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[PMID]:29245271
[Au] Autor:Tsuchihashi K; Yoshihiro T; Aikawa T; Nio K; Takayoshi K; Yokoyama T; Fukata M; Arita S; Ariyama H; Shimizu Y; Yoshida Y; Torisu T; Esaki M; Odashiro K; Kusaba H; Akashi K; Baba E
[Ad] Endereço:aDepartment of Medicine and Biosystemic Science, Graduate School of Medical SciencesbDepartment of Comprehensive Clinical Oncology, Faculty of Medical SciencescDepartment of Anesthesiology and Critical Care MedicinedDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
[Ti] Título:Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex: A case report.
[So] Source:Medicine (Baltimore);96(49):e8987, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. PATIENT CONCERNS: A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. DIAGNOSIS: Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. INTERVENTIONS: Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. OUTCOMES: Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. LESSONS: Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/diagnóstico
Carcinoma de Células Escamosas/patologia
Neoplasias Esofágicas/diagnóstico
Neoplasias Esofágicas/patologia
Pressorreceptores/fisiopatologia
Nervo Vago/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Carcinoma de Células Escamosas/terapia
Neoplasias Esofágicas/terapia
Esofagoscopia
Feminino
Seres Humanos
Metástase Linfática
Estadiamento de Neoplasias
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171225
[Lr] Data última revisão:
171225
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008987


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[PMID]:29053723
[Au] Autor:Weber TM; Lackner HK; Roessler A; Papousek I; Kolovetsiou-Kreiner V; Lucovnik M; Schmid-Zalaudek K; Lang U; Moertl MG
[Ad] Endereço:Department of Physiology, Medical University of Graz, Graz, Austria.
[Ti] Título:Heart rate variability and baroreceptor reflex sensitivity in early- versus late-onset preeclampsia.
[So] Source:PLoS One;12(10):e0186521, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia. METHODS: Matched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three "control"uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant). RESULTS: 24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50). CONCLUSIONS: Heart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
[Mh] Termos MeSH primário: Frequência Cardíaca
Pré-Eclâmpsia/fisiopatologia
Pressorreceptores/fisiologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171021
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186521


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[PMID]:28794084
[Au] Autor:Quinn TA; Jin H; Lee P; Kohl P
[Ad] Endereço:From the Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada (T.A.Q.); Department of Physiology, Anatomy, and Genetics, University of Oxford, United Kingdom (H.J., P.L.); and Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/
[Ti] Título:Mechanically Induced Ectopy via Stretch-Activated Cation-Nonselective Channels Is Caused by Local Tissue Deformation and Results in Ventricular Fibrillation if Triggered on the Repolarization Wave Edge (Commotio Cordis).
[So] Source:Circ Arrhythm Electrophysiol;10(8), 2017 Aug.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: External chest impacts (commotio cordis) can cause mechanically induced premature ventricular excitation (PVE ) and, rarely, ventricular fibrillation (VF). Because block of stretch-sensitive ATP-inactivated potassium channels curtailed VF occurrence in a porcine model of commotio cordis, VF has been suggested to arise from abnormal repolarization caused by stretch activation of potassium channels. Alternatively, VF could result from abnormal excitation by PVE , overlapping with normal repolarization-related electric heterogeneity. Here, we investigate mechanisms and determinants of PVE induction and its potential role in commotio cordis-induced VF. METHODS AND RESULTS: Subcontusional mechanical stimuli were applied to isolated rabbit hearts during optical voltage mapping, combined with pharmacological block of ATP-inactivated potassium or stretch-activated cation-nonselective channels. We demonstrate that local mechanical stimulation reliably triggers PVE at the contact site, with inducibility predicted by local tissue indentation. PVE induction is diminished by pharmacological block of stretch-activated cation-nonselective channels. In hearts where electrocardiogram T waves involve a well-defined repolarization edge traversing the epicardium, PVE can reliably provoke VF if, and only if, the mechanical stimulation site overlaps the repolarization wave edge. In contrast, application of short-lived intraventricular pressure surges neither triggers PVE nor changes repolarization. ATP-inactivated potassium channel block has no effect on PVE inducibility per se, but shifts it to later time points by delaying repolarization and prolonging refractoriness. CONCLUSIONS: Local mechanical tissue deformation determines PVE induction via stretch-activation of cation-nonselective channels, with VF induction requiring PVE overlap with the trailing edge of a normal repolarization wave. This defines a narrow, subject-specific vulnerable window for commotio cordis-induced VF that exists both in time and in space.
