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1.
Sci Prog ; 108(1): 368504241305904, 2025.
Artigo em Inglês | MEDLINE | ID: mdl-39763176

RESUMO

Introduction: Hospital admission due to fragility hip fracture has increased significantly in recent years. In patients with hip fracture, perioperative pain management is usually with opioids, whose dosage is difficult to adjust and have many side effects, especially in older adults. The purpose of this study was to determine the impact and the advantages of the implementation of the fascia iliaca blockade in older adults with hip fracture due to fragility included in the Orthogeriatric Clinical Care Center of the Fundación Santa Fe de Bogotá and the San José Infantil University Hospital in Bogotá, Colombia. The primary outcome of our study is the incidence of delirium during hospitalization. Methods: A retrospective observational cohort study was conducted. The data was collected from patients older than 65 years treated for a fragility fracture of the hip in two fourth-level hospitals in Bogotá, Colombia from the beginning of 2019 until the end of 2020. Results: A sample of 218 patients was obtained, of which 119 received conventional analgesic management. 99 patients underwent fascia iliaca blockade. No significant difference was found between the use of the block and the development of delirium (p = 0.442). There was a higher consumption of opioids in the conventional analgesia group compared to the block group (27.61 mg vs 16.34 mg, respectively, p = 0.003), longer duration of the surgical procedure (90.84 vs 81.08 min, respectively, p = 0.030) and longer hospital stay (6.06 vs 5.41 days, respectively, p = 0.641). Conclusions: While this study found no significant difference in the incidence of delirium, fascia iliaca blockade was associated with significant reductions in opioid consumption and shorter procedural times. These findings suggest that fascia iliaca blockade may improve pain management efficiency in older adults with hip fractures.


Assuntos
Analgesia , Fraturas do Quadril , Bloqueio Nervoso , Manejo da Dor , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Colômbia/epidemiologia , Delírio/tratamento farmacológico , Delírio/epidemiologia , Delírio/etiologia , Fáscia/inervação , Fáscia/efeitos dos fármacos , Fraturas do Quadril/cirurgia , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos
2.
Biol Res ; 58(1): 8, 2025 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-39871297

RESUMO

BACKGROUND: Cavernous nerve injury-induced erectile dysfunction (CNI-ED) is a common complication following radical prostatectomy and severely affects patients' quality of life. The mitochondrial impairment in corpus cavernosum smooth muscle cells (CCSMCs) may be an important pathological mechanism of CNI-ED. Previous studies have shown that transplantation of human adipose derived stem cells (ADSC) can alleviate CNI-ED in a rat model. However, little is known about the effect of human umbilical cord mesenchymal stem cells (hUC-MSC) on CNI-ED. It remains unclear whether hUC-MSC can ameliorate mitochondrial damage in CCSMCs. In this study, we aimed to investigate the impacts of hUC-MSC on the mitochondrial mass and function of CCSMCs, as well as elucidate its underlying molecular mechanism. METHODS: The CNI-ED rat model was established by bilaterally crushing cavernous nerves. Subsequently, hUC-MSC were transplanted into the cavernosum and ADSC were injected as a positive control group. Erectile function evaluation and histological detection were performed 4 weeks after cell transplantation. In vitro, CCSMCs underwent hypoxia and were then co-cultured with ADSC or hUC-MSC using a transwell system. The mitochondrial mass and function, as well as signaling pathways, were investigated. To explore the role of the SIRT1/PGC-1α/TFAM pathway in regulating mitochondrial biogenesis of CCSMCs, we knocked down SIRT1 by siRNA. RESULTS: The administration of hUC-MSC significantly improved erectile function of CNI-ED rats and reduced the ratio of collagen to smooth muscle. Specifically, hUC-MSC treatment restored mitochondrial mass and function in CCSMCs injured by CNI or hypoxia, and inhibited the apoptosis of CCSMCs. Mechanistically, the application of hUC-MSC activated SIRT1/PGC-1α/TFAM pathway both in rat penile tissues and CCSMCs. In addition, knockdown of SIRT1 in CCSMCs abolished the protective effects of hUC-MSC on mitochondrial mass and function, while leading to an increase in cellular apoptosis. CONCLUSIONS: hUC-MSC contribute to the recovery of erectile function in CNI-ED rats by restoring mitochondrial mass and function of CCSMCs through the SIRT1/PGC-1α/TFAM pathway. Our present study offers new insights into the role and molecular mechanisms of hUC-MSC in regulating mitochondrial homeostasis, thereby facilitating the restoration of the erectile function in CNI-ED.


