1,721,072 research outputs found
Exploring the Revolutionary Impact of YAP Pathways on Physical and Rehabilitation Medicine
Full text linkCellular behavior is strongly influenced by mechanical signals in the surrounding microenvironment, along with external factors such as temperature fluctuations, changes in blood flow, and muscle activity, etc. These factors are key in shaping cellular states and can contribute to the development of various diseases. In the realm of rehabilitation physical therapies, therapeutic exercise and manual treatments, etc., are frequently employed, not just for pain relief but also to support recovery from diverse health conditions. However, the detailed molecular pathways through which these therapies interact with tissues and influence gene expression are not yet fully understood. The identification of YAP has been instrumental in closing this knowledge gap. YAP is known for its capacity to perceive and translate mechanical signals into specific transcriptional programs within cells. This insight has opened up new perspectives on how physical and rehabilitation medicine may exert its beneficial effects. The review investigates the involvement of the Hippo/YAP signaling pathway in various diseases and considers how different rehabilitation techniques leverage this pathway to aid in healing. Additionally, it examines the therapeutic potential of modulating the Hippo/YAP pathway within the context of rehabilitation, while also addressing the challenges and controversies that surround its use in physical and rehabilitation medicine
Fascial Tissue: Future Perspectives in Regenerative Medicine
No full textRecent evidences show that fascia plays a key role in myofascial pain, such as chronic low back pain, chronic unspecific neck pain, plantar fasciitis, etc. Nevertheless, little is known about the microscopic structure and the molecular composition of this layer of collagen-rich fibrous connective tissue. Nowadays, many studies have focused attention on the possible role of hyaluronan in fascial gliding, and how the alteration of the gliding seems to be the cause of fascial pain. Actually, there are no studies in literature that analyse the microscopic aspects on the cells of fascia after the use of the various hormonal, pharmacological and physical stimuli, consequently every physician suggests the therapy according his personal experience. This is very dangerous for the patients and causes an uncontrolled cost for the health system.
Furthermore, knowing this information would allow us a more targeted therapy.
The fascial remodelling could be crucial to translate the role of rehabilitative treatments, but also in the regenerative medicine. Yet surprisingly, relatively little is known about properties and adaptation of connective tissue from fasciae in comparison the knowledge of others tissues.
For this purpose, I present a collection of ten peer-reviewed articles which aim to define the response of fascial tissue to different stimuli and the changes in its features as result of different physiological and pathological conditions.Recent evidences show that fascia plays a key role in myofascial pain, such as chronic low back pain, chronic unspecific neck pain, plantar fasciitis, etc. Nevertheless, little is known about the microscopic structure and the molecular composition of this layer of collagen-rich fibrous connective tissue. Nowadays, many studies have focused attention on the possible role of hyaluronan in fascial gliding, and how the alteration of the gliding seems to be the cause of fascial pain. Actually, there are no studies in literature that analyse the microscopic aspects on the cells of fascia after the use of the various hormonal, pharmacological and physical stimuli, consequently every physician suggests the therapy according his personal experience. This is very dangerous for the patients and causes an uncontrolled cost for the health system.
Furthermore, knowing this information would allow us a more targeted therapy.
The fascial remodelling could be crucial to translate the role of rehabilitative treatments, but also in the regenerative medicine. Yet surprisingly, relatively little is known about properties and adaptation of connective tissue from fasciae in comparison the knowledge of others tissues.