[Mh] Termos MeSH primário: Commotio Cordis/fisiopatologia
Pressorreceptores/fisiologia
Taquicardia Ventricular/fisiopatologia
Ferimentos não Penetrantes/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Commotio Cordis/complicações
Eletrocardiografia
Feminino
Sistema de Condução Cardíaco/fisiopatologia
Compostos Heterocíclicos de 4 ou mais Anéis/farmacologia
Canais Iônicos/fisiologia
Mecanotransdução Celular/fisiologia
Bloqueadores dos Canais de Potássio/farmacologia
Coelhos
Taquicardia Ventricular/etiologia
Ferimentos não Penetrantes/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Heterocyclic Compounds, 4 or More Rings); 0 (Ion Channels); 0 (Potassium Channel Blockers); 20WC4J7CQ6 (blebbistatin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE


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[PMID]:28687588
[Au] Autor:Ichinose M; Ichinose-Kuwahara T; Watanabe K; Kondo N; Nishiyasu T
[Ad] Endereço:Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, Tokyo, Japan; ichinose@meiji.ac.jp.
[Ti] Título:The carotid baroreflex modifies the pressor threshold of the muscle metaboreflex in humans.
[So] Source:Am J Physiol Heart Circ Physiol;313(3):H650-H657, 2017 Sep 01.
[Is] ISSN:1522-1539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of the present study was to test our hypothesis that unloading the carotid baroreceptors alters the threshold and gain of the muscle metaboreflex in humans. Ten healthy subjects performed a static handgrip exercise at 50% of maximum voluntary contraction. Contraction was sustained for 15, 30, 45, and 60 s and was followed by 3 min of forearm circulatory arrest, during which forearm muscular pH is known to decrease linearly with increasing contraction time. The carotid baroreceptors were unloaded by applying 0.1-Hz sinusoidal neck pressure (oscillating from +15 to +50 mmHg) during ischemia. We estimated the threshold and gain of the muscle metaboreflex by analyzing the relationship between the cardiovascular responses during ischemia and the amount of work done during the exercise. In the condition with unloading of the carotid baroreceptors, the muscle metaboreflex thresholds for mean arterial blood pressure (MAP) and total vascular resistance (TVR) corresponded to significantly lower work levels than the control condition (threshold for MAP: 795 ± 102 vs. 662 ± 208 mmHg and threshold for TVR: 818 ± 213 vs. 572 ± 292 kg·s, < 0.05), but the gains did not differ between the two conditions (gain for MAP: 4.9 ± 1.7 vs. 4.4 ± 1.6 mmHg·kg·s ·100 and gain for TVR: 1.3 ± 0.8 vs. 1.3 ± 0.7 mmHg·l ·min ·kg·s ·100). We conclude that the carotid baroreflex modifies the muscle metaboreflex threshold in humans. Our results suggest the carotid baroreflex brakes the muscle metaboreflex, thereby inhibiting muscle metaboreflex-mediated pressor and vasoconstriction responses. We found that unloading the carotid baroreceptors shifts the pressor threshold of the muscle metaboreflex toward lower metabolic stimulation levels in humans. This finding indicates that, in the normal loading state, the carotid baroreflex inhibits the muscle metaboreflex pressor response by shifting the reflex threshold to higher metabolic stimulation levels.