Assuntos
Modelos Animais de Doenças , Disfunção Erétil , Mitocôndrias , Pênis , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo , Ratos Sprague-Dawley , Transdução de Sinais , Sirtuína 1 , Masculino , Animais , Sirtuína 1/metabolismo , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Ratos , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , Pênis/inervação , Miócitos de Músculo Liso , Humanos , Fatores de Transcrição/metabolismo , Células-Tronco Mesenquimais , Ereção Peniana/fisiologia , Traumatismos dos Nervos Periféricos/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Proteínas Mitocondriais/metabolismo
3.
Einstein (Sao Paulo) ; 22: eAO0719, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39536210

RESUMO

OBJECTIVE: Hand reanimation for finger flexion in patients with total paralysis remains a reconstructive challenge, especially when tendon transfers or neurological reconstruction options are no longer viable. This study aimed to describe a series of patients without hand function by evaluating two hand reanimation techniques. METHODS: This observational retrospective study used a case series of hand reanimation. Two techniques were performed-functional free gracilis muscle transfer with microsurgical reconstruction, and transfer of the recovered biceps to the flexor digitorum profundus and flexor pollicis longus with tendon graft augmentation. The two groups, each undergoing one of the techniques, were evaluated for the final functional results using the British Medical Research Council (BMRC) grading system. RESULTS: Six consecutive patients with total hand paralysis were included, with a mean final follow-up of 7.5 years. After intervention, two patients, one from each technique group, achieved a BMRC grade 2. In the group where tendon transfer of the biceps to the finger flexors was performed, two patients achieved a BMRC grade 3. Additionally, two patients who underwent functional free muscle transfer were achieved a BMRC grade 4. CONCLUSION: The transfer of biceps to the finger flexors using tendon grafts, which involves fewer technical difficulties and reduced demands from the surgical team compared to functional free muscle transfer, is a viable alternative for treating patients requiring hand reanimation. However, functional free muscle transfer is recommended as the first option when technically feasible and adequate donor nerves are available, due to its potential for achieving greater final muscular strength in the finger flexors. Reconstructive microsurgeons can use both techniques as viable surgical options for hand reanimation.


Assuntos
Músculo Grácil , Transferência Tendinosa , Humanos , Transferência Tendinosa/métodos , Estudos Retrospectivos , Masculino , Músculo Grácil/transplante , Músculo Grácil/inervação , Feminino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Paralisia/cirurgia , Paralisia/fisiopatologia , Mãos/cirurgia , Mãos/inervação , Mãos/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Adulto Jovem , Microcirurgia/métodos , Músculo Esquelético/transplante
4.
High Blood Press Cardiovasc Prev ; 31(6): 687-694, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39557771

RESUMO

INTRODUCTION: The long-term efficacy of renal denervation (RDN) has not been extensively documented. AIM: To describe the long-term follow-up of patients after RDN. METHODS: We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated. RESULTS: The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m2 (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m2 (p = 0.034), and the uACR did not significantly change from baseline to follow-up. CONCLUSIONS: In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.


Assuntos
Anti-Hipertensivos , Pressão Sanguínea , Ablação por Cateter , Resistência a Medicamentos , Hipertensão , Rim , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Hipertensão/diagnóstico , Resultado do Tratamento , Fatores de Tempo , Pressão Sanguínea/efeitos dos fármacos , Ablação por Cateter/efeitos adversos , Rim/inervação , Anti-Hipertensivos/uso terapêutico , Adulto , Irrigação Terapêutica , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Artéria Renal/inervação , Estudos Retrospectivos , Monitorização Ambulatorial da Pressão Arterial , Fatores de Risco
5.
Proc Natl Acad Sci U S A ; 121(48): e2407648121, 2024 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-39560641

RESUMO

Dry eye disease (DED) is characterized by a dysfunctional tear film in which the corneal epithelium and its abundant nerves are affected by ocular desiccation and inflammation. Although adaptive immunity and specifically CD4+ T cells play a role in DED pathogenesis, the exact contribution of these cells to corneal epithelial and neural damage remains undetermined. To address this, we explored the progression of a surgical DED model in wild-type (WT) and T cell-deficient mice. We observed that adaptive immune-deficient mice developed all aspects of DED comparably to WT mice except for the absence of functional and morphological corneal nerve changes, nerve damage-associated transcriptomic signature in the trigeminal ganglia, and sustained tear cytokine levels. Adoptive transfer of CD4+ T cells from WT DED mice to T cell-deficient mice reproduced corneal nerve damage but not epitheliopathy. Conversely, T cell-deficient mice reconstituted solely with naïve CD4+ T cells developed corneal nerve impairment and epitheliopathy upon DED induction, thus replicating the WT DED phenotype. Collectively, our data show that while corneal neuropathy is driven by CD4+ T cells in DED, corneal epithelial damage develops independently of the adaptive immune response. These findings have implications for T cell-targeting therapies currently in use for DED.


