Sampling reflex as a new manometric marker in the diagnosis of defecation disorders: systematic review

Introduction: Distension of the rectum wall and subsequent momentary relaxation of the internal anal sphincter (IAS) trigger a reflex called the rectoanal inhibitory reflex (RAIR). This same rectal distension causes a reflex contraction of the external anal sphincter (EAS), responsible for conscious continence called rectoanal excitatory reflex (RAER). This set of reflexes are named sampling reflex. Objectives: The sampling reflex is necessary to initiate defecation or flatulence. The objective of this study is to evaluate the sampling reflex and its practical applicability as a manometric marker of the main defecation disorders. Methodology: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) items. The development method consisted of searching for articles in the research platforms BVS, PubMed, Cochrane Library, SciELO and ScienceDirect and for the selection of articles the Rayyan Platform was used. The articles resulting from the search strategies were added to the platform and five collaborators were invited for the blind selection. Finally, 6 articles were included in the final review. Results: An intact sampling reflex allows the individual to facilitate discrimination between flatus and stool and to choose whether to discharge or retain rectal contents. On the other hand, an impaired sampling reflex can predispose an individual to incontinence. Therefore, it was observed that patients with defecation disorders had an impaired sampling reflex, since it was found that constipated patients have incomplete opening of the IAS, lower amplitude of RAIR and increase of RAER. Most incontinent patients present a failure in the recruitment of the EAS, a decrease in the RAER and an increase in the RAIR, in duration and amplitude. (AU)

Diferencias en la duración del reflejo rectoanal inhibitorio en pacientes con constipación funcional refractaria y mielomeningocele / Differences in rectoanal inhibitory reflex duration between patients with refractory functional constipation and myelomeningocele

Introducción. Habitualmente, durante la manometría anorrectal, en lo correspondiente al reflejo rectoanal inhibitorio (RRAI) solo se pesquisa su presencia o ausencia. Estudios han reportado que su análisis detallado puede brindar datos de interés. Nuestra hipótesis es que la medición del RRAI puede dar información para reconocer causas orgánicas (médula anclada, lipoma, etc.) en pacientes en los que previamente se consideró como de causa funcional. Objetivos. Comparar la duración del reflejo rectoanal inhibitorio en la manometría anorrectal de pacientes con constipación funcional refractaria (CFR) y mielomeningocele (MMC). Población y métodos. Estudio observacional, transversal, analítico (2004-2019). Pacientes constipados crónicos con incontinencia fecal funcional y orgánica (mielomeningocele). Se les realizó manometría anorrectal con sistema de perfusión de agua y se midió la duración del RRAI con diferentes volúmenes (20, 40 y 60 cc). Grupo 1 (G1): 81 CFR. Grupo 2 (G2): 54 MMC. Se excluyeron pacientes con retraso madurativo, esfínter anal complaciente, agenesia sacra y aquellos no colaboradores. Resultados. Se incluyeron 135 sujetos (62 varones). La mediana de edad fue G1:9,57 años; G2: 9,63 años. Duración promedio G1 vs. G2 con 20 cc: 8,89 vs. 15,21 segundos; con 40 cc: 11.41 vs. 21,12 segundos; con 60 cc: 14,15 vs. 26,02 segundos. La diferencia de duración del RRAI entre ambos grupos con diferentes volúmenes fue estadísticamente significativa (p = 0,0001). Conclusión. La duración del RRAI aumenta a mayor volumen de insuflación del balón en ambas poblaciones. Pacientes con MMC tuvieron mayor duración del RRAI que aquellos con CFR. En los pacientes con RRAI prolongado, debe descartarse lesión medular.