[Mh] Termos MeSH primário: Barorreflexo
Artérias Carótidas/inervação
Células Quimiorreceptoras/fisiologia
Metabolismo Energético
Contração Muscular
Músculo Esquelético/irrigação sanguínea
Músculo Esquelético/inervação
Pressorreceptores/fisiologia
Vasoconstrição
[Mh] Termos MeSH secundário: Adolescente
Adulto
Pressão Arterial
Feminino
Antebraço
Força da Mão
Voluntários Saudáveis
Seres Humanos
Concentração de Íons de Hidrogênio
Isquemia/metabolismo
Isquemia/fisiopatologia
Masculino
Inibição Neural
Fluxo Sanguíneo Regional
Fatores de Tempo
Resistência Vascular
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE
[do] DOI:10.1152/ajpheart.00816.2016


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[PMID]:28363984
[Au] Autor:Wenker IC; Abe C; Viar KE; Stornetta DS; Stornetta RL; Guyenet PG
[Ad] Endereço:Department of Pharmacology, University of Virginia, Charlottesville, Virginia 22908.
[Ti] Título:Blood Pressure Regulation by the Rostral Ventrolateral Medulla in Conscious Rats: Effects of Hypoxia, Hypercapnia, Baroreceptor Denervation, and Anesthesia.
[So] Source:J Neurosci;37(17):4565-4583, 2017 Apr 26.
[Is] ISSN:1529-2401
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Current understanding of the contribution of C1 neurons to blood pressure (BP) regulation derives predominantly from experiments performed in anesthetized animals or reduced preparations. Here, we use ArchaerhodopsinT3.0 (ArchT) loss-of-function optogenetics to explore BP regulation by C1 neurons in intact, unanesthetized rats. Using a lentivirus that expresses ArchT under the Phox2b-activated promoter PRSx8 (PRSx8-ArchT), ∼65% of transduced neurons were C1 (balance retrotrapezoid nucleus, RTN). Other rats received CaMKII-ArchT3.0 AAV2 (CaMKII-ArchT), which transduced C1 neurons and larger numbers of unidentified glutamatergic and GABAergic cells. Under anesthesia, ArchT photoactivation reduced sympathetic nerve activity and BP and silenced/strongly inhibited most (7/12) putative C1 neurons. In unanesthetized PRSx8-ArchT-treated rats breathing room air, bilateral ArchT photoactivation caused a very small BP reduction that was only slightly larger under hypercapnia (6% FiCO ), but was greatly enhanced during hypoxia (10 and 12% FiO ), after sino-aortic denervation, or during isoflurane anesthesia. The degree of hypotension correlated with percentage of ArchT-transduced C1 neurons. ArchT photoactivation produced similar BP changes in CaMKII-ArchT-treated rats. Photoactivation in PRSX8-ArchT rats reduced breathing frequency ( ), whereas increased in CaMKII-ArchT rats. We conclude that the BP drop elicited by ArchT activation resulted from C1 neuron inhibition and was unrelated to breathing changes. C1 neurons have low activity under normoxia, but their activation is important to BP stability during hypoxia or anesthesia and contributes greatly to the hypertension caused by baroreceptor deafferentation. Finally, C1 neurons are marginally activated by hypercapnia and the large breathing stimulation caused by this stimulus has very little impact on resting BP. C1 neurons are glutamatergic/peptidergic/catecholaminergic neurons located in the medulla oblongata, which may operate as a switchboard for differential, behavior-appropriate activation of selected sympathetic efferents. Based largely on experimentation in anesthetized or reduced preparations, a rostrally located subset of C1 neurons may contribute to both BP stabilization and dysregulation (hypertension). Here, we used Archaerhodopsin-based loss-of-function optogenetics to explore the contribution of these neurons to BP in conscious rats. The results suggest that C1 neurons contribute little to resting BP under normoxia or hypercapnia, C1 neuron discharge is restrained continuously by arterial baroreceptors, and C1 neuron activation is critical to stabilize BP under hypoxia or anesthesia. This optogenetic approach could also be useful to explore the role of C1 neurons during specific behaviors or in hypertensive models.
