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AIMS/BACKGROUND: The United Nations Sustainable Development Goals (SDGs) has placed emphasis on improving early child development globally. This is supported through the Nurturing Care Framework which includes responsive caregiving. To evaluate responsive caregiving, tools to assess quality of caregiver-child interactions are used, however there is little information on how they are currently employed and/or adapted particularly in low- and middle-income countries (LMICs) where children have a greater risk of adverse outcomes. The aim of this review is to provide a comprehensive guide on methodologies used to evaluate caregiver-child interaction - including their feasibility and cultural adaptation. DESIGN/METHODS: We conducted a systematic review of studies over 20years in LMICs which assessed caregiver-child interactions. Characteristics of each tool, their validity (assessed with COSMIN Risk of Bias checklist), and the quality of the study (Mixed Methods Appraisal Tool) are reported. RESULTS: We identified 59 studies using 34 tools across 20 different LMICs. Most tools (86.5%) employed video-recorded observations of caregiver-child interactions at home (e.g. Ainsworth's Sensitivity Scale, OMI) or in the laboratory (e.g. PICCOLO) with a few conducting direct observations in the field (e.g. OMCI, HOME); 13.5% were self-reported. Tools varied in methodology with limited or no mention of validity and reliability. Most tools are developed in Western countries and have not been culturally validated for use in LMIC settings. CONCLUSION: There are limited caregiver-child interaction measures used in LMIC settings, with only some locally validated locally. Future studies should aim to ensure better validity, applicability and feasibility of caregiver-child interaction tools for global settings.
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BACKGROUND AND AIMS: Pancreatic resection is associated with pancreatic exocrine insufficiency (PEI) leading to nutritional consequences. The Pancreatic Nutrition Clinic was established to diagnose and manage PEI through standardised nutritional assessment. In this prospective observational study, we aimed to define the rate of PEI, diabetes mellitus and nutritional abnormalities in patients who underwent pancreatic resection. METHODS: All Pancreatic Nutrition Clinic patients were included for analysis. Clinical data were prospectively obtained at initial assessment. Biochemical data included micronutrient levels, faecal elastase-1 and haemoglobin A1c. Bone mineral density and nutritional assessment were undertaken. RESULTS: Ninety-eight patients were included. Fifty-nine per cent (58/98) had undergone a pancreatoduodenectomy. Ninety-three patients had a faecal elastase-1 result, 65% (60/93) of which had a faecal elastase-1 less than 200 µg/g of faeces. Seventy-five patients (76%) of the total population required PERT, and thirty-nine (40%) were classified as malnourished using the patient-generated subjective global assessment tool. Seventy-two per cent (70/97) had a biochemical deficiency of one or more micronutrients. Thirty-eight people (39%) had diabetes mellitus. Of the seventy-eight patients with a bone mineral density scan available for analysis, 29% (23/78) had osteoporosis and 49% (38/78) osteopenia. CONCLUSIONS: Pancreatic exocrine insufficiency, micronutrient deficiency, bone disease, diabetes mellitus and malnutrition are highly prevalent in patients who have undergone pancreatic resection.
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Diabetes Mellitus , Insuficiência Pancreática Exócrina , Desnutrição , Doenças Metabólicas , Humanos , Insuficiência Pancreática Exócrina/diagnóstico , Elastase Pancreática/análise , MicronutrientesRESUMO
Pulmonary arteriovenous malformation (PAVM) is a congenital vascular abnormality that can cause persistent cyanosis in children. PAVMs can go undetected till adulthood; however, there have been several neonatal cases reported over the years. This case report describes a classical manifestation of a child with isolated PAVM whose diagnosis was likely missed during the neonatal period. A high level of clinical awareness of this condition is crucial as early diagnosis and appropriate treatment can prevent lifethreatening complications and mortality. Diagnosis was confirmed by computed tomography pulmonary angiography and percutaneous transcatheter embolotherapy resulted in complete resolution of symptoms.
