulating the CN. The penis and major pelvic ganglia were harvested for histologic examinations. RNA and protein levels of neurotrophin factors (vascular endothelial growth factor, nerve growth factor, and brain-derived neurotrophic factor) in mono- or coculture MSCs and EPCs were assessed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. OUTCOMES: Intracavernous pressure and mean arterial pressure were measured to evaluate erectile function. Histologic examinations of the penis and major pelvic ganglia and RNA and protein levels of neurotrophin factors in MSCs and EPCs were performed. RESULTS: MSCs and EPCs expressed the specified cell markers and exhibited the typical appearance and characteristics. Treatments using MSCs and/or EPCs could increase endothelial and smooth muscle contents of the corpus cavernosum, decrease caspase-3 expression and increase penile neuronal nitric oxide synthase expression, and restore the neural component of the major pelvic ganglia in rats with CNI. Combined transplantation of MSCs and EPCs had a better effect on improving erectile function than single transplantation of MSCs or EPCs. Expression levels of vascular endothelial growth factor and nerve growth factor in coculture MSCs and EPCs were significantly higher than those of primary MSCs or EPCs. CLINICAL TRANSLATION: Combined transplantation of MSCs and EPCs was more effective in restoring erectile function in CNI-related erectile dysfunction models. STRENGTHS AND LIMITATIONS: The study, for the 1st time, proved that combined transplantation of MSCs and EPCs was more effective in restoring erectile function in rats with CNI. The rat model might not represent the human condition. CONCLUSION: Combined periprostatic transplantation of MSCs and EPCs could restore erectile function in rats with CNI more effectively. MSCs might restore CN fibers by secreting neurotrophin factors such as vascular endothelial growth factor and nerve growth factor, and EPCs could enhance the paracrine activity of MSCs. Fang J-f, Huang X-n, Han X-y, et al. Combined Transplantation of Mesenchymal Stem Cells and Endothelial Progenitor Cells Restores Cavernous Nerve Injury-Related Erectile Dysfunction. J Sex Med 2018;15:284-295.


Assuntos
Células Progenitoras Endoteliais/transplante , Disfunção Erétil/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Animais , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Diferenciação Celular , Modelos Animais de Doenças , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Músculo Liso/metabolismo , Ereção Peniana/fisiologia , Ratos , Ratos Sprague-Dawley , Traumatismos do Sistema Nervoso/complicações , Fator A de Crescimento do Endotélio Vascular/metabolismo
7.
J Sex Med ; 15(3): 304-313, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502979

RESUMO

BACKGROUND: Cavernous nerve injury (CNI) causes fibrosis and loss of smooth muscle cells (SMCs) in the corpus cavernosum and leads to erectile dysfunction, and lysyl oxidase (LOX) activation has been found to play an important role in fibrotic diseases. AIM: To evaluate the role of LOX in penile fibrosis after bilateral CNI (BCNI). METHODS: Rats underwent BCNI or a sham operation and were treated with vehicle or ß-aminopropionitrile, a specific LOX activity inhibitor. 30 days after BCNI, rats were tested for erectile function before penile tissue harvest. LOX and extracellular matrix component expression levels in the corpus cavernosum, including matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), fibronectin (FN), collagen (COL) I, and COL IV, were evaluated by real-time quantitative polymerase chain reaction and western blot. Corporal fibrosis was evaluated by Masson trichrome staining. Localization of LOX and SMC content in the corpus cavernosum were assessed by immunohistochemistry. OUTCOMES: Ratio of intracavernous pressure to mean arterial blood pressure; LOX, MMPs, TIMPs, COL I, COL IV, and FN expression; penile fibrosis; penile SMC content. RESULTS: After BCNI, there was an increase in penile LOX expression and activity, increased penile fibrosis, decreased SMC content, and impaired erectile function. TIMP1, TIMP2, COL I, COL IV, and FN expression was markedly upregulated, whereas the enzyme activity of MMPs was decreased after BCNI. ß-Aminopropionitrile treatment, at least in part, prevented a decrease in the ratio of intracavernous pressure to mean arterial blood pressure, decreased penile expression of TIMP1, TIMP2, COL I, COL IV, and FN, increased MMP activity, prevented corporal fibrosis, and preserved SMC content. CLINICAL TRANSLATION: LOX over-activation contributes to penile fibrosis and LOX inhibition could be a promising strategy in preventing the progression of CNI-induced erectile dysfunction. STRENGTHS AND LIMITATIONS: This is the 1st study to demonstrate the role of LOX activation in penile fibrosis. However, the exact mechanism of how LOX influences extracellular matrix protein synthesis and SMC content preservation awaits further investigation. CONCLUSION: CNI induced LOX over-activation in cavernous tissue, and inhibition of LOX preserved penile morphology and improved erectile function in a rat model of BCNI. Wan Z-H, Li G-H, Guo Y-L, et al. Amelioration of Cavernosal Fibrosis and Erectile Function by Lysyl Oxidase Inhibition in a Rat Model of Cavernous Nerve Injury. J Sex Med 2018;15:304-313.