Assuntos
Linfócitos T CD4-Positivos , Modelos Animais de Doenças , Síndromes do Olho Seco , Epitélio Corneano , Animais , Síndromes do Olho Seco/imunologia , Síndromes do Olho Seco/patologia , Linfócitos T CD4-Positivos/imunologia , Camundongos , Epitélio Corneano/patologia , Epitélio Corneano/imunologia , Epitélio Corneano/metabolismo , Córnea/inervação , Córnea/patologia , Córnea/imunologia , Lágrimas/metabolismo , Camundongos Endogâmicos C57BL , Transferência Adotiva , Citocinas/metabolismo , Feminino
6.
Rev Col Bras Cir ; 51: e20243781, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39607185

RESUMO

Clitoral hypertrophy is a condition that has a negative impact on a womans intimate life and can cause embarrassment and impact on her sexual life. The article describes a surgical technique of clitoroplasty performed with a 360° circumferential subcoronal incision only in the skin and Dartos tunica to avoid neuronal damage, followed by degloving to the base of the clitoris, preserving the dorsal neurovascular bundle. The body of the clitoris was amputated, preserving 0.5 cm of the stump of the clitoral shaft, and the glans was sutured to the rest of the remaining spongy tissue. Finally, it is noteworthy that there were no complaints of loss of sensitivity or sexual dysfunctions post-operatively.


Assuntos
Clitóris , Hipertrofia , Clitóris/cirurgia , Clitóris/inervação , Clitóris/irrigação sanguínea , Humanos , Hipertrofia/cirurgia , Feminino , Procedimentos de Cirurgia Plástica/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos
7.
Transl Vis Sci Technol ; 13(10): 31, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39432403

RESUMO

Purpose: The purpose of this study was to investigate the effect of sodium hyaluronate (SH) on benzalkonium chloride (BAK)-induced toxicity in the ocular surface epithelium and corneal nerves. Methods: Ocular surface epithelial cells from Balb/c mice were cultured with 0.1% to 0.4% SH and 0.001% to 0.01% BAK and their metabolic activity, viability, and wound repair capacity were assessed in vitro. Following a controlled corneal wound, re-epithelialization and recovery of epithelial barrier function and mechanosensitivity were measured in Balb/c mice treated with 0.4% SH 3 times/day and 0.01% BAK twice daily for 3 weeks. Nerve morphology was assessed by confocal microscopy of corneal whole mounts. Results: Whereas BAK exposure reduced metabolic activity, viability, and wound repair ability of ocular epithelial cells in vitro, pretreatment with SH ameliorated BAK toxicity in a concentration-dependent manner. The highest SH concentration partially reversed the effects of 0.01% BAK in vitro and increased the corneal healing rate of BAK-exposed mice. Although all corneal wounds closed after 4 days, continuous SH treatment improved corneal barrier dysfunction 18 days after wounding and accelerated the recovery of corneal mechanical sensitivity to baseline levels in BAK-exposed mice. SH treatment also increased corneal nerve density in the wounded area after 3 weeks. Conclusions: SH mitigates BAK-associated ocular epithelial and neurotoxicity in a concentration-dependent manner. Translational Relevance: Commercially available, high-concentration SH formulations may have added benefits in treating BAK-associated ocular surface toxicity.


Assuntos
Compostos de Benzalcônio , Epitélio Corneano , Ácido Hialurônico , Camundongos Endogâmicos BALB C , Animais , Compostos de Benzalcônio/farmacologia , Compostos de Benzalcônio/toxicidade , Ácido Hialurônico/farmacologia , Camundongos , Epitélio Corneano/efeitos dos fármacos , Epitélio Corneano/patologia , Cicatrização/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Córnea/efeitos dos fármacos , Córnea/patologia , Córnea/inervação , Conservantes Farmacêuticos/toxicidade , Microscopia Confocal , Modelos Animais de Doenças , Lesões da Córnea/induzido quimicamente , Lesões da Córnea/patologia , Lesões da Córnea/tratamento farmacológico , Lesões da Córnea/prevenção & controle
8.
Eur J Pharmacol ; 984: 177026, 2024 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-39396751

RESUMO

Individuals born preterm present altered cardiac autonomic function, a risk factor to heart diseases. Neonatal renin-angiotensin-system activation contributes to adult cardiomyopathy in rats exposed to neonatal hyperoxia, a well-established model of preterm birth-related conditions. Central angiotensin II receptor activation is a key modulator of the autonomic drive to the heart. Whether neonatal hyperoxia leads to alteration of the cardiac autonomic function through activation of the angiotensin II receptor type 1 (AT1) is unknown and was examined in the present study. Sprague-Dawley pups were exposed to hyperoxia or room air from postnatal days 3-10. AT1 antagonist losartan or water was given orally postnatal days 8-10. Blood pressure, autonomic function, left ventricular sympathetic innervation, ß-adrenergic-receptors expression, and AT1 expression in the solitary-tract-nucleus were examined in adult rats. Neonatal hyperoxia led to loss of day-night blood pressure variation, decreased heart rate variability, increased sympathovagal balance, increased AT1 expression in the solitary-tract, decreased left ventricle sympathetic innervation, and increased ß1-adrenergic-receptor protein expression. Losartan prevented the autonomic changes and AT1 expression in the solitary-tract but did not impact the loss of circadian blood pressure variation nor the changes in sympathetic innervation and in ß1-adrenergic-receptor expression. In conclusion, neonatal hyperoxia leads to both central autonomic and cardiac sympathetic changes, partly programmed by neonatal activation of the renin-angiotensin system.