[Mh] Termos MeSH primário: Anestesia
Pressão Sanguínea
Hipercapnia/fisiopatologia
Hipóxia/fisiopatologia
Bulbo/fisiopatologia
Pressorreceptores
[Mh] Termos MeSH secundário: Anestésicos Inalatórios/farmacologia
Animais
Pressão Sanguínea/efeitos dos fármacos
Células Quimiorreceptoras
Hipercapnia/genética
Hipertensão/fisiopatologia
Isoflurano/farmacologia
Masculino
Neurônios
Optogenética
Ratos
Ratos Sprague-Dawley
Transdução Genética
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); CYS9AKD70P (Isoflurane)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170402
[St] Status:MEDLINE
[do] DOI:10.1523/JNEUROSCI.3922-16.2017


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[PMID]:28320856
[Au] Autor:de Leeuw PW; Bisognano JD; Bakris GL; Nadim MK; Haller H; Kroon AA; DEBuT-HT and Rheos Trial Investigators
[Ad] Endereço:From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester
[Ti] Título:Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up.
[So] Source:Hypertension;69(5):836-843, 2017 May.
[Is] ISSN:1524-4563
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg ( <0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg ( <0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute ( <0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues.
[Mh] Termos MeSH primário: Barorreflexo/fisiologia
Pressão Sanguínea/fisiologia
Terapia por Estimulação Elétrica/métodos
Hipertensão/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Anti-Hipertensivos/farmacologia
Anti-Hipertensivos/uso terapêutico
Pressão Sanguínea/efeitos dos fármacos
Determinação da Pressão Arterial
Terapia Combinada
Método Duplo-Cego
Feminino
Seguimentos
Frequência Cardíaca/efeitos dos fármacos
Frequência Cardíaca/fisiologia
Seres Humanos
Hipertensão/tratamento farmacológico
Hipertensão/fisiopatologia
Masculino
Meia-Idade
Pressorreceptores/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antihypertensive Agents)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1161/HYPERTENSIONAHA.117.09086


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[PMID]:28286334
[Au] Autor:Qiu Z; Chen L; Cao H; Chen Q; Peng H
[Ad] Endereço:Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland).
[Ti] Título:Mechanical Strain Induced Expression of Matrix Metalloproteinase-9 via Stretch-Activated Channels in Rat Abdominal Aortic Dissection.
[So] Source:Med Sci Monit;23:1268-1276, 2017 Mar 13.
[Is] ISSN:1643-3750
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND The aim of the study was to investigate the expression of matrix metalloproteinase-9 (MMP-9) in rat abdominal aortic dissection (AD) induced by mechanical strain, so as to offer a better understanding of the possible mechanisms of AD. MATERIAL AND METHODS Experimental AD in rats was achieved by the injection of porcine pancreatic elastase. At days 0, 1, 3, 5, 7, 14, 21, and 30 after the establishment of AD model, serum MMP-9 levels were measured by enzyme-linked immunosorbent assay (ELISA). Four groups of vascular rings were stretched in vitro with a mechanical strength of 0 g, 1 g, 3 g, or 5 g for 30 min. Another four groups were pretreated with GdCl3, streptomycin, SN50, and SN50M, followed by stretching with 3 g for 30 min. The messenger RNA and the protein of MMP-9 were analyzed by real-time RT-PCR and Western blotting, and NF-κB p65 was detected by ELISA. RESULTS After the establishment of rat abdominal AD model, the serum MMP-9 levels of AD groups increased significantly. The results showed increased expression of MMP-9 in rat AD vessels stretched with mechanical strength of 1 g, 3 g, and 5 g, but this effect was mostly blocked by Gd Cl3 and streptomycin. The NF-κB activity in aortic rings was activated by stretching with a mechanical strength of 3 g and was blocked by SN50, but not by SN50M. CONCLUSIONS The expression of MMP-9 in serum was increased significantly after rat abdominal AD formation. Mechanical strain induced MMP-9 expression in AD vessels, which was mediated through the activation of the stretch-activated channel-induced NF-κB pathway.
