- Manometric recordings bring out post-stimulus refractory states in the anal canal in neonates. [Journal Article]
- CPConf Proc IEEE Eng Med Biol Soc 2018; 2018:4889-4892
- Anorectal manometry is a diagnostic technique used to investigate the correct mechanical performance of the internal anal sphincter (IAS). By distending the rectal ampulla while recording changes in ...
Anorectal manometry is a diagnostic technique used to investigate the correct mechanical performance of the internal anal sphincter (IAS). By distending the rectal ampulla while recording changes in the luminal pressure, this method allows for characterizing the anorectal reflex. It can also provide, indirectly, information about the electrical activity of the IAS. In this study, seventeen neonates having 24-hour delayed passage of meconium or presenting distal intestinal obstruction symptoms underwent anorectal manometry to discard Hirschsprung's disease. All patients had normal anorectal reflex. The time delay between stimulation of the rectal ampulla and the relaxation of the anal canal was studied. The average period of the pressure fluctuations was 5.44 ± 0.13s. The overall duration of the relaxation time was 9.71 ± 0.21s. The maximum lag between the onset of the stimulus and the relaxation of the IAS was 2.90 s, and was achieved when the stimulus was applied following a local maximum of the pressure wave. The existence of a refractory period during the suprathreshold depolarization of smooth muscle cells can explain the evidence of a temporal delay between the stimulus and the mechanical response. In occasions, relaxation appeared first distally. This phenomenon can be explained by the arrangement and morphology of bipolar cells, which may evidence the anisotropic propagation of the mechanical activity. These data may contribute to depict the alterations in excitability underlying the relaxation reflex by means of manometric recording of the anal canal.
- Spinal cord stimulation ameliorates detrusor over-activity and visceromotor pain responses in rats with cystitis. [Journal Article]
- NUNeurourol Urodyn 2018 Nov 09
- CONCLUSIONS: SCS improved bladder function and EUS relaxation during bladder infusion and significantly attenuated visceral nociceptive-related VMR during IBD in cystitis rats. SCS may have therapeutic potential for patients with hyperalgesia and IC/PBS.
- Comparative Evaluation of Sevoflurane, Propofol, and Combination of Sevoflurane and Propofol on Insertion Characteristics of Reusable Classic Laryngeal Mask Airway. [Journal Article]
- AEAnesth Essays Res 2018 Apr-Jun; 12(2):386-391
- Adequate depth of anaesthesia is needed for successful placement LMA. under lighter plane of anaesthesia inadequate mouth opening,coughing,body movements can lead to rejection of LMA and may be assoc...
Adequate depth of anaesthesia is needed for successful placement LMA. under lighter plane of anaesthesia inadequate mouth opening,coughing,body movements can lead to rejection of LMA and may be associated with breath holding and bronchospasm. Use of propofol in doses which allow adequqate jaw relaxation and prevent patient reaction to LMA commonly results in hypotension and prolonged apnoea. Apart from minimal respiratory irritant properties sevoflurane as compared to propofol has the advantage of providing better hemodynamic stability and a smoother transition to the maintainance phase without a period of apnea. However sevoflurane is associated with delayed jaw relaxation and a longer time for the insertion of the LMA.Our hypothesis is that induction of anaesthesia with the combination of sevoflurane and small dose of propofol may optimize the insertion conditions of LMA and decrease the side effects of individual drugs.
- Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report. [Journal Article]
- SCSurg Case Rep 2018 Jun 08; 4(1):54
- CONCLUSIONS: Patients with head and neck cancer are at risk for developing Boerhaave syndrome during CRT. In addition, since such patients often are in poor overall condition because of immunosuppression and protracted wound healing, Boerhaave syndrome can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
- The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine. [Journal Article]
- JBJ Biomech 2018 Apr 27; 72:152-158
- Occupations that involve sustained or repetitive neck flexion are associated with a higher incidence of neck pain. Little in vivo information is available on the impact of static neck flexion on cerv...
Occupations that involve sustained or repetitive neck flexion are associated with a higher incidence of neck pain. Little in vivo information is available on the impact of static neck flexion on cervical spinal tissue. The aim of this study was to assess changes in mechanical and neuromuscular behaviors to sustained neck flexion in healthy adults. Sixty healthy subjects aged 20-35 years participated in this study. The participants were exposed to static neck flexion at a fixed angle of full flexion for 10 min. Mechanical and neuromuscular responses of the cervical spine to sudden perturbations were measured pre- and post-exposure. Magnitude of load-relaxation during flexion exposure, stiffness, peak head angular velocity, and reflexive activities of cervical muscles were recorded. Effective neck stiffness decreased significantly, especially in female participants (P = 0.0001). The reflexive response of the cervical erector spinae muscles to head perturbation delayed significantly (P = 0.0001). Peak head angular velocity was significantly increased after exposure to neck flexion for 10 min, especially in female participants (P = 0.001). In the present study, static flexion resulted in changes in mechanical and neuromuscular behavior of the cervical spine, potentially leading to decreased stiffness of the cervical spine. The results confirm the importance of maintaining a correct head and neck position during work and improving the work environment to reduce the cervical spinal load and work-related neck pain.
- Prolonged-Release Oxycodone/Naloxone Improves Anal Sphincter Relaxation Compared to Oxycodone Plus Macrogol 3350. [Randomized Controlled Trial]
- DDDig Dis Sci 2017; 62(11):3156-3166
- CONCLUSIONS: Relaxation of the internal anal sphincter was significantly better after PR oxycodone/naloxone treatment compared to PR oxycodone plus macrogol 3350. These findings highlight that OIBD may require specific therapy against the complex, pan-intestinal effects of opioids.
