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Journal of Cataract and Refractive... Nov 2023To evaluate the impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction (SMILE) and laser in situ...
PURPOSE
To evaluate the impact of corrected refractive power on the corneal denervation and ocular surface in small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK).
SETTING
Singapore National Eye Center, Singapore.
DESIGN
Prospective study.
METHODS
88 eyes undergoing SMILE or LASIK were divided into low-moderate (manifest refractive spherical equivalent [MRSE] <-6.0 diopters [D]) and high myopic (MRSE ≥-6.0 D) groups. In vivo confocal microscopy and clinical assessments were performed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively.
RESULTS
In SMILE, high myopic treatment presented with significantly greater reduction in the corneal nerve fiber area (CNFA) and nerve fiber fractal dimension (CFracDim) compared with low-moderate myopic treatment (both P < .05). There was a significant and negative correlation between the corrected MRSE and the reduction in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length, CNFA, and CFracDim after SMILE (r = -0.38 to -0.66, all P < .05). In LASIK, a significant correlation between the MRSE and the changes in CNBD, corneal nerve fiber total branch density, CNFA (r = -0.37 to -0.41), and corneal nerve fiber width (r = 0.43) was observed (all P < .05). Compared with SMILE, LASIK had greater reduction in CNBD and CNFA for every diopter increase in the corrected MRSE. High myopic SMILE, compared with low-moderate myopic SMILE, resulted in significantly lower tear break-up time at 1 and 6 months (both P < .05). The changes in CNFA and CFracDim were significantly associated with Schirmer test values (both P < .001).
CONCLUSIONS
Postoperative corneal denervation was related to corrected refractive power in both SMILE and LASIK. With the same refractive correction, LASIK led to more prominent corneal denervation.
Topics: Humans; Keratomileusis, Laser In Situ; Corneal Stroma; Prospective Studies; Visual Acuity; Lasers, Excimer; Refraction, Ocular; Myopia; Denervation
PubMed: 37867284
DOI: 10.1097/j.jcrs.0000000000001278 -
BMC Pulmonary Medicine Nov 2023In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal... (Clinical Trial)
Clinical Trial Observational Study
PURPOSE
In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.
MATERIALS AND METHODS
Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012-2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12-36 months after renal denervation.
RESULTS
The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.
CONCLUSIONS
Although the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.
Topics: Humans; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Denervation; Hypertension; Kidney; Oxygen; Prospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 37996833
DOI: 10.1186/s12890-023-02757-1 -
BMC Anesthesiology Aug 2023Erector spinae plane block (ESPB) improves postoperative analgesia and significantly enhances the quality of recovery (QoR) after video-assisted thoracoscopic lobectomy... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of erector spinae plane block with different doses of dexmedetomidine as adjuvant for ropivacaine on the postoperative quality of recovery after video-assisted thoracoscopic lobectomy surgery: a randomized controlled trial.
BACKGROUND
Erector spinae plane block (ESPB) improves postoperative analgesia and significantly enhances the quality of recovery (QoR) after video-assisted thoracoscopic lobectomy surgery (VATLS). However, it is not known whether the use of dexmedetomidine (Dex) as an adjunct for ropivacaine to ESPB affects the QoR after VATLS. The purpose of this study was to explore the effects of different Dex dosages as an adjunct for ropivacaine in combination with ultrasound-guided ESPB on the quality of postoperative recovery in patients with VATLS.
METHODS
In this single-center, double-blind, randomized study, 120 patients between the ages of 18 and 65 who were scheduled for VATLS from december 2021 and october 2022 in our hospital under general anesthesia were randomly divided into three groups: ultrasound-guided ESPB with 30 mL of 0.5% ropivacaine (Group R), ultrasound-guided ESPB 0.5% ropivacaine plus 0.5 µg/kg Dex (Group RD1), and ultrasound-guided ESPB 0.5% ropivacaine plus 1.0 µg/kg Dex (Group RD2), ultrasound-guided ESPB was administrated at the T5 vertebral level before surgery. The primary outcome was the QoR-15 score 24 h after the surgery. The secondary outcomes included the QoR-15 scores at 12 h, 48 h, and 72 h after the operation, visual analogue scale (VAS) scores at 8 h, 12 h, 24 h, and 48 h after surgery, cumulative flurbiprofen consumption, postoperative nausea and vomiting (PONV), postoperative bradycardia, and hypotension.