Assuntos
Disfunção Erétil/etiologia , Ereção Peniana/fisiologia , Induração Peniana/patologia , Proteína-Lisina 6-Oxidase/antagonistas & inibidores , Animais , Modelos Animais de Doenças , Fibronectinas/metabolismo , Masculino , Pênis/cirurgia , Proteína-Lisina 6-Oxidase/metabolismo , Ratos , Ratos Sprague-Dawley , Traumatismos do Sistema Nervoso/complicações
8.
Pediatr Neurosurg ; 53(4): 282-285, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29566386

RESUMO

Although rarely reported in the literature, serious occipital and condylar fractures have been diagnosed more often with the widespread use of computed cranial tomography in traumas. In this paper, a 16-year-old female with a left occipital fracture extending from the left occipital condyle anterior of the hypoglossal canal to the inferior part of the clivus is presented. The fracture which had caused a neurological deficit was cured with conservative treatment. For delayed hypoglossal nerve paralysis due to swelling within the canal, methylprednisolone was started, and a complete cure was attained in about 10 days. Traumatic damage of bony structures of the condyle and clivus at the junction of many vital nerves, vessels, and ligaments may lead to traumatic deficit and death.


Assuntos
Fossa Craniana Posterior/lesões , Osso Occipital/lesões , Traumatismos do Sistema Nervoso/complicações , Adolescente , Anti-Inflamatórios/uso terapêutico , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Traumatismos do Nervo Hipoglosso/etiologia , Metilprednisolona/uso terapêutico , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Sistema Nervoso/diagnóstico por imagem
9.
Rev. neurol. (Ed. impr.) ; 66(2): 59-64, 16 ene., 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-171845

RESUMO

Introducción. La tartamudez neurógena es un trastorno del ritmo de habla de origen neurológico en el cual el paciente sabe perfectamente lo que quiere decir, pero es incapaz de articularlo a causa de la prolongación, el cese o la repetición involuntaria de un sonido. Objetivo. Reunir nuevos datos referentes a la epidemiología, la fisiopatología, el diagnóstico, la evaluación y el tratamiento de la tartamudez neurógena. Desarrollo. Se llevó a cabo una revisión de todos los artículos publicados en PubMed y Scopus entre enero de 2000 y septiembre de 2016. Se examinaron 33 publicaciones. La tartamudez neurógena es una entidad poco frecuente cuya incidencia epidemiológica no se ha definido completamente. Aparece en el marco de diversas enfermedades neurológicas y ligada a distintos lugares del sistema nervioso. A pesar de los avances recientes en el conocimiento del mecanismo subyacente, aún no ha sido posible determinar un único mecanismo fisiopatológico de este trastorno. El diagnóstico diferencial es complejo y requiere un buen conocimiento de otros trastornos del lenguaje. El tratamiento se basa actualmente en terapias logopédicas específicas. Conclusión. La tartamudez neurógena es un trastorno complejo que no se conoce con detalle. Nuevos estudios ayudarían a esclarecer los mecanismos fisiopatológicos que se ocultan tras ella y abrirían la puerta a nuevos métodos terapéuticos (AU)


