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PubMed1994

[Comparative study of the recovery phase. Laparoscopic cholecystectomy following isoflurane, methohexital and propofol anesthesia].

Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane. PATIENTS AND METHODS. After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I, II) were investigated in a prospective study. Patients were randomised to receive either isoflurane, methohexitone, or propofol. Perioperative management with regard to premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia was carried out identically for all groups. Postoperative vigilance, pain, and nausea scores were assessed 15, 30, 60, 120, and 360 min after extubation with a visual analogue scale (VAS). At the same points, psychomotor recovery was investigated with the following assays: sedation as shown in Table 1; orientation with ten questions as to person, time, and location; memory as expressed by the patient's ability to repeat five words; a calculation test with five subtractions of the number 7 beginning from 100; and word generation by the number of words with an initial "m" given within 1 min and with animal names. Data were analysed with Kruskal Wallis' test for multiple comparisons between the groups and with Friedman's test for repeated measurements. All values are given as medians (interquartile range) or ranges. RESULTS. There was no difference between the groups' physical condition (Table 2). All intraoperative parameters compared well between groups; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics. Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group, as indicated by sedation score, orientation, memory and calculation tests (Table 4), word generation tests (Fig. 4), and subjective vigilance score (Fig. 3). The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance. The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane (24%, P < 0.05) as compared to TIVA with either propofol (53%) or methohexitone (41%). However, there were only minor differences between the groups; the ability to cooperate and be mobilised was not limited. DISCUSSION. Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy. Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery, opioid-supplemented propofol anaesthesia is well established. Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery.

Adult↗

PubMed2003

Insulin addition after ischemia improves recovery of function equal to ischemic preconditioning in rat heart.

BACKGROUND: Ischemic preconditioning (IPC) is considered the most potent mechanism to improve ischemia tolerance. We have demonstrated that insulin addition during reperfusion improves recovery of function in the isolated working rat heart. We herein compare the relative importance of these two mechanisms in improving recovery of postischemic function. METHODS: Isolated working rat hearts were perfused with Krebs-Henseleit buffer containing glucose (5 mmol/l) plus oleate (0.4 mmol/l) for 20 min and were then subjected to 15 min of ischemia followed by 35 min of reperfusion. IPC was achieved by an ischemic period of fi ve minutes followed by 10 minutes of reperfusion before ischemia. Insulin (1 mU/ml) was or was not added at the beginning of reperfusion. Wortmannin (WM, 3 micro mol/l), an inhibitor of phosphatidylinositol 3-kinase, was or was not present in the perfusate from the beginning of the experiments. We measured glucose uptake with [2-(3)H]glucose, cardiac power and tissue metabolite content at the end of the experiments. RESULTS: Cardiac power before ischemia ranged from 7.17 to 10.4 mW. After ischemia, cardiac power recovered to 65.7 +/- 3.8% (Control). Insulin significantly improved recovery (96.3 +/- 10.8%, p < 0.05 vs. Control). This effect was also achieved by IPC (recovery 86.2 +/- 6.2%, p < 0.05). The effects of insulin and IPC were not additive (recovery 83.4 +/- 6.2%, p < 0.05). WM fully inhibited the effects of both insulin and IPC (69.5 +/- 3.3, 72.0 +/- 6.9, respectively). Basal glucose uptake ranged from 2.53 to 3.46 micro mol/gdry, and was significantly lower after ischemia in the presence of WM. CONCLUSIONS: Insulin is a potent tool to improve postischemic contractile function. The improvement of recovery afforded by insulin added after ischemia may be mediated through a similar mechanism as ischemic preconditioning.

Androstadienes↗

PubMed1999

A comparative study of age and degree of facial nerve recovery in patients with Bell's palsy.

The purpose of this study was to investigate if there is any relationship between the age of a patient and the degree of facial nerve recovery in patients with Bell's palsy. Between 1987 and 1995 250 patients with peripheral idiopathic facial nerve palsy were examined at the ENT Clinic of the University of Ioannina. In this group 134 were male and 116 were female. The patients' ages ranged from 4 to 80 years and had an average of 47.7 years. The average age of the male patients was 46.5 years and that of the female patients was 49.1 years. In the overall group of 250 patients 129 presented with a paralysis of the right facial nerve and 121 on the left. There was no case of bilateral palsies. When comparing the age of the patients and the degree of recovery, measuring age was associated with a decrease in complete recovery. While the percentage of complete recovery between age 4 and 50 years varied from 83% to 74%, respectively, the percentage of complete recovery decreased to less than 54% at age 80. Our results show that the age of the patient is a very important factor for facial nerve recovery.