Introduction. Usually, during anorectal manometry, only the presence or absence of rectoanal inhibitory reflex (RAIR) is investigated. Studies have reported that a detailed analysis may provide data of interest. Our hypothesis is that RAIR measurement may provide information to detect organic causes (tethered cord, lipoma, etc.) in patients in whom a functional cause had been previously considered. Objectives. To compare RAIR duration in anorectal manometry between patients with refractory functional constipation (RFC) and myelomeningocele (MMC). Population and methods. Observational, analytical, cross-sectional study (2004­2019). Patients with chronic constipation and functional and organic fecal incontinence (myelomeningocele). The anorectal manometry was performed with a water-perfused system, and the duration of RAIR was measured with different volumes (20, 40, and 60 cc). Group 1 (G1): 81 RFC. Group 2 (G2): 54 MMC. Patients with developmental delay, compliant anal sphincter, sacral agenesis and non-cooperative patients were excluded. Results. A total of 135 individuals were included (62 were male). Their median age was 9.57 years in G1 and 9.63 years in G2. Average duration in G1 versus G2 with 20 cc: 8.89 versus 15.21 seconds; 40 cc: 11.41 versus 21.12 seconds; 60 cc: 14.15 versus 26.02 seconds. The difference in RAIR duration with the varying volumes was statistically significant (p = 0.0001). Conclusion. RAIR duration was longer with increasing balloon inflation volumes in both populations. RAIR duration was longer in patients with MMC than in those with RFC. Spinal injury should be ruled out in patients with prolonged RAIR.

Rate of force development and stretch-shortening cycle in different jumps in the elite volleyball players / Tasa de desarrollo de fuerza y ciclo de estiramiento-acortamiento en diferentes saltos en jugadores de voleibol de élite

SUMMARY: As it is currently played, volleyball is a game in which success depends in large measure on the athleticism of the participants. The aim of this research was to point out the importance of the cycle of stretching and shortening in different jumps for elite volleyball players. Thus, it is common for volleyball athletes to place considerable emphasis on jump training. Not surprisingly, overload injuries of the knee and ankle joints, both acute and chronic, occur frequently among volleyball players and are related to the volume of jump training and skill repetition. Understanding the biomechanics of jumping is therefore a prerequisite for designing effective training programs which minimize the risk of overuse injuries that may result from excessive jumping, and the repetitive mechanical loading of muscles and joints that are involved in jump training Muscles acting about a joint function naturally through a combination of eccentric (lengthening) and concentric (shortening) activations. In the lower limb, the stretch-shortening cycle is a reflex arc in which the tendomuscular system acting about the knee or ankle is eccentrically preloaded (stretched) in the loading or impact phase of the jump before concentrically shortening in the push-off or take-off phase.

RESUMEN: Actualmente, el voleibol es un juego en el que el éxito depende en gran medida del atletismo de los participantes. El objetivo de esta investigación fue señalar la importancia del ciclo de estiramiento y acortamiento en diferentes saltos para jugadores de voleibol de élite. Es común que los atletas de voleibol pongan un énfasis considerable en el entrenamiento de salto. No es sorprendente que las lesiones por sobrecarga de las articulaciones de la rodilla y el tobillo, tanto agudas como crónicas, ocurran con frecuencia entre los jugadores de voleibol y estén relacionadas con el volumen de entrenamiento de saltos y la repetición de destrezas. Comprender la biomecánica del salto es, por lo tanto, un requisito previo para diseñar programas de entrenamiento efectivos que minimicen el riesgo de lesiones por uso excesivo que pueden resultar de un salto excesivo y la carga mecánica repetitiva de los músculos y las articulaciones que están involucrados en el entrenamiento del salto. Los músculos que actúan sobre una articulación funcionan de forma natural a través de una combinación de activaciones excéntricas (alargamiento) y concéntricas (acortamiento). En el miembro inferior, el ciclo de estiramiento-acortamiento es un arco reflejo en el que el sistema tendomuscular que actúa sobre la rodilla o el tobillo se precarga (estira) excéntricamente en la fase de carga o impacto del salto antes de acortarse concéntricamente en el despegue o toma. -fase de apagado.