Introduction. Neurogenic stuttering is a disorder of neurologic origin in the rhythm of speech during which the patient knows exactly what he wants to say but is unable to because of an involuntary prolongation, cessation or repetition of a sound. Aim. To assemble new insights regarding the epidemiology, pathophysiology, diagnosis, evaluation and treatment of neurogenic stuttering. Development. A review of all PubMed and Scopus published articles between January 2000 and September 2016 was performed. Thirty-three publications were analyzed. Neurogenic stuttering is a rare entity whose epidemiological incidence is yet not fully established. It is correlated with several neurological diseases and with several possible localizations within the nervous system. Notwithstanding the recent advances in the understanding of the underlying mechanism, it is not yet possible to establish a single pathophysiological mechanism of neurogenic stuttering. The differential diagnosis is complex and requires the detailed knowledge of other language disorders. The treatment is currently based on specific speech language therapy strategies. Conclusion. Neurogenic stuttering is a complex disorder which is not fully understood. Additional studies might help to better explain the underlying pathophysiological mechanism and to open doors to novel therapeutic methods (AU)


Assuntos
Humanos , Adulto , Gagueira/diagnóstico , Gagueira/epidemiologia , Traumatismos do Sistema Nervoso/complicações , Distúrbios da Fala , Doenças do Sistema Nervoso , Gagueira/fisiopatologia , Gagueira/terapia
10.
Neurocrit Care ; 29(3): 344-357, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28929324

RESUMO

Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.


Assuntos
Estado Terminal/terapia , Hemorragia Gastrointestinal/prevenção & controle , Antagonistas dos Receptores Histamínicos H2/farmacologia , Úlcera Péptica/prevenção & controle , Inibidores da Bomba de Prótons/farmacologia , Estresse Fisiológico , Traumatismos do Sistema Nervoso/complicações , Hemorragia Gastrointestinal/etiologia , Antagonistas dos Receptores Histamínicos H2/efeitos adversos , Antagonistas dos Receptores Histamínicos H2/economia , Humanos , Úlcera Péptica/etiologia , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/economia
13.
J Sex Med ; 13(12): 1844-1857, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27864032

RESUMO

INTRODUCTION: Cavernous nerve injury (CNI) in rats and radical prostatectomy (RP) in men result in loss of nitrergic function and increased adrenergic-neurogenic contractions of cavernosal tissue. AIM: To evaluate the modulation of the α-adrenergic system as a strategy to relieve erectile dysfunction (ED) and functional cavernosal alterations induced by CNI. METHODS: A non-selective α-blocker (phentolamine 1 mg/kg daily), a selective α1A-blocker (silodosin [SILOD] 0.1 mg/kg daily), or vehicle was orally administered for 4 weeks after bilateral crush CNI (BCNI). Erectile and neurogenic responses of the corpus cavernosum (CC) were evaluated. The acute effects of SILOD also were evaluated in vivo (0.03 mg/kg intravenously) and ex vivo (10 nmol/L). The effects of SILOD and tadalafil (TAD) on nitrergic relaxations were determined in human CC from patients with ED with a vascular etiology or ED secondary to RP. MAIN OUTCOME MEASURES: Erectile responses in vivo in rats and neurogenic contractions and relaxations of rat and human CC. RESULTS: Long-term treatment with SILOD significantly improved erectile responses and allowed for the potentiation of erectile responses by acute treatment with TAD (0.3 mg/kg intravenously) in rats with BCNI. SILOD partly recovered nitrergic relaxations and normalized neurogenic contractions in CC from rats with BCNI. Long-term treatment with SILOD partly prevented BCNI-induced decreases in neuronal nitric oxide synthase expression. Acute administration of SILOD (0.03 mg/kg intravenously) improved erectile responses in vivo and potentiated nitrergic relaxation and decreased neurogenic contractions ex vivo in CC from rats with BCNI. In human CC from patients with ED with a vascular etiology, TAD (30 nmol/L), SILOD (10 nmol/L), or their combination increased nitrergic relaxations. Potentiation by TAD was lost in human CC from patients with ED after RP but was recovered after co-treatment with SILOD. CONCLUSION: α-Adrenergic modulation, especially selective α1A-blockade, improves erectile and cavernosal functions after BCNI. Modulation of the adrenergic system, mainly in combination strategies, could have a role in the management of ED after RP.


