Articles: function.
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Arch Phys Med Rehabil · Nov 2013
Comparative StudyWalking ability and quality of life in subjects with transfemoral amputation: a comparison of osseointegration with socket prostheses.
To investigate walking ability and quality of life of osseointegrated leg prostheses compared with socket prostheses. ⋯ Osseointegration is a suitable intervention for persons whose prosthesis use is reduced because of socket-related problems. Subjects with OIP significantly increased their walking ability and prosthesis-related quality of life.
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Obesity confers a survival advantage in the critically ill and in patients undergoing cardiac surgery. We explored whether an obesogenic high fat diet could confer protection against post cardiopulmonary bypass (CPB) acute kidney injury (AKI) in a swine model. ⋯ A high fat diet promoted obesity and renal inflammation and prevented post CPB AKI in swine. This study provides insights into the obesity paradox and the failure of anti-inflammatory interventions to improve clinical outcomes in patients at risk of post cardiac surgery AKI.
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Modulation of L-type Ca(2+)-channel function by dopamine is a major determinant of the rate of action potential firing by striatal medium spiny neurons (MSNs). However, the role of these channels in modulating GABA release by nerve terminals in the basal ganglia is unknown. We found that depolarization induced [(3)H]GABA release in both the substantia nigra reticulata and the external globus pallidus, was depressed by about 50% by either the selective L-channel dihydropiridine blocker nifedipine or the P/Q channel blocker ω-agatoxin TK. ⋯ In the globus pallidus nifedipine blocked the effects of D2 and A2A receptor coactivation as well as the effects of activating adenylyl cyclase with forskolin. ω-agatoxin TK did not interfere with the action of these modulatory agents. The L-type Ca(2+)-channel agonist BAYK 8644 stimulated GABA release in both substantia nigra reticulata and globus pallidus. Because dihydropiridine sensitivity is a key criteria to identify L-type Ca(2+)-channel activity, our results imply that these channels are determinant of GABA release modulation by dopamine in striatonigral, striatopallidal and pallidonigral terminals.
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Failure of a double-lumen endotracheal tube (DLT) to isolate the lung during thoracic surgery can have significant consequences. In this report, we examine an approach for rescuing a malpositioned DLT. ⋯ A 7-Fr Arndt bronchial blocker was positioned through the tracheal lumen of the DLT to obtain 1-lung ventilation. This technique can be used to rescue a malfunctioning DLT without the need for extubating and reintubating the trachea.
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Total hip and knee arthroplasty (THA and TKA) are frequently performed surgical procedures with excellent long-term functional outcomes. However, pain is pronounced in the early post-operative phase, especially after TKA. Glucocorticoids have proven to relieve post-operative pain, but a higher dose might be needed, as compared with the lower dose recommended to reduce post-operative nausea and vomiting (PONV). Prior to this PhD study, procedure-specific data were limited on the effects of high-dose glucocorticoid on post-operative pain and recovery in THA and TKA. So, the following question remained to be answered: does high-dose glucocorticoid added to a multimodal analgesic regime reduce pain and improve recovery after THA and TKA? ⋯ This PhD thesis render new knowledge by demonstrating - for the first time - detailed procedure-specific beneficial effects of a single pre-operative dose of MP, 125 mg IV, on acute post-operative analgesia in THA, and on acute post-operative analgesia and on other immediate recovery aspects in TKA. Noteworthy, these benefits were observed with MP added to a comprehensive multimodal oral analgesic regime consisting of paracetamol, celecoxib and gabapentin - and in TKA also to an intra-operative local infiltration analgesia regimen. However, current data in hip and knee surgery preclude firm safety conclusions, and call for large-scale studies to definitively clarify the risk-benefit ratio, before final recommendations can be made. Also, the shortage of dose-finding data calls for studies to define the minimal effective dose to provide post-operative analgesia.