1
|
Zhou K, Luo W, Liu T, Ni Y, Qin Z. Neurotoxins Acting at Synaptic Sites: A Brief Review on Mechanisms and Clinical Applications. Toxins (Basel) 2022; 15:18. [PMID: 36668838 PMCID: PMC9865788 DOI: 10.3390/toxins15010018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Neurotoxins generally inhibit or promote the release of neurotransmitters or bind to receptors that are located in the pre- or post-synaptic membranes, thereby affecting physiological functions of synapses and affecting biological processes. With more and more research on the toxins of various origins, many neurotoxins are now widely used in clinical treatment and have demonstrated good therapeutic outcomes. This review summarizes the structural properties and potential pharmacological effects of neurotoxins acting on different components of the synapse, as well as their important clinical applications, thus could be a useful reference for researchers and clinicians in the study of neurotoxins.
Collapse
Affiliation(s)
- Kunming Zhou
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, College of Pharmaceutical Sciences, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Weifeng Luo
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Tong Liu
- Institute of Pain Medicine and Special Environmental Medicine, Nantong University, Nantong 226019, China
| | - Yong Ni
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Zhenghong Qin
- Department of Pharmacology and Laboratory of Aging and Nervous Diseases, College of Pharmaceutical Sciences, Suzhou Medical College of Soochow University, Suzhou 215123, China
| |
Collapse
|
2
|
Slysz JT, Boston M, King R, Pignanelli C, Power GA, Burr JF. Blood Flow Restriction Combined with Electrical Stimulation Attenuates Thigh Muscle Disuse Atrophy. Med Sci Sports Exerc 2021; 53:1033-1040. [PMID: 33105390 DOI: 10.1249/mss.0000000000002544] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to investigate the effects of blood flow restriction (BFR) combined with electrical muscle stimulation (EMS) on skeletal muscle mass and strength during a period of limb disuse. METHODS Thirty healthy participants (22 ± 3 yr; 23 ± 3 kg·m-2) were randomly assigned to control (CON; n = 10), BFR alone (BFR; n = 10), or BFR combined with EMS (BFR + EMS; n = 10). All participants completed unloading of a single leg for 14 d, with no treatment (CON), or while treated with either BFR or BFR + EMS (twice daily, 5 d·wk-1). BFR treatment involved arterial three cycles of 5-min occlusion using suprasystolic pressure, each separated by 5 min of reperfusion. EMS (6 s on, 15 s off; 200 μs; 60 Hz; 15% maximal voluntary contraction [MVC]) was applied continuously throughout the three BFR cycles. Quadriceps muscle mass (whole-thigh lean mass via dual-energy x-ray absorptiometry and vastus lateralis [VL] muscle thickness via ultrasound) and strength (via knee extension MVC) were assessed before and after the 14-d unloading period. RESULTS After limb unloading, whole-thigh lean mass decreased in the control group (-4% ± 1%, P < 0.001) and BFR group (-3% ± 2%, P = 0.001), but not in the BFR + EMS group (-0.3% ± 3%, P = 0.8). VL muscle thickness decreased in the control group (-4% ± 4%, P = 0.005) and was trending toward a decrease in the BFR group (-8% ± 11%, P = 0.07) and increase in the BFR + EMS group (+5% ± 10%, P = 0.07). Knee extension MVC decreased over time (P < 0.005) in the control group (-18% ± 15%), BFR group (-10% ± 13%), and BFR + EMS group (-18% ± 15%), with no difference between groups (P > 0.5). CONCLUSION Unlike BFR performed in isolation, BFR + EMS represents an effective interventional strategy to attenuate the loss of muscle mass during limb disuse, but it does not demonstrate preservation of strength.
Collapse
|
3
|
Côté A, Abasse KS, Laberge M, Gilbert MH, Breton M, Lemaire C. Orthopedist involvement in the management of clinical activities: a case study. BMC Health Serv Res 2021; 21:299. [PMID: 33794873 PMCID: PMC8017788 DOI: 10.1186/s12913-021-06299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists' level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. METHODS We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. RESULTS Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. CONCLUSIONS Beyond simply identifying the underlying dynamics of orthopedists' involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.
