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Hypertension Research : Official... Feb 2022
Topics: Denervation; Kidney
PubMed: 34912048
DOI: 10.1038/s41440-021-00808-w -
Hypertension Research : Official... Dec 2023Renal denervation (RDN) is currently confronted with the considerable heterogeneity of different post-procedural blood pressure responses. The challenges predominantly... (Review)
Review
Renal denervation (RDN) is currently confronted with the considerable heterogeneity of different post-procedural blood pressure responses. The challenges predominantly arise from not only the lack of selection of appropriate responders but also the absence of detection for the successful endpoints of intervention. In this paper, we summarize the significant characteristics of potentially appropriate hypertensive patients and propose a hopeful way to improve the accuracy of RDN, that is, the application of three-dimensional reconstruction technology combined with electrical renal nerve stimulation to guide the radiofrequency catheter ablation, which may promote the development of selective and accurate RDN in real-world clinical practice. This paper focuses on two current critical concerns of renal denervation (RDN): appropriate patient selection and the improvement in the accuracy of selective RDN. A hopeful way of accurate RDN may be the combination of 3D electroanatomic mapping systems for the renal artery with modified renal nerve stimulation (RNS) techniques and technology for appropriate hypertensive candidates.
Topics: Humans; Blood Pressure; Sympathectomy; Treatment Outcome; Kidney; Hypertension; Denervation
PubMed: 37500716
DOI: 10.1038/s41440-023-01380-1 -
Current Pain and Headache Reports Jul 2020The purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis.
RECENT FINDINGS
The mainstays of endometriosis advances of both surgical and medical management continue to evolve. Experimental pharmaceuticals include Gestirone, and aromatase inhibitors have shown promise but are still under scrutiny. Surgical techniques include laparoscopic uterosacral nerve ablation/resection and presacral neurectomy. No studies have directly compared medical versus surgical management, and as such, no one treatment modality can be recommend as superior to the other. Patients may initially be given a medical diagnosis and treated with nonsteroidal anti-inflammatory drugs, neurolepitcs, OCP, GNRH agonists/antagonists, and Danazol. Assessing the success of these regimens has proved difficult. Surgical management relies on various methods including excision/ablation of the lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy.
Topics: Denervation; Endometriosis; Female; Humans; Hysterectomy; Ovariectomy; Pain; Treatment Outcome
PubMed: 32671581
DOI: 10.1007/s11916-020-00884-6 -
Mayo Clinic Proceedings Sep 2019
Topics: Denervation; Humans; Hypertension; Kidney
PubMed: 31402055
DOI: 10.1016/j.mayocp.2019.07.006 -
CMAJ : Canadian Medical Association... Feb 2024
Topics: Humans; Hypertension; Kidney; Denervation
PubMed: 38316459
DOI: 10.1503/cmaj.230745-f -
Redox Biology Nov 2022Loss of innervation is a key driver of age associated muscle atrophy and weakness (sarcopenia). Our laboratory has previously shown that denervation induced atrophy is...
Loss of innervation is a key driver of age associated muscle atrophy and weakness (sarcopenia). Our laboratory has previously shown that denervation induced atrophy is associated with the generation of mitochondrial hydroperoxides and lipid mediators produced downstream of cPLA and 12/15 lipoxygenase (12/15-LOX). To define the pathological impact of lipid hydroperoxides generated in denervation-induced atrophy in vivo, we treated mice with liproxstatin-1, a lipid hydroperoxide scavenger. We treated adult male mice with 5 mg/kg liproxstain-1 or vehicle one day prior to sciatic nerve transection and daily for 7 days post-denervation before tissue analysis. Liproxstatin-1 treatment protected gastrocnemius mass and fiber cross sectional area (∼40% less atrophy post-denervation in treated versus untreated mice). Mitochondrial hydroperoxide generation was reduced 80% in vitro and by over 65% in vivo by liproxstatin-1 treatment in denervated permeabilized muscle fibers and decreased the content of 4-HNE by ∼25% post-denervation. Lipidomic analysis revealed detectable levels of 25 oxylipins in denervated gastrocnemius muscle and significantly increased levels for eight oxylipins that are generated by metabolism of fatty acids through 12/15-LOX. Liproxstatin-1 treatment reduced the level of three of the eight denervation-induced oxylipins, specifically 15-HEPE, 13-HOTrE and 17-HDOHE. Denervation elevated protein degradation rates in muscle and treatment with liproxstatin-1 reduced rates of protein breakdown in denervated muscle. In contrast, protein synthesis rates were unchanged by denervation. Targeted proteomics revealed a number of proteins with altered expression after denervation but no effect of liproxstain-1. Transcriptomic analysis revealed 203 differentially expressed genes in denervated muscle from vehicle or liproxstatin-1 treated mice, including ER stress, nitric oxide signaling, Gαi signaling, glucocorticoid receptor signaling, and other pathways. Overall, these data suggest lipid hydroperoxides and oxylipins are key drivers of increased protein breakdown and muscle loss associated with denervation induced atrophy and a potential target for sarcopenia intervention.
