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1.
Arthroscopy ; 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38331370

RESUMO

PURPOSE: To determine the most common indications for lateral extra-articular tenodesis (LET) augmentation of anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures. RESULTS: A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%). CONCLUSIONS: Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind. LEVEL OF EVIDENCE: Level I to IV, systematic review of studies.

2.
Kans J Med ; 16: 272-276, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37954883

RESUMO

Introduction: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration. Methods: A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure. Results: The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported. Conclusions: This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use.

3.
Support Care Cancer ; 31(1): 63, 2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36534177

RESUMO

In non-cancer populations, inorganic dietary nitrate (NO3-) supplementation is associated with enhanced cardiorespiratory function but remains untested in patients with a history of cancer. Therefore, this pilot study sought to determine if oral NO3- supplementation, as a supportive care strategy, increases left ventricular (LV) function and exercise performance in survivors of cancer treated with anticancer therapy while simultaneously evaluating the feasibility of the methods and procedures required for future large-scale randomized trials. Two cohorts of patients with a history of cancer treated with anticancer chemotherapy were recruited. Patients in cohort 1 (n = 7) completed a randomized, double-blind, crossover study with 7 days of NO3- or placebo (PL) supplementation, with echocardiography. Similarly, patients in cohort 2 (n = 6) received a single, acute dose of NO3- supplementation or PL. Pulmonary oxygen uptake (VO2), arterial blood pressure, and stroke volume were assessed during exercise. In cohort 1, NO3- improved LV strain rate in early filling (mean difference (MD) [95% CI]: - 0.3 1/s [- 0.6 to 0.06]; P = 0.04) and early mitral septal wall annular velocity (MD [95% CI]: 0.1 m/s [- 0.01 to - 0.001]; P = 0.02) compared to placebo. In cohort 2, NO3- decreased the O2 cost of low-intensity steady-state exercise (MD [95% CI]: - 0.5 ml/kg/min [- 0.9 to - 0.09]; P = 0.01). Resting and steady-state arterial blood pressure and stroke volume were not different between conditions. No differences between conditions for peak VO2 (MD [95% CI]: - 0.7 ml/kg/min [- 3.0 to 1.6]; P = 0.23) were observed. The findings from this pilot study warrant further investigation in larger clinical trials targeting the use of long-term inorganic dietary NO3- supplementation as a possible integrative supportive care strategy in patients following anticancer therapy.


Assuntos
Sobreviventes de Câncer , Neoplasias , Humanos , Nitratos , Projetos Piloto , Estudos Cross-Over , Suplementos Nutricionais , Método Duplo-Cego , Consumo de Oxigênio/fisiologia
4.
Appl Physiol Nutr Metab ; 45(6): 613-620, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31725319

RESUMO

High dietary sodium intake is a risk factor for arterial hypertension; given that the ability to overcome sympathetically mediated vasoconstriction (functional sympatholysis) is attenuated in individuals with hypertension, we investigated the cardiovascular responses to high salt (HS) intake in healthy humans. We hypothesized that a HS intake of 15 g/day for 7 days would attenuate functional sympatholysis and augment the blood pressure response to handgrip exercise (HGE). Thirteen participants (6 males, 7 females) underwent 2 individual days of testing. Beat-by-beat blood pressure and heart rate were recorded throughout the trial on the non-exercising limb. Forearm blood flow was derived from ultrasonography on the brachial artery of the exercising limb. Participants then underwent a flow-mediated dilation (FMD) test. Next, a submaximal HGE was performed for 7 min with lower body negative pressure initiated during minutes 5-7. A single spot urine sample revealed a significant increase in sodium excretion during the HS conditions (p < 0.01). FMD was reduced during the HS condition. Mean arterial pressure was significantly higher during HS intake. No alteration to functional sympatholysis was found between conditions (p > 0.05). In summary, HS intake increases blood pressure without impacting functional sympatholysis or blood pressure responsiveness during HGE. These findings indicate that brachial artery dysfunction precedes an inefficient functional sympatholysis. Novelty Functional sympatholysis was not impacted by 1 week of high sodium intake. High sodium intake augmented the rate pressure product during handgrip exercise in healthy humans.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Exercício Físico/fisiologia , Força da Mão/fisiologia , Sódio na Dieta/farmacologia , Adolescente , Adulto , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão , Masculino , Adulto Jovem
5.
Med Sci Sports Exerc ; 51(5): 1014-1021, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30531488