Collapse
Affiliation(s)
- André Côté
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada
| | - Kassim Said Abasse
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada. .,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada. .,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada. .,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada. .,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada.
| | - Maude Laberge
- Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Département d'opérations et systèmes de décision
- , Faculté des sciences de l'administration (FSA) Université Laval, Québec, QC, G1V 0A6, Canada
| | - Marie-Hélène Gilbert
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada
| | - Mylaine Breton
- Université de Sherbrooke, Longueuil Campus, Sherbrooke, Canada
| | - Célia Lemaire
- EM Strasbourg Business School, Université de Strasbourg, HuManiS (UR 7308), Strasbourg, France
| |
Collapse
|
4
|
Neurobiology and therapeutic applications of neurotoxins targeting transmitter release. Pharmacol Ther 2019; 193:135-155. [DOI: 10.1016/j.pharmthera.2018.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
5
|
McFarlane RA, Isbel ST, Jamieson MI. Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture. DEMENTIA 2015; 16:413-423. [PMID: 26289963 PMCID: PMC5424855 DOI: 10.1177/1471301215599704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.
Collapse
|
6
|
Ong KL, Lotke PA, Lau E, Manley MT, Kurtz SM. Prevalence and Costs of Rehabilitation and Physical Therapy After Primary TJA. J Arthroplasty 2015; 30:1121-6. [PMID: 25765130 DOI: 10.1016/j.arth.2015.02.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/12/2015] [Accepted: 02/21/2015] [Indexed: 02/01/2023] Open
Abstract
This study evaluated the trends in discharge patterns and the prevalence and cost of post-discharge PT. The 5% Medicare database (1997-2010) was used to identify 50,886 primary THA and 107,675 TKA patients. More than 50% of patients were discharged from hospital to an inpatient facility. There were an increase in discharges to skilled nursing units and a reduced rate to rehabilitation facilities. In contrast to hospital, surgeon reimbursement, and implant costs, the average annual PT cost per patient rose through the study period. Approximately 25% of PT costs were used on less common modalities. PT costs more than $648 million a year. With the increased pressure to control costs for primary TJA, these patterns may change unless PT effectiveness can be demonstrated.
Collapse
Affiliation(s)
| | - Paul A Lotke
- University of Pennsylvania, Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | | | - Michael T Manley
- Homer Stryker Center for Orthopaedic Education and Research, Mahwah, New Jersey
| | | |
Collapse
|
7
|
Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter? Am J Phys Med Rehabil 2015; 94:366-72. [PMID: 25251255 DOI: 10.1097/phm.0000000000000191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. DESIGN Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. RESULTS In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. CONCLUSIONS Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.
Collapse
|
8
|
Matthews CC, Lovering RM, Bowen TG, Fishman PS. Tetanus toxin preserves skeletal muscle contractile force and size during limb immobilization. Muscle Nerve 2014; 50:759-66. [DOI: 10.1002/mus.24231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/19/2014] [Accepted: 02/27/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Christopher C. Matthews
- Research Service, VA Maryland Health Care System; 10 North Greene Street Baltimore Maryland 21201 USA
- Department of Neurology; School of Medicine, University of Maryland; Baltimore Maryland USA
| | - Richard M. Lovering
- Department of Orthopaedics; School of Medicine, University of Maryland; Baltimore Maryland USA
| | - Thomas G. Bowen
- Research Service, VA Maryland Health Care System; 10 North Greene Street Baltimore Maryland 21201 USA
| | - Paul S. Fishman
- Research Service, VA Maryland Health Care System; 10 North Greene Street Baltimore Maryland 21201 USA
- Department of Neurology; School of Medicine, University of Maryland; Baltimore Maryland USA
| |
Collapse
|
9
|
Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK, Phillips AL, Nanovic KM, Cummings EC, Rosal MC, Ayers DC, Franklin PD. Variations in Delivery and Exercise Content of Physical Therapy Rehabilitation Following Total Knee Replacement Surgery: A Cross-Sectional Observation Study. ACTA ACUST UNITED AC 2014; Suppl 5. [PMID: 26594649 PMCID: PMC4651458 DOI: 10.4172/2329-9096.s5-002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Prevalence of total knee replacement (TKR) is large and growing but functional outcomes are variable. Physical therapy (PT) is integral to functional recovery following TKR but little is known about the quantity or content of PT delivered. Purposes of this study were to describe the amount and exercise content of PT provided in the terminal episode of PT care following TKR and to examine factors associated with utilization and content. Methods Subjects included participants in a clinical trial of behavioral interventions for patients undergoing primary unilateral TKR who had completed the 6-month study evaluation. PT records were requested from 142 consecutive participants who had completed their post-TKR rehabilitation, 102 in/out patient care, and 40 in homecare. Information on utilization and exercises was extracted from a retrospective review of the PT records. Results We received 90 (88%) outpatient and 27 (68%) homecare PT records. Records showed variability in timing, amount and content of PT. Patients receiving outpatient PT had more visits and remained in PT longer (p<0.001). Exercises known in the TKR literature were utilized more frequently in the outpatient setting (p=0.001) than in home care. Records from both settings had limited documentation of strengthening progression. Conclusions The study reveals considerable variability in timing, utilization and exercise content of PT following TKR and suggests sub-optimal exercise for strengthening. While methods we employed document variability, improved systematic PT documentation and in-depth research are needed to identify optimal timing, utilization and content of PT following TKR.