Topics: Male; Mice; Animals; Lipid Peroxides; Oxylipins; Sarcopenia; Muscular Atrophy; Muscle, Skeletal; Protein Biosynthesis; Denervation
PubMed: 36283174
DOI: 10.1016/j.redox.2022.102518 -
Heart Rhythm Oct 2021
Topics: Sympathectomy; Sympathetic Nervous System
PubMed: 34298169
DOI: 10.1016/j.hrthm.2021.07.050 -
Physical Medicine and Rehabilitation... May 2022Radiofrequency ablation for spinal zygapophyseal joint pain is a safe and effective procedure in carefully selected patients when an appropriate technique is used. The... (Review)
Review
Radiofrequency ablation for spinal zygapophyseal joint pain is a safe and effective procedure in carefully selected patients when an appropriate technique is used. The equipment and techniques for performing this procedure have evolved over the past several decades. Likewise, the selection criteria have been refined to optimize results. This article provides an overview of the epidemiology of zygapophyseal joint pain, patient selection and outcomes data associated with RFA, and risks and contraindications of the procedure.
Topics: Arthralgia; Catheter Ablation; Denervation; Humans; Radiofrequency Ablation; Treatment Outcome; Zygapophyseal Joint
PubMed: 35526970
DOI: 10.1016/j.pmr.2022.01.001 -
Journal of the American College of... Nov 2023
Topics: Humans; Kidney; Hypertension; Denervation; Longitudinal Studies; Antihypertensive Agents; Blood Pressure; Sympathectomy; Treatment Outcome; Blood Pressure Monitoring, Ambulatory
PubMed: 37914511
DOI: 10.1016/j.jacc.2023.09.795 -
European Journal of Internal Medicine Nov 2023Catheter-based renal artery denervation (RAD) is entering a new era. After the disappointing results of SYMPLICITY-HTN 3 trial in year 2014, several technical and... (Meta-Analysis)
Meta-Analysis Review
Catheter-based renal artery denervation (RAD) is entering a new era. After the disappointing results of SYMPLICITY-HTN 3 trial in year 2014, several technical and methodological advancements led to execution of important SHAM-controlled randomized trials with promising results. Now, the 2023 ESH Guidelines give RAD a class of recommendation II with a Level of Evidence B. Currently, catheter-based RAD has two main areas of application: (a) Hypertensive patients who are still untreated, in whom RAD is a sort of a first-line treatment; (b) Difficult-to-control or true resistant hypertensive patients. Notably, randomized SHAM-controlled trials met their primary end-point in both these conditions. So far, we do not dispose of established predictors of the antihypertensive response to RAD. Some data suggest that younger patients with systo-diastolic hypertension, absence of diffuse atherosclerosis and evidence of sympathetic nervous system overactivity experience a better BP response to the procedure. We reviewed the available data on catheter-based RAD and included an updated meta-analysis of the results of the available SHAM-controlled trials. Overall, the reduction in 24-h systolic blood pressure (BP) after RAD exceeded that after SHAM by 4.58 mmHg (95% CI 3.07-6.10) in untreated patients, and by 3.82 mmHg (95% CI 2.46-5.18) in treated patients, without significant heterogeneity across trials, patient phenotype (untreated versus treated patients) and technique (radiofrequency versus ultrasound). There were no important safety signals related to the procedure. Notably, some data suggest that RAD could be an effective additional approach in patients with atrial fibrillation and other conditions characterized by sympathetic nervous system overactivity.
Topics: Humans; Renal Artery; Motivation; Sympathectomy; Hypertension; Blood Pressure; Antihypertensive Agents; Catheters; Kidney; Treatment Outcome
PubMed: 37544846
DOI: 10.1016/j.ejim.2023.07.041