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Fístula Arteriovenosa , Malformações Arteriovenosas , Embolização Terapêutica , Veias Pulmonares , Adulto , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Criança , Embolização Terapêutica/métodos , Humanos , Recém-Nascido , Diagnóstico Ausente , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagemRESUMO
OBJECTIVES: To determine the prevalence of continued illicit drug use among people enrolled in methadone maintenance treatment (MMT), the association between hepatitis C status and methadone dosage, and the predictors for illicit drug abstinence during MMT. METHODS: Clinical records of active opioid dependents who underwent MMT between 1 January 2007 and 31 March 2021 in Hospital Tuanku Fauziah, Perlis, Malaysia were retrospectively reviewed. Data collected included baseline demographics, history of illicit drug use, temporal trend in methadone dosage modulation, and co-use of illicit drugs during the MMT. RESULTS: A total of 87 patients (mean age, 43.9 ± 8.33 years) were included. Their mean duration of involvement in MMT was 7.8 ± 3.69 years. The most commonly used drug was heroin (88.5%), followed by kratom (51.7%). Between 2019 and 2021, 61 (70.1%) patients had ceased abusing opioid, but 51 (58.6%) patients continued using any of the illicit drugs. Methamphetamine and amphetamine co-use was most common (n = 12, 37.5%). Hepatitis C status was not associated with the current methadone dose (U = 539.5, p = 0.186) or the highest dose required (t = -0.291, df = 74, p = 0.772). No predictor for illicit drug abstinence during MMT was identified. Methadone dose positively correlated with frequency of defaulting treatments (r = 0.22, p = 0.042). CONCLUSION: Among our patients, MMT for opioid dependents cannot sufficiently curb illicit drug use, and there is a shift toward stimulants abuse.
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Hepatite C , Drogas Ilícitas , Metanfetamina , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Pessoa de Meia-Idade , Analgésicos Opioides/uso terapêutico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Heroína , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estudos RetrospectivosRESUMO
Classically, MSC are identified by a CD45-CD106+ phenotype. In this study, we found that mouse MSC achieve this characteristic phenotype only at later passages. With increasing passages, CD45 (hematopoietic marker) expression shifts to negativity, whereas CD106 (vascular cell adhesion molecule-1) expression becomes increasingly positive. These results demonstrate that MSC cells cultured from mouse bone marrow acquire a classical MSC immunophenotype (CD45-CD106+) in later passages.
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Medula Óssea , Imunofenotipagem , Antígenos Comuns de Leucócito/genética , Células-Tronco Mesenquimais , Molécula 1 de Adesão de Célula Vascular/genética , Animais , Biomarcadores , Células Cultivadas , Matriz Extracelular/genética , Técnicas In Vitro , Camundongos , Modelos Animais , Osteoblastoma , Osteoblastos , OsteogêneseRESUMO
Some studies of animal models of serum-sickness nephritis have shown that the lesions of membranous nephropathy develop in animals exhibiting a poor antibody response to the administered antigen (if given in constant amounts). It is postulated that patients with idiopathic membranous nephropathy may share a similar characteristic, namely, a diminished capacity to produce sufficient amounts of antibody. To test this hypothesis, we examined the ability of lymphocytes isolated from 11 patients with this disorder to produce immunoglobulin (Ig)G and IgM on stimulation with a polyclonal B-cell activator, pokeweed mitogen. The peripheral blood lymphocytes (2 x 10(6) cells) from 24 normal individuals had geometric mean production rates of 1,779 ng for IgG, and 2,940 ng for IgM after 7 d of culture in the presence of pokeweed mitogen. By contrast, under identical conditions, lymphocytes from the 11 patients with membranous nephropathy produced significantly lower quantities of both immunoglobulins, with geometric mean concentrations of 511 ng for IgG and 439 ng for IgM. When lymphocytes from patients with membranous nephropathy were co-cultured with normal lymphocytes, the production of immunoglobulin by normal lymphocytes was depressed by 22-82%, suggesting that a population of suppressor cells was responsible for this disturbance in B-cell function. By co-culturing normal lymphocytes with patient lymphocytes depleted of either T cells or monocytes, the suppressor cell was identified as a monocyte.
