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S-nitrosoglutathione improves functional recovery in the isolated rat heart after cardioplegic ischemic arrest-evidence for a cardioprotective effect of nitric oxide.

The objective of this study was to assess the cardioprotective effect of the nitric oxide (.NO) donor, S-nitrosoglutathione (GSNO) and to investigate the mechanism of cardioprotection in a model of ischemia and reperfusion in isolated rat hearts. The role of .NO in myocardial protection was investigated by using nitronyl nitroxide as the .NO trap. Electron spin resonance spectroscopy was used to demonstrate that nitronyl nitroxide can trap .NO released from GSNO in a cardioplegic solution. .NO traps, oxyhemoglobin (4 mumol/l, n = 4) and nitronyl nitroxide (400 mumol/l, n = 5), inhibited the (2 mumol/l) GSNO-induced coronary vasodilation from the control value of 122% (n = 6) above base-line value to 73 and 60%, respectively. In the ischemia-reperfusion protocol, GSNO (20 mumol/l) was added to the cardioplegic solution during a 35-min ischemic arrest (n = 8). GSNO improved the functional recovery of ischemic hearts as compared to control (n = 6) as measured by the developed pressure (76 +/- 3 to 95 +/- 5% of base-line), rate pressure product (68 +/- 3 to 83 +/- 4% of base-line) and diastolic pressure (31 +/- 2 to 19 +/- 3 mm Hg). Reduction of coronary flow rate during reperfusion to control values in GSNO-treated hearts did not eliminate the improvement of functional recovery induced by GSNO. GSNO increased cyclic GMP production and slowed the accumulation of lactate (154 +/- 7 in control to 114 +/- 4 mumol/g dry wt.) and glucose-6-phosphate (3.66 +/- 0.19 in control to 2.18 +/- 0.10 mumol/g dry wt.) in myocardial tissue during ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

[An experimental study on the functional recovery of denervated muscles--effects of stump rotation in nerve suture (author's transl)].

There are many factors which affect the end result of nerve suture. Clinically it is said tht rotation of the stumps at suture site has an unfavorable effect upon functional recovery, owing to discrepancies of funicular patterns and inappropriate funicular approximation. In order to evaluate the effect of rotation of the stumps at suture sites, tibial nerves of thirty-three full grown rabbits were used. After the tibial nerve was cut at a point three cm proximal to the popliteal fossa, in one group (20 rabbits) the nerve was sutured without rotation (0 degrees group) and in another group (19 rabbits) with 180 degrees rotation of the proximal stump (180 degrees groups), using epineural technique under operating microscope. Six months later return of nerve function was evaluated electrophysiologically and histologically. Electrophysiological measurements included electromyography, motor conduction velocity and muscle strength stimulating proximal stump. Histological evaluation following weighing included H-E stain, DPN diaphorase stain for muscle and Cajal stain for axon. There were no significant differences between the two groups with regard to the passage rate of axons at the suture site, motor conduction velocity or recovery rate of muscle weight. But muscle strength of the plantaris in the 180 degrees group was significantly weaker than that of 0 degrees group, and in the 180 degrees group, recovery rate of muscle strength was lower than that of muscle weight, though they were the same in the 0 degrees group. Histochemically there was marked fibre type grouping of the reinnervated muscle in both groups. The author concluded that in the rabbits, the rotation of nerve stumps at suture site does not affect the passage rate of axons at the suture site nor maturation of the axon. However, it does impose unfavorable influence upon functional recovery. Further problems may arise for the recovery of complex functions when reconstitution of proprioceptive feed-back system is considered.

Action Potentials

Improved functional recovery of the atherosclerotic rabbit heart subjected to normothermic global ischemia.

Contractile function before, during and after a period of ischemia was evaluated in perfused hearts from rabbits fed either 2% cholesterol or a control diet for two months. Rabbits were sacrificed and the hearts were perfused by the Langendorff normothermic perfusion technique. After a 30-min baseline period, the hearts were subjected to a 60-min period of low flow ischemia (0.2 mL/min) with Krebs-Henseleit solution containing either 2.5 mM (normocalcemic) or 0.5 mM (hypocalcemic) calcium. Subsequently the hearts were reperfused for 30 mins. No significant differences in baseline contractile function (expressed by developed pressure and dP/dtmax) were observed between hearts from cholesterol-fed and control rabbits. Although, initially the degree of contracture, as measured by an increase in end diastolic pressure from baseline, was less in cholesterol-fed rabbit hearts, this difference did not persist beyond 40 mins of ischemic perfusion. Hypocalcemic ischemic perfusion was associated with a delay in development of contracture relative to normocalcemic perfusion in the hearts from cholesterol-fed rabbits. These results suggest an early resistance to ischemia by hearts from cholesterol-fed rabbits. Upon reperfusion, the hearts from control rabbits exhibited a sudden increase in contracture following ischemic perfusion with 0.5 mM calcium which was not observed in the hearts from rabbits fed a cholesterol diet. There was improved functional recovery and less contracture development post reperfusion in the hearts from cholesterol-fed rabbits, independent of the concentration of calcium used during ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Improved donor-site biomechanics and functional recovery with xenogeneic acellular dermal matrix after ALT flap harvest: A prospective randomized controlled study.