Assuntos
Animais Recém-Nascidos , Sistema Nervoso Autônomo , Pressão Sanguínea , Frequência Cardíaca , Coração , Hiperóxia , Losartan , Ratos Sprague-Dawley , Receptor Tipo 1 de Angiotensina , Animais , Receptor Tipo 1 de Angiotensina/metabolismo , Hiperóxia/fisiopatologia , Hiperóxia/metabolismo , Hiperóxia/complicações , Ratos , Coração/inervação , Coração/efeitos dos fármacos , Coração/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Losartan/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Masculino , Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/metabolismo , Feminino , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia
9.
High Blood Press Cardiovasc Prev ; 31(6): 669-676, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39395908

RESUMO

INTRODUCTION: Renal denervation has been associated with substantial and sustained blood pressure reduction and is considered to serve as an alternative treatment for patients with resistant hypertension. However, the first published SHAM-controlled trial assessing RDN safety and efficacy showed no difference between groups. AIM: We aimed to perform a meta-analysis quantifying the magnitude of blood pressure decrease secondary to renal denervation in patients with resistant hypertension. METHODS: Databases were searched for RCTs that compared RDN therapy to SHAM procedure and reported the outcomes of (1) 24-hour ambulatory blood pressure; (2) Office systolic blood pressure; (3) Daytime systolic blood pressure; and (4) Night-time systolic blood pressure. Mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I² statistics. P values of < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio 4.2.3. RESULTS: Nine studies and 1622 patients were included. The AMBP [MD -3.72 95%CI -5.44, -2.00 p < 0.001; I²=34%] and DSBP [MD -4.10 95%CI -5.84, -2.37 p < 0.001; I²=0%] were significantly reduced in the RDN arm. ODBP [MD -6.04 95%CI -11.31, -0.78 p = 0.024; I²=90%] and NSBP [MD -1.81 95%CI -3.90, 0.27 p = 0.08; I²=0%] did not reach a statistically significant difference between groups. CONCLUSION: Renal denervation demonstrates greater efficacy in reducing 24-hour ambulatory and daytime systolic blood pressure in patients diagnosed with resistant hypertension.


Assuntos
Pressão Sanguínea , Hipertensão , Rim , Ensaios Clínicos Controlados Aleatórios como Assunto , Simpatectomia , Humanos , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Hipertensão/diagnóstico , Rim/inervação , Resultado do Tratamento , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Masculino , Pessoa de Meia-Idade , Feminino , Resistência a Medicamentos , Idoso , Anti-Hipertensivos/uso terapêutico , Artéria Renal/inervação , Artéria Renal/cirurgia , Fatores de Tempo
10.
High Blood Press Cardiovasc Prev ; 31(6): 657-667, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39472408

RESUMO

INTRODUCTION: Resistant arterial hypertension (RAH) is one of the main causes of increased cardiovascular risk around the world. The benefits of ultrasound renal denervation (uRDN) as a non-invasive treatment are still not fully clear. AIM:  We aim to demonstrate the efficacy of uRDN in reducing office blood pressure of patients in treatment for RAH. METHODS: PubMed, Embase, and Cochrane were searched for randomized trials comparing uRDN to sham or medical control groups in RAH patients undergoing renal denervation. Mean Differences (MD) with 95% confidence intervals (CIs) were calculated, and I2 statistics assessed heterogeneity. Statistical significance was set at p < 0.05. Statistical analysis was performed using R software version 4.2.3. RESULTS: It was included 5 studies with 709 patients, of which 395 (55.71%) received uRDN treatment and 314 (44.29%) in the sham group. Mean follow-up time ranged from 2 to 48 months and mean age ranged from 52.3 to 62 years. The uRDN decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) in all measures significantly, including reductions in Office SBP (MD - 4.459 mmHg; 95% CI - 7.710 to - 1.208; p = 0.007; I2 = 47%) and Office DBP (MD - 2.039 mmHg; 95% CI - 3.975 to - 0.102; p = 0.039; I2 = 27%). CONCLUSIONS: This meta-analysis highlights uRDN's superiority over the sham group in controlling SBP and DBP in RAH. However, further studies are needed to fully understand the efficacy of uRDN procedure in the management of RAH.