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Formação de Anticorpos , Glomerulonefrite/imunologia , Imunoglobulinas/biossíntese , Linfócitos/imunologia , Adolescente , Adulto , Células Cultivadas , Feminino , Humanos , Imunoglobulina G/biossíntese , Imunoglobulina M/biossíntese , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Monócitos/citologia , Mitógenos de Phytolacca americana/farmacologia , Linfócitos T Reguladores/imunologiaRESUMO
The functions of the glomerular mesangium are served by at least two populations of cells--a cell bearing microfilaments that regulates blood flow, and a phagocytic cell bearing Ia determinants and Fc receptors. We provide evidence that mouse mesangial cells (bearing microfilaments) produce a factor(s) that stimulates spleen cell proliferation. The factor(s) appears to act via monocytes/macrophages, since its stimulatory activity is abrogated by prior depletion of the responding mononuclear cell population of monocytes/macrophages. Confirmation of its action on macrophages was documented by experiments that showed that medium from macrophages incubated with mesangial cell supernatant contained greater amounts of a factor that stimulated [3H]thymidine uptake by macrophage-depleted spleen cell populations. By the cothymocyte proliferation assay, it could be shown that mesangial cell supernatant induced splenic macrophage production of interleukin-1-like activity. Preliminary characterization reveals the factor to have a molecular weight greater than 100,000. Thus, a novel function is delineated for this mesangial cell type that appears capable of modulating the local immune response by providing an amplification signal.
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Extratos Celulares/farmacologia , Glomérulos Renais/citologia , Ativação Linfocitária/efeitos dos fármacos , Extratos de Tecidos/farmacologia , Animais , Cicloeximida/farmacologia , Temperatura Alta , Interleucina-1/análise , Cinética , Masculino , Camundongos , Timidina/metabolismo , Tripsina/metabolismoRESUMO
To determine the effect of activation of the reticuloendothelial system on the localization of immune complexes in the kidney, a model of passive serum sickness nephritis in the mouse was used, with activation of the reticuloendothelial system with Corynebacterium parvum. Groups of mice, control and C. parvum-treated animals, were injected with BSA-125I-anti-BSA complexes containing 3 mg 125I-anti-BSA. Blood was obtained at 5 min, at 3 h, and at 12 h, when the animals were killed. Blood concentrations of BSA-125I-anti-BSA complexes were reduced in C. parvum-treated animals compared with controls. This appeared to be mediated by two effects, increased uptake of complexes in the liver and spleen, and enhanced degradation of immune complexes as measured by TCA-soluble radioactivity. In vitro studies using cultures of peritoneal macrophages also showed enhanced uptake of immune complexes. The amount of immune complexes deposited in the glomeruli of C. parvum-treated animals was reduced as determined by quantitation of radiolabeled material bound to isolated gomeruli and by immunofluorescence techniques. The results of the study emphasize the role of the reticuloendothelial system in the modulation of immune complex localization in the kidney and suggest a potential use of stimulants of the reticuloendothelial system in the therapy of immune complex nephritis.
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Complexo Antígeno-Anticorpo , Doenças do Complexo Imune/imunologia , Glomérulos Renais/imunologia , Sistema Fagocitário Mononuclear/fisiopatologia , Animais , Feminino , Fígado/imunologia , Macrófagos/imunologia , Camundongos , Fagocitose , Baço/imunologiaRESUMO
To assess the role of circulating immune complexes in the pathogenesis of acute rejection, sera were measured for such complexes by the (125)I-C1(q) binding assay in 45 normal subjects, 24 allografted patients undergoing acute rejection, and in 11 allografted patients in a quiescent phase. Increased C1(q)-binding activity (C1(q)-BA) was detected in 14 patients with acute rejection, 9 of whom had renal biopsies showing fibrin deposition in the vasculature together with cellular infiltrates in the tubulo-interstitial structures; renal histology was not available in the other 5 patients. The other 10 patients with acute rejection, whose biopsies showed only cellular infiltrates, and the 11 patients in a quiescent phase posttransplantation did not have increased levels of serum C1(q)-BA. Of the group with increased serum C1(q)-BA, serial studies in eight patients showed a correlation between increased serum C1(q)-BA and the occurrence of rejection; with reversal by therapy, serum C1(q)-BA returned to within normal levels. Complexes from six patients were analyzed by sucrose density gradient ultracentrifugation to have sedimentation coefficients ranging from 15S to 18.4S. After acid dissociation and analysis by double-diffusion techniques, C1(q)-reactive complexes were shown to contain IgG. Immunofluorescent studies done in five renal biopsies from this group revealed granular deposits of immunoglobulin, and (or) less frequently, of complement in the glomeruli or the tubular basement membranes. The findings suggest that circulating immune complexes may mediate the type of acute rejection characterized by fibrin deposition in the kidney. The role of circulating immune complexes arising from the recipient's original kidney disease could be excluded in 10 patients with humoral rejection, inasmuch as the underlying renal pathology was of a "nonimmunologic" nature; this was corroborated by sequential studies in six patients in whom circulating immune complexes could not be demonstrated before rejection. The participation of administered antilymphocyte globulin (ALG) as an antigen also appears to be excluded in four patients, two who were not given ALG, and in two of whom episodes of rejection occurred unrelated temporally to ALG administration.