Adolescent↗

PubMed2004

The Surgical Recovery Index.

BACKGROUND: We developed a tool, the Surgical Recovery Index (SRI), specifically to measure surgical recovery. We then tested the ability of the SRI to discriminate between patients undergoing laparoscopic (L) operations and patients undergoing open (O) operations. METHODS: We surveyed 50 patients drawn from the practice of a single surgeon to establish the types of activities that define recovery from surgery. Their responses were used to construct the SRI, a self-administered questionnaire using a numerical rank-order scale format. A total score and two subscale scores (pain and activity resumption) were calculated for each patient. Mean and median scores were calculated for each patient group. Chi-square tests were used to evaluate group differences for individual questions; t-tests and Kruskal-Wallis tests were used to evaluate group differences for summary scores. RESULTS: In all, 149 patients completed the SRI (60 L, 89 O). Cronbach's alphas were 0.91 for pain questions and 0.97 for activity resumption questions. The scores for pain level with time (L vs O, 1-10 scale) at week 1 (mean, 4.42 vs 6.06, p = 0.03), week 2 (mean, 3.08 vs 4.38, p = 0.04), week 3 (mean, 2.03 vs 3.16, p = 0.02), and week 4 (mean, 1.18 vs 2.28, p = 0.00) all favored laparoscopy. The scores for pain level with activity (L vs O, 1-3 scale) for getting out of bed (mean, 1.62 vs 1.85, p = 0.04), hygiene activities (mean, 1.38 vs 1.65, p = 0.04), and computer work (mean, 1.15 vs 1.56, p = 0.00) were all significant, although pain with exertion (mean, 1.87 vs 2.10, p = 0.13) was not. Delay until return to activity (L vs O, 1-4 scale) was significant, favoring L for 13 activities (all p < 0.02), but it was not significant for three activities. The scores for subscales for pain (L vs O, mean, 20.7 vs 34.4, respectively) and activity resumption delay (mean, 44.3 vs 62.0), as well as total scores (mean, 33.0 vs 49.0), were also significant (all p = 0.00). The same differences were observed when median scores were considered instead of mean scores, suggesting the robustness of the group difference. CONCLUSIONS: Reduction in time to full recovery (i.e., pain resolution and activity resumption) is a fundamental advantage of laparoscopic surgery, yet there are no tools designed to specifically measure recovery. These data provide preliminary evidence of the reliability and validity of the new SRI as a measure of recovery in patients undergoing laparoscopic operations.

Activities of Daily Living↗

PubMed2001

Recovery of impaired muscle function in severe sciatica.

This is a prospective cohort study of patients with acute treated severe sciatica. The objectives of the study are, firstly, to describe the recovery of muscle performance by manual and isokinetic muscle testing in patients with acute severe sciatica over 1 year, and secondly, to discuss the potential clinical relevance of the isokinetic testing of the ankle for patients with acute sciatica. In clinical daily practice, muscle performance is evaluated by means of isometric manual tests. Different authors using manual muscle tests have reported the long-term outcome of the muscle function in patients with sciatica. Overall, the results are good in terms of the recovery of muscle strength. However, it is not clear whether the isometric strength is sufficiently relevant to evaluate the more complete muscle performance of the affected muscles in patients with sciatica. This study presents data on the muscle recovery measured with manual testing and isokinetic testing of patients with severe sciatica. Consecutive patients admitted to the Cantonal Hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and follow-up at 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires. Imaging and electromyography were conducted at the first visit. Isokinetic muscle tests at 30 degrees/s and 120 degrees/s were performed at discharge and follow-up visits. Manual and isokinetic tests were performed on foot and ankle flexor and extensor muscles. Eighty-two consecutive patients (66% men), with a mean age of 43 (+/-10.3) years, entered the study. The prevalence of major muscle weakness was low, with 7% of patients unable to perform toe walking and 11% unable to walk on the heel at visit one. Moreover, motor deficit defined as a score of 4 or less (out of 5) was found in 15% of subjects at the first evaluation. Such severe deficits were not found during the last three visits. The isokinetic tests showed a higher prevalence of muscle function impairment. At visit 5, the isokinetic test showed impaired muscle function recovery from 23% to 32%, while the manual test showed almost full recovery. The issues of agreement between manual and isokinetic muscle testing are discussed. In this selected and homogeneous cohort of patients, the prevalence of motor deficit was rather low and the outcome excellent according to the results of the manual testing. Isokinetic muscle tests showed a higher prevalence of deficit and a much slower recovery. The manual muscle test is a crude clinical test. For more indepth muscle performance evaluation, additional testing may be necessary, especially for those patients with physically demanding jobs or activities.