BACKGROUND: Donor-site management after anterolateral thigh (ALT) flap harvest is a significant yet underaddressed concern in reconstructive surgery for oral cancer. While xenogeneic acellular dermal matrix (Xeno-ADM) is common in soft-tissue repair, its efficacy for fascia lata reconstruction at the ALT donor site remains insufficiently characterized. This study aimed to assess the efficacy of xeno-ADM in fascia lata repair, focusing on compartment pressure, inflammatory and muscle injury biomarkers, and functional recovery. METHODS: In this prospective, randomized, single-blind trial, 200 patients undergoing ALT flap reconstruction were allocated to Xeno-ADM repair (n = 100) or primary closure (n = 100). Primary endpoints included compartment pressure, inflammatory markers in drainage fluid, serum muscle injury biomarkers, and functional outcomes. RESULTS: The xeno-ADM group showed significantly lower compartment pressures throughout postoperative days (POD) 1-5. Inflammatory markers in drainage fluid (CRP on POD 3 and 5) and serum muscle injury biomarkers (creatine kinase on POD 1 and 5) were significantly lower in xeno-ADM group. Functional outcomes were superior in the Xeno-ADM group, with faster gait recovery, lower pain scores at POD 7, and better lower-limb function at the 1- and 6-month follow-ups. Drainage duration did not differ between groups. Stratified analyses revealed that the benefits of xeno-ADM were more pronounced in patients with defect width >3 cm or a body mass index ≥24 kg/m2. CONCLUSION: Xeno-ADM provides a safe and effective approach for fascia lata repair, reducing biomechanical and inflammatory burdens while enhancing functional recovery. These findings support a transition from simple structural closure toward functional donor-site reconstruction.

Humans

Influence of systemic hypothermia on systolic and diastolic functional recovery after continuous warm antegrade blood cardioplegia.

Experimental observations in our laboratory indicate that myocardial recovery is similar following warm or cold antegrade blood cardioplegia when the core temperature is maintained at 37 degrees C. To determine the effects of hypothermia on myocardial recovery, 15 adult mongrel dogs were randomized to normothermic or hypothermic bypass (28 degrees C) during 60 min of continuous warm antegrade blood cardioplegia. The hypothermic group was rewarmed after releasing the aortic cross-clamp and bypass was discontinued at 30 min in both groups. Myocardial recovery was assessed at 60, 90, and 120 min after the arrest. Core temperature was maintained in the normothermic group but gradually decreased after bypass in the hypothermic group, reaching a low of 33.8 +/- 1 degrees C at 120 min. Myocardial functional recovery was preserved after normothermic bypass. The decrease in core temperature, however, that was observed after systemic hypothermia, was paralleled by significant decreases in the maximum rate of left ventricular pressure rise (dp/dt), the maximum elastance of the left ventricle, and preload recruitable stroke work. Diastolic function decreased slightly, but not significantly, during reperfusion following systemic hypothermia but was unaltered after normothermic bypass. Myocardial oxygen consumption was unchanged in both groups. Myocardial ultrastructure was preserved after normothermic bypass. In contrast, cellular oedema and mild ultrastructural changes were evident after systemic hypothermia. We therefore conclude that the use of systemic hypothermia during bypass is associated with lower core temperatures during early recovery which results in impaired functional recovery.

Animals

Improved postischemic ventricular functional recovery by amphetamine is linked with its ability to induce heat shock.