Collapse
Affiliation(s)
- Carol A Oatis
- Department of Physical Therapy, Arcadia University, 450 S. Easton Road, Glenside, PA 19038, USA
| | - Wenjun Li
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA ; Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jessica M DiRusso
- The Queens Medical Center, 1301 Punchbowl St, Honolulu, HI 96813, USA
| | - Mindy J Hoover
- The Physical Therapy Associates of Myerstown, 11 E Lincoln Ave, Myerstown, PA 17067, USA
| | - Katherine K Johnston
- Sports and More Physical Therapy, Inc., 8300 Health Park, Suite 127, Raleigh, NC 27615, USA
| | - Monika K Butz
- Drayer PT Institute, 998 Hospitality Way, Aberdeen, MD 21001, USA
| | - Amy L Phillips
- UPMC Shadyside, 5230 Centre Ave, Pittsburgh, PA 15232, USA
| | - Kimberly M Nanovic
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Elizabeth C Cummings
- HealthEast Optimum Rehabilitation, Midway Clinic, 1390 University Avenue West Saint Paul, Minnesota 55104, USA
| | - Milagros C Rosal
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Patricia D Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| |
Collapse
|
10
|
|
11
|
The Burden of Prevalent Vertebral Fractures is Negatively Associated with Functional Outcome in Women with Hip Fracture. Am J Phys Med Rehabil 2011; 90:1-7. [DOI: 10.1097/phm.0b013e31820174e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
12
|
van Twillert S, Postema K, Geertzen JHB, Hemminga T, Lettinga AT. Improving rehabilitation treatment in a local setting: a case study of prosthetic rehabilitation. Clin Rehabil 2009; 23:938-47. [PMID: 19717507 DOI: 10.1177/0269215509338125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To contribute to the discussion on the research-practice gap by illustrating obstacles and opportunities that arise in an evidence-informed improvement process of prosthetic rehabilitation in a local setting. SETTING Dutch rehabilitation centre. PRESUPPOSITION: The improvement process was considered as a two-way translation process rather than a unidirectional process of knowledge transfer between science and practice. METHOD Case study and participatory research methods comprising documentary analysis, treatment observations, individual and focus groups interviews, and literature studies. A qualitative software program (Atlas-ti) was used to triangulate the collected data. RESULTS The main concern of local practitioners was identified to be the post-discharge decline in functional capacity in elderly amputees. This was related to a predominantly biomedical and biomechanical approach, and accompanying traditional therapist-patient interactions. The content and underpinnings of prosthetic treatments were scarcely specified in either the scientific literature or the local setting. Generic principles and practices from other fields were useful for treatment innovation for post-discharge problems, such as task- and context-specific training and self-management education. A circuit training focused on motor learning and a problem-solving training focused on social learning were developed by integrating amputation-specific knowledge. CONCLUSION Improving rehabilitation practice with the use of available evidence is a heterogeneous and multifaceted scientific enterprise. Such an enterprise requires as much self-reflexivity from researchers as from practitioners.
Collapse
Affiliation(s)
- Sacha van Twillert
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands.
| | | | | | | | | |
Collapse
|
13
|
Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. Serum Levels of Insulin-Like Growth Factor-I Are Positively Associated with Functional Outcome After Hip Fracture in Elderly Women. Am J Phys Med Rehabil 2009; 88:119-25. [DOI: 10.1097/phm.0b013e31818e002d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|