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Complexo Antígeno-Anticorpo , Rejeição de Enxerto , Transplante de Rim , Proteína C-Reativa/metabolismo , Fibrina/análise , Imunofluorescência , Humanos , Rim/análise , Rim/patologia , Microscopia de Fluorescência , Ligação Proteica , Ensaio Radioligante , Transplante HomólogoRESUMO
BACKGROUND AND PURPOSE: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion. MATERIALS AND METHODS: In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization. RESULTS: Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery (P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery. CONCLUSIONS: Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.
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Encéfalo/irrigação sanguínea , Revascularização Cerebral/métodos , Circulação Cerebrovascular , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Arteriosclerose Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/cirurgia , Perfusão , Estudos ProspectivosRESUMO
BACKGROUND AND PURPOSE: Encephaloduroarteriosynangiosis has been shown to generate collateral vessels from the extracranial-to-intracranial circulation in patients with Moyamoya disease and intracranial arterial steno-occlusive disease. The mechanisms involved are not well-understood. We hypothesized that angiogenesis is the leading mechanism forming collaterals after encephaloduroarteriosynangiosis because there are no pre-existing connections. Angiogenesis-generated collaterals should exhibit higher architectural complexity compared with innate collaterals. MATERIALS AND METHODS: Pre- and postoperative digital subtraction angiograms were analyzed in patients enrolled in a prospective trial of encephaloduroarteriosynangiosis surgery. Branching angioscore, tortuosity index, and local connected fractal dimension were compared between innate and postoperative collaterals. RESULTS: One hundred one angiograms (50 preoperative, 51 postoperative) were analyzed from 44 patients (22 with intracranial atherosclerosis and 22 with Moyamoya disease). There was a significantly higher median branching angioscore (13 versus 4, P < .001) and a lower median tortuosity index (1.08 versus 1.76, P < .001) in the encephaloduroarteriosynangiosis collaterals compared with innate collaterals. Higher mean local fractal dimension peaks (1.28 ± 0.1 versus 1.16 ± 0.11, P < .001) were observed in the encephaloduroarteriosynangiosis collaterals compared with innate collaterals for both intracranial atherosclerosis (P < .001) and Moyamoya disease (P < .001) groups. The observed increase in high connectivity was greater in the intracranial atherosclerosis group compared with patients with Moyamoya disease (P = .01). CONCLUSIONS: The higher median branching angioscore and local connected fractal dimension, along with the lower median tortuosity index of encephaloduroarteriosynangiosis collaterals, are consistent with the greater complexity observed in the process of sprouting and splitting associated with angiogenesis.
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Angiografia Digital/métodos , Arteriopatias Oclusivas/patologia , Doenças Arteriais Cerebrais/patologia , Neovascularização Patológica/patologia , Neovascularização Fisiológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/cirurgia , Aterosclerose/patologia , Angiografia Cerebral , Doenças Arteriais Cerebrais/cirurgia , Criança , Circulação Colateral , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/patologia , Estudos Prospectivos , Adulto JovemRESUMO
The goal of this open-label trial was to examine the efficacy and safety of a 12-week omega-3 fatty acids supplementation among children suffering with Autism Spectrum Disorders (ASD). A total of 41 children and adolescents aged 7-18 years (36 boys, 5 girls; mean age = 11.66, s.d. = 3.05) diagnosed with ASD participated in the study. At post-treatment, participants showed significant improvements on all subscales of the Social Responsiveness Scale (P < 0.01) and the Social and Attention Problems syndrome scales of the Child Behavior Checklist (P < 0.05). Blood fatty acid levels were significantly correlated with changes in the core symptoms of ASD. Baseline levels of blood fatty acid levels were also predictive of response to the omega-3 treatment. Omega-3 fatty acids supplementation was well-tolerated and did not cause any serious side effects. Our findings lend some preliminary support for the use of omega-3 fatty acids supplementation in addressing ASD. Future randomized controlled trials of omega-3 fatty acids in ASD with blood fatty acid measurements with a larger sample and longer follow-up period is warranted.