Reflejo de Bezold-Jarish: una puesta al día en neurocirugía / Bezold-Jarisch reflex: an update in neurosurgery

El reflejo de Bezold Jarisch es un reflejo cardioinhibitorio que juega un papel en la homeostasis cardiovascular. Consiste en la triada dada por hipotensión, bradicardia y vasodilatación periférica que puede ser desencadenada tanto por estímulos mecánicos, como químicos. Se considera que el mecanismo eferente contrarresta e inhibe los efectos del influjo simpático y, por el contrario, activa los efectos producidos por el sistema parasimpático. Durante la cirugía neurológica, la disminución de la presión intracraneal posterior a la extracción de colgajo óseo en la craneotomía, el uso de medicamentos osmóticos para disminuir el edema cerebral e incluso la posición del paciente durante el procedimiento suponen situaciones más propensas a la aparición del reflejo.

The Bezold Jarisch reflex is a cardioinhibitory reflex that plays a role in cardiovascular homeostasis. It consists of a triad given by hypotension, bradycardia, and peripheral vasodilation that can be triggered by both mechanical and chemical stimuli. The efferent counteracting mechanism is considered to inhibit the effects of sympathetic influx and, conversely, activates the effects produced by the parasympathetic system. During neurological surgery, the decrease in intracranial pressure after bone flap extraction in the craniotomy, the use of osmotic medications to decrease cerebral edema and even the position of the patient during the procedure supposes situations more prone to reflex appearance

La receta médica: ¿reflejo condicionado o reflexión consciente? / Medical prescription: conditioned reflex or conscious reflection?

Resumen Extender una receta o indicar un tratamiento suele ser la última parte de la consulta médica. Este proceso crucial puede desvirtuarse debido a múltiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexión o tiempo. La información insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organización Mundial de la Salud, hace énfasis en hacer del proceso prescriptivo un ejercicio de reflexión.

Abstract Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise.

Red reflex test at the maternity hospital: results from a tertiary hospital and variables associated with inconclusive test results / Teste do reflexo vermelho na maternidade: resultados de um hospital terciário evariáveis associadas a um teste duvidoso

Abstract Objectives: Describe the results of the red reflex test in full-term newborns, as well as identify factors associated with red reflex test outcome and compare hospital length of stay between patients with inconclusive and normal red reflex test results. Methods: Descriptive cross-sectional study of the results of the red reflex test performed in a tertiary hospital maternity unit between 2014 and 2018. A nested case-control study was also performed to search for anthropometric, gestational, and neonatal variables associated with the outcome of the red reflex test. Results: There were121 identified cases of inconclusive red reflex test in 11,833 newborns. Sixteen alterations were confirmed, four considered severe: two cases of congenital glaucoma, one of cataract, and one of coloboma. Mean birth weight (p = 0.04), length (p = 0.03), and head circumference (p = 0.02) were lower in patients with inconclusive red reflex test; however without a relevant effect size (d = −0.21, −0.22, and −0.25, respectively).The proportion of white, mixed-race, and black patients was significantly different between the groups (p < 0.001), with a higher chance of inconclusive results in mixed-race (OR = 2.22) and black (OR = 3.37) patients when compared to whites. An inconclusive red reflex test led to an increase in hospital length of stay from 62 to 82 hours (p < 0.001). Conclusions: The red reflex test was able to identify four severe alterations in 11,833 newborns (0.03%). In the 121 newborns in which the red reflex test was classified as inconclusive, there was a 20-hour increase in the hospital length of stay, but a severe alteration was confirmed in only 3.3% of them. Differences in red reflex between white, mixed-race, and black patients should be considered.