Adult↗

PubMed2006

Successful voiding after trial without catheter is not synonymous with recovery of bladder function after colorectal surgery.

PURPOSE: The need for monitoring postoperative urine output and the possibility of lower urinary tract dysfunction following colorectal surgery necessitates temporary urinary drainage. Current practice assumes recovery of lower urinary tract function to coincide with successful micturition after removal of urethral catheter. The aim of this study was to analyze the recovery of bladder function following colorectal surgery. METHODS: Patients undergoing colorectal operations underwent preoperative and postoperative uroflowmetry and residual urine estimation. All patients were catheterized suprapubically at surgery. Uroflowmetry and postvoid residual volumes were recorded postoperatively until recovery of bladder function was complete. RESULTS: Thirty consecutive patients underwent suprapubic catheterization, 25 of whom completed the study. Seventeen (68 percent) patients were able to pass urine within 72 hours of surgery. Recovery of lower urinary tract function was delayed in patients undergoing rectal vs. colonic resections (median, 6 vs. 3 days, P = 0.0015). Postvoid residual volumes greater than 200 ml were noted in three (20 percent) patients following rectal resections beyond the tenth postoperative day, with complete emptying achieved by six weeks. CONCLUSIONS: Apparent successful micturition following rectal resections does not always indicate recovery of bladder function. The use of suprapubic catheters, in addition to being safe and effective, allows assessment of residual volumes postoperatively and smoothes the path to full recovery of lower urinary tract function.

Aged↗

PubMed2006

Recovered? Association between self-perceived recovery and the SF-36 after minor musculoskeletal injuries.

OBJECTIVE: Recovery after minor musculoskeletal injuries is often disproportionately protracted. Our aim was to relate Short Form-36 (SF-36), to self-perceived recovery assessed with the question" Do you feel recovered". We hypothesized that restitution of physical factors would be reported at least as often as improvement of symptoms or impairments and that social and mental factors would dominate over physical as determinants for recovery. We followed 318 patients with minor traffic-related injuries for up to 6 months. RESULTS: For all SF-36 subscores more than 60% of the recovered patients had returned to their pre-injury levels. The subscores with the highest proportions (> 80%) were all mainly reflecting disability. For no subscore, however, was the proportion 100%. Normalizations in the SF-36 subscores for "Bodily Pain" (BP) (Odds Ratio, OR = 7.2), "Role limitations due to physical function" (OR = 5.3) were associated with self-perceived recovery. CONCLUSION: Abolition of pain appears to be paramount for the self-perceived recovery, but it is neither a sufficient nor a necessary prerequisite. Contrary to our expectation, physical aspects of functional health status were more strongly associated with recovery than were emotional or social aspects.

Adult↗

PubMedDate not supplied

Propofol versus midazolam for monitored sedation: a comparison of intraoperative and recovery parameters.

