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Evaluation of gait and its associated deviations from normal requires an in-depth evaluation of the patient and an appreciation for the complexity of the task. Understanding gait starts with an appreciation of the basic determinants of gait. Foot drop is a common gait deviation. ⋯ This will result in alterations of the gait cycle during swing phase. The common compensations for a foot drop include steppage gait, circumduction, and a persistently abducted limb. Noninterventional options for management of common gait deviations secondary to ankle/foot dysfunction present challenges.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Propofol for induction and maintenance of anesthesia during heart surgery. Results of pharmacological studies in man].
Numerous reports have concluded that propofol is suitable for maintenance of anesthesia by continuous infusion. The aim of this study was to evaluate the use of propofol and fentanyl for coronary bypass surgery in patients with good left ventricular function. The effects of this anesthetic combination on quality of anesthesia, hemodynamic status, and endocrine and metabolic responses were assessed. ⋯ CONCLUSION. In summary, it can be concluded that a propofol infusion technique positively enhances the recovery period after cardiac surgery and provides good control during anesthesia. However, the use of propofolfentanyl for induction of anesthesia in patients with limited coronary perfusion is not recommended because of its hypotensive effect.
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We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services. ⋯ VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care.
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We tested the hypothesis that decreasing the control level of O2 from 95% to 40% reduces tissue partial pressure of oxygen (pO2), decreases extracellular nitric oxide (NO) and decreases intracellular superoxide (O2(-)) while maintaining viability in caudal solitary complex (cSC) neurons in slices (∼300-400 μm; neonatal rat P2-22; 34-37°C). We also tested the hypothesis that normobaric hyperoxia is a general stimulant of cSC neurons, including CO2-excited neurons. Whole-cell recordings of cSC neurons maintained in 40% O2 were comparable to recordings made in 95% O2 in duration and quality. ⋯ Likewise, a higher incidence of CO2-inhibited and lower incidence of CO2-excited neurons were observed in 85-95% O2. 82% of O2-excited neurons were also CO2-chemosensitive; CO2-excited (86%) and CO2-inhibited neurons (84%) were equally stimulated by hyperoxia. Our findings demonstrate that chronic (hours) and acute (minutes) exposure to hyperoxia stimulates firing rate in the majority of cSC neurons, most of which are also CO2 chemosensitive. Our findings support the hypothesis that recurring exposures to acute hyperoxia and hyperoxic reoxygenation-a repeating surge in tissue pO2-activate redox and nitrosative signaling mechanisms in CO2-chemosensitive neurons that alter expression of CO2 chemosensitivity (e.g., increased expression of CO2-inhibition) compared to sustained hyperoxia (85-95% O2).
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The Journal of physiology · May 2002
Quantification of the response of rat medullary raphe neurones to independent changes in pH(o) and P(CO2).
The medullary raphe nuclei contain putative central respiratory chemoreceptor neurones that are highly sensitive to acidosis. To define the primary stimulus for chemosensitivity in these neurones, the response to hypercapnic acidosis was quantified and compared with the response to independent changes in P(CO2) and extracellular pH (pH(o)). Neurones from the ventromedial medulla of neonatal rats (P0-P2) were dissociated and maintained in tissue culture for long enough to develop a mature response (up to 70 days). ⋯ In addition, under the conditions used here, acetazolamide (100 microM) did not have a significant effect on the response to hypercapnic acidosis. We conclude that chemosensitivity of raphe neurones can occur independently of changes in pH(o), P(CO2) or bicarbonate. The results suggest that a change in intracellular pH (pH(i)) may be the primary stimulus for chemosensitivity in these putative central respiratory chemoreceptor neurones.