Heat shock has been shown to increase the cellular tolerances to ischemic injury. In this study, we examined the effects of heat shock induced by amphetamine on postischemic myocardial functional recovery in a setting of coronary revascularization for acute myocardial infarction. Intramuscular injection of amphetamine (3 mg/kg, i.m.) to pigs increased the body temperature to 42.5 degrees C within 1 h, and maintained this temperature for an additional 2 h. Fourty h after the amphetamine injection, the pigs were placed on by cardiopulmonary bypass and then isolated, in situ heart preparations were subjected to 1 h of global hypothermic cardioplegic arrest and 1 h of normothermic reperfusion. Postischemic myocardial performance was monitored by measuring left ventricular (LV) pressure, its dp/dt, myocardial segmental shortening (%SS), and coronary blood flow. Cellular injury was examined by measuring creatine kinase (CK) release. Biochemical measurements included quantification of plasma catecholamines and study of the induction of heat shock gene expression and antioxidative enzymes in the heart tissue. The results of this study indicated significantly greater recovery of LV contractile functions by amphetamine as demonstrated by improved recovery of LVDP (61% vs 52%), dp/dtmax (52% vs 44%), and segmental shortening (46.2% vs 10%). Myocardial CK release was significantly reduced in the amphetamine group. Furthermore, amphetamine pretreatment was associated with the induction of heat shock protein (HSP) 27 mRNA and stimulated Cu/Zn-superoxide dismutase and catalase levels, suggesting that amphetamine mediated improved postischemic ventricular recovery might be linked with its ability to induce heat shock and stimulate antioxidant enzymes.

Amphetamine

Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy.

To assess the course of recovery of gluten sensitive enteropathy in adults, histological and functional recovery was studied in 22 patients, aged 20-79 years. Biopsy specimens taken at the time of diagnosis were studied in 20; after adhering to a gluten free diet for nine to 19 (mean 14) months in 14; and after adhering to the same diet for 24-48 (mean 34) months in 10 patients. Histological recovery was assessed morphometrically in the proximal jejunum. Mucosal linings significantly improved over time, but did not completely return to normal with a gluten free diet: at diagnosis the surface: volume ratio was 22% of normal, increasing to 48% and 66% after nine to 19 and 24-48 months, respectively, of a gluten free diet. Disaccharidase activities progressively increased. After 24-48 months maltase, sucrase, and isomaltase had returned to normal in the proximal jejunum; they were still significantly decreased in the distal duodenum. Duodenal and jejunal lactase activities were both below normal after 24 to 48 months. It is concluded that recovery of the intestinal mucosa of adults with gluten sensitive enteropathy during a gluten free diet continues beyond nine to 19 months and is still incomplete after two to four years. The recovery of disaccharidase activities extends from the distal to the proximal part of the small intestine, and is aligned to histological recovery.

Adult

Calcium oscillations index the extent of calcium loading and predict functional recovery during reperfusion in rat myocardium.

Delayed recovery of contractile function after myocardial ischemia may be due to prolonged recovery of high-energy phosphates, persistent acidosis, increased inorganic phosphate, and/or calcium loading. To examine these potential mechanisms, metabolic parameters measured by 31P nuclear magnetic resonance spectroscopy, and spontaneous diastolic myofilament motion caused by sarcoplasmic reticulum-myofilament calcium cycling indexed by the scattered light intensity fluctuations (SLIF) it produces in laser beam reflected from the heart, were studied in isolated atrioventricularly blocked rat hearts (n = 10) after 65 min of ischemia at 30 degrees C. All metabolic parameters recovered to their full extent 5 min after reperfusion. Developed pressure evidenced a small recovery but then fell abruptly. This was accompanied by an increase in end diastolic pressure to 37 +/- 5 mm Hg and a fourfold increase in SLIF, to 252 +/- 58% of baseline. In another series of hearts initial reperfusion with calcium of 0.08 mM prevented the SLIF rise and resulted in improved developed pressure (74 +/- 3% vs. 39 +/- 13% of control), and lower cell calcium (5.9 +/- 3 vs. 10.3 +/- 1.4 mumol/g dry wt). Thus, during reperfusion, delayed contractile recovery is not associated with delayed recovery of pH, inorganic phosphate, or high-energy phosphates and can be attributed, in part, to an adverse effect of calcium loading which can be indexed by increased SLIF occurring at that time.

Adenosine Triphosphate

[Results of strabismus surgery in adolescents and adults: cosmetic or functional recovery?].

PURPOSE: To answer the question, whether it is possible to achieve a functional improvement after strabismus surgery in adults. METHODS: The study comprised 71 patients, aged 13-53, in whom after strabismus surgery, deviation was reduced to +/- 4 degrees. The degree of binocular vision was examined with weak and strong dissociating tests. RESULTS: Complete binocular vision was achieved in 25% of cases, partial with peripheral fusion in 51%. The degree of binocular vision depended on the following factors: type of squint and time of its development, degree of amblyopia, refraction and presence of binocular vision before the surgery. In some cases binocular vision occurred immediately after surgery, in others in a long follow-up. Stabilization of surgical effect was observed in the cases with peripheral fusion. CONCLUSION: Strabismus surgery in adults could be a chance for functional recovery and not only for aesthetic improvement.