Resumo Objetivos: Descrever os resultados do teste do reflexo vermelho em recém-nascidos a termo. Identificar fatores associados ao resultado do teste do reflexo vermelho e comparar o tempo de internação entre pacientes com teste do reflexo vermelho duvidoso e normal. Métodos: Estudo transversal descritivo dos resultados do teste do reflexo vermelho feito em maternidade de hospital terciário entre 2014 e 2018. Foi ainda feito estudo de caso-controle aninhado para pesquisa de variáveis antropométricas, gestacionais e neonatais associadas ao resultado do teste do reflexo vermelho. Resultados: Foram identificados 121 casos de teste do reflexo vermelho duvidoso em 11.833 recém-nascidos. Foram confirmadas 16 alterações, 4 consideradas graves: 2 casos de glaucoma congênito, um de catarata e um de coloboma. As médias de peso de nascimento (p = 0,04), comprimento (p = 0,03) e perímetro cefálico (p = 0,02) foram menores nos pacientes com teste do reflexo vermelho duvidoso, entretanto sem um tamanho de efeito relevante (d = -0,21; -0,22 e -0,25; respectivamente). A proporção de pacientes brancos, pardos e negros foi estatisticamente diferente entre os grupos (p < 0,001), com maior chance de resultado duvidoso para pardos (OR = 2,22) e negros (OR = 3,37) em comparação a brancos. O teste do reflexo vermelho duvidoso levou a um aumento no tempo de internação de 62 para 82 horas (p < 0,001). Conclusões: O teste do reflexo vermelho foi capaz de identificar 4 alterações graves em 11.833 recém-nascidos (0,03%). Nos 121 recém-nascidos em que o teste do reflexo vermelho foi classificado como duvidoso, houve aumento de 20 horas no tempo de internação hospitalar, porém se confirmou alteração grave em apenas 3,3% deles. Diferenças no reflexo vermelho entre brancos, pardos e negros devem ser consideradas.

Privación sensorial temprana durante el neurodesarrollo y sus consecuencias cognitivas / Early sensory deprivation in neurodevelopment and its cognitive consequences / Privação sensorial precoce durante o neuro-desenvolvimento e suas consequências cognitivas

La aparición progresiva de habilidades sensoriales, motoras y cognitivo-afectivas en el humano a lo largo de su desarrollo es un reflejo de cambios fisiológicos que se gestan al interior del sistema nervioso. Dichos cambios hacen parte de procesos dinámicos y dependen, después del nacimiento, de la actividad eléctrica inducida por la experiencia. Considerando lo anterior, el sistema nervioso en desarrollo constituye una especie de protomapa, sobre el que la experiencia moldea características moleculares, neuroquímicas y de conectividad, que se reflejan en las actividades emergentes del sistema. La evidencia que soporta la importancia que la influencia experiencial tiene sobre el desarrollo del sistema nervioso viene en aumento. Esta revisión reúne información sobre estudios en modelos biológicos y en humanos sometidos a privación sensorial y ambiental. Se enfatiza en la caracterización de los rasgos cognitivos y sociales.

The progressive advent of sensory, motor, affective, and cognitive skills in the human being through its development, demonstrate physiological changes that are gestated within the nervous system. These processes are dynamic and dependent postnatally on electrical activity induced by experience. Taking this into account, the developing nervous system constitutes a protomap molded by experience dependent molecular, physiological and connectivity characteristics, which are reflected in the emergent principles of the system. The evidence that supports the importance of experience as influence over the development of this system has increased in the past years. This document gathers information about animal models and human studies enduring sensory and environmental deprivation, emphasizing in the characterization of their cognitive and social remarks.

O aparecimento progressivo de habilidades sensoriais, motoras e cognitivo-afetivas no humano ao longo do seu desenvolvimento é um reflexo de mudanças fisiológicas que se gestam no interior do sistema nervoso. Ditas mudanças fazem parte de processos dinâmicos e dependem, depois do nascimento, da atividade elétrica induzida pela experiência. Considerando o anterior, o sistema nervoso em desenvolvimento constitui uma espécie de "protomapa", sobre o que a experiência molda características moleculares, neuroquímicas e de conectividade, que se refletem nas atividades emergentes do sistema. A evidência que suporta a importância que a influência experiencial tem sobre o desenvolvimento do sistema nervoso vem em aumento. Esta revisão reúne informação sobre estudos em modelos biológicos e em humanos submetidos a privação sensorial e ambiental. Se enfatiza na caracterização das características cognitivas e sociais.