Assuntos
Pressão Arterial , Resistência a Medicamentos , Hipertensão , Rim , Artéria Renal , Simpatectomia , Humanos , Resultado do Tratamento , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Hipertensão/diagnóstico , Rim/irrigação sanguínea , Rim/inervação , Rim/fisiopatologia , Pessoa de Meia-Idade , Artéria Renal/inervação , Artéria Renal/diagnóstico por imagem , Feminino , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Masculino , Anti-Hipertensivos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Visita a Consultório Médico , Fatores de Tempo , Terapia por Ultrassom/efeitos adversos
11.
Am J Physiol Regul Integr Comp Physiol ; 327(6): R590-R600, 2024 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-39437542

RESUMO

Despite some evidence, the role of sympathetic nerve activity in the regulation of cerebral blood flow remains controversial. In humans, muscle sympathetic nervous activity (MSNA) is the only direct measure of sympathetic nerve activity that can be recorded with sufficient temporal resolution to allow association with dynamic regulation of cerebral blood velocity (CBv). This study tested the hypothesis that MSNA is associated with the regulation of CBv at rest and during different physiological maneuvers. Nine healthy subjects underwent two sympathoexcitatory maneuvers: 1) isometric handgrip exercise (HGR), and 2) cold pressor test (CPT). Mean arterial pressure (MAP; oscillometric method), CBv (transcranial Doppler ultrasound), and MSNA (microneurography) were measured continuously during experimental protocols. Ordinary and partial coherences of the MAP, CBv, and MSNA time series were estimated by transfer function analysis in the low-frequency range (0.07-0.20 Hz), using MAP and MSNA as inputs and CBv as the output variable. When the influence of MSNA was taken into account, the partial coherences between MAP and CBv were considerably reduced at baseline (P < 0.01), HGR (P = 0.02), and CPT (P < 0.01). Similarly, when the influence of MAP was taken into account, the coherence between MSNA and CBv was considerably reduced at baseline (P < 0.01), HGR (P = 0.02), and CPT (P = 0.01), leading to the conclusion, that MSNA was associated to dynamic regulation of CBv. Partial coherence analysis is a promising method for assessing the influence of the sympathetic nervous system on cerebral hemodynamics.NEW & NOTEWORTHY Partial coherence analysis has been instrumental in demonstrating, for the first time, that cerebral blood velocity (CBv) is continuously influenced, not only by fluctuations in mean arterial pressure but also muscle sympathetic nervous activity (MSNA), leading to similar dynamic responses at rest and during different sympathoexcitatory maneuvers in healthy subjects. Modeling the temporal relationship between MSNA and CBv opens new opportunities for advancing knowledge regarding the role of the sympathetic nervous system in the regulation of cerebral circulation in health and disease.


Assuntos
Circulação Cerebrovascular , Músculo Esquelético , Sistema Nervoso Simpático , Humanos , Sistema Nervoso Simpático/fisiologia , Masculino , Circulação Cerebrovascular/fisiologia , Adulto , Músculo Esquelético/inervação , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/fisiologia , Feminino , Velocidade do Fluxo Sanguíneo/fisiologia , Adulto Jovem , Força da Mão/fisiologia , Ultrassonografia Doppler Transcraniana , Pressão Arterial
12.
Int Braz J Urol ; 50(6): 764-771, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39133789

RESUMO

INTRODUCTION: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. MATERIAL AND METHODS: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. RESULTS: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. CONCLUSIONS: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.


Assuntos
Idade Gestacional , Pênis , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/embriologia , Pênis/inervação , Feto/irrigação sanguínea , Feto/embriologia , Imuno-Histoquímica , Desenvolvimento Fetal/fisiologia
13.
BMC Cardiovasc Disord ; 24(1): 433, 2024 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-39153977

RESUMO

BACKGROUND: The elevated blood pressure (BP) and lower cardiac autonomic modulation (CAM) are associated with higher morbidity mortality risk among older adults. Although exercise is an important intervention for cardiovascular promotion, it is unclear whether combat sports training could benefit cardiovascular outcomes as much as autonomic in this population. This study compared the effects of 12 weeks of Muay Thai (MT) training against functional training (FT) on CAM and hemodynamic parameters in older adults. METHODS: The sample consisted of 50 older adults (41 women; 66.0 ± 5.3 years old), who were equaly randomized into FT (n = 25) and MT (n = 25) intervention groups. CAM was measured by 30-min rest heart rate variability. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate (RHR) were measured using an automatic oscillometric device. Pulse pressure (PP) and the double product (DP) were also calculated. The interventions were carried out three times a week, with 60-min length per session, during 12 consecutive weeks. The intensity of the interventions was measured using the subjective perception of exertion scale and by accelerometer. Two-factor repeated measures analysis of covariance was used for groups comparison, considering intervention group and body mass as factors. The 95% confidence interval of the difference (95%CIdif) was also calculated and the effect size was measured using partial eta squared (η2p). RESULTS: CAM indices did not show significant changes across moments and intervention groups. In hemodynamic parameters, only in DBP was there an effect of the moment (F1,39 = 8.206; P = 0.007; η2p = 0.174, large) and interaction effect between group*moment (F1,39 = 7.950; P = 0.008; η2p = 0.169, large). Specifically, the MT group at the post-training moment showed lower DBP (P = 0.010; 95%CIdif = -13.3; -1.89) in relation to the FT group. Furthermore, the MT group showed a decrease in DBP during training (P = 0.002; 95%CIdif = -10.3; -2.6). Also, an increase in training intensity was also found over the 12 weeks in FT, with no difference between the groups. CONCLUSION: After 12 weeks of MT practice there was a reduction in DBP compared to FT in older adults. TRIAL REGISTRATION: NCT03919968 Registration date: 01/02/2019.