STUDY OBJECTIVE: To compare intraoperative and recovery parameters in patients who received either propofol infusion (PI), propofol bolus (PB), or midazolam bolus (MZ) for sedation. DESIGN: Randomized clinical study. SETTING: Medical/surgical patients in a specialized hospital. PATIENTS: Ninety patients, aged 18 to 85 years, scheduled for central venous access for chemotherapy and/or total parenteral nutrition. INTERVENTIONS: In 30 patients, sedation was induced with MZ 0.02 mg/kg intravenously (i.v.), repeated every 2 to 3 minutes to achieve a sedation level of 3 (eyes closed, responds to verbal stimulus) (SL3). Maintenance was with MZ 0.005 mg/kg i.v. repeated as necessary to maintain SL3. In both propofol groups (30 patients each), induction of sedation was with a bolus of propofol 0.75 to 1.0 mg/kg i.v. Maintenance in the PB group was with propofol 0.25 mg/kg IV, repeated as necessary to maintain SL3. Maintenance in the PI group was with propofol 2 to 4 mg/kg/hr or 33 to 66 micrograms/kg/min to maintain SL3. MEASUREMENTS AND MAIN RESULTS: Blood pressure, heart rate, respiratory rate, oxygen saturation, and sedation level were monitored each minute for 5 minutes and then at 5-minute intervals during the procedure. A right atrial blood sample was taken for pH and partial pressure of carbon dioxide at maximum sedation. Adequate sedation was achieved in all three groups. The time to reach SL3 was significantly shorter in the PB group than in the PI and MZ groups (p < 0.05 and p < 0.01, respectively). Cardiovascular and respiratory parameters were remarkably stable. Immediate recovery, as judged by spontaneous eye opening, response to commands, and ability to state date of birth, was significantly shorter in both the PB and PI groups than in the MZ group (p < 0.0001). Intermediate recovery, as measured by sedation score at recovery entry, Aldrete score, and time to standing, was slower in the MZ group (p < 0.05 for the MZ group vs. the PB and PI groups for sedation score and Aldrete score; p < 0.05 for the MZ group vs. the PI group in time to standing). Psychomotor recovery, judged by digit symbol substitution tests, was significantly faster in the PB and PI groups (p < 0.05 vs. the MZ group). Amnesia, measured by picture recall, was significantly greater in the MZ group than in the PI and PB groups (p < 0.05). Mood changes were measured on a visual analog scale. All groups showed improvement. Nausea, headache, dizziness, blurred vision, appetite, tension, pain, depression, drowsiness, and ability to concentrate were evaluated in the preoperative and postoperative periods. The frequency did not differ significantly between groups due to confounding factors such as postoperative chemotherapy and premedicant drugs. CONCLUSION: The PI, PB, and MZ groups all gave excellent sedation for patients undergoing surgical procedures with local anesthesia. Amnesia was greatest with midazolam, and recovery was more rapid with propofol.

Adolescent↗

PubMed2004

Comparison of functional recovery of mildly hypokinetic versus severely dysfunctional left ventricular segments after revascularization in patients with ischemic cardiomyopathy.

Dysfunctional left ventricular (LV) segments showing contractile reserve during dobutamine stress echocardiography (DSE) are considered viable myocardium; functional recovery is expected after revascularization. Many segments, however, particularly mildly hypokinetic segments, do not recover. The reason for this failure is unknown. Two-dimensional echocardiography at rest and low-high-dose DSE were performed before revascularization in 114 consecutive patients with ischemic cardiomyopathy. Two-dimensional echocardiography at rest was repeated after 9 to 12 months. Segmental function was scored by a 5-point grading score. Functional recovery after revascularization was assessed in mildly hypokinetic (score 2, group I) and severely dysfunctional segments (score 3 to 5, group II). For each segment, functional recovery was defined as an improvement in functional score of > or =1 grade compared with the baseline score at rest. During low-dose DSE (up to 10 microg/kg/min), 183 group I segments (68%) and 438 group II (39%) segments had contractile reserve (p <0.0001). However, functional recovery was observed less frequently in group I segments (41%) than in group II segments (55%) with contractile reserve (p <0.005). During high-dose DSE (up to 40 microg/kg/min), in the group I segments with contractile reserve at the low dose, the sustained improvement pattern (indicating subendocardial scar) was prevalent (73%). After revascularization, 73% of segments with sustained improvement did not recover. Conversely, the biphasic response (indicating ischemically jeopardized myocardium) was observed only in 27% of group I segments. Functional recovery occurred in 39 of these segments (78%) (p <0.001 vs sustained improvement). Hence, mildly hypokinetic segments probably indicate the presence of subendocardial scars, and may explain the failure in functional recovery after revascularization.

Adult↗

PubMed2005

Fluoxetine and recovery of motor function after focal ischemia in rats.

Neuroprotective therapies and tissue plasminogen activator (t-PA) have limited application for most stroke patients and thus rehabilitation is the primary treatment option for improving recovery of function. Following brain injury, environmental enrichment, pharmacological and rehabilitative treatments can markedly alter neuronal plasticity and behavioral recovery even when delayed by several weeks after the insult. Fluoxetine has been given to stroke patients to combat depression but its effects on recovery of function are not known. Functional magnetic resonance imaging reveals that fluoxetine alters brain activity and modulates motor performance in stroke patients in a use-dependent fashion. Several antidepressants, including fluoxetine, increase growth factors and other proteins associated with plasticity, such as brain-derived neurotrophic factor (BDNF). In this study, we examined whether chronic administration of fluoxetine combined with rehabilitation affected recovery of function on 3 separate tests of forelimb reaching, preference and limb coordination after focal ischemia in rats. Ischemia was induced in male Long-Evans rats by intracortical and striatal injections of endothelin-1. Fluoxetine (10 mg/kg/day) combined with rehabilitation therapy (6 h/day) for 4 weeks did not alter the degree or rate of recovery of function compared to non-treated animals. Despite the ability of fluoxetine to alter brain activity and increase growth factors, it does not appear to be an effective pharmacological adjunct to functional recovery after ischemia in rats.