[Mh] Termos MeSH primário: Aneurisma Dissecante/metabolismo
Metaloproteinase 9 da Matriz/genética
Metaloproteinase 9 da Matriz/metabolismo
[Mh] Termos MeSH secundário: Aneurisma Dissecante/genética
Animais
Aorta/fisiologia
Aorta Abdominal
Aneurisma Aórtico/metabolismo
China
Regulação da Expressão Gênica
Masculino
Metaloproteinase 9 da Matriz/sangue
NF-kappa B/metabolismo
Pressorreceptores
Ratos
Ratos Sprague-Dawley
Transdução de Sinais/efeitos dos fármacos
Estresse Fisiológico/genética
Estresse Fisiológico/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (NF-kappa B); EC 3.4.24.35 (Matrix Metalloproteinase 9)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE


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[PMID]:28245992
[Au] Autor:Ghali MGZ; Srinivasan VM; Hanna E; DeMonte F
[Ad] Endereço:Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. Electronic address: mgzghali@gmail.com.
[Ti] Título:Overt and Subclinical Baroreflex Dysfunction After Bilateral Carotid Body Tumor Resection: Pathophysiology, Diagnosis, and Implications for Management.
[So] Source:World Neurosurg;101:559-567, 2017 May.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Carotid body paragangliomas are rare, usually benign, tumors arising from glomus cells of the carotid body. Bilateral involvement is present in ∼5% of sporadic cases and up to one third of familial cases. In most patients undergoing bilateral resection of carotid body tumors, a condition known as baroreflex failure syndrome (BFS) develops after resection of the second tumor characterized by headache, anxiety, emotional lability, orthostatic lightheadedness, hypertension, and tachycardia. This condition is believed to result from damage to the carotid baroreceptor apparatus. Patients without overt cardiovascular abnormalities may have subclinical baroreceptor dysfunction evident only on specific testing, measuring heart rate and sympathetic nerve responses to baroloading (e.g., phenylephrine) and barounloading (e.g., Valsalva maneuver). Given the high incidence of BFS in patients undergoing bilateral resection of carotid body tumors, it is suggested that operation is limited to unilateral resection of the dominant/symptomatic lesion and nonsurgical intervention (i.e., embolization, radiotherapy) on the contralateral side. Alternatively, refinement of surgical technique to prevent injury to elements of the baroreceptor apparatus may prevent this complication of bilateral tumor resection. METHODS AND RESULTS: We present a case of a 16-year-old girl with bilateral jugular vagale and carotid body tumors who developed hypertension after surgical resection of her left jugular vagale tumor and worsening of hypertension concurrent with progression, requiring intensity-modulated radiation therapy and a resection for significant progression of her left jugular vagale tumor. Additional case studies and series of bilateral carotid body tumors and BFS were identified through a comprehensive literature search in the PubMed database. CONCLUSIONS: Our case shows the generalizability of BFS to patients with tumors involving the vagal baroafferent fibers.
[Mh] Termos MeSH primário: Barorreflexo/fisiologia
Tumor do Corpo Carotídeo/diagnóstico por imagem
Tumor do Corpo Carotídeo/cirurgia
Gerenciamento Clínico
Pressorreceptores/fisiopatologia
[Mh] Termos MeSH secundário: Adolescente
Feminino
Seres Humanos
Complicações Pós-Operatórias/diagnóstico por imagem
Complicações Pós-Operatórias/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE


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[PMID]:28132741
[Au] Autor:Jaenisch RB; Quagliotto E; Chechi C; Calegari L; Dos Santos F; Borghi-Silva A; Dal Lago P
[Ad] Endereço:Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Pau
[Ti] Título:Respiratory Muscle Training Improves Chemoreflex Response, Heart Rate Variability, and Respiratory Mechanics in Rats With Heart Failure.
[So] Source:Can J Cardiol;33(4):508-514, 2017 Apr.