Samambaias epífitas em trilhas do Parque Guairacá, município de Paula Freitas, Paraná / Epiphytic ferns in trails of the Guairacá Park, municipality of Paula Freitas, Paraná state

Os epífitos desempenham importantes funções ecológicas, e em particular as samambaias, mostram uma diversidade significativa em ambientes florestais, ocupando microambientes específicos e diversos. A diversidade de samambaias epifíticas no estado do Paraná ainda é relativamente pouco conhecida. A região de Paula Freitas, em particular, não apresenta estudos específicos para este grupo de plantas. Neste sentido, o presente estudo teve por finalidade avaliar a riqueza de espécies de samambaias epífitas em regiões de trilhas no Parque Municipal Guairacá em Paula Freitas, Paraná. Foram registradas 10 espécies distribuídas em oito gêneros e quatro famílias. A família Polypodiaceae foi a mais rica na área avaliada (oito espécies), reflexo das características morfoanatômicas comuns às espécies da família. Os resultados encontrados contribuem com o reconhecimento das características florísticas e ecológicas de samambaias epífitas ocorrentes no estado do Paraná.(AU)

Epiphytes play important ecological role, and the ferns shows a significant diversity in the forest environments, due to the numerous specific and diverse microenvironments. The diversity of epiphytic ferns in Paraná state is still relatively unknown. The Paula Freitas region, in particular, does not present specific studies for this group of plants. In this sense, the present study aimed to evaluate the diversity of epiphytic ferns in regions of trails in the Guairacá Municipal Park in Paula Freitas, Paraná. Ten species in eight genera and four families were recorded. The family Polypodiaceae (eight species) was the richest in the evaluated area, reflecting the morphoanatomic characteristics common to the family species. The results contribute to the recognition of the floristic and ecological characteristics of epiphytic ferns occurring in the state of Paraná.(AU)

Aproximaciones a estudios sobre la Burla desde la Perspectiva del Desarrollo / Mockery Studies from a Development Perspective

La burla emerge como una acción simbólica en la relación burlón-burlado. Usualmente se expresa en la modalidad hostil o en la modalidad amigable. El propósito de este artículo es reflexionar acerca de la noción de desarrollo que subyace a los estudios de la burla. Para cumplir con este objetivo se adoptaron los postulados de Jaan Valsiner acerca de los axiomas que conducen la investigación y las matrices de pensamiento psicológico que dan sentido a la re-organización de las teorías del desarrollo en tres modelos: Diferenciación, Equilibración y Enseñanza-aprendizaje. La revisión muestra una distribución de los estudios de la burla en el axioma no evolutivo y en el axioma evolutivo. Los estudios en el axioma evolutivo se caracterizan por la identificación de capacidades y habilidades cognitivas y sociales que se complejizan con la edad. En esta modalidad de trabajos se subordina la expresión de la burla respecto a otras expresiones humorísticas como el sarcasmo, la sátira y la ironía. Los referentes teórico-metodológicos de los estudios en el axioma evolutivo se aproximan al Modelo por Equilibración. Las conclusiones señalan la pertinencia de sostener la coherencia de las matrices de pensamiento psicológico en las investigaciones que indagan problemáticas del desarrollo.

The teasing emerges as a symbolic action in the interaction between a teaser and teased. It is Usually expressed in a hostile or in a friendly mode. The purpose of this article is to reflex about the development concept that underlies the teasing studies. To fulfill this objective, we were adopted Jaan Valsiner's postulates about the guided axioms in the developing research and also we adopted the psychological thought matrices that give meaning to the re-organization of theories of development in three models: Differentiation, Balance and Teaching and Learning. The review shows a distribution of studies of teasing in the evolutive axiom. The studies in the evolutive axiom are characterized by the identification of cognitive and social capabilities and abilities which complexitfy with the age. In this type of researches the teasing expression is subordinated respect to other humoristic expression as: the sarcasm, the satire and the irony. The theorical ­ methodological referents in the evolutive axiom are approach to the Balance Model. The conclusion focus on the pertinence to hold coherence in the psychological thought matrices for the researches that inquire in the development subject.