Assuntos
Sistema Nervoso Autônomo , Pressão Sanguínea , Frequência Cardíaca , Hemodinâmica , Humanos , Feminino , Masculino , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Fatores de Tempo , Pessoa de Meia-Idade , Resultado do Tratamento , Fatores Etários , Tailândia , Terapia por Exercício/métodos , Coração/inervação , População do Sudeste Asiático
15.
Int. j. morphol ; 42(4): 954-959, ago. 2024. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1569268

RESUMO

SUMMARY: Our team has modified Sihler's intramuscular nerve staining method to allow for calculation of nerve density. Therefore, this study aimed to show the overall distribution pattern of the thoracic cutaneous nerves to provide a morphological basis for selecting and matching sensory reconstruction during skin flap transplantation. Twelve Chinese adult cadavers were dissected; the thoracic skin was removed, and the modified Sihler's staining method was performed. Centered around the nipple, the chest skin was divided into four regions: medial-superior, lateral-superior, lateral-inferior, and medial-inferior. The thoracic skin was not only innervated by the branches of the 1st to 7th intercostal and supraclavicular nerves, but also by a small number of nerves that directly reached the skin and passed through the pectoralis major muscle. There is a phenomenon of cross overlap between the branches of adjacent intercostal nerves. The branches of the 2nd to 7th intercostal nerves were distributed in the breast, and the branches of the lateral and anterior cutaneous branches were densely distributed around the nipple, forming a grid-like anastomosis. There was no cross-overlapping innervation between the anterior cutaneous branches on both sides. The density of nerve distribution in the four regions of the chest was in the order of the medial-superior, lateral-superior, lateral-inferior and medial-inferior region, respectively. These results may be used to map sensory regions when designing thoracic skin flaps for reconstruction surgery to obtain improved sensory recovery.


Nuestro equipo ha modificado el método de tinción nerviosa intramuscular de Sihler para permitir el cálculo de la densidad nerviosa. Por lo tanto, este estudio tuvo como objetivo mostrar el patrón de distribución general de los nervios cutáneos torácicos proporcionando una base morfológica para seleccionar y combinar la reconstrucción sensorial durante el trasplante de colgajo de piel. Se diseccionaron 12 cadáveres de individuos adultos chinos. Se eliminó la piel torácica y se realizó el método de tinción de Sihler modificado, centrada alrededor del pezón, la piel del pecho se dividió en cuatro regiones: medial- superior, lateral-superior, lateral-inferior y medial-inferior. La piel torácica no solo estaba inervada por los ramos de los nervios intercostal y supraclavicular 1º a 7º, sino también por un pequeño número de nervios que llegaban directamente a la piel y pasaban a través del músculo pectoral mayor. Existe un fenómeno de superposición cruzada entre los ramos de los nervios intercostales adyacentes. Los ramos de los nervios intercostales 2º a 7º se distribuyeron en la mama, y los ramos de los ramos cutáneos lateral y anterior se distribuyeron densamente alrededor del pezón, formando una anastomosis en forma de rejilla. No hubo inervación cruzada entre los ramos cutáneos anteriores en ambos lados. La densidad de la distribución nerviosa en las cuatro regiones del tórax estaba en el orden de región medial-superior, lateral-superior, lateral-inferior y medial-inferior, respectivamente. Estos resultados pueden ser útiles para mapear regiones sensoriales al diseñar colgajos de piel torácicos para utilizarlos en cirugía de reconstrucción y obtener así una mejor recuperación sensorial.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pele/inervação , Coloração e Rotulagem , Tórax/inervação , Retalhos Cirúrgicos/inervação , Cadáver , Corantes
16.
J Hand Surg Asian Pac Vol ; 29(4): 365-369, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39005185

RESUMO

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).