Adolescent

Isometric contractile function recovery following tourniquet ischemia.

The purpose of this study was to document the recovery of isometric contractile function following tourniquet ischemia. Male Wistar rats (N = 27) were subjected to unilateral hindlimb tourniquet ischemia of 0 hr (control, N = 6), 1 hr (N = 5), 2 hr (N = 5), 3 hr (N = 5) and 4 hr (N = 3). Following a 2-week recovery period, isometric force measurements were made from both gastrocnemii of each rat with the contralateral limb acting as the control side. Each muscle was analyzed for maximal twitch (Pt, N/g), maximal rate of rise of twitch tension (DP/dt, N/sec), time to peak tension (TPT, msec), half relaxation time (RT 1/2, msec), maximal tetanus (P0, N/g, at 100 Hz), and fatigue (Burke Fatigue Protocol). Pt, P0, and DP/dt were significantly different from control values (P less than 0.05) for all hours of tourniquet ischemia. A strong negative correlation (P less than 0.001) was found for twitch (R = -0.84), tetanus (R = -0.78), and maximal rate of force development (R = -0.83) with respect to increasing hours of ischemia. The recovery of isometric twitch and tetanic function following tourniquet ischemia is inversely related to the ischemic interval. This study quantified the relationship between muscle ischemia and recovery of function following a 2-week interval and stresses the functional physiological changes which occur in skeletal muscle following tourniquet ischemia.

Animals

Recovery functions of common peroneal, posterior tibial and sural nerve somatosensory evoked potentials.

We studied recovery functions of the somatosensory evoked potentials (SEPs) of common peroneal (CPN), posterior tibial (PTN) and sural nerves (SN) using a paired conditioning-test paradigm. The interstimulus interval (ISI) of paired stimuli ranged from 2 to 400 msec. In all SEPs with ISIs of 12-20 msec, the amplitude recovery was close to or beyond 100% of the control response, though their latencies and wave forms were not the same as the control. Further increases of the ISI resulted in significant depression of SEP (late phase suppression), most markedly in CPN, and less prominently in SN-SEP. With a longer than 50 msec ISI there was progressive recovery of SEP, but full recovery differed depending on the nerve stimulated; 400 msec ISI was required for CPN-, 250 msec for PTN- and 100 msec for SN-SEP. The peroneal nerve block by local anesthetic injected just distal to the stimulus electrodes abolished the late phase SEP suppression observed before the nerve block. These findings suggest that the late phase SEP suppression is attributable to the "secondary" afferents as a result of activation of peripheral receptors (muscle, joint and/or cutaneous) by the efferent volley initiated from the stimulus point. The greater and longer duration of peripheral receptor activation in CPN than in PTN or SN stimulation could explain the more pronounced and the longer duration of late phase suppression in CPN-SEP.

Adult

[Functional recovery following surgical removal of traumatic epidural hematoma--factor analysis].

UNLABELLED: Factors contributing to functional recovery following evacuation of epidural hematoma were analyzed in 53 subjects. Subjects were limited to the cases with "pure" epidural hematoma. Fifty-three cases were classified into 3 groups based on presence or absence, and duration of preaggravation period (PAP) following occurrence of head trauma (Fig. 1). Level of consciousness at operation and at PAP is summarised in Fig. 2. Major neurological signs at operation are summarized in Table 1. Gradings of functional status were divided to 6 (Table 2). Gradings of 53 subjects which were judged 1 month after removal of epidural hematoma are summarized in Fig. 3. RESULTS: 1) As to outcome in relation to duration of preaggravation period (PAP) and consciousness level at operation (Fig. 4): The patients whose PAP was shorter and whose consciousness level at operation was more severe, took outcome of lower (worse) gradings. 2) As to outcome in relation to interval from the end of PAP to operation and PAP (Fig. 5): The patients whose PAP are within 3 hours, took outcome of relatively good recovery only when epidural hematoma was removed within 5.5 hours after the end of PAP. 3) As to outcome in relation to interval from the end of PAP to operation and consciousness level at operation (Fig. 6): The patients whose consciousness level at operation was better than semicoma took good recovery when epidural hematoma was evacuated within 5.5 hours after the end of PAP. This was right even in the patients who presented with decerebrate posture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Morphological and functional recovery of the canine gallbladder mucosa following two hours' ischemia.