Complete essential oils of Laurus nobilisinducing antinociceptiveaction by opioid mechanism in C-Reflex and spinal Wind-Up model in rat / Aceites esenciales totales de Laurus nobilis inducen acción antinociceptivamediante mecanismo opioide en el modelode Reflejo-C y Wind-Up espinal en ratas

The essential oil of Laurus nobilis L. was used to test their antinociceptive efficacy. It was applied intraperitoneally (i.p.) to rats subjected to a nociception test (C reflex and spinal wind-up). The results showed that the essential oil applied at higher doses (0.06 mg/Kg) causes a complete abolition of the spinal wind-up, while the C reflex was unchanged, indicating a clear antinociceptive effect. At lower concentrations (0.012 mg/Kg), there was a lowering in the wind-up by 85% within ten minutes of the essential i.p. oil application. Interestingly, there was an effect of naloxone (0.08 mg/Kg i.p.) When applied, a change occurs that almost entirely reversed the antinociception caused by the essential oil from Laurus nobilis. We conclude that there is a significant antinociceptive effect of the essential oil of Laurus nobilis subjected to electric nociception. In addition, it was observed that naloxone reversed the antinociceptive effect (wind-up) produced by Laurus nobilis.

El aceite esencial de Laurus nobilis L. se usó para probar su eficacia antinociceptiva. Se aplicó por vía intraperitoneal (i.p.) a ratas sometidas a una prueba de nocicepción (reflejo-C y wind-up espinal). Los resultados mostraron que el aceite esencial aplicado a dosis más altas (0.06 mg/Kg) abolió completamente el wind-up espinal, mientras que el reflejo-C no cambió, lo que indica un claro efecto antinociceptivo. A concentraciones más bajas (0.012 mg/Kg), hubo una disminución en el wind-up en un 85% dentro de los diez minutos del i.p. la aplicación del aceite esencial. Curiosamente, hubo un efecto de la naloxona (0.08 mg/Kg i.p.) la cual revierte casi por completo la antinocicepción causada por el aceite esencial de Laurus nobilis. Concluimos que existe un efecto antinociceptivo significativo del aceite esencial de Laurus nobilis sometido a nocicepción eléctrica. Además, se observó que la naloxona revirtió el efecto antinociceptivo (wind-up) producido por Laurus nobilis.

Conventional physical therapy and physical therapy based on reflex stimulation showed similar results in children with myelomeningocele / Fisioterapia convencional e fisioterapia com estimulação reflexa apresentaram resultados semelhantes em crianças com mielomeningocele

ABSTRACT We aimed to investigate whether infants with myelomeningocele would improve their motor ability and functional independence after ten sessions of physical therapy and compare the outcomes of conventional physical therapy (CPT) to a physical therapy program based on reflex stimulation (RPT). Twelve children were allocated to CPT (n = 6, age 18.3 months) or RPT (n = 6, age 18.2 months). The RPT involved proprioceptive neuromuscular facilitation. Children were assessed with the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory before and after treatment. Mann-Whitney tests compared the improvement on the two scales of CPT versus RPT and the Wilcoxon test compared CPT to RPT (before vs. after treatment). Possible correlations between the two scales were tested with Spearman correlation coefficients. Both groups showed improvement on self-care and mobility domains of both scales. There were no differences between the groups, before, or after intervention. The CPT and RPT showed similar results after ten weeks of treatment.

RESUMO O estudo investigou se crianças com mielomeningocele melhorariam sua habilidade motora/funcional após dez sessões de fisioterapia e comparou o quadro motor de um grupo submetido à fisioterapia convencional (FC) com outro tratado com fisioterapia com estimulação reflexa (RF). Doze crianças foram alocadas em FC (n=6, 18,3 meses de idade) ou FR (n=6, 18,2 meses de idade). FR envolveu facilitação neuromuscular proprioceptiva. As crianças foram avaliadas com a Medida de Função Motora Grossa (GMFM) e o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) antes e depois do tratamento. Testes de Mann-Whitney compararam a melhora na GMFM e PEDI (FC versus FR) e testes de Wilcoxon compararam FC e FR (antes versus depois). Possíveis correlações entre GMFM e PEDI foram testadas por coeficientes de Spearman. Ambos os grupos melhoraram na GMFM e PEDI (domínios autocuidado e mobilidade). Não houve diferença entre os grupos antes e após a intervenção. FC e FR apresentaram efeitos semelhantes depois de dez semanas de tratamento.