Assuntos
Transferência de Nervo , Quadriplegia , Transferência Tendinosa , Polegar , Humanos , Transferência Tendinosa/métodos , Quadriplegia/cirurgia , Quadriplegia/fisiopatologia , Polegar/inervação , Polegar/cirurgia , Masculino , Transferência de Nervo/métodos , Amplitude de Movimento Articular , Força da Mão/fisiologia , Dedos/cirurgia , Dedos/inervação
17.
Int J Mol Sci ; 25(13)2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-39000071

RESUMO

The Goldblatt model of hypertension (2K-1C) in rats is characterized by renal sympathetic nerve activity (rSNA). We investigated the effects of unilateral renal denervation of the clipped kidney (DNX) on sodium transporters of the unclipped kidneys and the cardiovascular, autonomic, and renal functions in 2K-1C and control (CTR) rats. The mean arterial pressure (MAP) and rSNA were evaluated in experimental groups. Kidney function and NHE3, NCC, ENaCß, and ENaCγ protein expressions were assessed. The glomerular filtration rate (GRF) and renal plasma flow were not changed by DNX, but the urinary (CTR: 0.0042 ± 0.001; 2K-1C: 0.014 ± 0.003; DNX: 0.005 ± 0.0013 mL/min/g renal tissue) and filtration fractions (CTR: 0.29 ± 0.02; 2K-1C: 0.51 ± 0.06; DNX: 0.28 ± 0.04 mL/min/g renal tissue) were normalized. The Na+/H+ exchanger (NHE3) was reduced in 2K-1C, and DNX normalized NHE3 (CTR: 100 ± 6; 2K-1C: 44 ± 14, DNX: 84 ± 13%). Conversely, the Na+/Cl- cotransporter (NCC) was increased in 2K-1C and was reduced by DNX (CTR: 94 ± 6; 2K-1C: 144 ± 8; DNX: 60 ± 15%). In conclusion, DNX in Goldblatt rats reduced blood pressure and proteinuria independently of GRF with a distinct regulation of NHE3 and NCC in unclipped kidneys.


Assuntos
Rim , Trocador 3 de Sódio-Hidrogênio , Animais , Rim/inervação , Rim/metabolismo , Ratos , Masculino , Trocador 3 de Sódio-Hidrogênio/metabolismo , Taxa de Filtração Glomerular , Denervação , Isquemia/metabolismo , Pressão Sanguínea , Ratos Wistar , Hipertensão/metabolismo , Canais Epiteliais de Sódio/metabolismo , Modelos Animais de Doenças , Trocadores de Sódio-Hidrogênio/metabolismo
18.
Acta Cir Bras ; 39: e394024, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39046042

RESUMO

PURPOSE: To evaluate the effects on peripheral neural regeneration of the end-to-side embracing repair technique compared to the autograft repair technique in Wistar rats. METHODS: Fifteen male Wistar rats were divided into three groups with five animals each: denervated group (GD), autograft group (GA), and embracing group (EG). For the evaluation, the grasping test, electroneuromyography (ENMG), and muscle weight assessment were used. RESULTS: Muscle weight assessment and ENMG did not show significant neural regeneration at the end of 12 weeks in the DG and GE groups, but only in GA. The grasping test showed an increase in strength between the surgery and the fourth week in all groups, and only the GA maintained this trend until the 12th week. CONCLUSIONS: The present study indicates that the neural regeneration observed in the end-to-side embracing neurorrhaphy technique, in the repair of segmental neural loss, is inferior to autograft repair in Wistar rats.


Assuntos
Regeneração Nervosa , Ratos Wistar , Animais , Masculino , Regeneração Nervosa/fisiologia , Eletromiografia , Ratos , Procedimentos Neurocirúrgicos/métodos , Músculo Esquelético/inervação , Traumatismos dos Nervos Periféricos/cirurgia , Transplante Autólogo/métodos , Fatores de Tempo , Reprodutibilidade dos Testes , Nervo Isquiático/cirurgia , Nervo Isquiático/lesões , Nervo Isquiático/fisiologia
19.
High Blood Press Cardiovasc Prev ; 31(4): 329-340, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38890242

RESUMO

INTRODUCTION: New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied. AIM: Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH. METHODS: A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes. RESULTS: In the 10 included studies, involving 1.182 patients, 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD - 9.5 mmHg; 95% CI - 16.81 to - 2.29; P = 0.01), office diastolic BP (MD - 5.1 mmHg; 95% CI - 8.42 to - 2.80; P < 0.001), 24 h systolic BP (MD - 4.8 mmHg; 95% CI - 7.26 to - 2.42; P < 0.001). For 24 h diastolic BP RDN did not have a significant reduction (MD - 2.3 mmHg; 95% CI - 4.19 to - 0.52; P = 0.012). The heterogeneity between the studies was high, visible in the funnel and Baujat plots. The OR was non-significant for non-serious adverse events, but also clinically significant for hypertensive crises and strokes for the RDN group. CONCLUSIONS: While the pharmacological regimen of 3 or more anti-hypertensive, including a diuretic, still be the first-line option for RH treatment, our results support that radiofrequency-based RDN is superior in reducing global BP and is safe.