Analysis of Variance↗

PubMed2006

Quantitative EEG and neurological recovery with therapeutic hypothermia after asphyxial cardiac arrest in rats.

We test the hypothesis that quantitative electroencephalogram (qEEG) can be used to objectively assess functional electrophysiological recovery of brain after hypothermia in an asphyxial cardiac arrest rodent model. Twenty-eight rats were randomly subjected to 7-min (n = 14) and 9-min (n = 14) asphyxia times. One half of each group (n = 7) was randomly subjected to hypothermia (T = 33 degrees C for 12 h) and the other half (n = 7) to normothermia (T = 37 degrees C). Continuous physiologic monitoring of blood pressure, EEG, and core body temperature monitoring and intermittent arterial blood gas (ABG) analysis was undertaken. Neurological recovery after resuscitation was monitored using serial Neurological Deficit Score (NDS) calculation and qEEG analysis. Information Quantity (IQ), a previously validated measure of relative EEG entropy, was employed to monitor electrical recovery. The experiment demonstrated greater recovery of IQ in rats treated with hypothermia compared to normothermic controls in both injury groups (P < 0.05). The 72-h NDS of the hypothermia group was also significantly improved compared to the normothermia group (P < 0.05). IQ values measured at 4 h had a strong correlation with the primary neurological outcome measure, 72-h NDS score (Pearson correlation 0.746, 2-tailed significance <0.001). IQ is sensitive to the acceleration of neurological recovery as measured NDS after asphyxial cardiac arrest known to occur with induced hypothermia. These results demonstrate the potential utility of qEEG-IQ to track the response to neuroprotective hypothermia during the early phase of recovery from cardiac arrest.

Animals↗

PubMed2006

Accelerated recovery of Atlantic salmon (Salmo salar) from effects of crowding by swimming.

The effects of post-crowding swimming velocity (0, 0.35, and 0.70 m/s) and recovery time (1.5, 6, and 12 h) on physiological recovery and processing quality parameters of adult Atlantic salmon (Salmo salar) were determined. Atlantic salmon crowded to a density similar to that of a commercial slaughter process (>200 kg/m(3), 40 min) were transferred to a swimming chamber for recovery treatment. Osmolality and concentrations of cortisol, glucose and lactate in blood plasma were used as physiological stress indicators, whereas image analyses of extent and duration of rigor contraction, and fillet gaping were used as measures of processing quality. Crowded salmon had a 5.8-fold higher plasma cortisol concentration than control salmon (P<0.05). The elevated plasma cortisol concentration was reduced by increasing the swimming velocity, and had returned to control levels after 6 h recovery at high water velocity. Similar effects of swimming velocity were observed for plasma osmolality and lactate concentration. A lower plasma glucose concentration was present in crowded than in control fish (P<0.05), although a typical post-stress elevation in plasma glucose was observed after the recovery treatments. Lower muscle pH was found in crowded compared with control salmon (P<0.05), but muscle pH returned to control levels after 6 h recovery at intermediate and high swimming velocities and after 12 h in the low velocity group. Crowding caused an early onset of rigor mortis contraction. However, subjecting crowded salmon to active swimming for 6 h before slaughter delayed the onset of rigor mortis contraction from 2.5 to 7.5 h post mortem. The extent of rigor mortis contraction was also affected by crowding and post-stress swimming activity (P<0.05), and the largest degree of contraction was found in crowded salmon. In conclusion, active swimming accelerated the return of plasma cortisol, hydromineral balance, and the energy metabolism of adult Atlantic salmon to pre-stress levels. Moreover, an active swimming period delayed the onset of rigor mortis contraction, which has a positive technological implication for the salmon processing industry.

Animals↗

PubMed2006

Differential effects of post-natal development, animal strain and long term recovery on the restoration of neuromuscular function after neuromyotoxic injury in rat.