For this purpose, I present a collection of ten peer-reviewed articles which aim to define the response of fascial tissue to different stimuli and the changes in its features as result of different physiological and pathological conditions
Fascial plane blocks: from microanatomy to clinical applications
Full text linkPurpose of review: In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs. Recent findings: There is ample evidence to support the role of FPBs in pain management. However, the exact mechanism of action remains unclear. Fasciae are composed of various structural elements and display complex anatomical characteristics at the microscopic level. They include various cell types embedded within an extracellular matrix abundant in collagens and hyaluronan. Increasingly, numerous studies demonstrated their innervation that contributes to their sensory functions and their role in proprioception, motor coordination and pain perception. Lastly, the diversity of the cellular and extracellular matrix, with their viscoelastic properties, is essential to understanding the FPBs' mechanism of action. Summary: Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management
Enhancing Neuroprotection in Cardiac and Aortic Surgeries: A Narrative Review
Full text linkBackground: Neurological injury poses a significant challenge in aortic surgery, encompassing spinal cord injury from thoraco-abdominal aorta intervention or stroke post-surgery on the arch and ascending aorta. Despite ample literature and proposals, a fully effective strategy for preventing or treating neurological injury remains elusive. This narrative review aims to analyze the most common neuroprotective strategies implemented for aortic arch surgery and aortic surgery. Results: Results from the reviewed studies showed that several strategies, including deep hypothermia cardiac induction (DHCA) and cerebral perfusion techniques (retrograde cerebral perfusion, RCP, and selective anterograde cerebral perfusion, SACP) aim to mitigate these risks. Monitoring methods such as electroencephalogram (EEG), somatosensory evoked potential (SEPs), and near-infrared spectroscopy (NIRS) offer valuable insights into cerebral function during surgery, aiding in the management of hypothermia and perfusion. Pharmacological agents and blood gas management (pH stat vs. alpha stat, hematocrit level, glycemic control) are crucial in preventing post-operative complications. Additionally meticulous management of atheromatous debris is essential to minimize embolic risks during surgery. Methods: For this narrative review, PubMed, Scopus, and Medline have been used to search articles about neuroprotection strategies in aortic and aortic arch surgeries. The search was narrowed to articles between 1975 and 2024. A total of 3418 articles were initially identified to be potentially relevant for this review. A total of 66 articles were included and were found to match the inclusion criteria. Conclusions: While an overabundance of neuroprotection strategies exists for cardiac surgery, particularly in procedures involving the aorta and the arch, their efficacy varies, with some well-documented and others still under scrutiny. Further research is imperative to advance our comprehension and refine prevention techniques for cardiac-surgery-related brain injury. This is crucial given its substantial contribution to both mortality and, notably, post-operative morbidity
Ultrasound imaging and Fascial Manipulation® for rigid retinacula in two cases of complex regional pain syndrome
Full text linkComplex regional Pain Syndrome (CRPS) is a complex disease with articulate impact on the quality of life and its management is challenging. Ultrasound imaging can identify/assess different musculoskeletal structures that might have role in its pathogenesis. We present two cases of CRSP in whom B-mode ultrasonography and sonoelastography showed rigid retinacula associated with the symptomatology. Both patients were also/successfully treated with Fascial Manipulation
Ultrasound imaging and Fascial Manipulation®: ‘Adding a twist’ on the ankle retinacula
No full textBackground: Retinacula of the ankle are thickening of the deep fascia of the leg (crural fascia) and foot i.e. inseparable structures. Recent studies report their crucial role in functional stability and proprioception of the ankle. Case presentation: A 38-yr-old Caucasian man -with a history of lateral malleolus fracture 12 years ago, obesity and right ankle osteoarthritis -was referred to a physiatrist for a right ankle pain that had significantly worsened over the last year. During walking, the patient experienced stinging pain in the area of tibialis anterior and peroneus tertius muscles, and the superior extensor retinaculum. Magnetic resonance imaging and ultrasonog-raphy showed clear thicknening (2.05 mm) of the oblique superomedial band of the inferior extensor retinac-ulum. Sonopalpation was performed to precisely evaluate/confirm the site of maximum pain. Foot function index (FFI) score was 42. Results: Subsequently, the patient was prescribed fascial manipulation, and he had clinical improvement after the first session (FFI: 21). At 1-month follow-up, the patient was still asymptomatic without any functional limitation (FFI: 24). US imaging confirmed the decreased thickness of the oblique superomedial band of the extensor retinaculum (1.35 mm). Conclusion: Fascial Manipulation (R) appears to be a useful tool to reduce thickness, stiffness, and pain in this case as displayed by the ultrasound Imaging
Editorial: Fascia as a multi-purpose structure of connective tissue - dysfunction, diagnostics and treatment
Full text linkVeno-Arterial Extracorporeal Membrane Oxygenation in Cardiotoxic Drug-Induced Cardiogenic Shock: A Systematic Narrative Review
Full text linkBackground: Severe poisoning can lead to catastrophic cardiovascular collapse, often progressing to multiorgan failure and death. While intensive supportive care and pharmacological intervention remain the cornerstone of management, cases of refractory cardiogenic shock, particularly those caused by membrane stabilizing agents and calcium channel blockers, pose a significant therapeutic challenge. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential life-saving intervention in critically ill patients. This review examines the feasibility, clinical outcomes, and optimal indications for ECMO in the management of drug-induced cardiogenic shock. Methods: A systematic narrative review was conducted to evaluate the current evidence of ECMO use in poisoning-related cardiovascular failure, with a particular focus on patient selection criteria and the prognostic determinants of therapeutic resistance. Results: Extracorporeal membrane oxygenation may serve as a crucial hemodynamic support strategy in drug-induced circulatory collapse. Most reported cases involve peripheral ECMO, demonstrating variable but promising survival outcomes. Conclusions: Despite its potential to rescue patients from otherwise fatal toxic cardiomyopathy, the role of ECMO remains incompletely defined. Further prospective studies are essential to refine patient selection criteria and identify the toxicant-specific predictors of therapeutic failure. A deeper understanding of these factors may enhance clinical decision making and improve survival rates in severe poisoning cases
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