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17

Cochrane reviews evidence on surgery for stress incontinence after controversy in Scotland

Surgery for urinary stress incontinence in women that involves mesh slings to support the muscles of the bladder is effective and has low rates of complications, an updated Cochrane review has found.1  
feeds.bmj.com
over 6 years ago
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11

Critical Care

Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underlying mechanisms. The early phase occurs temporally with the onset of lung injury, is driven by inflammation and disuse, and is marked predominantly by muscle atrophy from increased protein degradation. The ubiquitin-proteasome, autophagy, and calpain-caspase pathways have all been implicated in early-phase muscle dysfunction. Late-phase muscle weakness persists in many patients despite resolution of lung injury and cessation of ongoing acute inflammation-driven muscle atrophy. The clinical characteristics and mechanisms underlying late-phase muscle dysfunction do not involve the massive protein degradation and atrophy of the early phase and may reflect a failure of the musculoskeletal system to regain homeostatic balance. Owing to these underlying mechanistic differences, therapeutic interventions for treating muscle dysfunction in ARDS may differ during the early and late phases. Here, we review clinical and translational investigations of muscle dysfunction in ARDS, placing them in the conceptual framework of the early and late phases. We hypothesize that this conceptual model will aid in the design of future mechanistic and clinical investigations of the skeletal muscle system in ARDS and other critical illnesses.  
ccforum.com
over 6 years ago
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8

Goal setting for adults receiving clinical rehabilitation for disability | Cochrane

Goal setting is considered a key part of clinical rehabilitation for adults with disability, such as in rehabilitation following brain injuries, heart or lung diseases, mental health illnesses, or for injuries or illnesses involving bones and muscles. Health professionals use goals to provide targets for themselves and their clients to work towards. In this review we summarise studies that have investigated what effect, if any, goal setting activities have on achieving good health outcomes following rehabilitation.  
cochrane.org
over 6 years ago
Www.bmj
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8

Focal neurological deficits after trauma

A 38 year old woman developed headache (without neck pain) and weakness of her left upper and lower limbs after a concussive head trauma with scalp lacerations in a motor vehicle crash. On examination (more than 4.5 hours after the trauma), she was conscious, alert, and in cardiac sinus rhythm. There was no carotid bruit. She scored 7 points on the National Institute of Health stroke scale (maximum possible score 42). Positive neurological findings included mild blunting of the left nasolabial fold; left hemiparesis, with extensor muscles being weaker (3/5) than flexors in the left upper limb (4+/5), flexors being weaker (4 to 4+/5) than extensors in the left lower limb (4+ to 5/5), and distal more than proximal weakness in the left arm and leg. She also had brisk deep tendon reflexes in the limbs on the left side; a left extensor plantar response; left hemianopia; and left hemisensory (including the face) hypoaesthesia for pain, cold, and touch. Eyelid ptosis or paresis of extraocular movements were not present, and pupillary size and light reaction were normal.  
feeds.bmj.com
over 6 years ago
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10

Cerebral mass in HIV infection

A 34 year old woman from the Republic of Congo with known HIV infection presented with a one day history of sudden weakness of the right arm and mild headache. She had a history of cardiomyopathy, hypertension, and epilepsy. She had not travelled abroad since she had moved to the United Kingdom 10 years ago. Other than weakness in the extensor muscles of the right arm grade 4/5 on the Medical Research Council scale, the physical examination was unremarkable.  
feeds.bmj.com
over 6 years ago
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10

Critical Care

Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underlying mechanisms. The early phase occurs temporally with the onset of lung injury, is driven by inflammation and disuse, and is marked predominantly by muscle atrophy from increased protein degradation. The ubiquitin-proteasome, autophagy, and calpain-caspase pathways have all been implicated in early-phase muscle dysfunction. Late-phase muscle weakness persists in many patients despite resolution of lung injury and cessation of ongoing acute inflammation-driven muscle atrophy. The clinical characteristics and mechanisms underlying late-phase muscle dysfunction do not involve the massive protein degradation and atrophy of the early phase and may reflect a failure of the musculoskeletal system to regain homeostatic balance. Owing to these underlying mechanistic differences, therapeutic interventions for treating muscle dysfunction in ARDS may differ during the early and late phases. Here, we review clinical and translational investigations of muscle dysfunction in ARDS, placing them in the conceptual framework of the early and late phases. We hypothesize that this conceptual model will aid in the design of future mechanistic and clinical investigations of the skeletal muscle system in ARDS and other critical illnesses.  
ccforum.com
over 6 years ago
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15

Critical Care

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.  
ccforum.com
over 6 years ago
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2

Interventions for leg cramps during pregnancy | Cochrane

Leg cramps are experienced as sudden, intense involuntary contractions of the leg muscles. They are a common problem in pregnancy, especially in the third trimester. They are painful and can interfere with daily activities, disrupt sleep, and reduce quality of life. Various interventions have been used during pregnancy to treat leg cramps, including drug, electrolyte (magnesium, calcium, sodium) and vitamin therapies, and non-drug therapies such as muscle stretching. The goal of this review was to find out what is effective and safe for treating leg cramps during pregnancy.  
cochrane.org
over 6 years ago
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7

Anatomy Of The Tibialis Anterior Muscle - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing anatomy of the tibialis anterior muscle. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: h...  
youtube.com
over 6 years ago
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91

Cardiac Muscle | PhysiologyZone | Muscular Series

This is a penultimate episode in the muscular series which will cover cardiac muscle. In this tutorial we will cover: 1. Macroscopic organisation 2. Microsco...  
youtube.com
over 6 years ago
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0

QB1 System Fights Muscle Atrophy After Knee Surgery (VIDEO) |

CyMedica, a company based in Scottsdale, Arizona, won the European CE mark for its QB1 Muscle Activation System, a device designed to address quadriceps mu  
medgadget.com
over 6 years ago
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10

Imaging Case of the Week 166 Answer

The hamstring muscle group originates at the ischial tuberosity. The injury occurs as a result of forceful hip flexion with the knee in extension.  
emergucate.com
over 6 years ago
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8

Arm Muscles | Flashcard Anatomy

Arm muscles Anatomy Flashcard. Check out the 3D app at http://AnatomyLearning.com. More videos available on http://AnatomyZone.com. Use this brief flashcard ...  
youtube.com
over 6 years ago