We have analysed the effect of long term recovery, post-natal development and animal strain on the extent of restoration of neuromuscular function after neuromyotoxic injury in the rat (Rattus norvegicus). Muscle isometric contractile properties of soleus muscle in response to nerve stimulation were measured in situ in snake venom injured muscles and compared to contralateral uninjured muscles. We show here that neuromuscular function was not fully recovered until 24 weeks after injury in young adult (2-3 month old) Wistar rats. Moreover, the level of functional recovery 3 weeks after injury induced in juvenile rats (1 month old) was not globally different from that in younger adult, adult (10 month old) and older adult (24 month old) Wistar rats. Furthermore, the level of recovery of some contractile parameters differed between Wistar and Sprague-Dawley strains 3 weeks after injury. In conclusion, a very long time (>12 weeks) is required for full neuromuscular recovery following neuromyotoxic injury of young adult rats. Moreover, neuromuscular recovery during post-natal development is not markedly different from that during adult stage in the Wistar rat strain. Finally, some rat strain differences are observed in the recovery after injury of young adult rats.

Aging↗

PubMed2006

Dobutamine stress echocardiography is highly accurate for the prediction of contractile reserve in the early postoperative period, but may underestimate late recovery in contractile reserve after revascularization of the hibernating myocardium.

OBJECTIVE: We sought to investigate the accuracy of dobutamine stress echocardiography to predict the degree and timing of recovery in resting function and contractile reserve (CR) after revascularization of the hibernating myocardium. METHODS: In all, 24 patients with ischemic cardiomyopathy (ejection fraction < 40%) underwent dobutamine stress echocardiography 1 week before and 6 weeks, 3 months, and 6 months after coronary artery bypass grafting. RESULTS: Recovery rates at 6 weeks, 3 months, and 6 months postoperation were 21%, 33%, and 45% (P < .01) for resting function and 55%, 65%, and 74% (P < .01) for CR. Positive and negative predictive values for recovery of resting function and CR at 6 months postrevascularization were 66% vs 97% (P < .001) and 78% vs 48% (P < .001), respectively. Positive and negative predictive values were both high for recovery of CR at 6 weeks postrevascularization (89% and 78%). CONCLUSIONS: Dobutamine stress echocardiography can predict early recovery in CR postrevascularization with an excellent accuracy but may underestimate the degree of late recovery in CR.

Cardiomyopathies↗

PubMed2004

Accelerating sensory recovery after sciatic nerve crush: non-selective versus melanocortin MC4 receptor-selective peptides.

Melanocortin receptor ligands accelerate functional recovery after peripheral nerve crush. It is not known which mechanism is involved or via which melanocortin receptor this effect occurs, albeit indirect evidence favours the melanocortin MC4 receptor. To test whether the melanocortin MC4 receptor is involved in the effects of melanocortins on functional recovery, we used melanocortin compounds that distinguish the melanocortin MC4 receptor from the melanocortin MC1, MC3 and MC5 receptors on basis of selectivity and agonist/antagonist profile. Activation and binding studies indicated that the previously described peptides JK1 (Ac-Nle-Gly-Lys-D-Phe-Arg-Trp-Gly-NH2) and [D-Tyr4]melanotan-II ([D-Tyr4]MTII. Ac-Nle-c[Asp-His-D-Tyr-Arg-Trp-Lys]NH2) are selective for the rat melanocortin MC4 receptor as compared to the rat melanocortin MC3 and MC5 receptors, but are also potent on the melanocortin MC1 receptor. Both peptides did not accelerate sensory recovery in rats with a sciatic nerve crush, whereas the non-selective melanocortin agonist melanotan-II (MTII, Ac-Nle-c[Asp-His-D-Phe-Arg-Trp-Lys]NH2) was effective. The melanocortin MC3/MC4 receptor antagonist SHU9119 (Ac-Nle-c[Asp-His-D-Nal(2)-Arg-Trp-Lys]NH2) also enhanced sensory recovery. This effect was probably not due to interaction with the melanocortin MC4 receptor, since JK46 (Ac-Gly-Lys-His-D-Nal(2)-Arg-Trp-Gly-NH2), a selective melanocortin MC4 receptor antagonist, was ineffective. Taken together, these data suggest that melanocortins do not accelerate sensory recovery via interaction with the melanocortin MC4 receptor. From the known melanocortin receptors, only the involvement of the melanocortin MC5 receptor in acceleration of recovery could not be excluded.