Assuntos
Antagonistas Adrenérgicos alfa/farmacologia , Disfunção Erétil/tratamento farmacológico , Prostatectomia/efeitos adversos , Receptores Adrenérgicos alfa 1/efeitos dos fármacos , Animais , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Compressão Nervosa/efeitos adversos , Óxido Nítrico Sintase Tipo I/metabolismo , Ereção Peniana/efeitos dos fármacos , Pênis/irrigação sanguínea , Traumatismos dos Nervos Periféricos/complicações , Ratos , Ratos Sprague-Dawley , Tadalafila/farmacologia , Traumatismos do Sistema Nervoso/complicações
14.
Cien Saude Colet ; 21(10): 3161-3170, 2016 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-27783789

RESUMO

The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients' autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient's home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.


Assuntos
Pessoas com Deficiência/reabilitação , Alta do Paciente , Encaminhamento e Consulta , Traumatismos do Sistema Nervoso/reabilitação , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Sistema Nervoso/complicações
15.
Ciênc. saúde coletiva ; 21(10): 3161-3170, Out. 2016. tab
Artigo em Português | LILACS | ID: lil-797021

RESUMO

Resumo Trata-se de pesquisa de abordagem qualitativa realizada no segundo semestre de 2014, mediante entrevistas com 12 médicos e 13 enfermeiros gestores atuantes em Hospital de grande porte, referência na área de urgência e emergência para a Zona da Mata Mineira. Buscou identificar os critérios utilizados por médicos e enfermeiros para o preparo da alta de pessoas com lesão neurológica incapacitante e indicação para acesso a programa de reabilitação física. Para o tratamento dos dados, utilizou-se a técnica de Análise de Conteúdo, modalidade temática. Os resultados mostram que os gestores hospitalares ainda encontram dificuldades para proceder ao encaminhamento adequado dessas pessoas para serviços especializados de reabilitação, o que compromete a autonomia e independência para o autocuidado. Conclui-se que os gestores além de envolver cuidadores e familiares no preparo da alta de pessoas com lesão neurológica que resulta em incapacidades para o autocuidado, deveriam avaliar as condições de acessibilidade em seus domicílios e fazer encaminhamentos adequados para serviços de reabilitação disponíveis na comunidade, a despeito da pouca divulgação acerca dos fluxos da Rede de Cuidados da Pessoa com Deficiência.


Abstract The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients’ autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient’s home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pessoas com Deficiência/reabilitação , Alta do Paciente , Encaminhamento e Consulta , Traumatismos do Sistema Nervoso/reabilitação , Avaliação da Deficiência , Traumatismos do Sistema Nervoso/complicações
16.
Exp Neurol ; 283(Pt B): 550-9, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27151600

RESUMO

Myelin accelerates action potential conduction velocity and provides essential energy support for axons. Unfortunately, myelin and myelinating cells are often vulnerable to injury or disease, resulting in myelin damage, which in turn can lead to axon dysfunction, overt pathology and neurological impairment. Inflammation is a common component of trauma and disease in both the CNS and PNS and therefore an active inflammatory response is often considered deleterious to myelin health. While inflammation can certainly damage myelin, inflammatory processes also can positively affect oligodendrocyte lineage progression, myelin debris clearance, oligodendrocyte metabolism and myelin repair. In the periphery, inflammatory cascades can also augment myelin repair, including processes initiated by infiltrating immune cells as well as by local Schwann cells. In this review, various aspects of inflammation beneficial to myelin repair are discussed and should be considered when designing or implementing anti-inflammatory therapies for CNS and PNS injury involving myelinating cells.


Assuntos
Inflamação/etiologia , Bainha de Mielina/patologia , Traumatismos do Sistema Nervoso , Animais , Citocinas/metabolismo , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Oligodendroglia/patologia , Transmissão Sináptica , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/metabolismo , Traumatismos do Sistema Nervoso/patologia
17.
PLoS One ; 11(3): e0151855, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26998608

RESUMO

BACKGROUND: The human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals. METHODOLOGY: We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient's clinical history and examinations of the patient's reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed. MAIN FINDINGS: The prevalence of neurological disturbances-altered reflexes and skin tactile sensitivity and increased risk of falling-was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects. CONCLUSIONS: The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.