O - "não"- lugar do reflexo no modo causal de seleção pelas consequências de Skinner / The - "no"- place of the reflex in the causal mode selection by consequences of Skinner

Skinner em 1 981 propôs um modo causal geral para explicar o comportamento envolvendo dois processos básicos e complementares: variação e seleção. Algumas vezes o selecionismo é apresentado como um substituto do mecanicismo dentro e fora do âmbito comportamental. Contudo, há um ponto de tensão nessa interpretação: o comportamento/condicionamento reflexo. Esse tipo de comportamento e de aprendizagem seria explicado através de leis compatíveis com o mecanicismo, as leis do reflexo, não envolvendo variação e seleção. Em que medida, então, a seleção pelas consequências seria um modo explicativo geral se nem mesmo seria aplicável a todos os casos de comportamento? Uma interpretação alternativa é oferecida sobre a natureza e o alcance do selecionismo skinneriano

The Corneomandibular Reflex and the race of the reflexes: Clinical and Historical Aspects

The corneomandibular reflex was first described in 1902 by German doctor Von Sölder, who reported the presence of the reflex in patients and in the general population. For him, the corneomandibular reflex represented an exaggeration of the normal response. This was one of the more than 250 reflexes described in the beginning of the 20th century, during the so called "race of the reflexes".

O reflexo córneo-mandibular foi descrito pela primeira vez em 1902 pelo alemão Von Sölder, que relatou a presença de reflexos em pacientes e indivíduos normais. Segundo ele, o reflexo córneo-mandibular representa um exagero da resposta convencional. Este é um dos mais de 250 reflexos descritos no início do século XX, durante a chamada "corrida dos reflexos".

Relationship between anxiety, depression and quality of life with the intensity of reflex sweating after thoracoscopic sympathectomy for treatment of primary hyperhidrosis / Relação entre ansiedade, depressão e qualidade de vida com a intensidade da sudorese reflexa após simpatectomia torácica por videocirurgia para tratamento da hiperidrose primária

ABSTRACT Objective: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. Methods: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". Results: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. Conclusion: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction.

RESUMO Objetivo: avaliar a intensidade de sudorese reflexa com o grau de ansiedade e sua interferência na qualidade de vida de indivíduos submetidos à simpatectomia por videotoracoscopia nos períodos pré e pós-operatório. Métodos: foram avaliados 54 pacientes com média de idade de 26 anos (16 a 49 anos), submetidos à simpatectomia em nível R3-R4. Dois questionários foram aplicados em três momentos diferentes: "Qualidade de vida em pacientes com hiperidrose primária e "Escala para ansiedade e depressão". Resultados: dos pacientes estudados, 93% mostrou melhora significativa na qualidade de vida após 30 dias da cirurgia, com os efeitos remanescentes após seis meses. Não houve complicações pós-operatórias. A análise mostrou que o nível de ansiedade do paciente é altamente correlacionado com a intensidade da sudorese reflexa após 30 e 180 dias. Conclusão: a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.

Can intraurethral stimulation inhibit micturition reflex in normal female rats?

ABSTRACT Objective The study was designed to determine the effect of low frequency (2.5Hz) intraurethral electrical stimulation on bladder capacity and maximum voiding pressures. Materials and Methods The experiments were conducted in 15 virgin female Sprague-Dawley rats (220–250g). The animals were anesthetized by intraperitoneal injection of urethane (1.5g/kg). Animal care and experimental procedures were reviewed and approved by the Institutional Animal Care and Use Committee of Antwerp University (code: 2013-50). Unipolar square pulses of 0.06mA were used to stimulate urethra at frequency of 2.5Hz (0.2ms pulse width) in order to evaluate the ability of intraurethral stimulation to inhibit bladder contractions. Continuous stimulation and intermittent stimulation with 5sec ‘‘on’’ and 5sec ‘‘off’’ duty cycle were applied during repeated saline cystometrograms (CMGs). Maximum voiding pressures (MVP) and bladder capacity were investigated to determine the inhibitory effect on bladder contraction induced by intraurethral stimulation. Results The continuous stimulation and intermittent stimulation significantly (p<0.05) decreased MVP and increased bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group. Conclusions The present results suggest that 2.5Hz continuous and intermittent intraurethral stimulation can inhibit micturition reflex, decrease MVP and increase bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group.