Assuntos
Ablação por Cateter , Resistência a Medicamentos , Hipertensão , Rim , Simpatectomia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Ablação por Cateter/efeitos adversos , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Rim/inervação , Artéria Renal/inervação , Artéria Renal/cirurgia , Fatores de Risco , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Fatores de Tempo , Resultado do Tratamento
20.
Arq Neuropsiquiatr ; 82(5): 1-10, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38843846

RESUMO

BACKGROUND: The diagnosis of Hansen disease (HD) can be difficult when acid-fast bacilli are not detected in the patient's skin sample. OBJECTIVE: To demonstrate that detailed morphological analysis of nonspecific inflammatory and/or noninflammatory alterations in dermal nerves as well as skin adnexa in leprosy-suspected biopsy samples could improve the efficacy of histopathological diagnosis. METHODS: Patients with one to five skin lesions were enrolled in the study and classified into three groups by skin histopathology findings: Hansen disease (HD, n = 13), other diseases (OD, n = 11), and inconclusive cases (INC, n = 11). We quantified dermal nerve damage via the nerve lesion index (NLI) and PGP9.5-immunoreactive axon quantitative index in dermal nerves (AQI). We also measured inflammatory involvement of adnexa in cutaneous samples as indirect evidence of HD. RESULTS: We observed a higher median endoneurial inflammatory infiltrate NLI (HD = 0.5; INC = 0; OD = 0; p < 0.001) and more frequent inflammatory involvement of skin adnexa in samples of the HD group compared with those of the INC and OD groups (HD = 7; INC = 1; OD = 0). However, samples from the INC and OD groups also showed inflammatory and noninflammatory damage of dermal nerves, with 2 or more kinds of alterations in nerves in the same sample (respectively: INC = in 1 and 2 samples; OD = in 3 and 5 respectively). The quantification of PGP9.5-immunoreactive axons in dermal nerves revealed no difference between the groups. CONCLUSION: A detailed morphological analysis of cutaneous nerves in lesions with a suspicion of HD enabled us to select patients with nonspecific inflammatory or non-inflammatory lesions in the dermal nerves in the INC and OD groups, so they may be clinically monitored aiming at a possible future diagnosis of the disease. These INC and OD patients cannot have the HD diagnosis definitely excluded, and HD may coexist with another disease as a comorbidity.


ANTECEDENTES: A hanseníase pode ter o seu diagnóstico histopatológico dificultado quando bacilos álcool-ácido resistentes não são encontrados nas amostras de pele dos pacientes. OBJETIVO: Demonstrar que uma análise morfológica detalhada de alterações histopatológicas dos nervos dérmicos pode aumentar a eficácia diagnóstica. MéTODOS: Foram selecionadas amostras de pele de pacientes com uma a cinco lesões suspeitas de hanseníase. Os casos selecionados foram classificados conforme achados histopatológicos: hanseníase (HD, n = 13), casos inconclusivos (INC, n = 11), e outras doenças (OD, n = 11). Quantificamos as lesões dos nervos cutâneos por meio do índice de lesão de nervos (nerve lesion index, NLI, em inglês) e do índice quantitativo de axônios (axon quantitative index, AQI, em inglês) imunorreativos a PGP9.5 nos nervos cutâneos. Também medimos o envolvimento inflamatório dos anexos em amostras de pele como evidência indireta de hanseníase. RESULTADOS: Foram observadas no grupo HD medianas mais altas do NLI com relação a infiltrados inflamatórios endoneurais (HD = 0,5; INC = 0; OD = 0; p < 0,001) e mais alta frequência de acometimento inflamatório de anexos cutâneos (HD = 7; INC = 1; OD = 0). Entretanto, as amostras dos grupos INC e OD também mostraram comprometimento inflamatório e não inflamatório dos nervos cutâneos, com 2 ou mais tipos de alterações de nervos na mesma amostra (respectivamente: INC = 1 e 2; OD = 3 e 5). Não houve diferença significativa na quantidade de axônios endoneurais imunorreativos a PGP9.5 entre os grupos. CONCLUSãO: A análise morfológica detalhada dos nervos cutâneos em lesões suspeitas de hanseníase permitiu selecionar pacientes com lesões inespecíficas inflamatórias ou não inflamatórias nos nervos dérmicos nos grupos INC e OD, para que sejam monitorados clinicamente visando um possível diagnóstico futuro da doença. Esses pacientes INC e OD não podem ter o diagnóstico de HD definitivamente excluído, e a hanseníase pode coexistir com outra doença como uma comorbidade.


Assuntos
Imuno-Histoquímica , Hanseníase , Pele , Humanos , Masculino , Feminino , Hanseníase/patologia , Hanseníase/complicações , Pessoa de Meia-Idade , Adulto , Pele/inervação , Pele/patologia , Biópsia , Idoso , Adulto Jovem , Ubiquitina Tiolesterase/análise , Adolescente , Estatísticas não Paramétricas
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