RESUMO

INTRODUCTION: the aim of the current investigation was to examine if dietary nitrate supplementation would improve vascular control in hypertensive postmenopausal women (PMW). We tested the hypotheses that acute dietary nitrate supplementation would 1) significantly decrease arterial blood pressure (BP) at rest and during exercise, 2) increase limb blood flow during steady-state (SS) exercise, and 3) improve functional sympatholysis during SS exercise. METHODS: Ten hypertensive PMW underwent a randomized, double-blind, placebo-controlled trial with a nitrate-rich (NR) or nitrate-poor (NP) supplement. Beat-by-beat BP and heart rate were recorded throughout the trial on the nonexercising limb. Forearm blood flow was measured via ultrasonography on the brachial artery of the exercising limb. All patients performed a resting cold pressor test (CPT) (2 min) and then 7 min of submaximal handgrip exercise with a CPT applied during minutes 5-7. RESULTS: SS systolic (NR, 170 ± 7; NP, 171 ± 37 mm Hg), diastolic (NR, 89 ± 2; NP, 92 ± 2 mm Hg), and mean arterial (NR, 121 ± 4; NP, 123 ± 2 mm Hg) pressures were not different between NP and NR treatment conditions (P > 0.05). During SS exercise, forearm blood flow (NR, 189 ± 8; NP, 218 ± 8 mL·min; P = 0.03) in the NR treatment was significantly lower compared with NP. When the CPT was applied during minutes 6-7 of exercise, forearm vascular conductance was reduced by 15% in the NR condition, but only 7% in the NR condition. CONCLUSIONS: In summary, an acute NR supplement improved functional sympatholysis by ~50% versus an NP placebo condition. Improvements in functional sympatholysis may have important implications regarding exercise tolerance in hypertensive PMW.


Assuntos
Suplementos Nutricionais , Exercício Físico , Hipertensão , Nitratos/administração & dosagem , Beta vulgaris , Pressão Sanguínea , Artéria Braquial , Estudos Cross-Over , Método Duplo-Cego , Tolerância ao Exercício , Feminino , Antebraço/irrigação sanguínea , Sucos de Frutas e Vegetais , Força da Mão , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Nitritos/sangue , Pós-Menopausa
6.
Physiol Rep ; 6(23): e13933, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30511427

RESUMO

Increasing the relaxation phase of the contraction-relaxation cycle will increase active skeletal muscle blood flow ( Q˙m ). However, it remains unknown if this increase in Q˙m alters the vasoconstriction responses in active skeletal muscle. This investigation determined if decreasing mechanical impedance would impact vasoconstriction of the active skeletal muscle. Eight healthy men performed rhythmic handgrip exercise under three different conditions; "low" duty cycle at 20% maximal voluntary contraction (MVC), "low" duty cycle at 15% MVC, and "high" duty cycle at 20% MVC. Relaxation time between low and high duty cycles were 2.4 sec versus 1.5 sec, respectively. During steady-state exercise lower body negative pressure (LBNP) was used to evoke vasoconstriction. Finger photoplethysmography and Doppler ultrasound derived diameters and velocities were used to measure blood pressure, forearm blood flow (FBF: mL min-1 ) and forearm vascular conductance (FVC: mL min-1  mmHg) throughout testing. The low duty cycle increased FBF and FVC versus the high duty cycle under steady-state conditions at 20% MVC (P < 0.01). The high duty cycle had the greatest attenuation in %ΔFVC (-1.9 ± 3.8%). The low duty cycle at 20% (-13.3 ± 1.4%) and 15% MVC (-13.1 ± 2.5%) had significantly greater vasoconstriction than the high duty cycle (both: P < 0.01) but were not different from one another (P = 0.99). When matched for work rate and metabolic rate ( V˙O2 ), the high duty cycle had greater functional sympatholysis than the low duty cycle. However, despite a lower V˙O2 , there was no difference in functional sympatholysis between the low duty cycle conditions. This may suggest that increases in Q˙m play a role in functional sympatholysis when mechanical compression is minimized.


Assuntos
Força da Mão , Relaxamento Muscular , Músculo Esquelético/fisiologia , Condicionamento Físico Humano/métodos , Vasoconstrição , Adulto , Metabolismo Basal , Humanos , Contração Isométrica , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/metabolismo , Consumo de Oxigênio , Distribuição Aleatória
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