- Van Wyk-Grumbach Syndrome with Kocher-Debré-Sémélaigne Syndrome: Case Report of a Rare Association. [Journal Article]
- ETEur Thyroid J 2017; 6(1):47-51
- CONCLUSIONS: VWGS and KDSS are rare presentations of juvenile hypothyroidism, and their association is even rarer. Early diagnosis and prompt replacement therapy can avoid unnecessary investigations and surgical interventions.
- Classification of Involuntary Movements in Dogs: Myoclonus and Myotonia. [Review]
- JVJ Vet Intern Med 2017; 31(4):979-987
- Myoclonus is a sudden brief, involuntary muscle jerk. Of all the movement disorders, myoclonus is the most difficult to encapsulate into any simple framework. On the one hand, a classification system...
Myoclonus is a sudden brief, involuntary muscle jerk. Of all the movement disorders, myoclonus is the most difficult to encapsulate into any simple framework. On the one hand, a classification system is required that is clinically useful to aid in guiding diagnosis and treatment. On the other hand, there is need for a system that organizes current knowledge regarding biological mechanisms to guide scientific research. These 2 needs are distinct, making it challenging to develop a robust classification system suitable for all purposes. We attempt to classify myoclonus as "epileptic" and "nonepileptic" based on its association with epileptic seizures. Myotonia in people may be divided into 2 clinically and molecularly defined forms: (1) nondystrophic myotonias and (2) myotonic dystrophies. The former are a group of skeletal muscle channelopathies characterized by delayed skeletal muscle relaxation. Many distinct clinical phenotypes are recognized in people, the majority relating to mutations in skeletal muscle voltage-gated chloride (CLCN1) and sodium channel (SCN4A) genes. In dogs, myotonia is associated with mutations in CLCN1. The myotonic dystrophies are considered a multisystem clinical syndrome in people encompassing 2 clinically and molecularly defined forms designated myotonic dystrophy types 1 and 2. No mutation has been linked to veterinary muscular dystrophies. We detail veterinary examples of myotonia and attempt classification according to guidelines used in humans. This more precise categorization of myoclonus and myotonia aims to promote the search for molecular markers contributing to the phenotypic spectrum of disease. Our work aimed to assist recognition for these 2 enigmatic conditions.
- Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants. [Journal Article]
- AJAm J Physiol Gastrointest Liver Physiol 2016 Jun 01; 310(11):G1006-14
- The pharynx is a locus of provocation among infants with aerodigestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis, and reflux, and such infants o...
The pharynx is a locus of provocation among infants with aerodigestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis, and reflux, and such infants often receive nasal respiratory support. We determined the impact of different oxygen delivery methods on pharyngeal stimulation-induced aerodigestive reflexes [room air (RA), nasal cannula (NC), and nasal continuous positive airway pressure (nCPAP)] while hypothesizing that the sensory motor characteristics of putative reflexes are distinct. Thirty eight infants (28.0 ± 0.7 wk gestation) underwent pharyngoesophageal manometry and respiratory inductance plethysmography to determine the effects of graded pharyngeal stimuli (n = 271) on upper and lower esophageal sphincters (UES, LES), swallowing, and deglutition-apnea. Comparisons were made between NC (n = 19), nCPAP (n = 9), and RA (n = 10) groups. Importantly, NC or nCPAP (vs. RA) had: 1) delayed feeding milestones (P < 0.05), 2) increased pharyngeal waveform recruitment and duration, greater UES nadir pressure, decreased esophageal contraction duration, decreased distal esophageal contraction amplitude, and decreased completely propagated esophageal peristalsis (all P < 0.05), and 3) similarly developed UES contractile and LES relaxation reflexes (P > 0.05). We conclude that aerodigestive reflexes were similarly developed in infants using noninvasive respiratory support with adequate upper and lower aerodigestive protection. Increased concern for GERD is unfounded in this population. These infants may benefit from targeted oromotor feeding therapies and safe pharyngeal bolus transit to accelerate feeding milestones.
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- Delayed grip relaxation and altered modulation of intracortical inhibition with aging. [Journal Article]
- EBExp Brain Res 2016; 234(4):985-95
- Grip relaxation is a voluntary action that requires an increase in short-interval intracortical inhibition (SICI) in healthy young adults, rather than a simple termination of excitatory drive. The wa...
Grip relaxation is a voluntary action that requires an increase in short-interval intracortical inhibition (SICI) in healthy young adults, rather than a simple termination of excitatory drive. The way aging affects this voluntary inhibitory action and timing of grip relaxation is currently unknown. The objective of this study was to examine aging-related delays in grip relaxation and SICI modulation for the flexor digitorum superficialis muscle during grip relaxation. The main finding was that young adults increased SICI to relax their grips, whereas older adults did not increase SICI with a prolonged grip relaxation time (p < 0.05 for both SICI modulation and grip relaxation time). A secondary experiment showed that both young and older adults did not change H reflex excitability during grip relaxation. Our data suggest that grip relaxation is mediated by increased cortical inhibitory output in young adults, and aging-related impairment in increasing cortical inhibitory output may hamper timely cessation of muscle activity. Our data also suggest a lesser role of the spinal circuits in grip muscle relaxation. This knowledge may contribute to understanding of aging-related movement deterioration and development of interventions for improving modulation of SICI to improve muscle relaxation and movement coordination.