Reflex cough PEF as a predictor of successful extubation in neurological patients / Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

AbstractObjective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

ResumoObjetivo:Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.Métodos:Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.Resultados:A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR < 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.Conclusões:O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. .

Análise dos reflexos em prematuros submetidos ao posicionamento funcional em Terapia Intensiva Neonatal / Analysis of reflexes in premature infants undergoing functional positioning in a Neonatal Intensive Care

Objetivo: Verificar se prematuros extremos, submetidos ao posicionamento funcional, conseguem adquirir integração dos reflexos primitivos quando comparados aos prematuros. Métodos: Trata-se de um relato de série de oito casos constituído de prematuros extremos e prematuros. Os bebês foram submetidos ao posicionamento funcional na Unidade de Terapia Intensiva Neonatal, na postura prona, supina e decúbito lateral, utilizando-se coxins para assegurar a contenção e oferecer a sensação de segurança, três vezes por dia, durante a internação. Os reflexos dos bebês foram avaliados no 30º e 60º dias de nascimento, de junho a outubro de 2012, por meio do Teste de Performance Infanto Motora (TIMP). Resultados: Observaram-se diferenças entre os escores das avaliações no TIMP após o 30º dia de vida entre os grupos; contudo, não se verificaram diferenças na avaliação aos 60 dias. Conclusão: Os bebês submetidos ao posicionamento funcional precoce, adquiriram adequada integração dos reflexos primitivos após 60 dias de vida.

Objective: To determine whether the extremely preterm infants, who were subjected to functional positioning, can acquire integration of primitive reflexes when compared to preterm. Methods: This is a report of eight cases consisting of extremely preterm and preterm infants. All babies in the study were subjected to functional positioning in the Neonatal Intensive Care Unit, organized in the prone, supine and lateral positions with the use of cushions to ensure restraint and offer a sense of security, in a frequency of three times a day, during hospital length. The reflexes of the infants were evaluated at the 30th and 60th days of birth in the period from June to October 2012 through the Test of Infant Motor Performance (TIMP). Results: There were differences in scores of the TIMP after the 30th day of life among the groups; however, there was no difference in scores of the second evaluation performed at 60th day. Conclusion: Babies submitted to the early functional positioning managed to acquire proper integration of primitive reflexes after 60 days of life.

Muscular performance characterization in athletes: a new perspective on isokinetic variables

Background: Isokinetic dynamometry allows the measurement of several variables related to muscular performance, many of which are seldom used, while others are redundantly applied to the characterization of muscle function. Objectives: The present study aimed to establish the particular features of muscle function that are captured by the variables currently included in isokinetic assessment and to determine which variables best represent these features in order to achieve a more objective interpretation of muscular performance. Method: This study included 235 male athletes. They performed isokinetic tests of concentric knee flexion and extension of the dominant leg at a velocity of 60º/s. An exploratory factor analysis was performed. Results: The findings demonstrated that isokinetic variables can characterize more than muscle torque production and pointed to the presence of 5 factors that enabled the characterization of muscular performance according to 5 different domains or constructs. Conclusions: The constructs can be described by torque generation capacity; variation of the torque generation capacity along repetitions; movement deceleration capacity; mechanical/physiological factors of torque generation; and acceleration capacity (torque development). Fewer than eight out of sixteen variables are enough to characterize these five constructs. Our results suggest that these variables and these 5 domains may lead to a more systematic and optimized interpretation of isokinetic assessments. .