[Is] ISSN:1916-7075
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of the present report was to evaluate respiratory muscle training (RMT) effects on hemodynamic function, chemoreflex response, heart rate variability, and respiratory mechanics in rats with heart failure (HF rats). METHODS: Wistar rats were divided into 4 groups: sedentary-sham (Sed-Sham, n = 8), respiratory muscle trained-sham (RMT-Sham, n = 8), sedentary-HF (Sed-HF, n = 8) and respiratory muscle trained-HF (RMT-HF, n = 8). Animals were submitted to an RMT protocol performed 30 minutes per day, 5 days per week for 6 weeks, whereas the sedentary animals did not exercise. RESULTS: In HF rats, RMT promoted the reduction of left ventricular end-diastolic pressure, right ventricular hypertrophy, and pulmonary edema. Moreover, RMT produced a reduction in pressure response during chemoreflex activation, sympathetic modulation, and sympathetic vagal balance in addition to an increase in parasympathetic modulation. Also after RMT, HF rats demonstrated a reduction in respiratory system resistance, tissue resistance, Newtonian resistance, respiratory system compliance, and quasistatic compliance. CONCLUSIONS: These findings suggested that 6 weeks of RMT in HF rats promoted beneficial adaptations in hemodynamics, autonomic function, and respiratory mechanics and attenuated pressure response evoked by chemoreflex activation in HF rats.
[Mh] Termos MeSH primário: Exercícios Respiratórios/métodos
Insuficiência Cardíaca/reabilitação
Frequência Cardíaca/fisiologia
Condicionamento Físico Animal/métodos
Pressorreceptores/fisiopatologia
Mecânica Respiratória/fisiologia
Músculos Respiratórios/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Insuficiência Cardíaca/fisiopatologia
Masculino
Ratos
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170131
[St] Status:MEDLINE


  10 / 7520 MEDLINE  
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[PMID]:28104014
[Au] Autor:Feng YR; Chen XH; Kou XJ; Bai YL; Lu FQ; Yang J; Wang BC
[Ad] Endereço:Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China.
[Ti] Título:[Individualized treatment of bilateral carotid body tumor].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;52(1):37-43, 2017 Jan 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate individualized therapeutic strategy for bilateral carotid body tumors. Clinical data of 16 patients with bilateral carotid body tumor treated from January 2003 to August 2016 were retrospectively studied. Of the 16 patients, 9 were males and 7 were females; 5 were sporadic and 11 were familial; 8 cases were observed, 1 cases was malignant and treated with chemotherapy, and 7 cases were treated with surgery. The treatment course, perioperative complications and clinical efficacy were assessed. Comprehensive evaluation of bilateral carotid body tumors was performed based on the size of bilateral tumor, clinical manifestations, genetic tests and other indicators. Individual treatment strategies included observation, surgery and observation, bilateral surgery, radiotherapy or chemotherapy. Surgical resection of carotid body tumor was unilateral in 3 cases and bilateral in 3 cases; removal of bilateral carotid body tumors plus unilateral jugular bulb in 1 case; and the internal carotid artery was reconstructed with autologous greater saphenous vein in 1 case. All patients were followed up for 3 months to 12 years. There was no patient death during perioperative period. Superior laryngeal nerve injury occurred in 2 case. Baroreceptor failure syndrome occurred in one patient, but it gradually recoverd with medical treatments. It is important to identify whether bilateral carotid body tumors are hereditary and to make an individualized therapeutic strategy for each patient with bilateral carotid body tumors, focusing on the improvement in the quality of life of patient.
[Mh] Termos MeSH primário: Tumor do Corpo Carotídeo/tratamento farmacológico
Tumor do Corpo Carotídeo/cirurgia
[Mh] Termos MeSH secundário: Artéria Carótida Interna/cirurgia
Tumor do Corpo Carotídeo/etiologia
Tumor do Corpo Carotídeo/patologia
Feminino
Seres Humanos
Traumatismos do Nervo Laríngeo/etiologia
Masculino
Complicações Pós-Operatórias/etiologia
Pressorreceptores/fisiopatologia
Qualidade de Vida
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170121
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2017.01.007



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