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Transtorno do Espectro Autista/tratamento farmacológico , Suplementos Nutricionais , Ácidos Graxos Ômega-3/uso terapêutico , Adolescente , Atenção , Transtorno do Espectro Autista/sangue , Transtorno do Espectro Autista/psicologia , Escala de Avaliação Comportamental , Criança , Ácidos Graxos/sangue , Feminino , Humanos , Masculino , Projetos Piloto , Singapura , Resultado do TratamentoRESUMO
The influence of the serotonin (5-HT) system on the release of immunoreactive substance P after electrical stimulation of the lower incisor pulp was examined by perfusion of the superficial layers of the subnucleus caudalis of the brain stem trigeminal sensory nuclear complex of rabbits in situ. Increased release of immunoreactive substance P was observed after electrical stimulation of the pulp at 40 V. Stimulation of the nucleus raphe magnus significantly increased the release of 5-HT and completely inhibited the release of immunoreactive substance P, evoked by stimulation of the tooth pulp. Local application of 5-HT (10(-6) M) inhibited the release of immunoreactive substance P induced by stimulation and this inhibition was antagonized by methysergide (10(-4) M) applied concomitantly to the superficial layers of the trigeminal nucleus. These results suggest a functional interaction between substance P and 5-HT in the superficial layers of the trigeminal nucleus for regulation of transmission of dental pain.
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Polpa Dentária/inervação , Serotonina/fisiologia , Substância P/fisiologia , Núcleos do Trigêmeo/fisiologia , Animais , Estimulação Elétrica/métodos , Masculino , Metisergida/farmacologia , Coelhos , Núcleos da Rafe/fisiologia , Serotonina/farmacologia , Substância P/antagonistas & inibidores , Núcleos do Trigêmeo/efeitos dos fármacosRESUMO
N-ethyl-2-(1-ethyl-2-hydroxy-2-nitrosohydrazino)-ethanamine (NOC12), a nitric oxide donor, 3-morpholinosydnonimine (SIN-1), a generator of peroxynitrite (ONOO-), and peroxynitrite induced cell death accompanied by DNA fragmentation in human neuroblastoma SH-SY5Y cell cultures. Morphine prevented the cell death induced by SIN-1 or peroxynitrite, but not that induced by NOC12. The protective effect of morphine was concentration-dependent (10-100 microM), but was not antagonized by naloxone. The selective ligands for opioid receptor subtypes, [D-Ala2, N-Me-Phe4, Gly-ol5]enkephalin (DAMGO, micro-opioid receptor agonist), [D-Pen2,5]enkephalin (DPDPE, delta-opioid receptor agonist) and trans-(+/-)-3,4-dichloro-N-methyl-N-(2-[1-pyrrolidinyl]-cyclohexyl)benze neacetamide (U-50488, kappa-opioid receptor agonist) even at the concentration of 100 microM did not prevent the cell death induced by SIN-1. From measurement of the absorbance spectrum of peroxynitrite, the decomposition of peroxynitrite in 0.25 M potassium phosphate buffer (pH 7.4) was very rapid and complete within seconds. However, the absorbance was very stable in the presence of morphine. In addition, morphine inhibited peroxynitrite-induced nitration of tyrosine in a concentration-dependent manner. These results indicate that morphine rapidly reacts with peroxynitrite. The present study showed that morphine prevented peroxynitrite-induced cell death through its direct scavenging action, suggesting that morphine can protect cells against damage caused by peroxynitrite.