Animals↗

PubMed2005

A noninvasive ultrasonographic method to evaluate bladder function recovery in spinal cord injured rats.

Suprasacral spinal cord injury induces changes in the mechanical and neuronal properties of the bladder resulting in bladder areflexia followed by bladder-sphincter dyssynergia and detrusor muscle hypertrophy, which lead to urinary retention and increased bladder size. These changes are most often quantified using highly skilled urodynamic techniques that involve catheterization. We investigated whether a hand-held digital ultrasound imaging system could monitor urinary retention in the bladder following spinal cord injury in adult rats. Our findings indicate that contusive spinal cord injury resulted in high residual bladder volumes that decreased and stabilized by 2 weeks post-injury but remained significantly higher than control bladder volumes up to 46 days post-injury (the longest time point examined). Post hoc analysis indicated that the degree of bladder function recovery recorded at the end of the study correlated with the degree of bladder function recovery recorded at 6 days post-injury, indicating that bladder function recovery can be predicted by analyzing bladder volume as early as 6 days post-injury. Bladder function recovery correlated with locomotor recovery as assessed using the BBB locomotor rating scale. While providing a noninvasive assessment of bladder function with no detrimental impact on locomotor function or assessment, this protocol provides researchers with a clinically relevant outcome measure for quantifying bladder function recovery after spinal cord injury or after experimental treatments for spinal cord injury.

Animals↗

PubMed2005

Effects of carotid body excision on recovery of respiratory function in C2 hemisected adult rats.

In a previous study, we described the spontaneous recovery of respiratory motor function in adult rats subjected to a left C2 hemisection 6-16 weeks post-injury without any therapeutic intervention. We extend the previous findings by demonstrating in the present study that rats subjected to a left C2 hemisection with bilateral carotid body excision will also recover respiratory-related activity in the paralyzed ipsilateral hemidiaphragm. However, in this instance, recovery is significantly accelerated; i.e., it is evident as early as 2 weeks after spinal cord injury. Two experimental groups (and noninjured and sham-operated controls) of rats were employed in the study. H-CBE animals were subjected to a left C2 hemisection plus bilateral carotid body excision while H-CBI animals were subjected to a left C2 hemisection only. Carotid body excision was confirmed by the sodium cyanide test. The animals were allowed to survive for 2 weeks after hemisection. Thereafter, electrophysiologic assessment of respiratory activity was conducted in all animals. Spontaneous recovery of respiratory-related activity in the paralyzed hemidiaphragm (indicated by left phrenic nerve activity) was detected in all H-CBE animals while H-CBI animals did not express spontaneous recovery of diaphragmatic activity. The magnitude of recovered activity when expressed as a function of contralateral phrenic nerve activity was 48.8 +/- 3.8%. When expressed as a function of the homolateral phrenic nerve in noninjured animals, the magnitude amounted to 25.6 +/- 2.8%. Although the mechanisms responsible for the apparent early onset of spontaneous recovery are unknown, it is likely that a reorganization of the respiratory circuitry in the CNS may be involved. The significance of the findings is that it may be feasible to modulate the onset of functional recovery following cervical spinal cord injury by specifically targeting peripheral chemoreceptors.

Analysis of Variance↗

PubMedDate not supplied

Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patients.

BACKGROUND: An estimated 24% to 70% of individuals have prolonged paralysis or severe weakness after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated. OBJECTIVES: The purposes of this study were to (1) evaluate the relationship between recovery of neuromuscular transmission (NMT) and functional muscle activity after NMBA administration; (2) evaluate the relationship between delayed recovery of NMT or muscle activity and functional performance; and (3) determine the predictors of delayed recovery of NMT, muscle activity, and functional performance. METHODS: This was a multisite study using a prospective, nonexperimental, descriptive design with convenience sampling techniques. Instruments used included a five-point muscle score, Actigraph, and peripheral nerve stimulator. RESULTS: Key findings were as follows: (1) NMT returned promptly, whereas muscle activity remained severely depressed; (2) only two subjects (5%) recovered functional performance within 24 hours; (3) degree of muscle weakness immediately after neuromuscular blockade was associated with prolonged time to extubation and mobility; and (4) predictors of delayed recovery included cumulative dose of aminosteroid NMBAs, age, and renal function. CONCLUSION: Prolonged recovery of muscle activity and extreme weakness may occur despite brisk recovery of NMT after neuromuscular blockade.

Adult↗