RESULTS
The QoR-15 scores were higher in group RD2 than the R and RD1 groups on postoperative day 1 (P < 0.05), in addition, no significant difference was found in the QoR-15 scores between groups R and RD1 on postoperative day 1. The VAS scores were significantly lower in group RD2 than in groups RD1 and group R 12-24 h after surgery (P < 0.05). No significant differences were observed in the QoR-15 and VAS scores at 48 and 72 h after surgery between the three groups. The cumulative flurbiprofen consumption was markedly reduced during the 72 h after surgery in the RD2 group (P < 0.05). The incidence of postoperative nausea and vomiting was lower in the RD2 group (P < 0.05).
CONCLUSIONS
The combination of 1 µg/kg dexmedetomidine as an adjunct with 0.5% ropivacaine 30 ml for erector spinae plane block significantly improved the postoperative quality of recovery and provided better postoperative analgesia on postoperative day 1 in patients undergoing Video-assisted thoracoscopic lobectomy surgery. However, dexmedetomidine (1 µg/kg) as an adjunct for ropivacaine combined with erector spinae plane block did not enhance the postoperative quality of recovery at 48 and 72 h postoperatively.
TRIAL REGISTRY NUMBER
The number of this clinical trial registry is ChiCTR2100053230, date of registration: 16/11/ 2021).
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Ropivacaine; Dexmedetomidine; Thoracic Surgery, Video-Assisted; Pain, Postoperative; Flurbiprofen; Postoperative Nausea and Vomiting; Nerve Block; Ultrasonography, Interventional; Analgesics, Opioid
PubMed: 37550610
DOI: 10.1186/s12871-023-02231-9 -
Circulation Research Sep 2023The phrase complete vagal withdrawal is often used when discussing autonomic control of the heart during exercise. However, more recent studies have challenged this...
BACKGROUND
The phrase complete vagal withdrawal is often used when discussing autonomic control of the heart during exercise. However, more recent studies have challenged this assumption. We hypothesized that cardiac vagal activity increases during exercise and maintains cardiac function via transmitters other than acetylcholine.
METHODS
Chronic direct recordings of cardiac vagal nerve activity, cardiac output, coronary artery blood flow, and heart rate were recorded in conscious adult sheep during whole-body treadmill exercise. Cardiac innervation of the left cardiac vagal branch was confirmed with lipophilic tracer dyes (DiO). Sheep were exercised with pharmacological blockers of acetylcholine (atropine, 250 mg), VIP (vasoactive intestinal peptide; [4Cl-D-Phe6,Leu17]VIP 25 µg), or saline control, randomized on different days. In a subset of sheep, the left cardiac vagal branch was denervated.
RESULTS
Neural innervation from the cardiac vagal branch is seen at major cardiac ganglionic plexi, and within the fat pads associated with the coronary arteries. Directly recorded cardiac vagal nerve activity increased during exercise. Left cardiac vagal branch denervation attenuated the maximum changes in coronary artery blood flow (maximum exercise, control: 63.5±5.9 mL/min, n=8; cardiac vagal denervated: 32.7±5.6 mL/min, n=6, 2.5×10), cardiac output, and heart rate during exercise. Atropine did not affect any cardiac parameters during exercise, but VIP antagonism significantly reduced coronary artery blood flow during exercise to a similar level to vagal denervation.
CONCLUSIONS
Our study demonstrates that cardiac vagal nerve activity actually increases and is crucial for maintaining cardiac function during exercise. Furthermore, our findings show the dynamic modulation of coronary artery blood flow during exercise is mediated by VIP.
Topics: Animals; Sheep; Acetylcholine; Heart; Coronary Vessels; Cardiac Output; Atropine
PubMed: 37641938
DOI: 10.1161/CIRCRESAHA.123.323017 -
Ear, Nose, & Throat Journal Jun 2024Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with... (Review)
Review
INTRODUCTION
Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life. This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis.
METHODS
A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms.
RESULTS
The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms.
DISCUSSION
A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.
Topics: Humans; Synkinesis; Facial Paralysis; Facial Muscles; Quality of Life; Botulinum Toxins; Neuromuscular Agents; Denervation
PubMed: 34836457
DOI: 10.1177/01455613211054627 -
Actas Dermo-sifiliograficas Apr 2024Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system.... (Review)
Review
Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.
Topics: Adult; Child; Humans; Botulinum Toxins, Type A; Antiperspirants; Cholinergic Antagonists; Quality of Life; Prospective Studies; Sympathectomy; Hyperhidrosis
PubMed: 37714301
DOI: 10.1016/j.ad.2023.09.006 -
Radiology and Oncology Sep 2023A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided plane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB).