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Morte Celular , Morfina/farmacologia , Neuroblastoma/patologia , Nitratos/farmacologia , Interações Medicamentosas , Humanos , Morfina/metabolismo , Neuroblastoma/metabolismo , Nitratos/antagonistas & inibidores , Nitratos/metabolismo , Óxido Nítrico/farmacologia , Receptores Opioides delta/biossíntese , Receptores Opioides kappa/biossíntese , Receptores Opioides mu/biossíntese , Células Tumorais CultivadasRESUMO
The effect of (D-Ala, D-Leu) enkephalin (DADLE) on the binding of GTP in hippocampal preparations was studied. It was observed that treatment of hippocampal slices with 10(-5) -5 x 10(-5) M DADLE followed by the preparation of membrane fractions reduced the binding of 35S-GTP-gamma-S. There was no change in the affinity of the binding. This decrease of 35S-GTP-gamma-S binding was reversed when 5 x 10(-5) M naltrindole was included. The effect was not observed when the membrane fractions were incubated with DADLE. Photoaffinity labeling with the use of 32P P3-(4-azidoanilido)-P1 5'-GTP followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography revealed the incorporation of radioactivity into molecular mass of the 43 kDa and 33-34 kDa proteins. 32P Photolabeling of both the 43 kDa and 33-34 kDa bands decreased following treatment of hippocampal slices with 10(-4) M DADLE. These results suggested that DADLE reduces the GDP-GTP exchange in hippocampal membranes.
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Leucina Encefalina-2-Alanina/farmacologia , Proteínas de Ligação ao GTP/metabolismo , Guanosina 5'-O-(3-Tiotrifosfato)/metabolismo , Hipocampo/efeitos dos fármacos , Naltrexona/análogos & derivados , Marcadores de Afinidade , Animais , Autorradiografia , Azidas/metabolismo , Eletroforese em Gel de Poliacrilamida , Guanosina Trifosfato/análogos & derivados , Guanosina Trifosfato/metabolismo , Hipocampo/metabolismo , Técnicas In Vitro , Indóis/farmacologia , Masculino , Membranas/efeitos dos fármacos , Membranas/metabolismo , Morfinanos/farmacologia , Ratos , Ratos Sprague-DawleyRESUMO
Twenty-five cases of lumbar spinal canal stenosis were investigated by dynamic myeloscopy to explain the pathophysiologic mechanism of intermittent claudication, one of the characteristic signs of the disorder. Myeloscopic examination revealed that, in accordance with postural alteration, the diameter of blood vessels on the cauda equinae showed significant changes in many patients in the stenosis group, but showed no changes in control group. In this series, it was suggested that the microcirculatory disturbance of vessels on cauda equinae might play an important role in the development of intermittent claudication.
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Endoscopia , Claudicação Intermitente/etiologia , Estenose Espinal/diagnóstico , Adulto , Idoso , Cauda Equina/irrigação sanguínea , Espaço Epidural/irrigação sanguínea , Feminino , Humanos , Claudicação Intermitente/fisiopatologia , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Estenose Espinal/complicaçõesRESUMO
STUDY DESIGN: Isokinetically measured muscle strength of the trunk and lower extremities was analyzed. OBJECTIVES: The causes of the weak trunk muscle strength of subjects with low back pain were studied. SUMMARY OF BACKGROUND DATA: Although it is a commonly accepted conclusion that subjects with low back pain have weaker trunk muscles than the normal population, there are no reports concerning muscle strength of the lower extremities in subjects with low back pain. METHODS: Ninety-eight male volunteers were divided into control groups and groups with low back pain. The total trunk strength and total knee strength were defined as the sum of the peak torques of trunk extension, flexion and rotation, and of bilateral knee extension and flexion, respectively. RESULTS: The total trunk and knee strength in the group with low back pain (281 +/- 170 and 301 +/- 132 Nm) were significantly lower than in the control group (543 +/- 124 and 441 +/- 123 Nm). The total trunk and knee strength were linearly correlated in both groups (r = 0.67 and 0.79). CONCLUSIONS: In the group with low back pain, the muscles of the trunk and the lower extremities were similarly affected; this can be attributed to generalized muscular weakness or psychologic factors, such as fear of injury.
