Articles: function.
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Critical care medicine · May 2015
Inhibition of Forkhead BoxO-Specific Transcription Prevents Mechanical Ventilation-Induced Diaphragm Dysfunction.
Mechanical ventilation is a lifesaving measure for patients with respiratory failure. However, prolonged mechanical ventilation results in diaphragm weakness, which contributes to problems in weaning from the ventilator. Therefore, identifying the signaling pathways responsible for mechanical ventilation-induced diaphragm weakness is essential to developing effective countermeasures to combat this important problem. In this regard, the forkhead boxO family of transcription factors is activated in the diaphragm during mechanical ventilation, and forkhead boxO-specific transcription can lead to enhanced proteolysis and muscle protein breakdown. Currently, the role that forkhead boxO activation plays in the development of mechanical ventilation-induced diaphragm weakness remains unknown. ⋯ Forkhead boxO is necessary for the activation of key proteolytic systems essential for mechanical ventilation-induced diaphragm atrophy and contractile dysfunction. Collectively, these results suggest that targeting forkhead boxO transcription could be a key therapeutic target to combat ventilator-induced diaphragm dysfunction.
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Pain interventionists can interrupt pain through anesthetic blockade of neural transmission to virtually any part of the body. Temporary pain relief can be achieved by the direct application of targeted anesthetic. Diagnostically, nerve blocks help identify specific pain generators, refine differential diagnosis, and disrupt the neural transmission mechanisms to stop pain generation peripherally. ⋯ This study's results support the hypothesis that a combined interventional and cognitive motivational counseling treatment program can be effective in decreasing spine pain, reducing prescription pain medication use, and improving overall quality of life in chronic spine pain patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2015
[Perioperative heart failure - Acute intraoperative heart failure].
With respect to the fact that - with the notable exception of patients undergoing cardiac surgery - only sparse data and limited guideline recommendations on optimal treatment strategies in patients with intraoperative acute heart failure are available. Consecutively it is rather difficult to make clear suggestions for the optimal treatment of this complication. ⋯ Importantly, one has to to take into account that the use of beta-mimetic drugs for the treatment of acute heart failure is increasingly recognized as an isolated mortality factor. This suggests to use inotropes as restrictive as possible, and if inotropic treatment becomes inevitable, to use levosimendan as the only inotrope that has been shown to improve mortality in several meta-analyses.
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Randomized Controlled Trial
Intravenous parecoxib and continuous femoral block for postoperative analgesia after total knee arthroplasty. A randomized, double-blind, prospective trial.
Up until now, the optimal strategy for postoperative pain management after total knee arthroplasty (TKA) remains to be elucidated. ⋯ According to our findings intravenous parecoxib in combination with continuous femoral block provided superior analgesic efficacy and opioid sparing effects in patients undergoing TKA.