PATIENTS AND METHODS
A prospective randomized-control study was performed to compare outcomes of patients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h.
RESULTS
60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21. 64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups.
CONCLUSIONS
In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative complications, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.
Topics: Humans; Analgesics, Opioid; Intercostal Nerves; Prospective Studies; Nerve Block; Pain; Lung Neoplasms; Analgesia
PubMed: 37665743
DOI: 10.2478/raon-2023-0035 -
Journal of Cardiovascular Development... Aug 2023Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years,... (Review)
Review
Hypertension remains the leading cause of death worldwide. Despite advances in drug-based treatment, many patients do not achieve target blood pressure. In recent years, there has been an increased interest in invasive hypertension treatment methods. Long-term effects and factors affecting renal denervation effectiveness are still under investigation. Some investigators found that the renal arteries' morphology is crucial in renal denervation effectiveness. Accessory renal arteries occur in 20-30% of the population and even more frequently in patients with resistant hypertension. Diversity in renal vascularization and innervation may complicate the renal denervation procedure and increase the number of people who will not benefit from treatment. Based on previous studies, it has been shown that the presence of accessory renal arteries, and in particular, the lack of their complete denervation, reduces the procedure's effectiveness. The following review presents the anatomical assessment of the renal arteries, emphasizing the importance of imaging tests. Examples of imaging and denervation methods to optimize the procedure are presented. The development of new-generation catheters and the advancement in knowledge of renal arteries anatomy may improve the effectiveness of treatment and reduce the number of patients who do not respond to treatment.
PubMed: 37754800
DOI: 10.3390/jcdd10090371 -
Neurology India 2023
Topics: Humans; Muscle Spasticity; Denervation; Tibial Nerve
PubMed: 38174444
DOI: 10.4103/0028-3886.391337 -
Clinical Research in Cardiology :... Dec 2023Atrial fibrillation (AF) is the most common sustained arrhythmia which has been associated with increased sympathetic nervous system activity and hypertension. Recent...
BACKGROUND
Atrial fibrillation (AF) is the most common sustained arrhythmia which has been associated with increased sympathetic nervous system activity and hypertension. Recent evidence indicated that renal sympathetic denervation (RDN) could safely contribute to an improvement in AF burden.
OBJECTIVE
To investigate the long-term safety and efficacy of radiofrequency RDN in hypertensive patients with symptomatic AF.
METHODS
This pilot study included patients with symptomatic paroxysmal or persistent AF (European Hearth Rhythm Association class ≥ II) despite optimal medical therapy, office systolic blood pressure (BP) ≥ 140 mmHg and ≥ 2 antihypertensive drugs. AF burden was measured using an implantable cardiac monitor (ICM), implanted 3 months prior to RDN. ICM interrogation and 24-h ambulatory BP monitoring were performed at baseline and at 3/6/12/24/36 months post RDN. The primary efficacy outcome was daily AF burden. Statistical analyses were performed using Poisson and negative binomial models.
RESULTS
A total of 20 patients with a median age [25th-75th percentiles] of 66.2 [61.2-70.8] years (55% female) were included. At baseline, office BP ± standard deviation (SD) was 153.8/87.5 ± 15.2/10.4 mmHg, while mean 24-h ambulatory BP was 129.5/77.3 ± 15.5/9.3 mmHg. Baseline daily AF burden was 1.4 [0.0-10.9] minutes/day and throughout a 3-year follow-up period, no significant change was observed (- 15.4%/year; 95% confidence interval (CI) - 50.2%, + 43.7%; p = 0.54). The number of defined daily doses of antiarrhythmic drugs and antihypertensive drugs remained stable over time, while mean 24-h ambulatory systolic BP decreased with - 2.2 (95% CI - 3.9, - 0.6; p = 0.01) mmHg/year.
CONCLUSIONS
In patients with hypertension and symptomatic AF, stand-alone RDN reduced BP but did not significantly reduce AF burden up until 3 years of follow-up.
Topics: Humans; Female; Middle Aged; Aged; Male; Atrial Fibrillation; Antihypertensive Agents; Kidney; Pilot Projects; Treatment Outcome; Hypertension; Sympathectomy; Blood Pressure; Blood Pressure Monitoring, Ambulatory
PubMed: 37231258
DOI: 10.1007/s00392-023-02222-3