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Perna (Membro)/fisiopatologia , Dor Lombar/fisiopatologia , Músculo Esquelético/fisiopatologia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Contração MuscularRESUMO
BACKGROUND AND OBJECTIVES: Hypothermia is likely to develop faster during spinal anesthesia than epidural anesthesia. A natural consequence of the rapid temperature decrease during spinal anesthesia is that the shivering threshold will be reached sooner and that more shivering will be required to prevent further hypothermia. We tested the hypotheses that the onset of hypothermia is more rapid and the onset and intensity of shivering earlier during spinal than epidural anesthesia. METHODS: Patients undergoing cesarean delivery were randomly assigned to spinal anesthesia or epidural anesthesia. Spinal anesthesia was induced by injecting 2 mL 0.5% dibucaine into the L4-L5 interspace. Epidural anesthesia was induced with 20 mL 2% mepivacaine injected into the L2-L3 interspace. Thermal comfort and shivering were scored by a blinded observer. RESULTS: Fifteen patients given each type of anesthesia had upper sensory levels > or =T4 dermatome. Sensation was entirely absent from the leg during spinal anesthesia, but lower block levels were near S5 during epidural anesthesia. Tympanic membrane temperatures initially decreased faster during spinal anesthesia, but subsequently decreased at a rate of 0.5 degrees C/h in both groups. The onset and incidence of shivering (detected qualitatively) did not differ significantly between the two groups, but shivering intensity was significantly reduced during spinal anesthesia. Furthermore, the shivering thresholds were 36.4+/-0.3 degrees C (mean+/-SD) during spinal anesthesia versus 37.1+/-0.4 degrees C in those given epidural anesthesia (P=.006). There were no clinically important differences in thermal comfort with the two kinds of neuraxial anesthesia. CONCLUSIONS: We failed to confirm our hypothesis, but for an unexpected reason: Thermoregulation was impaired more by spinal anesthesia than epidural anesthesia. It seems likely that in our patients spinal anesthesia inhibited thermoregulatory control more than epidural anesthesia because it better blocked sensory input from the legs.
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Anestesia Epidural , Raquianestesia , Regulação da Temperatura Corporal/fisiologia , Cesárea , Adulto , Anestesia Obstétrica , Anestésicos Locais/farmacologia , Dibucaína/farmacologia , Feminino , Humanos , Mepivacaína/farmacologia , Gravidez , Estremecimento/fisiologiaRESUMO
In order to clarify the phase relationship between velocity pulse and pressure pulse propagating along microvessels, the red cell velocity and intravascular pressure were simultaneously measured in the rat pial arterioles of 41-53 microm in diameter with a high temporal resolution by a laser-Doppler anemometer and a servo-null micropressure system. It was found that the velocity pulse preceded the pressure pulse in all the measured arterioles by 18.7-35.6 ms. The corresponding phase difference was 43.6+/-6.9 degrees (mean +/- SD), which is not statistically different from 45 degrees. The value is consistent with the phase difference predicted for the blood flow in microvessels with a small reflection coefficient at frequencies as low as the heart rate of the rats. The present results suggest that the upstream changes in blood flow are transmitted by the velocity pulse faster than by the pressure pulse in the microvasculature.
Assuntos
Encéfalo/irrigação sanguínea , Eritrócitos/fisiologia , Animais , Arteríolas , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Fluxometria por Laser-Doppler , Masculino , Fluxo Pulsátil , RatosRESUMO
A survey was carried out into white line disease in 1781 Thoroughbred racehorses kept in stables at the Japan Racing Association (JRA) Miho Training Center (MTC) September-October 1996. The survey was conducted while horses were being shod by farriers. The horses that still exhibited damaged white lines after regular trimming were diagnosed as having white line disease. The factors recorded were age, sex, number of diseased horses, number of diseased hooves, number of lesions by region over the bearing border of the hoof and the classified length of such lesions. The percentage of total diseased horses was 11.5% (204 animals), with incidence increasing significantly with age (P< or =0.01). Occurrence was independent of sex (P>0.05) was more frequent in the fore- than in the hindhoof and developed more frequently at the toe than at any other region of the forehoof-bearing border. Most lesions ranged from 20 to 30 mm in length.