Temporary interruption of the circulation to the canine gallbladder causes hemorrhagic necrosis of the mucosa and an abolition of active transport of glycine in vitro. The first signs of epithelial recovery following two hours' ischemia are seen in animals examined 7 days after the injury and are characterized by the appearance of a layer of cuboidal epithelial cells in which some mitotic figures are observed, accompanied by a decrease in the amount of necrosis and the presence of granulation tissue. At the same time, there is some slight resumption in glycine uptake. Two weeks after injury, the new epithelium covers a larger surface of the gallbladder wall but recovery is still incomplete. Four weeks after operation, structural and functional recovery has occurred in almost all the animals studied: the epithelium is columnar and does not differ greatly from that seen in the normal gallbladder. Mucosal folds are present although their morphological appearance is slightly altered in comparison with those of control specimens. The gallbladder wall is thickened by fibrosis. Measurements of active glycine transport in vitro confirm that the new epithelium functions normally.

Animals

Contribution of serotonin neurons to the functional recovery after spinal cord injury in rats.

The contribution of serotonin neurons to the functional recovery after spinal cord injury was studied pharmacologically in rats with moderately severe neurologic impairment (complete paraplegia but responsive to tail pinching) 24 h after thoracic spinal cord (T11) compression-induced injury. Fourteen days after cord injury the levels of endogenous norepinephrine (NE, -33%), dopamine (DA, -50%) and serotonin (5-HT, -55%) in the lumbar cord in the injury control rats were decreased and there were significant correlations between the neurologic score and the NE level (rs = 0.562, P less than 0.01) and the 5-HT level (rs = 0.745, P less than 0.001) but not the DA level. Bilateral i.c.v. injection of 5,7-dihydroxytryptamine (200 micrograms/rat) 24 h after cord injury significantly retarded the neurologic recovery during the 14 days after injury, accompanied by a further reduction in the 5-HT level (-86%) but not in the NE or DA level. On the other hand, neither p-chlorophenylalanine (PCPA) (300 mg/kg, i.p., once daily starting 24 h after injury for 13 consecutive days) nor reserpine (1 mg/kg, i.p., 4 times, once 24 h after injury and then every fourth day) had any influence on the time course of the neurologic recovery during the 14 days after injury, although PCPA treatment further reduced the levels of NE (-50%) and 5-HT (-91%), and reserpine treatment further reduced the levels of NE (-95%), DA (-73%) and 5-HT (-85%).(ABSTRACT TRUNCATED AT 250 WORDS)

5,7-Dihydroxytryptamine

Improvement in functional recovery of stunned canine myocardium by long-term pretreatment with oral propranolol.

We investigated the effect of long-term oral pretreatment with the beta-adrenergic antagonist, propranolol (Inderal LA, 160 mg daily for 8 days) on the functional recovery of myocardium after 15-minute coronary artery occlusion followed by 3 hours of reperfusion in barbital-anesthetized dogs. Propranolol-pretreated dogs (N = 9) displayed a significantly lower left ventricular peak-positive rise in ventricular pressure (dP/dt), heart rate, and rate-pressure product throughout the experiment compared with the control group (N = 15). Subendocardial percent segment shortening as measured by sonomicrometry recovered to 65.4 +/- 7.2% of the preocclusion level after pretreatment with propranolol, whereas the control group recovered to only 11.1% +/- 10.2% after 3 hours of reperfusion. To ascertain the beneficial role of a lower heart rate on the recovery of regional contractile function, a third group of dogs (N = 6) was pretreated with propranolol, but heart rate was maintained at control levels by atrial pacing. The beneficial effects of pretreatment with propranolol were abolished in this group. There were no differences between groups in myocardial perfusion in the normal region as measured by the radioactive microsphere technique. However, in postischemic, reperfused myocardium, there was a significantly higher blood flow to subepicardium, mid-myocardium, and subendocardium after reperfusion in the propranolol-pretreated, unpaced group. Thus long-term oral pretreatment with propranolol enhances the contractile recovery of postischemic, reperfused myocardium. This protective effect of beta-adrenergic blockade is primarily related to the reduction in heart rate and enhanced perfusion in the postischemic region.

Administration, Oral

Macular recovery function (nyctometry) in diabetics without and with early retinopathy.

Nyctometry was used to assess macular recovery function in 234 diabetic patients; their retinopathy ranged from no retinopathy (99) to early background retinopathy (135). None had visual symptoms or macular oedema. Abnormal (reduced) nyctometry findings were significantly and directly related to the deterioration of diabetic retinopathy. There was no significant association between reduced or normal nyctometry findings and glycaemia at the time of the examination. The value of nyctometry in screening and follow-up is discussed.

Adaptation, Ocular