Assuntos
Pé/fisiopatologia , Infecções por HTLV-I/fisiopatologia , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/fisiologia , Pressão , Traumatismos do Sistema Nervoso/fisiopatologia , Traumatismos do Sistema Nervoso/virologia , Adulto , Feminino , Infecções por HTLV-I/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/patologia
18.
J Urol ; 195(3): 788-95, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26519654

RESUMO

PURPOSE: Recently intracavernous injection of stem cells has garnered great interest as a potential treatment of erectile dysfunction. However, most stem cells are washed out immediately after intracavernous injection. The goal of this study was to investigate using NanoShuttle™ magnetic nanoparticles to maintain stem cells in the corpus cavernosum after intracavernous injection, thereby improving stem cell therapy of erectile dysfunction in an animal model. MATERIALS AND METHODS: Adipose derived stem cells were magnetized with NanoShuttle magnetic nanoparticles to create Nano-adipose derived stem cells. A total of 24 rats underwent bilateral cavernous nerve crush and were randomly assigned to 3 groups, including adipose derived stem cells, Nano-adipose derived stem cells and Nano-adipose derived stem cells plus magnet. Cells were tracked at days 1, 3, 5 and 9 after intracavernous injection. Another 40 rats with bilateral cavernous nerve crush were randomly assigned to 4 groups, including bilateral cavernous nerve crush, bilateral cavernous nerve crush plus adipose derived stem cell intracavernous injection, bilateral cavernous nerve crush plus Nano-adipose derived stem cell intracavernous injection and bilateral cavernous nerve crush plus Nano-adipose derived stem cell intracavernous injection plus magnet. Functional testing and histological analysis were performed 4 weeks after intracavernous injection. RESULTS: In the in vitro study 1) NanoShuttle magnetic nanoparticles were successfully bound to adipose derived stem cells and 2) Nano-adipose derived stem cells migrated toward the magnet. In the in vivo study 1) cell tracking showed that Nano-adipose derived stem cells were successfully retained in the corpus cavernosum using the magnet for up to 3 days while most adipose derived stem cells were washed out in other groups by day 1 after intracavernous injection, and 2) intracavernous pressure/mean arterial pressure, and αSMA (α-smooth muscle actin) and PECAM-1 (platelet endothelial cell adhesion molecule 1) expression in the Nano-adipose derived stem cell group was significantly higher than in the other groups. CONCLUSIONS: Magnetization of adipose derived stem cells with NanoShuttle magnetic nanoparticles kept adipose derived stem cells in the corpus cavernosum and improved adipose derived stem cell therapy of erectile dysfunction in an animal model.


Assuntos
Adipócitos/transplante , Disfunção Erétil/etiologia , Disfunção Erétil/cirurgia , Nanopartículas/uso terapêutico , Pênis/lesões , Pênis/inervação , Transplante de Células-Tronco , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/cirurgia , Animais , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
19.
J Neurosurg Spine ; 24(1): 197-205, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26407087

RESUMO

Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the authors describe the case of a previously healthy and immunocompetent patient who developed a large retropharyngeal abscess with spinal osteomyelitis after a high-energy craniocervical injury. This unusual report of osteomyelitis with a delayed presentation after a high-energy traumatic injury of the craniocervical junction highlights the possibility of direct injury to a specific area in the oropharyngeal mucosa adjacent to the osteoligamentous structures of the craniocervical junction, an overall underrecognized complication of unstable craniocervical injuries.


Assuntos
Vértebras Cervicais/cirurgia , Abscesso Epidural/cirurgia , Osteomielite/cirurgia , Abscesso Retrofaríngeo/cirurgia , Traumatismos do Sistema Nervoso/cirurgia , Abscesso Epidural/diagnóstico , Abscesso Epidural/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/etiologia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/etiologia , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/diagnóstico , Resultado do Tratamento
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